bluuebunny/crossref_metadata_2025_split huggingface dataset:
155 Myocardial work in hypertension and mitral regurgitation- insights from non-invasive assessment of left ventricular pressure-strain relations
Authors: Loncaric F , Marciniak M , Nunno L , Fernandes J F , Mimbrero M , Tirapu L , Fabijanovic D , Sanchis L , Doltra A , Cikes M , Lamata P , Bijnens B , Sitges M 
Published: January 2020

Abstract

Funding Acknowledgements
Horizon 2020 European Commission Project H2020-MSCA-ITN-2016 (764738), Grant from Fundacio La Marató de TV3 (040310)

Background and aim
Non-invasive left ventricular (LV) pressure estimates and speckle-tracking deformation curves can be used to quantify an index of myocardial work (MWI) which may offer insight into the early changes and work distribution in hypertension (HTN) and mitral regurgitation (MR) – cardiac diseases related to pressure and volume overload. The aim is to assess segmental strain and MW indices in patients with HTN, MR, and in healthy controls.

Methods
An echocardiogram was performed in 73 participants: 31 patients with a diagnosis of long-standing HTN with signs of LV hypertrophy, 22 patients with MR without hypertension, and 20 healthy age- and sex-matched controls. LV speckle-tracking was performed in 4C, 2C, and 3C apical views. MWI was calculated between mitral valve closing and opening. Average regional values of strain and MW indices were calculated by averaging the 4C, 3C, and 2C basal, mid, and apical segments, as based on the 18-segment model of the LV. Total MW per minute (MWI/min) was calculated by multiplying global MWI by the heart rate.

Results
LV ejection fraction and global longitudinal strain (GLS) were preserved and similar in all groups (GLS, controls vs. mild/moderate MR vs. severe MR vs. HTN: -21.28 ± 2.36 vs. -21.30 ± 1.49 vs. -20.93 ± 2.46 vs. -20.93 ± 2.46, p = 0.602). MR was classified as mild or moderate in 45% (n = 10) and severe in 55% (n = 12). A strong trend of higher global MWI (controls vs. mild/moderate MR vs. severe MR vs. HTN: 2098 ± 373 vs. 2036 ± 341 vs. 2237 ± 351 vs. 2297 ± 427 mmHg%, p = 0.171), as well as MWI/min could be noted in patients with hypertension and severe MR. Averaged regional deformation values showed a gradient increasing from base to apex in all groups, significantly more pronounced in the HTN patients. This deformation pattern was reflected in myocardial work distribution. In HTN, the basal region performed a lower percentage of total work, with the apex performing an increased workload. In the MR subgroups, the work was distributed similarly to the healthy controls Results are shown in Figure 1.

Conclusion
Non-invasive pressure strain relations offer additional information on cardiac function in HTN and MR with preserved LVEF and GLS. In HTN, MW is elevated and redistributed in the LV with an apex-to-base gradient signaling an apical compensation of basal impairment in the setting of increased afterload. Mild and moderate MR is associated with a compensated state of normal global MWI and work distribution, however, MWI/min in severe MR reveals an overall increase in workload - potentially predicting further LV remodeling in these patients over time.
Abstract 155 Figure 1
P197 Assesment of cardiac function during trastuzumab therapy in HER2 positive breast cancer patients
Authors: Krstic I , Deljanin Ilic M , Pejcic I , Vrbic S , Marinkovic D 
Published: January 2020

Abstract

Background
Although trastuzumab has benefits in treatment of HER2 positive breast cancer, it also carries the risk of cardiotoxicity. It is very important to evaluate the cardiac status before and after therapy with trastuzumab, as well as monitoring of electrocardiografic and echocardiographic parameters.
The aim of this study was to assess of cardiac function during trastuzumab therapy in HER2 positive breast cancer patients.

Method
Ninety six HER2 positive female breast cancer patients (mean age, 59.57 ± 9.6 years) were enrolled in the study. At the time, they were on sequential therapy with anthracyclines (IV to VI cycles) within the FAC regimen (fluorouracil 500 mg/m2, doxorubicin 50 mg/m2, cyclophosphamide 500 mg/m2) on day 22, and after that trastuzumab therapy (6 mg/kg of body weight on day 21, for the period of one year). In all patients (pts) blood pressure (BP), heart rate (HR), electrocardiografic and echocardiographic parameters (left ventricular ejection fraction–LVEF(%); fractional shortening–FS(%); end-diastolic diameter–EDD(mm); left ventricular mass – LVM (g)) were assesed at the beginning and after the therapy with trastuzumab.

Results
There was no significant changes in arterial BP before and after trastuzumab in examined pts (systolic BP119.90 ± 16.04 mmHg vs 121.30 ± 13.06 mmHg; diastolic BP 75.89 ±7.25 mmHg vs 76.30 ± 7.65 mmHg) ns and HR (68.78 ± 7.69/min vs 67.92 ± 7.90/min) ns. All pts at the beginning and after the last therapy with trastuzumab on the electrocardiogram (ECG) were in sinus rhythm, one pts has LBBB and one RBBB. During therapy ectopic beats were registred in 11 pts, SVES in 7 (7.29%), VES in 4(4.16%). In the most of this patients with PSR in the middle of treatment period with trastuzumab sinus tachycardia was recorded as well. At the end of trastuzumab therapy in examined group LVEF was decreased by 1.73% (from 65.49 ± 5.82% to 63.76 ± 6.43%; p = 0.007), FS by 0.86% (from 36.18 ± 5.10% to 35.32 ± 4.91%; p = 0.123) ns, EDD increased by 1.26 mm (from 47.53 ± 4.48 mm to 48.80 ± 5.19 mm; p = 0.005) and LVM increased by 173.68 g (from 161.55 ± 43.76 g to171.15 ± 47.88 g; p = 0.031). Cardiotoxicity is registred in 4 (4.17%) patients, according to the criteria of EACVI and ASE.

Results
Tratsuzumab has not significant effect on BP and ECG changes.The rate of cardiotoxicity after trastuzumab therapy was low and was expressed through reduction of left ventricle ejection fraction, the increase in the end-diastolic diameter and the left ventricular mass.
P204 Recovery of left atrial function after restoration of sinus rhythm in patients with atrial fibrillation
Authors: Kupczynska K , Michalski B , Miskowiec D , Wejner-Mik P , Wierzbowska-Drabik K , Lipiec P , Kasprzak J D 
Published: January 2020

Abstract

Background
Atrial fibrillation (AF) is associated with impaired mechanical function of the atria. The restoration of sinus rhythm (SR) leads to improvement of mechanics, however the onset of those changes is not established yet.

Purpose
To analyse changes in left atrial (LA) mechanical function after conversion to SR.

Methods
Forty patients (mean age 65 ± 12 years, 63% male) with nonvalvular AF underwent successful electrical cardioversion. Transthoracic echocardiography with speckle tracking analysis (STE) of LA was performed in AF and within 24 hours after cardioversion, in SR. We analysed standard parameters of left ventricle (LV) and LA. By the use of STE we assessed peak atrial longitudinal strain (PALS), time to PALS indexed to RR interval (TT-PALS/RR) and intra-atrial asynchrony.

Results
Heart rate during echocardiography was higher before cardioversion - median (IQR) 90 beats per minute (80-110) vs 61 (56-72); p &lt; 0.0001. The mean LV ejection fraction in our study group was 48 ± 11%. We noticed significant improvement in LA STE measurements and in early diastolic (E’) mitral annular velocity. There were no significant changes in systolic (S’) mitral annular velocity and in the ratio of transmitral Doppler early filling velocity to E’ (E/E’). Detailed results are present in the table.

Conclusions
Speckle tracking measurements are able to detect early mechanical changes in LA even within 24 hours of SR.
Atrial fibrillation Sinus rhythm p S" (cm/s) 6 (5-6.5) 6 (5-6.6) NS E" (cm/s) 10 (7.5-13) 9.5 (6.8-10.5) 0.0008 E/E" 8.2 (6.3-12.3) 9.3 (7.5-13) NS PALS (%) 9.9 ± 4.6 14.5 ± 6 &lt;0.0001 TTP-PALS/RR (%) 51 (44-58) 42 (38-45) 0.0001 LA asynchrony 15 (11-19) 9 (8-14) 0.0007
P1580 Global regurgitant volume - approaching the critical mass in valvular-driven heart failure
Authors: Spinka G , Bartko P , Arfsten H , Heitzinger G , Pavo N , Kastl S , Prausmueller S , Strunk G , Mascherbauer J , Hengstenberg C , Huelsmann M , Goliasch G 
Published: January 2020

Abstract

Aims
Recent progress in the diagnosis of functional valve regurgitation forms a coherent perception of severity thresholds by quantitative assessment. However, thresholds focused on either valve in isolation -not accounting for the global hemodynamic burden arising from concomitant functional regurgitation of the mitral and tricuspid valves. We sought to determine whether the global regurgitant volume is associated with adverse cardiac remodeling and mortality.

Methods and results
This long-term observational study included 414 patients on guideline-directed medical therapy. Baseline global regurgitant load defined as the sum of mitral and tricuspid regurgitant volume was assessed by the proximal flow convergence method. All-cause mortality during five years follow-up served as the primary endpoint. The median global regurgitant load was 30ml (IQR 15-49) with 67% accounting for mitral and 33% accounting for tricuspid regurgitant volume. The global regurgitant load had significant impact on outcome with a crude HR of 1.46 (1.28-1.66; P &lt; 0.001) for a 1-SD increase in global regurgitant volume, results that remained virtually unchanged after bootstrap or clinical confounder-based adjustment (P &lt; 0.001 for adjusted models). Spline curve analysis showed a linearly increasing risk with a threshold of 50ml and sustained increasing risk thereafter.

Conclusions
The present study demonstrates the detrimental effect of the global regurgitant load in patients with HFrEF. The threshold where heart failure is driven by the valve lesions is a global regurgitant volume of 50ml with continuously increasing risk beyond that threshold. Future studies need to address whether an attempt to reduce the global regurgitant volume can improve outcome.
Abstract P1580 Figure 1 - Global RegVol
P1757 Novel echocardiographic markers as predictors for left ventricular reverse remodeling one year after edge-to-edge mitral valve repair in patients with functional mitral regurgitation
Authors: Papadopoulos K , Ikonomidis I , Chrissoheris M , Chalapas A , Kourkoveli P , Vardas P , Spargias K 
Published: January 2020

Abstract

Background
Percutaneous edge-to-edge mitral valve repair (PMVR) is a safe treatment option for high surgical risk patients with severe functional mitral regurgitation (FMR). Recent trials have proven this method’s efficiency but novel echocardiographic markers such as deformation imaging have never been analyzed in this subgroup of patients.

Purpose
The purpose of this study is to analyze novel echocardiographic parameters in patients treated for FMR and identify predictors of response in patients undergoing PMVR.

Methods
We retrospectively analyzed 79 consecutive high surgical risk patients (logistic EuroSCORE 21.8 ± 15.2%), with ischemic or dilated cardiomyopathy, reduced EF (31.0 ± 8.5%) and severe functional MR (FMR). Effective regurgitant orifice area (EROA) was measured at 28.8 ± 15.1mm2 and regurgitant volume (RV) at 41.7 ± 18.3ml. At baseline and 1-year after PMVR or optimal medical treatment (OMT) we assessed echocardiographic parameters such as LV global longitudinal strain (LVGLS) and peak left atrial longitudinal strain (PALS), LV end-systolic and end-diastolic volumes (LVESV, LVEDV), LA volume, MR severity along with BNP levels, NYHA class and 6 minute walking distance (6MWT).

Results
One year after PMVR there was a significant reduction of MR (3.7 ± 0.4 vs 1.7 ± 0.8) and BNP levels (980 ± 1027pg/ml vs 420 ± 338pg/ml, p = 0.005), improvement of NYHA class (3.20 ± 0.55 to 2.0 ± 0.6, P &lt; 0.05) and increase of 6MWD (240 ± 137 to 298 ± 139m, P &lt; 0.01). LA volume and LVEDV were reduced (141 ± 79ml to 114 ± 74ml and 221 ± 74 to 193 ± 62ml respectively) (P &lt; 0.01 for all comparisons). On the other hand, patients treated with OMT didn’t have any change of their MR (3.4 ± 0.5 vs 3.4 ± 0.9), BNP levels (601 ± 652 vs 610 ± 748) or NYHA class status (2.6 ± 0.6 vs 2.4 ± 0.6). Additionally, LA and LV volumes were approximately the same (134 ± 69 vs 141 ± 61ml and 222 ± 64 vs 222 ± 56ml respectively) (p &lt; 0.05 for all comparisons). Baseline LVGLS slightly increased post intervention (-8.5 ± 4.1% vs -9.1 ± 3.7%, r = 0.76, P &lt; 0.01), and was associated with the absolute (r=-0.46, p = 0.01) and percentage difference in LVEDV (r= -0.61, P &lt; 0.01). ROC curve analysis identified a cut-off value for GLS of -7.45% (AUC 0.815, 95% CI: 0.647-0.983; p = 0.007) associated with more than 15% LV reverse remodeling, with a sensitivity and specificity of 71% and 75% respectively.

Conclusions
Edge-to-edge repair is a safe and effective method for treating patients with functional MR and has a positive clinical impact in patients at one year follow up. A preserved LVGLS seems to be a good predictor of LV reverse modeling post intervention.
P251 Right ventricular free wall dissection clearly detected and recorded by echocardiography: a fatal complication after inferior myocardial infarction
Authors: Kawada Y , Yamada A , Hoshino N , Hoshino M , Yamabe S , Takada K , Sakaguchi E , Ozaki Y 
Published: January 2020

Abstract
An 81-year-old man was transferred to our institution by ambulance because of poor feeding, general fatigue and slight disorientation lasting for a week. On arrival, he was awake and able to speak, however, his blood pressure was low at 61/43 mmHg in spite of his medical history of hypertension. His ECG showed abnormal Q waves and ST elevation in II, III, aVF leads. The echo exam detected severe hypokinesis in the left ventricular inferior wall and reduced ejection fraction at 30%. Pericardial effusion was not observed in the first echo exam. The patient was diagnosed as cardiogenic shock due to recent inferior myocardial infarction. Coronary angiography was performed, which detected total occlusion of mid right coronary artery, followed by a successful percutaneous coronary intervention (PCI) with a drug-eluting stent under the support of intra-aortic balloon pumping. Nevertheless, his blood pressure remained low and intravenous adrenaline administration was necessary during and even after PCI. To detect the cause of prolonged low blood pressure, echo was performed again immediately after PCI. The echo exam detected new findings: right ventricular posterior free wall was dissected and abnormal shunt flows were obviously observed from left ventricle to right atrium through the dissection cavity during systole. An urgent surgical repair was considered as the only option for his survival, however, his family did not accept it because the operation itself was too risky. On the next day of his admission, he passed away. Right ventricular free wall dissection is a very rare but fatal complication after inferior myocardial infarction, nevertheless, we could detect it by echocardiography with clearly recorded images.
Abstract P251 Figure.
P1766 Comparison of left ventricular stroke volume in healthy adults among regions around the world: results from the World Alliance of Societies of Echocardiography (WASE) Normal Values Study
Authors: Miyoshi T , Addetia K , Blitz A , Lang R , Asch F 
Published: January 2020

Abstract

Funding Acknowledgements
WASE Normal Values Study is sponsored by American Society Echocardiography Foundation.

OnBehalf
the WASE Investigators

Background
The American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) chamber quantification guidelines provide normal reference values for a variety of size and function parameters. While used worldwide, these were predominantly obtained from American and European Caucasian populations and may not represent individuals from other regions around the world. Accordingly, ASE in collaboration with its International Alliance Partners conducted the World Alliance of Societies of Echocardiography (WASE) Normal Values Study to establish and compare normal echocardiographic values across races, ethnicities and countries worldwide. While most previous studies focused on left ventricular (LV) size and ejection fraction, LV stroke volume (SV) in healthy normal subjects has not been well defined. In this report, we aim to examine similarities and differences in normal LV SV indexed by body surface area (SVI) among regions around the world.

Methods
WASE Normal Values Study is a multinational, observational, cross-sectional study. Individuals free from known cardiac, lung and renal disease were prospectively enrolled with even distribution among age groups and gender. Echocardiographic images were acquired following a standardized protocol. LV SV was assessed by Doppler-derived (LVOT diameter and VTI) and two-dimensional (2D) biplane Simpson’s methods. LV SVI was calculated to account for differences in body size. These measurements were analyzed (TOMTEC) in a single core laboratory following ASE/EACVI Guidelines.

Results
As of May 2019, LV SV has been analyzed in 1164 cases from 13 countries, representing 8 distinct regions worldwide. In this population, age, body surface area and 2D LV ejection fraction were 47 ± 17 years old (range 18-87 years old), 1.76 ± 0.22 m² (range 0.95-2.44 m²) and 63.2 ± 2.9 % (range 52.7-73.7 %), respectively. LV SV and SVI by Doppler were larger than those obtained by 2D method in all regions. LV SV and SVI in both methods had significant differences among regions (p&lt; 0.0001, Kruskal-Wallis test). LV SV and SVI in South Asia (India) were smallest in both methods and were also significantly smaller than other Asian regions (Figure). North America and Europe had largest LV SV and SVI by Doppler method, while Oceania had largest values by 2D.

Conclusions
The WASE Normal Values Study shows geographical variability in LV SVI across continents and countries. This information should be considered when determining normative values for SV and SVI.
Abstract P1766 Figure.
P1774 Myocardial work indices in adult patients with repaired aortic coartation
Authors: Timoteo A T , Moura Branco L , Galrinho A , Ilhao Moreira R , Sousa L , Agapito A , Cruz Ferreira R 
Published: January 2020

Abstract

Background
Myocardial strain analysis is a tool that allows a more precise assessment of cardiac performance. However, strain is relatively load dependent. New tools have been developed, with afterload adjustment. It was our objective to assess myocardial work (MW) in patients with repaired aortic coartation (ACo).

Methods
Study of consecutive adult patients with corrected ACo submitted to a routine transthoracic echocardiogram in 2018 at our centre. Patients with an aortic valve prosthesis, more than mild aortic stenosis / regurgitation, with pacemakers, with other non-corrected congenital heart diseases (with the exception of bicuspid aortic valve) were excluded from the analysis. A semi-automated strain analysis was performed with speckle tracking technology and both global longitudinal strain (GLS) and MW were estimated using GE software™. Blood pressure was simultaneously measured in the patient’s right arm. We specifically assessed: Global Work Index (GWI), Global Constructive Work (GCW), Global Work Waste (GWW) and Global Work Efficiency (GWE)

Results
Twenty patients were included in the study, mean age of 36 ± 9 years, 30% males. Mean body surface area was 1.7. In this group of patients, 40% were hypertensives and in 55% there was a concomitant bicuspid aortic valve. Mean maximum aortic valve gradient was 11 mmHg and mean descending aortic gradient was 19 mmHg. Compared to recently published reference values for a normal population, repaired ACo patients had lower values of MW (Table). In multivariate linear regression analysis, independent predictors of GWI are systolic blood pressure (β=0.441) and let atrial volume indexed (LAVI) (β=0.507). For GCW, male gender (β=-0.605), LAVI (β=0.530) and diastolic blood pressure (β=-0.742). For GWE, the only predictor was LAVI (β=0.498) and no predictor was identified for GWW. The presence of bicuspid aortic valve, aortic valve gradient and descending aortic gradient did not have any influence in MW parameters, although higher aortic valve gradients were excluded from this study.

Conclusion
Adult patients with repaired ACo, present lower MW indices and the main determinant for that difference are LAVI and blood pressure. GWW is the most independent parameter.
Results Variable Reference population n = 226 Patients with repaired ACo n = 20 p-value GWI (mmHg%) 1896 ± 308 1782 ± 389 &lt;0.001 GCW (mmHg%) 2232 ± 331 2154 ± 390 &lt;0.001 GWW (mmHg%) 78 (53-122) 76 (56-197) &lt;0.001 GWE (mmHg%) 96 (94-97) 95 (91-97) &lt;0.001
P1822 Exercise stress echo in the preventive assessment of the coronary heart disease: experience in the real life practice
Authors: Acquistapace F 
Published: January 2020

Abstract
The predictive of the functional tests compared to the anatomical tests in the diagnosis of coronary artery disease (CAD) is still debated. Cost-effectiveness ratio play a primary role in the best application of clinical practice.Methods 3200 pts (1600 men and 1600 women) were selected during a medical and cardiological screening. Two groups. The first one: evaluation or absence of events and the second one: presence of CAD. Evaluated datas: risk factors (FRC) and presence of clinical parameters limiting the predictive value of the Stress ECG from Effort (EE) such as: ECG’s abnormalities, branch blocks, hypertrophic, cardiomyopathy, gender. FRC evaluated parameters: hypertension 2080 (65.5%: 1040m; 1040f), hypercholesterolemia 1084 (37%: 592m; 592f), smoking 595 (18.6%: 298m; 297f), familiarity 1088 (34%: 1038m; 1042f), anxiety, depression, dystonia 1210 (37.8%: 430m-35% | 780f-65%), diabetes 320 (10%: 176m-55% 144f-45%).Results 900 pts were subjected to ESE: 540m 360w. Outcome at 1 year of CAD for mortality due to myocardial infarction, hospitalization for unstable angina major complications (CM): no pts. After ESE coronary angiography (CG) followed in 60 pts (7%): revascularizations (PTCA/CABG) 8 (1%: all men). ESE/CG correspondence in 100%. Comparison of CAD without revascularizations, ie diffuse atheromasia with sub-critical stenosis 35 (4%: 9m-25%, 26f-75%) all in primary evaluation without events and all hypertensive, evaluable as vasospastic ischemia (ie: x syndrome). Nobody pts was exposed to further radioactive stress procedures.Conclusions the functional test with ESE is confirmed as a valid tool, in term of cost-effectiveness also, in the screening and follow-up of CAD. Women and pts with multiple risk factors are different in the development of CAD. They are more exposed to the risk of an unappropriated and useless investigations, also radioactive. In general, ESE improves the prognosis and cost- effectiveness ratio in management of the pts with CAD.