bluuebunny/crossref_metadata_2025_split huggingface dataset:
P317 Assessment of atrial function in elite soccer players
Authors: Castro F A , Lourenco M , Leite P V A , Azevedo O , Dias G , Faria B , Nogueira I , Lourenco A 
Published: January 2020

Abstract

Introduction
Athlete´s heart is associated with physiological remodelling as a consequence of repetitive cardiac loading. Atrial dilation may occur in athletes, but atrial size is insufficient to provide mechanistic information about the atrium itself and an increase in atrial size is not intrinsically an expression of atrial dysfunction. Two dimensional (2D) LA strain analysis by speckle tracking emerges as a gold standard for evaluation of atrial myocardial function.

Aim
To compare LA function between elite soccer players and sedentary healthy controls through 2D-strain analysis by speckle tracking.

Methods
We included 44 consecutive male professional soccer players and 25 sedentary male healthy controls, matched by age and race. All subjects underwent transthoracic echocardiogram, including evaluation of LA diameter and volume and 2D-strain analysis by speckle tracking. Peak atrial longitudinal strain (PALS) was measured at the end of the reservoir phase and peak atrial contraction strain (PACS) was measured just before the start of the active atrial contractile phase. The average of PALS and PACS was obtained from the 12 LA segments at apical 4 and 2-chamber views. The LA contraction strain index (CSI) (ratio PACS/PALS x100) was also calculated. SPSS 20.0 was used for statistical analysis.

Results
Mean age was similar between athletes and controls (22.3 ± 4.2 vs 25.0 ± 2.4 p = 0.13) as well as body mass index (23.3 ± 5.8 vs 24.6 ± 2.7 Kg/m2, p = 0.24).
Athletes had significantly higher LA volume (29.1 ± 6.9 vs. 21.1 ± 5.5, p &lt; 0.001). No statistical differences were observed in LA diameter between the two groups (18.7 ± 2 vs 18.0 ±1.7, p = 0.163).
Athletes had significantly lower PALS (36.3%±5.8 vs. 44.2%±8.9, p &lt; 0.001), PACS (9.5%±2.8 vs 15.3%±4.8, p &lt; 0.001) and LA CSI (26.3 ± 7.8 vs. 35.0 ± 9.3, p &lt; 0.001) than controls. LA volume was correlated with PALS (p &lt; 0.001 r = 0.99), but not with PACS or CSI (p = 0.089 and p = 0.142, respectively).

Conclusion
This study showed that in top-level athletes LA PALS and PACS are lower and PALS correlates with LA volume, suggesting that LA suffers not only a morphological but also a functional remodelling in response to intensive exercise. This can be mediated by increased LA workload imposed by the increased left ventricular work.
415 Comparison between two methods for assessing ventricular-arterial coupling: the Chen single-beat method and carotid artery wave intensity
Authors: Antonini-Canterin F , Pepe A , Strazzanti M , Luzza G , Penzo M , Nicolosi E , Pagliani L , Rivaben D 
Published: January 2020

Abstract

Background
Ventricular arterial coupling (VAC) can be defined as the ratio of the arterial elastance (Ea) to the ventricular elastance (Ees). . The Ea/Ees ratio has been consistently demonstrated to be a reliable and effective measure of cardiovascular performance. The Chen single-beat method is the most used non-invasive method for this measurement. Carotid artery wave intensity (WI) is also considered a index of VAC, as the first peak (W1) represents the forward compression wave, reflecting left ventricle (LV) contractile function. However, data about the relationship between the two methods are nowadays scarce.

Purpose
Aim of the study was to compare carotid WI and Ventricular-Arterial Coupling (VAC) in a population of patient with heart failure.

Methods
We examined 50 consecutive patients with heart failure (9 females, 41 males, mean age 67 + 12 years, range 29-97 years, 34 ischemic, 16 not ischemic). Carotid artery wave intensity was achieved merging the echo-tracking of the vessel with its doppler signal. Simultaneous not-invasive oscillometric blood pressure was obtained. The VAC was assessed by the ratio between the arterial elastance (Ea) and the end-systolic ventricular elastance (Ees). Ea was calculated from stroke volume (SV) and end-systolic pressure (Ea=(Systolic BP x 0.9)/SV) and Ees was calculated by the modified single-beat Chen method, using an estimated normalized ventricular elastance at arterial end-diastole (ENd) Ees = [Diastolic BP-(ENd(est) x Systolic BP x 0.9)]/(ENd(est) x SV). Three subgroups were created according to the left ventricle ejection fraction values (LVEF ≤ 35%, LVEF &gt;35% &lt;50%, LVEF ≥ 50%, with 26, 14, 10 patients respectively).

Results
The correlation between Ea/Ees and W1 was significant (Pearson’s correlation r= -0.35, p 0.01). The W1 and VAC values of the three LVEF-sorted subgroups were processed with ANOVA test (p 0.054 and p 0.0002 respectively). W1 values resulted to be, as expected, reduced especially in the group of severe ventricular dysfunction (mean 4,97+- 3,29), as well as the ventricular-arterial coupling was increased (mean 2.04 +- 1.04). Interestingly W1 shows to be correlated with the Left atrial volume index (Pearson’s correlation r= -0,30 p = 0,037).

Conclusions
Carotid WI technique seems to be a reliable method to estimate the ventricular-arterial interplay. Larger studies are needed to evaluate the respective role of W1 and Ea/Ees in the prognostic evaluation.
Results EF ≤ 35 (n = 10) 35 &lt; EF &lt; 50 (n = 14) EF≥ 50 (n = 26) p value W1 4.97 ± 3.29 8.05 ± 3.79 7.85 ± 3.12 0.054 Ea/Ees 2.04 ± 1.04 1.39 ± 0.31 1.16 ± 0.3 0.0002
Abstract 415 Figure.
P714 Contradicting the most basic tenet of black holes: light can, indeed, escape
Authors: Sousa J P , Ribeiro J , Puga L , Lourenco C , Teixeira R , Goncalves L 
Published: January 2020

Abstract
A 69-year-old man with history of non-insulin-treated type 2 diabetes mellitus, arterial hypertension and mixed dyslipidemia presented to the emergency department with chest pain lasting for four days. Immediate twelve-lead electrocardiogram unveiled an inferior ST-segment elevation myocardial infarction (STEMI), prompting emergent coronary angiography, which, in turn, revealed two-vessel disease, specifically proximal ramus intermedius 60-70% stenosis and proximal right coronary artery acute occlusion. Culprit lesion was successfully managed with balloon angioplasty and a single drug-eluting stent implantation. Still, clinical course was noticeable for deterioration, under the form of cardiogenic shock, which required invasive ventilation and intravenous vasopressor support with norepinephrine. Despite biventricular systolic function relative preservation, transthoracic echocardiography disclosed inferior akinesis, right ventricle dilation, mild circumferential pericardial effusion and, particularly, a 2.3cm posteroinferior ventricular septal defect (VSD), in the setting of a 4.4cm2 pseudoaneurism, resulting in left-to-right shunting, quantified through maximal/mean trans-VSD pressure gradients of 84/44mmHg. Further imaging with transesophageal echocardiography and cardiac computed tomography angiography allowing the conception of a 3D-printed model was performed. Surgical correction of the defect followed, achieving partial anatomic success, namely with residual shunting, as of a left ventricular systolic pressure of 80mmHg and a right ventricular systolic pressure of 25mmHg. Patient survived, recovered and got discharged three weeks later. At one-year follow-up, he was hospitalized for acute decompensated heart failure (hemodynamic profile C) twice, with medication non-adherence reported as the main precipitating factor. In addition to a significant remaining left-to-right shunt (maximal velocity 3m/s), adverse cardiac remodeling was recognized, featuring left ventricular ejection fraction of 30-35%, severe functional mitral regurgitation, severe postcapillary pulmonary hypertension and de novo left bundle branch block (QRS duration of 197ms). Having been deemed clinically unsuitable for another surgical correction, patient underwent percutaneous VSD closure with both AmplatzerTM septal and muscular VSD occluders, with a suboptimal result. He is now on New York Heart Association class III heart failure and on the waiting list for both MitraClip and cardiac resynchronization therapy implantation.
Reflecting numerous breakthroughs in the management of acute myocardial infarction, incidence of mechanical complications is on the decline. Nevertheless, when they occur, morbidity and mortality remain high. Acquired ventricular septal defects are no exception, demanding the best care from a tertiary hospital heart team.
Abstract P714 Figure.
P962 The Remodeling Index risk stratifies patients with hypertensive left ventricular hypertrophy
Authors: Le T T , Bryant J , Ang B , Su B , Cook S , Chin CALVIN 
Published: January 2020

Abstract

Funding Acknowledgements
National Medical Research Council

BACKGROUND
Hypertensive left ventricular hypertrophy (LVH) is associated with increased cardiovascular events. The authors previously developed the Remodeling Index (RI) that incorporated LV volume and wall-thickness in a single measure of advanced hypertrophy in hypertensive patients.

PURPOSE
This study examined the mechanisms and prognostic potential of the RI in reference with current LVH classifications.

METHODS
Cardiovascular magnetic resonance (CMR) was performed in 400 asymptomatic hypertensive patients. The newly derived RI ([(EDV)^1/3]/t; where EDV is LV end-diastolic volume and t is the maximal wall thickness across 16 myocardial segments) stratified hypertensive patients into 3 groups: without LVH, LVH with normal RI (LVH_Normal-RI) and LVH with low RI (LVH_Low-RI). The primary outcome was a composite of all-cause mortality, acute coronary syndromes, strokes and decompensated heart failure.

RESULTS
LVH_Low-RI was associated with increased LV mass index, fibrosis burden, impaired myocardial function and elevated biochemical markers of myocardial injury and wall stress. Over 18.3 ± 7.0 months (601.3 patient-years), patients with LVH_Low-RI had more than a 5-fold increase in adverse events compared to those with LVH_Normal-RI (11.6 events/100patient-years versus 2.0 events/100 patient-years, respectively; log-rank P &lt; 0.001; Figure A). The RI provided incremental prognostic value over and above a model consisting of clinical variables and LVH (P = 0.02). Conversely concentric and eccentric LVH were associated with adverse prognosis (4.5 events/100patient-years versus 6.0 events/100patient-years, respectively; log-rank P = 0.62) that was similar as the natural history of hypertensive LVH (5.1 events/100patient-years).

CONCLUSIONS
The RI provides mechanistic insights and prognostic value that improves risk-stratification of hypertensive LVH.
Abstract P962 Figure.
1039 Time course of left atrial performance in patients with paroxysmal atrial fibrillation undergoing radio-frequency catheter isolation of pulmonary veins
Authors: Katbeh A , Iliodromitis K , De Potter T , Geelen P , Balogh Z , Stefanidis E , Barbato E , Van Camp G , Penicka M 
Published: January 2020

Abstract

Background
Radio-frequency catheter isolation of pulmonary veins (RF-PVI) is associated with changes of left atrial (LA) structure and function. However, there is limited knowledge regarding the long-term impact of successful RF-PVI on the LA mechanics. The aim of the current study was to assess the time course of LA performance in patients with paroxysmal atrial fibrillation (pAF) undergoing RF-PVI.

Methods
The study population included 24 consecutive patients (age:62 ± 21 years; 66% male) with symptomatic pAF and preserved left ventricular ejection fraction (≥50%) undergoing the first RF-PVI and 23 healthy controls. A comprehensive echocardiographic examination was performed one day before and 1 day, 3- and 12- months after RF-PVI. The reservoir, conduit and contractile LA strain (LAS), strain rate (LASR) and mechanical dispersion (LAMD) were assessed using two-dimensional speckle tracking echocardiography in apical views.

Results
At baseline, patients with pAF showed a significant reduction of all three components of LAS and LASR compared with controls (all p &lt; 0.01). At 1 day after RF-PVI, LAS and LASR showed significant decrease compared with baseline (all p &lt; 0.05) (figure). At 3-month follow up, LAS and LASR recovered to baseline values while LAMD showed a significant improvement (77ms vs 58ms, p = 0.003). At 12-month follow up, both reservoir and contractile LAS showed further improvement compared to 3-month values (31% vs 27%, and 15% vs 13%, both p &lt; 0.05). Yet, even after 12 months, LAS values remained significantly lower compared with healthy controls (p &lt; 0.05). LA emptying fraction was restored and LA end-systolic (max) and end-diastolic (min) volume index showed a significant decrease compared to baseline and 3-month values (all p &lt; 0.05).

Conclusion
Successful RF-PVI is associated with acute decrease in LAS, followed by recovery to baseline values within 3 months and further improvement during one year. Reservoir and contractile LAS appears to be the most clinically useful indices to monitor LA performance in patients with pAF undergoing RF-PVI.

Figure
Time course of LA reservoir and contractile strain, LA max and min volume index, and LA mechanical dispersion (Baseline, 1-day FUP, 3- and 12-month FUP).
Abstract 1039 Figure.
1095 Effective image-guided medical management in effusive constrictive pericarditis
Authors: Montes A , Cecconi A , Alvarado T , Vera A , Barrios A , Caballero P , Olivera M J , De Rueda C , Gonzalez E , De La Cuerda F , Jimenez C , Perich J , Gamarra A , Jimenez Borreguero L J , Alfonso F 
Published: January 2020

Abstract
A 59 year old man was admited to hospitalization for persistent chest pain related to acute pericarditis. Within the admision tests, a transthoracic echography was performed, showing a moderate pericardial effusion with ventricular septal bounce and significant respiratory variations in mitral and tricuspid inflows, all of it consistent with effusive-constrictive pericarditis (Panel A). Anti-inflammatory treatment with ibuprofen and colchicine was started.
During the first 48 hours of admission there was a clinical and hemodinamic worsening in the patient’s condition that forced the performance of a pericardial window, obtaining a very little quantity of dense pericardial fluid. Looking for a more accurate study of the pericardium, a cardiovascular magnetic resonance (CMR) was performed, revealing a thick heterogeneous pericardial effusion (Panel B) and a significant late gadolinium enhancement of both pericardial layers (Panel C). All these findings where consistent with an effusive constrictive pericarditis with persistent inflammatory activity despite high doses of conventional inflammatory treatment. Furthermore, the growth of Propionibacterium acnes in the pericardial fluid disclosed the etiology of this condition.
Medical treatment was enhanced with high doses of intravenous corticosteroid, ceftriaxone and doxycycline. During the following days, the patient showed an excellent response achieving the complete clinical and echocardiographic relief of constrictive signs (Panel D).
Effusive constrictive pericarditis is characterized by the presence of pericardial effusion and constriction secondary to an inflammatory process of the pericardium. Pericardiectomy might be necessary in case of failure of medical treatment, a very common scenario in this kind of .pericarditis.
Our case is remarkable because it demonstrates the value of CMR to detect persistent inflammation of pericardium despite high doses of conventional medical treatment for pericaricarditis guiding the successful escalation to intravenous corticosteroid and avoiding the risk of an unnecessary cardiac surgery.
Abstract 1095 Figure.
1099 Constrictive pericarditis:a challenge in Cardiology
Authors: Kairis C , Stefanidis C , Saxpekidis B , Petridis C , Mosialos L , Stosic T , Tsinopoulos G , Koufou E 
Published: January 2020

Abstract

Funding Acknowledgements
none
A 50-year old woman had complained about dyspnea and leg swelling despite taking furosemide 80 mgr per day.
Her past medical history had included radiation therapy for Hodgkin"s lymphoma, prosthetic heart valves (mechanical MV, AV- INR = 3,2) and permanent pacemaker. Also her coronary vessels were normal.
On clinical examination she was non-febrile, the arterial pressure was 120/80mmHg,there was atrial fibrillation at 70 pulses/min at rest and oxygen saturation was 96%.
The chest x-ray finding was left pleural effusion. The patient also had ascites.
Kidney function was normal without proteinuria. The diagnostic paracentesis and biochemical analysis of ascitic fluid was indicative of transudative fluid.Cytologic analysis was negative for malignancy. Moreover,needle biopsy specimen was subjected to histopathology,which was negative for malignancy.
Echocardiography had revealed normal size and function of left ventricle ( LV = 46mm-EF = 60%). The mechanical valves had normal function, without paravalvular leak or masses. Also right ventricle was normal. The pulmonary artery pressure measured by echocardiography was in the normal range (RVSP = 35mmHg), but the inferior vena cava was dilated.There were also dilated hepatic veins and hepatic vein flow reversal.There was variation&gt; 25% in triscupid inflow with respiration. TEE had confirmed the findings of transthoracic echo with regard of prosthetic valves.
CT of chest and abdomen findings were no pathologic lymphadenopathy,no pulmonary embolism and absence of tumor compressing inferior vena cava. Chest CT scan had demonstrated pericardium thickening,indicative of constrictive pericarditis. CMR was not performed because of permanent pacemaker.
The final step in diagnostic algorithm was cardiac catheterization:
a)the pulmonary artery systolic pressure measured during right heart catheterization was 35mmHg.
b)dip & plateau’ pattern or ‘square root sign of right ventricle, i.e. pattern of accentuated early dip in diastolic pressure, followed by plateauing in mid-late diastole.
c)prominent y wave of right atrium- absent x wave because of AF.
d)left ventriculography was not performed because of mechanical aortic valve.
At the end constrictive pericarditis was confirmed by the surgical report.
According to ESC guidelines a diagnosis of constrictive pericarditis is based on the association of signs and symptoms of right heart failure and impaired diastolic filling due to pericardial constriction by one or more imaging methods, including echocardiography, CT, CMR, and cardiac catheterization.
However,the most important step is the suspicion of constrictive pericarditis, especially in patients with history of radiation therapy and heart surgery.
Abstract 1099 Figure.
P1253 A case report of acromegalic cardiomyopathy with severe left ventricular hypertrophy
Authors: Kuklina M D , Melkozerov K V , Kalashnikov V Y 
Published: January 2020

Abstract

Introduction
Acromegaly is a rare disease, mostly caused by a growth hormone (GH)-secreting benign pituitary tumor, with an increased production of GH and insulin-like growth factor 1 (IGF-1). One hallmark feature of the disease is acromegalic cardiomyopathy, a syndrome of progressive cardiac dysfunction characterized by left ventricular hypertrophy, diastolic dysfunction, and combined systolic and diastolic dysfunction in the very advanced stage.

Clinical case
A 54-year-old male with history of arterial hypertension and abnormal electrocardiogram (ECG) for more than 10 years was diagnosed with active stage of acromegaly (IGF-1-1711ng/ml, cardiac magnetic resonance (CMR) – pituitary tumor). Surgical treatment was recommended. He was referred for preoperative cardiac evaluation preceding transsphenoidal resection of a pituitary adenoma. He denied syncope or any chest pain. The standard 12-lead ECG demonstrated sinus rhythm, left atrial enlargement and left ventricular (LV) hypertrophy with deep negative T waves in V3-V6 leads. Holter monitor demonstrated episodes of non-sustained ventricular tachycardia. Transthoracic echocardiography revealed severe asymmetric LV hypertrophy without LVOT obstruction at rest and maneuver Valsalva (max. grad. – 19mm. Hg) with mildly abnormal LV ejection fraction (48%, range ≥52%), severe reduced global longitudinal strain (-8,2%, range &lt;-18%) and grade II diastolic dysfunction. CMR imaging was performed. According to CMR suggested hypertrophic cardiomyopathy (HCM) demonstrating area of myocardial fibrosis on extensive late gadolinium enhancement, maximal LV wall thickness of 40 mm, increased myocardial mass (index 277g/m2, range 68–103g/m2) and mildly reduced systolic LV function (LVEF - 54%, range 57-74%). Coronary angiography did not show significant stenosis. After cardiac examination, transsphenoidal adenomectomy was done. There are currently no algorithms sudden cardiac death (SCD) for patients with acromegalic cardiomyopathy, but he was recommended implantation of cardioverter defibrillator devices on a scale for HCM (Risc SCD – 4,17%). Acromegaly-induced cardiomyopathy can mimic HCM. He was also recommended genetic typing for HCM, considering the results of MRI.
Conclusion/Discussion: Reduction GLS might be expected to result in a fall in LVEF, however this is often not the case in hypertrophic LV diseases. It is important to note that measures of regional function such as myocardial strain may actually reflect global systolic function better than the ejection fraction. The results may improve our ability to provide a more accurate prognosis and better assessment of actual systolic function. Because cardiomyopathy is an important cause of mortality in acromegaly, diagnosis and appropriate management are critical to improve survival.
Abstract P1253 Figure.
P1269 Relationship between left ventricle mass index and abdominal obesity in patients with metabolic syndrome hospitalized due to acute coronary syndrome
Authors: Furman-Niedziejko A , Rostoff P , Palka I , Golonka M , Golinska-Grzybala K , Nessler J 
Published: January 2020

Abstract

Background
There is evidence that metabolic syndrome (MS), as a cluster of acute coronary syndrome (ACS) risk factors, is associated with increased left ventricle mass index (LVMI). According to the 2009 IDF criteria of MS diagnosis, elevated waist circumference (≥94 cm in M, ≥80 cm in F), as a determinant of abdominal obesity (AO), is not an obligatory component of MS. Little is known about the relation of abdominal obesity to LVMI in pts with ACS.

Purpose
The aim of this study was to evaluate the relationship between abdominal obesity and LVMI, determined as LVM/H2,7, in patients with MS hospitalized due to ACS.

Methods
444 consecutive pts were enrolled based on ACS diagnosis. The pts were divided into two groups depending on MS diagnosis: group A – 310 pts with MS and AO (205 M, mean age 63.3 ± 10.5 yrs), group B - 134 pts without MS (101 M, mean age 61,4 ± 12.7 yrs). The group A was divided to two subgroups depending on AO diagnosis: group A1 - 288 pts with MS and AO (185 M, mean age 63.4 ± 10.2 yrs and group A2 - 22 pts with MS without AO (19 M, mean age 62,6 ± 12.7 yrs). In all enrolled pts hypertension was diagnosed.

Results
A significant difference was found between group A and B with the respect to LVMI (68.4 ± 25.9 vs. 58.3 ± 16.5, p &lt; 0.05). In the group B, a significant association was found between LVMI and waist circumference (r = 0.39, p &lt; 0.05), weight (r = 0.22, p = 0.012), as well as BMI (r = 0.35, p &lt; 0.05). In group A, LVMI was significantly correlated only with weight (r = 0.24, p &lt; 0.05). No significant differences were found between pts with AO and without AO with respect to LVMI (68.9 ± 26.2 vs. 61.4 ± 20.9, p = 0.187).

Conclusion
1. In individuals without MS hospitalized due to acute coronary syndrome significant positive correlation was found between LVMI and waist circumference, weight as well as BMI. 2. There is significant difference between pts with MS and without MS with the respect to LVMI. 3. No significant differences were found in LVMI between pts with AO and without AO.