bluuebunny/crossref_metadata_2025_split huggingface dataset:
P879 3D transoesophageal echocardiography to asses a case of a non-ebstein tricuspid valve congenital regurgitation
Authors: Sanz Ortega I , Velasco Del Castillo S , Onaindia Gandarias J J , Rodriguez Sanchez I , Florido Perena J , Oria Gonzalez G , Zugazabeitia Irazabal G , Salcedo Arruti A 
Published: January 2020

Abstract

Introduction
Due to the complexity of congenital heart disease and limitations of transthorathic echocardiogram (TTE), especially in adult patients, it is not unusual to need other image techniques to assess cardiac anatomy and function. The most common primary anomaly of tricuspid valve (TV) is Ebstein anomaly, but there are other much rarer primary anomalies of this valve consisting in prolapse, cord retraction.... without downward displacement of the leaflet, generally causing tricuspid regurgitation (TR) that can be severe and sometimes intervention is needed, preferably reparation. Due to anatomical issues, it is difficult to assess anatomy of TV in TTE, so sometimes 3D-TTE must be performed to clarify the mechanism and to measure orifice, but when transthoracic view is not enough, 3D transoesophageal echocardiogram (TOE) can be useful for this purpose.

Case
We report the case of a 15-year-old boy that was referred to our clinic because of shortness of breath and a systolic tricuspid murmur. TTE was performed and an image compatible with tricuspid valve prolapse with no apical displacement of any leaflets (Figure, A) causing severe TR (Figure, B) was noticed, as well as severely dilated right chambers, with good ejection fraction of both ventricles. It was not clear the mechanism so 2D TOE was done, showing a prolapse of a leaflet (Figure, C) causing severe TR (Figure, D). The mechanism was finally clarified by 3D TOE (figure E). This was a prolapse of lateral portion of posterior leaflet (asterisk) with restrictive movement of anterior (triangle) and septal (arrow) ones, causing a huge coaptation defect in systole leading to a very severe tricuspid insufficiency with signs of volume overload of right ventricle. There was no atrial septal defect and pulmonary drainage anomalies were ruled out by cardiac magnetic resonance. Patient was referred to surgery due to symptoms and great dilatation of right chambers.
Conclusión: Due to anatomical complexity and limitations of echography, cross and multimodality cardiac imaging is usually needed in assessing congenital heart disease. Apart from Ebstein anomaly, other congenital entities of tricuspid valve such as prolapse and/or retraction can lead to severe tricuspid regurgitation. Due to limitations of 2D TTE in assessing tricuspid valve anatomy, 3D TTE has to be performed, but if it is not enough, 3D TOE can be an option to evaluate mechanism and directly see the orifice of regurgitation in congenital disease of tricuspid valve.
Abstract P879 Figure
P895 Relationship between left ventricular function components and cardiovascular risk factors in asymptomatic individuals
Authors: Vancheri F , Henein M Y 
Published: January 2020

Abstract

Funding Acknowledgements
none

Background and Aim
Coronary artery disease is commonly related to conventional cardiovascular (CV) risk factors. The exact role of those risk factors in early development of CV disease or left ventricular (LV) dysfunction before the development of sign and symptoms remains debated. We studied the relationship between conventional risk factors and LV systolic, diastolic and synchronous function in a population sample of asymptomatic individuals.

Methods
All participants underwent a detailed echocardiographic examination as part of a cross-sectional survey for the prevalence of coronary risk factors in randomly selected individuals from general population. LV end-systolic and end-diastolic dimensions, and LV volumes and ejection fraction (EF) were all calculated. From the spectral Doppler flow, LV early diastolic (E wave) and atrial systolic (A wave) velocities were measured and E/A ratio calculated. LV filling time (FT) was also measured from the onset of E wave to the end of A wave, and LV ejection time (ET) from the onset to the end of aortic Doppler velocity. Global LV dyssynchrony was assessed using total isovolumic time (T-IVT) as 60 – (total filling time + total ejection time), and Tei index was also calculated.

Results
The study population comprised 184 individuals (96 male and 88 female, mean age 55.9 (11.3), range 25-78 years). There was no relationship between systolic LV function expressed by EF and CV risk factors. Markers of diastolic function: LV filling velocities and E/A ratio, were correlated with age (r= -0.36, p &lt; 0.000, r= -0.57, p &lt; 0.000, respectively), with glycemia (r= -0.21, p &lt; 0.000, r= -0.14, p = 0.004,) and with systolic blood pressure (r= -0.31, p &lt; 0.000, r= -0.34, p &lt; 0.000). Markers of LV dyssynchrony, in the form of prolonged T-IVT, and raised Tei index, directly correlated with age, glycemia and systolic blood pressure (r = 0.58, p &lt; 0.000, r = 0.18, p &lt; 0.000, r = 0.33, p &lt; 0.000, respectively). However, when these correlations were adjusted for age in a multivariate analysis, the statistical significance was strongly reduced (LV filling) or completely lost (IVT and E/A).

Conclusions
In normal asymptomatic population, age, rather than CV risk factors, is the main determinant of changes in diastolic and synchronous function.
P896 Feasibility and accuracy of echocardiographic estimates of tricuspid annular displacement
Authors: Tan Y , Manouras A , Lund L H , Venkateshvaran A 
Published: January 2020

Abstract

Background
Tricuspid annular plane systolic excursion (TAPSE) is a validated index of right ventricular function in heart failure. Current guidelines recommend that TAPSE be measured employing M-mode echocardiography (TAPSEM). However, TAPSEM is often overlooked during routine clinical assessment. This study aimed to assess the correlation and strength of agreement between other retrospectively obtainable echocardiographic equivalents of tricuspid annular displacement during systole (TAD) and TAPSEM.

Methods
An echocardiographic review was performed in consecutive subjects in sinus rhythm referred for the assessment of dyspnoea or heart failure. TAD was measured employing 2D (TAD2D), tissue velocity imaging (TADTVI), and speckle tracking echocardiography (TADSTE) and compared with TAPSEM as reference.

Results
100 subjects were analysed (age: 61± 14; 49% Female) All methods demonstrated good feasibility. Of all the evaluated methods, TAD2D demonstrated the strongest association with TAPSEM with minimal bias and reasonable limits of agreement (Table 1). Bias between methods was further reduced in subjects with significant pulmonary hypertension (RVSP &gt; 50mmHg (35%); Bland-Altman mean ± SD = 0.09 ± 2.0 mm). A good agreement between TADSTE and TAPSEM was as well observed. In contrast, TADTVI yielded an underestimation of TAPSEM.

Conclusions
TAD2D and TADSTE provide feasible and accurate alternatives to TAPSEM and maybe useful during retrospective analysis of RV longitudinal function.
Feasibility, Correlation & B-A Analysis TAD Methods Feasibility R value P Value Bland-Altman mean difference ± SD TAD2D 92% 0.94 &lt;0.001 0.22 ± 1.87 mm TADTVI 88% 0.86 &lt;0.001 1.59 ± 3.1 mm TADSTE 85% 0.87 &lt;0.001 0.47 ± 2.7 mm TAD, Tricuspid annular displacement; 2D, Two dimensional; TVI, tissue velocity imaging; STE, speckle tracking echocardiography
P897 The role of oxidative stress and inflammation for stress induced left ventricular diastolic dysfunction in non-severe chronic obstructive pulmonary disease patients
Authors: Cherneva Z , Lozanov V L , Sugareva P S , Cherneva R C H 
Published: January 2020

Abstract

Background
Oxidative stress and inflammation have been implicated in the pathogenesis of diastolic dysfunction (DD) and are both present in chronic obstructive pulmonary disease (COPD).

Purpose
To evaluate the role of oxidative stress markers (8-isoprostane) and inflammation (prostaglandin E2, resistin) in the pathogenesis of stress induced left ventricular diastolic dysfunction (LVDD) in non-severe COPD.

Materials and methods
104 patients with non-severe COPD (FEV1 &gt; 50%) and preserved left ventricular ejection fraction &gt;50% underwent incremental cardio-pulmonary exercise testing (CPET). Echocardiography was performed before CPET and 1-2 minutes after peak exercise. Peak E/e’ ratio &gt;15 was a marker for stress LVDD. Urine concentration of 8-isoprostanes was assumed as surrogate marker for oxidative stress; urine concentration of prostaglandine-E2 and plasma resistin levels as inflammatory markers. Mass spectrometry was applied for 8-isoprostane and prostglandine E2 (Cayman. Chemical) measurement. Values were normalised to urine creatinine (µmol/l/cre). ELISA was applied for resistin measurement (Raybio_Human) (ng/ml).

Results
Patients were divided into two groups: subjects with stress LVDD (67) and subjects without stress LVDD (37). 8-isoprostane levels were higher in subjects with LVDD vs those without LVDD (32.9 vs 29.67µmol/l/cre; p&lt; 0.05). The same is observed regarding resistin plasma levels (22.51 vs 15.68ng/ml). Urine concentrations of prostaglandin E2 did not differ between the two groups (50.76 vs 51.07 µmol/l/cre)

Conclusions
In non-severe COPD patients the levels of oxidative stress (8-isoprostanes) and inflammation (resistin) seem to be associated with stress induced left ventricular diastolic dysfunction.
P909 Diagnostic evaluation of rheumatic heart disease in aborigonal population
Authors: Chapman M J , Surikow S , Stadler D , Rose J , Henthorn R , Aldridge E , Zeitz C J 
Published: January 2020

Abstract

Background
Among Indigenous Australians, rates of Acute Rheumatic Fever (ARF) continue to be among the highest in the world. Diagnosis remains a clinical decision based on identification of major and minor manifestations of the illness. Treatment involves lengthy prophylaxis and should continue for a minimum of 10 years.
ARF can cause permanent damage to the heart known as rheumatic heart disease (RHD).
We therefore utilised echocardiography as a diagnostic tool incorporating Tissue Quantification Backscatter expressed in decibels (dB) and global LV work efficiency estimated from left ventricle (LV) pressure-strain loops to identify rheumatic changes of the Mitral Valve and help improve early diagnosis of RHD.

Method
Data from patients with suspected RHD (n = 14), and age matched controls (n = 10) underwent Mitral Valve Backscatter Analysis (MVBS). MVBS was expressed as a ratio % (MVBS ratio %) by dividing the average MVBS and the average blood pool value expressed in decibels (dB). Furthermore LV function was utilised via 2D longitudinal strain and indices of myocardial work were derived.

Result
MVBS ratio % was significantly higher in the control group as compared to the RHD group (p = 0.001) (fig1). Of the RHD group echocardiography parameters showed there were no significant mitral valve stenosis or regurgitation. Correlates of LV function included: Global work Index (GWI), Global longitudinal Strain (GLS) and Global work efficiency (GWE). Of the above correlates the control group showed Backscatter vs GLS (r= -0.89, p = 0.001), the RHD group: Backscatter vs GLS (r = 0.52. p = 0.12). Within the RHD group the ratio vs GWE (r= 0.57, p = 0.09) these results showed a trend to significance.

Conclusions
Currently diagnosis of RHD remains a clinical decision based on the identification of major and minor manifestations. In addition treatment involves prophylaxis injections for a minimum of ten years. Of this group there were no significant echocardiography changes, rather clinical manifestation to derive RHD.
This study shows that calibrated MVBS ratio % and determinants of myocardial work may be a promising quantitative tool to detect early manifestation of RHD potentially aiding an early treatment plan and thus reducing the clinical burden of monthly penicillin injections for a ten year period.
Abstract P909 Figure. RHD and Myocardial correlates
P914 Changes of echocardiographic parameters in primary mitral regurgitation and determinants of symptom: an assessment from the Asian valve registry data
Authors: Amano M , Izumi C , Kim Y J , Park S J , Park S W , Tanaka H , Hozumi T , Ling L H , Yu C M , Fukuda S , Otsuji Y , Song J K , Sohn D W 
Published: January 2020

Abstract
[Background]Clinicians often have a difficulty in determining the presence of mitral regurgitation (MR)-relatedsymptoms because of subjectivity.However, there are few actual measurement data for echocardiographic left ventricular (LV) and left atrial (LA) size related to the severity of MR and the relationship between MR-related symptoms and these echocardiographic parameters.
[Purpose] The purpose of this study was to clarify actual values for echocardiographic parameters related to severity of MR and determinant factors of MR-related symptoms.
[Methods] Among patients enrolled in the Asian Valve Registry, we investigated 778 consecutive patients with primary MR showing sinus rhythm. Symptoms were determined by NYHA (≤ II or ≥ III).
[Results]MR severity was mild in 106, moderate in 285, and severe in 387 patients. LA volume index, LV end-diastolic diameter, and LV mass index increased with increasing MR grade [LA volume index: 47.9 (mild), 56.2 (moderate), and 64.9 ml/m2(severe) (p &lt; 0.001), LV end-diastolic diameter: 51.2, 54.5, 58.1 mm (p &lt; 0.001), and LV mass index: 101, 109, 123 g/m2(p &lt; 0.001)]. Regarding moderate and severe MR, 70 patients (10.4%) were symptomatic. Table shows multivariable analysis for being symptomatic in moderate and severe MR patients. LV mass index (p = 0.040), ejection fraction (p &lt; 0.001), female gender (p = 0.004), and heart rate (p = 0.007) were independent factors for MR-related symptoms.
[Conclusions] LV and LA parameters on echocardiography worsened as MR severity progressed. Larger LV mass index and lower ejection fraction were independent determinant factors for MR-related symptoms. We should also pay attention to LV hypertrophy in patients with primary MR.
Determinant factors for mitral regurgita Model 1 Model 2 OR (95% CI) P-value OR (95% CI) P-value Age, per 1-y increment 1.03 (1.00-1.05) 0.035 1.02 (0.99-1.05) 0.053 Sex (female) 2.23 (1.20-4.16) 0.011 2.28 (1.31-3.98) 0.004 Hear rate, per 1 bpm increment 1.03 (1.00-1.05) 0.025 1.03 (1.01-1.05) 0.007 LVDs index, per 1 mm increment 0.99 (0.90-1.09) 0.90 EF, per 1% increment 0.95 (0.92-0.99) 0.019 0.96 (0.93-0.98) &lt;0.001 LV mass index, per 10 g/m2increment 1.12 (1.01-1.25) 0.033 1.09 (1.005-1.18) 0.040 LA volume index, per 10 mL/m2increment 0.96 (0.90-1.03) 0.23 E wave, per 1cm/s increment 1.81 (0.70-4.66) 0.23 TR pressure gradient &gt;40 mmHg 2.11 (0.97-4.57) 0.057 Hypertention 1.40 (0.75-2.63) 0.29
P918 Screening protocol of patent foramen ovale in cryptogenic stroke
Authors: Menezes Fernandes R , Mota T , Bispo J , Azevedo P , Guedes J , Costa H , Bento D , Cafe H , Shamasna M , Fidalgo A P , Jesus I 
Published: January 2020

Abstract

Introduction
Cryptogenic stroke reaches a prevalence of 30% and entails a significant risk of recurrence. Transesophageal echocardiography is the gold standard in identifying potential proximal embolic sources, including patent foramen ovale (PFO). Based on recent evidence, PFO percutaneous closure is recommended in selected cases of cryptogenic stroke, especially if associated with high risk features. Since PFO is present in up to 27% of the general population, the real challenge is to define which patients have a pathogenic PFO.

Purpose
To develop a pathogenic PFO screening protocol in patients with cryptogenic stroke, aimed at secondary prevention.

Methods
We revised the literature, analysing published articles in PubMed in the last 5 years, with the keywords "patent foramen ovale and cryptogenic stroke". Subsequently, we produced a screening algorithm based on cryptogenic stroke definition, on RoPE (Risk of Paradoxical Embolism) Score and on the inclusion and exclusion criteria of the CLOSE, REDUCE and RESPECT studies, which showed promising results of PFO closure in this context.

Results
Our protocol establishes that patients who present with ischemic stroke should be evaluated for risk factors and undergo a detailed etiological study. When the study is inconclusive, the RoPE score is applied to determine the probability of finding a pathogenic or an incidental PFO. If equal or greater than 7 points, in the absence of predefined exclusion criteria, a transesophageal echocardiogram is performed. If the screening is positive, the patient will be referred to the Cardiology Department for therapeutic guidance. If negative, alternative complementary diagnostic methods may be considered.

Conclusion
Through the application of this protocol, patients with high probability of having a pathogenic PFO and, consequently, those who may benefit from percutaneous closure, will be selected to undergo a screening transesophageal echocardiogram. The implementation of a PFO screening protocol in patients who present with cryptogenic stroke is relevant, by proposing to reduce its recurrence rate through the early referral of young patients with indication for an invasive strategy.
P926 High prevalence of left ventricular systolic dysfunction assessed by speckle tracking in asymptomatic HIV patients
Authors: Kapelios C , Bonou M , Basoulis D , Masoura C , Athanasiadi E , Papadopoulou M , Skouloudi M , Psichogiou M , Barbetseas J 
Published: January 2020

Abstract

Background
Cardiomyopathy presenting in people living with HIV (PLWHIV) has been attributed to the effect of inflammation, opportunistic infections, myocyte invasion and cardiac steatosis, while peripheral artery disease (PAD) is linked to immune activation, abnormalities in lipid metabolism, and traditional risk factors. The diagnosis of subclinical myocardial dysfunction and PAD could enable prompt implementation of therapeutic measures. However, data available to date on the specific topic are limited.
Μethods:We investigated the association between global longitudinal strain (GLS) and a) patient history, b) baseline characteristics, c) carotid intima-media thickness (IMT) and presence of carotid atheromatic plaque(s) d) temperature difference (ΔT) along each carotid artery, measured by microwave radiometry (MWR) and e) basic blood panel measurements, including high-sensitivity troponin-T(hsTnT) and NT-proBNP in PLWHIV and no history of cardiovascular disease.

Results
We prospectively enrolled forty asymptomatic PLWHIV on long-term highly active antiretroviral therapy. Thirty-seven (93%) were men, while mean age was 52 ± 13 years. Subclinical left ventricular systolic dysfunction(SLVSD), defined as a value of GLS&gt; -18.7%, was present in 35% of patients. GLS value was significantly associated with age (r = 0.410,P = 0.013), history of hyperlipidemia (r = 0.370,P = 0.026), body mass index (r = 0.462,P = 0.005), waist circumference (r = 0.471,P = 0.007) and right bulb IMT (r = 0.390,P = 0.036). hs-TnT levels were significantly associated with age (r = 0.513, P = 0.001), CD4 count (r=-0.357,P = 0.025), serum creatinine (r = 0.338,P = 0.035) and the presence of carotid plaque (r = 0.374,P = 0.038). NT-proBNP levels were significantly associated with history of diabetes (r = 0.336,P = 0.048) and serum creatinine (r = 0.548,P = 0.001). No significant associations were demonstrated between carotid ΔΤ and other parameters.

Conclusion
Our results indicate that apart from age, a dysmetabolic component, expressed by higher BMI and history of hyperlipidemia, may be implicated in the pathogenesis of SLVSD, which may lead to cardiomyopathy, in PLWHIV.
P952 Left ventricle ejection fraction and global longitudinal strain values in lymphoma patients previously treated with anthracycline-based chemotherapy
Authors: Codina M , Ramirez-Escudero Ugalde G , Manzanal Rey A , Garcia Ibarrondo N , Asla Ormaza C , Lambarri Izaguirre A , Candida Urizar R , Ugedo Alzaga K , Castellanos Alcalde M , Arregui Lopez A , Marquez Navarro J A , Uriarte Elguezabal J , Archocha Torres M F , Ormaetxe Merodio J , Ruiz Gomez L 
Published: January 2020

Abstract
Anthracyclines (anth) are potent antineoplasic agents, although, their efficacy is limited by cardiotoxicity. Most lymphoid malignancies tend to recur and commonly require anthracycline-based chemotherapy (anth-bch) re-treatment. Our aim is to compare the pretreatment left ventricle ejection fraction (lvef) and global longitudinal strain (gls) between patients (pts) with new diagnosis of lymphoma (lym) and pts with lym recurrence that were treated previously with anth-bch.
Among pts referred to assess lvef and gls prior to start ttm, lym patients were selected and divided in two groups: pts with recurrent lymp previously treated with anth and pts with new diagnosis of lymp. Patients data, lvef and gls values were collected retrospectively.
96 pts data were analyzed (see table): 23 pts (24%) with previous anth ttm and 73 newly diagnosed pts. No differences were found in baseline characteristics. Pts who previously had been treated with anth-bch demonstrated significantly lower lvef than the other group and there were more patients with lvef in the normal lower limit. Gls was also lower but the difference was not significant. The fact that gls was not calculated in all patients may explain this finding. No differences were found in diastolic function.
Previous cardiotoxic ttm and lower limit of normal lvef have been described as patient-related risk factors for developing cardiotoxicity. Currently, previous cardiotoxicity risk assessment is critical to allow preventive measures. Cardio-oncology units are crucial to address cardiovascular (cv) needs of cancer patients.
* p &lt; 0.05 Previous anthracycline No previous anthracycline p n (%) 23 ( 24 %) 73 ( 76%) Women, n (%) 9 (39%) 34 (47%) 0,31 Age (m +/- SD) 66,2 +/- 14,6 63,2 +/- 17,4 0,44 Arterial hypertension, n(%) 8 (35%) 26 (36%) 1 Diabetes, n (%) 5 (22%) 8 (10%) 0,29 Dyslipidemia, n (%) 7 (30%) 28 (37%) 0,62 ACE inhibitor, n (%) 2 (8,7%) 4 (5,5%) 0,62 Betablokers, n (%) 5 (22%) 19 (26%) 0,78 FEVI (Simpson)*, m +/- SD 57,3 +/- 7 62,7 +/- 6 0,0007 GLS -19,3 +/- 3 -20,2 +/- 3,7 0,52 LVEF &lt; 55%* 5 (22%) 4 (5,5%) 0,03 Comparison between lymphoma patients treated previuosly with antrhacycline and with no previous cardiotoxic treatment.