bluuebunny/crossref_metadata_2025_split huggingface dataset:
P850 Role of echocardiography in a patient with heart failure and multiple cerebral strokes
Authors: Ansari-Ramandi M M , Yarmohammadi H , Baghaie B , Jafarian Moghaddam F , Fathabadi B 
Published: January 2020

Abstract
A 78 years old male with a history of hypertension and heart failure from 10 years before presented to our hospital with dyspnea, transient loss of consciousness and fatigue. He also had a history of frequent transient ischemic attacks previously with the most recent one being one year before. He was on standard heart failure treatment without any echocardiography done during the past year. On physical examination, he had stable blood pressure and heart rate but increased respiratory rate and respiratory distress. He also had aphasia and rales in the base of his lungs. His oxygen saturation was 70% and was admitted in the intensive care unit. On baseline laboratory data he had a creatinine level of 3.6 mg/dl. After treatment with furosemide and oxygen (O2) therapy and stabilization, brain computed tomography (CT) was done for the patient which showed an old stroke in the territory of right posterior cerebral artery and a new stroke in the territory of the inferior division of the middle cerebral artery (shown in part A of the figure). Echocardiography was done for the patient which showed a large mobile apical left ventricle (LV) clot and moderate LV systolic dysfunction (Three chamber view is shown in part B of the figure) . He was put on anticoagulation and was a candidate for referral to a tertiary center for surgery but after consult due to his acute renal failure and taking in mind his own and family concerns and their refusal for surgery he stayed at our center for continuing his treatment. Unfortunately, after 2 days of treatment, his brain status deteriorated and he had more ischemic brain symptoms for which brain CT scan was done which showed a new infarct in the upper parietal lobes (shown in part C of the figure). Echocardiography was repeated (Three chamber view shown in part D of the figure) which showed a smaller LV clot which was possibly due to a partial detachment of the clot and embolization into the cerebral arteries. With heart failure treatment and proper hydration his creatinine level reduced to 1.1 mg/dl after 6 days of treatment but because of respiratory infection and distress he was intubated and put on mechanical ventilation (Lung CT scan is shown in part E of the figure). He was then put on antibiotic treatment and anticoagulation was done with heparin. His INR level increased and he had a high bleeding tendency which forced us to discontinue anticoagulation. Although his vital signs were stable all through treatment but unfortunately after 14 days of treatment he had bradycardia and asystole and did not respond to cardiopulmonary resuscitation. Conclusion: The case describes a patient with heart failure and multiple cerebral strokes because of an LV clot diagnosed by echocardiography. The case emphasizes the difficulties faced while treating a heart failure patient with co-morbid conditions and the role of echocardiography in diagnosis and guiding management.
Abstract P850 Figure
P854 The role of multimodality imaging in revealing a rare cause of persistent ascites
Authors: Buburuz A M , Marcu D T M , Demsa I , Tinica G , Petris A , Crisu D 
Published: January 2020

Abstract
Primary cardiac tumors are very rare causes of intracavitary masses, about 5% of all cardiac tumors. Most of them are benign tumors, and 50% are represented by atrial myxomas. They are usually developed in the left atrium, with a pedicle attached to the interatrial septum. Cardiac myxomas are one of the "greatest mimes" of pathology, with a polymorphic clinical presentation, from obstructive, to embolic and constitutional clinical manifestation.
We present the case of a 58-year-old female patient with 4 years history of chronic obstructive pulmonary disease (COPD), on bronchodilator treatment and long-term oxygen therapy. She accused two months duration of abdominal distension due to ascites, for which she was evaluated in the gastroenterology department and received diuretics association. The symptoms were refractory to the treatment, so the patient was referred for cardiovascular examination.
At presentation, the patient was afebrile, with a heart rate of 100/minute, blood pressure was 125/90 mmHg. Cardiovascular examination did not reveal any murmurs, jugular venous distension was present. 12-lead electrocardiogram (ECG): sinus rhythm, with right atrial enlargement. The transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) revealed a lobulated giant mass in RA, which occupied almost the entire cavity, with prolapse towards the right ventricle during diastole. Due to the large intracavitary mass, the point of attachment could not be ascertained. Computed tomography (CT) of the thorax was performed and it confirmed the presence of the giant right cardiac mass.
The patient underwent surgical excision of the tumor under cardiopulmonary bypass. Intraoperative findings were represented by a yellowish-brown lobulated friable mass in the right atrium cavity, measuring 70/30/35 mm. The pedicle of the tumor was inserted on the free wall of the right atrium. The histopathological examination revealed round to stellate cells in a myxoid stroma, specific for cardiac myxoma. Postoperative evolution was influenced by the severe pulmonary disease, with prolonged mechanical ventilation and positive inotropic support, but it was slowly favorable, and the patient was discharged in good condition.
Right atrial myxoma is a very rare intracardiac tumor with nonspecific forms of clinical presentations, that create difficulties in diagnosis. Ascites represents an unusual form of manifestation in a patient with a cardiac tumor. The insertion of the pedicle of the myxoma was atypical and induced difficulties in early evaluation of the tumor type. Even though myxomas are mainly benign tumors, the complication rate is very high, especially of embolic events due to the friable tumoral mass, so they can become life threatening conditions. Early diagnosis of cardiac myxoma based on multimodality imaging is essential, leading to optimal surgical management, with good long-term survival.
Abstract P854 Figure. TEE view of giant RA tumor
P859 Can we connect intraventricular exercise induced gradients to sudden cardiac death?
Authors: Cotrim C , Costa F , Severino D , Baquero L , Guardado J 
Published: January 2020

Abstract

Background
Some publications, on exercise induced intraventricular gradients, admit the possibility they can be related to some cases of unexplained sudden cardiac death (SCD).

Clinical case
We present the case of a young male athlete (16 years) that after winning a triathlon competition has sudden cardiac death.
No cardiovascular risk factors.
No family history of SCD
A previous episode of dizziness, accompanied by nausea and vomiting related to intense training happens 6 months before.
In September 2018 about 30 minutes after winning a triathlon competition has SCD episode having been resuscitated on site by the competition physician having been defibrillated and transported to intensive care unit.
After discharge, cardiac MRI, Coronary AngioTC, complete genetic study for heart diseases, flecainid test, transthoracic echocardiogram, stress echocardiogram with hyperventilation and ergometrine. All have normal results (Figure)
During 24 hours Holter ECG isolated premature ventricular complexes were detected and during exercise stress echocardiography a significant intraventricular gradient without systolic anterior movement of mitral valve was detected (Figure).
The athlete was disqualified for sports practice, refuses CDI implantation and started bisoprolol 2,5 mg daily.
To the best of our knowledge this is the first case of association between SCD and exercise induced intraventricular gradient. This possible association should be studied in the future.
Abstract P859 Figure. Intraventricular gradient in SCD athlete
P872 A case of transient atrioventricular block: the role of cardiac magnetic resonance imaging
Authors: Ferreira J , Faria D , Augusto J , Teixeira P , Beringuilho M , Roque D , Ferreira H , Morais C 
Published: January 2020

Abstract

A 42-year old man with no relevant past medical history presented to the emergency department for recurrent transient loss of consciousness in the last 12 hours. 3 weeks earlier he had flu-like symptoms which spontaneously resolved.
Physical examination revealed altered mental state, heart rate 30 beats per minute, respiratory rate 30 cycles per minute, blood pressure 70/40mmHg and basal lung rales on pulmonary auscultation. Blood gas analysis revealed hyperlactacidemia with hypocapnia.
Electrocardiogram showed third-degree atrioventricular block. Atropine was administrated (total dose 3mg) with no rate response. Transcutaneous pacing was initiated followed by a temporary transvenous pacemaker, removed after 72 hours.
Transthoracic echocardiogram revealed compromised left ventricular systolic function (ejection fraction by Simpson’s method 45%) due to septal dyskinesia and reduced global longitudinal strain (-11%).
Blood analysis revealed erythrocyte sedimentation rate 20mm/hr, C-reactive protein 2.43mg/dL and negative high-sensitivity troponin T (9.44ng/L). Rheumatologic screening was negative. Coronary computed tomography angiography revealed normal epicardial coronaries.
Cardiac magnetic resonance imaging (CMRI) performed 7 days after admission revealed preserved left ventricular systolic function (ejection fraction 51%). Late gadolinium enhancement showed scared myocardium in the medium and basal segments of the interventricular septum, compatible with subacute myocarditis.
Due to the history of recurrent syncope, a permanent pacemaker was inserted. The patient was discharged the day after. No further syncope occurred. In last pacemaker follow-up, 9 months after presentation, patient had 0% auricular and ventricular pacing and 100% sensing over the previous 6 months.

Discussion
Transient atrioventricular block is a well-known complication of myocarditis when there is involvement of the conduction system by the inflammatory reaction. However, in rare cases it can persist or recur. CMRI plays an important role in these cases. Gadolinium-enhanced CMRI can be used to access the extent of inflammation and cellular edema and delayed-enhanced CMRI can also be used to quantify scarring which has important prognostic value. CMRI can also play a crucial role in excluding infiltrative disorders with conduction system involvement. Also, in these patients, the transient aspect of atrioventricular block poses a challenge when deciding about permanent pacemaker insertion.
Abstract P872 Figure. Magnetic Ressonance IVS
P881 Young patient with left ventricular hypertrophy and accidentally discovered aortic dissection: hypertensive heart or hypertrophic cardiomyopathy?
Authors: Gawor M , Franaszczyk M , Kowalik E , Spiewak M , Michalowska I , Grzybowski J 
Published: January 2020

Abstract
A 36-year-old male with positive family history of sudden cardiac death (his uncle"s son died suddenly at the age of 25), hospitalized a month ago in a local hospital due to acute hypertensive cardiogenic pulmonary edema, was referred to our institution for further evaluation with suspicion of hypertrophic cardiomyopathy.
On admission patient was asymptomatic, without fatigue, exertional dyspnoea, chest pain or syncope. On physical examination his BP was significantly elevated (180/100 mmHg). The lungs were clear on auscultation, liver was not enlarged, jugular veins were normal, there was no oedema of lower extremities. Abdominal auscultation revealed vascular murmur in umbilical region.
The baseline level of NT-proBNP was 811.4 (range 0–125) pg/mL, and high-sensitivity cardiac troponin T was 20.2 (range 0–14) ng/L. The standard 12-lead electrocardiogram demonstrated sinus rhythm, left atrial enlargement and left ventricular (LV) hypertrophy with nonspecific ST segment and T-wave changes (Fig. 1A). No significant pathology was present on chest X-ray (Fig. 1B).
Transthoracic echocardiography revealed significant concentric LV hypertrophy with preserved LV ejection fraction (EF 70%) and moderately decreased global longitudinal strain (GLS-13.7%). There was mild dilatation of left atrium. Ascending aorta diameter was in normal range (Fig. 1C-D). Cardiac magnetic resonance (CMR) scan confirmed concentric LV hypertrophy with the maximal wall thickness of 18 mm at interventricular septum, and increased myocardial mass (LV mass index 124 ml/m2, range 59–92). Moreover, small areas of late gadolinium enhancement were found in LV segments (Fig. 1E-F).
Due to presence of vascular murmur in abdomen, ultrasound imaging was performed. The exam revealed abdominal aortic dissection (Fig. 1G-H). Patient was transferred to the computed tomography (CT) unit to confirm the diagnosis. Aortic dissection originated below renal arteries and involving common illiac arteries was detected (Stanford B). The presence of thrombi within the lumen created by the aortic dissection suggested chronic presentation.
Patient was managed conservatively with strict blood pressure control and close follow up arranged. We decided to perform genetic analysis. Currently we are awaiting the results in hope that it will help us to establish the diagnosis and differentiate hypertensive heart from hypertrophic cardiomyopathy.
In conclusion, aortic dissection typically presents with tearing chest pain and severe hemodynamic compromise. Painless dissection, like in this case, is relatively rare. Differential diagnosis between hypertensive heart and hypertrophic cardiomyopathy is crucial as it has direct therapeutic impact.
Abstract P881 Figure 1
P893 Left ventricular flow energetics predicts worsening heart failure in dilated cardiomyopathy
Authors: Takahashi L , Uejima T , Hayama H , Cho J , Chikamori T , Yamashita T 
Published: January 2020

Abstract

Background
Blood flows through healthy hearts form optimal flow structures; they store flow kinetic energy (KE) that can be used for ejection. In contrast, in failing hearts, intracardiac flows become disorganized so that they may be energetically inefficient. However, it remained unknown whether left ventricular (LV) flow energetics prognosticates in heart failure.

Methods
This study included 61 patients with dilated cardiomyopathy (DCM). The temporal change in KE during early diastole (ED), atrial contraction (AC) and isovolumic contraction (IVC) was measured using Vector Flow Mapping particle tracking (Hitachi, figure top). LV inflow (total flow) were divided, based on whether they were ejected (direct flow, DF) or stayed in LV (retained flow, RF) in the following systole. KE of DF can be made use of for ejection, whereas KE of RF is supposed to be wasted. Diastolic function was graded, according to current EACVI/ASE guidelines. The patients were followed up for three years. Primary endpoint was hospitalization for worsening heart failure (WHF).

Results
12 patients had hospitalizations for WHF in the follow-up period. KE of total flow did not show any significant difference through the cardiac cycle between patients with and without WHF. KE of DF was slightly, but not significantly, smaller (ED: p = 0.252, AC: p = 0.119, IVC: p = 0.122), and KE of RF was slightly, but not significantly, larger (ED: p = 0.971, AC: p = 0.085, IVC: p = 0.134) in patients with WHF than those without events. The ratio of DF and RF (DF/RF ratio) showed significant differences between these two groups, especially from AC through IVC (figure, bottom-left). Cox proportional hazard analyses demonstrated that DF/RF ratio during IVC showed a significant correlation with clinical outcomes (p = 0.033, hazard ratio = 0.067). It remained significant even after adjusted for diastolic function grade (p = 0.046, hazard ratio = 0.074). Kaplan-Meier analysis confirmed the above results (figure, bottom-right). Conclusion: Efficiency of KE recruitment for LV ejection during IVC is associated with clinical outcomes in DCM.
Abstract P893 Figure. LISA
P900 The Heart Model: Automated LVEF calculation in the real world
Authors: Dhunnoo G , Mills A , Lloyd E F , Sabra A , Margulescu A , Bahlay B , Etheridge J , Ionescu A 
Published: January 2020

Abstract

Background
Heart Model (HM) is a proprietary, model-based algorithm for measurement of left ventricular ejection fraction (LVEF) in a 3D dataset acquired from an apical 4-chamber view by transthoracic echocardiography (TTE). There is evidence for superior reproducibility compared to 2D echo methods for LVEF measurement.

Objective
To assess the correlation of LVEF by HM with conventional, 2D LVEF methods.

Methods
All TTEs performed between 04-08/02/2019 by 2 HM-trained sonographers were included. Demographic characteristics, indication for TTE, LVEF by Simpson"s (LVEF_S), by "eyeballing" (LVEF_EB) and by HM (LVEF_HM), were recorded; LVEF for each study was also estimated by eye-balling by an experienced observer unaware of the reported LVEF (LVEF_IND). We compared LVEF by each method, their reciprocal correlations and their correlation with LVEF_HM. Image quality was rated excellent (endocardial border visible for all segments in the 3 apical views), good (&lt; 1 segment was not visible / view), adequate (&lt; 3 segments were not visible) and limited (&lt;4 segments were not visible). Indications for TTE were: assessment of LVEF in 1/3 of the studies, murmurs in 1/5, and other indications in the rest.

Results
We included 74 patients (42 M, mean age (SD) 69.8(13.9), range 18-92 years). Forty-nine (66%) patients were in sinus rhythm, 23 (31%) were in AF, and the rest were in various paced rhythms. Fifty patients (68%) had excellent, good or adequate images. The EFs calculated by different methods are shown in the Table (p &gt; 0.05 for all), an the Bland Altman plot (LVEF_EB vs HM) in the figure. LVEF_HM correlated modestly with the other methods if all studies were included (r = 0.535 LVEF_HM vs. LVEF_EB); the correlation improved if only good-quality studies were included (r = 0.769, p &lt; 0.001 for both). All combinations of LVEF_IND, LVEF_EB and LVEF_S had correlation coefficients &gt;0.93.

Conclusions
The Heart Model algorithm for LVEF measurement correlates well with traditional 2D methods in patients with good endocardial border definition, where its use can potentially improve reproducibility and reduce exam duration.
LVEF by method (good-quality studies) N = 50 Simpson"s Eyeballing HeartModel Independent Mean(%) 48.6 48.9 50.9 48.8 SD(%) 17.8 16.6 14.9 15.7 Median(%) 54.5 52.5 53 50 Range(%) 16-74 17.5-72.5 19-88 15-75 SD - standard deviation Independent - LVEF estimate (eyeballing) by independent observer unaware of reported EFs. LVEF_EB was chosen as it was available inall the reports.
Abstract P900 Figure. Bland Altman Plot (LVEF_EB vs LVEF_HM)
P902 Abnormal diastolic function in patients with transfusion dependant thalassemia major
Authors: Abdelmottaleb W A , Nadar S , Daar S , Al-Rahbi S , Hassan M 
Published: January 2020

Abstract

Aim and Background
Cardiac complications secondary to iron deposition are the commonest cause of death in patients with beta thalassemia major (TM) and can cause various abnormalities. The aim of this study was to assess the diastolic function in patients with transfusion dependant TM and compare with normal controls.

Methods
This was a retrospective study involving patients with transfusion dependant TM , on chelation therapy who had a MRI T2* and a transthoracic echocardiogram during the preceeding 6 months. We compared the findings with those from normal controls. We also correlated the echo findings with the MRI T2* values.

Results
Patients with TM (n = 92, 45% male, mean age 26+ 6 years), with median MRI T2* of 32 (18-39) and normal LV function had signs of diastolic dysfunction as compared to normal controls (41% male, mean age 25 + 6 years) with E/E’ at 6.6 + 1.6 vs 5.5 +1.2 (p &lt; 0.001) and altered pulmonary vein s/d ratio (0.88 + 0.30 vs 1.04 +0.42 for controls, p = 0.02)even in the presence of normal LV systolic function (Ejection fraction 61+ 7% vs 3.4% for controls). There was no difference in the other dimensions. The E/A ratio also corelated well with the MRI T2* (spearmans correlation rho -0.226 p 0.04). There were no other significant correlations between either the MRI T2* or myocardial Iron concentration and any of the other echo parameters

Conclusion
In patients with TM signs of diastolic dysfunction appear before LV systolic dysfunction and may be used to monitor these patients in absence of MRI facilities.
Echo findings in thalassemia Controls (n= 53) Thalassemia Major (n = 92) P value Sex Male Female 22 (41%) 31(59%) 42(45%) 50(55%) 0.5 Mitral E 0.84 + 0.16 1.01 + 0.16 &lt;0.001 Mitral A 0.47 +0.11 0.55 +0.16 &lt;0.001 E/A 1.85 +0.52 1.98 + 0.71 0.24 TDseptal 13.1 + 2.6 13.2 + 3.4 0.9 TDlateral 17.1+ 3.3 17.3 +4.1 0.7 E/E’ 5.5 +1.2 6.6 + 1.6 &lt;0.001 PVs/d 1.04 + 0.41 0.88 +0.30 0.02 TD= tissue doppler; PV- pulmonary vein
P905 Value of global longitudinal strain (GLS) in the short term prognosis of geriatric patients with asymptomatic severe aortic stenosis
Authors: Ramos Sanchez M , Quezada M , Garcia A , Ayala R , Herrera C , Gomez Pavon F J , Jaramillo J , Toro R 
Published: January 2020

Abstract

Funding Acknowledgements
VII Convocatoria del Banco de Santander and Alfonso X el Sabio University.

Background
Detection of symptoms in geriatric population with aortic stenosis (AS) is challenging, especially when they associate other comorbidities or frailty. Left ventricular global longitudinal strain (GLS) occurs before left ventricular ejection fraction impairment and could be useful for risk stratification and management of these patients.

Purpose
We sought to analyze the usefulness of GLS for predicting major cardiovascular adverse events (MACEs) in geriatric patients with asymptomatic severe AS.
Material and Methods:
Prospective study on 54 patients older than 70 years old with severe asymptomatic AS. Patient evaluation included biochemistry tests, electrocardiogram and echocardiography. We use a GLS cut-off point of 18% to dichotomize patients. Outcomes were defined as the composite of MACEs – occurrence of death from any cause, hospitalization for heart failure, appearance of symptoms or change in treatment.

Results
The mean age was 83.2 ± 7.1, with 60.4% of women. 24.5% showed atrial fibrillation. At 6 months of follow-up, 33% of patients reached the endpoint: 5.6% CHF, 11.1% death, 3.7% symptoms without changes in management and 13% were referred to an invasive treatment. The event-free survival rate at 6 months for the global population was 83%. 41.5 % of the subjects had GLS &lt; 18%. Kaplan Meier analysis showed that the probability of freedom from MACEs was not significant in patients with lower GLS (Log Rank p = 0.39). In the multivariate analysis only AVA was an inverse predictor of events (AVA) HR 0.05 (95% CI 0.007- 0.471, p &lt; 0.05).

Conclusions
The value of GLS was not a predictor of short term events in geriatric patients. Only assessment of AVA was an independent marker of MACES and in this kind of subjects.
Charasteristics of the global population Global N = 53 (%) GLS ≥ 18 N = 31 (58.5%) GLS &lt; 18 N = 22 (41.5%) (p) HBP 42 (79.2) 27 (87.1) 19 (82.6) 0.09 Atrial fibrillation 13 (24.5) 6 (19.4) 7 (31.8) 0.29 CVD 6 (11.3) 1 (3.2) 5 (22.7) 0.02 LVEF: Normal &gt;50% 48 (92) 31 (100) 17 (77.2) 0.05 Peak velocity 3.72 ± 0.72 3.81 ± 0.71 3.60 ± 0.74 0.315 Mean gradient 34.01 ± 14.06 35.61 ± 13.54 32.09 ± 15.07 0.29 Integral ratio 0.25 ± 0.08 0.26 ± 0.09 0.25 ± 0.08 0.83 AVA 0.8 ± 0.26 0.78 ± 0.27 0.83 ± 0.26 0.651 Indexed AVA 0.48 ± 0.16 0.48 ± 0.17 0.48 ± 0.16 0.9 AVA Aortic valve area; CVD: cerebro vascular disease; HBP: High blood presure; LVEF: left ventricule ejection fraction.
Abstract P905 Figure. Kapplan-Meier event-free survival curves