bluuebunny/crossref_metadata_2025_split huggingface dataset:
P782 Septal flash is a prevalent and early dyssynchrony marker in transcatheter aortic valve replacement-induced left bundle branch block
Authors: Calle S , Coeman M , Kamoen V , De Pooter J , Timmermans F 
Published: January 2020

Abstract

BACKGROUND
New-onset left bundle branch block (LBBB) is a frequent complication after transcutaneous aortic valve replacement (TAVR). LBBB is associated with echocardiographic dyssynchrony in heart failure patients, but this has not been thoroughly investigated in acute LBBB following TAVR.
PURPOSE
This study aims to assess the timing and incidence of echocardiographic dyssynchrony in acute TAVR-induced LBBB patients.
METHODS
The study enrolled all TAVR-induced LBBB patients at our Hospital between January 2013 and May 2019. Presence of LBBB was scored within 72 hours following TAVR. Dyssynchrony was assessed by: 1/ presence of septal flash (SF), 2/ interventricular mechanical delay (IVMD, the difference between left and right ventricular pre-ejection interval using pulsed wave Doppler; cut-off ≥40 ms) and 3/ presence of ‘classical dyssynchronous strain pattern’ assessed with speckle tracking (Figure 1). As a control, these three LBBB-related dyssynchrony markers were assessed and compared to LBBB patients without TAVR (non-TAVR patients) in normal ànd reduced EF, but all having SF.
RESULTS
Out of 134 consecutive TAVR procedures, 30 (22%) were complicated by acute LBBB. SF was present in 72% of TAVR-induced LBBB patients, with a median time from TAVR to SF diagnosis of 24 hours. However, only 1 (5%) of these TAVR patients exhibited a classical dyssynchronous contraction strain pattern (Figure 1), despite presence of SF. Finally, the IVMD values in these TAVR-LBBB patients did not meet the ‘dyssynchrony’ cut-off.
As a control, we compared these dyssynchrony parameters in patients with non-TAVR related LBBB with normal and reduced EF, all exhibiting SF. A classical strain pattern was present in 33% of non-TAVR LBBB patients with preserved left ventricular ejection fraction (LV EF) (p = 0.17), and in 80% of non-TAVR LBBB patients with reduced LV EF ≤30% (p &lt; 0.001). The IVMD in non-TAVR LBBB patients with SF and preserved LV EF was 52 ms (p = 0.002) and 57 ms in non-TAVR LBBB patients with SF and LV EF ≤30% (p = 0.009).

CONCLUSION
SF as dyssynchrony marker develops early after TAVR-induced LBBB and is much more prevalent than the classical strain-based dyssynchrony pattern and IVMD.
Our findings from the control population suggest that progressive LBBB-induced LV remodeling (septal thinning and relative lateral thickening) may be required for a ‘classical dyssynchrony strain pattern’ or significant IVMD to occur in TAVR-LBBB patients, but longitudinal follow-up studies in TAVR-LBBB patients are required as proof-of-concept.
Abstract P782 Figure 1
P784 Cardiac remodelling in elite rowers - insights from novel echocardiographic techniques
Authors: Kleinnibbelink G , Panhuyzen-Goedkoop N M , Hulshof H G , Van Dijk A P J , George K P , Somauroo J D , Oxborough D L , Thijssen D H J 
Published: January 2020

Abstract

Funding Acknowledgements
No financial support
Background
Chronic exercise training leads to cardiac remodelling; the so-called Athlete’s Heart. Previous studies are often limited by a cross-sectional design whilst longitudinal training studies are often constrained to the assessment of non-athletes. Echocardiography provides comprehensive assessment of mechanics and may give additional insight into short-term changes in training volume in the elite athlete.
Purpose
To examine the impact of a short-term (9 months) increase in training volume on cardiac structure and mechanics in elite international competing rowers.
Methods
As part of the work-up to the 2012 Olympic Games, twenty-seven elite rowers (26.4 ± 3.7 years, 19 male) underwent baseline echocardiography prior to and post (9-months) a planned increase in training volume. Conventional echocardiographic indices including mechanics of all cardiac chambers were assessed.
Results
In response to increased training volume, there was a significant increase in left ventricular (LV) size (IVSd 9.2 ± 1.2 to 9.7 ± 1.1 mm, p = 0.001; PWd 8.3 ± 1.3 to 8.7 ± 1.4 mm, p = 0.013), LVIDd (56.5 ± 4.6 to 57.9 ± 4.2 mm, p = 0.001), and LVMi (90.2 ± 17.8 to 100.8 ± 17.1 g/m2, p = 0.000), see table. There was a significant increase in LV twist (9.2 ± 4.5 to 11.2 ± 4.7 °, p = 0.04; basal rotation -4.4 ± 3.1 to -4.5 ± 3.4 °, p = 0.84; apical rotation 5.8 ± 3.4 to 7.1 ± 3.7 °, p = 0.011), see figure, however, there were no changes in any other conventional indices of function or any other cardiac mechanics. There was a significant increase in left atrial (LA) volume (58.8 ± 15.2 to 65.3 ± 17.6 mm, p = 0.01) whilst no changes were observed in right heart structure.

Conclusion
An increase in exercise training volume in elite rowers across 9-months induced mild balanced structural remodelling of the LV and LA with a concomitant increase in LV twist. Contradictory to findings in non-athletes, there was no increase in right ventricular or atrial structure or function which may be representative of the elite athlete status and possibly already at threshold for physiological adaptation.
Abstract P784 Figure.
P793 Is gender a key determinant of exercise tolerance in moderate-to-severe aortic stenosis?
Authors: Bandera F , Ghizzardi G , Milani V , Boveri S , Alfonzetti E , Guazzi M 
Published: January 2020

Abstract

Background
Gender-related differences are known about pathophysiology and clinical outcome of aortic stenosis (AS). Nevertheless, the impact due to gender on effort intolerance as well as its mechanisms has not been defined. We sought to assess functional capacity in AS labelling gender differences.

Methods
Sixty patients [age 69(63-76)years; female 24(40%)] with at least moderate AS (rest Vmax &gt;3 m/s) underwent to rest and exercise echocardiography with simultaneous cardiopulmonary exercise test (CPET) during maximal symptom-limited exercise. Differences on echocardiographic and CPET variables were assessed according to gender.

Results
Women showed lower effort tolerance [female vs male: workload 51(46.5-72.5) vs 92.5(74-118.5)watts, p&lt;.0001; peakVO2 13.2(12-15.2) vs 17.7(14.2-22-7)mL/kg/min, p=.002; Predicted peakVO2 63.5(53.5-74) vs 76(61.5-101)%, p=.006; anaerobic threshold 11.4(9.8-13.2) vs 12.8(11.4-15-7)mL/kg/min, p=.01; VE/VCO2 29.5(26.1-30.2) vs 26.2(24.3-28.5), p=.008] characterized by lower chronotropic reserve [age-predicted heart rate (HR) reserve 69.5(58.6-78.9) vs 82.8(74.6-89.7)%, p=.003; HR reserve 40.5(33.6-51) vs 47.5(39-67.5), p=.02; HR recovery at 1 min 9(4-12) vs 14(8.5-20), p=.002)], lower cardiac output (CO) response [exercise CO 7.9(6.4-8.8) vs 8.6(7.9-9.9) L/min, p=.01; CO reserve 2.9(2.1-3.6) vs 4.3(3.2-5.4)L, p=.0008] and lower peripheral extraction [C(A-V)VO2 12(9.7-14.2) vs 15.4(13.8-16.6)mL/100mL, p=.0007]. At 12 months follow up, the incidence for AVR was 0.55(0.31-0.73) in women and 0.29(0.15-0.45) in men, while at 60 months it was respectively 0.69(0.44-0.85) and 0.59(0.11-0.35).

Conclusions
in women, moderate-to-severe AS generates a higher degree of functional limitation compared to men. A lower CO reserve, mainly determined by an impaired chronotropic response and lower C(A-V)O2, plays a central role. This unfavourable phenotype is associated with a less advanced LV remodelling pattern and an earlier incidence of AVR.
P796 Feasibility of exercise stress echocardiography and its correlation with angiographically significant coronary disease
Authors: Chowdhary A , Nadarajah R , Hammond C , Burnett N , Mwambingu T , Artis N , Patel P A 
Published: January 2020

Abstract

Background
European Society of Cardiology (ESC) guidelines on the management of stable coronary artery disease (CAD) advocate stress echocardiography (SE) as a first line assessment for functionally significant ischaemia. Pharmacological stressors such as dobutamine are typically utilised in most UK centres in view of practical benefits when compared with treadmill testing. However, exercise provides the best physiological mimic and enables additional data on haemodynamics and electrocardiogram (ECG) changes to be obtained.

Purpose
To assess the feasibility and safety of exercise stress echocardiography (ESE), and the correlation of positive testing with significant coronary disease and major adverse cardiovascular events.

Methods
A retrospective, single-centre analysis of 500 consecutive patients undergoing ESE for investigation of stable CAD. Cases were excluded when a pharmacological stressor was utilised, or in contexts where ESE was performed for other clinical indications. ESE reports were interrogated for patient demographics, co-morbidities, achievement of target heart rate (HR), procedural sequelae, image quality and findings. Electronic records were reviewed after 24 months to assess results of invasive angiography, when performed, and long-term outcomes including myocardial infarction (MI) and cardiovascular mortality. Concordance between ischaemic territory on ESE and coronary lesions on angiography was also collated.

Results
95% (475/500) of patients were suitable for inclusion. Of these, 83% (394/475) achieved target HR. Sequelae arose in 0.02% (9/475), with the most frequent being ectopy (4 cases). Image quality was adequate in 98% (465/475), with the requirement for contrast agent in the remainder. There were no significant differences in burden of cardiovascular risk factors between the positive and negative ESE groups. 13% (63/475) were positive for inducible ischaemia in one or more myocardial segments. Of these, 71% (45/65) underwent angiography, with 48% (31/65) requiring stenting or bypass surgery. Ischaemic territory on ESE correlated with angiographic lesions in 65% (29/45) of cases. ESE underestimated extent of significant CAD in only 7% (3/45). In the subcohort positive for ESE, 3% (2/63) suffered a MI and cardiovascular mortality was 1.5% (1/63).

Conclusions
ESE is a safe, non-invasive modality for functional testing that reaches diagnostic threshold in the vast majority of cases. It has reasonable concordance in localising ischaemic coronary territory to enable targeted revascularisation.
P808 Association between left ventricular diastolic dysfunction and subclinical coronary artery calcification
Authors: Mansour M , Chammas E , Hamoui O , Honeine W , Aljaroudi W 
Published: January 2020

Abstract

Funding Acknowledgements
None

Background
Assessment of diastolic dysfunction (DD) by echocardiography is an integral part of the evaluation of patients with normal ejection fraction (EF) and symptoms suggestive of heart failure. However, many patients with DD are asymptomatic. Computed tomography calcium scoring (CTCS) is often used to assess patients at low-intermediate risk for coronary artery disease (CAD).

Aim
The purpose of this study is to evaluate the association of DD with subclinical coronary artery calcification.

Methods
Consecutive patients presenting for executive check-up who underwent resting transthoracic echocardiography followed by CTCS were retrospectively identified between January 2010 and December 2014. Two‑dimensional and tissue Doppler imaging parameters were analyzed for assessing and grading of DD. Coronary artery calcium (CAC) score was quantified.

Results
A total of 191 patients (mean age 52 ± 12 years, 17% age ≥ 65, 20% with diabetes) were included. Of them, 69 (36%) patients had DD. Patients with higher CAC score were older, had more comorbidities, lower e’ velocity, and were more likely to have DD. In the multivariate analysis, DD alone, age &gt; 65 years, or both were associated with almost 3-fold increase of subclinical atherosclerosis. After propensity analysis, DD was still associated with increased odds ratio (OR) for subclinical CAC (OR 3.66 [1.54-8.72], P = 0.03), and similarly for e’&lt; 10 cm/s. Compared to patients age &lt; 65 years and normal diastolic function, those age &gt; 65 years or DD had OR 3.49 (1.45-8.35) for subclinical coronary atherosclerosis (CAC &gt; 0), whereas those age &gt; 65 years and DD had OR 9.30 (2.00-42), (P = 0.005 and P = 0.004, respectively).

Conclusions
Our analysis suggests that DD was strongly associated with CAC &gt; 0 even after adjusting for age and comorbidities. Assessment of CAC as part of the routine clinical evaluation of patients with normal EF and atypical symptoms without a history of coronary atherosclerotic disease is warranted for further risk stratification.
Table 1
Abstract P808 Figure. Baseline characteristics
P816 Right Ventricular assessment using Advanced Cardiac Imaging in Mid-Range patients: Keys to detect the risk
Authors: Pascual Izco M , Garcia Martin A , Lorente Ros A , Hinojar Baydes R , Alonso Salinas G L , Vieitez Flores J M , Gonzalez Gomez A , Sanchez Vega J D , Ramos Jimenez J , Casas Rojo E , Jimenez Nacher J J , Garcia De Vicente A , Urena A , Zamorano J L , Fernandez-Golfin Loban C 
Published: January 2020

Abstract

Background
Patients with mid-range ejection fraction heart failure (HFmrEF) are a new category defined in actual guidelines. The aim of this study was to establish the prognostic value of several parameters obtained by Cardiac Magnetic Resonance (CMR) and Transthoracic Echocardiography (TTE) in patients with HFmrEF.

Methods
Thirty patients, defined as HFmrEF by TTE and CMR, were included between 2012-2018. Patients with structural heart disease different from Left Ventricular (LV) dysfunction were excluded. Cine sequences in CMR (SSFP) were used to obtain atrial and ventricular volumes and mass. Myocardial fibrosis was quantified by late gadolinium enhancement. TTE was used to obtain anatomical and functional parameters as LV and Right Ventricular (RV) ejection-fraction, LV and RV global longitudinal strain, and RV free-wall longitudinal strain.
The primary endpoint was the combination of all-cause death or heart failure admission. The median follow-up was 1.9 (0.5-3.3) years.

Results
Mean age was 59.3 ± 12.4 years, and 67.9% patients were male. The aetiology of LV dysfunction was mainly ischemic (n = 16, 53.3%). Results are shown in Table1. Patients who presented the primary endpoint had a lower RV ejection-fraction by CMR and a lower absolute value of RV free-wall longitudinal strain by TTE(Figure 1).

Conclusions
In HFmrEF patients, worse RV function (by CMR and TTE-Speckle Tracking) may be associated with a worse prognosis. Larger studies are needed to confirm this hypothesis.
Table1 All-cause death or HF admission (n = 5; 16.7%) No all-cause death of HF admission (n = 25; 83.3%) p iRVEDV (ml/m2) by CMR 65.5 ± 13.5 66.2 ± 12.3 0.906 iRVESV (ml/m2) by CMR 30.4 ± 7.5 24.4 ± 6.2 0.065 iLVEDV (ml/m2) by CMR 85.8 ± 23.7 98 ± 19.5 0.225 iLVESV (ml/m2) by CMR 47.8 ± 15.3 54.9 ± 11.7 0.246 Indexed LA Volume (ml/m2) by CMR 42.8 (36.5 - 49) 48.4 (42 - 63.5) 0.386 LVEF (%) by CMR 44.9 ± 3.3 44 ± 2.6 0.506 RVEF (%) by CMR 52.2 ± 7.2 61.7 ± 7.2 0.012 RV-FAC (%) by TTE 43.4 ± 4.4 44.7 ±7.5 0.378 TAPSE by TTE 2.1 ± 0.3 2.5 ± 0.1 0.032 LV Longitudinal Global Strain by TTE -14.3 ± 3.3 -15.5 ± 4.9 0.663 RV Longitudinal Global Strain by TTE -11.3 (-13.2 - -7.0) -19.5 (-23.7 - -10) 0.089 RV Free-Wall Longitudinal Strain by TTE -11.5 (-14.2 - -8.2) -20 (-26 - -13.7) 0.043 HF: Heart Failure; CMR: Cardio Magnetic Resonance; LV: Left Ventricle; RV: Right Ventricle; iRVEDV: Indexed RV End-Diastolic Volume; iRVESV: Indexed RV End-Systolic Volume; iLVEDV: Indexed LV End-Diastolic Volume; iLVESV: Indexed LV End-Systolic Volume; LA: Left Atrium; LVEF: LV Ejection Fraction; RVEF: RV Ejection Fraction; RV-FAC: RV Fractional Area Change; TAPSE: Tricuspid Annular Plane Systolic Excursion
Abstract P816 Figure 1
P823 Usefulness of myocardial deformation imaging for assessment and long - term prognosis in young patients with Kawasaki disease
Authors: Marinov R , Hristova K , Telcharova A , Chakarov I 
Published: January 2020

Abstract

Kawasaki disease is an autoimmune process, which characterizes with the engagement of arteries and especially - the coronary arteries of the heart.The aim of the study was to assess global and regional LV myocardial function and to predict the long-term prognosis of Kawasaki disease.Design and method: We analyzed 62 children (mean age 9,4 ±3,9 years ), 28 of them with a residual coronary aneurism and 20 healthy children ( mean age 9,6 ±4, 8). The myocardial deformation indexes of the LV – global and regional longitudinal, circumferential and radial stain were analyzed. The patients are divided into groups according to the type of treatment and the occurrence of complications - residual aneurysms. Apical, middle and basal short axis for 2D images were acquired (65 ± 7 frames/s) in addition to apical four, three and two-chamber views. Global and regional peak systolic strain - longitudinal, radial and circumferential of the LV was derived and the strain curves (eLL, eCC, eRR) were extracted using a commercial softwareResults: Global longitudinal strain measurements of the LV were non-significantly different between the Kawasaki group without an aneurysm and normals (GLS -19,81± 1,91% vs -19,69 ± 1,91%) In the group of Kawasaki with an aneurysm was found significantly reduced GLS compared to healthy patients (-17,25 ± 3.48% vs -19,69± 1,81%. ). Concerning the regional analysis,in the group with aneurysms, the radial, circumferential and longitudinal strain were significantly reduced, especially on the basal and middle LV-segments.

Conclusion
Decreased myocardial strain values are signs of regional hypokinesia with a possible local segmental ischemia in the group with coronary aneurysms on coronary artery and are marker for developing severe LV dysfunction in the future. The contribution in this study was the introduction of a new non-invasive assessment of myocardial function after Kawasaki disease, despite the apparently "normal" global systolic heart function.
Global and regional myocardial strain 2D strain % Healthy controls Patients with Kawasaki disease and aneurysms Patients with Kawasaki disease without aneurysms 2Ds_rr 51.06 ± 4.95 37.24 ± 7.53* 41.91 ± 4.87 2Ds_cc -20.91 ± 0.76 -16.45 ± 3.01* -18.91 ± 2.73 2Ds_ll -19.69 ± 1.82 -17.25 ± 3.48* -19.81 ± 1.91 Basal level 2Ds_rr 2Ds_cc 2Ds_ll 52.03 ± 9.09 -20.68 ± 1.56 -19.74 ± 1.94 36.40 ± 12.57* -15.32 ± 2.81* -15.32 ± 2.81* 46.10± 8.37 -18.32 ± 2.01 -19.32 ± 0.97 Middle 2Ds_rr 2Ds_cc 2Ds_ll 49.54 ± 6.41 -21.3 ± 2.27 -20.92 ± 3.37 35.77 ± 9.26* -15.44 ± 3.04* -15.01 ± 2.79* 44.01 ± 10.12 -17.92 ± 1.11 -19.02 ± 1.31 Apical 2Ds_rr 2Ds_cc 2Ds_ll 51.30 ± 2.27 -21.30 ± 2.27 -20.92 ± 3.37 39.52 ± 12.93* -17.73 ± 4.45* -16.78 ± 4.49* 46.66± 8.57 -19.22 ± 1.87 -19.32 ± 1.01 * p &lt; 0.01
P841 Case report of cardiac myxoma presenting with palpitations in young female
Authors: Nalmpantis A 
Published: January 2020

Abstract

Funding Acknowledgements
none

Introduction
Atrial myxoma is a benign tumor of the heart , most commonly found in left atrium. The tumor must be surgically removed, because if remain untreated can lead to embolism, to arrhythmia and/or obstruction of mitral valve.

Case report
A 29 years old female presented due to palpitations and fatigue In the last two-three months. From recent blood tests she had a normal hematocrit and normal function of the thyroid gland. From the physical examination she had a blood pressure of 95/55 mmHg, S1S2 without any murmur, ECG with sinus rhythm and rsr" pattern. A bedside transthoracic echocardiography has performed and the findings were normal left systolic cardiac function, normal right systolic cardiac function, a large mass in left atrium without obstruction of mitral valve and a mild mitral regurgitation.
The young female has been submitted for surgical removal of the cardiac mass and the anatomopathological examination has confirmed the benign nature of the atrial myxoma.

Conlusion
A common symptom such as palpitations are , has lead the young female to us in order to evaluate her and finally to reveal a benign cardiac tumor .
Abstract P841 Figure. myxoma
P848 Left sided cardiac lymphoma
Authors: Scheggi V , Mazzoni C 
Published: January 2020

Abstract

Background
Primary cardiac lymphoma (PLC) is a rare neoplasm, defined as a lymphoma with the main bulk localized in the heart; diffuse B-cell lymphoma (DLBCL) is the most common type. It usually involves the pericardium and the right heart, especially the right atrium, and have a poor prognosis with a median survival of less than one year.
Case summary
A 62-year-old female presented to the emergency department on February 2018 for palpitations and recent-onset dyspnea on exertion. Her previous medical history was unremarkable except for a hospital admission in october 2017 for dyspnea, when she underwent pleuroscopy of a left pleural effusion with histologic findings negative for a neoplastic process.
The echocardiogram showed a round-shaped mass (23x13mm) in the left atrium, attached to its lateral wall, a mild circumferential pericardial effusion and an hyperechogenic mass at the level of the atrio-ventricular junction of suspected pericardial origin.
A subsequent thoracic CT scan demonstrated the presence of a bulky mediastinal mass with colliquative aspects developing around the cardiac structures, strictly attached to the left heart and infiltrating its posterior wall, the left pulmonary veins and the inferior lobar bronchus. Another mass of similar characteristics surrounded the antero-superior portion of the right heart. Colliquative lymphadenopathies and a left basal pleural effusion were also present.
After performing a total-body CT scan which excluded the presence of lesions in other districts, the patient underwent CT-guided biopsy and the diagnosis of double-expressor DLBCL was made. Given the potential risk of heart rupture during chemotherapy, the first cycle of R-CHOP was performed in a in-hospital setting with initial reduction of the mediastinal mass and of the lymphadenopathies. The patient was discharged home and referred to the hematology department. After completing 6 cycles of R-CHOP, imaging studies showed rapid progression of the disease; the patient was then started on the salvation protocol R-DHAOX but died of septic shock in december 2018.

Discussion
PCL is rare and accounts for less than 2% of primary cardiac tumors; double-expressor DLBCL carries a poor prognosis.
As in most cases, diagnosis was made after the onset of nonspecific symptoms (dyspnea) but -despite the strong predilection for right heart involvement reported in literature- our patient had a predominant left atrial infiltration.
Abstract P848 Figure.