bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1539 Role of global longitudinal strain diastolic index in assessment of coronary artery disease in patients with stable angina and normal or borderline ejection fraction
Authors: Bolog M I , Dumitrescu M , Pacuraru E , Romanoschi F , Rapa A 
Published: January 2020

Abstract
Background Previous studies demonstrated that 2 D strain imaging segmental transverse diastolic index is a marker of regional ischemia and that global longitudinal strain diastolic index (GLSDI) correlates with left ventricular (LV) filling pressures and NTproBNP. However, usefulness of GLSDI in clinical practice has to be established.
Purpose The aim of the study is to examine the utility of global longitudinal strain diastolic index in the assessment of patients with suspected ischemic heart disease (IHD).
Methods We performed 2 D standard echocardiography and strain imaging in 30 healthy subjects and in 148 patients with stable angina with indication for coronarography. Patients with severe symptoms, severe valvulopathy, arrythmia and/or ejection fraction (EF) less than 45% were excluded. Standard echocardiographic parameters, left ventricular global longitudinal strain (LVGLS) and global longitudinal strain diastolic index were analysed. The patients subsequently underwent coronary angiographic examination.
Results GLSDI was significantly lower in angina pectoris vs control group (0.41 vs 0,69, p &lt;0.001). After coronarography patients were divided in three subgroups: 74 patients (50%) with more than 50% obstruction in any major artery, 26 patients (17.5%) with previous revascularisation but no significant obstructive lesions at present and 48 patients (32.5%) without obstructive artery disease. Average GLSDI was significantly lower in the subgroup with obstructive coronary disease vs the other two subgroups (0.32 vs 0.41 and 0.46 respectively, p &lt; 0.05). Mean LVEF was different in subgroups but with no statistical significance (50 % vs 48 % vs 54 %, p= 0.08). Mean LVGLS was lower in the obstructive artery disease subgroup (-16.4% vs -18.2% vs -21% respectively, p&lt; 0.05). In univariate analysis lower GLSDI was associated with a higher risk of coronary artery disease (Hazard Ratio 1.39, 95% Confidence Interval 1.09-1.49; p &lt; 0.05 per 0.1% decrease). There was significant correlation between reduced GLSDI and the presence of coronary artery disease (r= -0,54, P &lt; 0.05), hypertension (r=- 0.61, p &lt; 0.05), left ventricular hypertrophy (-0.68, p &lt; 0.05) and diastolic disfunction (-0.69, p &lt; 0.05). GLSDI lower than 0.5 had a good sensitivity (84%) and negative predictive value (71%) and a lower specificity (40%) and positive predictive value (52%) for detection of ischemic heart disease.
Conclusions Global longitudinal strain diastolic index is significantly lower in patients with stable angina and normal or borderline reduced ejection fraction compared with normal subjects. A cut off value lower than 0.5 selects patients with a higher probability of obstructive coronary heart disease.
P1541 Left ventricular global longitudinal strain can predict the risk of ventricular arrhythmias in hypertrophic cardiomyopathy patients with preserved left ventricle function
Authors: Marinho V , Alves P , Domingues C , Ferreira J , Milner J , Antonio N , Martins R , Elvas L , Goncalves F , Goncalves L 
Published: January 2020

Abstract

Introduction
Hypertrophic cardiomyopathy (HCM) is characterized by a heterogeneous clinical expression with increased risk of sudden cardiac death (SCD) from ventricular arrhythmias (VAs).Several studies have shown that patients with malignant arrhythmias have increased electrical dispersion and in homogeneity of intraventricular conduction. Strain by echocardiography is an excellent tool for assessing regional and global left ventricular (LV) function and mechanical dispersion reflects heterogeneous myocardial contraction. We aimed to explore the value of strain parameters in prediction of VAs in HCM with LV preserved systolic function.

Methods
Retrospective observational study including all patients with HCM and ICD implanted in setting of primary prevention in our centre. Patients with LVEF &lt; 40% or coronary artery disease were excluded. LV GLS was defined as the average of peak longitudinal strains from a 16 LV segments model, obtained from three apical views. Time to peak strain was defined as the time from onset Q/R wave on ECG to peak negative longitudinal strain during the entire cardiac cycle. Mechanical dispersion was defined as the standard deviation of time to peak negative strain in 16 LV segments. Patients with VA (group1) and patients without VA (group2) were compared.

Results
The study population included 48 patients, 63.3% of male gender. A family history of HCM was present in 64 pts (43%). All patients were under anti arrhythmic therapy (BB in 95.6%, other anti-arrhythmic in 28.2%). VAs (sustained and non sustained) were documented in 27 (55%) patients. The study groups did not differ regarding to mean age (54 ± 12 vs 56 ± 12 years, p = 0.67), male gender (54% vs 56%, p = 0.87) and BB therapy (91% vs 96%,p = 0.07). Mean LVEF was 58% in group 1 and 61% in group 1, p = 0.56; a LVOT gradient &gt;30mmHg was present in 52% of group 1 pts and 45% of group 2 pts, p = 0.06. Mean wall thickness was 22mm vs 18 mm, p = 0.03, respectively.
GLS was significantly lower in group 1 (- 13.9 ±3.4 vs -16.1 ±3.5, p = 0.02), mechanic dispersion was significantly higher in group 1(81 ± 14 vs 60 ± 12ms, respectively, p = 0.01. Using a multivariate logistic regression model including variables included in SCD HCM risk score proposed by ESC mechanical dispersion (OR: 1.54 (1.03–8.7), p = 0,03) was a strong and independent risk predictor of VA. Using optimal cut-off values from ROC analyses, patients with mechanical dispersion &gt;67 ms (AUC = 0.82, p= 0.02) had more VAs.

Conclusions
Mechanical dispersion and GLS may help to identify HCM patients with high risk of VAs and SCD.
Abstract P1541 Figure 1
P1556 Significance of combined cardiopulmonary and echocardiographic stress test to distinguish the hemodynamic and metabolic responses of hypertensive patients with or without heart failure
Authors: Pugliese N R , Mazzola M , De Biase N , Natali A , Gargani L , Pedrinelli R , Dini F L 
Published: January 2020

Abstract

Background
Arterial hypertension (HT) is one of the main risk factors for the development of heart failure with preserved ejection fraction (HFpEF). However, little is known regarding the hemodynamic and metabolic responses of patients with HT during the stress test.

Purpose
We assessed the hemodynamic and metabolic characteristics of HT subjects and patients with HFpEF and HT (HFpEF-HT) by combining cardiopulmonary exercise test (CPET) and exercise stress echocardiography (ESE).

Methods
We studied 170 consecutive subjects, undergoing a symptom-limited graded ramp bicycle CPET-ESE: 52 stable (NYHA I-III) outpatients with HFpEF-HT (69 ± 13 years; 44 males, 85%), 86 well-controlled HT subjects (66 ± 10 years; 72 males, 84%) and 32 age and sex-matched healthy controls (59 ± 15 years; 24 males, 75%). During the exercise, we assessed oxygen consumption (VO2), cardiac output (CO) systemic vascular resistance (SVR) and arterial-venous oxygen content difference (AVO2diff).

Results
Peak systolic blood pressure was significantly more elevated in HT subjects (205.7 ± 23 mmHg) than controls (190.9 ± 29 mmHg; p = 0.005) and patients with HFpEF-HT (177.5 ± 26 mmHg; p = 0.03). HT patients exhibited a peak VO2 (18.7 ± 2 ml/min/kg) that was higher than HFpEF-HT patients (15.2 ± 2 ml/min/kg; p &lt; 0.0001), but lower than controls (24.4 ± 7.3 ml/min/kg; p &lt; 0.0001). Peak CO was significantly more elevated in HT (12.3 ± 0.4 ml/min) and controls (13.3 ± 0.6 ml/min) than in HFpEF-HT (9.8 ± 0.4 ml/min; p &lt; 0.0001). Both HFpEF-HT and HT patients displayed a significantly reduced peak AVO2diff (13.3 ± 1 and 13.5 ± 1 vs 16.9 ± 1 mL/dL; p &lt; 0.0001) and increased SVR compared to controls (1066 ± 36 and 1054 ± 33 vs 904 ± 42 dyne·s/cm; p = 0.01).

Conclusions
CPET-ESE was valuable to characterise the hemodynamic and metabolic responses of patients with HT (Figure). HT subjects present a decreased AVO2diff similar to HFpEF patients, suggesting an early peripheral dysfunction, probably related to the impaired reduction of SVR during exercise.
Abstract P1556 Figure.
P1563 A new dimension in patent foramen ovale size estimation
Authors: Demulier L , Paelinck B P , Coomans I , Hemelsoet D , De Backer J , Campens L , De Wolf D 
Published: January 2020

Abstract

Introduction
Detailed multidimensional assessment of patent foramen ovale (PFO) size with transesophageal echocardiography (TOE) may help to determine PFO pathogenicity in cryptogenic stroke patients and may improve the procedural outcome of percutaneous PFO closure.

Purpose
We explored the potential additive value of Live xPlane and three-dimensional (3D) TOE anatomical PFO sizing techniques.

Methods
Imaging data of 45 patients who underwent a 3D TOE-assisted PFO closure were included. The two-dimensional (2D) PFO separation distance and right to left (RL) contrast shunt magnitude were retrospectively assessed at rest and during release of a Valsalva maneuver on pre‑procedural 2D TOE recordings. Peri-procedural measurements of the triangular anatomic PFO opening (base, height and area) were performed after positioning of a stiff guidewire (SW) through the PFO, using Live xPlane imaging and 3D Zoom mode.

Results
The peri-procedural PFO SW base was on average five times larger than the pre-procedural 2D PFO separation (median difference +/- IQR : 13 +/- 5 mm ; p &lt; 0.001), having the biggest impact on total PFO area. The width of the PFO SW base was highly variable, even for a given separation, and significantly larger in patients with a large versus a small to moderate PFO RL contrast shunt (18 versus 15 mm; p = 0.007) and in those with a spontaneous versus a provoked shunt (18 versus 14 mm; p = 0.003).

Conclusion
The PFO SW base, assessed by Live xPlane and 3D TOE, seems a more precise estimate of anatomical PFO size compared to the conventional 2D PFO separation distance. This new PFO dimension may be taken into account for optimization of device and patient selection strategies.
Abstract P1563 Figure. 3D Zoom PFO size measurement
P1571 Echocardiograms on Twitter: the good, the bad and the ugly
Authors: Irenji N , Mcaloon C 
Published: January 2020

Abstract
Background - Case reports are a well-established part of the medical literature presenting interesting cases which require patient consent and peer review as a prerequisite. The advent of social media platforms has changed the way knowledge is shared. Twitter is a micro-blogging site utilised by the medical profession including cardiologists and allied health care professionals (HCP), allowing sharing of interesting cases. Echocardiography is particularly complementary to the medium as images and short films can be included in Tweets. However, its immediacy means traditional safeguards are absent, meaning patients might be identifiable.
The study aim was to sample the prevalence of echocardiography cases being shared on Twitter and analyse the degree of identifiable information present.
Methods - A retrospective observational study of videos of echocardiograms uploaded to Twitter under the hashtag #echofirst over 4 months (Nov 18-Feb 19) was performed in May 2019. Only English language Tweets were included. All Tweeter Demographics and Followers were manually collected by reviewing biographies. Tweets were screened for ‘direct’ (name, address, date-of-birth) and ‘indirect’ (age, gender, ethnicity, diagnosis, clinical diagnosis, date study performed) patient identifiers. Numbers of interactions (replies, likes, retweets, views) were recorded at the time of viewing tweets.
Results - 324 of screened tweets (120 unique users; 114 individuals, 6 organisations) met study criteria. 81 (67%) stated their city. 35 (29%) stated their hospital. One Tweet contained directly identifiable information. Patient consent was not mentioned in any Tweet. Table 1 demonstrates Tweets with the number of identifiers cross-referenced with Tweeters" location.
Discussion - Social media is a highly accessible method for cardiologists and allied HCP to instantly share and discuss echocardiography cases. However, our analysis potentially demonstrates that specific patients could be identified based location and identifiers. Caution must be applied when posting cases as Tweets. Specific guidelines on this practice should be considered.
Table 1 Identifiers (n) Worldwide (n = 324) Country (n = 284) City (n = 221) Hospital (n = 112) 0 98 (30%) 88 (31%) 64 (29%) 27 (24%) 1 114 (35%) 97 (34%) 77 (35%) 39 (35%) 2 50 (15%) 45 (16%) 33 (15%) 19 (17%) 3 24 (7%) 20 (7%) 15 (7%) 5 (4%) 4 36 (11%) 32 (11%) 31 (14%) 21 (19%) 5 2 (1%) 2 (1%) 1 (&lt;1%) 1 (1%)
P1573 Late recovery of left ventricular function in patients with non-severe ischemic mitral regurgitation and multivessel disease qualified to cardiosurgery treatment
Authors: Piatkowski R , Kochanowski J , Budnik M , Grabowski M , Scislo P , Kosior D A , Opolski G 
Published: January 2020

Abstract

Late recovery of left ventricular function in patients with non-severe ischemic mitral regurgitation and multivessel disease qualified to cardiosurgery treatment.

Purpose
In patients (pts) after myocardial infarction (MI) with chronic left ventricle (LV) dysfunction, the presence and degree of ischemic mitral regurgitation (IMR) are predominantly related to LV remodelling and mitral valvular deformation. The aim of this study was to compare functional recovery (LVFR) as well as reverse remodelling of the left ventricle (LVRR) in pts with non-severe IMR qualified for cardiosurgical treatment - coronary artery bypass grafting alone (CABGa) or CABG with mitral repair (CABGmr in the 12-month follow-up.

Materials and methods
A total of 100 pts (mean age 64,4 ± 7,9 years) after MI, eligible for CABG, were included in a prospective study. Echo and clinical assessment were performed before and 12-months after surgery. Pts were referred for CABG a(gr.1; n = 74) or CABGmr (gr.2; n = 26) based on clinical assessment, 2D echo at rest and exercise and myocardial viability assessment (low dose dobutamine - dbx). Effective regurgitation orifice area (EROA) was used for quantitative IMR assessment. An increase in EF≥ 5% (ΔEF) from baseline value was considered as LVFR. A decrease in LV end-systolic volume &gt; 15% from baseline value was considered as LVRR. Multivariable logistic regression analysis was used to identify the strongest factors of lack of LVFR and LVRR.

Results
An LVFR was observed, at late control, in 35 (49%) of pts in the CABGa group and in 11 (48%) of pts in CABGmr group (p = 0,948). LVRR was observed in 41 (56%) of pts in the CABGa group and in 16 (70%) of pts in CABGmr group 12 months follow-up (p = 0,5). In pts with LVFR, there was a lower incidence of at least moderate IMR at follow-up (ΔEF dbx≥5% vs ΔEFdbx &lt; 5%:11% vs 30% pts; p = 0,05). Multivariable logistic regression analysis revealed that in both CABGa and CABGmr group only preoperative age and EF changes during stress echo remained the independent predictors of the lack of LVFR in 12 months follow-up (table 1).

Conclusions
1. LVFR and LVRR were reported in most of the pts in both analyzed groups.
2. Preoperative assessment of changes EF during dbx (ΔEFdbx)can be used to identify pts with IMR at increased risk of lack of improvement in LV function and risk of residual IMRin 12-month f-up after surgery.
Parameters Odds ratio (OR) Odds ratio (OR) p CABGa vs CABGmr 0,644 0,215 - 1,927 0,432 Age (increase by every 5 years) 1,11 1,039 - 1,879 0,003 ΔEF dbx (increase by every 5%) 0,21 0,096 - 0,46 &lt;0,001 Table 1. Prognostic factors lack improvement in left ventricle function.
P1574 Variation in myocardial work performance after surgical and transcather aortic valve replacement: A pilot echocardiographic study
Authors: Hatam N , Donuru S , Musetti G , Lotfi S H , Spetsotaki K , Steffen H , Autschbach R , Zayat R 
Published: January 2020

Abstract

Funding Acknowledgements
none

Objective
Perioperative myocardial injury occurs after surgical aortic valve replacement (SAVR) as well as after transcather aortic valve replacement (TAVR). The novel non-invasive method for regional LV pressure– strain corresponds well with invasively measured myocardial work (MW) and is independent of afterload compared to ejection fraction and global longitudinal strain (GLS) . In this pilot study, we aimed to compare changes of LV-MW index (MWI) between SAVR and TAVR in the early postoperative period.

Methods
25 TAVR (Corevalve & Symetis) and 25 SAVR (Perimount) patients, scheduled for elective procedures received transthoracic echocardiography studies pre- and 7 days postoperatively. Besides routine measurements the following parameters were analyzed: MWI, global MW efficiency (MWE), global wasted myocardial work (GWMW), GLS and global strain rate (GSR).

Results
In the TAVR group, 17 patients received transfermoral, 8 patients transapical TAVR. As expected, EuroSCORE II was significantly higher in the TAVR group (p = 0.015). GLS was significantly lower (better) in the SAVR group compared to the TAVR group preoperatively (-13.4 + 4.9 vs.-16.7 ± 4.2, p = 0.027). Postoperative GLS increased (worsened) in the SAVR group, though no significant difference was detected between the groups (-12.7 ± 5.1% vs. -10.4 ± 3.4%, p = 0.215) postoperatively. MWI was significantly lower in the TAVR group preoperatively (p = 0.033). Within the TAVR group MWI did not decrease significantly postoperatively (1242 mmHg% vs. 1108 mmHg%, p = 0.476). However, postoperative MWI decreased significantly in the SAVR group (1632 mmHg% vs. 1267mmHg%, p = 0.043). MWE and GWMW did not differ between the groups or within the groups comparing pre- and postoperative values.

Conclusion
Despite better GLS values in SAVR patients preoperatively, we could detect a better preservation of GMWI in TAVR Patients postoperatively. To evaluate the clinical impact of MWI, further studies with larger cohort and correlation with biomarkers of myocardial injury and follow-up assessments are required.
Abstract P1574 Figure. Myocardial work changes after TAVI
Subxiphoid approach for robotic single-site-assisted thymectomy
Authors: Park Seong Yong , Han Kook Nam , Hong Jeong In , Kim Hyun Koo , Kim Dae Joon , Choi Young Ho 
Published: January 2020

Abstract

OBJECTIVES
We previously reported a transthoracic approach using the da Vinci Single-Site™ platform. This study describes the outcomes of robotic single-site thymectomy via a subxiphoid approach based on our previous experiences.

METHODS
This study included patients, who underwent single-site robotic thymectomy via the subxiphoid approach between September 2018 and October 2019. A 3- to 4-cm vertical incision was made over the subxiphoid area, and the Lapsingle port with CO2 gas was introduced. After docking at the single site, a 5-mm curved cannula, 5-mm cardiere grasper and Maryland bipolar forceps or permanent cautery hook was inserted. The single-site robotic platform was used to conduct all surgical procedures except the dissection around the inferior portion of the thymic tissue performed via a thoracoscopic approach through the same incision.

RESULTS
Overall, 13 patients, including 2 with myasthenia gravis, were enrolled. The mean duration of the surgery and chest drainage were 167.3 ± 52.8 (range 73–253) min and 2.2 ± 0.9 (range 1–5) days, respectively. All surgeries were successfully completed without conversion to an open surgery, and there were no major post-surgical complications. The diagnoses based on histopathology included thymoma in 10 patients, thymolipoma in 2 patients and atypical carcinoid tumour in 1 patient with free resection margin.

CONCLUSIONS
This study demonstrated that robotic single-site-assisted thymectomy via the subxiphoid approach is a safe and technically feasible procedure. Although this initial series comprised relatively simple cases, more advanced and complex procedures can soon be performed with the advent of single-port robotic platform.
Outcomes of non-elective coronary artery bypass grafting performed on weekends
Authors: Beller Jared P , Chancellor William Z , Mehaffey J Hunter , Hawkins Robert B , Krebs Elizabeth D , Speir Alan M , Quader Mohammed A , Yarboro Leora T , Ailawadi Gorav , Teman Nicholas R 
Published: January 2020

Abstract

OBJECTIVES
A weekend effect with increased mortality has previously been reported in surgical patients and those with acute myocardial infarction (MI). We hypothesized that a similar phenomenon may exist in coronary artery bypass grafting (CABG).

METHODS
Patients undergoing non-elective isolated CABG (2011–2017) were included from a multicentre regional Society of Thoracic Surgeons database. Patients were stratified by weekend versus weekday operations and further analysed by specific day of the week.

RESULTS
A total of 14 374 patients underwent urgent or emergency isolated CABG with 410 (2.9%) operated on over the weekend. Weekend operations were more often emergency (36.1% vs 5.0%, P &lt; 0.001) and more likely to be in the setting of MI (70.0% vs 51.2%, P &lt; 0.001). Cardiopulmonary bypass times were similar [91 min (71-114) vs 94 min (74-117), P = 0.0749] and the frequency of complete revascularization equivalent (83.4% vs 85.3%, P = 0.284) between weekend and weekday operations. In risk-adjusted analyses, there was no increased odds for mortality in patients operated on over the weekend [odds ratio (OR) 1.07, P = 0.811]; however, there was an increased odds of major morbidity (OR 1.37, P = 0.034). Furthermore, compared with Monday, morbidity increased as the operative day approached the weekend (Tuesday 0.98, P = 0.828; Wednesday 1.07, P = 0.469; Thursday 1.12, P = 0.229; Friday 1.19, P = 0.041; weekend 1.47, P = 0.014).

CONCLUSIONS
While patients requiring surgery on the weekend are higher risk, there is no independent effect of weekend surgery on mortality. However, these patients are at increased risk for major morbidity, the causes of which require further investigation.
Childhood Misfortune and Late-Life Stroke Incidence, 2004–2014
Authors: Zaborenko Callie J , Ferraro Kenneth F , Williams-Farrelly Monica M 
Published: January 2020

Abstract

Background and Objectives
Although most strokes occur in later life, recent studies reveal that negative exposures decades earlier are associated with stroke risk. The purpose of this study was to examine whether accumulated and/or specific domains of early misfortune are related to stroke incidence in later life.

Research Design and Methods
A decade of longitudinal data from stroke-free participants 50 years or older in the Health and Retirement Study were analyzed (N = 12,473). Incident stroke was defined as either self-reported first incident stroke or death due to stroke between 2004 and 2014.

Results
Analyses revealed that accumulated misfortune was associated with increased stroke risk, but the relationship was moderated by wealth. Examining specific domains of childhood misfortune revealed that stroke incidence was greater for persons with behavioral/psychological risks, but that this relationship also was moderated by higher wealth for those with only one behavioral/psychological risk.

Discussion and Implications
Accumulated childhood misfortune and adolescent depression heighten the risk of stroke in later life, but the influence is remediable through adult wealth. Reducing poverty in later life may decrease stroke incidence for persons exposed to negative childhood exposures.