bluuebunny/crossref_metadata_2025_split huggingface dataset:
P752 Mitral regurgitation in patients with severe aortic stenosis: role of valvular calcification in the persistence of mitral regurgitation after aortic valve replacement
Authors: Squeri A , Ferri A , Calvi S , Albertini A , Censi S , Conti R , Barbieri A 
Published: January 2020

Abstract

Introduction
mitral regurgitation is often associated with severe aortic stenosis but the indications for its correction at the time of aortic valve surgery are still unclear. Despite the indication for mitral valve repair or replacement in the case of severe secondary mitral regurgitation, many patients are left untreated. This is due to the common belief that secondary mitral regurgitation mostly improves after the aortic valve is treated.

Purpose
the aim of the study is to investigate the prevalence and distribution of mitral calcifications, their role in the development of mitral regurgitation and in its reduction after aortic valve replacement.

Methods
we reviewed all patient’s records who underwent aortic valve replacement for aortic stenosis at our institution from 12/2014 to 12/2016. Pre and post-operative echocardiograms were reviewed by experienced echocardiographer. Patients were then divided into 4 categories (functional, mild, moderate and severe calcification) on the basis of the presence, distribuition and severity of calcification on the mitral apparatus.

Results
at the end 651 patients were collected and analyzed. Mean age was 74yo. 334 (51,4%) of them were males. Most patients (63,1%) had only mild mitral regurgitation but 147 (22,6%) of them had moderate or severe mitral regurgitation. The presences of moderate or severe calcification of the mitral apparatus resulted to be a risk factor for the presence of mitral regurgitation associated with aortic stenosis as shown in Table 1. After surgical aortic valve replacement less than 21% of the patients showed a reduction of the degree of mitral regurgitation. We found no statistical difference between groups about mitral regurgitation changes after aortic valve replacement.

Conclusions
Mitral regurgitation is a common finding in patients with severe aortic stenosis and it’s prevalence is higher in patients with mitral calcifications. Few patients, however showed a reduction in the degree of mitral regurgitation after surgical aortic valve replacement with no difference related to the severity of annular or leaflets calcifications.
TABLE 1 Logistic regression for the presence of mitral regurgitation Mitral Regurgitation Change after Aortic Valve Replacement CALCIFICATION DEGREE OR C.I. 95% p Reduced p Unchanged p Increased p Functional 53(21%) 176(71%) 18(7%) Mild 1.244571 0.81 - 1.93 0.32 28(20%) 0.86 105(76%) 0.43 6(4%) 0.34 Moderate 1.637297 1.05 - 2.56 0.03* 25(17%) 0.41 109(76%) 0.34 9(6%) 0.86 Severe 2.369245 1.46 - 3.85 &lt;0.01* 29(25%) 0.48 78(68%) 0.67 7(6%) 0.86 OR= Odds Ratio; C.I.=Confidence Interval; Functional= no calcification; Mild, Moderate and Severe= degree of mitral annular and leaflets calcifications.
P798 Right atrial phasic function and correlation with right ventricular function in patients with reduced left ventricular ejection fraction and no pulmonary hypertension:insights from 3D echocardiography
Authors: Vijiiac A E , Muraru D , Jarjour F , Kupczynska K , Palermo C , Cecchetto A , Baritussio A , Aruta P , Dorobantu M , Badano L P 
Published: January 2020

Abstract

Background
The right atrium (RA) is a highly dynamic chamber with 3 mechanical functions (reservoir, conduit, booster pump) and prognostic implications in heart failure (HF) and pulmonary hypertension (PH). However, RA function and its interplay with the right ventricular (RV) performance in patients (pts) with reduced left ventricular ejection fraction (LVEF) and without PH remain to be clarified.

Methods
We used three-dimensional echocardiography to study 55 pts (61 ± 14 years, 43 men) with LVEF &lt; 40% no more than mild tricuspid regurgitation (TR), and maximum velocity of the TR jet &lt; 3 m/s. We measured the three-dimensional RA total, passive, active ejection volumes (EV) and the respective emptying fractions (EF). In addition, we compared RV volumes and ejection fraction (RVEF) between patients with normal and abnormal RA function.

Results
Mean LVEF was 30 ± 7%. Mean echo-derived pulmonary vascular resistance was 1.64 ± 0.54 Wood units. 28 pts (51%) had reduced RA reservoir function (total EF = 34 ± 9%), 34 pts (62%) had reduced RA conduit function (passive EF = 15 ± 4%), and 10 pts (18%) had reduced RA pump function (active EF = 11 ± 3%). Pts with reduced RA reservoir function showed larger RV end-systolic volume (RVESV 124 ± 48ml vs. 90 ± 32ml; p = 0.004) and lower RVEF (38 ± 8% vs. 46 ± 6%; p &lt; 0.001) than pts with normal RA function. Pts with reduced RA conduit function showed smaller RV stroke volume (RVSV 65 ± 19 ml vs. 80 ± 22ml; p = 0.009). Pts with impaired RA pump function showed larger RVESV (142 ± 45ml vs. 99 ± 41ml; p = 0.02) and lower RVEF (36 ± 6% vs. 43 ± 8%; p = 0.006).
RVESV was positively correlated with total (r2 = 0.47, p &lt; 0.001), passive (r2 = 0.29, p = 0.03) and active (r2 = 0.39, p = 0.003) RAEV, while it was negatively correlated with total (r2=-0.41, p = 0.002), passive (r2=-0.34, p = 0.01) and active (r2=-0.31, p = 0.02) RAEF. RVSV showed a positive correlation with both total (r2 = 0.4, p = 0.002) and passive (r2 = 0.41, p = 0.002) RAEV. Finally, RVEF was positively correlated with total (r2 = 0.51, p &lt; 0.001), passive (r2 = 0.47, p &lt; 0.001), and active (r2 = 0.36, p = 0.007) RAEF.

Conclusions
RA dysfunction is not uncommon in pts with reduced LVEF, even in the absence of PH. In these pts, RA function is associated with significant changes in RV function. The RA acts as a dynamic modulator of RV pump function by redistributing RV filling and ejection force among reservoir, conduit and pump functions in the setting of altered hemodynamics. The clinical and prognostic significance of RA function in pts with reduced LVEF warrant further studies.
P801 A virtual reality tool for measurement of 3D echocardiographic images
Authors: Wheeler G , Deng S , Pushparajah K , Schnabel J A , Simpson J M , Gomez A 
Published: January 2020

Abstract

Funding Acknowledgements
Work supported by the NIHR i4i funded 3D Heart project [II-LA-0716-20001]
Background/Introduction
Cardiac measurements are clinically important and are invariably required in any clinical imaging software. The advent of Virtual Reality (VR) imaging systems is introducing intuitive and natural ways of visualising and interrogating echo images in a 3D environment. The 3D nature of the VR experience requires purpose-designed measurement tools, which may benefit from better depth perception and easier localisation of 3D landmarks.

Purpose
Comparison of the accuracy of our VR 3D linear measurement system to commercial clinical imaging software, using both multi-plane reformatting (MPR) and volume rendered views.

Method
Each virtual reality measurement was made by selecting two points in 3D, directly in the volume rendering. The participants could edit the measurements until satisfied with their accuracy. 5 expert clinicians carried out 26 measurements each - 6 measurements on a calibration phantom, and 5 anatomically meaningful measurements (for example: aortic valve, left atrium, left ventricle) on 4 datasets. The same measurements were made by all participants using our VR system (volume rendering), Philips" QLAB (MPR) and Tomtec (volume rendering). The frame number and view (for example: long axis) were consistent for each measurement across the 3 packages used.
Results
Preliminary results are shown in the figure below. MPR measurements made on Philips’ QLAB are used as a reference, as this is the most commonly used software for this purpose at our institution. We compare measurements made in Tomtec and VR, both using volume rendering, using Bland-Altman plots. Each measurement data point is the mean of all participants measurements for each dataset/measurement combination. The mean of the measurement differences for the VR system is closer to zero, compared to Tomtec. However, the variation of these differences is larger for the VR system than for Tomtec.

Conclusion
Our preliminary results suggest that the accuracy of line measurements made using volume rendering within a VR system is comparable to measurements made using approved software packages for volume rendering displayed on a 2D screen. This shows promise for more complex interrogation methods.
Abstract P801 Figure. Comparison of Tomtec and VR with QLAB
P804 Heart complication of chikungunya fever: ecocardiographic evaluation of late effects
Authors: Del Castillo J M , Albuquerque E S , Mazzarollo C , Oliveira K B , Araujo D C L , Sena A D M , Alencar M P C , Brindeiro-Filho D F , Silveira C A M 
Published: January 2020

Abstract

Introduction
Chicungunya fever, epidemic caused by Alphavirus (CHIKV) transmitted by mosquitoes of the genus Aedes, is characterized by highly debilitating joint pain and can cause atypical cardiac complications in 10% of patients. CHIKV produces direct damage to myofibrils (inflammation and infiltration) and secondary damage due to hypersensitivity and necrosis.

Objective
To evaluate, by echocardiography, the chronic cardiac alterations of the CHIKV infection.

Methods
Thirty-two patients were studied (mean age was 56 ± 14 years, 17 females) with CHIKV-confirmed infection and signs of cardiac involvement between 5 and 25 months of evolution. The dimensions and function of the ventricles were measured by two-dimensional and Doppler echocardiography. The global longitudinal strain (GLS) of the left ventricle (LV) and left atrial longitudinal strain (LALS) were evaluated. Patients were divided into Group A, with duration of CHIKV infection shorter than 12 months (12 patients) and Group B, with disease duration equal to or greater than 12 months (20 patients). Comparative statistical data were considered significant when p &lt;0.05.

Results
The diameters and volumes of LV, Left atrium (LA), right ventricular (RV) diameter and RV wall thickness were increased in Group B. LV ejection fraction (EF) was lower in Group B patients. The GLS was decreased in both Groups and the regression equation with EF were significant (r = 0.74, r ² = 0.55, p &lt;0.00001). LALS was decreased in Group B. Diastolic dysfunction was predominantly grade 1 in Group A and restrictive in Group B. Segmental alteration (akinesia, dyskinesia) occurred in 7 patients. No patient had a history of precordial pain or coronary disease, nor clear signs of myocardial infarction on the ECG. Seven patients were hypertensive and four were diabetic. Eccentric LV hypertrophy and concentric remodeling of the walls were observed in 14 patients. Two patients had atrial fibrillation. Nine patients presented other types of arrhythmia, mainly ventricular extrasystoles.

Conclusion
Decreased EF of LV and SLG was observed in most patients with chronic CHIKV infection. In the first 12 months of evolution, the dimensions of the LV were normal, but after one year, most of the patients had dilatation of the cavity. LV concentric remodeling was more frequent in the first year and eccentric hypertrophy after one year of evolution. Segmental changes were observed in almost a quarter of the cases, as well as a high incidence of arrhythmias. All these findings suggest the progressive nature of the disease. Echocardiography plays an important role in the detection of cardiovascular alterations caused by Chicungunya fever and should be used after confirmation of infection, to initiate appropriate treatment already in the acute phase, which will probably minimize the deleterious effects of disease.
P818 Association between baseline left ventricular longitudinal strain and follow-up left ventricular ejection fraction in patients with dilated cardiomyopathy
Authors: Jung I H , Byun Y S , Park J H 
Published: January 2020

Abstract

Funding Acknowledgements
no

Background
Left ventricular global longitudinal strain (LV GLS) offers sensitive and reproducible measurement of myocardial dysfunction. The authors sought to evaluate whether LV GLS at the time of diagnosis may predict LV reverse remodeling (LVRR) in DCM patients with sinus rhythm and also investigate the relationship between baseline LV GLS and follow-up LVEF.

Methods
We enrolled patients with DCM who had been initially diagnosed, evaluated, and followed at our institute.

Results
During the mean follow-up duration of 37.3 ± 21.7 months, LVRR occurred in 28% of patients (n = 45) within 14.7 ± 10.0 months of medical therapy. The initial LV ejection fraction (LVEF) of patients who recovered LV function was 26.1 ± 7.9% and was not different from the value of 27.1 ± 7.4% (p = 0.49) of those who did not recover. There was a moderate and highly significant correlation between baseline LV GLS and follow-up LVEF (r = 0.717; p &lt;0.001).

Conclusion
There was a significant correlation between baseline LV GLS and follow-up LVEF in this population.
Baseline Follow-up Difference (95% CI) p-value All patients (n = 160) LVEDDI, mm/m2 35.6 ± 6.6 35.6 ± 6.6 -2.7 (-3.4 to -2.0) &lt;0.001 LVESDI, mm/m2 30.3 ± 6.1 26.6 ± 6.6 -3.7 (-4.6 to -2.8) &lt;0.001 LVEDVI, mL/m2 95.0 ± 30.7 74.3 ± 30.2 -20.7 (-25.6 to -15.8) &lt;0.001 LVESVI, mL/m2 70.0 ± 24.8 50.2 ± 26.8 -19.8 (-24.2 to -15.4) &lt;0.001 LVEF, % 26.8 ± 7.5 33.9 ± 12.6 7.2 (5.2 to 9.2) &lt;0.001 LV GLS (-%) 9.2 ± 3.1 11.0 ± 4.8 1.8 (1.3 to 2.2) &lt;0.001 Patients without LVRR (n = 115) LVEDDI, mm/m2 34.9 ± 6.8 34.1 ± 6.8 -0.8 (-1.3 to -0.3) 0.002 LVESDI, mm/m2 29.5 ± 6.1 28.4 ± 6.4 -1.4 (-1.8 to -0.4) 0.002 LVEDVI, mL/m2 92.0 ± 30.5 83.4 ± 29.8 -8.6 (-12.4 to -4.8) &lt;0.001 LVESVI, mL/m2 67.1 ± 24.4 59.5 ± 25.3 -7.6 (-10.9 to -4.3) &lt;0.001 LVEF, % 27.1 ± 7.4 27.8 ± 7.4 0.7 (-0.2 to 1.6) 0.126 LV GLS (-%) 8.2 ± 2.9 8.7 ± 3.2 0.5 (0.7 to 3.6) &lt;0.001 Patients with LVRR (n = 45) LVEDDI, mm/m2 37.4 ± 5.5 29.8 ± 5.2 -7.5 (-9.1 to -6.0) &lt;0.001 LVESDI, mm/m2 32.2 ± 5.7 21.9 ± 4.4 -10.3 (-11.9 to -8.6) &lt;0.001 LVEDVI, mL/m2 102.7 ± 30.2 51.1 ± 15.0 -51.7 (-61.6 to -41.7) &lt;0.001 LVESVI, mL/m2 77.3 ± 24.5 26.4 ± 11.3 -50.9 (-58.8 to -43.1) &lt;0.001 LVEF, % 26.1 ± 7.9 49.4 ± 9.5 23.9 (20.4 to 27.5) &lt;0.001 LV GLS (-%) 11.9 ± 1.6 16.9 ± 2.7 5.1 (4.2 to 5.9) &lt;0.001 Baseline and Follow-up LV Functional Echocardiographic Data
Abstract P818 Figure.
P820 Echocardiographic assessment of late-onset right ventricular dysfunction following continuous-flow left ventricular assist device
Authors: Ruiz Cano M , Ramazyan L , Morshuis M , Schoenbrodt M , Lauenroth V , Gummert J , Paluszkiewicz L 
Published: January 2020

Abstract

Early right ventricular failure (RVF) remains one of the main factors associated with early mortality following continuous-flow left ventricular assist device (LVAD) implantation. However, late-onset RVF (LoRVF) has emerged as an increasing concern, but little is known about its incidence rate and the value of transthoracic echocardiography (TTE) to predict this complication during the LVAD follow-up.

Methods and results
We retrospectively analyzed the 1-year hemodynamic and clinical data from patients (p) that, between 2016 and 2018, underwent a right heart catheterization (RHC) after LVAD as bridge to transplantation (BTT). 73 p (84% males, 52 ± 12 years, 49% Heart Ware LVAD, 51% Heart Mate 3 LVAD), out of 187 LVAD implants, were studied. According to the Intermacs definition, LoRVF was assigned if the RHC showed a central venous pressure (CVP)&gt;18 mmHg with cardiac index&lt; 2.3 L/min/m2. Isolated LoRVF was assigned if LoRVF was present in the absence of elevated pulmonary capillary wedge pressure (PCWP) ≤15 mmHg. TTE was performed at the time of the RHC and the following parameters were obtained: parasternal long-axis left ventricular end diastolic diameter (LVEDD), basal (RVED1) and mid-cavity (EDRV2) end diastolic RV linear dimension in 4 chamber view, severity of tricuspid regurgitation (TR) and of mitral regurgitation (MR), tricuspid annular plane systolic excursion (TAPSE), and the position of the LVAD inflow cannula (IC).
LoRVF was present in 16 p (22% of the studied population): 12 p (75%) presented a PCWP &gt; 15 mmHg and 4 p (25%) presented isolated LoRVF. Symptoms and signs of venous congestion were present in 2/3 of the p with LoRVF and elevated PCWP. On the other hand, all the p with isolated LoRVF presented severe signs of venous congestion, and 50% of them could be successfully transplanted in high urgent status. P with LoRVF showed more dilated RV (RVED1 43.8 ± 9.2 vs 37.7 ± 5.3 mm, p = 0.02) and lower TAPSE (11 ± 2 vs 14 ± 2 mm p &lt; 0.01) than the no LoRVF group. RVED1 showed a weak significant correlation with CVP (R = 0.3, p = 0.02). On the other hand, the presence of an elevated PCWP was not related to etiology of the cardiomyopathy, type and speed of LVAD, position of the IC, LVEDD, nor the presence of MR &gt; mild.

Conclusion
LoRVF is a frequent complication during LVAD support as BTT and most of the cases are associated with persistent elevated PCWP. Isolated LoRVF, which is not associated with high PCWP, has a bad prognosis. RV evaluation with TTE during the clinical follow-up can be useful to detect LoRVF. However a persistent elevated PCWP is not associated with echocardiographic signs of incomplete unloading of the LV by the LVAD.
P839 The lucky unlucky patient: a case report
Authors: Habjan S , Cantisani D , Scarfo` I S , Avitabile V , Semeraro G , Cicchini L , La Canna G 
Published: January 2020

Abstract

Introduction
Carcinoid tumors are rare neuroendocrine malignancies arising from the neural crest amine precursor uptake decarboxylation cells and are most commonly (90%) located in the gastrointestinal system, the most malignant arising from the ileum. Approximately 50% of patients with carcinoid syndrome will develop carcinoid heart disease, which is commonly characterized by the thickening and retraction of the tricuspid ± the pulmonary valves resulting in significant regurgitation ± stenosis. Hepatic metastasis must be present for the carcinoid heart disease to develop. In order to develop left-sided heart valve lesions, communication between the left and right heart chambers must be present.

Case presentation
A 50-year-old female patient with a known neuroendocrine tumor of the ileum with hepatic and peritoneal metastasis presented at our facility for evaluation of the heart valves. She was diagnosed with the neuroendocrine tumor in 2017, a resection of the intestinal ileocecal segment and peritoneal nodules was done in the same year (stadium pT3N1M1b ki 67 2%), the tumor was angio and neuroinvasive. The disease was treated with somatostatin analogues with minimal regression of the disease. She started peptide receptor radionuclide therapy and completed 3 cycles. In October 2018 an increment of one of the hepatic lesions was documented, with other hepatic lesions remaining of stable dimensions. Due to the recent appearance of dyspnea in mild to moderate physical activities she was sent to our facility for echocardiography.
The transthoracic and transesophageal echocardiography revealed severe tricuspid regurgitation with mild stenosis (tricuspid anatomic area 3.5 cm², max gradient 7 mmHg, mean gradient 4 mmHg) caused by thickened and retracted cusps with a significant coaptation deficit. Severe stenosis and insufficiency of the pulmonary valve was also noted (maximum gradient 22 mmHg, mean gradient 15 mmHg, pulmonary valve area 0.5 cm²), with a rapid deceleration regurgitation jet limited to protodiastole, caused by thickened and retracted pulmonary valve leaflets. The interatrial septum exhibited an aneurysm with a patent foramen ovale (PFO) and mild left-to-right shunt. Despite the shunt left-sided heart valves were not affected, therefore we recommended a replacement of the tricuspid and pulmonary valves with an intraoperative closure of PFO and intraoperative verification of the efficacy of the surgical closure.

Conclusion
Carcinoid heart disease is an important cardiac complication of the neuroendocrine neoplasms. Communication between the right and left heart chambers (for example a PFO) must be present for the development of left heart valve lesions. Our patient had a PFO with a mild left to right shunt, but fortunately no left sided lesions were found.
Abstract P839 Figure. Carcinoid heart disease
P867 Mitral stenosis: from mild to severe in less than a year
Authors: Ugedo Alzaga K , Candina R , Lambarri A , Castellanos M , Aurrekoetxea G , Bravo I , Codina M , Manzanal A , Garcia N , Ramirez-Escudero G , Ruiz L , Ormaetxe J M 
Published: January 2020

Abstract
We report the case of an 82-year-old woman, with personal history of hypertension, diabetes mellitus, dyslipemia and permanent atrial fibrillation. In 2013 aortic valve substitution surgery was performed with a mechanic prosthetic valve. In her last echocardiogram in May 2018 a mild double mitral lesion was detected, with a normal aortic valve functioning.
In March of 2019 she was admitted in hospital with symptoms of heart failure and 38ºC fever.
A transthoracic echocardiogram was performed, which revealed a vegetation in the native mitral valve that caused a severe mitral stenosis (area 0.64 cm2). In blood cultures Streptococcus gallolyticycus was isolated.
In this situation, a tranesophagical echocardiogram was performed, which confirmed the diagnosis of an infective endocarditis in the native mitral valve. It also showed spontaneous echocontrast as well as a thrombus in the left atrial appendage, despite anticoagulant medication.
Given these findings, antibiotic therapy was initiated and surgery programmed. Substitution of the native mitral valve for a biological prosthesis was made. In the transthoracic echocardiographic control the prosthesis was normal functioning. A colonoscopy was performed taking into account the strong association between Streptococcus gallolyticus and colonic lesions, which showed no abnormal findings. At the discharge the patient had no signs or symptoms suggestive of heart failure or infection.
Streptococcus gallolytycus is included in the D group of Streptococci. Among hospitalized patients, this group accounts for approximately 5% of streptococcal bloodstream isolates. For humans, the gastrointestinal tract is the most frequent entry point, other potential sources include the hepatobiliary tree and the urinary tract. Clinical manifestations include bacteremia and endocarditis, which is usually highly destructive and frequently bivalvular. Bone infection, meningitis or peritonitis can also be present. Due to the frequent association between this microorganism and colonic neoplasm, colonoscopy is necessary to dismiss pathological findings. Typically D Streptococci can be treated with penicillins, ceftriaxone, carbapenems, vancomycin, daptomycin, and linezolid. The preferred regimen for streptococcal prosthetic valve endocarditis includes a beta-lactam combined with an aminoglycoside, to achieve synergistic effect.
Abstract P867 Figure. Mitral stenosis