bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1412 A new light to improve the view of the anatomical details during micro-invasive trans-ventricular repair of degenerative prolapse of mitral valve
Authors: Vairo A , Marro M , Speziali G , Rinaldi M , Salizzoni S 
Published: January 2020

Abstract

BACKGROUND
Mitral valve repair is the preferred surgical treatment for severe mitral regurgitation due to degenerative leaflet prolapse. Within the growing era of transcatheter treatments for valvular heart disease, an innovative micro-invasive trans-ventricular beating-heart procedure was developed. Three-dimensional (3D) transoesophageal echocardiographic guidance is crucial to assist the operator in instrument navigation and chords positioning. 3D ultrasound technology is constantly evolving and a special light, that can be mobilized within the 3D images, has recently been invented. This light allows to illuminate the structures from different points of view and increase the definition of the anatomical details.

PURPOSE
To show the advantages of this new 3D image analysis technology, described above, through a sequence of intra-procedural images of a mitral valve repair by trans-ventricular polytetrafluoroethylene (ePTFE) chords implantation.

METHODS
The procedure is performed using a device that is introduced through a posterolateral ventriculotomy and it is advanced towards the mitral valve under real-time 3D transoesophageal guidance. The prolapsing segment, in this case central part of posterior leaflet (Fig. 1 A, B and C), is grasped with the jaw of the instrument (J in Fig. 1D), then the chords are implanted, tensioned and secured outside the ventricle. Figure 1A shows the pre-operative image of posterior leaflet prolapse with flail (P2 segment) and the light illuminates the valve from above. The broken chords (arrow in Fig. 1A) can be recognized with high definition. The light can also be placed on the valve plane (Fig. 1B) or below (Fig. 1C). When illumination occurs from the left ventricular side, the coaptation loss due to the P2 flail is highlighted (arrow in Fig. 1C). After placement, tensioning and securing the chords outside the ventricle, the prolapse disappears and the correct coaptation is re-established (Fig. 1E). The coaptation deficit is no longer visible, even with the light placed below the valve and it is possible to see the light coming out of the aortic valve (Ao), opened in systole, with mitral valve closed (Fig. 1F).

RESULTS
At the end of the procedure the residual mitral regurgitation was trivial and no loss of coaptation can be evidenced even with the light placed in the left ventricle (Fig. 1F).

CONCLUSIONS
This new light allows to improve the anatomical definition of 3D echocardiographic images, allows better visualization of the coaptation defects and can be used as a further verification of the result especially in cases of micro-invasive mitral repair.
Abstract P1412 Figure 1
P1418 Clinical profile and outcome of infective endocarditis patients transferred to a tertiary center
Authors: Gonzalez M , Vallejo N , Nunez R , Llibre C , Berastegui E , Lopez Ayerbe J , Munoz C , Bayes Genis A 
Published: January 2020

Abstract

Previous studies have described a selection bias with more need for surgery in patients transferred to a tertiary referral hospital. In addition, multidisciplinary Infective Endocarditis units establish criteria for referring patients to the tertiary hospital and keep in contact with the county hospital.

METHODS
Prospective observational study with a retrospective analysis of 468 episodes of infectious endocarditis admitted to our center from 2003 to 2018. Of these, 252 (54%) were admitted directly in our center and 216 (46%) were transferred from hospitals in the area of influence. We analyze the features and compare them.

RESULTS
The average age from transferred patients was lower (63 vs. 66 years; p = 0.015), from which 74% were men. Non-transferred patients had major comorbidity with a significant percentage of comorbidities (81 vs. 66%; p = 0.005), greater Charlson"s index (3.4 vs. 1.98; p 0.005) and EuroScore (logistic Euroscore I ; 27 vs. 22; 0.034). The diagnosis delay was similar (7.3 vs. 7.6 days) with a large number of clinical (84% vs. 73%) and echocardiographic (52 vs. 40; p = 0,012) complications in transferred patients with more need for surgery (81 vs. 61%, p = 0.002), and with more operated patients of those transferred. The mortality of non-transferred patients, admitted directly in the tertiary center, was higher (51 vs. 43%), but presenting no significant differences.

CONCLUSIONS
Patients transferred from other centers have a profile with less comorbidity but high need for surgery, possibly related to well-stablished selection and derivation criteria, with a slightly lower mortality, although with no significant differences in comparison to patients admitted directly to the tertiary referral hospital.
P1419 Sex-related differences in cardiac remodeling in health and hypertension
Authors: Phua A I H , Tara S W , Le T T , Bryant J A , Toh D F K , Ang B W Y , Su B , Cook S A , Chin C W L 
Published: January 2020

Abstract

Funding Acknowledgements
National Medical Research Council

OnBehalf
National Heart Centre Singapore

BACKGROUND
Adverse cardiac remodelling is associated with worse cardiovascular outcomes. Development of left ventricular hypertrophy (defined as increased myocardial mass) is a complex process mediated by myocardial wall thickening and/or ventricular dilatation. Sex-related differences in the relationship between myocardial mass and wall thickening/ventricular dilatation have not been well-described.

PURPOSE
We examine differences in determinants and patterns of cardiac remodeling between males and females.

METHODS
Comprehensive cardiovascular magnetic resonance imaging was performed in 1006 participants: 316 healthy volunteers (50% males, 46 ± 14 years) and 690 asymptomatic hypertensive patients (60% males, 57 ± 11 years). Myocardial mass, ventricular volumes and maximal myocardial wall thickness (across 16 myocardial segments) were measured using standardized contouring techniques. Clinically relevant variables (age, weight, height, and adiposity) that demonstrated significant univariate association with myocardial mass (P &lt; 0.05) were selected in the multivariable linear regression model using the forward approach.

RESULTS
Increased body weight, lower body fat composition and higher systolic blood pressures were independently associated with increased myocardial mass in healthy volunteers (males and females) and hypertensive females. In hypertensive males, only increased body weight and elevated systolic blood pressure were independently associated with increased myocardial mass.
The association between myocardial mass and ventricular volumes was almost identical between males and females (P = 0.65 for interaction; Figure). Conversely, there was a significant gender-related difference in the association between wall thickness and myocardial mass after adjusting for potential confounders (P &lt; 0.001 for interaction). Concentric remodeling was initially more evident in males; but further with increase, myocardial mass was associated with greater concentric remodeling in females (Figure). Similar results were observed when analyses were performed separately in healthy volunteers and hypertensive patients.

CONCLUSION
There were sex-related differences in concentric remodeling at progressive stages of myocardial hypertrophy that may explain the higher prevalence of heart failure with preserved ejection fraction reported in females.
Abstract P1419 Figure
P1427 Mechanical dispersion assessed with echocardiography versus scar characterization with cardiac magnetic resonance to predict malignant arrhythmia in cardiac resynchronization therapy patients
Authors: Doltra A , Bertolani Y , Linhart M , Acosta J , Tolosana J M , Mont L L , Berruezo A , Sitges M 
Published: January 2020

Abstract

Background
Recent data have shown that scar characterization with late gadolinium enhancement magnetic resonance (LGE-CMR) is useful to predict malignant arrhythmic events in a cardiac resynchronization therapy (CRT) population. On the other hand, echocardiography 2D strain parameters (such as mechanical dispersion – MD) have been recently suggested as a predictor of ventricular arrhythmia (VA).

Purpose
To compare the usefulness of strain echocardiography and MR scar parameters to predict VA and sudden cardiac death (SCD) in CRT patients (pa).

Methods
110 pa undergoing CRT implant were included. A 2D strain echo and a 3D LGE-CMR were performed before the implant. In the echocardiographic exam, left ventricle ejection fraction (LVEF), global longitudinal strain (GLS), mechanical dispersion (MD) and delta contraction time were quantified. Regarding LGE-CMR, scar mass, border zone (BZ) mass and the presence of BZ channels were assessed with specific software. The primary endpoint was the presence of SCD or appropriate implantable cardioverter-defibrillator therapy at long-term follow-up (FU).

Results
The primary outcome occurred in 23 pa (20.9%) during a mean FU of 53.5 ± 10.4 months. In these pa, MD was significantly increased (130.3 ± 55.5ms vs. 102.0 ± 45.1ms, p &lt; 0.05) whereas LVEF, GLS and delta contraction time were not significantly different. All LGE-CMR parameters were significantly increased in PA with events. At multivariate analysis, both MD and LGE-CMR parameters were independent predictors of malignant arrhythmia (table). The MD cut-off value for prediction of VA was 80.88 ms, with 91.3% sensitivity and 36.8% specificity. The figure shows the Kaplan-Meier curves. Regarding LGE-CMR parameters, the cut-off value, sensitivity, and specificity were 13.8g/82.6%/81.6% for scar mass, 5.54g/85.7%/81.8% for BZ mass, and 90.9%/82.1% for presence of BZ channels.

Conclusions
MD and LGE-CMR scar parameters are independent predictors of VA and SCD in CRT. Due to its high sensitivity, MD could be used to identify pa at high arrhythmic risk that could benefit from a more complex and specific LGE-CMR study.
Multivariate analysis Model 1 Model 2 Model 3 HR (95% CI) p HR (95% CI) p HR (95% CI) p Basal LVEF 1.01 (0.94-1.09) 0.731 1 (0.93-1.07) 0.974 1.04 (0.97-1.11) 0.273 MD (ms) 1.01 (1.00-1.02) 0.043 1.01 (1.00-1.02) 0.017 1.01 (1.00-1.02) 0.003 BZ mass (g) 1.08 (1.05-1.11) &lt;0.001 Presence of BZ channels 18.39 (4.26-79.51) &lt;0.001 Scar mass (g) 1.06 (1.04-1.08) &lt;0.001 LVEF: left ventricle ejection fraction; MD:mechanical dispersion; BZ:border zone
Abstract P1427 Figure. Kaplan-Meier curves
P1435 The impact of intermediate wall shear strain on changes of plaque morphology in CAD: A systematic review and meta-analysis
Authors: Bytyci I , Artan Bajraktari A B , Elezi S , Michael M Y 
Published: January 2020

Abstract

Background and Aim
The experimental studies found that high wall shear strain (WSS) resulted in the development of more vulnerable plaque compared to low WSS. The aim of this meta-analysis is to assess the role of intermediate WSS on atherosclerotic plaque.

Methods
We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry from 1989 to May 2019 in order to select clinical trials and observational studies, which assessed the relationship between WSS measured by intravascular ultrasound (IVUS) and plaque morphology in CAD.

Results
A total of 32,083 segments were recruited in 7 studies with mean follow up 8.4 months. The pooled analysis showed that baseline low WSS is associated with similar plaque morphology to that with intermediate WSS: lumen area WMD 0.96 [-0.12 to 2.04, p = 0.08], plaque area WMD -0.43 [-0.09 to 0.13, p = 0.13], necrotic core area WMD -0.18 [-0.45 to 0.08, p = 0.18], dense calcium score WMD -0.12 [-0.26 to 0.02, p = 0.09] as well as fibrous WMD -0.35 [-0.89 to 0.19, p = 0.21] and fibro-fatty area WMD -0.05 [-0.12 to 0.02, p = 0.12]. At follow-up, the only difference found was an increase of fibrous WMD 0.08 [0.01 to 0.16, p = 0.04] and fibro-fatty area, WMD 0.07 [0.01 to 0.12, p = 0.02] in low WSS compared intermediate WSS.

Conclusions
Intermediate WSS group is associated with plaque features changes similar to those occurring with low WSS. This finding emphasis the role of IVUS in outcome of atherosclerotic plaque in CAD.
P1441 Predictors of systemic embolisms in a large cohort of left ventricular noncompaction patients
Authors: Casas G , Oristrell G , Limeres J , Barriales R , Gimeno J R , Garcia Pavia P , Zorio E , Villacorta E , Jimenez Jaimez J , Bayes A , Garcia Pinilla J M , Palomino A J , Evangelista A , Ferreira I , Rodriguez-Palomares J F 
Published: January 2020

Abstract
BACKGROUND
Left ventricular noncompaction (LVNC) is associated with an increased risk of systemic embolisms (SE). However, incidence and risk factors are not well established.
PURPOSE
To evaluate the rate of SE in LVNC and describe risk factors.
METHODS
LNVC patients were included in a multicentric registry. Those with SE were considered for the analysis.
RESULTS
514 patients with LVNC from 10 Spanish centres were recruited from 2000 to 2018. During a median follow-up of 4.2 years (IQR 1.9-7.1), 23 patients (4.5%) had a SE. Patients with SE (Table 1) were older at diagnosis, with no differences in gender and had similar cardiovascular risk factors. They were more frequently under oral anticoagulation (OAC). Besides, they had a more reduced LVEF, and more dilated LV and left atrium (LA). Late gadolinium enhancement (LGE) was more frequent, altogether suggesting a more severe phenotype.
Patients with SE had non-significantly higher rates of hospitalization for heart failure (33% Vs 24%, p = 0.31) and atrial fibrillation (35% Vs 19%, p = 0.10). In multivariate analysis, only LA diameter was an independent predictor of SE (OR 1.04, p = 0.04). A LA diameter &gt; 45 mm had an independent 3 fold increased risk of SE (OR 3.04, p = 0.02) (Image 1).
CONCLUSIONS
LVNC carries a moderate mid-term risk of SE, which appears to be irrespective of atrial fibrillation and associated with age, LV dilatation and systolic dysfunction and mainly LA dilatation. This subgroup of patients should be considered for oral anticoagulation in primary prevention.
Table 1 Systemic embolisms (n = 23) No systemic embolisms (n = 491) p Men, n (%) 15 (65) 289 (56) 0.52 Median age at diagnosis (IQR) - yr 60 (48-76) 48 (30-64) 0.02 Median follow up (IQR) - yr 5.9 (3.1-7.8) 4.2 (1.8-7.1) 0.18 OAC, n (%) 19 (83) 118 (24) 0.01 LVEF (SD) - % 37 (15) 48 (17) 0.01 LVEDD (SD) - mm 58 (11) 54 (10) 0.04 LA diameter (SD) - mm 46 (9) 39 (9) 0.01 Characteristics of patients with and without systemic embolisms
Abstract P1441 Figure. Image 1
P1442 Outcomes of patients with left ventricular noncompaction and preserved ejection fraction
Authors: Casas G , Oristrell G , Limeres J , Barriales R , Gimeno J R , Garcia Pavia P , Zorio E , Villacorta E , Jimenez Jaimez J , Bayes A , Garcia Pinilla J M , Palomino A J , Evangelista A , Ferreira I , Rodriguez-Palomares J F 
Published: January 2020

Abstract

BACKGROUND
Left ventricular noncompaction (LVNC) has a wide phenotypic expression. Prognosis of patients with preserved ejection fraction (pEF) remains uncertain.
PURPOSE
To describe the characteristics and natural history of this subgroup of patients.
METHODS
LVNC patients were included in a multicentric registry. Those with pEF (LVEF &gt; 50%) were considered for the analysis.
RESULTS
491 LVNC pts from 10 Spanish centres were recruited from 2000 to 2018. 239 (49%) had baseline pEF. Compared to those with reduced EF (rEF), they were younger, with no differences in gender and had less comorbilities (Table 1). Mean LVEF was 62% (SD 8). 18 pts (9% of the available CMR) had fibrosis even though LV volumes and LVEF were normal.
Family screening was completed in 199 pts, being positive in 113 (57%). Genetic testing was performed in 146 index cases, being positive in 80 (55%): ACTC1 (40), MYH7 (17), TTN (8), HCN4 (6) and other individual variants.
During a median follow-up of 4.9 years (IQR 2.1-7.3), there was a significant decrease in LVEF: last LVEF was 30- 40% in 5 pts (2%) and 40-50% in 21 (9%) (p = 0.01 compared to baseline LVEF). 6 pts (2.5%) died during follow-up, only 1 of cardiovascular cause. 9 patients (4%) presented heart failure (HF) and 25 (10.5%) ventricular tachycardia or fibrillation (VT/VF). All cardiovascular outcomes were less frequent compared to rEF (Image 1, all p &lt; 0.05). In multivariate analysis (including demographic, imaging, genetic and family aggregation parameters) the only predictor for HF was change in LVEF (OR 0.89, mean LVEF at the event 47%, p = 0.01 compared to no HF). Fibrosis was not associated with VT/VF.

CONCLUSIONS
Patients with LVNC and pEF have an overall excellent prognosis, which is markedly better than those with rEF. However, there is progressive decrease in LVEF, associated with heart failure, and moderate risk of life threatening arrhythmias. Therefore, periodic follow-up should be promoted.
Table 1 LVNC pEF (n = 239) LVNC rEF (n = 252) p Men, n (%) 131 (55) 146 (58) 0.65 Median age at diagnosis (IQR) - yr 38 (23-54) 58 (42-72) 0.01 Median follow up (IQR) - yr 4.9 (2.1-7.3) 3.9 (1.4-7.9) 0.04 QRS (SD) - ms 93 (18) 117 (32) 0.01 LGE, n (%) 18 (9) 52 (30) 0.01
Abstract P1442 Figure. Image 1
P1446 Correlation of B-Type natriuretic peptide with LV and RV function assessed by echocardiography in adults congenital heart diseases patients
Authors: Kavouras C , Dimopoulos K , La Leggia A , Barracano R , Brida M , Cazzoli I , Gatzoulis M , Li W 
Published: January 2020

Abstract

Introduction
Brain natriuretic peptide (BNP) is a well-established marker for heart failure in the general population however limited data are available on the value of BNP as a diagnostic and prognostic marker in adults with congenital heart disease (ACHD). The purpose of our study is to evaluate the relation between BNP levels and biventricular systolic and diastolic function in patients with ACHD.

Methods
We evaluated clinically stable ACHD patients who underwent echocardiography from May 2015 until January 2018. We studied the correlation of BNP with the degree of systolic and diastolic dysfunction of the left ventricle. Moreover we also investigate the relation of BNP with the right tricuspid annular plane systolic excursion (TAPSE), the fractional area change (FAC) and the pulmonary arterial systolic pressure (PASP).

Results
In total, 385 patients were included in our study (median age, 43 ±12 years; 61% male). Of the 385 patients, 193 (50%) had tetralogy of Fallot, 94 (24%) had systemic RV, including patients with transposition of the great arteries (TGA) after atrial switch operation (Mustard or Senning) and congenitally corrected TGA -ccTGA , 43 (11%) had univentricular hearts and Fontan physiology, 55 (14%) had other lesions. BNP levels were 66 ± 26 pg/mL and 93, ±31pg/mL, for patients with EF &gt; 50% and 50%&gt; EF &gt;35% respectively (p = 0.003). BNP levels correlate with parameters reflecting LV filling pressure, including transmitral early diastolic velocity (E) 81 ± 29pg/mL and its ratio to early diastolic annular myocardial tissue velocity (E/Ea) 77 ± 17pg/mL. (r=-0.607, p = 0.003 r=-0.598, p = 0.005, respectively) BNP levels were also significantly higher in patients with impaired tricuspid annular plane systolic excursion 87 ± 21 pg/mL (TAPSE &lt; 14mm; p = 0.002) and decreased RV FAC 81 ± 18 pg/mL (FAC &lt;35% P= 0.004) and in patients with PASP≥35 mmHg (p = 0.003). The ROC curve and logistic regression analysis spotted the role of BNP in identifying systolic and diastolic dysfunction patterns in ACHD patients. Conclusion: In clinical stable ACHD patiens BNP levels correlate well with LV systolic dysfunction as well as with impaired diastolic function. Furthermore patients with impaired RV function and increased PASP have raised BNP levels. Therefore monitoring BNP levels plays an important role in management of clinical stable ACHD patients
P1450 Pulmonary artery sarcoma mimicking as pulmonary thromboembolism for a young man: the role of multimodality imaging for diagnosis
Authors: Ereminiene R , Sakaviciute E , Ereminas R , Jankauskas A , Poskiene L , Ruminaite A , Miliauskas S , Benetis R , Ereminiene E 
Published: January 2020

Abstract

Patient presentation
A 33-year-old man was referred to our hospital suffering fever with shivers, dyspnea, dry cough, and weakness.
Initial work up
Symptoms appeared three weeks until hospitalization. Laboratory results showed leukocytosis and high levels of inflammatory markers. Haematological diseases were excluded, a chest x-ray showed infiltration in the lower lobe of the right lung, antibiotics were prescribed.
Diagnosis and management
When clinical and laboratory results showed no signs of improvement, chest computed tomography (CT) scan was performed and bilateral pulmonary artery thromboembolism with right lung infarct-pneumonia was diagnosed (Figure 1, 2). Treatment was supplemented with intravenous anticoagulants. In the course of treatment patient’s status worsened, respiratory failure progressed, so CT scan was performed again and showed massive pulmonary artery thromboembolism without the effect of treatment. Transthoracic 2D echocardiography showed dilated right heart chambers, relative severe tricuspid valve regurgitation, increased systolic pulmonary artery pressure (Video 1, figure 3), pulmonary artery valve masses in the stem which caused obstruction with maximum gradient about 50 mmHg(Video 2, figure 4). For a detailed workup, magnetic resonance imaging (MRI) was done, that revealed tumorous masses from pulmonary artery valve to the pulmonary trunk and right pulmonary branch (Figure 5, 6, 7). The patient underwent pulmoangiography and biopsy was taken out of the masses that suspected sarcoma. The multidisciplinary team came to a conclusion to perform surgery considering worsening patient’s status. The patient underwent pulmonary artery prosthesis implantation and right pneumonectomy (Figure 8). Masses from pulmonary artery valve were examined by pathologists, surgical specimen results showed high grade poorly differentiated pulmonary artery intimal sarcoma (Figure 9, 10).
Follow up
Early postoperative period was complicated with cardiogenic shock and respiratory failure. Despite extracorporeal membrane oxygenation (ECMO) and high doses of vasopressors patient did not survive the 2nd postoperative day.

Conclusions
Pulmonary artery sarcoma (PAS) frequently can be misdiagnosed as thromboembolism. Multimodality imaging should be considered pulmonary artery filling defects persist despite proper anticoagulation therapy for early diagnosis and better survival.
Abstract P1450 Figure 3.