bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1501 Huge lateral wall ventricular pseudoaneurysm complicating a silent myocardial infarction
Authors: Almaghraby A , Abdelnabi M , Shehata H , Saleh Y , Ozden Tok O , Laymouna R , Elsharkawy E 
Published: January 2020

Abstract

Introduction
Mechanical complications of acute myocardial infarction (AMI) are mainly ventricular septal rupture (VSR), free wall rupture, and ischemic mitral regurgitation. If the patient survives the acute phase, negative remodeling starts to occur leading to aneurysm or pseudoaneurysm formation.

Case report
A 44-year-old male patient, smoker with a past medical history of hypertension, diabetes mellitus and no past cardiac history except for recurrent pericardiocentesis of hemorrhagic pericardial effusion in another hospital since 3 months with no available data, presented to our medical facility complaining of dyspnea grade III with no orthopnea or paroxysmal nocturnal dyspnea that started 4 months ago and progressed gradually with no history of any acute events. He was hemodynamically stable with no audible murmurs and clear chest auscultation. Transthoracic echocardiography (TTE) showed reduced left ventricular (LV) systolic function (ejection fraction 40%) with accidentally discovered large lateral wall ventricular pseudoaneurysm containing a large mural thrombus (Panels A and B) and a small pericardial effusion with no evidence of constriction or tamponade. Cardiac Computed tomography (CT) confirmed the presence of large ventricular pseudoaneurysm with mural thrombus lining the wall of the aneurysm (Panels C and D). Invasive coronary angiography (CA) revealed a total occlusion of the left circumflex artery (LCx) and non significant lesions in the remaining coronaries. The patient refused to have surgery and he was discharged on anti-ischemic, anti-failure measures and anti-coagulation with close follow-up.

Conclusion
Bedside echocardiography is still the mainstay procedure for diagnosis of mechanical complications following AMI and other imaging modalities such as cardiac CT and cardiac magnetic resonance (CMR) are new diagnostic tools for confirming the diagnosis and planning for further interventions. Although rare, mechanical complications of AMI should always be considered in every ischemic patient.
Abstract P1501 Figure. Echo and CT images
P1520 Aortic flow reversal caused by aortic regurgitation deteriorates renal function
Authors: Yamaguchi K , Yoshitomi H , Nakamura T , Okazaki K , Morita Y , Kawahara Y , Kagawa Y , Ouchi T , Sato H , Watanabe N , Endo A , Tanabe K 
Published: January 2020

Abstract

Background
Chronic kidney disease is a growing public health problem. Renal dysfunction is known as a strong risk factor for cardiovascular disease and end-stage renal failure. The presence of pan-diastolic flow reversal in the abdominal aorta is a very specific sign of severe aortic regurgitation (AR). A higher aortic reverse/forward flow ratio is associated with lower intrarenal forward flow. However, the influence of AR on renal function has been poorly understood. We hypothesized that the aortic flow reversal reduces the renal artery forward flow and accordingly leads to renal dysfunction in patients with severe AR.

Methods
The study consisted of 21 consecutive patients (mean age 69 ± 11 years) with severe AR who underwent aortic valve replacement (AVR). We compared echocardiographic indices and the glomerular filtration rate (GFR) before and 603 ± 541 days after AVR.

Results
Blood pressure was 122 ± 16/54 ± 8 mmHg before AVR and 123 ± 16/76 ± 11 mmHg after AVR. After AVR, left ventricular (LV) end-diastolic dimension decreased from 57 ± 9 to 44 ± 5 mm and LV ejection fraction increased from 58 ± 12 to 60 ± 11 %. Estimated GFR significantly increased from 62.9 ± 18.9 to 71.8 ± 18.1 mL/min per 1.73 m2 after AVR (p = 0.003).
Conclusions An increase in aortic flow reversal caused by severe AR reduces forward flow into the kidney and thereby deteriorates renal function. This study demonstrated a key mediating role of central hemodynamic factors, particularly an exaggerated aortic flow reversal in renal dysfunction and severe AR.
P1523 Impact of different techniques for mitral valve repair on left ventricular function: a 2D/3D echocardiographic analysis
Authors: Cimino S , Birtolo L I , Maestrini V , De Leo F , Vinciguerra M , Filomena D , Monosilio S , Luongo F , Neccia M , Petronilli V , Cantisani D , Greco E , Miraldi F , Fedele F , Agati L 
Published: January 2020

Abstract

Funding Acknowledgements
None

Aim
Different surgical techniques are available for mitral valve (MV) repair in patients with degenerative severe mitral regurgitation (MR). Leaflet resection (LR) and neochordoplasty (NP), both including ring annuloplasty (RA), are the most frequently performed techniques for posterior mitral leaflet prolapse/flail repair. Despite NP technique is supposed to preserve LV physiology more than LR, it is unclear which technique provides the best haemodynamic pattern. In the present study, the results of the two different surgical techniques in terms of left ventricular (LV) dimension and function are investigated.

Methods
23 consecutive patients who underwent MV surgical repair were enrolled. All patients underwent, before surgery and after 8 ± 2 months, 2D and 3D echocardiography with automatic (Heart Model, Philips) assessment of LV volumes and ejection fraction (EF), left atrial (LA) volume, right ventricular (RV) dimension and function, pulmonary artery systolic pressure (PASP), MR, tricuspid regurgitation (TR) and MVPG quantification. MR was corrected using 1) NP with polytetrafluoroethylene sutures and 2) triangular LR, both with RA. Patients were divided in 2 groups according to the surgical technique. Results: techniques were able to successfully correct MR. There were no significant differences in baseline echocardiogram and demographic characteristics between the two groups. There were no significant differences in terms of post-surgical MVPG between the two groups. In all patients a trend in reduction in LV dimension at follow-up was observed, but it was statistically significant only in NP patients (pre-surgical EDV 150 ± 41 VS post-surgical EDV 100 ± 27 ml, p = 0.03).

Conclusions
Both MV repair techniques showed a successful MV repair and an improvement in LV volumes at follow-up, especially in NP group. Further perspective studies are necessary to demonstrate the hypothesis of more physiological haemodynamic pattern associated with NP techniques.
Echo parameters pre VS post MV Repair Parameter pre post p value LVEDV RN (ml) 150 ± 41 100 ± 27 0.03 LVESV RN (ml) 58 ± 20 46 ± 14 NS LVEF RN (%) 58 ± 8 55 ± 7 NS LVEDV RR (ml) 160 ± 58 118 ± 31 NS LVESV RR (ml) 62 ±11 51 ±13 NS LVEF RR (%) 59 ± 8 57 ± 4 NS EDV: end-diastolic volume, ESV: end-systolic volume, EF: ejection fraction, RN = Ring + Neochordae; RR= Ring + Resect.
P1529 Impact of the new PH guidelines on echocardiographic definition leading to double demand of right heart catheterization
Authors: Fauvel C , Raitiere O , Burdeau J , Si Belkacem N , Bauer F 
Published: January 2020

Abstract

Background
Doppler echocardiography is the most widespread and well-recognized technique for the screening of patients with pulmonary hypertension (PH). When tricuspid regurgitation peak velocity (TRPV) ≥3.4 m/s, right heart catheterization is requested to confirm mean pulmonary artery pressure &gt;25 mm Hg. In the proceedings from the 6th world symposium on pulmonary arterial hypertension recently released, the new definition of PH has been lowered to mean pulmonary artery pressure &gt; 20 mm Hg.

Purpose
The purpose of our work was twofold : i) to determine a new cut-off value for TRPV to accommodate the new hemodynamic definition of PH, ii) to investigate the impact on the demand of right heart catheterization (RHC) from our echo CORE lab.

Methods
We extracted and analyzed both the haemodynamic and echocardiographic records of 130 patients who underwent investigations the same day. Tricuspid regurgitation peak velocity was measured in apical-4 chamber view using continuous-wave doppler modality and compared to mean pulmonary artery pressure recorded from fluid-filled catheter.

Results
Tricuspid regurgitation peak velocity has a weak correlation with mean pulmonary pressure (y = 9.2x-2.2, r² = 0.22, p &lt; 0.01). Targeting a mean pulmonary pressure on right heart catheterization of 20 mm Hg for the definition of PH, receiver operating characteristic curve analysis demonstrated a good association between TRPV and PH diagnosis (area under the curve, 0.78 ; p &lt; 0.001). The cut-off value obtained for TRPV was 3.0 m/s (Se = 0.78, Sp = 0.37). From 01/01/18 to 31/12/18, 2539 out of 6215 had TRPV recorded from which 283 had TRPV ≥ 3.0 m/s (24,1%) and 615 had TRPV ≥ 3.4 m/s (11,1%). When applied to a community population the new TRPV cutoff &gt; 3m/s used as surrogate for mean pulmonary artery pressure &gt; 20 mm Hg may produce a 111% increase of right heart catheterization demand.

Conclusions
The new definition of pulmonary hypertension (invasive mean pulmonary artery pressure &gt; 20mm Hg) necessitates revisiting tricuspid regurgitation peak velocity &gt; 3 m/s as a screening test leading to more than twice RHC demand.
P1532 Segmental assessment of left ventricle in patients with Fabry"s disease
Authors: Losi V , Rodolico M S , Faro D C , Licciardi S , Tamburino C , Monte I P 
Published: January 2020

Abstract
Anderson-Fabry disease (AFD) is a rare X-linked metabolic disorder due to deficiency in lysosomal enzyme activity of a-galactosidase A, resulting in pathological accumulation of glycosphingolipids in several tissues and a progressive multi-organ dysfunction.
The Global Longitudinal Strain (GLS) of the left ventricle (LV) by Speckle-tracking echocardiography (STE) has been show to detect subclinical cardiac involvement in many cardiomyopathies. The Mechanical Dispersion (MD), derived from STE is considered able to reflect a heterogeneous myocardial contraction, evaluated in many cardiopathies. A reduction in GLS was associated with myocardial fibrosis in the subclinical stages of AFD cardiomyopathy, but there is no MD data in AFD.
The aim of the study was to evaluate the distribution of GLS and MD of LV in patients with AFD.
47 consecutive AFD adult patients treated (37F, 12 M, age 45 + 17 years) were examined by a complete echocardiographic examination from a Vivid E95 ultrasound scanner (Horten, Norway). The STE post-processing was performed by Echopac 2.02, in apical long-axis, 4-chambers, and 2-chambers views to determine GLS and MD. Data were expressed as mean± standard deviation. The comparison between the AFD group and 20 normal subjects (N) was performed with unpaired T-test.
Compared to N, the AFD group showed higher values of LVMi, LAVi, E/E’, and MD, but a lower value of GLS (Table). GLS was significantly lower in the basal (sept p&lt;.002; post p&lt;.0001) and mid segments (ant-sept p&lt;.008; post p&lt;.0001; ant p&lt;.001). MD was significantly higher in the inferior (basal p&lt;.003; mid p&lt;.01; apical p&lt;.005) and lateral segments (mid p&lt;.004; apical p&lt;.001).
In patients with AFD, MD added to GLS seems to be a promising tool for the early diagnosis of segmental dysfunction .
Table1: Results AFD N p&lt; m SD m SD LVMi g/sqm 77.1 29.8 62.3 14.1 0.008 LVEF % 65.7 5 63.6 3.5 0.04 LAVi ml/sqm 25.5 11 18.2 4.5 0.000 E/E" 8.3 3 5.4 1.1 0.000 TV vmax m/s 2.2 0.4 2.1 0.3 - LV GLS % -17 4 -20 2 0.003 LV MD ms 52 38 29 8 0.000
P1559 3D echocardiography improves the agreement between left ventricular and right ventricular stroke volumes in healthy individuals
Authors: Pilalidou A P , Kantartzi V K , Adamopoulos C A , Zitiridou L Z , Dimtsa M D , Sotiriou S S , Karakanas A K , Stamatiadis N S , Moschovidis V M , Koutavas N K , Zaravalis I Z , Konstantinidou M K , Gogos C G , Styliadis I S , Sachpekidis V S 
Published: January 2020

Abstract

Funding Acknowledgements
None
Background/Introduction: Calculation of the LV and RV stroke volumes (SV) with the volumetric method can be useful for assessment of valvular regurgitant volumes and intracardiac shunt ratios. However, this method often yields significant differences between the estimated LV and RV SV even in healthy subjects. We hypothesized that this discrepancy can be largely due to the assumption of LV and RV outflow tract circularity which forms the basis of 2D derived areas.

Purpose
To assess if the use of 3D transoesophageal (TOE) derived LVOT and RVOT areas can improve the agreement between LV and RV stroke volumes using the volumetric approach in healthy subjects with no valvular abnormality or intracardiac shunt.

Methods
We studied 20 patients (9 Males, age: 51 ± 19 y) submitted to TOE for various reasons, who had normal cardiac anatomy and function and good quality 3D TOE LVOT and RVOT data. Two dimensional TOE measurements of the LVOT and RVOT diameters were made in a zoomed mid oesophageal long axis and short axis view respectively; using these measurements 2D TOE LVOT and RVOT derived areas were calculated assuming circularity. In a similar way, we calculated the 2D LVOT and RVOT areas using data from transthoracic echo (TTE) for each patient. Offline analysis of the 3D TOE data allowed direct planimetry of the LVOT and RVOT areas devoid of any geometric assumptions. Finally, calculation of the 2D TTE, 2D TOE and 3D TOE LV and RV stroke volumes were performed for each patient based on the acquired data. The difference between LV and RV stroke volume (which theoretically should be around zero) for each technique and for each patient was also calculated.

Results
The mean LV and RV SV for the whole cohort, did not differ significantly within each method: 2D-TTE. However, the mean absolute difference between LV and RV stoke volumes for each technique was significantly lower with the use of 3D TOE compared to both 2D TTE and 2D TOE. Mean values and dispersion of absolute differences for each method are shown in Figure 1.

Conclusions
Compared to 2D, use of direct 3D TOE RVOT and LVOT planimetry yielded significantly less difference between RV and LV stroke volumes in healthy individuals. This finding can have potential clinical implications for more accurate assessment of valvular regurgitant volumes or intracardiac shunts.
The mean absolute difference LV-RV Absolute mean defference between LV and RV 95%ΔΕ F(2.38) p-value TTE 2D 18,65 ± 11,72 (13,2-24,1) 8.63 0.001 TOE 2D 13,45 ± 12,44 (7,6-19.3) 8.63 0.001 TOE 3D 6,45 ± 3,62 (4,8-8,1) 8.63 0.001
Abstract P1559 Figure. Bland Altaman Analysis
P1564 Changes in coronary flow velocity measuring during coronary bypass grafting can predict elevation of cardiac troponin
Authors: Zagatina A , Novikov M , Zhuravskaya N , Balakhonov V , Shmatov D 
Published: January 2020

Abstract

Background
Stenosis of a coronary artery results in an increase in flow velocity in the pathologic segment. Effective grafting should decrease the stenotic native coronary velocity according to a hemodynamic law. The range of decreased velocity can hypothetically reflect the effectiveness of a graft. Grafting effect insufficiencies often cause elevations in periprocedural cardiac troponin (cTn) elevation. The aim of the study is to determine, if measuring coronary flow velocity changes during coronary artery bypass grafting (CABG) can predict further cTn elevation.

Methods and results
Consecutive 68 patients (48 men, 64 ± 9 years old), who were referred for CABG, were included into the study. A standard basic perioperative transesophageal echocardiography (TEE) examination was performed with additional scans of the left main, left anterior descending (LAD), and circumflex (LCx) arteries’ proximal segments. Measurements of coronary flow velocities was performed before and after grafting in the same sites of the arteries. The maximal value of cTnI within 48 hours after CABG was accounted for in the analysis. All patients had arterial hypertension, 15 patients (22%) had diabetes mellitus, 12 patients (18%) was current smokers. Forty-one patients (60%) had prior myocardial infarctions, 18 persons (26%) had previous coronary stenting. The ejection fraction before the operation was 56 ± 13%. Before grafting the mean velocity in the left main artery was 79 cm/s (25th-75th quartile, 42-111), in LAD 98 cm/s (25th-75th quartile, 71-125), and in LCx 116 cm/s (25th-75th quartile, 68-156).
There was a strong significant correlation between changes in coronary flow velocities and the value of cTnI (R = 0.56, p &lt; 0.0004). The patients with and without significant elevations in cTnI had differences in coronary velocity changes before and after grafting (p &lt; 0.009). Patients with elevated cTnI in more than 5 times, had, on average, an increase in the velocities for native arteries of 21 ± 19 cm/s.

Conclusion
Coronary flow velocity assessment during CABG could predict an elevation of cardiac troponins after cardiac surgery.
Abstract P1564 Figure.
Practical guidance for P2Y12 inhibitors in acute myocardial infarction undergoing percutaneous coronary intervention
Authors: Lee Seung Hun , Kim Hyun Kuk , Jeong Myung Ho , Yasuda Satoshi , Honda Satoshi , Jeong Young-Hoon , Lee Joo Myung , Hahn Joo-Yong , Kang Jeehoon , Chae Shung Chull , Seong In-Whan , Park Jong-Seon , Chae Jei Keon , Hur Seung-Ho , Cha Kwang Soo , Kim Hyo-Soo , Seung Ki-Bae , Rha Seung-Woon , Hwang Jin-Yong , Choi Dong-Ju , Oh Seok Kyu , Kim Sung Soo , Park Taek Kyu , Yang Jeong Hoon , Song Young Bin , Choi Seung-Hyuk , Gwon Hyeon-Cheol ,   KAMIR, JAMIR, and SMART-DATE Investigators
Published: January 2020

Abstract

Aims
Potent P2Y12 inhibitors for dual antiplatelet therapy (DAPT) is crucial for managing acute myocardial infarction; however, the selection of drugs is based on limited clinical information such as age and body weight. The current study sought to develop and validate a new risk scoring system that can be used to guide the selection of potent P2Y12 inhibitors by balancing ischaemic benefit and bleeding risk.

Methods and results
Derivation cohort of 10 687 patients who participated in the Korea Acute Myocardial Infarction Registry-National Institutes of Health study was used to construct a new scoring system. We combined the ischaemic and bleeding models to establish a simple clinical prediction score. Among the low score group (n = 1764), the observed bleeding risk (8.7% vs. 4.4%, P &lt; 0.001) due to potent P2Y12 inhibitors exceeded ischaemic benefit (1.3% vs. 2.2%, P = 0.185) during 12 months. Conversely, the high score group (n = 1898) showed an overall benefit from taking potent P2Y12 inhibitors from the standpoint of observed ischaemic (17.1% vs. 8.6%, P &lt; 0.001) and bleeding events (10.1% vs. 6.8%, P = 0.073). The performance of ischaemic [integrated area under the curve (iAUC) = 0.809] and bleeding model (iAUC = 0.655) was deemed to be acceptable.

Conclusion
The new scoring system is a useful clinical tool for guiding DAPT by balancing ischaemic benefit and bleeding risk, especially among Asian populations. Further validation studies with other cohorts will be required to verify that the new system meets the needs of real clinical practice.
Maturity evaluation of orthodontically important anatomic structures with computed tomography
Authors: Ok Gokcen , Sen Yilmaz Berza , Aksoy Direnc Ozlem , Kucukkeles Nazan 
Published: January 2020

Summary

Background/objectives
The success of the orthopaedic treatment is closely related to the patient’s skeletal maturation. This study aimed to evaluate the midpalatal suture (MPS), the zygomaticomaxillary suture (ZMS) maturation, and the closure degree of the spheno-occipital synchondrosis (SOS) in patients of different age groups. The presence of a correlation between these parameters and the palatal dimensions was also verified.

Subjects/methods
The study was based on computed tomography images of 314 patients between 7 and 30 years of age with no orthodontic treatment history. The images were retrieved from the archive of the Radiology Department of Bezmialem Vakif University Hospital and divided into six groups according to the patient’s age: 7–10, 11–13, 14–16, 17–20, 21–25, and 26–30 years. The maturation scores of ZMS, SOS, and MPS were determined, and palatal thickness and length were recorded. The data were analysed by using Statistical Package for Social Sciences for Windows 22.0.

Results
A positive relationship was found between SOS closure degree and MPS/ZMS maturation (MPS–ZMS: r = 0.816, MPS–SOS: r = 0.736, ZMS–SOS: r = 0.868, P = 0.000). The degrees of ZMS and MPS maturation were significantly increased as the SOS closure degree increased. The MPS maturation score was significantly lower in patients with a short and thick palate (MPS–palatal thickness: r = 0.405, MPS–palatal length: r = 0.387, P = 0.000).

Conclusions
A positive correlation indicated the simultaneous progress in the maturation of the SOS, MPS, and ZMS. Moreover, the ANS–PNS length increase was found to be correlated with the increase of the MPS, ZMS, and SOS maturation scores. In contrast, a negative correlation was observed between the palatal thickness and the maturation stage of these structures.
Genomic Analysis of Mycobacterium tuberculosis Isolates and Construction of a Beijing Lineage Reference Genome
Authors: Wang Woei-Fuh , Lu Mei-Yeh Jade , Cheng Ting-Jen Rachel , Tang Yi-Ching , Teng Yu-Chuan , Hwa Teh-Yang , Chen Yi-Hua , Li Meng-Yun , Wu Mei-Hua , Chuang Pei-Chun , Jou Ruwen , Wong Chi-Huey , Li Wen-Hsiung 
Published: January 2020

Abstract
Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis, kills over 1 million people worldwide annually. Development of drug resistance (DR) in the pathogen is a major challenge for TB control. We conducted whole-genome analysis of seven Taiwan M. tuberculosis isolates: One drug susceptible (DS) and five DR Beijing lineage isolates and one DR Euro-American lineage isolate. Developing a new method for DR mutation identification and applying it to the next-generation sequencing (NGS) data from the 6 Beijing lineage isolates, we identified 13 known and 6 candidate DR mutations and provided experimental support for 4 of them. We assembled the genomes of one DS and two DR Beijing lineage isolates and the Euro-American lineage isolate using NGS data. Moreover, using both PacBio and NGS sequencing data, we obtained a high-quality assembly of an extensive DR Beijing lineage isolate. Comparative analysis of these five newly assembled genomes and two published complete genomes revealed a large number of genetic changes, including gene gains and losses, indels and translocations, suggesting rapid evolution of M. tuberculosis. We found the MazEF toxin–antitoxin system in all the seven isolates studied and several interesting mutations in MazEF proteins. Finally, we used the four assembled Beijing lineage genomes to construct a high-quality Beijing lineage reference genome that is DS and contains all the genes in the four genomes. It contains 212 genes not found in the standard reference H37Rv, which is Euro-American. It is therefore a better reference than H37Rv for the Beijing lineage, the predominant lineage in Asia.