bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1291 Are we ready for machine learning in HCM risk stratification?
Authors: Adamczak D M , Bednarski M , Rogala A , Antoniak M , Kiebalo T , Oko-Sarnowska Z 
Published: January 2020

Abstract

BACKGROUND
Hypertrophic cardiomyopathy (HCM) is a heart disease characterized by hypertrophy of the left ventricular myocardium. The disease is the most common cause of sudden cardiac death (SCD) in young people and competitive athletes due to fatal ventricular arrhythmias, but in most patients, however, HCM has a benign course. Therefore, it is of the utmost importance to properly evaluate patients and identify those who would benefit from a cardioverter-defibrillator (ICD) implantation. The HCM SCD-Risk Calculator is a useful tool for estimating the 5-year risk of SCD. Parameters included in the model at evaluation are: age, maximum left ventricular wall thickness, left atrial dimension, maximum gradient in left ventricular outflow tract, family history of SCD, non-sustained ventricular tachycardia and unexplained syncope. Patients’ risk of SCD is classified as low (&lt;4%), intermediate (4-&lt;6%) or high (≥6%). Those in the high-risk group should have an ICD implantation. It can also be considered in the intermediate-risk group. However, the calculator still needs improvement and machine learning (ML) has the potential to fulfill this task. ML algorithm creates a model for solving a specific problem without explicit programming - instead it relies only on available data - by discovering patterns and relations.

METHODS
252 HCM patients (aged 20-88 years, 49,6% were men) treated in our Department from 2005 to 2018, have been enrolled. The follow-up lasted 0-13 years (average: 3.8 years). SCD was defined as sudden cardiac arrest (SCA) or an appropriate ICD intervention. All parameters from HCM SCD-Risk Calculator have been obtained and the risk of SCD has been calculated for all patients during the first echocardiographic evaluation. ML model with variables from HCM SCD-Risk Calculator has been created. Both methods have been compared.

RESULTS
20 patients reached an SCD end-point. 1 patient died due to SCA and 19 had an appropriate ICD intervention. Among them, there were respectively 6, 7 and 7 patients in the low, intermediate and high-risk group of SCD. 1 patient, who died, had a low risk. The ML model correctly assessed the SCD event only in 1 patient. According to ML, the risk of SCD ≤2.07% was a negative predictor.

CONCLUSIONS
The study did not show an advantage of ML over HCM SCD-Risk Calculator. Because of the characteristic of the dataset (approximately the same number of features and observations), the selection of machine learning algorithms was limited. Best results (evaluated using LOOCV) were achieved with a decision tree. We expect that bigger dataset would allow improving model performance because of strong regularization need in the current setup.
P1293 Coronary artery flow velocity alteration by transthoracic echo in a group of young adult males
Authors: Sukhanova O , Zagatina A , Zhuravskaya N , Ivanov A V , Shmatov D 
Published: January 2020

Abstract

Funding Acknowledgements
university Grand

Background
Atherosclerosis is a chronic and progressive disease that causes high mortality primarily in persons over the age of forty. However, a lot of atherosclerosis cases are only discovered after a fatal cardiovascular event. Several techniques can be used to identify atherosclerosis when it is still in its subclinical stages and at ages before the symptoms of atherosclerosis became marked. The SCORE chart and other scores were developed for this purpose. However, the SCORE chart doesn’t cover the people under 40 years old. A significant portion of patients with a high risk of cardiovascular disease have major cardiac events before reaching 40 years of age. The aim of the study was to define subclinical coronary flow alteration in apparently healthy men between the ages of 30-39.

Methods
This is part of a study intended to facilitate risk estimation in apparently healthy persons between 30 and 39 years old with no documented cardiovascular disease. Seventy-two consecutive men (34 ± 3 years old) who were assumed healthy, were recruited into the study. A standard cardiology exam; analysis of blood lipids; basic transthoracic echocardiography examination with additional scans of the left main, left anterior descending, and circumflex arteries; and carotid ultrasound were performed.

Results
Among the study population there were eight obese patients (12.5%), twenty-two (22%) smokers, forty-eight (66%) had dyslipidaemias, and six (8%) had
a first-degree relative with known premature coronary or vascular events. All of them had a normal ejection fraction (65 ± 4%) and heart chamber sizes. The mean global longitudinal strain (GLS) was -19.3 ± 2%, myocardial mass index was 77 ± 12 g/m2, and intima-media thickness (IMT) was 0.74 ± 0.19 mm.
Intima-media thickening at standard site was found in twelve patients (17%, 95% CI 9-26%), atherosclerosis with pronounced plaques in carotid arteries was diagnosed in twenty-one man (29%, 95% CI 19-40%). The group with atherosclerotic plaques had a higher maximal velocity in coronary arteries (44 ± 16 vs. 33 ± 11 cm/s, p &lt; 0.002) compared to other patients. Ejection fraction (65 ± 5 vs. 65 ± 4 %, p = 0.93), myocardial mass index (81 ± 13 vs. 75 ± 12, g/m2 p = 0.053), and GLS (-19 ± 3 vs. -19 ± 2 %, p = 0.55) were similar. There was a significant correlation between IMT and maximal velocity in coronary arteries (r=-0.44, p &lt; 0.0005). Three patients of atherosclerotic group (14%, 95% CI 3-32%) had coronary flow velocity more than 68 cm/s corresponding significant coronary artery lesions.

Conclusion
There is a high prevalence of subclinical atherosclerosis among men between the ages of 30 and 39 in a population with a high risk of cardiovascular disease by SCORE chart. Coronary flow velocity assessment could be helpful for detection of coronary lesions in young adult patients with carotid plaques.
P1296 Effects of contact-to-balloon time on variations of the left ventricle global and regional function during hospitalization of STEMI patients: an echocardiographic study
Authors: Cammalleri V , Stelitano M , Muscoli S , Marsili G , Manzon W , Tavernese A , Monaco C , Zanin F , Uccello G , Bonanni M , Mauceri A , Macrini M , Di Landro A , Mollace R , Romeo F 
Published: January 2020

Abstract

Background
Ischemic time duration is one of the most important determinants of infarct size in patients with ST-segment elevation myocardial infarction (STEMI). An early reperfusion with percutaneous coronary intervention (PCI) therapy reduces the adverse events and mortality. It also influences the wall motion abnormalities and left ventricular ejection fraction (LVEF), which can be easily detected by a standard transthoracic echocardiogram (TTE).

Purpose
Aim of our study was to assess the immediate effects of an early percutaneous revascularization in STEMI patients on variations of the left ventricle (LV) global and regional function.

Methods
The study population consists of 141 consecutive patients with STEMI undergoing PCI from January to June 2018. The population was divided into two groups basing on first medical contact-to-balloon time (C2B), respectively ≤90 minutes and &gt;90 minutes. Cardiac biomarkers were obtained uniformly. A standard TTE was performed in all patients, at moment of in-hospital admission and at the time of discharge, recording the LV wall motion abnormalities and LVEF, using the wall motion score index (WMSI) and modified Simpson’s rule, respectively. Finally, we performed a sub-analysis in the group of patients who showed an improvement of the LVEF ≥10% at discharge.

Results
In both groups at baseline, patients suffered from a moderately reduced LVEF (41 ± 8.3% in ≤90 min group vs 40.97 ± 8.91% in &gt;90 min group, p = ns). A WMSI &gt;1 was recorded uniformly: 1.78 ± 0.39 in patients with C2B ≤90 min and 1.81 ± 0.40 in patients with C2B &gt;90 min, without significant differences between the two groups. At the time of discharge, a significant improvement of LVEF (from 41 ± 8% to 44 ± 9%, p = 0.013) and WMSI (from 1.78 ± 0.39 to 1.64 ± 0.38, p = 0.036) exclusively emerged in the ≤90 min group. Furthermore, we identified 37 patients who experienced, at the time of discharge, an improvement of the LVEF ≥10% compared to baseline values. In these patients the C2B time resulted significantly shorter, when compared with patients with LVEF improvement &lt;10%: 42 min (IQR 18.5-77.5) vs. 104 (IQR 48-176), p &lt; 0.0001. Additionally, these patients had lower significant levels of cardiac biomarkers. A significant improvement in WMSI was also observed in the ≥10% group (1,69 ± 0,41 vs 1,49 ± 0,41, p= 0.039).

Conclusion
Our study shows the immediate effects of an early revascularization. In particular, the duration of C2B time influences the recovery of ventricular function, in terms of ejection fraction and parietal kinetics. A standard TTE is a low cost and easily available examination, which may provide immediate results without impacting significantly on health costs.
P1312 Implications of a large atrial roof thrombus
Authors: Fountoulakis P , Hamodraka E , Siama A , Tsoukas A , Manolis A J 
Published: January 2020

Abstract

Funding Acknowledgements
No funding

Introduction
Rheumatic heart disease is the most common cause of mitral valve stenosis. Rheumatic valve disease presents a strong predisposing factor to intracardiac thrombi formation in the left atrium, particularly when there is a background of atrial fibrillation. The predominant location for thrombus creation is the left atrial appendage, due to its morphology, and rarely the free wall or roof of the left atrium. In either case, the presence of intracardiac thrombi in the left cardiac cavities poses a severe risk factor for systemic embolism which can prove detrimental for the patient leading to increased morbidity and mortality. Transesophageal echocardiography remains the gold standard for screening of the left atrium.

Case presentation
We present the case of a 72 year old woman who was admitted to the Emergency Department of our Hospital because of palpitations and progressive weakness over the last month. She had a known history of rheumatic mitral valve stenosis and chronic atrial fibrillation under standard anticoagulant treatment with acenocoumarol.
Methods - Results: On admission, the patient was hemodynamically stable without signs of heart failure. The electrocardiogram revealed atrial fibrillation with a ventricular rate of approximately 135 bpm. Chest X-Ray did not demonstrate any signs of pulmonary congestion. Blood tests were normal, except from a subtherapeutic INR 1.3. Transthoracic echocardiography depicted a suspicious large echogenous mass located on the posterior wall of the left atrium. Furthermore, there was severe mitral valve stenosis with calcification of the mitral annulus as well as reduced mobility of the leaflets (Mitral Valve Area ∼0.8 cm2, Mean gradient = 15 mmHg) and mild aortic valve stenosis. The left ventricle had normal dimensions and good overall systolic function. Systolic pulmonary pressure was estimated at 50 mmHg.
Transesophageal echocardiography confirmed the presence of a large echogenous mass (2,6 x 2,9 cm) located on the posterior wall of the left atrium between the right and left pulmonary veins as well as another mass at the left atrial appendage. Contrast echocardiography ensued, which revealed no absorption of the contrast medium by the mass thus suggesting a lesion with no vascularity, compatible with thrombus. Furthermore there was diffuse slow flow within the left atrium (smoke) indicating blood stasis. The patient was treated with a cardioselective beta blocker and combination of aspirin and acenocoumarol with a target INR of 2,5-3 and was referred for cardiothoracic consultation.
Conclusion/Discussion: We describe a rare case of moderate mitral stenosis with presence of a large thrombus with mobile parts in an unusual location. In this setting the indication for surgery (mitral valve replacement) is upgraded since there is increased risk of thrombus detachment and debilitating systemic embolism.
Abstract P1312 Figure.
P1314 A singular explanation of stroke in young adults
Authors: Campos I , Azevedo P , Costeira Pereira A , Salome N , Vieira C , Pereira V H , Costa Oliveira C , Marques Pires C , Medeiros P , Flores R , Mane F , Mare R , Marques J 
Published: January 2020

Abstract

INTRODUCTION
Although primary cardiac tumors are rare, papillary fibroelastoma (PFE) is the most common benign neoplasm of cardiac valvular structures. Because patients are often asymptomatic the true prevalence is unknown, being most commonly recognized given the evolution of higher-resolution imaging technology. The clinical presentation of PFEs can diverge between being asymptomatic to symptomatic based on the serious complications that can occur, such as acute valve dysfunction or embolization, giving rise to a wide variety of presenting features including neurologic events, acute coronary syndrome, and distal embolic events. The location on the mitral valve does not occur frequently, with rare cases reported in the literature. Here, we present an unusual case of a 32-year-old male with an acute stroke secondary to a PFE in the mitral valve.
CASE REPORT DESCRIPTION
A 32-year-old male patient with a history of crohn"s disease was admitted to our emergency department with a transient sudden-onset aphasia associated with a right hemiparesis. At admission, these symptoms had completely resolved. On further questioning, the patient described another episode of transient right hemiparesis in the last year. On physical examination, the patient"s vital signs were stable. The patient was awake, alert, and oriented with full Glasgow Coma Scale. There was no focal neurological deficit on neurological examination and his cardiovascular examination was normal with no murmurs, added sounds or carotid bruit. A cranial CT showed no signs of acute intracranial disease. Head MRI showed multiple areas of restricted diffusion in the left frontal lobe consistent with acute stroke. As part of the workup to determine the cause of his embolic stroke, a transthoracic echocardiogram and transoesophageal echocardiography were performed, showing a spherical and highly mobilemass attached on the downstream side of the anterior mitral valve leaflet of approximately 1.1 cm in diameter, suggesting the diagnosis of PFE. A bubble study was negative which out ruled patent foramen ovale. After completing the rest of the workup, it was determined that PFE was likely the cause of his stroke. Cardiothoracic surgery was consulted and the patient underwent surgical resection. Histology confirmed the diagnosis of PFE. After 5 years the patient remains asymptomatic, without new embolic events.
DISCUSSION AND CONCLUSIONS
We present a special case that illustrates the importance of diagnosing primary cardiac tumours in a young patient presenting with acute stroke with minimal or no risk factors.Although primary cardiac tumours are rare, diagnosis and treatment at an early stage may prevent serious complications and reduce the morbidity and mortality of embolic stroke.
P1337 Left ventricle outpouchings. Assesing diagnostic complexity
Authors: Blasco Turrion S , Marcos Fuentes L , Moruno Tirado A , Coserria Sanchez F , Valverde Perez I 
Published: January 2020

Abstract
Congenital left ventricle outpouchings (LVO) are a very rare condition that include left ventricle accessory chamber, left ventricle aneurysm (LVA), left ventricle diverticulum (LVD), double-chambered left ventricle and accessory left ventricle, without well-stablished diagnostic criteria. A recent article by Elaheh Malakan et al tries to show this difficulties and propose an algorithm to help define this different pathologies.
We present the case of a 26-day-old boy that was admitted to our Hospital with suspicion of dilated cardiomyopathy. In his physical exam a systolic murmur was detected, and his mother described tiredness during intakes and tachypnea. His ECG showed a sinus rhythm, with an 80º QRS axis. No signs of hypertrophy or dilated cavities were detected. As part of the study a TTE was performed, detecting a dilated left ventricle with a tract crossing the apical side from the LV lateral wall. The MRI confirmed the presence of an incomplete muscular septum from de LV lateral wall up to the apex encompassing the papillary muscles in the mid left ventricle, dividing the LV in two chambers with telediastolic size of 3.5x3cm and 2.6x2.4cm respectively. This secondary appendix, with a pseudoaneurysm morphology, distended in systole with a dyskinetic motion. Globally, the left ventricle was dilated and had mild systolic disfunction. The right cavities were morphological and functionally normal.
In this case initially a common dilated cardiomyopathy was suspected, being able to confirm the presence of a muscular tract crossing the mid left ventricle. The MRI described the image as an LV pseudoaneurysm, however the TTE images and the diagnostic algorithm proposed by Elaheh Malakan et al would include this case as a two-chamber left ventricle, denoting the still present difficulties in the diagnostic process in these cases, and its impact in their therapeutic approach.
Abstract P1337 Figure.
P1366 Low-flow, low-gradient severe aortic stenosis: might mitral regurgitation be a culprit?
Authors: Ferreira J , Beringuilho M , Faria D , Roque D , Ferreira H , Augusto J , Freitas A , Morais J , Morais C 
Published: January 2020

Abstract

Introduction
According to current guidelines, given a patient with low-gradient (aortic valve maximum velocity &lt; 4m/s and/or aortic valve mean gradient &lt;40mmHg), aortic valve area (AVA) &lt; 1cm2 and low-flow (stroke volume (SV) &lt; 35mL/min/m2), with preserved left ventricle function (ejection fraction (EF) ≥50%), an integrated approach for assessment of aortic stenosis severity is proposed. We aimed to investigate whether mitral regurgitation can play a role in those cases, possibly being responsible for low antegrade systolic flow.

Methods
We retrospectively analysed 121 consecutive transthoracic echocardiograms (TTEs) of patients with severe aortic stenosis, with AVA &lt; 1.0cm2 as assessed by continuity equation. Patients with low ejection fraction (&lt; 50%) were excluded. We therefore included 84 patients (females 53,6%, mean age 79,1+-10 years). Stroke volume was assessed by Doppler at the left ventricle outflow tract (LVOT). We then compared the prevalence of more than mild mitral regurgitation among patients with low-gradient and low-flow and the other patients.

Results
15 patients had both low-gradient, low-flow and preserved ejection fraction. There was a significant association regarding the presence of more than mild mitral regurgitation among these patients (p = 0.028, OR = 4.7, CI 95% 1.1-20.1). In these patients, it was also observed a higher prevalence of atrial fibrillation (p = 0.03, OR = 6.9, CI 95% 1.74-27.1), lower longitudinal systolic function of right ventricle as measured by TAPSE (16.6 vs 21.5mm, p = 0.028), and a tendency towards higher left atrial volume (113 vs 87mL, p = 0.06).

Conclusions
Given the findings that the prevalence of more than mild mitral regurgitation is higher in patients with severe aortic stenosis as assessed by AVA with both low-gradient, low-flow and preserved ejection fraction, we suggest that the presence of more than mild mitral regurgitation should be considered on the approach of aortic stenosis classification of these patients.
P1367 Prevalence of left ventricular hypertrophy, diastolic dysfunction and pulmonary hypertension in patients with severe aortic valve stenosis
Authors: Stoebe S , Kandels J , Tayal B , Laufs U , Sogaard P , Hagendorff A 
Published: January 2020

Abstract

Background
The prognostic and therapeutic consequences of aortic valve stenosis (AS) are incompletely described by the effective orifice area (EOA) and transvalvular flow velocities (AV-Vmax) in echocardiography. The aim of the study was to evaluate parameters of left ventricular hypertrophy (LVH), diastolic dysfunction and pulmonary artery hypertension (PAH) in severe AS.

Methods
Patients (n = 320) with severe AS (mean age 78 ± 9.5 years) defined by EOA &lt; 1cm2 and/or a AV-Vmax &gt; 4m/s were included. Left ventricular (LV) volumes and ejection fraction (EF), relative wall thickness (RWT), LV mass index (LVmassi), several parameters of diastolic function, e.g. E/A-ratio, e/e", indexed left atrial (LA) volumes (LAVI min. and max.) and systolic pulmonary artery pressure were assessed. Patients were grouped in four subgroups according to their mean pressure gradient (mPGAV) and indexed stroke volume (Low-Flow/Low-Gradient (LFLG), Normal-Flow/Low-Gradient (NFLG), Low-Flow/High-Gradient (LFHG) and Normal-Flow/High-Gradient (NFHG)).

Results
LVH was documented in 83%, diastolic dysfunction in 75% and PAH in 79% of all patients, whereas &gt; 50% exhibited pathological values for all three and 82% for at least two of these cardiac alterations. Further, in no patient normal ranges of all three cardiac alterations were observed. EOA (0.74 ± 0.18 vs 0.78 ± 0.17, p = 0.047) was lower and mPGAV (34.0 ± 16.6 vs 29.3 ± 14.1, p = 0.009) was higher in patients presenting all three cardiac alterations vs. patients presenting less than three cardiac alterations. Prevalences of diastolic dysfunction and LVH did not differ among AS subgroups (Fig.1/Tab. 1, p &gt; 0.05). In contrast, higher prevalence of PAH was observed in HG-AS (89%) compared to LG-AS (76%) (p = 0.02).

Conclusion
Severe AS is highly associated with LVH, diastolic dysfunction and PAH. This analysis sets the stage to determine the prognostic importance of the analyzed cardiac alterations in patients with severe AS.
Tab.1-Prevalence of cardiac alterations Parameters LFLG-AS (n = 135) NFLG-AS (n = 97) LFHG-AS (n = 21) NFHG-AS (n = 67) Relative wall thickness &gt; 0.42 121 (89%) 90 (92%) 19 (90%) 67 (100%) LVmass index &gt; 115 g/m2 (men), &gt; 95 g/m2 (women) 120 (88%) 84 (86%) 17 (81%) 62 (93%) e/e" &gt; 14 94 (70%) 56 (59%) 15 (71%) 41 (61%) Tricuspid regurgitation &gt; 2.8 m/s 95 (70%) 71 (75%) 16 (76%) 47 (70%) Increased LAP and diastolic dysfunction grade 2 or 3 103 (76%) 69 (73%) 17 (81%) 50 (75%)
Abstract P1367 Figure. Fig.1-Prevalence of cardiac alterations