bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2448Evolution of clinical quality activities within a national echocardiography database: seven-year trends from the GenesisCare Outcomes Registry
Authors: Eccleston D , Cehic D , Cross D , Srivastava P 
Published: October 2019

Abstract

Introduction
Despite rapid technologic advances and sustained growth, less attention has been focused on quality in imaging than in other areas of cardiovascular medicine. To address this deficit, the ACC proposed additional areas of effort such as data standardisation, structured reporting identifying key data elements and imaging registries. We explored these changes within a large multi-centre Australian registry.

Methods
From 2010–2014 we introduced direct online entry of echocardiographic studies into an electronic database, selection and auditing of key data elements and quality improvement pathways to maximise completeness of data acquisition and reporting across 4 states. We compared completeness of key data elements (AV peak velocity, EF, E/E', LA area, rhythm, RVSP) by time and state using de-identified data.

Results
464,688 echocardiographic procedures were captured from 2011 to 2018.
Data completeness improved significantly from 2011 to 2018 (72.0±26.8 vs 88.2±13.5%, p=0.02). Inter-practice variability fell from 2011 to 2018 for both EF and E/E', p<0.002

Conclusion
Identification, systematic capture and auditing of key echo data elements can significantly improve the quality and reduce inter-practice variability of echo data. Developing a national database allows rapid adoption of local quality improvements.

Acknowledgement/Funding
None
P2450The atrial electromechanical conduction delay with ultrasound based two-dimensional speckle-tracking predicts very late recurrence following catherter ablation for atrial fibrillation
Authors: Fujii A , Inoue K I , Kinoshita M K , Nagai T N , Sasaki Y S , Akazawa Y A , Higashi H H , Uetani T U , Aono J A , Nishimura K N , Ikeda S I , Yamaguchi O Y 
Published: October 2019

Abstract

Background/Introduction
Long-term efficacy following catheter ablation (CA) of atrial fibrillation (AF) remains unknown. Left atrial (LA) reverse remodeling following CA may be important to reduce the risk of very late recurrence (VLR).

Purpose
We hypothesize that improved mechanical conduction delay with myocardial strain is associated with LA reverse remodeling indicates efficacy following AF ablation. This study aimed to investigate the clinical utility of mechanical conduction delay to predict VLR in patients with AF undergoing CA.

Methods
We enrolled 114 consecutive patients undergoing initial CA in patients with AF from January 2012 to February 2014. 20 patients were excluded due to poor echocardiographic image quality. 38 patients had AF recurrence within 12 months after CA. Finally, 54 patients (age 62 years, 13 female, 15 persistent AF) were analyzed. Trans-thoracic echocardiography (TTE) was performed within 24 hours as baseline, and every 6–12 months following the initial CA as follow-up. We compared the TTE data with baseline and latest test when sinus rhythm was maintained. To assess atrial electromechanical conduction delay, we adopted a parameter based on speckle tracking echocardiography (EMT-ε), which was defined as the interval from the P- wave onset to the peak late diastolic longitudinal strain in the basal lateral wall of LA (Figure).

Results
Eleven patients had VLR after CA. In patients with VLR, left atrial volume index (LAVI) at baseline was significantly higher than those without VLR (49±17 vs 35±14 ml/m2, P<0.05). EMT-ε had no significant difference between two groups (225±52 vs 208±49 ms, P=NS).
During 58±22 months, LAVI and EMT-ε were significantly improved (LAVI: 38±16 vs 33±14 ml/m2, EMT-ε: 215±48 vs 197±45 ms, P<0.05, respectively). The change of LAVI had no significant difference between two groups (−2 (−10, 4) vs 33 (−13, 6) ml/m2, P=NS). EMT-ε shortening was significantly greater in AF-free patients than patients with VLR (−27 (−66, −3) vs 23 (−1, 79) ms, P<0.01). At a cut-off value of −9 ms, the change of EMT-ε predicted VLR with sensitivity (100%) and specificity (68.9%).

Conclusion(s)
The atrial electromechanical conduction delay could predict VLR after CA in patients with AF.
P2456Role of left atrial volume as simple and early predictor of cardiotoxicity
Authors: Cerrito L F , Schiavone A , Bergamini C , Dal Porto M , Benfari G , Dolci G , Setti E , Comunello A , Rossi A , Fiorio E , Ribichini F L 
Published: October 2019

Abstract

Background
It is crucial to predict and early detect Trastuzumab (TZ)-related cardiotoxicity (CT) in patients with HER2-positive breast cancer (BC). Although baseline left atrial (LA) volume and its changes over time assessed by echocardiography have been used as prognostic tool in various clinical conditions, up to now there are no well-defined LA-based parameters predictive of chemotherapy-related dysfunction.

Aim
To define the role of increased baseline LA indexed volumes (LAVI) and its changes over time as early predictors of TZ-related CT in a larger and well characterized cohort of BC patients.

Methods
HER-2 positive BC patients receiving TZ were retrospectively recruited. Patients underwent consecutive transthoracic echocardiography at baseline and then every three months. CT was defined as decrease in left ventricular ejection fraction (LVEF) to a value <50% or a decrease of >10 percentage points from baseline, according to our oncology unit.

Results
Eligible patients were 280, mean age 56±12 years. Mean follow-up (FU) was 15±5 months and CT occurred in 64 patients (22,9%). Baseline LAVI showed to be associated with development of CT (p=0,003), and to predict its onset, Odds Ratio (OR) per 5 ml/mq LAVI increase 1,32 (95% CI 1,07: 1,62), p=0,006. After multivariate adjustment (age, systolic arterial pressure, anthracycline treatment) baseline LAVI remained an independent predictor of CT: OR 1,25 (95% CI 1,00- 1,56), p=0,04. LAVI showed an increasing trend that has been evident since the very beginning (at three months) and continued over time. LAVI dilation appeared to be small on average, but became significant in patients with subsequent CT (Figure 1). Early LAVI dilation (0–3 months) was able to predict CT OR 1.22 (CI 1.03–1.47) p=0.02 per 5 ml/mq increase, Even when adjusted for baseline LAVI, age, and systolic arterial pressure, OR 1.31 (CI 1.07–1.58), p=0.004. In patients who had mitral regurgitation at baseline, there was no significant worsening of regurgitation overtime.

Conclusion
Baseline LAVI, as assessed by routine practice, provides an incremental predictive value about CT risk over the other known clinical features. On top, LAVI dilation over time seems to begin before LVEF decreases, and hence could anticipate the development of left ventricular dysfunction. Even if LAVI is a simple and well known echocardiographic measurement, it could be used in this newborn context to stratify patients after validation with prospective studies.
P2457Left atrial strain parameters predict clinical outcomes in patients with HFmrEF and HFpEF
Authors: Vrettos A , Al Saikhan L , Matiti L , Plymen C , Low B , Nihoyannopoulos P 
Published: October 2019

Abstract

Background
Heart failure with preserved ejection fraction (HFpEF) and with mid-range ejection fraction (HFmrEF) are conditions sharing similar diagnostic criteria and symptoms. Left ventricular (LV) diastolic dysfunction has often been considered central to the pathophysiology of both, as determined by current conventional echocardiographic measures of elevated filling pressure and/or an increased in left atrial (LA) volume. However, the independent prognostic importance of LA function, beyond clinical predictors and LV features, in those groups remains unclear.

Aims
To evaluate the prognostic value of LA function measured by speckle tracking echocardiography in patients with new diagnosis of HFpEF and HFmrEF.

Methods
A total of 171 consecutive patients diagnosed with HFpEF with an Ejection Fraction (EF) ≥50%, or HFmrEF with an EF of 40–49% were prospectively enrolled and followed up. Follow-up was completed in 134 patients with HFpEF (n=100) and HFmrEF (n=34) for a median period of 57 months. Baseline characteristic and comorbidities were recorded, as well as conventional resting echocardiographic parameters of systolic and diastolic function. Left atrial phasic function was analysed using 2D-Specle Tracking. Peak-atrial longitudinal strain (PALS) and peak-atrial contraction strain (PACS) were measured, reflecting LA reservoir and pump function respectively. We looked at the relationship of traditional parameters of systolic and diastolic function and LA strain, with the following cardiovascular (CV) events: acute coronary syndromes, new atrial fibrillation, cerebrovascular events, HF-related admissions and cardiac deaths.

Results
During a median follow up period of 57 months (range 11.10), of 134 patients, 42 (31%) had at least one CV event, 10 (8%) out of whom had at least one HF-related hospitalization and 5 (4%) had cardiac death. 92 patients (69%) remained event-free. In univariate analysis, lower PALS and PACS were associated with increased risk for the composite endpoint of all CV-events (PALS OR=0.92 p<0.01 and PACS OR=0.92 p<0.05), but only PALS predicted HF admissions (PALS OR=0.86 p<0.05). In multivariate analysis after adjusting for LV EF, E/e' and LAVi, PALS remained significant at predicting CV-events (OR=0.91 p<0.05) and HF admissions (OR=0.85 p<0.05), but PACS did not. Amongst all echocardiographic parameters measured, PALS had the greatest Area Under the Curve at Receiver Operating Characteristics analysis (AUC=0.78 p<0.05) and a PALS value of <23% best predicted future HF-related admissions (sensitivity 0.9, specificity 0.6).

Conclusion
LA dysfunction in HFpEF and HFmrEF is associated with a higher risk of CV events and HF hospitalizations. The association of LA strain with HF hospitalization remained significant after adjustment for systolic and diastolic parameters.
P2461The presence of L wave was associated with non-invasively estimated left atrial stiffness in heart failure patients
Authors: Masai K , Goda A , Ohta Y , Oshita T , Asakura M , Ishihara M 
Published: October 2019

Abstract

Background
The mid-diastolic L wave is recorded as mid-diastolic mitral forward flow with conventional Doppler echocardiography. L wave is occasionally detected in heart failure (HF) patients but its mechanism of occurrence is still unknown. It is hypothesized that L wave was induced by a positive atrioventricular gradient caused by left atrial filling via pulmonary veins, and the magnitude of the L wave is augmented by increasing ventricular stiffness. We speculate that also Left atrium (LA) function will relate with the presence of L wave because the L wave flow occurs passing LA. LA function has been known to have reservoir, booster pump and conduit function. It is reported that LA conduit function related to LA stiffness. The aim of this study is to clarify the association between LA functions and presence of L wave in HF patients.

Methods and results
Eighty two patients who admitted to our hospital for HF were enrolled in this study. We performed echocardiography before discharge. LA speckle-tracking strain was analyzed by an external software program using apical 4 chamber view. Reservoir function was measured as peak strain value at end systole, and booster pump function was measured as the value of atrial contraction. Conduit function was calculated as the difference of the peak value at end systole and atrial contraction. There were 23 patients who had L wave before discharge and 59 patients without L wave. Transmitral E wave (E) and left atrial volume index (LAVI) were higher in patients with L wave than in those without L wave. LA reservoir strain was not different in two groups, but poster pump strain was lower and conduit strain was higher in patients with L wave than those without. LA reservoir strain and booster pump strain weakly correlated with A wave velocity (r=0.39 p=0.004, r=46 p=0.001) and LAVI (r=−0.23 p=0.0383, r=−0.31 p=0.005), but conduit strain had no correlation with A wave (r=0.12 p=0.26) and LAVI (r=−0.04 p=0.67). In multivariate regression analysis for the presence of L wave with A wave velocity, LAVI and LA conduit strain, LA conduit strain remained independent predictors of the presence of L wave (HR 1.12 95% CI 1.04–1.23; p=0.004).

Conclusion
LA conduit function was not correlated with conventional echo parameters of LA function (A wave velocity and LAVI). The presence of L wave was associated with LA conduit strain.
P2462Left atrial appendage wall velocity evaluated by transthoracic echocardiography is a feasible parameter for predicting cardiac prognosis in patients with heart failure
Authors: Hashimoto N , Watanabe T , Tamura H , Tsuchiya H , Wanezaki M , Kato S , Nishiyama S , Arimoto T , Takahashi H , Shishido T , Watanabe M 
Published: October 2019

Abstract

Background
It was reported that left atrial (LA) remodeling is occurred in patients with heart failure (HF), and increased LA volume index (LAVI) is a feasible predictor for poor prognosis of HF. It was reported that LA remodeling is associated with LA appendage (LAA) dysfunction. We previously reported that LAA wall motion velocity (LAWV) obtained by transthoracic echocardiography (TTE) can noninvasively evaluate LAA dysfunction. However, it remains to be determined whether LAWV is useful for predicting poor prognosis in patients with HF.

Purpose
We investigated whether LAA dysfunction assessed by LAWV is associated with poor prognosis in patients with HF.

Methods
We performed TTE at discharge in 217 consecutive patients who hospitalized for HF (126 males, 71±13 years) and prospectively followed them up. LAWV was measured using Doppler tissue imaging at the LAA tip from the parasternal short-axis view on TTE imaging.

Results
There were 86 patients with cardiac events including 14 cardiac deaths and 72 rehospitalizations for HF during a median follow-up period of 404 days (interquartile range 168–748 days). LAWV was significantly lower in patients with cardiac events than in those without. LAWV was significantly decreased with advancing left ventricular diastolic dysfunction grade. Kaplan-Meier analysis demonstrated that significantly higher cardiac event rate was observed in patients with low LAWV (log-rank test, P=0.004). Cox multivariate hazard analysis revealed that LAWV was an independent predictor for cardiac events after adjusting for confounding factors (hazard ratio 0.57, 95% confidence interval 0.40–0.82, P<0.05). Further, we categorized the patients into 3 groups based on the median of LAWV and left atrial volume index (LAVI), and Kaplan-Meier analysis showed that patients with both low LAWV and high LAVI had the highest rate of cardiac events among 3 groups (log-rank test, P<0.001; Figure).
Figure 1

Conclusion
LAWV may be a feasible parameter for predicting cardiac prognosis in patients with HF.
P2463Advanced interatrial block is a surrogate for left atrial strain reduction which predicts atrial fibrillation and stroke
Authors: Lacalzada Almeida J , Armarnani Armarnani V , Garcia-Niebla J , Izquierdo-Gomez M M , Elosua R , Jimenez-Sosa A , Baranchuk A , De La Rosa-Hernandez A , Mari-Lopez B , Baez-Ferrer N , Duque-Gonzalez A , Laynez-Cerdena I , Barragan-Acea A , Bayes De Luna A 
Published: October 2019

Abstract

Background
The association between advanced interatrial block (aIAB) and atrial fibrillation (AF) is known as “Bayes' Syndrome”. There is little information on the prognostic role that new speckle tracking echocardiographic (STE) imaging techniques could play in it.

Purpose
We have examined the relationship between left atrial (LA) STE and the prediction of new-onset AF and/or stroke in IAB patients.

Methods
Observational study with 98 outpatients: 55 (56.2%) controls with normal ECG, 21 (21.4%) with partial IAB (pIAB) and 22 (22.4%) with aIAB. The end-point was new-onset AF, ischemic stroke, and the composite of both.

Results
During a mean follow-up of 1.9 (1.7–2.3) years, 20 patients presented the end-point (18 new-onset AF and 2 strokes): 8 (14.5%) in the control group, 3 (14.3%) in pIAB and 9 (40.9%) in aIAB, p=0.03. In multivariable comprehensive Cox regression analyses, a decrease of strain rate during the booster pump function phase (SRa) was the only variable independently related to the appearance in the evolution of the end-point, in the first model (age, P wave duration and SRa): HR 19.9 (95% CI, 3.12–127.5), p=0.002 and in the second (age, presence of aIAB and SRa): HR 24.2 (95% CI, 3.15–185.4), p=0.002.

Conclusions
In patients with IAB, a decrease in absolute value of LA SRa with STE predicts new-onset AF and ischemic stroke.

Acknowledgement/Funding
None
P2468Clinical and cardiac structural differences between paroxysmal and persistent/permanent non-valvular atrial fibrillation
Authors: Bhat A , Chen H H L , Khanna S , Gan C H , Menzies R , Nunes C M , MacIntyre R , Tan T C 
Published: October 2019

Abstract

Background
Atrial Fibrillation (AF) is a heterogeneous condition and is traditionally classified by duration (paroxysmal, persistent and permanent). There is a relationship between AF and left atrial (LA) remodeling, with increased likelihood of AF recurrence and maintenance with increasing LA volumes.

Purpose
To assess clinical and cardiac structural differences between the subtypes of AF.

Methods
We examined 1247 (68±13.4y; 50% men) consecutive admissions presenting to our institution with the primary diagnosis of AF. Repeat admissions (n=263) were excluded. Of remaining 984 subjects, a majority had diagnosed paroxysmal (72.2%), with lower numbers of persistent (23.4%) and permanent (4.4%) AF. Echo parameters of cardiac chamber size and function were examined in a subset of subjects with complete echo (n=646) performed during incident hospital admission.

Results
There were significantly higher rates of diabetes mellitus (p=0.03), ischaemic heart disease (IHD; p=0.04) and peripheral vascular disease (PVD; p=0.02) in those with persistent/permanent AF compared to paroxysmal AF. No significant differences in age (p=0.19), BMI (p=0.42), OSA (p=0.05), or hypertension (p=0.76) was noted. There were significant differences in left ventricular (LV) mass and systolic function, LA size and function between the two groups (Table 1). Receiver operator curve analysis revealed that LAEF was a discriminator for persistent/permanent AF with an area under the curve of 0.689 (95% CI, 0.646 to 0.732; p<0.001).
Echo parameters in AF subtype Echocardiographic Parameters Paroxysmal AF (n=433) Persistent and Permanent AF (n=213) Significance (p value) LVEDD (cm) 4.8±3.0 5.0±0.9 0.29 LVESD (cm) 3.3±1.3 3.7±1.1 <0.01 IVS thickness (cm) 1.2±0.7 1.1±0.3 0.44 PW thickness (cm) 1.1±0.7 1.1±0.2 0.77 LV mass (g) 92.3±28.3 108.2±35.3 <0.01 LVEF (%) 56.1±14.1 47.4±16.8 <0.01 LA Expansion Index 89.4±69.1 53.4±40.3 <0.01 Min LA Volume indexed (ml/m2) 18.9±17.2 27.3±20.6 0.01 Max LA Volume indexed (ml/m2) 32.5±19.2 37.7±15.3 <0.01 LAEF (%) 41.8±16.4 31.5±13.6 <0.01

Conclusions
Our results suggest diabetes, IHD and PVD are associated with persistent/permanent AF. Additionally, greater LA remodeling and reduced atrial function was noted in this group, suggestive of an association between duration of AF electrical burden and LA remodeling and function.
P2477Assessment of intraventricular flow dynamics in acute heart failure studied by Vector Flow Mapping
Authors: Masuda K , Minami S , Stugaard M , Kozuma A , Takeda S , Nakayama T , Asanuma T , Nakatani S 
Published: October 2019

Abstract

Background
Although left ventricular (LV) flow dynamics should be closely related to LV morphology and function, little is known about how heart failure (HF) changes it. Pathline Analysis (PA), a recently developed software based on Vector Flow Mapping (VFM, Hitachi), enables us to trace the virtual blood particles entering to the LV in diastole and being ejected in systole. We investigated the change of flow dynamics in HF induced in dogs using PA.

Methods
In 15 open-chest dogs, HF was induced by intracoronary injection of microspheres. Color Doppler images of apical long-axis view were acquired using Prosound F75 (Hitachi) before and after HF and were analyzed by PA. We calculated the ratio of the numbers of entering particles in diastole and ejected particles in systole (ejection rate) and the distance reached by the particles in diastole corrected by the LV long-axis diameter (propagation distance). Apical and basal short axis images were acquired using GE Vivid E9 and were analyzed for peak rotation and peak twist.

Results
After inducing HF, LV end-diastolic pressure increased from 6±2 to 15±5 mmHg (p<0.001) and ejection fraction (EF), apical peak rotation and peak twist decreased significantly (EF; 58±5 to 36±8%, apical peak rotation; 14±5 to 3±2 degree, peak twist; 19±5 to 6±3 degree, p<0.05, respectively). PA showed most of the entering particles to the LV were ejected in the following systole at the control stage, but in HF, a significant part of the entering particles were not ejected and remained in the LV (Figure). Ejection rate decreased from 50±11 to 26±11% (p<0.001) and the propagation distance decreased from 85±9 to 66±13% (p<0.001) after inducing HF. There were significant relationships between indices obtained by PA and EF and peak twist (Table).

Conclusion
A significant part of inflow is not ejected directly to the outflow in the next systole and remains in the LV in HF, suggesting inefficient flow dynamics.
P2484SGLT2 inhibitors in diabetes with CKD
Authors: Malik A H , Yandrapalli S , Goldberg M , Jain D , Frishman W H , Aronow W S 
Published: October 2019

Abstract

Background
DM mellitus (DM) and chronic kidney disease (CKD) significantly increase the risk of cardiovascular morbidity and mortality. Current guideline recommendations do not support the use of SGLT2 inhibitors in patients with CKD stage III or higher. We performed a comprehensive meta-analysis to evaluate their cardiovascular effects in patients with type 2 DM and CKD stage III or higher.

Methods
A comprehensive search was performed in PubMed, Cochrane central and Embase for randomized controlled trials (RCTs) evaluating the cardiovascular outcomes of SGLT-2 inhibitors in patients with type 2 DM and CKD defined as glomerular filtration rate of <60ml/min. There were no data available on patients with end-stage renal disease. We calculated treatment effects and associated standard errors from the corresponding odds ratio and confidence interval. These values were imputed in software R to perform meta-analysis via generic inverse variance method. Additionally, we conducted a network meta-analysis to compare the relative efficacy and safety of each agent.

Results
Data from 7 RCTs and 6,527 participants was available. In patients with type 2 DM and CKD, SGLT-2 inhibitor use resulted in a significant reduction of myocardial infarction (22%), heart failure hospitalization (39%), and major adverse cardiac events (20%) (all p-value<0.05). There was also a trend towards a reduction in stroke and cardiovascular mortality. In a network meta-analysis, canagliflozin was the most effective in reduction of MI, stroke and heart failure hospitalization. Empagliflozin performed better for the outcome of cardiovascular mortality, but the results failed to reach significance.

Conclusion
SGLT-2 inhibitors significantly improve cardiovascular outcomes in patients with type 2 DM and CKD stage III or higher. This meta-analysis confirms that renal dysfunction should not be a deterrent to the widespread utilization of SGLT-2 inhibitors. Further studies are needed to identify the mechanisms behind these improved cardiovascular outcomes

Acknowledgement/Funding
None