bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1741 Echocardiographic assessment of rate versus rhythm control strategy in patients with persistent atrial fibrillation
Authors: Piatkowski R , Kosior D A , Kochanowski J , Szulc M 
Published: January 2020

Abstract

BACKGROUND
Patients with persistent atrial fibrillation (AF) can be managed with either rhythm or rate control strategy. The restoration and maintenance of the sinus rhythm (SR) is not superior to the rate control regarding the total mortality and the rate of thromboembolic complications. Data concerning the effect of these strategies on left ventricular morphology and function is missing.

PURPOSE
The objective of our prospective randomised multicenter study in patients with persistent AF was to evaluate the effect of these two approaches on left ventricular morphology and function.

METHODS
The study group consisted of 205 patients (F/M 71/134; mean age 60.8 ± 11.2 years), including 101 patients randomized to the rate control approach (Group I) and 104 patients randomized to SR restoration with cardioversion and subsequent antiarrhythmic drug treatment (Group II). Mean duration of AF was 231.8 ± 112.4 days. At the end of follow-up (12 months), SR was present in 64% of patients in Group II. Echocardiographic examination was performed at a baseline and at 2 and 12 months. In the rate-control group, both right (22.1 ± 4.1 vs. 23.2 ± 3.8 cm2; p &lt; 0.05) and left atrial (25.9 ± 5.2 vs. 26.8 ± 4.6 cm2 p &lt; 0.05) enlargement was observed during the 12 months follow-up. A significant decrease in right (21.8 ± 3.0 vs. 21.2 ± 3.5 cm2; p &lt; 0.05) and left atrial (26.2 ± 4.6 vs. 25.5 ± 5.0 cm2; p &lt; 0.05) size in the rhythm control arm was observed. Both strategies led to a significant increase in left ventricular fractional shortening (32.1 ± 7.3 vs. 34.2 ± 6.5% and 31.3 ± 6.7 vs. 35.5 ± 8.9%, respectively; p &lt; 0.05). The comparison of the left ventricular end-diastolic diameter revealed no difference within and between groups (50.8 ± 5.6 mm vs. 52.2 mm ± 6.8 mm at a baseline and 50.0 ± 6.0 vs. 52.0 ± ± 7.4 mm at 12 months, respectively). In rhythm-control group such trend was observed only in pts. with successfully maintained SR. According to LV function improvement, rhythm-control strategy was preferred in pts. with hypertension (RR 2.63; 95% C.I.: 0.93-5.45; p &lt; 0.05) or congestive heart failure in NYHA II or III class (RR 2.13; 95% C.I.: 0.98-4.42; p &lt; 0.05).

CONCLUSIONS
Both strategies led to a significant increase in LV FS. Rate-control strategy led to right and left atrium enlargement, but rhythm control resulted in their decrease.
P1752 Prognostic role of Multilayer Strain Speckle Tracking Echocardiography in patients with severe aortic stenosis treated with Transcatheter Aortic Valve Implantation
Authors: Cimino S , Maestrini V , Monosilio S , Luongo F , Neccia M , Birtolo L I , Petronilli V , Salvi N , Cantisani D , Filomena D , Mocci M , Quaranta S , Mancone M , Fedele F , Agati L 
Published: January 2020

Abstract

Background
Myocardial Strain evaluation helps to assess the efficacy of therapeutic interventions and to predict the prognosis and clinical outcomes. The aim of the present study was to assess whether Multilayer Global longitudinal Strain (GLS) can be useful in estimation of left ventricle (LV) function in patients with severe symptomatic aortic stenosis (AS) who have undergone transcatheter aortic valve implantation (TAVI).

Methods
35 patients with severe AS who successfully underwent TAVI, were enrolled in the study. GLS was measured from the endocardial layer (Endo-LS), epicardial layer (Epi-LS) and full thickness of myocardium before the procedure. Analysis included other parameters such as age, sex, LV volumes and ejection fraction (LVEF), type of prosthesis implanted, right ventricular (RV) dimension and function. Occurrence of cardiovascular (CV) events (rehospitalization for HF or CV death) were collected after 24 months follow-up.Results: CV events occurred in 7 patients (20%). Patients were divided in two groups accordingly with CV events occurrence. No differences in baseline, demographic, echocardiographic and procedural characteristics were found. Patients who developed CV events had a more impaired pre-procedural GLS (-10.2 ± 2.4% vs -12.6 ± 2.2%, p = 0.029), mostly due to his subendocardial layer (Endo-LS -10.8 ± 2 vs -13.9 ± 2, p = 0.003). Moreover, by ROC curve analysis, a cut-off value of -12.4% of endo LS was associated with CV events (sensitivity of 83% and specificity of 65 %, AUC 0.8, p = 0.024), with a log-rank p value assessed by survival analysis of 0.044.

Conclusion
Multilayer GLS analysis could provide additional information for prognosis stratification in patients with severe symptomatic AS before TAVI, above and beyond assessment of LVEF alone.
Parameter Event-group (7/35 pz= 20%) Non-event group (28/35 pz= 80%) p Age (y.o) 86 ± 4 80 ± 7 NS LVEDV (ml) 112 ± 34 94 ± 32 NS LVESV (ml) 51.2 ± 6 56.9 ± 6 NS LVEF(%) 55.7 ± 6 56.9 ± 6 NS AVA (cm2) 0.77 ± 0.2 0.73 ± 0.2 NS GLS (%) -10.2 ± 2.4 -12.6 ± 2.2 0.029 Endo-LS (%) -10.8 ± 2 -13.9 ± 2 0.003 Epi-LS (%) -10.2 ± 2 -11.9 ± 2 NS
Abstract P1752 Figure.
P1753 Echocardiographic assessment of prosthetic aortic valve in children
Authors: Hayashi T , Shindo T , Misaki Y , Ono H 
Published: January 2020

Abstract

Introduction
Although the diagnostic utility of Doppler-derived hemodynamic parameters of prosthetic aortic valve (PAV) for detecting prosthetic dysfunction has been demonstrated in adults, interpreting these parameters in children is difficult, as the relative size of PAV varies more greatly in them than in adults. We aimed to elucidate how the Doppler-derived hemodynamic parameters change as the PAV size decreases relative to the somatic growth of children.

Methods
We reviewed 11 echocardiographic examinations of 9 mechanical PAVs in 8 children. The median age at echocardiographic examination was 10.2 (0.5-17.7) years. Underlying diagnoses leading to aortic valve replacement were aortic regurgitation due to dysplastic aortic valve in 3 children, Marfan syndrome in 1, persistent truncus arteriosus in 1, and aortic stenosis associated with interrupted aortic arch/coarctation of the aorta in 3. The PAV functioned normally in all examinations. PAV size was 19 mm in 8 examinations and 17 mm in 3 examination, which was standardized to body surface area at the examination by calculating z-scores based on previously published normative data of aortic valve diameter. We assessed the Doppler-derived hemodynamic parameters, namely peak velocity, mean pressure gradient, and accerelation time of the transprosthetic flow, the velocity-time integral (VTI) ratio of the left ventricular outflow to the transprosthetic flow, and effective orifice area (EOA) of the PAV calculated by using the continuity equation. The Pearson correlation coefficients between the PAV size z-score and Doppler-derived hemodynamic parameters of the normally functioning PAVs were evaluated. A p-value of &lt;0.05 was considered statistically significant.

Results
All the Doppler-derived hemodynamic parameters except for EOA had a statistically significant correlation with PAV size z-score (Pearson correlation coefficients: peak velocity, -0.76; mean pressure gradient, -0.70; acceleration time, -0.66; and VTI ratio, 0.76). Multivariate analysis revealed that VTI ratio was the sole parameter that independently correlated with PAV size z-score.

Conclusions
VTI ratio, which is theoretically less dependent on cardiac preload than other hemodynamic parameters, strongly reflects BSA-indexed PAV size. Disproportionately decreased VTI ratio in relation to PAV size might indicate prosthetic obstruction in children with PAV.
Abstract P1753 Figure. Correlation of PAV size and VTI ratio
P1769 Levels of serum markers of myocardial injury in patients with ST-elevation myocardial infarction correlate with global left ventricular longitudinal deformation
Authors: Szymczyk E , Lipiec P , Michalski B , Kasprzak J D 
Published: January 2020

Abstract

The aim of this study was to assess the correlation of levels of serum markers of myocardial injury with parameters of myocardial function assessed by 2D-speckle tracking echocardiography in patients with ST-elevation myocardial infarction (STEMI)
Material and methods. The study group comprised 96 patients (69 male, mean age 58 ± 10 years) with first STEMI treated with successful primary percutaneous coronary intervention. Levels of serum markers of myocardial injury (troponin T and CKMB mass) were assessed on admission and then monitored during the hospitalization. 7-12 days after STEMI, all patients underwent resting 2D echocardiography with subsequent offline analysis using 2D speckle tracking algorithm. Measurements of left ventricular deformation included peak systolic longitudinal and transverse strain (SLS and STS) – maximal value before aortic valve closure, peak longitudinal and transverse strain (PLS and PTS) – including possible postsystolic contraction, systolic longitudinal and transverse strain rate (SLSR and STSR) at baseline.

Results
On admission median values (I – III quartile) of CKMB mass and troponin T were 20,0 ng/ml (6,3 – 59,0; range 1,9 – 475,3) and 0,25 ng/ml (0,06 – 1,04; range 0,01 – 11,2), respectively. Maximal values (I – III quartile) of CKMB mass and troponin T were 94,1 (28,0 – 215,7; range 3,2 – 500) and 3,29 (1,6 – 6,3; range 0,42 – 17,2), respectively. Statistically significant correlations were observed for the global values of the longitudinal strain parameters and the concentration of troponin T and CKMB mass (rs from 0.22 to 0.36). The strongest correlations were noted for the maximum serum level of troponin T. Among the best strain parameters was the global systolic longitudinal deflection (SLS). There was no statistically significant correlation between the parameters of transverse deformation and the concentrations of markers for myocardial necrosis.

Conclusions
Troponin T correlates with global left ventricular longitudinal deformation in patients with ST-elevation myocardial infarction.
P1778 Preeclampsia is associated with reduced myocardial work efficiency during pregnancy
Authors: Chow Y Y , Chapman M , Mahadevan D , Dekker G , Arstall M 
Published: January 2020

Abstract

AIM
Preeclampsia (PrE) is a systemic disorder unique to human pregnancy, which is characterised by hypertension and multiorgan involvement. It is associated with cardiac dysfunction with a reduction in global longitudinal strain (GLS) and long-term cardiovascular disease. The aim of this study is to evaluate the effects of the loading conditions on the GLS results utilising myocardial work (MW) a non-invasive assessment of left ventricular (LV) pressure strain loops.

Methods
We evaluated 41 pregnant women, aged between 18-40, at 28.4-40 (Mean 35) weeks of gestation and within one week of the diagnosis of PrE. 49 normotensive pregnant women (control) were matched for age and gestation. These patients were reassessed after six months postpartum. All patients underwent echocardiography for left ventricular indices and assessment with speckle tracking for global longitudinal strain (GLS%) and myocardial work indices - performed at both time points.

Result
PrE had a mean LV mass index (LVMi) of 14.53g.m2 higher than control (P value = 0.000) during pregnancy which normalised at six-months postpartum. There was a reduction in GLS between PrE and controls during pregnancy (p = 0.002) and this remained significant postpartum (p = 0.001). (Fig1) However, there was no change over time within each group. During pregnancy, peak global myocardial work efficiency (GWE%) in PrE was significantly lower than controls (p = 0.001) and no different six months postpartum (p = 0.169) (Fig2). In contrast, during pregnancy, myocardial work index (GWI mmHg) was significantly higher in PrE (p &lt; 000) compared to control, but not in postpartum (p = 0.165) There was a significant change over time of GWI in both groups (p &lt; 0.05) (Fig3).

Conclusion
During pregnancy and post-partum PrE patients show a reduction in GLS when compared to matched normotensive pregnant women. This finding is consistent with previous studies which suggests subclinical LV dysfunction in PrE. However, the GWI was significantly increased but reduced in efficiency (GWE). The GWI increase is likely a result of an increase in LV mass index. The hypertrophied LV allows the increase in work at the cost of a reduction in efficiency but normalises when the hypertrophy improves post-partum. Our study is the first to use myocardial work in PrE patients, which we believe provides a better assessment of cardiac adaptation post-partum and does not suggest long term subclinical LV dysfunction.
Abstract P1778 Figure.
P1782 Left ventricular deformation proprieties in aortic coarctation: insights from multilayer strain imaging
Authors: Sorrentino R , Fiorillo L , Canonico M E , Lembo M , Luciano F , Santoro C , Esposito R , Borgia F , Galderisi M 
Published: January 2020

Abstract

Background
Patients with coarctation of the aorta (CoA) have proven impaired left ventricular (LV) myocardial deformation that will persist even after successful transcatheter intervention compared to normal controls. However, little is known about layer specific contraction in this clinical setting.

Purpose
To investigate multi-layer longitudinal strain in patients with repaired CoA, compared with a control group of healthy subjects.

Methods
In a case-control study, 13 CoA patients (F/M = 9/4, age = 15.1 ± 4.4 years) and 13 healthy age- and sex-matched controls, underwent a complete echocardiogram, including speckle tracking assessment for quantification of LV transmural global longitudinal strain (GLS), subendocardial longitudinal strain (LSsubendo), subepicardial longitudinal strain (LSsubepi), and myocardial longitudinal strain gradient (LSsubendo - LSsubpepi).

Results
CoA patients had similar blood pressure, heart rate, and body surface area in comparison with healthy controls. The two groups did not differ for ejection fraction and LV diastolic indices. Increased maximal gradient (&gt;20 mmHg) in descending aorta was found in 9 (69.2%) CoA patients. In CoA population, 5 (38.5%) had LV concentric remodeling (RWT &gt; 0.42) and 2 (15.4%) LV hypertrophy (Z score &gt;2.0). LV mass index (92.4 ± 31.1 vs. 60.9 ± 12.5 g/m^2.7, p = 0.002), septal wall thickness (8.7 ± 2.0 vs 6.6 ± 0.9 mm p = 0.002), posterior wall thickness (8.2 ± 1.7 vs. 6.6 ± 1.4 mm, p = 0.02) and RWT (0.38 ± 0.06 vs. 0.27 ± 0.08, p &lt; 0.001) were greater in CoA patients. By multi-layer deformation analysis, GLS (21.2 ± 1.9 vs. 22.9 ± 1.4%, p &lt; 0.01), LSsubepi (19.3 ± 1.6 vs. 21.0 ± 1.6%, p &lt; 0.01), LSsubendo (22.9 ± 1.8 vs. 25.4 ± 1.9%, p = 0.003) and longitudinal strain gradient (3.6 ± 1.1 vs. 4.7 ± 1.1, p &lt; 0.02) were lower in CoA patients than in healthy controls. Separate sub-analyses in patients without LV hypertrophy, substantially confirmed the same results: GLS 20.9 ± 1.6 vs. 22.8 ± 0.9%, p = 0.004; LSsubepi 19.0 ± 1.4 vs. 21.1 ± 1.3%, p = 0.004; and LSsubendo 22.4 ± 1.2 vs. 25.3 ± 1.4%, p &lt; 0.0001; strain gradient 3.4 ± 1.0 vs. 4.6 ± 1.1, p = 0.02. Notably, LSsubepi (18.6 ± 1.4 vs. 20.6 ± 1.0%, p = 0.03) and, with greater significance, LSsubendo (22.1 ± 1.1 vs. 24.7 ± 1.8%, p &lt; 0.0001) were lower in CoA patients with increased aortic gradient versus those without significant gradient increase.

Conclusions
In CoA patients, layer specific strain imaging highlights an impairment of LV longitudinal deformation, which mainly involves LSsubendo and causes reduction of longitudinal strain gradient. This preferential impairment of subendocardium is particularly evident in patients with residual aortic gradient and is independent of LV hypertrophy.
Abstract P1782 Figure. Multilayer strain in CoA vs. controls
P1787 Pharmacologic stress test: still an important prognostic factor? a follow-up study
Authors: Ferreira V , Moura Branco L , Galrinho A , Rio P , Aguiar Rosa S , Gameiro F , Cacela D , Castelo A , Garcia Bras P , Branco Mano T , Reis J , Cruz Ferreira R 
Published: January 2020

Abstract

Introduction
Dobutamine stress echocardiography (DSE) is an established exam for evaluation of extent and severity of coronary artery disease.

Purpose
To analyse the results and complications of DSE and identify prognostic predictors in patients (P) who underwent DSE for myocardial ischemia detection.

Methods
220P who underwent consecutive DSE from 2013 to 2017. P with significant valvular disease were excluded. Clinical data, echocardiographic parameters and data from follow up (FU) regarding all-cause mortality and MACEs were analysed. Mean age 64.8 ± 12.0 years(Y), 143 men (65%).

Results
88P (40%) had positive, 102 had negative and 30 had inconclusive DSE; complications rate of 15%. Prevalence of hypertension, diabetes mellitus (DM), dyslipidemia, prior MI, percutaneous coronary interventionc (PCI), coronary arterial bypass graft (CABG) and HF was 82.7%, 42.3%, 67.7%, 35.9%, 31.8%, 10.9% and 9.5%, respectively. Mean left ventricular endsystolic (LVSD) and enddiastolic dimensions were 33.7 ± 8.9 and 52.8 ± 7.1 mm. Mean resting wall motion score index (rWMSI) and peak (pWMSI) were 1.16 ± 0.28 and 1.24 ± 0.34. Mean resting GLS (rGLS) and peak GLS (pGLS) were -16.3 ± 4.3 and -16.6 ± 4.3. Mean no. of ischemic segments was 1.7 ± 2.4 and 16.8% had ischemia &gt;3 segments. There was ischemia in left anterior descending (LAD) coronary in 53P and in circumflex and right coronary territories in 18 and 68P. 22.6% had more than one ischemic territory. 43P (49.4%) underwent intervention, 38 with PCI and 5 with CABG. During a mean FU of 38.8 ± 16.8 months, 47 MACEs were observed, including 32 deaths (14.5%). Positive DSE (p = 0.012), no. of ischemic segments (p = 0.019), ischemia in the LAD (p = 0.003), rGLS (p = 0.038) and pGLS (p = 0.038) were related to the occurrence of MACEs. In Cox regression analysis, age (p = 0.005), DM (p = 0.005), HF (p = 0.006), prior CABG (p = 0.015), LVSD (p = 0.026), rWMSI (p = 0.029), pWMSI (p = 0.013) and pGLS (p = 0.038) were associated with increased all-cause mortality. Kaplan–Meier survival analysis showed that survival was significantly worse for ischemia &gt; 3 segments (log rank 0.005), ischemia of more than one territory (log rank 0.025) and pWMSI &gt;1.5 (log rank &lt; 0.0005). With multivariate Cox regression analysis, age &gt;65Y (HR 4.22, p = 0.004), DM (HR 2.49,p = 0.038) and pWMSI &gt; 1.5 (HR 9.73,p = 0.007) were independently associated with all-cause mortality.

Conclusion
In patients who underwent DSE there were some baseline and DSE-related independent predictors of long-term prognosis: age, DM and peak WMSI.
Abstract P1787 Figure. Kaplan–Meier curves
P1792 Coronary flow velocity reserve and prognosis during stress echocardiography
Authors: Ciampi Q , Zanella H , Borguezan Daros C , Cortigiani L , Gaibazzi N , Zagatina A , Wierzbowska-Drabik K , De Castro E Silva Pretto J L , Djordjevic-Dikic A , Amor M , Merlo P M , Lowenstein J , De Nes M , Carpeggiani C , Picano E 
Published: January 2020

Abstract

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

Background
Stress echocardiography (SE) based on regional wall motion abnormalities (RWMA) has established risk stratification capabilities, further enhanced by assessment of coronary flow velocity reserve (CFVR) on mid-distal left anterior descending coronary artery which assesses not only epicardial coronary artery stenosis but also coronary microcirculation.

Aim
To assess the value of CFVR in predicting outcome

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 631, dipyridamole in 1184, adenosine in 10, dobutamine in 43) in 9 quality-controlled centers of 6 countries. CFVR was measured from pulsed wave Doppler as peak/rest ratio of peak diastolic flow. All patients were followed-up for a median of 16 months.
Results CFV was 28 ± 10 cm/s at rest and 62 ± 19 cm/s at peak stress (p&lt;.001) with a CFVR of 2.25 ± 0.58. At individual patient analysis, CFVR was abnormal (≤2.0) in 528 (28%) patients: 265 (42%) with exercise, 254 (21%) with vasodilator and 9 (21%) with dobutamine stress. At follow-up, there were 218 events: 22 deaths, 22 non-fatal myocardial infarctions, 62 acute heart failures, and 112 late (&gt; 3 months from SE) myocardial revascularizations. At multivariable analysis, stress-induced RWMA (Hazard Ratio 3.883, 95% Confidence Intervals: 2.379-6.336, p&lt;.0.001) and CFVR (Hazard Ratio 1.590, 95% Confidence Intervals: 1.123-2.275, p&lt;.009) were independent predictors. Kaplan-Meier curves showed progressively worsening event-free survival with progressively lower values of CFVR: see figure
Conclusion In patients referred to SE, CFVR assessing coronary microvascular dysfunction allows a more accurate prediction of outcome than RWMA which only detect epicardial coronary artery stenoses.
Abstract P1792 Figure. CFVR and event-free survival curves
P1793 Blunted heart rate reserve during exercise or vasodilator stress echo is a predictor of outcome
Authors: Prota C , Cortigiani L , Gaibazzi N , Borguezan Daros C , Zagatina A , Djordjevic-Dikic A , Wierzbowska-Drabik K , Kasprszak J D , Torres M A T , Boshchenko A , De Nes M , Paterni M , Carpeggiani C , Ciampi Q , Picano E 
Published: January 2020

Abstract

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

Background
A blunted heart rate reserve (HRR) during exercise or vasodilator stress echo (SE) has been associated with a poor outcome in retrospective studies.
Aim. To assess the prognostic value of HRR in patients undergoing SE in prospective study.

Methods
We prospectively recruited a sample of 1825 patients (none with pacemakers or atrial fibrillation; mean age 63 ± 11 years; 1099 male, 60%; 1125, 62% on beta-blockers at the time of testing). All underwent SE with either exercise (n= 631, 543 with semi-supine bicycle and 88 with post-treadmill) or vasodilator (n = 1194, 1184 with accelerated high dose dipyridamole and 10 with adenosine) SE for evaluation of known or suspected coronary artery disease and/or heart failure in 7 accredited laboratories of 5 countries. HRR was calculated by ECG as the peak/rest HR ratio. All patients were followed-up.

Results
During a median follow-up time of 480 days, 211 events occurred: 20 deaths, 22 non-fatal myocardial infarctions, 58 hospital admissions for acute decompensated heart failure and 111 late (&gt; 3 months from SE) myocardial revascularizations. Positivity cutoff for HRR identified by ROC analysis was ≤1.67 (sensitivity 51.0, specificity 63.4) in the exercise group and ≤1.32 (sensitivity 65.0, specificity 48.9) in the vasodilator group. The separation was present both in the exercise (left panel) and the vasodilator (right panel) subsets : see figure. At multivariable analysis, blunted HRR was an independent predictor of event-free survival in the overall group (Hazard Ratio 1.422, 95 % Confidence Intervals: 1.055-1.917, p=.021), independent of beta-blocker therapy.

Conclusion
A blunted HRR is a useful non-imaging predictor of adverse events during both vasodilator and exercise SE, independent of inducible ischemia and beta-blocker therapy.
Abstract P1793 Figure. HRR and event-free survival curves