bluuebunny/crossref_metadata_2025_split huggingface dataset:
P915 Bicuspid aortic valve: differences between populations
Authors: Sharif D , Azzam E , Sharif-Rasslan A , Dobrecky Mery I 
Published: January 2020

Abstract
Congenital bicuspid aortic valve (BAV) is the most common congenital valve abnormality, with an estimated incidence of 0.5-2% in adults. However, BAV is much less prevalent in some populations and racial differences were reported. Aim: Comparison between Arab and Jewish patients with BAV in Israel. Methods: Screening of 18962 echocardiographic studies in Bnai Zion Medical Center and evaluation of demographic, atherosclerotic risk factors, clinical and echocardiographic parameters was performed. Results: Male to female ratio in Arab patients was 4.6:1 while in Jewish patients 1.6:1, p &lt; 0.01. The age of both populations with BAV was similar 45 ± 21yeras, however larger prevalence was found of cigarette smoking and diabetes mellitus in Arabs 31.1% and 6.7% than in Jews 8.2% and 3.5% respectively, p &lt; 0.05. Left ventricular, left atrial and aortic dimensions as well as Doppler parameters were similar in both groups except for large mitral peak A-wave velocities in Jewish patients. Prevalence of aortic valve stenosis in Jewish patients was 35% similar to that in Arabs 33% with similar severity and mean pressure gradients. Aortic valve regurgitation was fond in 53% of Arab patients and in 46% of Jewish patients, p = ns, however, moderately severe and severe aortic regurgitation was more prevalent in Arab patients 22% compared to 13% of Jewish patients, p &lt; 0.05. During 10 years follow up, 25% of Arab patients needed aortic valve replacement while in Jewish patients 10% had surgery, p &lt; 0.05. Conclusion: In Arab patients, male to female ratio was larger, with higher prevalence of moderately severe to severe aortic regurgitation and higher rate of aortic valve replacement compared to Jewish patients.
P921 Left atrial appendage flow velocity (LAAV) and n-terminal pro brain natriuretic peptide (NT-proBNP) as strong predictors of high thromboembolic events in patients with nonvalvular atrial fibrillatio
Authors: Luntungan M , Panda A L P 
Published: January 2020

Abstract

Background
Many studies demonstrated that the presence of non valcular atrial fibrillation (NVAF) increased the risk of cardioembolic stroke from fivefold to sixfold. Cardioembolic stroke is commonly sourced by thrombi in Left Atrial Appendage (LAA) and since this is a treatable condition, early detection would be highly beneficial for a better prognosis.
Aim : The aim of this study was to investigate the change of LAA flow felocity (LAAV) and its correlation with NT-proBNP plasma levels, Left atrial spontaneous echo contrast (LASEC) and CHA2DS2-Vasc score, as well as evaluating the prognostic value of these parameters in detecting thromboembolic events in patients with NVAF.

Methods
A non-interventional, cross-sectional observational study of 31 people with NVAF.
Baseline patient characteristics, CHA2DS2-Vasc score, the five-grades of LASEC, NT-proBNP plasma levels were measured and LAAV visualized by transesophageal echocardiography (TEE) were performed.
Results : LAAV were correlated with NT-proBNP (r = -0,511 , p = 0,003), high degree of SEC (r= -0,866 , p &lt; 0,0001) and high CHA2DS2-VASc Score (p = 0.004). In addition, the receiver operating characteristic analysis revealed that the best cut-off value of NT-proBNP to predict higher risk of thromboembolic evants in patientswas 1052pg/mL with 76% sensitivity and 83.3% specificity (area under the curve: X2 = 7,441, p = 0.003). In the subgroup analysis based on different CHA2DS2-VASc scores, the predictive value of NT-proBNP remained significant in patients with a CHA2DS2-VASc score of ≥ 2.

Conclusion
LAAV were significanty correlated positively with NT-proBNP levels, degrees of SEC and CHA2DS2-VASc score. Plasma NT-proBNP along with CHA2DS2-VASc score were strong predictors of thromboembolic events in patients with NVAF
P922 Thrombus and dense spontaneous echo con-trast in left atrial appendage yield high risk of stroke and death, how to resolve it ?
Authors: Kosmalska K , Malgorzata Rzyman M-R , Marcin Fijalkowski M-F 
Published: January 2020

Abstract

Background
Thrombi and sludge in patients with atrial fibrillation and atrial flutter are common. Both thrombus and sludge worses prognosis. Thrombus is a contraindication for cardioversion but further therapeutic guidance is not stated. We focused on: (i) death and stroke risk of patients with thrombus or sludge, (ii) effectiveness of anticoagulation in thrombus resolution and influence of resolution on prognosis (iii) comparison of solid clot and sludge

Methods
77 from 267 (29%) patients with persistent AF were diagnosed in TOE with left atrial thrombus or sludge. After the diagnosis 34 of patients (44%) were marked as chronic AF with OAC therapy. 43 patients (56%) were the group of further attempts of cardioversion with 3 methods of anticoagulation (VKA with rigorous control of INR, higher doses of NOAC or therapeutic doses of low molecular weight heparin). Risk of death and stroke was analyzed (i) in thrombus/sludge vs clean appendage, (ii) in chronic AF with standard anticoagulation versus persistent AF with „intensive" anticoagulation, (iii) with regard to method of anticoagulation, (iv) in persistent thrombus/sludge versus resoluted thromboembolic material, (v) in sludge vs clean appendage and (vi) in sludge vs thrombus.

Results
Annual death risk in patients with thrombus/sludge is high : 17 of 77 (22%). In patients free from thrombus/sludge annual death risk is low: only 3 from 190 (1,6%). Annual risk of stroke in thrombus/sludge is also high: 13 patients (17%); in 6 patients - 46% stroke was fatal. Risk of stroke in patients without diagnosed thrombus/sludge is very low: 2 from 190 (1%); none of the strokes was fatal. More effective in thrombus resolution was LMWH (81% effectiveness) than NOAC (44%) and VKA (43%). Heparin vs OAC, despite better effectiveness, did not yield better survival. Strokes were not significantly less frequent in LMWH group - 9% than OAC - 13%. Incidence of stroke and death in patients with thrombus resolution was not significantly lower: 2 strokes (8%) and 4 deaths (15%) in group of resoluted thrombus and 2 strokes (12%) and 4 deaths (25%) in the group of persistent thrombus. We picked up less cases of deaths and strokes in patients referred to further TOE control versus those not subjected to TOE control but the differences were not significant: 4 patients (9%) of supervised patients had ischemic stroke and 7 (16%) died but in the group with no supervision 7 patients (21%) experienced stroke and 10 (29%) died. There is no statistical difference comparing sludge to clot : 2 patients experienced ischemic stroke (11%) and 3 (16%) died in sludge group and 9 strokes (16%), 16 deaths (24%) occured in clot group.

Conclusions
Patients with thrombus in LAA are of high risk of death and stroke. Best treatment for thrombus resolution was LMWH. Neither resolving the thrombus nor any treatment method decreases the risk significantly. Sludge is equally threatening as solid thrombus.
P931 Feasibility of comprehensive multi-plane right ventricular free wall longitudinal strain evaluation pre-LVAD implantation - preliminary results from a single centre experience
Authors: Bowen D J , Strachinaru M , Mcghie J S , Van Den Bosch A E , Soliman O , Caliskan K 
Published: January 2020

Abstract

Introduction
Right ventricular failure (RVF) is recognized as a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation and identifying patients at risk remains a challenge. Given its structural complexity, it is not possible to fully assess the RV from one echocardiographic 2D plane and entire free wall visualization is more challenging in advanced heart failure patients with very severely dilated left ventricles. Our centre previously introduced a novel multi-plane approach whereby four different RV free wall segments (lateral, anterior, inferior and inferior coronal – figure 1) can be imaged from the same echocardiographic position using focused RV views and electronic plane rotation.
Purpose
The aim of the study was to determine the feasibility of using multi-plane echocardiography (MPE) to quantify right ventricular free wall longitudinal strain (RV-FWLS) in a small cohort of advanced heart failure patients prior to LVAD implantation.
Methods
Sixteen advanced heart failure patients underwent detailed RV assessment by MPE prior to LVAD implantation (median - 15 [6.3-29.8] days before). Feasibility and values of RV-FWLS were retrospectively assessed by an experienced sonographer on each of the 4 free wall segments using specialised RV strain analysis software. Feasibility was confirmed if all regions of the free wall were visualised and tracked appropriately throughout the cardiac cycle. Standard right heart 2D echo parameters and pre-implant right heart catheterisation (RHC) data were also collated.
Results
Mean RV-FWLS and feasibility in the four segments were as follows: lateral -12.4 ± 4.3% (81.3%); anterior -12.7 ± 6.1% (62.5%); inferior -11.8 ± 4.7% (75.0%); inferior coronal -11.6 ± 3.9% (43.8%). TAPSE values on the same segments were feasible in 100% of cases and mean values were as follows: lateral 15.1 ± 4.9mm; anterior 15.3 ± 4.7mm; inferior 13.4 ± 5.2mm; inferior coronal 11.4 ± 5.1mm. Mean pulmonary artery pressure (mPAP) measured by RHC was 27.2 ± 11mmHg. There was a slightly stronger negative correlation of RV-FWLS with increased mPAP in the lateral, anterior and inferior RV free wall segments compared to TAPSE (r²: -0.07-0.11 v -0.01-0.05).

Conclusion
There is reasonable feasibility for assessing RV-FWLS using MPE in 3 out of the 4 free wall segments and mean values were considerably lower than normal reference values. A stronger negative correlation with increasing mPAP suggests that RV dysfunction may be detected better by strain than by TAPSE measurement in pre-LVAD recipients. Larger, multi-centre studies are required to further assess these preliminary findings.
Abstract P931 Figure. Multi-plane RV imaging with strain
P932 What is new in the assessment of patients with hereditary hemochromatosis - can 2D speckle tracking echocardiography be helpful in the early detection of heart abnormalities?
Authors: Danilowicz-Szymanowicz L , Rozwadowska K , Swiatczak M , Sikorska K , Fijalkowski M , Raczak G 
Published: January 2020

Abstract

Background
Hereditary hemochromatosis (HH) is a very common genetic disease. Abnormally increased intestinal iron absorption and accelerated recycling of iron lead to progressive body iron accumulation and the generation of oxidative stress in tissues. In the late stages iron overload of the heart can lead to the left ventricular (LV) dysfunction. It is believed, that two dimensional speckle tracking echocardiography (2D STE) can evaluate LV dysfunction more accurately and earlier than conventional echocardiography. Evaluation of such assessment was the purpose of this paper.

Methods
We prospectively enrolled 58 patients with genetically confirmed HH; 29 healthy age- and sex-matched volunteers constituted the control group. Classic echocardiographic and 2D STE parameters (GE VIVID E9, EchoPAC v201) were compared between the groups, additionally correlations between echo and iron turnover parameters were performed.

Results
The HH patients had all standard echo parameters within the normal range. All 2D STE parameters were significantly worse in HH than in control group (Table 1). We did not find any correlation between echo and iron turnover parameters, whilst significant correlation with the time from diagnosis and the numbers of venesections was noticed.

Conclusions
Novel 2D STE analyzes seem to be helpful in early detection of heart abnormalities in HH patients. The correlations between the echo and iron indices are weak, allowing to suggest the lack of a "direct" relationship between the iron turnover and myocardial function and that myocardial iron overload is not the only mechanism involved in development of HH cardiomyopathy.
HH All n = 58 Controls n = 29 p LAVI (ml/BSA) 31 (23-37) 22 (19-27) &lt;0.001 RWT 0.42 (0.38-0.47) 0.38 (0.34-0.43) &lt;0.003 LVMI (g/BSA) 78 (58-96) 66 (53-72) &lt;0.006 E/Em 7.0 (5.6-8.3) 6.7 (5.0-7.5) 0.071 LVEF (%) 60 (54-62) 63 (61-65) &lt;0.006 LV twist (º) 17.2 (13.1-22.2) 24.1 (19.9-32.1) &lt;0.001 LV torsion (º/cm) 2.2 (1.6-2.9) 3.3 (2.7-4.3) &lt;0.001 LV peak rotation velocity (º/s) 118.0 (88.3-146.3) 140.0 (112.7-168.9) &lt;0.015 LV peak untwisting velocity (º/s) -132.0 (-163.5–93.0) -156.0 (-197.0–122.6) &lt;0.039 Peak systolic longitudinal strain (%) -18.3 (-20.0–16.9) -21.0 (-22.0–19.3) &lt;0.001
P938 Myocardial work analysis in hypertrophic cardiomyopathy: low work or high work?
Authors: Manganaro R , Dulgheru R , Marchetta S , Cozza F , Zito C , Carerj S , Lancellotti P 
Published: January 2020

Abstract

Background
Myocardial Work (MW) is an interesting novel non-invasive parameter to evaluate cardiac performance by left ventricle (LV) pressure-strain loops.

Purpose
The present study sought to investigate MW in patients with both non-obstructive (NOHCM) and obstructive hypertrophic cardiomyopathy (OHCM).

Methods
Forty-four patients with hypertrophic cardiomyopathy (HCM) and twenty controls (mean age 53 ± 20 years vs 52 ± 17 years, respectively, p = 0.8) underwent standard two-dimensional and speckle-tracking echocardiography. Global Work Index (GWI), global constructive work (GCW), global work waste (GWW) and global work efficiency (GWE) were estimated by LV pressure-strain loops. In OHCM group, MW was evaluated by adding LVOT peak gradient to SBP. Analysis of multilayer LV longitudinal strain (LS) and left atrial (LA) LS was performed.

Results
Global LS (GLS), endocardial LS, epicardial LS and LA LS were significantly reduced in patients compared to controls (p &lt; 0.001 for all). All patient population had significantly lower GWI, GCW and GWE and higher GWW respect to controls. Regional GLS, endocardial LS, epicardial LS and regional WI were significantly reduced in hypertrophic area compared to no-hypertrophic area in the patient population (p &lt; 0.001 for all). OHCM group ( n = 14) had higher values of GWI and GCW compared to NOHCM ( n = 30) (2160 (1877-2250) vs 1547 (1148-1767)mmHg% and 2285 ± 411 vs 1755 ± 584 mmHg% respectively, p &lt; 0.05 for both, Figure).

Conclusions
GWI and GCW are reduced in patients with NOHCM. Patients with OHCM, have higher GWI and GCW compared to non-obstructive ones, as expression of work at higher level of energy necessary to counteract high afterload. Our proposed method to estimate MW in OHCM needs to be validated in invasive studies.
Abstract P938 Figure.
P943 Added value of quantification of dobutamine stress echocardiography in patients with suspected coronary artery disease
Authors: Stankovic I , Stefanovic M , Janicijevic A , Milicevic P , Panic M , Kalezic-Radmili T , Putnikovic B , Neskovic A N 
Published: January 2020

Abstract

Background
Patients with chest pain and suspected coronary artery disease (CAD) frequently undergo dobutamine stress echocardiography (DSE) which is based on visual wall motion analysis.

Purpose
In this prospective study, we investigated accuracy and clinical utility of quantification of DSE.

Methods
In 81 consecutive patients scheduled for DSE, standard test was performed in 35 patients, while in the remaining 46 DSE was quantified. Visual assessment of wall motion abnormalities (WMA) was compared to speckle tracking–derived longitudinal strain parameters – global longitudinal strain (GLS) and mechanical dispersion (MD) at different stages of DSE. Reliable tracking was impossible at high-dose DSE in most patients.

Results
In most patients, it was impossible to obtain reliable speckle tracking analysis at high-dose DSE due to high heart rates. New WMA were observed in 23 patients (28%). Patients with dobutamine-induced WMA had similar values of GLS and MD at rest and during low-dose DSE as those without WMA (p &gt; 0.05 for both). However, during the recovery phase, patients with new WMA at high dose DSE showed a greater amount of MD than those without (52 ± 16 vs. 40 ± 14 ms, p &lt; 0.05). Both MD ≥60 ms and GLS ≤-16% during recovery phase had a low sensitivity (20% for both) but high specificity (90% for GLS and 92% for MD) for the detection of WMA during DSE. (Table).

Conclusions
Patients with WMA during DSE exhibit a lower GLS and a greater extent of mechanical dispersion («ischemic memory») during recovery phase. Clinical utility of strain-based quantification of DSE is limited due to inability to define effective cutoff values of strain parameters.
Abstract P943 Figure.
P944 From systolic pulmonary arterial pressure to pulmonary vascular resistance and reserve: a simplified method for exercise stress echocardiography
Authors: Wierzbowska-Drabik K , Ferrara F , D"alto M , Ciampi Q , Kasprzak J D , Agoston G , Varga A , Amor M , Bossone E , Picano E 
Published: January 2020

Abstract

OnBehalf
On behalf of Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI).

Background
The potential of exercise stress echocardiography (ESE) seems to be still underused especialy in the assessment of pulmonary hemodynamics.

Aim
To assess the feasibility and compare pulmonary vascular resistance (PVResistance) and reserve (PVReserve) during ESE in patients at risk of pulmonary hypertension (PH) and controls.

Methods
We performed semi-supine ESE, in 97 subjects (age 49 ± 16 yrs, 63 females): 58 patients (Group 1) at risk for PH (systemic sclerosis and other connective tissue diseases) and 39 healthy controls (Group 2). Rest and stress assessment included: tricuspid regurgitant velocity (TRV), pulmonary acceleration time (ACT), cardiac output (CO), SPAP estimation with Bernouilli equation or from ACT with formula: log10 SPAP= - 0.004 (ACT) + 2.1. We estimated PVResistance from Abbas formula, and PVReserve as ΔCO/ ΔSPAP or (when CO was not available) as minutes of exercise/ΔSPAP. When ΔSPAP was &lt;10 mmHg, it was considered equal to 1.

Results
With TRV or ACT to estimate pressures, and cardiac output or its proxy to estimate flow, PVResistance or PVReserve could be measured in all patients. At peak exercise, PVResistance was higher and PVReserve lower in Group 1 : see Table.

Conclusion
Estimation of PVResistance and/or PVReserve can be obtained in all patients during ESE, integrating TRV with ACT, and using exercise-time as a proxy of CO when the latter is not available. These indices may be useful for a better, noninvasive characterization of the heterogeneity of pulmonary hemodynamics.
Pulmonary hemodynamics ESE data Parameter Group 1, PH (n = 58) Group 2, normals (n = 39) P value TRV rest (cm/s) 243 ± 63 204 ± 31 =0.0147 TRV peak (cm/s) 344 ± 68 204 ± 53 &lt;0.0001 ACT rest (ms) 113 ± 33 128 ± 20 =0.0205 ACT peak (ms) 86 ± 19 94 ± 22 ns SPAP rest (mm Hg) 26 ± 10 21 ± 4 =0.0039 SPAP peak (mm Hg) 45 ± 19 28 ± 13 &lt;0.0001 CO rest (mL/min) 4.9 ± 1.7 5.1 ± 1.7 ns CO peak (mL/min) 7.8 ± 2.8 7.6 ± 2.9 ns Exercise time (min) 7 ± 2 13 ± 3 &lt;0.0001 PVResistance (WU) rest 1.63 ± 0.52 1.54 ± 0.34 ns PVResistance (WU) peak 2.01 ± 0.89 1.27 ± 0.42 =0.0219 PVReserve (ΔCO/ΔSPAP) 1.38 ± 1.13 3.55 ± 2.45 =0.001 PVReserve (Extime/ΔSPAP) 4.69 ± 2.67 10.96 ± 4.39 &lt;0.0001 Legends: WU -Wood Unit, Ex time - exercise time
P949 Step by step guidance of MitraClip procedure with a new quantitative parameter
Authors: Gavazzoni M , Taramasso M T , Pozzoli A P , Miura M M , Tanner F T , Maisano F M , Zuber M Z 
Published: January 2020

Abstract
Background/Introduction. In step by step guidance of percutaneous mitral valve (MV) repair with MitraClip System (Abbott Vascular, Santa Clara, CA, USA) evaluation of step by step MR reduction by color-Doppler echocardiography can be challenging requiring multiparametric approach and to freeze and process images while the procedure is going. Purpose: This prospective study aimed to assess the role of a new echocardiographic parameter obtained from 3D-Color-Full volume imaging of MR for evaluation of step-by-step MR reduction during MitraClip procedures by a comparison with step-by-step reduction of m-LAP. Methods: We prospectively performed the computation of a new parameter that is obtained by acquisition of MR by 3D-zoomed-color image in dual volume layout for seeing the ventricular aspect of the jet area corresponding to proximal isovelocity surface "zone"; then, measure of that area is traced, so that it represents the 2D area of the proximal isovelocity surface zone visualized from the ventricular view, without any imaging processing ("3D dual volume PISA area"). In double orifice, we added the two computations obtained by the two orifices. We compared the variation of this parameter with variations of m-LAP at the two steps of MitraClip procedures requiring implantation of 2 MitraClips. Results: The study includes dataset of 19 patients. The baseline value of 3D dual volume PISA area was 1,47 ± 0,49 cm2 and the mean change obtained after first clip was 0,25 ± 0,21 cm2 (- 65 % of reduction from baseline, p value: 0.001) and a further change from first to second clip was of 46% (p 0,1). Conversely, the m-LAP decreased more in the second step of procedure: basal m-LAP was 15 ± 13,3 mmHg and decreased by 32% by the end of procedure; in the first step m-LAP was reduced of 12% from baseline (from 15 ± 13,3 to 14,1 ± 9,8 mmHg) and in the second step of 18% (from 14,1 ± 9,8 to 11 ± 4 mmHg). We tested correlation between relative reduction of 3D-PISA and reduction of m-LAP at each of the procedural steps and we observed significant correlation only during the first procedural step (baseline-to-first clip) (R: 0,527, p 0.02), not in the second (1 st-to-2 nd clip) (R: 0,345, p 0.13). Considering the whole procedure, reduction of 3D-PISA was correlated to reduction of m-LAP at the end. Conclusions: Our study demonstrate that this new parameter is related to hemodynamic improvement during procedures, mostly in the first step, when the amount of reduction is marked; for further step invasive monitoring of LAP would be more pivotal. These data need to be confirmed by a larger study.