bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1768 The value of global longitudinal strain in non-alcoholic steatohepatitis-associated cirrhosis
Authors: Dimitroglou Y , Aggeli C , Alexopoulou A , Alexopoulos T , Nitsa A , Apostolou I , Patsourakos D , Vasilieva L , Dourakis S P , Tousoulis D 
Published: January 2020

Abstract

Introduction
Non-alcoholic steatohepatitis (NASH) in patients with metabolic syndrome is a common cause of cirrhosis and has been associated with increased cardiovascular mortality. In patients with liver cirrhosis systolic or diastolic dysfunction can be observed and is independent of the cirrhosis etiology. Only few studies using newer echocardiography indices such as Global Longitudinal Strain (GLS) have been published in cirrhotic patients.

Purpose
To evaluate GLS in patients with NASH cirrhosis when compared to other etiologies.

Methods
A total of consecutive 36 cirrhotic patients aged 18-70 were included in our study. Standard speckle-tracking software was used for offline analysis of standard apical views and GLS was calculated. Stroke Volume Index (SVI) was calculated with the Simpson method and a standard 2D, Doppler and Tissue Doppler examination was performed in all patients.

Results
Median age of the study population was 58 (IQR 50-64) years, 78% were male and 17% had ascites. Cirrhosis was considered decompensated in 21 (58%) of patients. The 28%, 42% and 19% had NASH-associated, alcoholic and viral etiology of cirrhosis, respectively. Median ejection fraction (EF) was 60% (IQR: 57%; 65%) and GLS was -21.1% (-19.7%; -23.1%) in the total population. Absolute value of GLS was lower in patients with NASH cirrhosis compared to other etiologies (p = 0.009) (figure 1). EF, SVI, left atrial volume index (LAVI), E/e’ ratio and mitral annular velocity (e’) did not differ significantly between those with NASH associated cirrhosis and the rest. GLS values were significantly correlated with EF (r=-0.588, p = 0.002), SVI (r=-0.469, p = 0.016) and BNP levels (r=-0.571, p = 0.007), but not with age, left ventricular end diastolic volume, left atrial volume index, E/e’, mitral annular velocity and blood pressure. According to a multivariable linear regression model, NASH etiology [B = 2.1 (0.6; 3.7), p = 0.008)] and EF (per 10% increase) [B=-1.7 (-3.3; -0.2), p = 0.03)] were the only independent factors associated with GLS values in cirrhotic patients.

Conclusions
GLS values are within normal limits in cirrhotic patients but seem to be affected in patients with NASH associated cirrhosis. Further studies are needed to assess the prognostic implications of this finding.
Abstract P1768 Figure 1
P1771 Gender differences of the blood pressure effects on early changes of left ventricle mechanics in untreated hypertension
Authors: Tsai W C , Tsai H R , Huang M S , Lee W H 
Published: January 2020

Abstract

Background
Left ventricular (LV) diastolic dyssynchrony and global and layer-specific strain can be used for evaluation of early myocardial changes in hypertension. We tried to investigate the gender differences in these early changes in untreated uncomplicated hypertension.

Methods
This study included 43 consecutive patients (mean age 51.3 ±12.5 years, 56% men) with newly diagnosed hypertension from an out-patient clinic. All subjects were free of complications including renal dysfunction, LV hypertrophy, and diabetes. Comprehensive transthoracic echocardiography (E9, GE, USA) was conducted before treatment of hypertension. Diastolic and systolic parameters were measured by two-dimension (2D), Doppler, tissue Doppler imaging and 2D speckle tracking echocardiography (STE). The time-to-peak early diastolic myocardial annulus velocity (Te) at 6 LV segments from apical-4-chamber, apical-2-chamber and apical-3-chamber views were measured with reference to the QRS complex. The time to peak early diastolic strain rate (TDSr), global longitudinal strain (GLS), layer-specific longitudinal strain included sub-epicardial strain (EpiLS) and sub-endocardial strain (EndLS) were measured from 18 LV segments by STE. Diastolic dyssynchrony parameters were defined as the standard deviation (SD) of Te of all LV segments (Te-SD), SD of TDSr of 18 LV segments (TDSr-SD), and the maximal difference between any two TDSr of the 18 LV segments (MaxD-TDSr).

Results
There were no differences between men (56%) and women (44%) regarding age, initial blood pressure, hypertension duration, LV mass index, LV ejection fraction, and early mitral velocity to average early annulus velocity ratio. Regarding diastolic dyssynchrony parameters, men were significantly higher than women including Te-SD (22.3 ± 13.8 vs. 14.7 ± 4.2 ms; p = 0.016), TDSrSD (46.0 ± 13.3 vs. 35.3 ± 11.4 ±ms; p = 0.008), and MaxD-TDSr (162.0 ± 40.3 vs. 128.1 ± 50.7 ms; p = 0.019). Men also had worse GLS (-17.6 ± 1.9 vs. -19.5 ± 2.5 %; p = 0.007), EpiLS (-15.1 ± 1.7 vs. -17.0 ± 2.3, p = 0.003), and EndLS (-20.5 ± 2.2 vs. -22.4 ± 2.8 %; p = 0.018) than women. After multivariate analysis controlling age, systolic blood pressure, and LV mass index, TeSD (p = 0.039), TDSrSD (p = 0.018), MaxD-TDSr (p = 0.035) were still significantly higher than women. GLS (p = 0.046), and EpiLS (p = 0.025) were still worse in men.

Conclusion
In the same age, blood pressure, hypertension duration and LV mass index, men have more diastolic dyssynchrony and worse myocardial strain in untreated hypertension.
P252 Incidental finding of a chronic left ventricular pseudoaneurysm years after surgical aortic valve replacement
Authors: Klappacher G , Beitzke D 
Published: January 2020

Abstract

Case presentation
A 35-years old female was referred to our outpatient clinic with unclear thoracic pain and dyspnea. Clinical chemistry testing was unremarkable. Electrocardiography (ECG) showed T-wave inversion in the anterior-lateral leads. Chest X-ray displayed an oval bulge on the left border of the heart. The physical exam revealed a systolic murmur on top of the closing click sound of a mechanical aortic valve prothesis which had been implanted nine years ago. Since that time, the patient had not had regular checkups and the actual consultation was motivated by her aggravating symptoms only.
Findings. In transthoracic echocardiography, the mechanical aortic valve prothesis exhibited an acceptable peak velocity of 2.7 m/s with a mean gradient of 18 mm Hg and only mild paravalvular regurgitation. The native mitral and tricuspid valves were functionally and morphologically normal. Left and right ventricle were of normal systolic and diastolic function and normal size. No signs of pericardial effusion were detected. However, a big (40x22mm) saccular structure with a narrow (10 mm) neck was visible at the apex of the left ventricle, see left panel of figure. At the neck, a bidirectional flow between the saccular structure and the left ventricle was detected with a peak velocity of 2,5 m/sec indicating the presence of a pseudoaneurysm. Its linings were calcified and free of discernable thrombus formation, although the flow inside was turbulent as evidenced in the contrast echocardiogram, see right panel of figure. Subsequently, CT-imaging confirmed the diagnosis and surgical resection of the pseudoaneurysm was successfully performed 10 days later. The surgeon noted that the walls of the resected cavity contained thrombotic masses despite respective negative findings on CT and echo. The postoperative course was uneventful, and the patient was discharged in good condition with normal left and right ventricular function and no regional left ventricular wall abnormalities. A year later, she was however re-admitted with prosthetic aortic valve stenosis due to thrombus formation on one the leaflets in the second trimester of a pregnancy.

Discussion
This is an exceptional case of chronic left ventricular pseudoaneurysm following aortic valve replacement. Since the patient had no history of myocardial infarction or of other potential causes that could explain the formation of a pseudoaneurysm, it is likely to be a remnant of venting the left ventricle during the original surgical procedure. The patient had been unattended and asymptomatic for several years which allowed chronification as indicated by the calcifications of the inner linings. Still, immediate surgical repair was mandatory due to the high risk of rupture and thromboembolism.
Abstract P252 Figure.
P1776 Longitudinal change of regional left ventricular deformation by 2D speckle tracking for chemotherapy-induced cardiotoxicity in patients with breast cancer
Authors: Fujiwara J , Nochioka K N , Sugimura K S , Terui Y T , Sato H S , Tada H T , Ota H O , Funamizu Y F , Miki T M , Saijo Y S , Takase K T , Ishida T I , Shimokawa H S 
Published: January 2020

Abstract

Funding Acknowledgements
Japan Agency for Medical Research and Development, Japan Heart Foundation Research Grant

Background
In breast cancer patients, chemotherapy-induced cardiotoxicity (CIC) may affect deformation in left ventricle segmentation differently over time.

Purpose
To evaluate longitudinal change of regional LV deformation caused by CIC in patients with breast cancer by 2D speckle tracking echocardiography (STE).

Methods
From 2017 to 2019, we enrolled 21 women with breast cancer and followed with continuous echocardiographic examination at enrollment (before chemotherapy), 3 months, 6 months, 9 months, and 12 months after chemotherapy at our hospital. We assessed conventional 2D echocardiographic indices and regional LV deformation analyzing longitudinal strain (LS), circumferential strain (CS), and radial strain (RS) by 2D STE.

Results
During the follow-period, there was no change in BNP (12.3 at baseline vs. 14.7 at 3 months vs. 16.6 at 6 months vs 18.3 at 9 months vs 10.9 pg/ml at 12 months, P = 0.96) and LVEF (62.2 vs. 62.0 vs. 61.2 vs 61.1 vs 62.9%, P = 0.84). However, significant decreases were observed in GLS (-20.3 vs. -19.0 vs. -17.9 vs -17.1 vs -17.7%, P &lt; 0.01), and Troponin T (0.006 vs. 0.018 vs. 0.015 vs 0.009 vs 0.007 ng/ml, P &lt; 0.01) after chemotherapy while there were no difference in global CS (-30.3 vs. - 29.1 vs. -27.0 vs -26.7 vs -28.0%, P = 0.15) and RS (46.8 vs. 47.9 vs. 49.6 vs 42.4 vs 46.3%, P = 0.17). When assessing regional deformation, we observed significant decrease in mid-inferoseptal region LS, mid-anterolateral region LS, mid-anterior region LS and apical-inferior region LS (Figure 1A). Of note, CS was impaired in basal- anterolateral region and mid-anteroseptal region (Figure 1B). However, none of regional RS showed significant difference after chemotherapy.

Conclusion
These results suggest that BNP and LVEF may not be ideal to detect CIC at early phase, and impaired GLS and increased Troponin T between 3 and 6 months after treatment may be initial signs by CIC. Longitudinal change of regional deformation implied that Mid-wall segmentation was vulnerable by chemotherapy more than other segmentations.
Abstract P1776 Figure 1
P1791 Outcome prediction with regional wall motion abnormalities during stress echocardiography
Authors: Zagatina A , Ciampi Q , Cortigiani L , Gaibazzi N , Djordjevic-Dikic A , Borguezan Daros C , Wierzbowska-Drabik K , Kasprzak J D , Boshchenko A , Vrublevsky A , Zhuravskaya N , Dekleva M , Lattanzi F , Carpeggiani C , Picano E 
Published: January 2020

Abstract

OnBehalf
Stress Echo 2020 study group of the Italian Society of Cardiovascular Imaging

Background
Over the last 3 decades, we observed a progressive decline in the prognostic value of a negative stress echo (SE) test based on regional wall motion abnormalities (RWMA), likely reflecting both an increase in risk in patients (older and more often diabetics) as well as a potential decrease in test performance due to concomitant anti-ischemic therapy.

Aim
To assess the value of SE in predicting outcome in contemporary populations

Methods
From September 2016 to December 2018, we enrolled 1848 patients (age 63 ± 11 years; 1121 males, 60%) with known or suspected coronary artery disease and/or heart failure evaluated with SE (exercise in 543, dipyridamole in 1184, adenosine in 10, dobutamine in 43) in 9 quality-controlled centers of 6 countries. Wall motion score index (WMSI) was evaluated at rest and peak stress (17-segment model, from 1 = normal-hyperkinetic to 4 = dyskinetic).All patients were followed-up for a median of 16 months.
Results WMSI was 1.09 ± 0.23 at rest and increased during stress (1.17 ± 0.32, p&lt;.001). At individual patient analysis, inducible ischemia with RWMA was present in 352 pts (18.8%). At follow-up, there were 218 events: 22 deaths, 22 non-fatal myocardial infarctions, 62 hospital admissions for acute heart failures, and 112 late (&gt;3 months from SE) myocardial revascularizations. Multivariable analysis identified stress-induced RWMA (Hazard Ratio 2.754, 95% Confidence Intervals: 2.053-3.963, p&lt;.0.001) as an independent predictor of events. Kaplan-Meier curves showed progressively worsening event-free survival for 1247 pts with normal (WMSI = 1.0), 298 pts with mildly (1.05-1.39), 250 pts with moderately (1.4-1.99) or 73 pts with severely (&gt;2.0) abnormal peak WMSI: see figure. In patients with negative SE, event-rate was 1.4% per year considering hard events (death and myocardial infarction) and 0.8 % per year considering only death.
Conclusion RWMA show risk stratification capability in contemporary patients referred to SE testing. The higher the peak WMSI, and the worse the prognosis. Nevertheless, the positivity rate is low (&lt; 20%) and patients with normal baseline and stress function still have a significant event rate. A more comprehensive risk assessment with other parameters is warranted
Abstract P1791 Figure. Survival curves and peak WMSI
P1802 Prevalence and prognostic significance of pulmonary artery aneurysms in patients with pulmonary artery hypertension
Authors: Sakata K , Mitsuda H , Ito J , Isaka A , Furuya M , Minamishima T , Matsushita K , Soejima K 
Published: January 2020

Abstract

Background
Pulmonary artery aneurysm (PAA) occurs in some patients with pulmonary arterial hypertension (PAH) and can be accompanied by various complications.

Objective
The aim of the this study is to evaluate the characteristics of cardiac dysfunction and the prognostic impact of PAA by analysing the outcome of patients with PAH complicated by PAA.

Methods
We performed echocardiography and right-heart catheterization in 130 PAH patients. We measured the maximum dimensions of the main pulmonary artery (MPA) trunk. We evaluated the right ventricular (RV) function and the five-year prognosis of patients with PAA.

Results
The maximum MPA trunk diameter of &gt;40 mm by echocardiography was defined as PAA. PAA appeared in 32 of the 130 PAH patients (24.6%: Group PAA), other 98 patients were defined as Group non-PAA. Systolic pulmonary artery pressure (76 ±18 vs. 61 ± 21 mmHg, P = 0.0008) and mean right atrial pressure (10.0 ± 8.1 vs. 5.4 ± 3.8 mmHg, P &lt; 0.0001) were significantly higher in Group PAA than in Group non-PAA. RV end-diastolic area index was significantly larger (37.3 ± 8.8 vs. 32.3 ± 7.8 mmHg, P = 0.0048), and RV fractional area change (32 ± 8 vs. 36 ± 9 %, P = 0.0176) and RV longitudinal strain amplitude (-16 ±5 vs. -20 ± 6, P = 0.0017) were significantly lower in Group PAA than those in Group non-PAA. During the five-year follow-up period, 20 patients (15%) died. The five-year mortality rate was significantly higher in Group PAA compared to Group non-PAA (30% vs. 10%, P = 0.007).

Conclusion
In PAH patients with PAA, RV dysfunction was more severe and the prognosis was poor. Assessment of PAA can be a useful index for the extraction of high-risk PAH patients.
P1809 Intraoperative myocardial protection in patients with septic endocarditis
Authors: Islambekova S H A , Nazirova L A , Aliev S H M 
Published: January 2020

Abstract

Funding Acknowledgements
there was not financial support

OnBehalf
cardiosurgery
Introduction The choice of myocardial protection method in patients with septic endocarditis (SE) during heart surgery is currently controversial. The results of several studies have shown positive aspects of the use of crystalloid cardioplegia del Nido. However, the use of this method in adults is not sufficiently studied.
Purpose.To determine the effectiveness of the use of crystalloid cardioplegia Del Nido in adult patients with septic endocarditis during a heart surgery with cardiopulmonary bypass.

Methods
We analyzed data of 100 patients with SE underwent surgical correction with cardiopulmonary bypass. There were 64 males and 36 females. Patients age ranged from 20 to 56 years (mean 44,4 ± 10,8years). The patients were divided into two groups: the main group (n = 50) with the use of cardioplegia Del Nido and the control group (n = 50) using conventional crystalloid cardioplegia. The dose of cardioplegia was 30 ml / kg for 1-2 minutes.

Results
Patients in the del Nido group required significantly less cardioplegia (1007,6 ± 347.3ml vs. 2450,4 ± 491,1ml, p &lt; 0.001). The duration of asystole after clamping of the aorta in the main group lasted up to a maximum of 103 minutes, versus to the control group, where it was necessary to administer an additional dose every 25-30min, due to the appearance of spontaneous electrical activity of the heart. Both groups did not differ in the time of onset of asystole since the introduction of cardioplegia (1,62 ± 0.2min and 1,69 ± 0.3min). Cardiac activity was restored through the resolution of the complete blockade or through ventricular fibrillation. The frequency of rhythm disturbance (ventricular tachycardia, atrial fibrillation and ventricular fibrillation) was more often observed in the control group (25/50 – control group, 7/52 –main group, p &lt; 0,005). The need for inotropic support was significantly less in the main group (10/50 main group, 20/50 control group). Postoperative mortality in the main group was lower (2%) compared with the control (13%).

Conclusion
Crystalloid cardioplegia del Nido provides better protection of the myocardium in adult patients with septic endocarditis and reduces postoperative cardiac rhythm disturbances and mortality.
P1818 Baseline clinical, echocardiographic and laboratory characteristics of HFrEF patients who were started with sacubitryl+ walsartan in different clinical status: long-term stabile vs after acute heart f
Authors: Wisniowska-Smialek S , Karabinowska A , Holcman K , Dziewiecka E , Lesniak-Sobelga A , Hlawaty M , Podolec P , Rubis P 
Published: January 2020

Abstract

Background
According to the latest approach new class ARNI with sacubitryl-valsartan may be ordered in clinically stable heart failure patients with reduced ejection fraction ( HFrEF) or short time after acute heart failure exacerbation. Methods: Since July 2016 till February 2019 we started ARNI in 50 HFrEF patients; 33 (66%) were clinically stabile during at least 3 months and 17 (34%) were short time after HF exacerbation. Results: There were no differences in age (63 vs 58) and BMI between groups. Clinically stabile patients presented significantly lower NYHA class (2 ± 0,5 vs 3 ± 0,7) and lower NT-proBNP level (1948 pg/ml vs 5570 pg/ml) in comparison to those after HF decompensation. There were no differences in left ventricular end-diastolic diameter (LVEDD), volume (LVEDV) and ejection fraction (EF) between both groups. Patients after HF decompensation had greater left and right atrium area(LAA, RAA respectively), higher estimated pulmonary artery pressure (PASP) and reduced right ventricular systolic function expressed with TAPSE (tricuspid annular plane systolic excursion) in comparison to stabile patients. Patients from both groups presented similar physical activity tolerance estimated with 6-minute walking test ( 6- MWT): 369 m vs 402 m (tbl). Conclusions: Clinical, echocardiographic and laboratory differences were observed between groups of HFrEF patients with different clinical status when ARNI was administrated.
Parameter Stabile n = 33 After HF decompensation n= 17 p- value BMI [kg/m2] 25(23-36) 25(21-26) 0,72 Age [years] 63 (39-68) 58 (42-67) 0,81 NYHA 2 ± 0,5 3 ± 0,7 0,001 NT-proBNP [pg/ml] 1948(601-2933) 5570(4147-8021) P&lt; 0,001 6 MWT dystans [m] 369(327-432) 402(240-480) 0,32 FW [%] 23 (18-28) 19(15-26) 0,17 LVEDD [mm] 69(59-76) 64(63-71) 0,32 LVEDvol [ml] 242(153-324) 225(178-235) 0,29 TAPSE [mm] 19(14-21) 14(13-16) 0,02 LAA [cm2] 28(24-34) 36(27-39) 0,032 RAA [cm2] 19(16-30) 26(23-32) 0,046 PASP [mmHg] 31(23-43) 43(38-55) 0,046
P1830 Single-beat aortic arch pulse wave velocity by dual-gate simultaneous Doppler technique: a novel method for arterial stiffness evaluation
Authors: Antonini-Canterin F , Pepe A , Strazzanti M , Rivaben D , Nicolosi E , Pagliani L , Luzza G , Penzo M , Piaser P 
Published: January 2020

Abstract

Background
Guidelines recommend increased aortic stiffness as a negative prognostic factor to be considered in primary and secondary prevention. Pulse wave velocity (PWV) is a frequently employed surrogate marker of aortic stiffness. Carotid-femoral PWV is the most common index in research and clinical practice, but recently several velocity-encoded magnetic resonance imaging (MRI) techniques have been used for the evaluation of regional aortic arch PWV, where the stiffness seems to be particularly relevant from a prognostic point of view.
Purposes. We developed a new ultrasound method for the assessment of aortic arch PWV, using a single-beat dual-gate simultaneous pulsed wave Doppler tracing. The aim of the study is to evaluate the feasibility of this new technique in a group of healthy volunteers.

Methods
We examined 126 healthy volunteers (81 females, 45 males, mean age 42 + 15 years, range 13-83 years) using a commercially available machine equipped with simultaneous dual-gate pulsed Doppler. Using the suprasternal approach, the first sample volume was placed in ascending aorta and the second one in descending aorta. The distance between the two sites was directly measured with a curvilinear tracing in the middle of the vessel, following the shape of the aortic arch. PWV was calculated as the ratio of distance (in millimiters) and the transit time (in milliseconds) measured using the "foot-to-foot" method. The results are then easily transformed, simplifying in the commonly unit of meters/second.

Results
Feasibility was 99%; in one case it was not possible to measure accurately the aortic arch PWV due to unfavorable suprasternal acustic window. The procedure time was very fast, requiring 2 + 1 minutes. Intraobserver and interobserver variability were 7% and 9% respectively. Aortic arch PWV, as expected, showed a strong correlation with age in males as well as in females (r= 0.71 and r = 0.60 respectively, p &lt; 0.001 for both); there was also a significant correlation with body mass index (r = 0.31; p &lt; 0.001). Aortic arch PWV values ranged from 3.1 to 8.5 m/s, showing a substantial overlap with normal values reported in MRI studies.

Conclusions
The direct measurement of aortic arch PWV is feasible and reproducible with ultrasound, using the novel single-beat dual-gate simultaneous pulsed wave Doppler tracing. This technique could be implemented in a standard echo examination, that is much more available than MRI studies. Further studies are needed to evaluate if Doppler-derived aortic arch PWV could provide additional prognostic information.
Abstract P1830 Figure. Aortic Arch PWV