bluuebunny/crossref_metadata_2025_split huggingface dataset:
P329 Outcome prediction with force-based left ventricular contractile reserve during stress echocardiography
Authors: Morrone D , Zagatina A , Ciampi Q , Cortigiani L , Gaibazzi N , Djordjevic-Dikic A , Borguezan Daros C , Wierzbowska-Drabik K , Kasprzak J D , Boshchenko A , Ryabova T , Zhuravskaya N , Torres M A R , Carpeggiani C , Picano E 
Published: January 2020

Abstract

OnBehalf
Stress Echo 2020 study group of the Italian Society of Cardiovascular Imaging

Background
Stress echo (SE) risk stratification is based on regional wall motion abnormalities (RWMA). The assessment of global left ventricular contractile reserve (LVCR) based on load-independent Force may refine prognosis.

Aim
To assess the value of LVCR during SE in predicting outcome

Methods
From September 2016 to December 2018, we prospectively enrolled 1848 patients (age 63 ± 11 years; 1121 males, 60%) with known or suspected coronary artery disease and/or heart failure evaluated with SE (exercise in 543, dipyridamole in 1184, adenosine in 10, dobutamine in 43) in 9 quality-controlled centers of 6 countries. Force was measured at rest and peak stress as the ratio of systolic blood pressure by cuff sphygmomanometer/end-systolic volume by 2D and biplane Simpson method of disks. When Simpson method was not feasible, apical single plane or linear parasternal methods were used to calculate volumes. Abnormal values of LVCR (peak/ rest) based on force were ≤1.10 for dipyridamole and adenosine; ≤1.61 for exercise or dobutamine. All patients were followed-up for a median of 16 months.
Results RWMA and Force-based LVCR were obtained in all pts. Force was 4.24 ± 1.88 mmHg/ml at rest and increased during stress (7.07 ± 4.60 mmHg/ml, p&lt;.001). At individual patient analysis, LVCR was abnormal in 495 (26%) and normal in 1373 (74%) patients. At follow-up, there were 218 events: 22 deaths, 22 non-fatal myocardial infarctions, 62 hospital admissions for acute heart failures, and 112 late (&gt; 3 months from SE) myocardial revascularizations. At multivariable analysis, stress-induced RWMA (Hazard Ratio, HR, 2.899, 95% Confidence Intervals, CI: 2.032-4.137, p&lt;.0.001), force-based LVCR (HR 1.747, 95% CI: 1.245-2.470, p=.002) were independent predictors. Kaplan-Meier curves showed worse event-free survival for pts with abnormal LVCR: see figure.
Conclusion LVCR based on Force is a useful adjunct to RWMA for risk stratification with SE.
Abstract P329 Figure. Survival curves and LVCR
P331 Application of 3-dimensional transthoracic echocardiography in the evaluation of implantable cardioverter defibrillator lead position
Authors: Kaminska M , Lopatowska P , Sobkowicz B 
Published: January 2020

Abstract

Over the last decade there has been a significant increase in the number of implantable cardiac defibrillators (ICD) in patients with heart failure with reduced ejection fraction (HFrEF). These leads have been reported to cause or to increase tricuspid regurgitation (TR). Echocardiography is not routinely used to elucidate the mechanisms of lead interference with tricuspid valve leaflets in individual patients.

AIM
To evaluate of usefulness of 3-dimensional transthoracic echocardiography (3D TTE) in the assessment of ICD lead position and its relations to tricuspid valve.

METHODS
A population consisting of 44 consecutive patients with ICD was evaluated (43 – patients with HFrEF, 1 – patient with hypertrophic cardiomyopathy). 3D TTE full-volume images of the right ventricle and/or zoomed images of the tricuspid valve were obtained. Images were analysed off-line to determine the position of the device-lead in relation to the tricuspid valve leaflets. Severity of TR was estimated as not important (+, ++) and important (+++, ++++).

RESULTS
An evaluation of the device-lead position was impossible due to poor diagnostic quality of echocardiographic images in 4 patients (9%). Among 40 remaining subjects in 12 (30%) lead was in central position, without interfering with leaflet motion, in 14 (35%) - impinging on the posterior leaflet, 6 (15%) - impinging on the septal leaflet, 8 (20%) – lead was positioned near the posteroseptal commissure. Among 15 patients (38%) TR was assessed as important. There was no correlation between device-lead position and severity of TR.

CONCLUSIONS
3D TTE enables to determinate ICD-lead position and its relation to tricuspid valve. 3D TTE can explain a mechanism of associated TR in individual patients. Further studies are necessary to investigate possible relationship between lead position and TR severity.
P338 The road to zero-fluoroscopy catheter ablation in recurrent paroxysmal atrial fibrillation using ICE: training, learning, getting closer
Authors: Minciuna I A , Puiu M , Cismaru G , Istratoaie S , Simu G , Florea C , Gusetu G , Zdrenghea D , Pop D , Rosu R 
Published: January 2020

Abstract

INTRODUCTION
Catheter ablation is the treatment of choice for patients with recurrent paroxysmal atrial fibrillation (AF) in which antiarrhythmic drug therapy has failed to maintain sinus rhythm. Since its first introduction, intracardiac echocardiography (ICE) has proved to increase the efficacy and reduce complications in AF catheter ablation. One of the main advantages of ICE in the electrophysiology laboratory is the reduction of radiation exposure, for both the patient and the physician. Multiple recent studies have shown the feasibility and safety of zero or near-zero fluoroscopy AF ablation, including transseptal puncture, and outlined the importance of using ICE under the support of 3D mapping systems in reducing radiation exposure.

PURPOSE
The aim of this study was to show whether the use of ICE reduced the radiation exposure and total procedure time in recurrent paroxysmal AF patients undergoing radiofrequency catheter ablation.

METHODS
Forty patients that undergone radiofrequency catheter ablation for recurrent paroxysmal AF between January 2018 and May 2019 were included. They were divided in two groups: Group 1 – 20 patients in which ICE was performed and Group 2 – 20 patients in which ablation was performed without ICE guidance. We compared the total ablation time and fluoroscopy dose and time between the two groups. The total ablation time was defined as the time from the groin puncture until the withdrawal of all catheters.

RESULTS
Among the 40 patients included, 28 were men (70%) and the mean age was 57 years old. The mean procedure time was similar between the two groups (175 ± 52.0 for group 1 and 193 ± 49.9 for group 2, p = 0.33). The difference between the two groups was observed in fluoroscopy dose (9914.13 ± 5018.14 vs. 14561.43 ± 7446.1, p = 0.02) and time (26.04 ± 12.5 vs. 40.52 ± 12.6, p = 0.001). We found that in both groups higher fluoroscopy dose was correlated with higher fluoroscopy time (R = 0.74, p = 0.0001 vs. R = 0.57, p = 0.008) and higher total procedure time (R = 0.63, p = 0.002 vs. R = 0.46, p = 0.03). Furthermore, there was also a correlation between higher fluoroscopy dose and time (R = 0.59, p = 0.005 vs. R = 0.58, p = 0.006). No severe procedure-related complications were recorded.

CONCLUSIONS
This study shows that the use of ICE for recurrent paroxysmal AF catheter ablation reduces radiation exposure by lowering the fluoroscopy dose and the time of exposure. As a result, by increasing the training and learning curve in low-experienced centers it may finally get us closer to the ideal zero or near-zero fluoroscopy ablation.
Abstract P338 Figure. ICE-guided transseptal puncture
P340 New tools for the assesment of diastolic function in attr cardiac amyloidosis
Authors: Gonzalez Ferrero T , Abou Jokh Casas C A J C , Cacho Antonio C C A , Abou Jokh Casas E A J C , Antunez Muinos P A M , Perez Dominguez M P D , Torrelles Fortuny A T F , Pubul Nunez V P N , Martinez Monzonis A M M , Gonzalez Juanatey J R G J 
Published: January 2020

Abstract

INTRODUCCION
Cardiac amyloidosis (CA) is a cardiomyopathy where the main disturbances are due to diastolic dysfunction. This requires a meticulous clinical and echocardiograpic evaluation.

METHODS
The aim of this study was to analyse the association between previously described parameters of diastolic dysfunction and others less known such as left atrial peak strain.

RESULTS
Thirty-six patients with suspicion of cardiac amyloidosis were submitted to DPD scintigraphyand transthoracic echocardiography, and were divided into two groups.
Of these patients, eleven had no visual gammagraphic catchment whereas twenty-four, (68%) did. Median peak of atrial strain was 16.8 in sinus rhythm and 6.8% in atrial fibrillation (p &lt; 0.0001) with no differences in the proportion of AF.
Median value of the velocity of E wave in patients with no catchment was 1.17 m/s whereas in those with ATTR-CA 0.77 m/s (p= 0.004). No differences were observed in other parameters such as A wave, E/A ratio or deceleration slope of E wave.
We found that the strongest predictor of high filling pressures (E/e’&gt; 14) was systolic strain left atrial peak (p = 0,004 IC 95% 0.8-0.9) with an accurate predictive ability, AUC (76%).

CONCLUSIONS
Left atrial strain peak could be an interesting parameter for the assessment of diastolic dysfunction and a protective value for elevated filling pressures in CA-ATTR patients.
Basal features ABSENCE OF CATCHMENT POSITIVE CATCHMENT P-value E (m/s) 0.77 1.17 0.04 A (m/s) 0.76 0.9 0.64 E/A 195 181 0.91 E/e’ 14 0.9 0.73 Atrial strain peak 8.5 11.8 0.78 35% AF 45% AF Fractional shortening (%) 34.34 31.80 0.81 Differences between both groups
Abstract P340 Figure. Relationship: E/e" and atrial strain
P359 Dipyridamole stress cardiac magnetic resonance in the assessment of utility of coronary revascularization in patients with stable angina
Authors: Igual Munoz B , Maryem Ezzitouny M E , Elena Sanchez Lacuesta E S L C , Jose Luis Diez Gil J L D G , Vicente Miro Palau V M P , Francisco Ten Morro F T P , Maria Ferre Valverdu M F V , Alberto Berenguer Jofesa A B J , Jose Leandro Perez Bosca J L P B , Rafael Paya Serrano R P S 
Published: January 2020

Abstract

The prognostic impact of coronary revascularization in patients with stable angina is limited being reserved nowadays for patients with symptoms or severe ischemia in imaging tests. We propose to study the usefulness of stress CMR to assess the utility of coronary revascularization in patients with stable angina.

Methods
A retrospective cohort study was conducted including consecutive patients with inducible ischemia in dypiridamol stress CMR. Patients with acute coronary syndrome or severe valvular disease were excluded. The decision to revascularize after MRI was made by the responsible medical team following the guidelines of clinical practice. The presence of cardiovascular events (death, admission or need for new revascularization) was analyzed during follow-up. The stress cardiac MR imaging protocol included a baseline functional study (b-SSFP sequences) and after administration of 0.84 mg / kg IV dipyridamole, perfusion sequences (b-SSFP) obtained during the administration of IV gadolinium contrast and F-GRE viability sequences. Clinical data such as the severity of coronary involvement, the type of coronary revascularization and if it was complete as well as data derived from the baseline functional study of ventricular volumes, segmental contractility score, transmurality and extension of necrosis, extension of hypoperfusion and also number of segments with severe ischemia considering as such those segments with transmural hypoperfusion or stress-induced systolic dysfunction.

Results
We included 424 patients of mean age of 65+ 10 years, 182 (43%) of them had known coronary artery disease and 93 (20%) of them had pevious percutaneous revascularization. Thirty-five (8%) had left main disease and 176 (41%) multivessel disease. Twenty five patients had normal stroke volume (SV) and depressed left ventricle ejection fraction (LVEF) and 60p had normal LVEF and low SV . One hundred and seven patients of the total group were revascularized (2.5% surgically). Coronary revascularization showed a significant increase in survival only if it was complete (p &lt;0.004). All analized data were introduced in a multivariate Cox model showing SV as the most powerfull predictor of events (OR:0.9, p = 0.04, CI: 0.96-0.99) and also that patients with indexed SV &lt;40ml / m2 significantly improved their survival after coronary complete revascularization (p = 0.003).

Conclusions
1. SV is the most powerful predictor of events in patients with stable angina and ischemia in CRM dypiridamol stress test.
2. Patients with an SVi &lt;40ml / m2 significantly improve their survival after coronary complete revascularization.
Abstract P359 Figure. Survival curves regarding SV
P367 Cardioprotective effect of angiotensin converting enzyme inhibitors and beta-blockers in the primary prevention of cardiotoxicity: systematic review and meta-analysis of randomised studies
Authors: Moral S , Coma N , Eraso A , Ballesteros E , Vinas G , Frigola J M , Morales M , Robles R , Albert X , Fluvia P , Fort A , Vilardell P , Romera Martinez I , Brugada R 
Published: January 2020

Abstract

Funding Acknowledgements
none

OnBehalf
none

Background
Chemotherapy cardiotoxicity is a serious complication in breast and haematological malignancies. However, its primary prevention with angiotensin converting enzyme inhibitors (ACEI)/angiotensin II receptor antagonists (ARB) and/or beta-blockers (BB) medication has discrepant results. The aim of our study was to establish whether primary prevention using these treatments prevents cardiotoxicity and whether any of them is superior to the others.

Methods
A systematic review and meta-analysis was performed following a search of EMBASE, MEDLINE and PsycINFO from January 2005 to April 2019 of all randomised studies evaluating primary prevention of cardiotoxicity by chemotherapy with any of these treatments. Cardiotoxicity was defined as the drop of the left ventricular ejection fraction below 50% or greater than 10% and/or clinical heart failure during the first year of follow-up.

Results
Nine randomised studies with 913 participants in which chemotherapy was performed were included: 337 (37%) received BB, 152 (17%) received ACEI/ARB, 45 (5%) received BB + ACEI and 379 (41%) were controls. One hundred and eight cases (12%) developed cardiotoxicity (follow-up range: 1-12 months). Patients receiving cardioprotective treatment had a lower risk of developing cardiotoxicity than controls (RR = 0.381, IC95%, 0.160-0.911, P = 0.030, I2 = 63.2%; Fig.1). The subgroup analysis showed a non-significant tendency for both treatments to have a cardioprotective effect (BB: RR = 0.477; IC95%, 0.178-1.275; P = 0.140; I2 = 57.3%) / ACEI/ARB: RR = 0.283; IC95%, 0.027-2.982; P = 0.293; I2 = 79.0%). There was no difference between both treatments in those studies comparing them (RR = 0.743, CI95%, 0.325-1.698, P = 0.481, I2 = 0.0%). The estimated number of patients to be treated to avoid one case of cardiotoxicity was 10 patients.
Conclusions
Primary prevention with BB and/or ACEI/ARB reduces cardiotoxicity by chemotherapy during the first year in breast and haematological malignancies. For every 10 patients treated, one case of cardiotoxicity could be avoided.
Figure 1. Cases treated with BB and/or ACEI/ARB versus control group without treatment of the different randomised studies comparing the number of patients who developed cardiotoxicity during the first year.
Abstract P367 Figure 1
P376 Epicardial to pericardial adipose tissue ratio: predicting ischemic etiology of left ventricular systolic dysfunction
Authors: Garcia Campos A , Alonso Vazquez V , Colunga Blanco S , Velasco Alonso E , Vega Hernandez B , Leon Duran D , Gonzalez Sanchez T , Segovia Martinez-Salinas E , Lozano Martinez-Luengas I 
Published: January 2020

Abstract

Background
Epicardial adipose tissue (EPI) and pericardial adipose tissue (PERI) measured using echocardiography or magnetic resonance imaging have shown to be markers of metabolic syndrome and begin to be regarded as predictors of coronary artery disease. EPI is also thought to have paracrine effects on coronary vessels and, therefore, might be more intimately linked to ischemic heart disease.

Purpose
We aim to study if EPI related to PERI thickness is a predictor of ischemic etiology of left ventricular (LV) systolic dysfunction among ambulatory patients.

Methods
We retrospectively evaluated 56 consecutive patients followed on a heart failure clinic. A cardiologist, blind to the clinical records and systolic dysfunction etiology, reviewed the echocardiographic images and measured EPI and PERI thickness on right ventricle free wall (parasternal long axis view). Cardiovascular risk factors, body mass inex (BMI), LV dimensions by echo, LV systolic dysfunction etiology (investigated by other means such as angiography or magnetic resonance) were analyzed.

Results
Echocardiographic image quality allowed for analyzing 55 patients (80% male, 62% hypertension, 51% diabetes, 44% dyslipidemia, BMI 28,9 ± 4,0, age 66 ± 14 years). Mean EPI thickness was 3,4 ± 2,0 mm and PERI was 5,6 ± 3,4 mm. LV ejection fraction 33 ± 10% and LV end diastolic volume 157 ± 48ml. Supplementary investigations showed an ischemic etiology of LV systolic dysfunction in 45% of patients. We found that patients with EPI thickness equal or greater than PERI were more likely to have an ischemic etiology (univariate analysis: OR 9,8 p = 0,002; adjusted for BMI and diabetes: OR 5,8 p = 0,032).

Conclusions
Epicardial adipose tissue thickness equal or greater than pericardial adipose tissue, parameter easily obtained using transthoracic echocardiography, may predict ischemic etiology of LV systolic dysfunction in a cohort of ambulatory patients . Future research will be necessary to confirm this finding and its possible value in every-day clinical practice as marker of coronary artery disease.
ALL ISCHEMIC NON ISCHEMIC p Epicardial Adipose Tissue 3,4 ± 2,0 3,7 ± 1,6 3,1 ± 2,2 0,53 Pericardial Adipose Tissue 5,6 ± 3,4 4,6 ± 3,0 6,4 ± 3,5 0,09 Ratio EPI/PERI 0,82 ± 0,66 1,16 ± 0,83 0,55 ± 0,28 0,000 Table Adipose tissue thickness measured on paraesternal long axis (mm): mean ± SD.
420 Vortex formation in the pre-ejection phase in the left ventricle
Authors: Daae A , Wigen M , Lovstakken L , Stoylen A 
Published: January 2020

Abstract

Funding Acknowledgements
Central Norway Regional Health Authority
Background/Introduction:
Vortex formation during left ventricular filling have been described since the 1980’s. We have investigated vortices in the left ventricle (LV) in healthy adults with a new technology based on high frame rate vector flow imaging (VFI) using blood speckle tracking.

Purpose
In this study we investigated the intraventricular flow pattern during the pre-ejection period.

Material and methods
We examined 21 healthy volunteers with a GE E95 ultrasound scanner, both in ordinary clinical mode and with an experimental setup. The latter was developed to achieve high frame rates by utilizing plane waves in combination with ECG-gating over multiple (5-6) heart cycles, allowing continuous acquisition of &gt; 3500 FPS. Blood speckle tracking followed by model based regularization was used to obtain vector flow velocity measurements.

Results
During the pre-ejection phase we observed blood flow from the apex to the basis of the LV along the septum. At the base, the flow is deflected. A basal vortex is then created just above the mitral valve, which persists into the isovolumetric contraction (IVC). The lateral part of the vortex is then seen as an apically directed flow during IVC, as shown in the illustration. The vortex is also visible in the first phase of the ejection; the part of the blood in the LV not passing through the aortic valve is deflected and continues to conserve this vortex. These findings correspond to patterns found in colour M-Mode (CMM), showing a column of blood toward the apex in the IVC/early ejection phase. Time from peak R to the first sighting of this IVC vortex, and to the pre-ejection spike in tissue Doppler imaging (TDI), are similar, as reported in table 1.
Conclusion(s):
Our imaging setup allows for a very high temporal resolution (&gt;3500 FPS), and enables VFI using blood speckle tracking, without using a contrast agent. We observed an intraventricular vortex during pre-ejection and into early ejection, with the same direction as the later vortices seen in filling. Initiation of this vortex may be conserved energy from late filling. This vortex is simultaneous with the pre-ejection spike in TDI. We postulate that this IVC vortex contributes to the closing of the anterior mitral leaflet in the IVC. As we also observe this vortex during the early ejection phase, we believe it may conserve rotational energy into early filling.
Table 1 Timing of the IVC vortex and the pre-ejection spike in TDI Mean Median SD Min Max Time between R and the basal vortex during IVS (ms) 16,7 16 15,1 -13 47 Time between R and the pre-ejection spike TDI (ms) 16,3 21 14,4 -10 36
Abstract 420 Figure.
424 Left ventricular function after correction of a proportionate mitral regurgitation: impact of the clipping approach
Authors: Hubert A , Galli E , Leurent G , Corbineau H , Leclercq C , Donal E 
Published: January 2020

Abstract

Aims : Secondary mitral regurgitation (MR) is associated with poor outcome in systolic heart failure (HF-)patients. Percutaneous edge-to-edge mitral valve repair (PMVR) recently failed to prove any beneficial effect over optimal medical treatment (OMT). Nevertheless, little is known about the effect of PMVR on LV performance and mechanics in HF-patients with severe secondary MR.

Method and results
Thirty-seven patients with severe secondary MR treated by PMVR were included and compared (according to indices of LV myocardial function) to nineteen patients with treated by OMT. Both groups were clinically comparable. At 6-month follow-up, only LV constructive work improve significantly in both groups (977 vs 1101 mmHg.%, p =0,003, 967 vs 1110 mmHg.%, p = 0,002 for PMVR and OMT groups, respectively) whereas left ventricular (LV) end-systolic volume index, LV ejection fraction and global longitudinal strain were not different. Compared to MITRA-FR and COAPT studies, our population had a proportionate MR (blue point in Figure 1, panel A). Figure 1-panel B demonstrate that only five patients of PMVR group had disproportionate MR (red points). Interestingly, these patients hadn’t any major event during 6 months FU.

Conclusion
Echocardiographic characteristics at 6-month follow-up are not different when compare PMVR and OMT for HF- patients with a severe proportionate secondary MR.
Main echocardiographic characteristics PMVR OMT Inclusion 6-month p Inclusion 6-month p NYHA 2.6 ± 0.6* 1.8 ± 0.7* &lt;0.0001 2.3 ± 0.5* 2.2 ± 0.4* 0.43 LVESVi(ml.m-2) 76 ± 36 75 ± 35 0.6 94 ± 32 90 ± 31 0.35 LVEF (%) 33 ± 6 33 ± 13 0.78 30 ± 8 31 ± 8 0.53 GLS (%) -9.8 ± 4 -9.9 ± 3.9 0.84 -10.0 ± 4 -10.3 ± 3.3 0.62 MR grade 3.4 ± 0.5 1.3 ± 1.0* &lt;0.0001 3.5 ± 0.5 2.8 ± 1.1* 0.007 Global work index (mmHg.%) 831 ± 370 933 ± 406 0.07 875 ± 314 939 ± 304 0.14 Constructive work (mmHg.%) 977 ± 366 1101 ± 404 0.003 967 ± 290 1110 ± 349 0.002 *symbols denote p &lt; 0.05 between both groups
Abstract 424 Figure.