bluuebunny/crossref_metadata_2025_split huggingface dataset:
P950 Impact of True Vue-Trans- Illumination rendering imaging for intraoperative echocardiography in a wide range of interventions
Authors: Gavazzoni M , Zuber M Z , Taramasso M T , Pozzoli A P , Maisano F M 
Published: January 2020

Abstract

Background
Volume rendering methods have been improved to further enhance the quality of imaging and make the communication between echocardiographers and interventionists more fast, reliable and simple. The last innovation in this field is the "3D Real Time True Vue-Transillumination (TI)" rendering method. This allows to freely move virtual light inside a sample volume to enhance image details and depth. No studies have addressed the advantage of this method in the context of procedural guidance for structural interventions.

Purpose
The aim of the present paper is to test the advantages of this method when applied to interventional TOE during cardiac structural interventions.

Methods
During different procedures we prospectively collected the apparent added value of TI compared to conventional rendering scored independently by two cardiologists in charge of procedural guidance, one being in training (observer 1) and one trained (observer 2). The score was performed in a Likert scale from 1 to 5 with refer to advantage of TI for different procedural concerns (from 1 that meant "strongly disagree" to 5 "strongly agree"). We tested the inter-rater reliability with the K coefficient of agreement between the two observers. In this analysis we included multiple procedural targets to be imaged during different procedures.

Results
We included 8 complex procedures performed in our institutions between November 2018 and March 2019 and collected the agreement of the two observers about the following procedural concerns: evaluation of MV area for MV repair procedures; evaluation of MV main target lesion at the beginning of repairing procedure for procedural planning; evaluation of calcifications of MV leaflet and annulus and cleft for patients selection; evaluation of device trajectory with 3D real time imaging before crossing the valve plane during orienting manoeuvre; assessment of residual lesion after first clip for procedural decision making; evaluation of para-valvular leak: site and amount;evaluation of inch point of leaflets for direct annuloplasty in mitral valve and tricuspid valve regurgitation; visualization of coronary sinus during the implant of anchors of Cardioband in posterior part of tricuspid annulus. We collected the scores for a total of 13 records. The 2 observers perceived an added value for TI for all the procedural concerns analysed (mean score of 4.0 ± 0,75); a good agreement was obtained about the superiority of TI rendering in these 13 concerns with a Kappa coefficient of inter-agreement of 0.71, p &lt; 0.0001.

Conclusions
this is the first experience comparing the new 3D TI rendering with 3D conventional rendering in the context of intra-procedural guidance for structural valve interventions. We obtained good inter-agreement between two echocardiographist with different levels of experience suggesting that TI may have advantages even for education.
P956 Prognostic role of right ventricular hypertrophy in anderson fabry disease
Authors: Graziani F , Lillo R , Panaioli E , Pieroni M , Locorotondo G , Lombardo A , Sicignano L L , Manna R , Lanza G A , Crea F 
Published: January 2020

Abstract

Background
Right ventricular hypertrophy (RVH) is a common finding in Anderson Fabry disease (AFD). In other infiltrative and storage cardiomyopathies right ventricular (RV) involvement may influence prognostic stratification. Nevertheless, the prognostic implications of right ventricle involvement in AFD have never been assessed.

Purpose
Evaluation of the prognostic significance of RVH and RV systolic function in AFD cardiomyopathy.

Methods
Forty-five AFD patients (56% male) with extensive baseline evaluation, including assessment of RVH and RV systolic function, were followed-up for an average of 44.9 ± 8.5 months. RV systolic function was assessed by standard and tissue Doppler echocardiography and quantified using RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and Systolic tissue Doppler velocity of the tricuspid annulus (RV Sa). Cardiovascular events were defined as new-onset atrial fibrillation, heart failure or pace-maker implantation; renal events were defined as progression to dialysis and/or renal transplantation or significant worsening of glomerular filtration rate; cerebrovascular events were defined as stroke or transient ischemic attack. The outcome was defined as the time to death or the first event in any of the above predefined categories.

Results
Fourteen patients (31.1%) presented RVH, while RV systolic function was normal in all cases. During the follow-up period, 13 patients (28.8%, 11 male) experienced major events including two deaths. Pace-maker implantation (6 cases) was the most common type of event. At univariate analysis several variables were associated with the occurrence of events, including RVH and indexes of RV systolic function. However, at multivariate analysis only proteinuria (HR:8.3, 95% CI: 2.88 to 23.87, p ˂0.001) and LV mass indexed (HR: 1.01, 95% CI: 1.00 to 1.03, p = 0.03) were independent predictors of outcome.

Conclusions
The presence and extension of RVH is not associated with outcome in AFD. Our study confirms that at variance with other infiltrative or storage cardiomyopathies, RV involvement in AFD is an innocent bystander and does not influence prognosis.
P964 Assessment of long-term durability of transcatheter implanted aortic valves - structural and nonstructural deteriorations in 5 years follow-up
Authors: Linkova H , Petr R , Paskova E , Kocka V , Tousek P 
Published: January 2020

Abstract

Introduction
Transcatheter aortic valve implantation (TAVI) is the method of choice for patient with a significant stenosis (AS) who are contraindicated for cardio-surgical procedure. Medium – term results of TAVI are comparable with results observed for surgical replacements. There is limited knowledge of structural, nonstructural and clinical complications in five years follow-up which could contribute to TAVI indication for implantation in young patients.
Goal. The aim of this study is to assess structural and non-structural deterioration of TAVI prosthesis by echocardiography and clinical evaluation at 5 years follow-up.

Methods
By the end of 2013, 112 patients were implanted TAVI in our center( average age, 80,4 ± 7,2 y, 53(47% ) males. All patients underwent both clinical and echocardiographic examination once a year and underwent native CT after five year. We analysed mortality, structural and non- structural deteriorations, and standard echocardiographic parameters before and after implantation, and at 5 years follow-up.

Results
5-years mortality was 58%. There was not a statistically significant difference in age between the patients who survive and who died (80,2 ±7,3 vs 80,6 ± 7,3 p = 0.77) ,they had similar logistic EUROSCORE (17,0 ± 12,4 vs 16,9 ± 15,0, p = 0,96) and EF 53,8 ± 11,1 vs 52,3 ± 11,7,p= 0,51) before the procedure. 48 patients underwent the five years follow –up. Only one patient had to undergo reTAVI due to the earlier prosthetic degeneration. The average EOA was 1,88 ± 0,33 cm2), the average V max. after five years was 1,8 ± 0,4 m/s, PG max 13,6 ± 6,2 mm Hg a PG mean 8 ± 3,6 mm Hg ( no significant increase in time),Post procedural paravalvular regurgitation ≥ 2/4 appeared in 14 % patients. Twenty –three patients underwent CT scan which resulted in Agaston score O on TAVI replacement in 19(83 %) patients.

Conclusion
After 5 years follow-up, low rates of structural and nonstructural deterioration after TAVI were noted, suggesting good long- term durability.
P976 Can calcium score predict the appropriate treatment for high risk patients? (a 5 years follow up study)
Authors: Stanciu S , Gurzun M , Dumitrescu S , Naftanaila F , Spanu A , Cuzino D 
Published: January 2020

Abstract
Coronary artery calcium score (CAC) measures the calcium contained in the artery wall and it is evaluated using multi-slice cardiac CT and CAC represents a useful tool for appreciating the burden of coronary atherosclerosis and for determining the risk for cardiovascular events.
The purpose of this study is that CAC can be use for guiding treatment strategy in patients classified as high risk based on Framingham score .
We prospectively enrolled 64 pts (79% male), 62,7+/-5 year, between 2002-2017. All included patients were considered high risk based on EuroSCORE model.
A multislice heart CT scan was performed for every patient with CAC score determination quantified with the Agatston score and expressed as Agatston Units (AU). The patients were divided in 3 groups according to the treatment that they received during the 5 years follow up: optimal medical treatment for coronary artery disease (OMT) – 35.9% (23), percutaneous coronary angioplasty (PCA) – 29.7% (19) and coronary artery bypass graft (CABG) – 34.4%.
The CAC score for pts treated by OMT vs CABG +/_ PCA were compared using the ROC curves. CAC score was statistically significantly superior in CABG+ PCA patients versus OMT (AUC: 0.96, p &lt; 0.001 vs AUC 0.42, p = 0.212). Also, a comparison of CAC score score for CABG vs OMT revealed the same results (AUC: 0.96, p&lt; 0.001 vs AUC: 0.42, p = 0.264). OMT vs CABG + PCA presented a cut-off value of 382 AU with a specificity of 90% and a sensitivity of 95%. OMT vs CABG presented a cut-off value of 530 AU with a specificity of 89% and a sensitivity of 95%.
In conclusion, CAC score has a good predictability and sensitivity in determining the outcome and can be a promising tool to guide therapy in high risk patients, mainly regarding medical vs surgical treatment for coronary artery disease.
1026 Prognostic implications of global and regional RV strain in patients with heart failure and conduction delays
Authors: Janicijevic A , Stankovic I , Zivanic A , Stefanovic M , Putnikovic B , Neskovic A N 
Published: January 2020

Abstract

Background
Right ventricular (RV) dysfunction is present in a substantial proportion of candidates for cardiac resynchronization therapy (CRT) but its prognostic implication has not been fully determined. We investigated the association of different echocardiographic indices of RV function and survival in patients with heart failure (HF) and conduction delays.

Methods
A total of 122 HF patients with bundle branch blocks (BBB), not treated with device therapy, were included in this retrospective observational study. RV function was assessed by measuring the tricuspid annular plane systolic excursion (TAPSE) and RV free wall longitudinal strain (RVFWSL). Patients were followed for cardiac mortality during a median period of 33 months.

Results
Both TAPSE ≤ 18 mm and RVFWSL≥-25% were associated with unfavorable long-term survival (log rank p &lt; 0.05 for both, Figure A and B). Importantly, in patients with normal TAPSE, RVFWSL remained predictive of long-term outcome (HR 1.15, 95% CI 1.003-1.327; p = 0.045). In the multivariate regression analysis, only NYHA class (HR 2.21, 95%CI (1.122 – 4.357; p = 0.022) and RVFWSL (HR 1.11, 95%CI 1.029 – 1.204; p = 0.008) were independently associated with cardiac mortality. Significant differences among segmental RVFWLS values were observed, including a basal-to-apical gradient with the highest strain values in the base and the lowest in the apex (Figure C).

Conclusions
RV dysfunction is associated with unfavorable survival in HF patients with BBB. RVFWSL appears to be stronger predictor of mortality than TAPSE. Different segments of the RV may contribute differently to RV dysfunction in patients with conduction delays.
Abstract 1026 Figure.
1049 High single-beat Doppler signals in low-gradient aortic stenosis are associated with higher aortic valve calcium
Authors: El-Am E , Alsidawi S , Oguz D , Scott C , Thaden J , Pislaru S , Morant K , Pellikka P , Oh J , Nkomo V 
Published: January 2020

Abstract

Funding Acknowledgements
Mayo Clinic

Background
Variability in Doppler signals is common in patients with atrial fibrillation (AF) and AF is common in low-gradient AS (LGAS). Presence of high single beat Doppler signals (peak velocity ≥4m/s or mean gradient ≥40mmHg) is not factored into decision-making in low-gradient aortic stenosis (LGAS).

Objective
Determine prevalence of at least one high Doppler signal in AF LGAS and its relationship to computed tomography aortic valve calcium score (AVCS) versus sinus rhythm (SR) high-gradient aortic stenosis (HGAS).

Methods
Consecutive patients with aortic valve area ≤1cm2 and left ventricular ejection fraction ≥50% during echo were identified (January 1, 2012-December 31, 2016). At least three consecutive Doppler signals were averaged in sinus rhythm (SR) and five in atrial fibrillation (AF).

Results
Of 1,854 patients, age 76± 11 years, male 52%, 301/1,854 (16%) were in AF and LGAS was present in 122/301 (41%). At least one high Doppler signal in AF LGAS was present in 43/122 (35%). AVCS within 1 year of echo was available for 36% of patient with SR HGAS and 34% of AS LGAS. Median AVCS was not different in SR HGAS 2424 (IQR 1623, 3445) vs AF LGAS with at least one high Doppler signal 2509 [IQR1547, 3119], p =0.10 AVCS threshold for severe AS (men &gt;2000 women &gt;1200) was met in 80% SR HGAS vs 86% AF LGAS with high signals.

Conclusions
High Doppler signals in AF LGAS are associated with high AVCS more frequently exceeding thresholds for severe AS. Single-beat high Doppler signals instead of the average correlate better with AVCS and classic HGAS.
1102 Rare association of left ventricular non-compaction and hypertrophic cardiomyopathy
Authors: Hotta V T , Monge N M S , Vieira M L C , Fernandes F , Mady C 
Published: January 2020

Abstract

Background
LVNC and HCM are cardiomyopathies with distinct clinical presentation that may present common genetic mutations. Some studies suggest a common genetic basis between HCM and LVNC and the possibility of a phenotypic association of these two cardiomyopathies in the same patient.

Case report
A 39 year old man was referred to our hospital with syncope. His past medical history was unremarkable. His father died of sudden death, at age 49, without investigation of Left ventricular non compaction (LVNC) or Hypertrophic cardiomyopathy (HCM). Physical examination was unremarkable. Electrocardiogram showed sinus rhythm with left chambers overload and isolated ventricular extrasystoles. Transthoracic Echocardiogram (TTE) evidenced significant left ventricular (LV) hypertrophy predominantly in the apical region and inferolateral wall, in the absence of a significant intraventricular gradient at rest and after provocative maneuvers, with preserved LV function, suggesting non-obstructive HCM. Cardiac magnetic resonance imaging (CMRI) showed LV hypertrophy predominantly in the lateral wall, with a maximum thickness of 35 mm, no signs of left ventricular outflow tract (LVOT) obstruction and prominent apical trabeculation, compatible with the association of LVNC and HCM. A genetic test was performed on this patient with inconclusive results.

Conclusions
The association of diagnostic criteria in cardiac imaging tests (TTE and CMRI) compatible with LVNC and HCM in the same patient is uncommon. This patient shows an infrequent location of the most prominent hypertrophy in the inferolateral wall.This case highlights the importance of integrating cardiac imaging methods in the diagnosis of these two disctinct and rare cardiomyopathies.
Legend Figure 1: 2D TTE evidencing prominent hypertropfhy and intraventricular recesses at apical region and inferolateral wall (red arrows), abnormalities suggesting HCM and LVNC at LV apex (blue arrows) in Paraesternal Long Axis (A and B), Short Axis View (C to F), Apical 4 Chambers (G and H) and Apical 2 Chambers View (I and H). Speckle tracking analysis evidencing incipient LV systolic dysfunction by reduced global longitudinal strain (GLS:-8,9%) despite the preserved LVEF (K to N). CMR evidencing findings compatible with the association of LVNC (blue arrows) and HCM (red arrow) in 4 Chambers (O and P), 2 Chambers (Q and R) and Short Axis Views (S to V).
Abstract 1102 Figure 1
1111 Atrial thrombi or cardiac tumors? The challenge of multimodality imaging of intracardiac masses
Authors: Castrichini M , Albani S , Pinamonti B , Bussani R , Belgrano M , Sinagra G 
Published: January 2020

Abstract
A 83-year-old man with hypertensive cardiomyopathy with left ventricular dysfunction diagnosed 5 years before (without coronary artery disease) in permanent atrial fibrillation since 8 years, was admitted to the ER for heart failure. He was not in anticoagulation therapy because contraindication for the presence of cerebral venous angiomas found several years before.
An urgent ultrasound scan was performed that showed bilateral intra-atrial masses. UFH was started.
The echocardiography(Fig. 1 panel A)show within the left atrium an isoechoic, not pedunculated mass, 8x5 cm, with lobulated margins, attached to the anterior wall and left atrial appendage, and expanding in the atrial cavity. Within the right atrium a smaller mass with the same characteristics was attached to the anterior wall, 4 x 3 cm (Fig. 1 panel B). TEE confirmed these characteristics and showed also vacuolated aspects inside the masses (Fig. 1 panel C).
MDCT was then performed, the atrial masses appeared morphologically very similar to atrial myxomas, but they didn’t enhance iodine contrast agent resembling a typical thrombus behavior (Fig. 1 Panel D). No systemic emboli nor extracardiac tumors were found. CMR could not be performed due to patient claustrophobia.
Considering intra-atrial thrombi as a main hypothesis, the treatment with UFH was continued and the masses were monitored by TTE. However, after more than one week the masses volume did not change.
A contrast echocardiography with IV Sonovue was performed. A mild contrast enhancement of left atrial mass was seen, thus suggesting the diagnostic hypothesis of cardiac tumor (Fig. 1 Panel E).
In this context we decided to perform transvenous biopsy of right atrial mass under intracardiac echocardiography guidance. The biopsy samples from the outer wall of the right atrial mass showed thrombotic features.
After a long discussion in heart team, patient underwent to surgical resection of the masses through atrial approach and the surgical inspection was suggestive of neoplastic origin.
The histological examination was performed showing thrombotic material with several phases of organization and mild aspects of neo-angiogenesis combined with mild lymphocyte infiltration and necrosis areas (Fig. 1 Panel F).
We hypothesized that the histological features of the lesion, with the presence of vessel within the mass could explain the mild late contrast enhancement at Sonovue echocardiography simulating the features of cardiac tumor.
In summary, in this case, despite a multimodal imaging approach, the nature of the bilateral intra-atrial masses could not be defined and the histological examination after surgical removal had a key diagnostic role showing organized thrombotic material. A proper differential diagnosis is extremely important in order to decide the appropriate treatment, but sometimes it is extremely challenging.
Abstract 1111 Figure 1
1116 Atypical, cardiac location of melanoma
Authors: Zapolski T , Mariusz Kozak M K , Agnieszka Styczen A S , Marta Karas Glodek M K G , Andrzej Tomaszewski A T , Elzbieta Czekajska Chehab E C C 
Published: January 2020

Abstract
A 66 – year – old woman, never treated because of any cardiac illnesses in the past, suffering from the chest pain evoked by physical activity, came to the outpatient clinic on January, 12 th 2019 for the diagnostics. Clinical examination, apart from an elevated blood pressure – 180/100 mmHg, showed no changes. In the ECG – SR 55 bpm. Performed TTE revealed an abnormal structure, having the dimensions 41x29 mm. Heart chamber dimensions, except for moderately enlarged LA, were in the normal range; ejection fraction was preserved. The patient was referred to the Department of Cardiology aiming at further diagnostics. In the course of hospitalization CT of the heart was done, during which the presence of hipodensic, mobile tissue change, having irregular borders, coming out of left ventricle wall was confirmed. PET examination excluded the existence of other remote changes. TEE corroborated the diagnosis of a tumor, originating from the inferior wall of left ventricle. Performed angiography ruled out significant changes in coronary arteries. Subsequently, the patient underwent the removal of the left ventricle tumor on February, 2 nd 2019 in the Department of Cardiosurgery. Histopathological examination result after the surgery wasn’t unequivocal – differential diagnosis should have included melanoma, myoepithelial cancer and MPNST ‘high – grade’ sarcoma. Immunohistochemical examination was continued. In the meantime, a control TTE was performed, which detected a tumor 14x10 mm.
After the immunohistochemical examination results a woman was qualified to immunotherapy with the usage of pembrolizumab, initiated on March In TTE done on March, 30th 2109 the dimensions of tumor 30x20 mm suggested the disease progression. Therapy was continued. Next echocardiography didn’t visualise the presence of tumor. The patient was after the second cycle of chemotherapy.
Abstract 1116 Figure.
1159 Right ventricular electromechanical dyssynchrony in relation to right ventricular remodeling, dysfunction and exercise capacity in Ebstein anomaly
Authors: Akazawa Y , Fujioka T , Kuhn A , Hui W , Slorach C , Roehlig C , Mertens L , Vogt M , Friedberg M 
Published: January 2020

Abstract

Background
Abnormal atrioventricular conduction and functional right ventricular (fRV) dysfunction are common in patients with Ebstein anomaly (EA). However, the relation of fRV dyssynchrony to fRV function in EA has not been studied.

Purpose
We hypothesized that fRV electromechanical dyssynchrony is associated with fRV remodeling, dysfunction and exercise intolerance in EA patients.

Methods
Non-operated EA patients and age-matched controls prospectively underwent echocardiography, cardiovascular magnetic resonance imaging (CMR) and cardiopulmonary exercise testing to quantify RV remodeling, dysfunction and exercise capacity, respectively. The relation of these to fRV dyssynchrony was investigated. RV mechanical dyssynchrony was defined by early septal activation (right-sided septal flash), RV lateral wall prestretch/late contraction, postsystolic shortening, and the maximal intra-RV delay (difference in time to peak of lateral basal RV and apical septal segments) using 2-dimensional strain echocardiography.

Results
Thirty-five EA patients (age 31.6 ± 17.3 years, 19 female) and 35 age-matched controls were studied. QRS duration and intra-fRV mechanical delay were significantly longer in EA compared with controls. 19/35(54%) of EA patients had early activation of septal segments with simultaneous stretching and consequent late activation and post-systolic shortening of RV lateral segments. QRS duration correlated with fRV end-diastolic (fRVEDVI, r = 0.46, P &lt;0.01) and end-systolic indexed volumes (fRVESVIr = 0.57, P &lt;0.001). Intra-fRV delay correlated with RV global longitudinal strain (GLS, r=-0.45,P &lt;0.05) and RV fractional area change (r=-0.56, P &lt;0.01). Intra-fRV delay was also associated with fRVEDVI (r = 0.43, P &lt;0.05), fRVESVI (r = 0.63, P &lt;0.001), fRVEF (r=-0.46,P &lt;0.05) and predicted peak VO2 (r=-0.39, P &lt; 0.05). EA patients with versus without a septal flash had lower fRVEF (45 ± 11 vs. 54 ± 8%, p &lt; 0.05) and predicted peak VO2 (0.71 ± 0.19 vs. 0.92 ± 0.33, p &lt; 0.05).

Conclusions
In EA, fRV electromechanical dyssynchrony is associated with fRV remodeling, dysfunction and impaired exercise capacity and may constitute a therapeutic target.
Abstract 1159 Figure.