bluuebunny/crossref_metadata_2025_split huggingface dataset:
P186 In search of lost time
Authors: Ureche C , Ailoaei Ș , Tapoi L , Clement A , Boca S , Cazacu A , Grecu M , Sascau R , Statescu C 
Published: January 2020

Abstract
Arrhythmogenic right ventricular dysplasia (ARVD) is one of the most difficult to diagnose and manage of the cardiomyopathies. Physical exercise can be a contributing factor and may accelerate the progression of the disease.
We present the case of a 49-year-old, a former professional football player, with a history of cardiac arrest in 2011 by ventricular tachycardia (VT) (normal coronary arteries). Between 2011 and 2019 the patient didn"t present for reevaluation and resumed endurance sports activity in spite of doctor recommendation. In 2019 he was directed to our clinic for a syncope followed by constrictive anterior chest pain and palpitations, the clinical expression of a VT with LBBB morphology and inferior axis, most likely originated in the RVOT, for which cardioversion was required. Upon admission, the patient was hemodynamically and respiratory stable, at sinus rhythm 60/min with left anterior hemiblock and negative T waves in V1-V2. Biologically, myocardial and hepatic cytolysis enzymes were within normal limits, with mild hypokalemia. Echocardiography showed significant dilatation of RV and RVOT with RV dysfunction (TAPSE 16 mm, FAC 20%, s" 8.6 cm/s). LV was nondilated, with normal systolic function and kinetic, but with trabeculation of the apex. To confirm the diagnosis of ARVD, cardiac MRI was performed and confirmed fat infiltration in the RV free wall with biventricular involvement. Given the high arrhythmic risk (two resuscitated VT episodes, syncope), a two-chamber ICD was implanted, without immediate post-procedural complications.
In the second postprocedural day, the patient suddenly installed important epigastric pain with thoracic irradiation. The ECG showed sensing and pacing malfunction and radioscopy showed evidence of ventricular probe displacement. The echocardiography confirmed the myocardial perforation. Emergency surgery by median thoracotomy was performed, with successful extraction of the electrode and myocardial suture. Postoperative progression was favorable under treatment with beta-blocker and amiodarone. A subcutaneous ICD will be implanted as soon as available.
In conclusion, this case is a very particular one. First of all, we’ve documented two distinct phases in the evolution of the ARVD (electrical phase – 2011 and structural phase - 2019). Moreover, by resuming endurance sports activity and in concordance with the literature data, we can only assume that the progression of the disease was accelerated and the arrhythmic risk was greater. Complications related to probe stability are common in this population, but myocardial perforation is a very rare and dangerous one. The therapeutic management of patients with ARVD has evolved over the years and continues to be an important challenge. To further improve risk stratification and treatment of patients, more information is needed on the natural history, long-term prognosis, and risk assessment.
Abstract P186 Figure. Echocardiografic and MRI aspect
P187 Multimodality in tuberculous constrictive pericarditis
Authors: Leite De Barros Filho A , Moreira H T , Santos M K , Schmidt A , Santana R C , Rodrigues A J , Maciel B C , Marin-Neto J A , Romano M M D 
Published: January 2020

Abstract

CASE PRESENTATION
K.C.P., a 26 y.o. female, presenting dizziness and progressive dyspnea since 9 months ago. Physical examination showed hepatomegaly at 2 centimeters below the right inferior costal border, but without edema, cardiac murmurs or other findings. Electrocardiogram showed atria overload and diffuse ventricular repolarization abnormality. Chest X-ray revealed normal sized cardiac silhouette but with signs of pericardial calcification. Transthoracic echocardiogram revealed: enlargement of both atria, no signs of myocardial left ventricular (LV) hypertrophy; dilated inferior vena cava with minimal respiratory variation; septal bounce; septal e´= 17.20 cm/s, lateral e´= 6.09 cm/s; E/e" septal ratio = 3.9; E deceleration time = 144 ms; thickening and hyper-refringence of the pericardium with calcification adjacent to the lateral and inferior walls of the LV and the free wall of the right ventricle. For evaluation of thickness and extent of pericardial involvement, computed tomography (CT) was performed, showing gross calcifications of the pericardium, mainly in basal and lower portions, without pericardial effusion. Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement revealed areas suggestive of active inflammation adjacent to the basal wall of the LV. With this evidence of active inflammatory activity, the patient was treated empirically against the etiologic agent for tuberculosis. Because of progressively severe edema and dyspnea pericardiectomy was warranted providing relief of symptoms. DISCUSSION: The echocardiogram is the initial image exam for diagnosis and monitoring of pericardial conditions. It is a widely available, low-cost method that does not use ionizing radiation and allows a complete morphological and functional evaluation of the heart. However, in up to 20% of cases, pericardial thickening may not be detectable at echocardiography. CT allows a more accurate assessment of pericardial thickening, while CMR allows detection of active inflammatory process. CONCLUSION: A typical and illustrative clinical case of constrictive pericarditis is presented, where the multimodality of cardiac imaging was decisive for the diagnostic and therapeutic delineation.
P188 Coronary fistula
Authors: Kangelidis I , Spiromitros G 
Published: January 2020

Abstract

Background
A coronary arterial fistula is a connection between one or more of the coronary arteries and a cardiac chamber or great vessel. Most of these fistulas are congenital in origin and remain asymptomatic until the second or third decade of life. After this period, patients may present with symptoms of easy fatigue, myocardial infarction, atrial arrhythmias or heart failure. Also, coronary steal syndrome could be observed, leading to myocardial ischemia of the cardiac wall which is supplied with blood by the corresponding artery.

Case
We present a 50-year-old female who was submitted to ED with palpitations. From her medical history, she suffered from arterial hypertension and dyslipidemia. The clinical evaluation revealed a continuous murmur that could be heard mainly at Aortic Valve point. The only abnormal finding from blood exam was troponin: 288 pg/ml. Admission ECG was consistent with supraventricular tachycardia and the patient was treated with intravenous solution of adenosine. Bedside echocardiography revealed an abnormal flow coming out from the aortic root, next to the right coronary casp. Transesophageal echocardiography confirmed the previous findings. The main differential diagnosis includes patent ductus arteriosus, ruptured sinus of Valsalva aneurysm, aortopulmonary window and coronary arterial fistula although other congenital arteriovenous shunts need to be excluded. For further evaluation, the patient underwent cardiac MRI which revealed right atrial enlargement and dilatation of proximal right coronary artery, from which a dilated arterial branch originates and passes between the aortic root and the right atrium. All these could be attributed to the presence of an arterial fistula. Thus, the patient went on to have CT coronary angiography which confirmed the hypothesis. In particular, CT angiography depicted a fistula between the right coronary sinus and the posterior wall of right atrium.

Conclusion
This case highlights the use of CT coronary as robust tool for investigating the origin, course and drainage site of a coronary arterial fistula.
Abstract P188 Figure. FISTULA
P193 Echocardiographic prognosis score and stratification of the risk of major cardiovascular events after acute coronary syndrome
Authors: Menzou F , Laraba N , Ait Ali M , Krim M 
Published: January 2020

Abstract

Introduction
The stratification of the risk of a major cardiovascular event after an acute coronary syndrome by doppler echocardiography provides prognostic support to the different clinical models and allows a non-invasive evaluation of the risk, independent of comorbidities. The echo-score provides a better definition of the categories of high-risk and intermediate patients for whom a more aggressive approach improves outcomes.

Purpose
The aim of our study is to identify the echocardiographic parameters predictive of major cardiovascular events in the acute phase and after six months of follow-up of an acute coronary syndrome

Methods
To identify the echocardiographic parameters associated with major cardiovascular event, we recruited 302 patients in intensive care unit of cardiology for acute coronary syndrome consecutively on admission. Patients were assessed by clinical risk scores (GRACE, TIMI, CRUSADE) and resting echocardiography,

Results
We have 181 patients with major cardiovascular event. After studying the survival curves, univariate and multivariate analysis, acute coronary events echoscore (HR 1,95 ; p &lt; 0,0001), has four echocardiographic variables (VG-Simpson - biplane ejection fraction, VD-surface - Simpson shortening fraction, M-strain longitudinal total deformation and pulmonary ultrasonic comet). Its discrimination capacity (AUC= 0,85) greater than that of the scores clinical prognosis, (GRACE; AUC = 0,72, TIMI; AUC = 0,71, HR 1,33; p &lt; 0,0001) and (CRUSADE; AUC = 0,76; HR 1,03; p = 0,005)

Conclusion
The developed echocardiographic model could prove very useful in the decision-making process and optimization of the therapeutic strategy in some high-risk patients with acute coronary syndromes following an invasive strategy. It is appropriate for expert interpretation, yet relatively simple because it contains only four echocardiographic variables as predictors, (score 4 points for low risk with a probability of major cardiovascular event 3.4%, up to 16 points for risk high with a probability of 15.1%)
P198 Long-term outcomes after mitraclip implantation
Authors: Dias Ferreira Reis J P , Moura Branco L , Almeida Morais L , Ilhao Moreira R , Rio P , Galrinho A , Fiarresga A , Cacela D , Ferreira R 
Published: January 2020

Abstract

Background
Mitraclip implantation (MI) is a well-established option for patients (P) with severe mitral regurgitation (MR) noneligible to surgery. Its impact on long term prognosis is being addressed by several recent studies.

Purpose
To identify predictors of morbidity and mortality in P undergoing MI and evaluate if the COAPT, Everest and MITRAFR exclusion criteria (EC) had any impact on the outcome of our population.

Methods
prospective study of P who underwent MI between 2013 and 2018 in one medical center. EC: COAPT: LVEF &lt; 20%, LV end-diastolic diameter &gt; 70mm or pulmonary artery systolic pressure &gt; 70mmHg; Everest: LVEF &lt; 25% or LV end-systolic diameter (LVESD)&gt;55mm; MITRA-FR: LVEF &lt; 15% or &gt;40% or primary MR. An univariate analysis was performed followed by a multivariate Cox analysis to evaluate overall mortality (M), overall mortality/ heart failure hospitalization (MH) and mortality in the first year post-MI(M1). Survival analysis using Kaplan-Meier plots. p &lt; 0.05 were considered significant.

Results
40P, 60% male, mean age 66 ± 12 years (Y) and mean follow-up time of 18 ± 15 months. 67.5% presented with MR grade IV and 75% had functional MR. Successful implantation in 97.5%, with 55% presenting mild MR post-procedure. Overall mortality was 30% (12P), mostly due to cardiovascular causes, with 9P dying in the first year (30%). There was no difference between pts with functional and primary MR: M- 33%vs20% (p = 0.6); MH– 53.3%vs30% (p = 0.5). P who met the COAPT exclusion criteria (N-22) presented an inferior 1Ysurvival (64.5%vs86.7%, p = 0.046). The overall outcome was comparable between P who matched and didn"t match Everest and MITRA-FR exclusion criteria. Basal BNP value (p = 0.037), mean preprocedural MAGGIC score (p = 0.040) and EROA (p = 0.039) were associated to M1. Multivariate Cox analysis revealed that basal BNP was an independent predictor of M (p = 0.017), whereas a higher distance in the pre-procedural 6 minute walk test (p = 0.008) and the "reduction in the MR severity and PASP" (p = 0.008) presented a protective effect. LVESD &gt; 55mm was an independent predictor of MH (p = 0.017), but MR of grade 2 or less after procedure was protective (p = 0.006).

Conclusion
There was no M difference between P with functional and primary MR. P with COAPT exclusion criteria had worse 1Ysurvival. A higher distance in 6MWT and a reduction in MR severity and PASP were protective. An LVESD &gt; 55 mm had a worse prognosis. Careful P selection may be crucial to improve MI"s results
Abstract P198 Figure. Kaplan-Meier Plots
P209 Mitraclip - experience of a portuguese tertiary care center - mid-term review of results
Authors: Dias Ferreira Reis J P , Moura Branco L , Almeida Morais L , Ilhao Moreira R , Rio P , Galrinho A , Fiarresga A , Cacela D , Ferreira R 
Published: January 2020

Abstract

Background
Mitral regurgitation (MR) is a marker of bad prognosis in heart failure (HF) patients (pts). Mitraclip implantation (MI) leads to a clinical improvement.

Purpose
To characterize the adult population submitted to MI and evaluate its mid-term results.

Methods
Prospective analysis of 40 pts with moderate to severe MR (grades III-IV) submitted to MI between 2013 and 2018. Paired sample t-test to assess the procedure’s effect on several variables. P-values &lt; 0.05 were considered significant.

Results
40pts, 60% male, with a mean age of 66 ± 12 years (Y) and mean follow-up time of 18 ± 15 months (M), of which 67.5% presented with grade IV MR (mean regurgitant volume - 43.5 ± 29 ml; mean EROA - 34.8 ± 13 mm2 ) and 75% with functional MR. Mean LVEF of 35%±10.3, with 55% presenting a LVEF &lt; 35%. Mean Euroscore II of 6.0 ± 7. 27.5% had already undergone a previous cardiac surgery, in most cases CABG (63.6%). 30% had already suffered an acute coronary syndrome and 62.5% had atrial fibrillation. Mean pre-procedural peak VO2 of 14.5mL/kg/min and mean distance in the 6 minute walk test (6MWT) of 321 ± 100m. The device implantation was successful in 39 pts with a device success rate of 85% (successful implantation and reduction in MR to grade 2 or less), with 55% of pts presenting mild MR before discharge. There were immediate complications related to the procedure in 17.5% of pts, with 4pts experiencing tendinous cord rupture and 2pts leaflet tear. There were no cases of pericardial tamponade or embolic complications. Follow-up mortality of 30% (12pts), 9 deaths (D) due to cardiovascular events. 9D in the first-year post-procedure (1D within the first M), with 1 pt referred to cardiac surgery due leaflet tear and 1pt to heart transplantation. Successful MIwas associated with an improvement in NYHA functional class (3.0vs2.0, p &lt; 0.001) and in several echocardiographic variables in the first 6M following the procedure: left ventricular (LV) end diastolic volume: 194.5mLvs168.4mL, p = 0.012; LV end systolic volume: 132.6mLvs106.7mL, p = 0.008; systolic pulmonary artery pressure: 50.5mmHgvs40.8mmHg, p = 0.013. It was also associated with a significant improvement in both 6M peak VO2 (14.4vs15.5, p = 0.028) and 6MWT distance (321.3mvs374m, p &lt; 0.001).

Conclusion
MI is a safe procedure with a low rate of periprocedural complications. It’s associated with a functional class improvement and a significant reverse left ventricular remodeling.
P210 The influence of the right ventricle on the right atrium: a speckle tracking echocardiography study
Authors: Zehnpfennig M , Braun C , Kupczynska K , Kasprzak J D , Michalski B , Wejner-Mik P , Wdowiak-Okrojek K , Szymczyk E , Lipiec P 
Published: January 2020

Abstract

Purpose
To investigate the relationship between right atrial deformation and the right ventricular size and function.

Methods
94 patients with various cardiovascular pathologies have been included in the study group. All patients underwent transthoracic echocardiography with subsequent off-line analysis using speckle tracking technique and measurement of numerous right atrial deformation parameters, including peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS), as well as established indices of right ventricular size and function, including right ventricular basal diameter in apical four-chamber view (RVITd), tricuspid annular peak systolic excursion (TAPSE) and global longitudinal strain (GLS).

Results
There was a statistically significant weak correlation between RA strain (PACS and PALS) and RV parameters. RV-GLS showed significant correlation with PALS (r = -0,38; p = 0,0015) and PACS (r = - 0,30; p = 0,013). Similarly, TAPSE correlated with PALS and PACS (r = 0,34; p = 0,02) and (r = 0,23; p = 0,04) respectively. However, there was no correlation between right atrial function and RVIT.

Conclusions
Right atrial deformation parameters weakly correlate with right ventricular function indices and show no correlation with the size of the right ventricle.
P215 Effects of ARNI therapy on left atrial and ventricular longitudinal deformation and functional capacity in HFrEF patients
Authors: Mandoli G E , Spera L , Giannoni A , Cassano F , Incampo E , Borrelli C , Sciarrone P , Taddei C , Emdin M , Mondillo S , Cameli M 
Published: January 2020

Abstract

Background
valsartan and sacubitril combination (angiotensin receptor-neprilysin inhibitor, ARNI) was superior, in randomized trials, to lone ACE inhibitors in terms of reduction of cardiovascular mortality rate and hospitalization for acute heart (HF) in patients with HF with reduced ejection fraction (HFrEF). Purpose: the main goal of our study was to assess the effects of ARNI on left atrial (LA) and left (LV) and right ventricular (RV) function, evaluated by standard and speckle tracking echocardiography (STE), and on patients’ functional capacity by cardiopulmonary exercise testing (CPET), in patients with HFrEF. Methods: we prospectively enrolled 16 patients with a LV EF ≤35% and &gt;18 years old, in two different centers with high expertise in HF management. Exclusion criteria included: symptomatic hypotension, stage IV renal failure (eGFR &lt; 30 ml/min/1.73 m2), ACE-inhibitor (ACEi) intolerance or previous angioedema, poor acoustic window, refuse to participate to the study. At enrollment (T0), all patients were in therapy with ACEi or sartans (ARBs) and underwent physical examination, ECG, blood test (including NT-proBNP), standard echo, STE and CPET. We shifted therapy from ACEi/ARBs according to HF guidelines and we repeated all tests after 6 months. Results: population had an average age of 63 ± 9 years, 94% was males. Etiology was ischemic in one third of the subjects. At 6 months follow up, NT-proBNP was significantly lower (512.2 ± 518.5 vs 431.2 ± 330.1 ng/l, p 0,001) together with reduced LV filling pressure evaluated by E/A ratio and E/e’ ratio (11.2 ± 8.6 vs 8.8 ± 4.8, p 0.01). LV EF improved from 31.7 ± 3.4% to 36.2 ± 7.2% (p 0.01) and LV dimensions decreased. LV global longitudinal strain (GLS) did not change significantly while free wall RV GLS increased from – 20.4 ± 6.3% to – 24.6 ± 9%, p 0.001, as peak atrial longitudinal strain (PALS) did (16.1 ± 2.6% vs 27.6 ± 4.1%, p 0.001). Between CPET indexes, only VE/VCO2 slope improved but only with borderline statistical significance (32.7 ± 5.3 vs 29.7 ± 6.8, p 0.05, Fig. 1). Conclusions: this preliminary study evaluated for the first time the effects of ARNI on echocardiographic and CPET parameters at the same time. Our results could explain the favorable clinical benefits of ARNI therapy in HFrEF: improved biventricular function, lower LV filling pressure and a more efficient ventilatory response during effort.
Abstract P215 Figure. Fig.1
P231 Cardiac metastasis mimicking a myocardial infarction
Authors: Chiampan A , Lanzoni L , Lanzoni L , Adamo E , Adamo E , Dugo C , Dugo C , Bonapace S , Bonapace S , Castagna F , Castagna F , Barbieri E , Barbieri E 
Published: January 2020

Abstract
We present the case of a 79 years old male patient affected by a lung squamous cell carcinoma (T4 N0 M1a) diagnosed in december 2018 with a 5x5 cm mass in the inferior lobe of the left lung close to the pericardium and a second 5 cm mass in the apical lobe of the right lung. TT echocardiography at that time was normal. Treatment with gemcitabine was scheduled with slight progression of the disease at the CT scan control in april 2019 when initial invasion of the left inferior pulmonary vein was detected. An ECG performed during routine control revealed the presence of q waves and ST segment elevation in the inferior leads. The patient was asymptomatic about the heart but the blood tests revealed a slight increase of HS Troponin I. We decided to repeat the TT echo, which showed the presence of a rounded mobile mass of about 3x2.5 cm in the left atrium close to the upper left pulmonary vein and another formation of about 5x2 cm infiltrating the inferior wall of the left ventricle that appeared akynetic. Both metastatic and thrombotic origins were debated and anticoagulant therapy with LMWH was started. We chose to perform a TE echocardiography, which confirmed the presence of the rounded mass in the left atrium, enlarged as compared to the TT evaluation. At the 3D reconstruction, it appeared to come from the left inferior pulmonary vein, completely occluding it, and expanding to the left superior vein, narrowing but not closing its orifice. The mass was well delimitated, disomogenous and vacuolated, thus confirming its likely neoplastic origin. From the trans-gastric view, we confirmed the large infiltration of the inferior wall of the left ventricle. General conditions of the patients quickly deteriorated and he experienced an ischemic stroke. At the TT echo re-evaluation the mass in the left atrium was greatly reduced as compared to the previous control. Cardiac metastases are a rare and frequently clinically silent occurrence; However, in a minority of cases they may present with ECG alterations such as ST-T segment modifications. In neoplastic patients an ischaemic ECG pattern not following its typical progression, without typical symptoms of ischaemia should rise the suspicion of a cardiac metastasis. In our case the abnormalities could be caused by a loss of viable myocardium secondary to the infiltrating mass or by a compression of the right coronary artery. In this context the echocardiography, both TT and especially TE, is a valuable tool that allow to recognize the real cause of these abnormalities and provides useful informations that enable to distinguish neoplastic mass from a thrombus. The ischaemic stroke was probably due to an embolization of the mass from the left atrium, as confirmed by its important reduction at the last echo control.
Abstract P231 Figure. ECG abnormalities and TE echo alteration