bluuebunny/crossref_metadata_2025_split huggingface dataset:
P812 A comparative echocardiographic study of young healthy males with early repolarization pattern
Authors: Frigy A , Szabo I A , Kocsis L , Laszlo S Z , Gabor Kelemen H , Fehervari L 
Published: January 2020

Abstract

Background
Early repolarization pattern (ERP) takes part from the J-wave syndromes and is associated with enhanced ventricular arrhythmogenesis in susceptible individuals. The main reason of our study was, that possible existence of subtle structural and functional cardiac changes related to ERP is still not well estabilished.

Methods
We compared 32 echocardiographic parameters (standard measures and specle tracking derived strain) of 30 young men (mean age 21.5 years) with ERP and 32 age and body-mass matched young men without ERP. T-test and chi-square test were used for statistical analysis (significant difference if p &lt; 0.05).

Results
Only the presence of mild mitral regurgitation was significantly more frequent in the ERP group (36.7% vs. 9.5%, p = 0.01). There were no significant differences regarding the other parameters, e.g., the interventricular septum (9.5 mm vs. 9.4 mm, p = 0.97), the end-diastolic diameters of the left and right ventricles (45 mm vs. 46.6 mm, p = 0.11; 34.9 mm vs. 33.8 mm, p = 0.42), the left ventricular ejection fraction ( 62.4% vs. 60.9 %, p = 0,3), the longitudinal diameters of the left and right atrium (51.8 mm vs. 53.1 mm, p = 0.27; 36.8 mm vs. 36.1 mm, p = 0.20), and the left ventricular global longitudinal strain (-21.75% vs. -21.28, p = 0.77).

Conclusion
In young males with ERP the vast majority of echocardiographic parameters was not different from those measured in their counterparts without ERP. The existence and clinical significance of the more prevalent mild mitral regurgitation in the ERP group has to be confirmed in a larger cohort.
P829 Cardiac uptake level in 99mTc-DPD scintigraphy in ATTR amyloidosis: is there any association with the prognosis?
Authors: Almeida I , Victor M , Cruz I , Marques A , Gomes C , Pereira H 
Published: January 2020

Abstract

Introduction
The uptake of bone-seeking radiotracers in 99mTc-DPD scintigraphy has been shown to be highly sensitive for cardiac transthyretin (ATTR) amyloid. Progressive levels of cardiac involvement are associated with poor prognosis.

Purpose
Evaluation of the prognostic impact of the tracer uptake level in the heart through 99mTc-DPD scintigraphy.

Methods
Single center retrospective analysis of patients’ data referred to perform a 99mTc-DPD between September 2014- July 2018 due to an abnormal echocardiogram or family history of ATTR. Data was collected regarding clinical, echocardiographic and 99mTc-DPD parameters to evaluate prognostic impact of the uptake level on cardiovascular events, namely hospitalizations due to acute heart failure, myocardial infarction or stroke, and all-cause mortality.

Results
35 patients were reviewed of whom 12 (34.3%) had a positive 99mTc-DPD, performing the diagnosis of an ATTR amyloidosis: mean age 78.4 ± 7.3 years, 100% male. 33.3% had a cardiac uptake level 2 (group 1) and 66.6% level 3 (group 2). Group 1 patients were younger (mean age 72.3 ± 4.6 versus 81.5 ± 6.5 years, p 0.03). At the time of diagnosis, most patients in both groups were in NYHA class II. Mean value of NTproBNP in group 1 patients was 4322.4 ± 35.0 versus 6387.7 ± 60.0 pg/ml (p 0.03); troponin level was not statistically different between groups (88.3 ± 63.1 versus 54.5 ± 16.1 pg/ml, p 0.228). On transthoracic echocardiogram evaluation, there were no significant differences between groups regarding cardiac function: mean ejection fraction 48.8 ± 6.3 versus 43.9 ± 11.5% (p 0.453) and mean global longitudinal strain -10.4 ± 2.8 versus -9.0 ± 2.9% (p 0.531). Although almost patients presented a nearly normal ejection fraction, almost have diastolic dysfunction (75 versus 100%, p 0.140) and pericardial effusion (100% in both groups). Hypertrophy level was similar between groups: septum thickness was 19.5 ± 0.7 in group 1 and 19 ± 1.4mm in group 2 (p 0.386). During follow-up, 25% of group 1 patients were hospitalized due to acute heart failure and 25% died. In group 2 patients, there were 25% of hospitalizations due to heart failure and all-cause mortality rate of 50%.

Conclusions
In our population, there was no significant association between the cardiac uptake level in 99mTc-DPD scintigraphy and cardiac symptoms or cardiac function evaluated through transthoracic echocardiogram at the time of diagnosis. However, higher levels of cardiac uptake were associated with higher mortality in the follow-up period. This data suggests that 99mTc-DPD scintigraphy should be performed not only for diagnosis but also for prognosis assessment in these patients.
P834 Pulmonary arterial hypertension in patients with direct-acting antiviral medications for hepatitis C virus infection - a prospective observational cohort study
Authors: Schild D , Hellige G J , Piso R J , Arenja N 
Published: January 2020

Abstract

Funding Acknowledgements
Kantonsspital Olten, Switzerland

Background
In patients with chronic hepatitis C virus (HCV) infection, a higher risk for pulmonary artery hypertension (PAH) has been described after interferon (IFN) therapy. With the development of direct-acting antiviral (DAA) agents, vast improvements have been made in tolerance and less complications of HCV treatment. However, except of a few case reports, to date no clinical study about the evidence of PAH in patients with DAA medication for HCV infection has been published. We hypothesized that in patients, who receive DAA medication for HCV-infection, the systolic pulmonary artery pressure (sPAP) will not change significantly during and after competition of the therapy and there may be a lower post treatment risk for PAH within the population.

Methods
We prospectively enrolled patients who underwent treatment with DAA for chronic HCV infection. The patients received a transthoracic echocardiography (TTE) for the measurement of the pulmonary artery pressure before, during (8 weeks after starting the medication) and 8 weeks after completion of the HCV medication for evaluation of sPAP (figure 1). The whole treatment period took 8-12 weeks.

Results
Between June 2016 and October 2018, 33 patients completed the study protocol. In mean, the patient’s age was 50.1 ± 1.4 years and 30% of the population were female. Three patients (9 %) were HCV and human immunodeficiency virus (HIV) coinfected. The patients received different treatment regimens, according to hepatitis C genotype and co-medication. The left ventricular systolic and diastolic function were normal in all patients before treatment was started (left ventricular ejection fraction 60.7% [59.7 – 61.7%], E/A 1.18 [1.0 – 1.37]). The following table depicts the right ventricular parameter before the DAA therapy was started, 8 weeks after therapy start, and 8 weeks after therapy was completed. The analysis showed no significant difference between the sPAP in all three groups (25.9 ± 1.2 mmHg vs. 26.0 ± 1.3 mmHg vs.26.9 ± 1.1 mmHg, p-value 0.37, see figure).

Conclusion
DAA-therapy in chronic HCV infected patients is not associated with PAH in a follow-up of 2 months after the treatment was completed.
Echocardiography Data Echocardiography data Before DAA medication was started 8 weeks after DAA-therapy 8 weeks after completion of DAA-therapy p-Value Right ventricular fractional area change (FAC), % 49.1 ± 1.4 51.7 ± 1.0 51.8 ± 1.1 0.09 Tricuspid Annular Plane Systolic Excursion (TAPSE), mm 25.2 ± 1.1 25.8 ± 0.7 24.3 ± 0.5 0.4 Right ventricular/right atrial gradient, mmHg 19.9 ± 1.0 20.5 ± 0.9 21.0 ± 0.8 0.24 Systolic pulmonary artery pressure (sPAP), mmHg 25.9 ± 1.2 26.0 ± 1.3 26.9 ± 1.1 0.37
Abstract P834 Figure. Multiple variable graph of sPAP
P842 The sword in the heart
Authors: Scheggi V , Mariani T , Alterini B 
Published: January 2020

Abstract

Introduction
Needle embolism is a rare complication of intravenous drug abuse which has only been reported on a handful of occasions. Potential sequelae include cardiac perforation, tamponade, infective endocarditis and recurrent pericarditis. We report the case of a young intravenous opiate abuser.

Case Report
A 23-year-old heroin addicted man presented to the emergency department because of chest pain ensued six months before; the pain was sharp, was relieved by sitting up and leaning forward and increased with coughing, swallowing, deep breathing or lying flat. He complained also fatigue and fever since one month before presentation.
Echocardiography revealed non haemodinamic pericardial effusion and pleural effusion, treated with pleural drainage. Three haemocoltures were negative. Cardiac biomarkers were negative. HIV, HBV and HCV sierology was negative. He was treated with cochicine and ibuprofen and empiric antibiotic therapy with initial improvement of symptoms and rapid recurrence of them. After a few weeks an ECG showed widespread concave ST segment elevation and an echocardiogram revealed pericardial effusion relapse.
A chest radiograph showed a needle near the right ventricle. The patient underwent computed tomography angiography that was able to localize a needle inside the pericardium. A second echocardiogram confirmed the presence of the fragment in the pericardial cavity, beside the right ventricle.
The patient underwent minithoracototomy surgical removal of the needle fragment and of 500 cc of haematic pericardial fluid.

Discussion and conclusions
The presence of a foreign body in the heart may result from either a direct injury to the heart such as a gunshot injury or from some other embolization to the heart from distal penetration sites (eg, the migration of a catheter or a needle fragment from a peripheral vessel). It may cause fever, recurrent pericarditis and arrhythmia. Surgical extraction in the therapy of choice.
Abstract P842 Figure.
P843 A rare cause of chest pain: paradoxical embolism in Ebstein"s anomaly
Authors: Abdelgawad H S A , Hisham N , Shehata M , Abdelhay M A 
Published: January 2020

Abstract

Introduction
Ebstein’s anomaly is characterized by displacement of the proximal attachments of the tricuspid valve from the atrioventricular ring into the right ventricle. This structural abnormality divides the right ventricle into an ‘atrialized’ portion and a distal ‘ventricularized’ portion. The severity is variable and accounts for the broad clinical spectrum, from severe disease causing fetal or neonatal death to mild disease compatible with natural survival as late as the eighth decade of life. Ebstein’s anomaly is an uncommon defect occurring in less than 1% of patients with congenital heart disease, but it is disproportionately represented in the adult congenital heart disease population because of its favourable natural history

Case report
A 55 year old man with no previous cardiac history .He presented to our medical facility complaining of acute retrosternal squeezing retrosternal chest pain few hours before admission. On clinical examination, he had a pansystolic murmur over the tricuspid area .ECG showed right bundle branch block. Laboratory results were unremarkable except elevated cardiac enzymes. 2D Transthoracic Echocardiography revealed a small well-functioning right ventricle, 15 mm/m2 apical displacement of the tricuspid septal leaflet with severe tricuspid regurgitation . 2D and 3D transesophageal echocardiography with intravenous agitated saline injection revealed patent foramen ovale with right to left shunt with immediate crossing of bubbles.Coronary angiography revealed normal coronaries.
The patient refused intervention and he was maintained on warfarin treatment .

Conclusion
The clinical presentation of Ebstein’s anomaly is highly variable—depending on anatomic severity, haemodynamics ,and degree of interatrial shunting. The majority of patients have shunting through a secundum ASD or patent-foramen ovale. Paradoxical embolism maybe an indication for PFO/ ASD closure
Abstract P843 Figure.
P852 Cancer-associated thrombotic diathesis: one of your worst nightmares
Authors: Sousa J P , Neves C , Jesus E , Chaves A , Lourenco C , Goncalves L , Sousa G 
Published: January 2020

Abstract
A 34-year-old male patient was diagnosed with undifferentiated sarcoma of the right thigh, with lung metastasis. He underwent primary lesion resection surgery and initiated chemotherapy with both doxorubicin and ifosfamide. Though primary tumor burden was substantially reduced, secondary lesions were found to be irresponsive to drug therapy, leading to regimen switching to both gemcitabine and docetaxel. Three months later, patient started complaining of atypical chest pain and palpitations. Electrocardiography revealed very frequent supraventricular ectopic complexes, while a transthoracic echocardiogram unveiled a pulmonary vein thrombus, which extended into the left atrium. This finding, which was further characterized by cardiovascular magnetic resonance imaging, prompted anticoagulation initiation, under the form of enoxaparin 1mg/kg bid. At this time, chemotherapeutic scheme was, again, swapped, and a cycle of both doxorubicin and olaratumab was introduced. A combined episode of inferolateral ST-segment elevation myocardial infarction and peripheral arterial embolism followed shortly thereafter. Emergent invasive coronary angiogram revealed no signs of both epicardial atherosclerosis and thrombus, whereas subsequent transthoracic echocardiography showed a massive left heart thrombus, extending into the aortic valve annulus. Anti-thrombotic approach involved increasing enoxaparin dosage to 1.5mg/kg bid but no fibrinolytic therapy. Despite a rather uneventful immediate clinical course, with no electric or hemodynamic instability and no limb-threatening ischemia, lamentably, patient died two weeks later, before thrombus definitive imaging reassessment. As no autopsy was performed, it is unclear whether a cardiovascular acute event or neoplasm inexorable progression is to blame as the primary cause of death.
Thrombosis is a common, costly and potentially fatal cancer complication. Patients receiving systemic chemotherapy for advanced diseased are at higher risk. Despite major management developments in the past fifteen years, evidence still supports traditional low-molecular-weight heparins as the first-line therapy and prognosis remains dismal.
Abstract P852 Figure.
P861 Immediate aortic dissection after transcatheter aortic valve replacement (TAVR)
Authors: Rujirachun P , Junyavoraluk A , Jakrapanichakul D , Wongpraparut N , Chunhamaneewat N , Maneesai A , Sakiyalak P 
Published: January 2020

Abstract
Transcatheter aortic valve replacement (TAVR) is a treatment of choice for treating symptomatic severe aortic stenosis patient whose condition is considered the high and intermediate operative risk for surgical aortic valve replacement. Here, we present a case of 67-year-old man with symptomatic severe aortic stenosis, triple vessels disease, type 2 diabetes mellitus and end-stage renal disease who was treated with TAVR. After the valve was deployed, we found the abnormal leakage at descending aorta by transesophageal echocardiogram (TEE). Under intraoperative close monitoring, the dissection was slowly expanding so we decided to perform thoracic endovascular repair (TEVAR). In conclusion, TEE after TAVR procedure is helpful to detect this rare complication.
Reported cases of AD status post TAVR Author Sex/Age Comorbidity Detection time of AD Site of AD Detection of AD Treatment for AD Result Route access of TAVR This case 2018 M/67 DM, ESRD Immediate after implant Ds TEE TEVAR Recovery Femoral Losmanova et al. 2018 F/81 NA 3 yrs As Autopsy Conservative Died NR Kratimenos et al. 2016 F/81 COPD, renal dysfunction, angiodysplasia 12 days Ds CT TEVAR Recovery Femoral Nagasawa et al. 2016 F/86 Heart failure During the procedure Ds TEE Conservative Recovery Femoral Yashima et al. 2015(14) F/88 NA 3 days As CT Conservative Recovery Femoral Van Mieghem et al. 2013 F/86 Coronary artery disease, post total knee prosthesis 1-2 hours As Angiogram TEVAR Recovery Femoral Loeser et al. 2013 F/89 NA 2-5 hours As Autopsy NA Cardiogenic shock and died Femoral Bibombe et al. 2013 M/83 Previous CBG, HT, DLP During the procedure As and Ds TEE, CTA, angiogram Open surgery Recovery Femoral Al-Attar et al. 2013 F/84 HT, thrombophlebitis 8 months 2 weeks As CT Open surgery Arrest and died Femoral D"Onofrio et al. 2012 F/79 RA, pulmonary edema, cerebral hemorrhage Immediate after implant As TEE Open surgery Died 32 day later due to septic shock Aortic Ong et al. 2011 M/90 HT, CA prostate, CKD, gastric and duodenal ulcer Immediate after implant As TEE Conservative Recovery Femoral Gerber et al. 2010 F/83 DM, LE 22 days As Autopsy NA Cardiac arrest and died Femoral Abbreviations M Male; F Female; DM Diabetes mellitus; ESRD End-stage renal disease; NA Not available; COPD Chronic obstructive pulmonary disease; CBG Coronary bypass graft; HT hypertension; DLP Dyslipidemia; RA Rheumatoid arthritis; CA cancer; CKD Chronic kidney disease; LE Lupus erythematosus; AD Aortic dissection; As Ascending; Ds Descending; TEVAR Thoracic endovascular aortic repair.
Abstract P861 Figure. Intraoperative TEE after TAVR
P863 Large pericardial effusion two months after transcatheter aortic valve implantation: case report of a post-cardiac injury syndrome
Authors: Alves Pinto R , Martins Carvalho M , Proenca T , Araujo P M , Nunes A , Torres S , Grilo P D , Resende C X , Dias P , Almeida R , Silva J C , Maciel M J , Macedo F 
Published: January 2020

Abstract
We present a case of a 87-year-old female with a symptomatic severe aortic stenosis (aortic valve area 0.9 cm2, mean transvalvular pressure gradient 44 mmHg). She was refused to surgical aortic valve replacement due to marked aortic root calcification. A transcatheter aortic valve (ACCURATE neo™ 27) was electively implanted. In immediate post-procedure, the patient presented an episode of hypotension, rapidly reverted with supportive treatment. A transthoracic echocardiogram (TTE) showed a circumferential mild pericardial effusion (PE) without prosthetic valve disfunction and with preserved biventricular systolic function. Due to paroxysmal episodes of atrial fibrillation, it was decided to withdraw anti-aggregation and to start anticoagulation. Four days after transcatheter aortic valve implantation (TAVI) the patient presented newer intraventricular and atrioventricular conduction disturbance (left bundle branch block and type-I second-degree atrioventricular block). A definitive pacemaker was implanted without complications. PE maintained stable and seven days after TAVI the patient was discharged from hospital.
Two months after TAVI, the patient was admitted to Intensive care unit (ICU) with increasing asthenia, dyspnea and pleuritic thoracic pain over the preceding two weeks. Laboratory workup exhibited elevation of inflammatory markers (leukocytosis and C-reactive protein). A TTE was performed and showed a large circumferential PE (29 mm) with signs of hemodynamic impact (swinging heart, inferior vena cava dilation with &lt;50% inspiratory collapse, right atrial collapse &gt;1/3 of cardiac cycle, proto-diastolic right ventricular collapse and mitral respiratory flow variation &gt;25%). The patient started treatment with anti-inflammatory drugs (aspirin 1000mg every 8h plus colchicine 0.5mg twice daily) and pericardiocentesis was initially postponed. In spite of clinical and echocardiographic improvement, she maintained elevated inflammatory markers and a moderate PE. Prednisolone 30mg daily was added to initial therapy and serial evaluations showed a pronounced reduction of PE as well as of inflammatory markers. Two weeks after admission to ICU the patient was discharged with a residual PE measuring less than 5mm. The previous recent cardiac intervention and the effective response to anti-inflammatory treatment suggest a post-cardiac injury syndrome.
This case report wants to show that post-cardiac injury syndrome is a diagnosis that should be keep in mind after TAVI.
Abstract P863 Figure. TTE showing large pericardial effusion
P870 The role of transthoracic doppler echocardiography in chronic total occlusion diagnosis in a patient with stable angina and cerebral atherosclerosis
Authors: Pavlova N 
Published: January 2020

Abstract

Introduction
The issue of sudden cardiac death (SCD) remains one of the most actual problem in healthcare. Several reports underscores that about 50-80% of SCD is linked to ischemic heart disease (IHD). The usage of contemporary risk-stratification criteria of SCD and implementation of new noninvasive ultrasound methods allow to improve patient’s prognosis through early start of optimal medical therapy and surgical treatment.
Material and methods: 63 years-old male with moderate class II stable angina. Patient undergone eversion endarterectomy 2 years prior to initial admittance due to an 80% left internal carotid stenosis and received appropriate optimal medical therapy provided by the modern dyslipidemia guidelines. We’ve used ECG (MAC 1600, GE); transthoracic doppler echocardiography, stress-echo, triplex scanning (VIVID E9, E95, GE); ergometry stress test (eBike, GE), quantitative coronary angiography (Innova 3100, GE).

Results
ECG (sinus rhythm, 62bpm, left ventricular hypertrophy) and brachiocephalic arteries triplex scan were unremarkable. Patient had dyslipidemia with low HDL. Transthoracic echocardiography revealed no region wall motion abnormalities, concentric remodeling, mild diastolic dysfunction, preserved ejection fraction (57%, Simpson). Transthoracic doppler echocardiography showed retrograde mid-LAD flow and patient was scheduled for noninvasive stress-echocardiography (Level III, 100W 2:00 min). Stress-echo was positive with apical anterior and lateral akinesia, septal and mid-lateral hypokinesia, GLS rest 15 %, GLS peak 13% and dynamic ST-segment changes in V4-V6. Invasive coronary angiography showed LAD CTO and subtotal LCx lesion. Then LAD and LCx PTCA with stenting were performed with good clinical outcome.

Conclusion
Novel methods of cardiac and coronary visualization are feasible in coronary flow reserve assessment and chronic total occlusions identification, especially in patients with multifocal atherosclerosis.