bluuebunny/crossref_metadata_2025_split huggingface dataset:
P185 Primary cardiac lymphoma: an unexpected finding
Authors: Riesgo A , Ibero J , Rodriguez M , De La Torre F , Muniz J , De La Fuente A , Salterain N , Diaz I , Rifon J J , Bastarrika G , Gavira J J 
Published: January 2020

Abstract

BACKGROUND
Primary cardiac malignancies are rare, with a reported incidence of 0.1%. Up to 10% of cardiac tumors are malignant and primary cardiac lymphoma represents (PCL) a very low proportion of them. The wide variety of clinical manifestations and the inespecificity of them, difficults the diagnosis and delays treatment impacting directly in the prognosis of these patients. Here we present a lady with diagnosis of PCL treated in our center.

CASE REPORT
We present a 69 year old female with arterial hypertension and paroxismal atrial fibrilation that attended our clinic in april 2013. She referred severe dyspnoea with daily activities and peripheral oedema for the last three weeks. She also complaint of painful swallowing for bothliquids and solids. Physical exploration was unremarkable and observations where within normal limits. Transthoracic echocardiogram (TTE) was performed which showed an hipoechogenic mass invading the right ventricle, both atria and left ventricle outflow tract. She underwent cardiac MRI which revealed a myocardial isointense mass, with marked signal enhancement in T2 and heterogeneity in late gadolinium enhancement sequences, that was consistent with primary cardiac lymphoma. For histologycal characterization, biopsy of the mass guided with endoscopic ultrasonography was performed, confirming B-cell lymphoma. Positron emmision tomography (PET) scan showed bulky hypercaptant mass invading both atria, superior vena cava and pericardium, with hypercaptant adenopathies in right pulmonary hilum, subcarinal and phrenic chain. Her case was discussed in multidisciplinary team meeting and prompt initiation of treatment under R-CHOP regime was decided. After three cycles, follow up PET was requested, and revealed complete metabolic response. A repeat TTE showed only minimal infiltration of the right atria without ventricular involvement or hemodynamic compromise.

DISCUSSION
The patient we presented, was sent to Cardiology due to heart failure symptoms. Acute heart failure as well as embolisation and life-threatening arrythmias are typical manifestations of PCL. As reported in the literature, our case was a diffuse large B-cell lymphoma, which is the most frequent subtype. Dysphagia, exertional dyspnoea and constitutional symptoms can be present in early stages, as our patient referred. The main strength of this case is based on the quick diagnosis and early treatment. In contrary to what is reported, the overall survival was excellent, and to date the patient is still alive with no signs of relapse. Although TTE sensitivity is 55-60%, it has a key role in the diagnosis, which was supported later on MRI. Right chambers (specially right atria) are more typically involved than the left heart, including right venous drainage. Early systemic chemotherapy can achieve a high response rate and improve survival.
Abstract P185 Figure. Img1
P189 Duplication of the tricuspid valve (DOTV): case report of a rare congenital anomaly
Authors: Moscatelli S , Trocchio G , Stagnaro N , Siboldi A , Derchi M , Nuri H , Pome" G , Marasini M 
Published: January 2020

Abstract

Introduction
Tricuspid valve duplication is an extremely rare condition and in most of the cases it is associated with other congenital cardiac malformations. Because of its rarity, the clinical presentation and the management are not defined yet.

Clinical Case
We report the case of an 18 y/o caucasian male, who was admitted to our Hospital in February 2018 for rapid atrial flutter not responsive to medical therapy (propanolol and digossin). He had a pre-natal diagnose of ventricular septum defect (VSD) and tricuspid straddling. At 1 year of age he underwent pulmonary artery bandage and one year later VSD closure was performed. Blood test showed sub-clinic hypothyroidism, probably related to previous amiodaron therapy. A transthoracic echocardiogram was obtained. The right atrium (RA) was severely dilated and the atrial septum dislocated towards left ventricle (LV); two right atrioventricular valves (tricuspid valves) were detected: the ‘true’ tricuspid opening was inside the right ventricle, and an ‘accessory‘ opening was located inside the LV and severely regurgitant into the RA; the mitral valve was morphologically and functionally normal; both ventricles were dilated with preserved systolic function; systolic pulmonary artery pressure was not detectable. A Cardiac Magnetic Resonance clearly delineated the anomaly. Atrial flutter radio frequency transcatheter ablation was succesfully performed before corrective surgery. The regurgitant accessory tricuspid orifice was closed with an heterologous pericardial patch and a right reduction atrioplasty was also done. The post-operative course was uneventful and only a mild paraseptal tricuspid jet with LV to RA shunt was present at post op echocardiography. After one year follow-up the patient remained asymptomatic, without arrhythmia recurrence.

Conclusion
DOTV is an extremely rare condition that could be responsible of severe tricuspid regurgitation. At the moment, there are not sufficient data to establish the correct timing for surgical intervention. In our case, the presence of severe tricuspid regurgitation, right atrium dilatation, biventricular overload and atrial flutter guided the clinical management and suggested surgical correction.
Abstract P189 Figure.
P195 Postinfarction myocardial remodelling according to 2D ECHO data and genetic predictors: effect of genetic common variants in HSPB7 and MADD genes
Authors: Kuular A , Gamza A A , Ulitin A M , Tishkova V M , Muraviev A S , Kozyreva A A , Lyasnikova E A , Kostareva A A , Sitnikova M YU 
Published: January 2020

Abstract

Purpose
To study the impact of genetic variants rs1739843, rs2290149 and rs10838692 in HSPB7 and MADD genes on myocardial remodeling in the patients with postinfarction cardiosclerosis.
Methods and Results. The study included 252 men aged 30-65 y.o., who had MI more than 1 year ago. All patients had Q-MI of the anterior wall of the LV. Echocardiography was performed by the standard method (Vivid S6, GE, USA). Arterial hypertension (AH) was registered in more than 60% patients. Myocardial revascularization (CABG/PCI) was performed in more than in 50% of cases. Among 252 cases studies 156 patients had HFrEF (II–IV NYHA) LVEF (Sim)&lt;40% (№1 group) and 96 patients had no clinical signs of HF and LVEF (Sim)&gt;55% (№2 group). The groups were comparable in the AH prevalence and age. Patients all groups were on optimal drug therapy. Polymorphic genetic variants were studies using real-time-PCR. Eccentric types of LV remodeling prevailed in group 1 and concentric types of LV remodeling prevailed in group 2 (p &lt; 0.001). The presence AH combined with CC genotype of rs1739843 in HSPB7 gene and TT genotype of rs2290149 in MADD and simultaneous carriage of the CC genotype of rs1739843 HSPB7 were associated with the presence of non-dilated ventricle (LV volume index ≤75 mL/m2) and relative wall thickness (RWT) &gt;0.42 independently to LV mass index (p = 0.03). The T allele of rs1739843 HSPB7 (p = 0.006) and a combination of T allele of rs1739843 HSPB7 with the TT genotype of rs2290149 of the MADD gene were associated with the presence of dilated ventricles (p = 0.009) with LV hypertrophy (LV mass index &gt;115 g/m2) independently to RWT.

Conclusion
Our preliminary data demonstrate that the genotype of HSPB7 (rs1739843) can modulated the association of AH and MADD rs2290149 with markers of ventricular hypertrophy and predispose to various types of post-MI remodeling of LV.
P196 Effect of tofogliflozin on systolic and diastolic cardiac function in type 2 diabetic patients
Authors: Matsumura K , Otagaki M , Sugiura T , Park H , Yamamoto Y , Shiojima I 
Published: January 2020

Abstract

Funding Acknowledgements
None

Background
Recent studies have shown that sodium glucose cotransporter 2 (SGLT2) inhibitors have a favorable effect on cardiovascular events in diabetic patients. However, the underlying mechanism associated with favorable outcome has not been clearly identified.

Purpose
The purpose of this study was to investigate the effect of tofogliflozin, SGLT2 inhibitor, on systolic and diastolic cardiac function in patients with type 2 diabetes mellitus (T2DM).

Methods
We enrolled 26 consecutive T2DM out-patients on glucose-lowering drugs who initiated tofogliflozin and underwent echocardiogram before and ≥ 6 months after tofogliflozin administration. During this period, we also enrolled 162 T2DM out-patients taking other glucose-lowering drugs as a control group. Propensity score analysis was performed to match the patient characteristics. As a result, 40 patients (tofogliflozin group: 20 patients and control group: 20 patients) were finally used for analysis. Left ventricular systolic function was assessed by measuring 2D-echocardiographic left ventricular ejection fraction (LVEF) and diastolic cardiac function by pulsed wave Doppler derived early diastolic velocity (E/e’).

Results
There were no significant differences in patient characteristics and echocardiographic parameters at baseline. Follow-up E/e’ was significantly improved in tofogliflozin compared to control (11.7 ± 3.5 vs. 14.4 ± 4.5, p = 0.037). Moreover, the change in LVEF from baseline to follow up was 5.8± 7.2% in tofogliflozin group and 1.2 ± 6.9% in control group; difference significant: p = 0.047.

Conclusions
In addition to conventional oral glucose-lowering drugs, additional tofogliflozin administration had a favorable effect on left ventricular systolic and diastolic function in patients with T2DM.
P201 Cost-effectiveness analysis of 3D versus 2D transesophageal echocardiography for the evaluation of patients with primary mitral regurgitation with indication of surgical treatment
Authors: Miglioranza M , Le Bihan D , De Resende M V C , Oliveira Jr W P , Nunes C G O , Lucchetta R C , Dos Santos W M , Holanda P , Rosim M P , Okumura L , Nita M E , Riveros B , Pedro G O , Vieira M 
Published: January 2020

Abstract

Funding Acknowledgements
Department of Cardiovascular Imaging / Brazilian Society of Cardiology

OBJECTIVES
To perform the cost-effectiveness analysis of three-dimensional transesophageal echocardiography (3DTEE) in comparison to two-dimensional transesophageal echocardiography (2DTEE) for the anatomic-functional evaluation and surgical planning of severe primary mitral regurgitation. METHODS: a complete economic study was based on a systematic review of 3DTEE and 2DTEE accuracy and private health system costs of two different surgical interventions: mitral valve plasty and mitral valve replacement. The prevalence of common postoperative complications was also predicted for elective procedures: atrial fibrillation (8.6%); acute myocardial infarction (1.4%); thrombosis (3.5%); bleeding (1.5%); endocarditis (6.3%). The decision tree method was adopted as a data analysis model. The Bayes" theorem was used based on sensitivity and specificity measurements. The costs, considering literature and professional tables, were: 3DTEE = US$ 349; 2DTEE = US$ 204; diagnostic evaluation = US$ 597; surgical procedure = US$ 3,643; surgical treatment = US$ 374. RESULTS: The deterministic analysis of the diagnostic test shows that 3DTEE (non-dominated) is superior to 2DTEE (absolutely dominated). The 3DTEE presents a cost reduction of US$ 1,147 and incremental effectiveness (true identification) of 22% when compared to 2DTEE. The multivariate probabilistic sensitivity analysis showed that after 100,000 iterations, the diagnosis based on the 3DTEE becomes the first choice regardless of the willingness to pay threshold. CONCLUSIONS: 3DTEE was cost-effective compared to 2DTEE. Thus, 3DTEE is a potential device to promote health compared to 2DTEE for surgical planning of severe primary mitral regurgitation
Abstract P201 Figure. Sensitivity Analysis
P203 Prognostic value of deformation parameters in stemi patients with preserved left ventricular ejection fraction
Authors: Oleinikov V , Galimskaya V , Kupriyanova S , Golubeva A 
Published: January 2020

Abstract

Purpose
to assess the ability of global deformation parameters, determined using the speckle tracking method, to predict the possible development of heart failure and pathological left ventricular (LV) remodeling 6 months after revascularization.

Methods
the study included 149 people with primary STEMI: 16 women and 133 males between the ages of 32 and 67 years (51.3 ± 8.5). Myocardial infarction was confirmed by ECG, a clinically significant level of cardiospecific markers (troponin T, CPK-MB) and according to the results of coronary angiography with the presence of a single infarction-related coronary artery without significant stenoses of other arteries. Echocardiography was performed with an ultrasound scanner at the 7-9 days and 6 months after the disease onset. A quantitative analysis of contractility was performed using global longitudinal and circumferential strain indicators (GLS and GCS) using a software. Longitudinal strain indices were obtained from frame-by-frame recording of speckle displacement with a frequency of at least 60 per second from apical 4, 2, and 5-chamber positions in each LV segment. The values of circumferential strain were obtained in parasternal positions at the level of the mitral valve and papillary muscles, respectively. LVEF was calculated by the Simpson biplane method from two-dimensional apical 4- and 2-chamber images. Analysis of the pathological remodeling development was carried out using ROC - analysis using three criteria. To assess the quality of the model, the area under the curve (AUC) was determined with the calculation of 95% confidence intervals and the statistical significance of the point estimate of the area.

Results
among those included in the study, 132 people (88.5%) in the early period of PCI had the EF more than 40% or corresponded to the normal level. After 6 months of follow-up among these patients in 8 (6%) cases the EF was below the critical value (40%). The AUC for GLS based on a criterion for EF &lt;40% after 6 months from the myocardial infarction onset was 0.759 [95%, CI 0.647; 0.870], (p = 0.01); the cut-off point was 13.4%, sensitivity and specificity - 83.1% and 66.7%. For GSC, the AUC was 0.715 [95%, CI 0.602; 0.827], (p = 0.01); cut-off point - 13.4%, sensitivity - 84%, specificity - 67%, respectively.

Conclusions
GLS and GCS parameters, recorded by speckle tracking method with high sensitivity and specificity, make it possible to predict the development of systolic heart failure after 6 months of follow-up in STEMI patients with preserved LVEF.
P205 Maternal left ventricular global longitudinal strain correlates with parameters of fetal intrauterine growth and uteroplacental hemodynamics
Authors: Palermo C , Muraru D , Badano L , Balducci E , Carli S , Aruta P , De Virgilio A , Pinto F , Cosmi E , Visentin S 
Published: January 2020

Abstract

Impairment of physiological mechanisms responsible for maternal cardiovascular adaptation during pregnancy may be associated to intrauterine growth restriction (IUGR).

Purpose
To compare maternal cardiac parameters between pregnancies with IUGR and with fetal growth appropriate for gestational age (AGA).

Methods
Twenty-one IUGR (median age 31 years) were compared with 18 AGA matched for age, body size and gestational age (p &gt; 0.35 for all). LV volumes and ejection fraction (LVEF) were measured by 3D echocardiography, and LV mass (LVM) and outflow velocity time integral (VTI) by conventional echocardiography. LV longitudinal strain (GLS) was assessed by speckle-tracking.

Results
Compared to AGA, IUGR mothers had similar LV volumes and LVEF, but larger LV mass (76 vs 63 g/m2, p = 0.006), LV mass/volume (1.14 vs 1.0 g/ml, p = 0.036) and lower VTI (19.9 vs 21.5 cm, p = 0.046) and GLS (-20 vs -22%, p = 0.032). Maternal LV GLS correlated with fetal growth and utero-placental hemodynamics (Table). At ROC curve analysis, maternal GLS had a good ability to discriminate IUGR from AGA (Figure).

Conclusions
IUGR had larger LV mass/volume and lower GLS than AGA. GLS was more sensitive than LVEF to detect LV function changes in IUGR. This is the first study reporting that worse maternal LV GLS correlates with fetal growth restriction and suboptimal utero-placental hemodynamics.
Rho Spearman p APGAR score 0.36 0.03 Birthweight percentile 0.38 0.02 Biparietal diameter 0.47 0.003 Cranial circumference 0.31 0.07 Abdominal circumference 0.30 0.07 Umbilical vein velocity 0.64 0.003 Uterine artery mean pulsatility index -0.36 0.028 LV length 0.36 0.034 LV mid diameter 0.32 0.05 LV end-systolic volume 0.34 0.046 MAPSE 0.45 0.006 TAPSE 0.41 0.004 Mitral E wave 0.50 0.002 Mitral A wave 0.38 0.02 Correlation of maternal GLS (considered as positive) and fetal parameters.
Abstract P205 Figure. GLS ability to discriminate IUGR vs AGA
P212 Computed tomography derived left ventricular outflow tract area downgrades severity of prosthesis-patient mismatch after transcatheter aortic valve replacement
Authors: Fukui M , Tiang L , Lesser J , Niikura H , Nunes M , Burns M , Schneider L , Han K , Garcia S , Gossl M , Sorajja P , Cavalcante J 
Published: January 2020

Abstract

Background
Prosthesis-patient mismatch (PPM) is associated with poor outcomes after surgical aortic valve replacement, but evidence in the era of transcatheter aortic valve replacement (TAVR) is small. Although PPM is conventionally defined by transthoracic echocardiogram (TTE) derived indexed effective orifice area (EOAi), TTE may underestimate left ventricular outflow tract (LVOT) area when compared with cardiac computed tomography angiography (CTA).

Purpose
To evaluate the inter-modality (TTE vs CTA) agreement and inter-valve (balloon-expanding valve (BEV) vs. self-expandable valve (SEV)) differences in EOAi and the severity of PPM after TAVR.

Methods
We analyzed all patients who underwent TAVR between 2015 to 2017and who had both of CTA and TTE at 30-days after TAVR. EOAi was calculated using the continuity equation and then indexed to body surface area as per guidelines using TTE derived LVOT diameter (EOAi-TTE) or post-procedure CTA derived LVOT area (EOAi-CTA). The external LVOT diameter was measured at inflow of TAVR bioprosthetic stent frame as per recommendations. The EOAi was used to define the grading severity of PPM: None (&gt; 0.85 cm²/m²); Moderate (0.65 to 0.85 cm²/m²); and Severe (&lt; 0.65 cm²/m²). Paired or Student t-test and Chi-square test were used to assess the inter-modality and inter-valve difference.

Results
A total of 280 patients were included (the mean age, 81.2 ± 8.1 years; 48%, female). BEV was used in 150 patients (54%). The mean EOAi-TTE vs. EOAi-CTA was 1.00 ± 0.32 and 1.41 ± 0.50 cm²/m², respectively, p &lt; 0.001. Prevalence of severe (TTE 9% versus CTA 4%, p &lt; 0.01) and moderate (TTE 28% versus CTA 7%, p &lt; 0.01) PPM was lower when adjudicated by CTA (Figure-Panel A). There was a trends towards smaller EOAi by either TTE (0.97 ± 0.31 vs. 1.04 ± 0.33, p = 0.07) or CTA (1.38 ± 0.45 vs. 1.46 ± 0.56, p = 0.21) for BEV vs. SEV (Figure-Panel B). There was no significant difference in the severity of PPM defined by either EOAi-TTE (Figure-Panel C) or EOAi-CTA (Figure-Panel D) between these patients.

Conclusion
EOAi-CTA was larger and downgraded the severity of PPM than the EOAi-TTE. There was no significant difference in the severity of PPM defined by post-procedure CT between patients treated with BEV and those with SEV.
Abstract P212 Figure.
P235 A happy ending for a dancing thrombus on the right atrium
Authors: Ferreira J , Freitas A , Gomes R , Faria D , Beringuilho M , Roque D , Morais C 
Published: January 2020

Abstract

A 62-year-old male, was admitted in the emergency department with chest discomfort and dyspnea for the last 2 days; he also referred pain on the right leg. He had been submitted to prostatic surgery 1 month before and since then he reduced is usual physical activity. At admission he was normotensive, with sinus tachycardia, with elevated D-Dimers and hypoxemia and hypocapnia on arterial blood gas analysis. Transthoracic echocardiogram (TTE) was performed and it showed dilation of right ventricle with diastolic left ventricular "D-shape" compatible with right ventricle pressure overload. Furthermore, it was visible a large and filiform thrombus on the right atrium, causing procidency into the right ventricle through the tricuspid valve during diastole (image top-left and top-right). Patient was hemodynamically stable at that time, and the case was promptly discussed with cardiothoracic surgery. The decision was to adopt a conservative strategy, and non-fractioned heparin (NFH) perfusion was initiated accordingly to local protocol.
Patient remained hemodynamically stable, and, after 24h of treatment with NFH echocardiographic re-evaluation showed disappearance of the thrombus previously seen of the right chambers (image bottom-left). Angio-TC scan of thorax performed at that time showed extensive bilateral pulmonary thromboembolism, but with normal perfusion of the pulmonary artery trunk and both right and left pulmonary arteries. After 48h of NFH the patient started oral anticoagulation. The rest of the admission was unremarkable apart from a respiratory tract infection successfully treated with piperacillin-tazobactam.
Pre-discharge TTE performed 12 days after admission showed no dilation of the right ventricle, with normal systolic function (image bottom-right), as well as no evidence of pulmonary arterial hypertension.

Discussion
Large right atrial thrombus in the setting of PTE is a clinical situation in which there is no consensus regarding clinical management. In most cases, management is dictated by haemodynamic status of the patient. In the setting of a hemodynamically stable patient, systemic anticoagulation can be an option. Surgery, fibrinolysis and percutaneous aspiration have also been advocated. Successful treatment of right heart thrombus with anticoagulation alone has been reported, but there are also reports of unsuccess with that strategy. This is a case of a successful treatment with anticoagulation alone and so, we currently consider that the choice of treatment strategy based on hemodynamic status continues to be the wisest strategy to adopt.
Abstract P235 Figure. Thrombus before and after