bluuebunny/crossref_metadata_2025_split huggingface dataset:
159 LV volumes, EF, MAPSE, myocardial mass and systolic compression and relation to ageing. Results from the HUNT study
Authors: Stoylen A , Molmen H E , Dalen H E 
Published: January 2020

Abstract

Background
Myocardial mass increase with age, but the impact of recently discovered length reduction by age has not been taken into account. Long axis shortening is considered the main contributor to LV stroke volume. There is still disagreement about the relative contributions of cross sectional vs long axis shortening. Long axis shortening decrease with age, but EF do not. It has been postulated that this is due to increased transverse function, but this has not been demonstrated. Also, the degree of systolic myocardial compression is unresolved.

Methods
The HUNT study examined 1266 subjects without evidence of heart disease from a mixed urban/rural population of North Trøndelag county, Norway. Linear dimensions of diastolic left ventricular annulus to apex distance, systolic and diastolic wall thicknesses (WT), chamber diameter (LVID), and mitral annular plane displacement (MAPSE) were measured. Measurements were applied to a half-ellipsoid model of the left ventricle with assumption of 50% thinner apex than midway thickness, for calculations of left ventricular length (LVL), LV cavity volume (LVEDV), stroke volume (SV) and EF as shown in fig. 1.

Results
Dimensions and volumes are given in table 1. LV internal diameter was unchanged by age, and so was fractional shortening (FS). Wall thickness increased by age (p &lt; 0.001), corresponding to an increase in external diameter, but LVL decreased (p &lt; 0.001), so increase in myocardial volume (MyoV) although significant (p &lt; 0.001), was less. Wall thickening decreased from 59 to 52% by age group (p &lt; 0.001). MAPSE decreased by age (p &lt; 0.001). Similarly systolic external diameter reduction (from 13.6 to 11.9%), and SV also decreased by age, while EF was unchanged. MAPSE contributed 74% to stroke volume, external diameter reduction to 26% These relative contributions did not change by age. Systolic myocardial compression was 2.5%, at all ages.

Conclusion
LVEDV decreases with age due to LV shortening, not wall thickening. EF is maintained by a simultaneous reduction in SV and EDV. MAPSE decreases by age, and so does transverse function. Thus, both are decreasing in proportion, and the reduction in SV is due to both, not to any increase in transverse function.
Table 1 Age (years) WT (mm) LVL (mm) LVID (mm) LVEDV (ml) MyoV (ml) MAPSE (mm) SV (ml) EF (%) &lt;40 8.1 (1.3) 94.2 (7.5) 50.9 (4.9) 124.0 (30.0) 101.4 (27.9) 17.3 (2.0) 83.7 (21.4) 67 (6) 40 - 60 8.9 (1.4) 92.9 (8.1) 50.9 (5.4) 122.5 (31.0) 111.2 (29.2) 15.8 (2.3) 82.4 (22.8) 67 (6) &gt;60 9.5 (1.4) 89.0 (7.9) 50.3 (6.1) 113.8 (31.7) 113.9 (31.7) 14.0 (2.2) 76.0 (24.1) 66 (9) 8.8 (1.4) 92.4 (8.1) 50.8 (5.4) 121.1 (31.1) 109.2 (29.1) 15.8 (2.5) 81.4 (22.9) 67 (8) Diastolic dimensions volumes and functional measures by age.
Abstract 159 Figure 1
P169 Uterine leiomyoma extension into right side cardiac
Authors: Diniz Ferrer K , Silveira CARLOS , Reis ADRIAN , Abreu E Lima PAULA , Diniz ROBERT , Navarro CAROL , Silva JUCIAN , Melo MARCIA 
Published: January 2020

Abstract

Funding Acknowledgements
governmental grants
Uterine leiomyoma is a commom disease in women, however, intravenous leiomyomatosis of uterine origin extending via inferior vena cava into the right side of the heart,known as intracardiac leiomyomatosis is a rare condition (3%). In 1907, Durk reported the first case of intracardiac extension.
The patient was a Woman, 35 years old, admitted to our emergency department for an intracardiac mass. She had shortness of breath,fatigue and chest pain. The transthoracic two dimensional echocardiography showed an echogenic oval mass mobile in right atrium and projected through right ventricle in diastole. This mass was observed to extend from inferior vena cava to the right atrium. The echotransesophageal three dimensional showed a large mobile mass that extended from inferior vena cava to the right atrium. A Computer tomographic (CT) scan showed a hypodense multilobulated mass in the pelvis, which had invaded the inferior vena cava and right atrium. The patient underwent a two stages surgery. In first stage (transatrial tumor resection). The operation was performed normal temperature with establisment of cardiopulmonary bypass (CPB). Subsequently, the pathological report was confirmed uterin smooth muscle origin. The second stage surgery ( total histerectomy) was done four weeks later for removing lobulated mass uterin with dimensions 20x15x7.5cm with confirmed histopathological of leiomyoma.
Because of it is nonspecific clinical presentation and rarity, an intracardiac Leiomyomatosis continues to be a misdiagnosed as either thrombus or myxoma. The cardiac imaging techniques like a transthoracic echocardiography 2d and transesophageal echocardiography 3d have been used to define the presence, extension of tumor as appearance of the mass and involvement of adjacent structures.
Abstract P169 Figure. Echotransesophageal 3D (bicaval view)
P181 An uncommon mechanism of severe mitral regurgitation due to infective endocarditis mimicking acute myocardial infarction
Authors: Collevecchio A , Simeti G , Previtero M , Iliceto S , Muraru D , Badano L P 
Published: January 2020

Abstract

A 53-year-old man, smoker, with diabetes mellitus, presented to the Emergency Department because of intense chest and abdominal pain, accompanied by dyspnea and high fever (39.5 °C) in the previous 4 days. Physical examination revealed an apical holosystolic murmur, with no signs of peripheral or pulmonary edema. An ECG showed sinus rhythm (90 bpm), complete right bundle branch block and minimal ST elevation in the inferior leads. A transthoracic echocardiography showed a mild reduction in left ventricle ejection fraction (EF 44%) due to akinesia of the infero-lateral wall, and mild mitral regurgitation (MR) due to mitral valve prolapse. An abdominal ultrasound ruled out signs of acute cholecystitis. Blood cultures were collected, and an empirical antibiotic therapy was started. Urgent blood exam showed high Troponin I (72000 ng/L) and high C-reactive protein (290 mg/L).
An acute coronary syndrome was suspected based on clinical, ECG and echocardiography exam, and the patient underwent coronary angiography (Figure 1, Panel A) that showed no significant coronary stenosis, except for two small filling defects in the very distal part of both the left anterior descendent and the circumflex coronary arteries suspected for coronary emboli. The patient was then admitted in the coronary care unit, but after just a few hours his clinical and hemodynamic condition deteriorated. A transesophageal echocardiography was performed to rule out mechanical complications related to the acute myocardial infarction and revealed severe MR (Panel D), elongated, hyperechogenic and dysfunctioning antero-lateral papillary muscle (ALPM) with an abnormal mobility suggestive for myocardial abscess, and a mobile mass attached on the aortic valve suggestive for vegetation (Panel B and C). Due to the worsening hemodynamic status, the patient underwent urgent cardiac surgery. Histological analysis confirmed the presence of an abscess of the ALPM due to Staphylococcus Aureus. The patient died after a week because of cerebral hemorrhage. Autopsy reported multiple lungs, renal and cerebral embolic septic infarctions.

Learning points
coronary artery embolization and papillary muscle abscess are very rare and often fatal consequences of infective endocarditis (IE). High (otherwise unexplained) fever and signs of embolism are minor Duke modified criteria for IE that should lead the physician to look for major criteria, such as positive blood cultures or echocardiography suggestive for IE. Emboli seen in the very distal part of the coronary arteries might have caused the ALPM abscess.
Abstract P181 Figure
P183 Cor medusae
Authors: Vladova M , Tasheva I , Simova Y , Petrov I , Polomski P , Mihailov M 
Published: January 2020

Abstract
A 75-years-old man presented in our cardiology service with easy fatigue, shortness of breath and palpitations for last two months. His ECG showed atrial fibrillation and LBBB. Until now he was not anticoagulated. We performed first transthoracic echocardiography and found reduced EF - 33%, with global hypokinesia of the LV and LV hypertrophy. Many atrial and ventricular septal perforating arteries. Dilated right coronary sinus. Mild mitral, aortic and tricuspid regurgitation with no pulmonary hypertension. We identified a strongly curved vascular structure in right atrioventricular groove. We performed coronary CT angiography and found abnormal coronary vessels "Cor Medusae" (coronary arteriovenous fistula). Giant RCA - 31mm in diameter with many branches, one of them has comuniction with left atrium and one of the other comunicate with truncus pulmonalis. LAD, LCx and D1 came from truncus pulmonalis. A very rare congenital condition. On a cardiology discussion we decided to apply conservative treatment.
Abstract P183 Figure. CT reconstruction cor medusae
P191 Pellets in rigth ventricle. Without entry point?
Authors: Pinillos Francia G , Gutierrez Fernandez A , Alvarez Roy L , Ruiz Zamora I , Gomez Llorente M , Sufrate Sorzano E , Alonso Perez L , Aguiar Souto P , Azcarate Aguero P M 
Published: January 2020

Abstract

Case Report
A 39-year-old male patient was transferred to emergency room by mobile intensive care unit after receiving a firearm wound in the neck while hunting: accidentally hit by a shotgun. Physical examination highlighted the existence of multiple entry holes at right side face and neck and some above the shoulder girdle line, the rest of the thorax and abdomen did not present skin lesions. Axial tomography (CT) showed multiple pellets in the face and neck tissues and two intracardiac pellets in the right ventricle. He did not present pneumothorax, pneumopericardium or pericardial effusion. He underwent surgical intervention by otolaryngology and vascular teams due to right cervical hematoma and secondary alterations to the shot in the right internal jugular vein. Enucleation of the right eye was also necessary. Echocardiographic study showed the presence of a small hyperechogenic mass with posterior acoustic shadow located in interventricular septum. Another similar structure was also found, in the right ventricle, next to the tricuspid annulus: normal tricuspid valve function. Considering the trajectory (blue triangle) of the shot and the absence of thoracic complications, we thought about the plausibility of projectile embolization from the right internal jugular vein.

Discussion
The presence of projectiles in different cardiac structures can occur by direct impact (the most frequent mechanism), passing through thoracic and/or abdominal structures to be lodged in the pericardium and/or myocardium. They are often accompanied by manifestations such as pericardial effusion or pneumothorax as a result of their trajectory. Embolization to the heart is a much more uncommon mechanism by impacting in another anatomical location such as the neck or lower extremitie. In these cases there may be no extra-cardiac manifestations and can be an incidental finding of a previous event. In our case the intracardiac pellets were s was handled conservatively and the rest of the wounds produced by the shot showed a good evolution. The patient remained asymptomatic from a cardiological point of view during hospitalization and follow up. There is no evidence to support the therapeutic attitude that should be followed in these cases. When the patient is stable and the projectiles are non-mobile, conservative treatment with periodic follow-up is a suitable option.
Abstract P191 Figure. A. 3D echo, B. Xplane, C. CT VR.
P200 The impact of left venticule ejection fraction on long-term outcome in patients with high- and low-gradient severe aortic stenosis - data from ASRegistry
Authors: Strozyk A , Marlega J , Nowak M , Galaska R , Fijalkowski M 
Published: January 2020

Abstract

Background
Aortic stenosis (AS) is the most common primary valve disease leading to surgery or catheter intervention with a growing prevalence due to the ageing population. Severe aortic stenosis with reduced transaortic flow and gradient although it is a common finding still remains diagnostic challenge.

Purpose
The aim of study was to analyse the outcomes of patients with high- and low-gradient aortic stenosis depending on the ejection fraction.

Methods
621 patients hospitalized in the First Department of Cardiology, with severe aortic stenosis defined as aortic valve area &lt;1cm2 were enrolled to the Aortic Stenosis Registry (ASRegistry). The high-gradient aortic stenosis (HG-AS) [mean transvalvular pressure gradient (PGmean) ≥40mmHg and peak transvalvular velocity (Vmax) ≥ 4 m/s] and low-gradient aortic stenosis (LG-AS) [mean transvalvular pressure gradient (PGmean) &lt;40mmHg and peak transvalvular velocity (Vmax) &lt;4 m/s] were observed in 54%(n = 340) and 45% (n = 281) patients, respectively. In the subgroup of HG-AS were 80% (n = 275) and in the subgroup of LG-AS were 61%(n = 174) of patients with preserved left ventricle ejection fraction (LVEF &gt; 50%). The patients were observed for a period of 6 years (2012-2018). The primary end-point, all-cause mortality, was obtained from Nation Health Registry.

Results
Patients with LG-AS had a significantly higher risk of mortality compared to patients with HG-AS: 35% (n = 101) vs 26% (n = 87), p &lt; 0,05. Mortality in both group with HG-AS and LG-AS was significantly higher in the subgroup with diminished left ventricle dysfunction than in the subgroup with preserved ejection fraction: HG-AS: 44%(n = 29) vs 21%(n = 58), p &lt; 0,05 and LG-AS: 53%(n = 57) vs 25%(n = 44), p &lt; 0,05. The highest mortality rates was observed in the LG-AS group with left ventricule dysfunction, p &lt; 0,001.

Conclusions
The study shows the negative impact of left ventricle dysfunction in both groups of patients: high- and low-gradient severe aortic stenosis. The worst prognosis is in patients with LG-AS and low LVEF.
P202 Two-dimensional and three-dimensional transesophageal echocardiography in the diagnosis of infective endocarditis of native and prosthetic valves
Authors: Capotosto L , Tanzilli G , Mangieri E , Ciardi M R , Gaudio C , Miraldi F , Vullo V , Vitarelli A 
Published: January 2020

Abstract

Purpose
The purpose of this study was to examine the incremental value of three-dimensional transesophageal echocardiography (3D-TEE) compared to two-dimensional transesophageal echocardiography (2D-TEE) in the diagnosis of infective endocarditis (IE) of native and prosthetic valves.

Methods
Forty-three patients with clinically suspected IE were studied. The patients had clinical, microbiological and echocardiographic assessment to establish a diagnosis of IE in accordance to current guidelines recommendations. Presence, location and size of vegetations, new or progressive valve regurgitation, possible chordae tendineae rupture, paravalvular extension, and new dehiscence of a valve prosthesis were assessed by echocardiography.

Results
In 25 (58%) patients the diagnosis of IE was established. Thirteen patients had native valves and 12 patients had prosthetic valves (9 mechanical, 3 biological). 2D-TEE and 3D-TEE showed a sensitivity, specificity, positive and negative predictive value for diagnosis of IE of 91% and 89%, 88% and 91%, 84% and 86%, and 93% and 90%, respectively, in native valves, and of 92 and 90% 91% and 97% (p = 0.002), 84% and 82% and 89% and 95% (p = 0.01), respectively, in patients with prosthetic valves. Major vegetation diameter was 18mm for 3D-TEE and 16mm for 2D-TEE in native valves and 19mm for 3D-TEE and 14mm for 2D-TEE in prosthetic valves (p = 0.04). Peri-annular extension was detected by any of the echocardiographic modalities in three patients with native valve IE and two patients with prosthetic valves, and by 3D-TEE only and not by 2D-TEE in one patient with prosthetic valve.

Conclusions
Patients with prosthetic valve infective endocarditis seem to have more additive benefit from 3D-TEE compared to patients with native valve IE.
P208 Abnormal coronary flow reserve assessed with stress echocardiography induces a reduction in transmural strain gradient and an increase in heterogeneous myocardial electrical activation
Authors: Sierra Lara M J D , Rodriguez-Zanella H , Calvillo O , Posada E L , Ortiz X O , Arroyo C , Raymundo G , Ruiz Esparza M E , Fritche J F , Wierzbowska-Drabik K , Gaibazzi N , Picano E , Arias J A 
Published: January 2020

Abstract

OnBehalf
Echo Lab INC

Background
The integrated quadruple stress echo (IQ-SE) is a state-of-the-art protocol that expands the risk stratification potential of SE. The coronary flow reserve (CFVR) has pronostic implication mainly in the absence of wall motion abnormalities. Longitudinal multilayer strain analysis assesses trasmural strain gradient. The prognostic value of multilayer strain analysis alongside the IQ-SE has not been established. We aim to determine the additive value of multilayer strain analysis during IQ-SE.

Methods
Prospective observational study. We evaluated one hundred twenty intermediate-high risk patients without obstructive coronary artery disease (mean age 61 ± 12 years, female 43%) with IQ-SE dipyridamole at our institution. Abnormal CFVR was defined as CFVR &lt;2. Multilayer strain analysis and mechanical dispersion, were performed during rest and stress, with an automatic frame-by-frame with speckle tracking.

Results
The IQ-SE was feasible in all patients. At rest, mean three-dimensional left ventricular ejection fraction (3D LVEF) was 59% (53-62) without wall motion abnormalities. Abnormal CFVR was seen in 38 patients (32%) and reduced left ventricular contractile reserve (LVCR) in 56 patients (46%). Patients with abnormal CFVR, showed a reduction in EndoLS and transmural strain gradient, and an increase in mechanical dispersion and in lung B-lines during stress. No differences were observed in 3D LVEF and LVCR.

Conclusions
Endocardial ischemia due to microvascular dysfunction leads to a reduction in transmural strain gradient. Adding multilayer strain analysis to IQ-SE might detect myocardial subclinical dysfunction, arrhythmic risk and pulmonary congestion due to microvascular dysfunction.
Left ventricular mechanics analysis CVFR &lt;2 (38) CVFR &gt;2 (81) P Rest EpiLS (%) -14.9 ±4.2 -18 ± 3.7 0.001 EndoLS (%) -20.2 ± 5.9 -23.5 ± 4.5 0.001 EndoLS- EpiLS 5.1 (3.8-6.3) 5.4 (4.2-6.3) 0.27 Mechanical Dispersion (ms) 57.7 (42.2-69) 44.2 (35-54) 0.006 Stress EpiLS (%) -17.2 ± 4.8 -20 ± 4.4 0.003 EndoLS (%) -23 ± 6 -26.6 ± 5.7 0.002 EndoLS- EpiLS 5.6 (4.5-6.7) 6.3 (5.4-7.9) 0.01 Mechanical Dispersion (ms) 47 (39.5 - 59) 39 (30-54.6) 0.007 CVFR: coronary flow reserve; EpiLS: Epicardium longitudinal strain; EndoLS: endocardial longitudinal strain; EndoLS- EpiLS: trasmural strain gradient.
Abstract P208 Figure. IQ-SE and Multilayer Strain
P218 Accuracy and reproducibility of aortic root assessment by eSie Valves in patients candidate to transcatheter aortic valve implantation: a comparative study with computed tomography
Authors: Granata G , Veltri A , Iuliano S , Romano V , Stella S , Capogrosso C , Ancona F , Ingallina G , Melillo F , Montorfano M , Agricola E 
Published: January 2020

Abstract

Background
Accurate imaging assessment of the aortic root (AR) is critical for prosthesis sizing in transcatheter aortic valve implantation. Multislice computed tomography (MSCT) is the gold standard for this purpose. 3D transesophageal (3D-TOE) reconstruction tools have recently been introduced, which automatically configures a geometric model of AR from 3D-TOE dataset and perform quantitative analyses of the AR.

Purpose
The aim of the study was to compare semi-automated measurements of AR obtained by eSie Valves (EV) (Siemens Medical Solution, California, USA) tool with MSCT.

Methods
We prospectively enrolled 26 consecutive patients (mean age 79.5 ± 7.5 years; 38% men) with severe symptomatic aortic stenosis (mean gradient 48.8± 13.6 mmHg) who underwent both 3D-TOE and MSCT as part of TAVI evaluation protocol. Volumetric datasets of the AR, acquired with 3D-TOE in mid-esophageal view, were analyzed with EV tool. EV tool automatically detected AR landmarks and, after user validation, created 3D model of AR providing values of area, perimeter, diameters of aortic annulus (AA) and coronary ostia heights (Fig 1).

Results
EV tool analysis on 3D-TOE volumetric data sets was feasible in all patients.
Strong correlation between EV tool and MSCT assessment for AA major diameter (r = 0.79), AA minor diameter (r = 0.81), AA perimeter (r = 0.89) and AA area (r = 0.89) (all p&lt; 0.0001) was found. On average EV tool underestimated MSCT measurements of AA major diameter (1.2 mm, 4.5%), AA minor diameter (2.6 mm, 11.3%), AA perimeter (4 mm, 5.2%) and AA area (65.3 mmq, 13.6%).
Moderate correlation between the two methods, already in this initial sample, for right coronary artery ostium height (r = 0.53, p = 0.007) was discovered. Finally, weak correlation for left coronary artery ostium height (r = 0.33, p = 0.1) was revealed.

EV tool measurements from two different volumetric datasets of the same patient showed an excellent reproducibility
intraclass correlation coefficient (ICC) for AA area 0.94 and ICC for right coronary height 0.98.

Conclusion
With these initial results EV tool could be used in clinical practice for quick and reliable assessment of AA area, perimeter and diameters. A larger group of patients will be needed to assess the consistency of coronary ostia height evaluation by EV tool.
Abstract P218 Figure. eSie Valve landmarks and 3D model of AR