bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1281 Are left atrial and left ventricular strains independent from each other?
Authors: Malaescu G , Petrescu A , Capota R , Duchenne J , Cvijic M , Bezy S , Voigt J-U 
Published: January 2020

Abstract

Introduction
Left atrium (LA) and ventricle (LV) share the mitral annular plane so that the motion and deformation of both chambers are coupled.

Purpose
To investigate the interdependence between LA and LV strain curves using strain-strain loops.

Methods
We included 101 patients with a wide range of pathology and selected for having sufficient image quality for both LA and LV analysis. Patients with a mobile interatrial septum and more than mild valvular regurgitation were excluded. LA and LV strains were assessed using speckle tracking in 4 and 2 chambers apical views, using the same cardiac cycle and R-R gating. Strain-strain-loops were reconstructed using LV strain data on the x-axis and corresponding, synchronized LA strain data on the y-axis (Fig .A). Linear regressions were calculated for the entire strain-strain-loop as well as for the three phases of the cardiac cycle (systole, early and late diastole) seperately. LA and LV volumes were also measured on the same images and their ratio was calculated and correlated with the slope of the regression line of the strain-strain loop (Fig. B).

Results
Our study population comprised normal volunteers (27), amyloidosis (8), hypertrophic cardiomyopathy (6), ischemic disease (19), non-ischemic cardiomyopathy (22), aortic stenosis (13) atrial fibrillation (6).
On average, LA and LV strain curves correlated with an R2= 0.92 ± 0.04 for the entire loop, R2= 0.97 ±0.01 in systole, R2= 0.98 ± 0.02 in early diastole and R2= 0.97 ±0.03 late diastole. Further, in the individual patients, the ratio of LV/LA volumes correlated with the LA/LV strain ratio with a slope of ∼1.0 (R2 = 0.8).

Conclusions
LA and LV deformation are closely coupled. Strain curves have a similar shape throughout the cardiac cycle leading to a tight correlation of strain values from both chambers. The relation of LA and LV strain is dominated by the two chambers" dimensions.
Abstract P1281 Figure.
P1284 The role of three-dimensional echocardiography in the evaluation of geometry and function of the left ventricle in patients with chronic chagas cardiomyopathy
Authors: Barros-Filho A C L , Moreira H T , Martins K S M , Simoes M V , Schmidt A , Maciel B C , Marin-Neto J A , Romano M M D 
Published: January 2020

Abstract

BACKGROUND
A hallmark of chronic Chagas" cardiomyopathy (CCC) is the early appearance of regional wall motion abnormalities of the left ventricle (LV), especially in the lateral and apical regions. The morphological and functional assessment of LV by two-dimensional (2D) echocardiography, besides depending on geometric assumptions, may not include the most affected segments. The three-dimensional (3D) method offers advantage for the quantification of chamber volumes, but its role in the assessment of patients with CCC is not well established. PURPOSE: The aim of this study is to evaluate the concordance between 3D and 2D methods in the quantification of left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) in patients with CCC. METHODS: 44 patients with CCC were selected. Seven subjects were excluded from the analysis (3 for atrial fibrillation, 1 for frequent ventricular extrasystoles, 3 for inadequate acoustic window), resulting in 37 patients. Subjects were submitted to 2D and 3D transthoracic echocardiography by a single experienced examiner following the recommendations from the chamber quantification guidelines. The concordance between the methods was evaluated using the Lin concordance correlation coefficient (CCI) and the Bland-Altman graph analysis. Descriptive analyses of the percentage of individuals reclassified as to altered or to non altered-LVEDV and LVEF values were performed using normal values of 3D as a reference. RESULTS: Age = 58 ± 12 years, 54% men. LVEF-2D = 47 ± 9% and LVEDV- 2D = 73 ± 18 ml / m². The CCI for the measurements of LVEDV and FEVE by both methods was 0.861 and 0.833, respectively. The mean difference found was 3 mL for LVEDV and 3% for LVEF. The 95% agreement limits found were (-14, 20 ml) for LVEDV and (-5; 11%) for LVEF. When assessed with 2D, 27% of individuals previously classified as having LV enlargement were reclassified as having normal LV volumes using the 3D method. Conversely, regarding LVEF, 16% of individuals considered normal by 2D were reclassified as having reduced LVEF with the 3D method. CONCLUSION: In individuals with CCC measurements of LVEDV and LVEF by 3D and 2D methods show high agreement. However, 3D evaluation allows the reclassification of 27% and 16% of the individuals regarding the presence of LV dilatation and LV systolic dysfunction, respectively.
Abstract P1284 Figure. Bland-Altman plot - LVEF
P1288 Male gender and left atrial volume index predict non valvular atrial fibrillation recurrence. The NeAfi echo registry
Authors: Sorrentino R , Capone V , Esposito L , Lo Iudice F , De Roberto A M , Lembo M , Santoro C , Esposito R , Canonico M E , Galderisi M 
Published: January 2020

Abstract

Background
In non-valvular atrial fibrillation (AF) patients, risk stratification scores such as CHA2DS2VASc and HASBLED allow the prediction of thromboembolic and bleeding risks, respectively. However, no risk score for the prediction of AF recurrence has been yet validated.

Purpose
To evaluate the mayor anthropometric and echocardiographic determinants of AF recurrence in non-valvular paroxysmal AF patients at 1 year follow-up.

Methods
Among 395 consecutive adult patients with non valvular AF enrolled in the Neapolitan Atrial Fibrillation (NeAfi) Echo registry, 177 (F/M = 87/90, age = 66.5± 11.9 years) had paroxismal AF and underwent 1-year follow-up. Fifteen patients had AF recurrence. Anthropometric parameters and blood pressure (BP) were recorded and CHA2DS2VASc and HASBLED scores were calculated. At baseline, patients underwent a comprehensive echo-Doppler exam, including quantification of left atrial (LA) size measurements, peak atrial longitudinal strain (PALS) and left ventricular (LV) global longitudinal strain (GLS). Binary logistic regression analysis was used to establish a mathematical model of the relationship between the variables and AF recurrence. The covariates for regression analysis were chosen as potential confounding factors based on their significance in independent T test analyses for continuous variables of chi-square for dichotomous variables, or on their biological plausibility.

Results
AF recurrence was higher in male than in female patients (14.4 vs 2.3%, p = 0.008). Patients with AF recurrence had similar body mass index, systolic and diastolic BP and heart rate compared to those without. The two groups were similar for LV end-systolic and end-diastolic volumes, ejection fraction, LV mass index, diastolic indexes, pulmonary artery systolic pressure and GLS. LA diameter (p = 0.235) and PALS (p = 0.375) were also similar between the two groups, whereas LA volume index (LAVi) was greater in patients experiencing AF recurrence (45.5 ± 15.7 vs. 36.7 ± 10.4 ml/m², p = 0.003). Binomial multiple regression analysis model explained 25% (Nagelkerke R²) of the variance in AF recurrence and correctly classified 95.0% of cases. Males were 8.9 times more likely to exhibit AF recurrence than females (p = 0.04). Greater LAVi was associated with an increased likelihood of exhibiting AF recurrence (OR = 1.07, p = 0.03), whereas CHA2DS2VASc &gt;1 in men and &gt;2 in women, HASBLED &gt;3 and greater LA diameter or lower PALS did not add significant information to the model.

Conclusions
Male gender and, with a lower extent, LAVi appear to be major determinants of AF recurrence in non-valvular paroxysmal AF. The quantification of PALS does not seem to add valuable information in the prediction of recurrent AF.
P1300 Analysis of clinical and echocardiographic follow-up of patients with heart failure and severe secondary mitral regurgitation 1 year after MitraClip implantation, single centre experience
Authors: Petr R , Linkova H , Paskova E , Bednar F , Budesinsky T , Kocka V 
Published: January 2020

Abstract

Introduction
MitraClip implantation is one possible method of treatment of patients with heart failure and severe mitral regurgitation.
Goal. Analysis of clinical and echocardiographic data of patients 1 year after MitraClip implantation.

Methods
The first 63 consequtive patients whom underwent MitraClip implantation at our cardiocentre were analyzed. Implantation was performed after all possible conservative treatment options according to guidelines were exhausted. Each patient underwent careful clinical and echocardiographic examination before and 12 months after implantation.

Results
Average age of the patient population was 70,5 ± 7,4 years. Baseline average ejection fraction (EF) of left ventricle (LV) was 35,2 ± 12,6%, enddiastolic volume of LV 196 ± 53ml, 63 (100%) had mitral regurgitation (MR) ≥ 3/4, average ERO 27,4 ± 10,2cm2 RV 40,5 ± 12,9ml. During 1 year follow-up 11 (17%) of patients died, 1 (1,6%) from a periprocedural complication. In the patients who survived we observed a decreasing incidence of severe mitral MR , (MR ≥ 3/4 before procedure in 63 (100%) vs. 12 (19%) in patients after procedure). A significant improvement in functional class NYHA (NYHA II-IV before implantation in 63 (100%) patients vs. 17 patients (33%) at one year follow-up). Mortatility was mostly influenced by Euroscore (p 0,08), creatitnine level (p 0,10), from echocardiographic parameters LV EF (36,4% vs. 29,5% p 0,10) and TAPSE (17,8 vs. 15,2mm p 0,04).

Conclusion
One year mortality in our study population was comparable with previously published data from larger registries. Significant regression of mitral regurgitation and improvement of symptoms was observed in patients after implantation. Moratility was affected by comorbidities, and systolic function of left and right ventricle.
P1302 B-cell lymphoma presenting as an ejection systolic murmur
Authors: Constantinides T , Ioannides M , Yiagou K , Avraamides P 
Published: January 2020

Abstract

OnBehalf
Nicosia General Hospital
We present the case of a young patient with large B-cell lymphoma causing severe extrinsic pulmonary stenosis. This patient presented to the emergency department with chest discomfort ,fatigue and dyspnea on minimal exertion. A loud ejection mid-systolic crescendo-decrescendo murmur with widely split S2 located in 2nd left parasternal border, raised the suspicion of pulmonary stenosis and patient underwent immediate transthoracic echocardiography as the first imaging modality of choice.On transthoracic echocardiography a large mass was seen, causing severe extrinsic pulmonary stenosis, and was further diagnosed as B-cell lymphoma after CT-guided biopsy. We discuss the high index of lymphoma suspicion in cases of pulmonary stenosis findings such as loud ejection murmur in pulmonic valve auscultation area, in otherwise healthy patients, with no history of congenital heart disease. Lymphoma and other mediastinal masses represent the most common aetiology of acquired pulmonary stenosis and should be suspected in otherwise healthy patients who present with clinical findings of pulmonary stenosis and vice-versa, pulmonary stenosis should be suspected in the presence of symptomatic mediastinal masses.
Abstract P1302 Figure. Lymphoma PSAX
P1319 Speckle tracking echocardiography in patients with acute coronary syndrome: the added value
Authors: Di Lisi D , Polizzi A , Bentivegna R , Nugara C , Lunetta M , Immordino F , Novo S , Novo G 
Published: January 2020

Abstract

Background
Speckle tracking echocardiography with assessment of left ventricular global longitudinal strain (GLS) allows to identify early signs of cardiac dysfunction.
The superiority of GLS in the prediction of all-cause mortality in the general population compared with LVEF is well known; in addiction GLS improves risk stratification and recognize early left ventricular dysfunction in several clinical setting.

Purpose
the aim of this study was to assess the diagnostic and prognostic role of global and segmental strain in the early identification of cardiac dysfunction in patients with myocardial infarction without persistent ST segment elevation (NSTEMI) and without obvious wall motion abnormalities and to assess the ability to predict the presence/extension of coronary artery disease in this population.

Methods
an observational study was carried out enrolling 56 patients (median age 66 ± 11,7 years) admitted for NSTEMI. Electrocardiogram, echocardiogram with global and segmental strain measurement (GE’s Automated Function Imaging) and coronary angiography were performed in all patients. In addition we measured territorial longitudinal strain (TLS) defined as the mean of peak systolic strain of the segments pertinent to the perfusion territories of each epicardial coronary arteries in a 17-segment LV model.

Results
mean LVEF was 53%. We found a significant relationship between GLS values and coronary artery disease extension: GLS -19,1 % ±5,7% in patients without significant coronary artery stenosis, -18,74% ±4,85% in patients with one coronary artery disease, -15,6% ±4,3% in patients with two coronary artery disease, -14,2% ±5,4% in patients with 3 coronary artery disease (p = 0,03).
We also found a correlation between territorial strain value and corresponding coronary artery stenosis.
TLS was significantly reduced in patients with significant coronary disease of the perfused territory for each artery (LAD TLS 15,1% ± 6,74 % vs -20,73± 4,47 p = 0,002; CX TLS -11,42 % ± 6,59 %,vs -17,06 ± 7,1, p = 0,0 05 , RCA -14,02 % ± 6,00 % vs-17,6 ± 5,21 p = 0,02).
At ROC analysis we identified a TLS value of -16,9 % to identify patients with significant stenosis of LAD (sensibility 58,3% and specificity 89,4%, AUC = 0,74, P &lt; 0,001), TLS -18,2% for circumflex artery (sensibility 86,2% and specificity 78,9%, AUC = 0,78, P &lt; 0,001) TLS -18% for right coronary (sensibility 73,9% and specificity 56,2%, AUC = 0,67, P = 0,027)

Conclusions
global and segmental strain measurement in patients with NSTEMI help to identify the presence and extension of significant coronary artery disease.
P1340 Clinical report: alert to iatrogenia
Authors: Redondo Bermejo B , De La Torre Carpente M M , Alonso Rodriguez M C , Tapia Ballesteros C , Munoz San Jose J C , Escudero Caro T , Revilla Martinez M , Rollan Gomez M J 
Published: January 2020

Abstract

Background
Leftatrial appendageclosure is an alternative to systemic anticoagulation for stroke prevention in appropriate atrial fibrillation patients,however, it is not without complications. Most complications arise during the procedure and in the following days, however they can also be extended over time and therefore, we must be alert.

Case summary
We present the clinical case of a 68-year-old man admitted to our hospital three weeks after being discharged due to a percutaneous closure of the left appendage complicated with a pericardial tamponade resolved mediated pericadiocentesis with pericarditis clinic with persistent severe pericardial effusion. After a week without being able to remove the drainage tube, he required pericardiotomy due to superinfection with adequate subsequent evolution. In the following weeks he presented a recurrent left pleural effusion that required several evacuating thoracocentesis. After last thoracocentesis, he presented a cardiac perforation showing the catheter lodged in the pulmonary artery in the chest Computed Tomography, so he was again submitted to cardiac surgery for catheter extraction. Finally after stabilization, the patient could be discharged and after 6 months of follow-up he is stable and without new complications.

Discussion
Post-cardiac injury syndromes is a group of inflammatory pericardial syndromes including post-myocardial infarction pericarditis, post-pericardiotomy syndrome and post-traumatic pericarditis iatrogenic or not, that’s include pericarditis after invasive cardiac interventions. It is presumed that these syndromes have an autoimmune pathogenesis triggered by an initial damage and after a latent period of a few weeks are revealed.
Our patient evidence of pericardial effusion with elevated CRP several weeks after a cardiac injury due to perforated during a percutaneous closure of the left appendage complicated with a pericardial tamponade resolved mediated pericadiocentesis. The persistent effusion motivated he imposibility of removed pericadiocentesis tube, and it superinfecction required an urgent pericardiotomy. After pericardial window, the effusion continued into the left pleural.
The perforation of cardiac cavities after an evacuatorythoracocentesis is a described but unusual complication that requires surgical removal.
Our patient survived a pericardiocentesis, several evacuatorythoracocentesis and two cardiac surgeries, all after a percutaneous closure of the left appendage.

Conclusion
Any invasive procedure presents a risk of iatrogenic complication, especially in elderly patients with comorbidities. We must be alert and start a treatment as soon as possible to solve the problem.
Abstract P1340 Figure. Chest-CT_EECHO2019
P1341 An old patient with two tales: left cor triatriatum and atrial septal defect
Authors: Agoston Vas Coldea L N , Vrancianu P , Tutu A , Agoston R , Muresan I , Mocan T 
Published: January 2020

Abstract

Introduction
Cor triatriatum sinistrum is a rare congenital condition, diagnosed in 0.4% of cases at autopsy, in which the left atrium is divided in two chambers by a fibromuscular membrane. In 80% of the cases it is associated with other cardiac abnormalities, the most common being ostium secundum atrial septal defect.

Case report
A 71-year-old man with a history of congestive heart failure was admitted to the hospital for dyspnoea, fatigue and ankle swelling. The physical examination revealed jaundice, severe pretibial oedema, bibasal crackles, irregular heart sounds, a 3/6 mitral and tricuspid systolic murmur, jugular vein distension, hepatomegaly. Electrocardiographical findings included atrial fibrillation and right bundle branch block. Transthoracic echocardiography showed severely enlarged right cavities, an ostium secundum atrial septal defect of 23 mm with right to left shunt, a dilated left atrium divided by a membrane and severe pulmonary arterial hypertension. Cardiac magnetic resonance imaging revealed nodular late gadolinium enhancement (LGE) areas and confirmed ostium secundum atrial septal defect and also a fibromuscular membrane, dividing the left atrium into a proximal and distal chamber. Despite appropriate therapy, the patient’s clinical state altered in the following days and he eventually died, due to ventricular fibrillation. The autopsy confirmed the ostium secundum atrial septal defect and the cor triatriatum sinister and also revealed an abnormal emergence of the circumflex artery from the left coronary sinus (Figure).

Conclusion
Cor triatriatum sinistrum and also ostium secundum atrial septal defect are rare abnormalities usually recognized early in lifetime due to unspecified symptoms of heart failure. In adults it can become symptomatic later in time, like in our case, with the development of multiple associated conditions: atrial fibrillation, pulmonary hypertension, left ventricle dysfunction, with a poor prognosis.
Abstract P1341 Figure
P1344 Right ventricular mass: multimodality diagnostic approach to an incidental finding
Authors: Ambrozic J , Kovac A , Zbacnik R , Ponorac S , Kogoj P , Dimitrovska L , Dolenc-Strazar Z , Antolic B , Sinkovec M 
Published: January 2020

Abstract

Background
Cardiac masses are rare entities and often diagnostically challenging. When incidentally found multimodality diagnostic approach is warranted for further characterization and evaluation of its contribution to the patient’s symptoms.
Case report
62-year-old male, smoker, with a history of non-Hodgkin lymphoma treated with radiation and chemotherapy 10 years ago, was admitted due to subacute myocardial infarction. Coronary angiogram showed subacute occlusion of partly collateralized RCA, subsequently treated with dilatation and stenting. Echocardiography revealed signs of dilated cardiomyopathy with severely reduced left ventricular ejection fraction (EF 20%), that could be due to chemotherapy-related cardiotoxicity. On admission CTA was performed to exclude aortic dissection since the patient presented with very severe chest pain radiating to the back. It showed a heterogeneous formation within the right ventricle (RV) extending along the interventricular septum from the apex towards the tricuspid annulus, appearing to involve interventricular septum as well. According to the imaging characteristics the mass was suspected to be a liposarcoma (Figure A). With contrast echocardiography hypoechogenic formation in the RV on parasternal long-axis view could be visualized (Figure B). Due to previous history of malignancy PET scan was performed that revealed hypometabolic RV mass, suggesting a benign tumor, without any sign of metastasis. We decided for percutaneous biopsy that was done under intracardiac echocardiography (ICE) guidance using the view from the RV towards RV outflow tract (Figure C). Histology revealed proliferation of mature adipocytes, either orthotopic or multiplied (Figure D). To exclude well-differentiated liposarcoma FISH (fluorescent in situ hybridization) with amplification of MDM2 gene was undertaken, confirming benign lesion, most probably cardiac lipoma. It was concluded that the mass was an incidental finding, not related to the patient’s symptoms and not causing any functional disturbances; therefore surgical therapy could be avoided.

Conclusion
While echocardiography remains the first-line imaging modality, multimodality diagnostic approach is mandatory for evaluation and treatment decision of a newly-discovered cardiac mass. Histology provides definitive diagnosis and ICE could be helpful for guiding percutaneous biopsy, thus avoiding invasive open-heart procedures.
Figure. Cardiac CTA (A), contrast echocardiography (B), intracardiac echocardiography (C) and histologic specimen (D) of the right ventricular mass (arrows).
Abstract P1344 Figure.