bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1750 Association of high-sensitivity troponin elevation and LVEF decline in anthracycline-treated breast cancer patients
Authors: Cardoso Torres S , Sousa C , Maia Araujo P , Simoes J , Nunes A , Tavares Silva M , Pinto R , Paiva M , Macedo F , Maciel M J 
Published: January 2020

Abstract

Introduction
Cancer therapies have been linked to a wide variety of side effects, with cardiotoxicity being the most significant one. Early detection of subclinical cardiac dysfunction in cancer patients (pts) is necessary in order to prevent unfavorable outcomes. High-sensitivity troponin I (hsTI) levels have been proposed as predictors of cancer therapy related cardiotoxicity and may guide cardioprotective therapy initiation.

Purpose
To describe the incidence of cancer treatment related cardiac dysfunction (CTRCD) in a population of breast cancer pts under chemotherapy in a single center cardio-oncology unit and to assess its relationship with hsTI levels.

Methods
We retrospectively evaluated 83 women on anthracycline therapy for breast cancer, with or without anti-HER2 therapy, followed-up between January 2017 and July 2018.
CTRCD was defined as more than 10% absolute reduction of LV ejection function (LVEF) to a value below 50%. Elevation of hsTI was defined as at least one measurement above the 99th percentile upper reference limit during follow-up (&gt;34 ng/L).
Pts had an organized follow-up in our cardio-oncology unit, consisting of a clinical, laboratorial (with dosing of cardiac biomarkers) and echocardiographic assessment at 0, 3, 6 and 12 months (or more frequently in selected high-risk cases).

Results
A total of 83 women with a mean age of 49 years (26-76) were included. 4 pts (4.8%) developed CTRCD. 17 pts (20.5%) were considered at high risk of cardiac dysfunction due to hsTI elevation.
During follow-up, the percent increase in the hsTI level (from basal level) correlated with CTRCD (p = 0.02). On the other hand, the absolute maximum value of hsTI did not (p = 0.159).
In fact, pts who developed CTRCD had a significantly higher percent increase in the hsTI levels (142.9% +- 57.5%) vs those without CTRCD (14.29% +- 4.6%), p &lt; 0.001. On ROC curve analysis, percent increase in troponin was a good identifier of CTRCD (AUC of 0.986; 95% CI 0.95-1.00; p = 0.022) and the best cut-off value was a 79.8% increase in hsTI (sensitivity: 100%; specificity: 97.2%).

Conclusion
In our population, the percent increase in the hsTI levels correlated with CTRCD. Larger studies are needed to prove this parameter as a predictor of CTRCD.
Abstract P1750 Figure.
P1755 Clinical and echocardiographic outcomes of mitral valve repair surgery
Authors: Garcia Bras P , Moura Branco L , Coelho P , Vaz Ferreira V , Castelo A , Galrinho A , Timoteo A T , Banazol N , Rodrigues R , Fragata J , Ferreira R C 
Published: January 2020

Abstract

Background
Mitral valve regurgitation (MVR) represents the second most frequent valvular heart disease. MV surgical repair is often the preferred treatment when MV anatomy is suitable.

Purpose
To characterize the population who underwent MV repair surgery and evaluate the outcomes of residual MVR, allcause mortality and functional classification.

Methods
Retrospective analysis of 262 patients (P) admitted between 2008 and 2017 for MV repair surgery. P who undergone simultaneous coronary artery bypass graft (CABG) surgery, atrial fibrillation (AF) surgery and tricuspid valve repair were also included. P with endocarditis, P who underwent simultaneous aortic valve replacement and P with rheumatic predominant MV stenosis were excluded, the remaining 204 P were analysed. Clinical and echocardiographic characteristics were evaluated in a mean follow-up of 30 months.

Results
204 P, 67.2% male, mean age 62 + 14 years. The most frequent etiology was organic (80.4%), mostly of degenerative cause. Functional etiology was present in 19.6%, mostly ischemic (72.4%). 16.8% underwent simultaneous CABG, 12.3% tricuspid valve repair and 7.8% AF ablation.
Hypertension was significantly associated with functional etiology (90% vs 72.8%, p = 0.022), as well as hypercholesterolemia (80% vs 48.2%, p &lt; 0.001) and diabetes mellitus (32.5% vs 10.4%, p &lt; 0.001). Baseline left ventricular ejection fraction (LVEF) was &gt;50% in 78.4%, reduced (30-50%) 18.1% and poor (&lt;30%) in 3.4%.
Functional etiology was significantly associated with LVEF &lt;50% (70% vs 9.1%, p &lt; 0.001).
161P (78.9%) had MV prolapse: 120P (74.5%) posterior, 29P (18%) anterior and 7.4% (12P) of both leaflets. P2 was the most frequently involved scallop, in 92P (57.1%), followed by P3, in 41P (25.4%). There was MV chordae rupture in 94P (58.3%).
Post-surgery echocardiography revealed that 93.8% had mild or no residual MVR.
30-day mortality rate was 0%.
There was MVR recurrence with MV replacement surgery in 15P (7.5%), mean time 37.1 months. All-cause mortality was registered in 28P (13.7%), with a mean time of 43.7 months after MV surgery.
Of the P without MVR recurrence or mortality, 111P (70%) were in NYHA class I, 41P (26%) in NYHA class II and 6P (4%) in NYHA class III. 6P were lost to follow-up. Upon echocardiographic revaluation there was no residual MVR in 53P (39%), mild MVR in 67P (49%) and moderate MVR in 16P (11.8%).

Conclusion
In P who underwent MV repair surgery, there was 7.5% recurrence rate with follow-up MV replacement surgery and an all-cause mortality of 13.7%. In a mean follow-up of 30 months, 70% of P were in NYHA I class and there was none or mild residual MVR in 88% of P.
P1760 Cardiac prognosis of patients with subaortic membrane according to their morphology
Authors: Graterol Torres F R E , Moral S , Robles R , Ballesteros E , Morales M , Maria Frigola J , Albert X , Muntaner L , Ramos R , Vilardell P , Brugada R 
Published: January 2020

Abstract

INTRODUCTION
Subaortic membrane is an entity which evolves during adulthood and can associate cardiac complications. Different morphologies have been described, although it is unknown if their prognosis varies according to these patterns. The aim of this study was to evaluate the cardiac prognosis of patients with subaortic membrane according to their morphological characteristics in adulthood.

METHODS
Forty-five patients diagnosed with subaortic membrane by imaging techniques were consecutively included (March 1999-August 2018). Three morphologies were described: fibromuscular ridge (FR), crescent-shaped (CS) and filamentous-shaped (FS). Cardiac complications were defined as mortality due to heart failure and/or necessity of aortic valve surgery and/or membrane resection.

RESULTS
Twenty-six cases (58%) had FR, 16 (35%) had CS and 3 (7%) presented FS (7%) (Fig.1). No differences were found in basal clinical parameters between groups. FR type was associated with the presence of dynamic gradient in baseline study (27% vs 0%, p = 0.014), but there were no differences in left ventricular ejection fraction (68 ± 8% vs 64 ± 8%; p = 0.092), nor in maximum thickness of basal interventricular septum (12.1 ± 3.9mm vs 11.7 ± 4.1mm, p = 0.699), nor in the presence of moderate/severe aortic stenosis (15% vs 11%, p &gt; 0.999) with the other morphologies. During follow-up (mean ± SD= 5.8 ± 4.4years) 15 (33%) patients presented cardiac complications (2 deaths due to heart failure and 12 valvular interventions and/or membrane resection). FR type patients presented a higher cardiac complication rate (50% vs 11%, p = 0.006) and greater necessity of open-heart surgery (46% vs 11%, p = 0.011) than the other groups during follow-up.
CONCLUSIONS
FR type is associated with a higher rate of cardiac complications during follow-up than other subaortic membrane morphologies. Dynamic gradient associated to this pattern could be the basis of a possible pathophysiological mechanism related to the worst prognosis of these patients.
Figure 1. Different morphologies of subaortic membranes. (A) Fibromuscular ridge type; (B) Crescent-shaped type; (C) Filamentous-shaped type. aL: anterior leaflet of mitral valve ; Ao: aorta; LA: left atrium; LV: left ventricle; RV: right ventricle.
Abstract P1760 Figure.
P1783 Concealed structural abnormalities detected by 2D speckle tracking strain echocardiography persist post ablation in patients with idiopathic ventricular arrhythmias
Authors: Trivedi S , Kumar S , Thomas L 
Published: January 2020

Abstract

Background
Idiopathic ventricular arrhythmias (IVA) occurs in patients without overt heart disease. 2D speckle tracking strain echocardiography parameters, including global longitudinal strain (GLS) and mechanical dispersion (MD), have been shown to predict ventricular arrhythmias. It is unclear if the abnormalities are due to structural substrate abnormality, or substrate abnormality consequent to electrical alterations. Aim: We sought to assess whether patients with IVA have impaired left ventricular (LV) strain indices, and if so, whether these persist following successful treatment with radiofrequency ablation (i.e. correction of electrical alteration). Methods: 2D strain analysis was performed (in sinus rhythm) in 23 consecutive patients with IVA (no structural heart disease by cardiac magnetic resonance imaging (MRI); Group A) prior to electrophysiological mapping/ablation, and compared to 23 age and gender matched healthy controls (Group B). Follow up echocardiography and multiday Holter monitoring was performed 12 months post ablation. Results: Baseline characteristics were similar for indexed LV end diastolic volume (EDV) and ejection fraction (EF) (p = 0.1 for both) (Table 1). LV GLS was lower (p = 0.03) and LV MD was increased (p = 0.002) in the IVA group prior to treatment. At follow up, 18 patients (78%) (Group C) remained free of ventricular arrhythmias – in these patients, LV GLS improved and was similar to controls (p = 0.217); however, LV MD remained significantly increased at 12 months compared to controls (p = 0.009). In the 5 patients (22%) (Group D) that continued to have ventricular arrhythmias at follow up, both LV GLS (p = 0.04) and LV MD (p = 0.008) remained significantly impaired compared to controls. Conclusion: Despite demonstrable absence of structural abnormalities with cardiac MRI, 2D strain can detect subtle alterations in myocardial contraction heterogeneity. Furthermore, 12 months post successful ablation treatment, the increase in MD persists. This suggest the presence of subtle substrate abnormality that results in IVA. In uncured patients, both myocardial deformation parameters remain impaired, suggesting the need for close future surveillance of these patients. Long term follow up with greater number of patients is required to further validate these findings.
Table 1. Echocardiographic parameters Group Indexed LVEDV (ml/m2) LVEF (%) LV GLS (%) LV MD (ms) IVA (Group A) 55 ± 15 61 ± 5 -19.9 ± 3* 44 ± 12* Controls (Group B) 54 ± 14 64 ± 7 -21.2 ± 2 33 ± 9 Group C 12 months follow up -21.7 ± 3 42 ± 11* Group D 12 month follow up -19.8 ± 2* 43 ± 11* * denotes p &lt; 0.05
P253 Patient after correction of Taussig-Bing anomaly with severe neoaortic regurgitation and after sudden cardiac arrest
Authors: Bielecka-Dabrowa A M , Rybak M , Pawliczak F , Lewek J , Banach M , Maciejewski M 
Published: January 2020

Abstract
The Taussig –Bing anomaly is a rare congenital heart malformation that was first described in 1949 by Helen B. Taussig and Richard J. Bing. It is characterized by the presence of a large subpulmonic ventricular septal defect (VSD) and, usually, side-by-side great vessels that arise entirely from the right ventricle. Unlike TGA with VSD, this anomaly is characterized by the presence of a bilateral conus and the absence of aortomitral continuity. Increased pulmonary blood flow leads to early onset of pulmonary vascular disease, hence repair in the early infancy period is recommended. VSD closure combined with arterial switch is currently the preferred procedure. Lecompte introduced a new surgical technique that includes extensive resection of the conal septum and direct reimplantation of the pulmonary trunk on the superior margin of the right ventricular infundibulotomy.
We present case of 18-year-old male patient with Taussig-Bing anomaly after pulmonary artery binding and closure of ductus arteriosus when one year old and after anatomical Jatene correction with modified Lacompte procedure at the age of two years. The patient was admitted to our Department in October 2018 after episode of sudden cardiac arrest in the mechanism of ventricular fibrillation. Echocardiographic examination revealed preserved systolic function of both ventricles (LVEF 62%, TAPSE 25 mm, RV S’ 13cm/s) without contractility disturbances. The enlarged and hypertrophic left ventricle consists of the primary cavity connecting by VSD (size 39 mm) with a fragment of the right ventricle separated from the rest of the right ventricle by a patch with Gore-Tex acting as a ventricular septum - without any leakage features (Figure 1A and 1B). We noticed also enlarged left atrium, increased diameter of neoaorty bulb (50 mm), severe neoaortic regurgitation (AV max: 1,85 m/s, ERO-70, VC-8mm, PHT 327 ms) (Figure 1C), moderate mitral regurgitation (type I according Carpentier) (Figure1D). On 8.01.2019 a subcutaneous ICD Boston Scientific Emblem with a subcutaneous defibrillation electrode was implanted. In performed spiroergometry decreased peak oxygen consumption (2,24 ml/min/kg), the study was stopped because of fatique, assessed expiratory exchange ratio, and episode of nsVT. After decision of Heart Team the patient is qualified for surgical treatment of valve defects.
Abstract P253 Figure 1
P1806 Relation between carotid artery wave intensity compression wave and left ventricular dp/dt
Authors: Antonini-Canterin F , Strazzanti M , Pepe A , Penzo M , Nicolosi E , Pagliani L , Luzza G , Rivaben D 
Published: January 2020

Abstract

Background
Invasive catheter-based studies demonstrated a correlation between left ventricular (LV) dP/dt, a well known index of contractility, and carotid artery wave intensity compression wave.
It is possible to estimate LV dP/dt with ultrasound, evaluating the slope of continuous Doppler wave of mitral regurgitation in early systole. Wave intensity (WI) is achieved merging the echo-tracking of the common carotid artery with the simultaneous pulsed Doppler signal inside the vessel. The first peak (W1) represents the forward compression wave, reflecting theoretically LV contractile function. Nowadays data about the relationship between the two dP/dt methods are scarce.

Purpose
The aim of the study is to compare carotid artery WI and mitral regurgitation wave-derived LV dP/dt in a population of patients with ischemic and not ischemic heart failure.

Methods
We examined 31 consecutive patients with heart failure (7 females, 24 males, mean age 66.7 + 13.9 years, range 29-97 years, 21 ischemic, 10 not ischemic). All patients had at least a mild mitral regurgitation. Two subgroups were created according to the left ventricle ejection fraction values (LVEF ≤ 45% and LVEF &gt; 45%, with 15 and 16 patients respectively). A simultaneous not-invasive brachial blood pressure was obtained.

Results
The W1 was significantly linearly correlated with the echocardiographic LV dP/dt value (r = 0.41, p 0.02). Both W1 and LV dP/dt correlated significantly with LV ejection fraction.

Conclusions
Carotid WI evaluation, and specifically its first peak W1, could be reinterpreted as an alternative method to estimate not invasively LV contractility performance. Larger studies are needed to evaluate the relative prognostic role of carotid artery W1 and LV dP/dt in clinical practice.
Results LVEF ≤ 45 % (n = 15) LVEF &gt; 45 % (n = 16) p value W1 6.19 +- 3.77 9.3 +- 3.43 0.02 dP/dT 789 +- 329 1244 +- 337 0.0007
Abstract P1806 Figure. Common Carotid Artery eTracking
P1816 Cerebral microembolism in low-risk patients with paroxysmal atrial fibrillation before and after pulmonary vein isolationCerebral microembolism in low-risk patients with paroxysmal atrial fibrillation
Authors: Wieczorek J , Cichon M , Wieczorek P , Hoffmann A , Wnuk-Wojnar A , Szydlo K , Lasek-Bal A , Mizia-Stec K 
Published: January 2020

Abstract

BACKGROUND
Invasive treatment of atrial fibrillation (AF) becomes more suitable and effective therapy. There are no consistent data describing the occurrence of potential neurological complications in low-risk patients with paroxysmal AF.

AIM
to determine the occurrence, consequences and risk factors for brain white matter hiperintensities (WMH) assessed in magnetic resonance imaging (MRI) in low-risk patients before and after pulmonary vein isolation (PVI) treatment.

METHODS
Eighty patients with symptomatic paroxysmal AF (median age: 58 years (IQR 50-63), K/M: 30/50), CHA2DS2-Vasc ≤ 3 (CHA2DS2-Vasc: 2 (IQR 1-2.5)) were included in the study. Before and after a minimum of 6-month period after PVI-RF treatment (med. 9,9 months, IQR 7.6-11.8 months) a clinical evaluation with brain MRI and Mini Mental State Examination (MMSE) test were determined. Severity of brain WMH in MRI was assessed in the Fazekas scale (pic 1). The efficacy of PVI-RF treatment analyzed in a 7-day Holter monitoring was confirmed in 43 (53.8%) patients.

RESULTS
Baseline WMH lesions were found in 55 (68.8%) patients. Patients with baseline WMH lesion obtained similar results in the MMSE test, compared to patients with a normal brain image in the MRI study. There was a statistically significant more frequent occurrence of cerebral WMH lesions among older patients, with a higher CHA2DS2-Vasc score, with left atrial (LA) dilatation and dysfunction. Factors affecting the severity of the WMH were: the co-occurrence of the patent foramen ovale (PFO) and coronary artery disease (CAD).
After PVI-RF treatment there were no significant changes in the presence and severity of WMH lesions. Similarly, there were no significant changes in the cognitive abilities assessed with MMSE test compared to the pre-procedural evaluation. There were also similar factors predisposing to brain WMH changes: older age, higher CHA2DS2-Vasc score and higher BMI. In turn, the degree of the brain WMH severity after observation period was dependent on age, higher CHA2DS2-Vasc score, presence of PFO and CAD and the initial LA function.
CONCLUSIONS Cerebral microembolism assessed in MRI is often found in low-risk patients with paroxysmal AF, and its presence and severity are associated with LA dilatation and dysfunction, age and higher CHA2DS2-Vasc score. Additional factors affecting the severity of WMH lesions are: the co-occurrence of PFO and CAD. PVI-RF procedure and its efficacy does not influence on MRI lesions. In the population of relatively young AF patients with no significant cardiovascular disease burden, cerebral microembolism is not related to cognitive impairment.
Abstract P1816 Figure. pic 1
P256 Takotsubo syndrome early after treatment due to non cardiotoxic chemotheraphy agents
Authors: Ozbay B , Gurses E , Kemal H , Simsek E , Kultursay H 
Published: January 2020

Abstract

Physicians have encountered cardiotoxicity in different situations. The most known scenario is heart failure after especially anthracycline treatment. In this case, immediately after chemotherapy typical Takotsubo syndrome developed and was diagnosed with normal coronary angiography with apical ballooning movement in ventriculography. Acute cardiotoxicity may depend on different pathogenesis than ordinary toxicity mechanism.

Case report
A 65 years old female attended emergency department with epigastric pain after chemotherapy. She had vinorelbine and gemcitabine treatment for malignant urotelial renal carcinoma. The patient was consulted with cardiology department, because of progressive high troponin T levels. She had no prior history except urotelial carsinoma for one year and hypertension for seven years. Her prior chemotherapy protocols included carboplatine and docetaxel. She did not describe typical angina pectoris or shortness of breath.
Electrocardiography (ECG) at admission had symmetrical T wave inversion on precordial derivations (figure 1). Echocardiography (echo) showed typical apical ballooning of the left ventricle (figure 2 and 3). We do not know the patient’s prior cardiac performance and acute coronary syndrome and Takotsubo syndrome were our preliminary diagnosis. Normal coronary arteries were seen on coronary angiography, ventriculography revealed apical ballooning movement of the left ventricle (Figure 4) and this supported our diagnosis as Takotsubo syndrome. She was already on valsartane 160 mg daily for hypertension and we included metoprolol 50 mg daily and enoxoparine 6000 IU s.c twice a day. For several days deep symmetrical T wave inversion persisted on ECG. After third day her ECG changings resolved (Figure 5) and echo images had recovered. The patient was discharged uneventfully and is followed.
Abstract P256 figures
P1825 Myocardial bridging and coronary artery disease in hypertrophic cardiomyopathy: a matched case control study
Authors: Van Der Velde N , Huurman R , Yamasaki Y , Kardys I , Galema T , Budde R , Zijlstra F , Schinkel A , Michels M , Hirsch A 
Published: January 2020

Abstract

Funding Acknowledgements
None.

Introduction
The etiology of chest pain in hypertrophic cardiomyopathy (HCM) is diverse and includes coronary artery disease (CAD) as well as HCM-specific causes. Myocardial bridging (MB) has been associated with HCM, chest pain, and accelerated atherosclerosis. To investigate differences in the presence of MB and CAD, we compared HCM patients with age-, gender- and CAD pre-test probability (PTP)-matched outpatients presenting with chest pain.

Methods
We studied 84 HCM patients who underwent cardiac computed tomography and compared these with 168 matched controls (age 54 ± 11 years, 70% men, PTP 12% [5%–32%]). MB, calcium score, plaque morphology and presence and extent of CAD were assessed for each patient. Linear mixed models were used to assess differences between cases and controls.

Results
Differences between HCM patients and controls are described in the table. In summary, MB was more often seen in HCM patients (50% vs. 25%, p &lt; 0.001), who were also more likely to have &gt;1 segment affected (14% vs. 2%, p &lt; 0.05). In the HCM group, MB was associated with pathogenic mutation status. Calcium score and the presence of obstructive CAD were similar in both groups (9 [0-225] vs. 4 [0-82] and 18% vs. 19%; p &gt; 0.05 for both).

Conclusion
MB was twice as prevalent in the HCM group. However, in a matched analysis, the prevalence and extent of CAD was equal among patients with and without HCM. These finding illustrate that despite a higher prevalence of MB, the prevalence of CAD is similar between groups, also demonstrating satisfactory performance of pre-test risk prediction in HCM patients.
Assessment of CAD by CT HCM group(n = 84) Control group (n = 168) p-value Agatston score 9 [0-225] 4 [0-82] 0.22 No. of pts with score* 0.07 0-399 31 (89%) 149 (91%) &gt;400 8 (11%) 15 (9%) Obstructive CAD 15 (18%) 32 (19%) 0.82 No. of pts with MB 42 (50%) 42 (25%) &lt;0.001 No. of vessels with MB &lt;0.001 1 34 (40%) 39 (23%) 2 8 (10%) 3 (2%) No. of pts with &gt;1 segment with MB 12 (14%) 4 (2%) &lt;0.001 Abbreviations CAD = Coronary artery disease, MB = Myocardial bridging, pts = patients *Only measured in 73/84 HCM patients and in 164/168 control patients