bluuebunny/crossref_metadata_2025_split huggingface dataset:
P911 3D echo imaging of tricuspid valve: new look at the tricuspid valve
Authors: Abdelgawad H S A , Shehata M , Abdelnabi M , Almaghrabi A , Abayazeed R , Abdelhay M A 
Published: January 2020

Abstract

Introduction
"" En face"" visualisation of the tricuspid valve (TV) leaflets and commissures is not possible using two-dimensional transthoracic echocardiography (TTE) unless the right ventricle (RV) is dilated via parasternal short axis or subcostal views. With the aid of three dimensional echocardiography (3DE) , complete assessment of the TV apparatus including the leaflets, annulus and subvalvular apparatus can be easily accomplished.

Aim
To use different modes of three dimensional (3D TTE) to assess TV in three standard views in different diseases.
Methods : 6 patients with different tricuspid valve diseases (mean age is 29 ± 18 years, 3 were women)were studied.We used three-dimensional echocardiography to acquire zoomed mode and multi-beat, full-volume data sets of the TV to assess the leaflets and commissures. .Moreover, tricuspid valve area(TVA) was assessed by direct planimetry of the valve orifice at the level of the leaflets tips at end diastolic frame in cases of TV stenosis.

Results
Direct visualization of the leaflets motion and number, commissures and TVA were achieved in all patients.Tricuspid valve posterior leaflet prolapse was seen in two patients (figures A, B).2 patients had tricuspid valve stenosis ; one showed characteristic commissural fusion in a rheumatic heart (3D TVA= 1.2 cm2 )(Figure D) and the other has a peculiar commissural sparing in a carcinoid pathology (3D TVA = 1.9 cm2) (Figure E) .One patient revealed rudimentary anterior leaflet suggesting unguarded TV orifice (Figure F). Regarding the numerical variations: one patient got 4 leaflets (Figure C) while another one had 2 leaflets only.

Conclusion
Simultaneous visualization of the three TV leaflets is limited by using 2DE.On the other hand, RT-3DE allows better understanding of the anatomy and mechanisms of the TV diseases .Comprehensive assessment of the morphology and function using RT-3DE can provide a valuable road map to guide the intervention according to each individual case.
Abstract P911 Figure. Different TV morpholgies.
P912 Echocardiographic analysis of acute effects after treatment of functional mitral regurgitation by percutaneous mitral annuloplasty
Authors: Stoebe S , Kreyer K , Lavall D , Laufs U , Hagendorff A 
Published: January 2020

Abstract

Background
Secondary or functional mitral regurgitation (FMR) is associated with increased morbidity and mortality, especially in heart failure patients, patients with many comorbidities and/or in the elderly. Previous studies about percutaneous mitral annuloplasty have shown evidence for long-term reduction of degree of FMR severity and left ventricular (LV) remodeling. In comparison to previous studies the present study did focus on the echocardiographic analysis of acute effects after percutaneous mitral annuloplasty (PMA).

Methods
Transthoracic echocardiography (TTE) has been performed in 30 patients with moderate or severe FMR before and after (± 3.5 days) percutaneous mitral annuloplasty (Carillon®). LV volumes and LV ejection fraction and semi-quantitative parameters, e.g. tenting Area, vena contracta and velocity-time-integral ratios of transmitral inflow and LV outflow (VTIMV/VTILVOT) were assessed. The assessment of the regurgitant volume (RV), regurgitant fraction (RF) and effective regurgitant orifice area (EROA) was quantitatively performed by the PISA method. RV and RF was also estimated by subtracting the effective forward stroke volume (SVLVOT, SVRVOT) from the total stroke volume (SVLV planimetry). Further, parameters of left ventricular contractility, e.g. global longitudinal strain (GLS), cardiac efficiency, peak power index etc., were assessed.

Results
a postinterventional reduction of degree of FMR severity was achieved in 25/30 patients (83%). In average, RF was reduced from 49 ± 11% to 34 ± 13% (p &lt; 0.001), RV from 33 ± 13ml to 25 ± 12ml (p &lt; 0.001) and EROA from 0.24 ± 0.1cm2 to 0.19 ± 0.1cm2 (p &lt; 0.05). Significant decreases were also noted for vena contracta and VTIMV/LVOT. DiamMV (long axis) was reduced from 3.6 ± 0.6cm to 3.4± 0.6cm (p &lt; 0.001), DiamMV (4-chamber view) from 3.9 ± 0.5cm to 3.6 ± 0.6cm (p &lt; 0 .05). In patients with sinus rhythm (SR) or pacemacer stimulation a considerably higher reduction of RF was observed (ΔRF 20 ± 12%) in comparison to patients with atrial fibrillation (ΔRF 10 ± 12%). No significant changes were obtained for parameters of LV remodeling and LV contractility, e.g. GLS, cardiac efficiency, peak power index.

Conclusion
A reduction of degree of FMR severity can be achieved by percutaneous mitral annuloplasty (PMA) and acute effects can be quantitatively assessed by echocardiography. Further data are necessary to evaluate whether these acute effects will maintain in follow-up investigations.
Abstract P912 Figure. Fig1-Reduction of RF and VC after PMA
P917 Additional value of atrial parameters evaluated by echocardiography on the scales of cardioembolic risk in atrial fibrillation
Authors: Moral S , Panaro A , Ballesteros E , Morales M , Frigola J M , Robles R , Albert X , Trucco E , Aboal J , Vilardell P , Palet J , Carballo J , Brugada R , Evangelista A 
Published: January 2020

Abstract

Background
Atrial morphological parameters may influence the presence of atrial thrombus, a factor strongly associated with cardiac thromboembolism, independently of those included in the CHA2DS2-VASc risk estimation scale in patients with a history of atrial fibrillation (AF). The aim of our study was to evaluate this possible association by transthoracic echocardiography (TTE).

Methods
Prospective multicenter study including 401 patients with a history of AF, in which a TTE and a transesophageal echocardiogram (TEE) were performed for evaluation of atrial thrombus between 2016-2019. The parameters included in the CHA2DS2-VASc scale, the heart rhythm at the time of the study and the anticoagulant treatment performed, as well as the atrial morphological parameters were collected.

Results
Twenty-three patients (6%) presented with atrial thrombus in TEE. The left atrial area (28 ± 6cm2 vs 33 ± 6cm2; p &lt; 0.001), the presence of AF during the study (83% vs 17%; p = 0.002) and CHA2DS2-VASc (1.7 ± 1.5cm2 vs 3.0 ± 1.3cm2; p &lt; 0.001) were associated with the presence of atrial thrombus. The left atrial area was a diagnostic predictor of atrial thrombus (area under the curve = 73%; p = 0.001): a value &gt;30cm2 presented a sensitivity of 79% and a specificity of 70% to detect its presence. Logistic regression analysis, including heart rhythm during the study and anticoagulant treatment, showed that CHA2DS2-VASc (OR = 1.5; CI95%=1.1-1.9; p = 0.003) and left atrial area &gt;30cm2 (OR = 5.2;CI 95% =1.7-16.0; p = 0.004) were independent predictors of atrial thrombus presence.

Conclusions
The left atrial area is associated with the presence of atrial thrombus in patients with a history of AF independently of the CHA2DS2-VASc scale, heart rhythm during the study, and anticoagulant treatment. This parameter should be evaluated to be included in the cardioembolic risk scales.
P929 Routine Left Atrium Strain in acute STEMI: to do or not to do
Authors: Tadic S , Ilic A , Stefanovic M , Stojsic-Milosavljevic A , Stojsic S , Popov T 
Published: January 2020

Abstract

Introduction and purpose
Left atrium strain (LAS) is a very useful, modern method of establish left atrium (LA) function and rarely use in predicting adverse events (AE) in acute anterior ST-elevated myocardial infarction (STEMI). The purpose of our study was to compare LAS among other echocardiographic parameters of LA and left ventricle (LV) function, in patients that developed AE (heart failure, all cause mortality, reinfarction and rehospitalization) after acute anterior STEMI during one year follow up.

Methods
All 101 patients with a first acute anterior STEMI treated by primary PCI had early echocardiography in first 24 hours. After one year follow up, patients were divided in two groups: AE group (27 patients; 27%) and non-AE group (74 patients; 73%). We compared: LA size, LA maximal volume index, LAS, systolic and diastolic left ventricle parameters, between groups for the purpose of identifying early AE predictors.

Results
Among all left atrium parameters, LA strain was most prognostic for AE between groups (AE group vs. non-AE group): LA diameter (3,7cm vs. 3,5cm, p = 0,03), LA maximal volume index (27 ml/m2 vs. 24,5 ml/m2, p = 0,03), LAS (30% vs.37%, p &lt; 0,0001)
Statistically significant differences in systolic and diastolic LV function between AE and non-AE groups were: ejection fraction (p &lt; 0.0001), stroke volume index (p &lt; 0.0001), fractional shortening (p &lt; 0.0001), cardiac index (p &lt; 0.0001), LV systolic work (p &lt; 0,0001), WMSI- wall motion score index (p &lt; 0,0001), average LV peak systolic longitudinal global strain- LGSav (p &lt; 0,001), mitral inflow peak early velocity/average mitral annular peak early velocity- E/e"av (p &lt; 0,001).
After adjustment for all echocardiographic parameters, LA strain (OR 0,91 95% CI, p = 0,04), WMSI ≥ 2 (OR 6.1 95% CI, p &lt; 0.001), average peak systolic left ventricle LGS (OR = 15.1 95% CI, p &lt; 0.0001) and cardiac index (OR 2.6 95% CI, p = 0.01) were independently associated with adverse outcomes.

Conclusion
Routine left atrium strain is very prognostic parameter of high-risk STEMI patients for adverse events and could possibly be considered as an important component of the new predictive score system for MACE and mortality of STEMI patients in the near future.
P934 Left atrial strain association with left ventricular diastolic function
Authors: Rodriguez Sanchez I , Anton A , Onaindia J J , Velasco S , Florido J , Oria G , Cacicedo A , Urkullu A , Benegas A 
Published: January 2020

Abstract

Objectives
to evaluate the relationship between left atrial (LA) peak strain and left ventricular (LV) diastolic function and determine whether LA strain could be used to detect elevated filling pressures in a population of patients with preserved LV ejection fraction (LVpEF).

Background
the assessment of diastolic function is complex and multiparameter. 2016 ASE and EACVI algorithm has simplified this approach, but there are still patients with discrepant values leading to an indeterminate diagnosis, specially in patients with preserved ejection fraction.

Methods
we prospectively included 129 patients in our cohort. Inclusion criteria were LVEF &gt; 50% and sinus rhythm. Patients with atrial fibrillation, significant mitral valvulopathy or poor quality imaging were excluded. Two-dimensional speckle tracking was used to measure peak LA strain in all LA segments (using apical 4 chamber, 2 chamber and 3 chamber views). We evaluated the association of LA global peak strain and LA 4 chamber peak strain with the different categories of diastolic function according to the 2016 ASE and EACVI algorithm.

Results
Both LA global peak strain and 4 chamber LA peak strain showed a progressive decrease with worsening diastolic dysfunction (DD) severity (Table 1). A global LA peak strain cutoff value of 28,35% was very accurate to differentiate normal from elevated filling pressures (normal function or grade 1 DD from grades 2 and 3 DD). Diagnostic accuracy: 80.20%; area under the curve: 0,80 (0,72-0,88); A significant group of patients (21,1%) could not be categorized using 2016 algorithm.

Conclusions
Both LA global peak strain and 4 chamber LA peak strain demonstrated a progressive decrease with worsening DD severity. Global LA peak strain value of 28,35% was an accurate cutoff to differenciate patients with normal vs elevated filling pressures.
LA strain values and diastolic function Total LA global peak STRAIN LA 4C STRAIN N (%) p-value p-value Total 129 30.90 %(11.77) 30.43 (12.36) Diastole &lt;0.0001 &lt;0.0001 Normal function 36 (28.13) 39.72% (9.59) 39.98 (10.59) Indeterminate Diastolic Function 23 (17.97) 31.07% (7.97) 30.19 (7.50) Indeterminate DD 4 (3.13) 30.68 % (6.72) 29.75 (7.31) grade 1 DD 22 (17.19) 32.69 % (12.54) 32.98 (14.46) grade 2 DD 36 (28.13) 23.90 % (9.32) 23.53 (9.49) grade 3 DD 7 (5.47) 15.43 % (5.72) 15.85 (7.32)
P935 Association of intracellular iron status with left ventricular systolic function response to exercise in heart failure with preserved ejection fraction
Authors: Przewlocka-Kosmala M , Jasic-Szpak E , Jankowska E A , Ponikowski P , Kosmala W 
Published: January 2020

Abstract

The intracellular iron depletion has been recognized to contribute to the dysregulation of cell energetics. The soluble transferrin receptor (sTfR) is regarded as a marker of cellular iron balance, and its elevated level reflects an insufficient iron delivery to target tissues. Despite the strong pathophysiological link, there is a scarcity of data on the impact of intracellular iron status on myocardial performance.

Aim
To investigate the association between the intracellular iron status, as assessed by sTfR, and left ventricular (LV) function in a well-characterized population with heart failure and preserved ejection fraction (HFpEF).

Methods
A complete echocardiogram including evaluation of LV global longitudinal deformation by speckle tracking (GLS) was performed at rest and immediately post-exercise in 83 pts (age 66 ± 8 yrs) with symptomatic HFpEF.

Results
Pts with the highest sTfR concentrations (from the 3rd sTfR tertile) demonstrated significantly lower exertional GLS than their peers from the other 2 tertiles and lower resting GLS vs. the 2nd tertile (Table). Exercise GLS was inversely correlated with sTfR (r=-0.27, p = 0.01), and this association remained significant after adjustment for age, sex, BMI, LV mass, exercise blood pressure, hemoglobin and serum galectin-3 – a marker of fibrosis (beta=-0.24, p = 0.04).

Conclusions
In HFpEF, higher sTfR reflecting a decreased global intracellular iron content is independently associated with reduced LV longitudinal contractility response to exertion. This might represent another mechanism of exercise intolerance and should be considered in management strategies in this condition.
Abstract P935 Figure.
P936 Early signs of cardiac dysfunction in obesity patients, results of the CARDIOBESE study
Authors: Snelder S M , De Groot - De Laat L E , Biter L A , Castro Cabezas M , Pouw N , Birnie E , Boxma - De Klerk B , Klaassen R A , Zijlstra F , Van Dalen B M 
Published: January 2020

Abstract

Introduction
Obesity is becoming a global epidemic. Current knowledge on early signs of cardiac dysfunction in obesity patients is insufficient. The onset of heart failure in obesity patients cannot be fully explained by the presence of traditional cardiovascular risk factors.

Purpose
To detect early signs of cardiac dysfunction in obesity patients without known cardiovascular disease.

Methods
The CARDIOBESE-study is a cross-sectional multicentre study of 100 obesity patients scheduled for bariatric surgery (body mass index (BMI) ≥35 kg/m2) without known cardiovascular disease, and 50 age-matched and gender-matched non-obese controls (BMI ≤30 kg/m2). Speckle tracking echocardiography, biomarkers and Holter monitoring were used to identify parameters that are able to show cardiac dysfunction at a very early stage in obesity patients.

Results
Obesity patients had impaired left ventricular ejection fraction, global longitudinal strain (GLS) and diastolic function parameters (e.g. septal e" velocity, lateral e" velocity, E/e’ and E/A-ratio) as compared to the non-obese controls (Table). C-reactive protein (CRP) and heart rate were increased, whereas heart rate variability (Standard deviation of NN intervals, SDNN) was decreased. Obesity patients were subdivided in patients with impaired (&lt; -17%, n = 56) or normal GLS (n = 36). Comparison between these patients revealed no differences regarding BMI, prevalence of traditional cardiovascular risk factors or CRP value. Nevertheless, patients with abnormal GLS had a higher waist circumference and lower SDNN.

Conclusion
There is a high prevalence of subclinical cardiac dysfunction as measured by GLS in obesity patients (56%), which appears to be related to abdominal fat and decreased heart rate variability and not to BMI, traditional cardiovascular risk factors or CRP.
Non-obese controls (n = 50) Obesity patients (n = 100) p-value Obesity patients with normal GLS (n = 36) Obesity patients with impaired GLS (n = 56) p-value Age (years) 49.2 ± 9.5 47.9 ± 7.6 0.36 47.6 ± 7.1 48.3 ± 7.6 0.68 BMI (kg/m2) 24.9 ± 3.2 42.9 ± 4.1 &lt;0.001 42.7 ± 4.2 42.7 ± 4.1 0.98 Waist circumference (cm) 81.1 ± 10.4 133.1 ± 12.3 &lt;0.001 128.2 ± 11.5 135.2 ± 10.5 0.006 E/A- ratio 1.19 ± 0.26 1.01 ± 0.3 &lt;0.001 1.08 ± 0.2 0.96 ± 0.27 0.048 Septel e" velocity 10.3 ± 9.8 8.1 ± 1.8 0.03 8.2 ± 1.9 7.8 ± 1.7 0.24 E/e" 8.5 ± 2.1 8.9 ± 2.5 0.32 9.5 ± 2.4 8.7 ± 2.5 0.14 CRP (mg/L) 1.9 ± 2.9 8.8 ± 8.8 &lt;0.001 8.5 ± 7.3 9.3 ± 10.1 0.67 SDNN 160.2 ± 35.4 109.4 ± 46.0 &lt;0.001 130.4 ± 48.3 98.9 ± 41.2 0.001 Table: Selection of parameters. Values are means ± SD. SDNN= Standard deviation of NN intervals (heart rate variability)
P947 Left- and right ventricular mechanics in athletes: a true marker of fitness?
Authors: Lakatos B K , Kiss O , Sydo N , Tokodi M , Fabian A , Kantor Z , Bognar C , Major D , Kovacs A , Merkely B 
Published: January 2020

Abstract
Regular physical exercise results in marked changes of ventricular morphology and function, also referred as the athlete’s heart. Despite the marked changes of cardiac morphology and function in athletes, data is scarce regarding the relationship between exercise performance and cardiac adaptation to exercise.
Accordingly, our aim was to examine the relationship between ventricular morphology and function and exercise capacity in a prospective cohort study.
Young elite soccer players (n = 18, age: 16 ± 1 years) were enrolled and examined at baseline and following 1 year. Athletes underwent cardiopulmonary exercise testing to determine peak oxygen uptake (VO2/kg). Following exercise testing, 3D echocardiography was performed and LV and RV focused loops were obtained. By off-line analysis, we measured left- (LV) and right ventricular (RV) end-diastolic volume indices (EDVi) and LV mass index (LVMi) indexed to body surface area and LV and RV ejection fractions (EF). By 3D speckle-tracking analysis of the LV and RV we also determined global longitudinal (GLS) and circumferential (GCS) strains.
We found improved and decreased peak exercise performance as well during the 1 year follow-up with an overrall increased mean exercise capacity (dVO2/kg: 2.6 ± 7.3 ml/min/kg). LV and RV morphology did not change significantly according to LVEDVi and RVEDVi (LVEDVi: 84 ± 14 vs. 80 ± 7 ml/ m², RVEDVi: 82 ± 11 vs. 84 ± 10 ml/m², both p = NS). LVMi significantly increased (82 ± 14 vs. 89 ± 9 g/m², p &lt; 0.001). LV and RV EF did not change during one year follow-up (LVEF: 58 ± 4 vs. 57 ± 5%; RVEF: 57 ± 4 vs. 55 ± 6%, both p = NS), while LVGLS decreased compared to baseline (19.7 ± 1,8 vs. 19.3 ± 2,8%, p &lt; 0.01). The change in VO2/kg showed correlation with decreased LVGLS and also with decreased RVGCS (dLVGLS vs. dVO2/kg: r=-0.56, dRVGCS vs. dVO2/kg: r=-0.50, both p &lt; 0.05)
During 1 year follow-up cardiac morphology and function significantly changed in our athlete cohort, and these changes showed relationship with the changes of peak exercise performance. Detailed assessment of myocardial mechanics may help to monitor training in athletes.
P948 Assessment of maternal cardiac remodeling and systolic function by 3D echocardiography in gestational hypertension and preeclampsia
Authors: Ilic A , Stojsic S , Papovic J , Stefanovic M , Grkovic D , Miljkovic T , Bjelobrk M , Tadic S , Ilic D J , Radisic B , Milovancev A , Bjelic S , Bogdanovic D , Stojsic-Milosavljevic A 
Published: January 2020

Abstract

Background
It was recently showed that there is a difference between 3D and 2D evaluation of the left ventricular (LV) myocardial mass and cardiac function in gestational hypertension (GH) probably due to more pronounced heart shape changes in hypertensive pregnant women. It is also known that preeclampsia (PE) is associated with a deterioration in maternal cardiac function. Purpose: We were interested whether there was a difference in 3D morphological and functional parameters of the LV in relation to the blood pressure (BP) profile in GH, but also between GH and PE. Methods: 22 women and 55 with GH (28 with dipping pattern of BP, and 27 non-dippers) underwent 3D echocardiography and ambulatory blood pressure monitoring in the third trimester. LV mass index, LV volumes, SV index and parameters of systolic function of the LV: CO index, EF, longitudinal strain (LS), circumferential strain (CS), radial strain (RS) and area strain (AS) were estimated using 3D software. These three groups (PE, dippers and non-dippers) were each other"s control. Results: Groups did not differ in age and LV massi. SVi was significantly lower in non-dippers (p = 0,045) and PE (p = 0,031) compared with dippers, without significant difference between non-dippers and PE (p = 0,59). Similar results were obtained when we analyzed the EF in these three groups. COi was the lowest in PE (2,76 ± 0,3), compared with dippers (3,43 ± 0,5; p&lt; 0,0005), with significant difference between non-dippers (2,97 ± 0,4; p&lt; 0,0005) and dippers, and with a small difference between PE and non-dippers (p = 0,045). Evaluation of the systolic function by 3D strain, also showed that the systolic function was significantly lower in PE, but also in non-dippers compared to dippers (Table 1). Multivariate regression analysis revealed that nocturnal BP (p = 0,001; OR 1,106; 95% CI 1,029 - 1,142) and presence of proteinuria (p&lt; 0,0005; OR 7,2; 95% CI 1,896 – 36,5) strongly predict preterm delivery. Conclusions: Deterioration of 3D systolic function is more pronaunced in PE, but also in non-dipping pattern of BP in GH compared with dippers, without significant difference in 3D LV massi between groups.
Values od 3D strain in groups Dippers Non-dippers PE p1 p2 p3 LS -18,62 -16,99 -16,91 p&lt; 0,0005 p&lt; 0,0005 ns CS -18,22 -16,22 -16,21 p&lt; 0,0005 p&lt; 0,0005 ns RS 52,85 48,3 48,1 p&lt; 0,0005 p&lt; 0,0005 ns AS -31,77 -27,67 -27,98 p&lt; 0,0005 p&lt; 0,0005 ns p1 - difference between dippers and non-dippers; p2 - difference between dippers and PE; p3 - difference between non-dippers and PE