bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1478 Evaluation of reversibility of alcoholic cardiomyopathy using doubaimine stress echocardiography
Authors: Park D G , Seo W W , Kim S E , Lee J H , Han K R , Oh D J 
Published: January 2020

Abstract
Alcoholic cardiomyopathy (CM) is known as a reversible CM. Appropriate medications with cessation of alcohol may lead to full recovery of chamber size and contractility. But there is not much information about morphologic and hemodynamic changes over the course of treatment, and predictors of reversibility. We experienced the patient with alcoholic CM who was admitted with heart failure and recovered over 1 year and 5 months. He consumed daily 180g alcohol for 6 months before admission. On initial echocardiography, left atrial (LA) dimension, left ventricular (LV) systolic dimension (SD) and diastolic dimension (DD), inferior vena cava (IVC) size, and ejection fraction (EF) were 50 mm, 69 mm, 78 mm, 27 mm and 22%, respectively. Doppler examination revealed a restrictive pattern in tansmitral flow, and a systolic peak velocity/diastolic peak velocity (S/D) ratio of less than 1 in pulmonary vein flow (PVF). Pressure gradient through tricuspid regurgitation was 29 mmHg. Coronary angiogram confirmed no significant stenosis. Within 1 week after medications, LVEF increased mainly by decrease of enlarged LVSD which might be partly caused by volume overload, evidenced by respiratory variation of transmitral flow. On 8th day, we performed dobutamine stress echocardiography (DSE) to evaluate reversibility because LVEF slightly decreased despite decrease of LVDD. During dobutamine infusion, both LVDD and LVSD decreased along with increase of LVEF according to dose escalation. From 1 to 2 months, LVEF slightly increased with decrease of LVDD and LVSD. Afterwards, LVEF was normalized mainly with decrease of LVSD, and LVEF was completely normalized at 1 year and 5 month after initiation of treatment. Initial increase of LVEF might reflect decrease of LVSD by relief of volume overload rather than improving LV contractility. Based on this observation of serial change of chambers and LVEF, we speculate that increased LV wall tension, which is induced by increase of preload as a compensating mechanism for increasing stroke volume, might aggravate LVEF in later stage of heart failure with reduced EF. The sequence of normalization in chamber size was IVC, and then LA, and then LVDD. Transmitral flow as an indicator of diastolic dysfunction changed from restrictive (transiently existed only for 1 week) to abnormal relaxation pattern (no change since that time). PVF pattern showed S/D ratio &lt; 1 until 1 week, and then triphasic pattern at 1 month, finally biphasic pattern at 8 month after initiation of medications. We observed a serial change of echocardiographic findings in patient with alcoholic CM, which might provide an insightful information to understand reverse of LV or LA remodeling associated with hemodynamic parameters, and DSE might be helpful to evaluate reversibility of LV systolic function and convince patients who are reluctant to medications.
P1489 Late cardiovascular manifestations of Gregg syndrome: Importance of multimodal imaging approach to optimize diagnosis
Authors: Higuera Leal S A , Perez-Fernandez O M , Bernal A , Gallo-Bernal S , Forero J F , Medina H M 
Published: January 2020

Abstract

Background
Congenital rubella syndrome, also known as Gregg syndrome (after Dr. Norman Gregg’s first description in 1941) is a variable constellation of multisystemic manifestations caused by rubella intrauterine infection. In this case, a patient known to have Gregg syndrome underwent trans-thoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) for optimizing the characterization and determining the status of her disease.
Case report
A 31-year-old female attends routine cardiology outpatient clinic prior initiation of pregnancy due to prior history of Gregg syndrome. Extent of disease includes congenital cataracts, neurosensorial bilateral hearing loss, supra-valvular aortic stenosis (treated percutaneously at age 4 with a subsequent aortic root reconstruction with homograft at age 6) and pulmonary artery stenosis (status-post surgical correction followed by angioplasty at age 9). The patient was asymptomatic with functional class NYHA I and was taking no medication.
A TTE was requested which showed a left ventricle with low-normal systolic function. At the pulmonary valve, she had a residual peak velocity and mean gradient of 2.6 m/sec and 15 mmHg, respectively, with moderate regurgitation; the right ventricle was dilated with mild systolic dysfunction. Doppler evaluation of the ascending aorta revealed a peak velocity of 3,5 m/sec and a mean gradient of 30 mmHg (Figure 1a). Anatomical evaluation was limited because of the acoustic window but due to the cited hemo-dynamics, a CMR was requested for further characterization of her disease prior to pregnancy.
CMR showed a normal sized left ventricle with an ejection fraction of 62%, without late gadolinium enhancement. The right pulmonary artery lumen was diminished, probably corresponding to an artifact due to previous stent angioplasty. In the ascending aorta there was residual supra-valvular aortic stenosis 9 mm from the sino-tubular junction with an adjacent, non-mobile, 33 x 39 x 20 mm mass, anterior to the aorta and immediately posterior to the sternum, consistent with aortic pseudoaneurysm (Figure 1b). Due to this finding pregnancy was discouraged, and she was referred to the Cardiovascular Surgery for aortic pseudoaneurysm correction.

Conclusion
Although infrequent because of successful worldwide vaccination policies, sporadic cases of Gregg syndrome can still be seen, especially in neglected populations with poor access to health services or in unvaccinated patients. Long-term follow-up of all patients undergoing repair procedures is warranted for evaluation of late occurring complications. This case underscores the importance of multimodality imaging for a complete anatomical and functional diagnosis of complex cardiovascular conditions.
Abstract P1489 Figure 1
P1491 Aneurysm of the membranous septum after spontaneous closure of ventricular septal defect combined with bicuspid aortic valve
Authors: Drakopoulou M , Nyktari E , Soulaidopoulos S , Oikonomou G , Toutouzas K , Tousoulis D 
Published: January 2020

Abstract
An 18-year-old asymptomatic patient with a cardiac background of ventricular septal defect (VSD) and bicuspid aortic valve diagnosed in early childhood, was referred to our Adult Congenital Heart Disease (ACHD) outpatient clinic for routine assessment. Imaging by transthoracic echocardiography and Cardiac Magnetic Resonance (CMR) showed a well-developed multilobulated appendiform saccular formation (34x20mm) arising from the right ventricular side of the membranous septum inferior to the anterior aortic cusp and just beneath the septal leaflet of the tricuspid valve, protruding into the right ventricular outflow tract and the body of right ventricle. The fibrous quality and the absence of myocardium in this structure led to the formation of an aneurysm of the membranous septum (AMS) with the characteristic outpouching or ‘windsock’ appearance from its distention during ventricular systole (Figure). There was no shunt between the ventricles. The aortic valve was true bicuspid with severe aortic regurgitation and an eccentric jet towards the anterior leaflet of the mitral valve. The left ventricle was dilated with preserved systolic function. On the basis of the above information the Heart Team decided for surgical management.Both the presence of a true bicuspid valve (embryologically linked to VSD) as well as the pre-existing left-to-right shunting (until the spontaneous VSD closure) seem to have contributed to aortic valve dysfunction in this case. An interesting physical phenomenon concerning fluid dynamics, known as the ‘Venturi effect’, occurs in patients with ‘aneurysmal transformation’ of the ventricular septum, where the VSD becomes smaller creating thus a low-pressure zone that affects the adjacent aortic valve cusp, causing prolapse and, hence, aortic valve regurgitation.
Non-invasive imaging evaluation of patients with AMS is required for optimal diagnosis and treatment as well as for follow-up examinations. Echocardiography is an effective tool for diagnosing AMS, mainly as an incidental finding in asymptomatic subjects whereas CMR is capable of three-dimensional anatomical assessment and provides functional data about the blood flow into the aneurysm and integrity of the ventricular membranous septum.
Abstract P1491 Figure
P1493 Univentricular heart diagnosed by echocardiography in a patient with good functional capacity
Authors: Pourkia R , Ansari-Ramandi M M , Ziaie N , Pourkia M 
Published: January 2020

Abstract
A 32 years old male without a history of cardiac disease or surgery was referred to our hospital due to abnormal findings on electrocardiography (ECG). He was a healthy active young man applying for private health insurance and did not have any symptoms. On physical examination he had normal vital signs and a systolic ejection murmur was present in the pulmonic area. His Oxygen saturation was 93% and had a functional capacity of 11 METs. On electrocardiography which is shown in part A and B of the figure, he had right axis deviation and poor R progression. On chest x-ray (part C of the figure) he had top normal cardiothoracic ratio and prominent main pulmonary artery (PA). On laboratory data he had normal complete blood count and normal electrolytes. Because of the murmur found in physical examination and the right axis deviation in ECG, transthoracic echocardiography was done for the patient which revealed single ventricle with left ventricle morphology and mild systolic dysfunction (part D of the figure). Abdominal and atrial situs were solitus. There was normal inferior vena cava continuity into the right atrium. Transesophageal echocardiography was also done for the patient which revealed thickening of the pulmonary valve and presence of a subvalvular web which resulted in severe subvalvular PS (part E and F of the figure). There were dilated main PA and its branches. The left sided atrioventricular valve had mild regurgitation while the right sided one had mild to moderate regurgitation. There was dilated coronary sinus due to persistent left superior vena cava. The case describes the role of echocardiography in diagnosing rare congenital heart disease in a patient without symptoms of cardiac disease.
Abstract P1493 Figure
P1498 Right atrial thrombus in a young septic patient with lymphoma
Authors: Habjan S , Erzen B , Miklic M , Skarlovnik A 
Published: January 2020

Abstract

Background
Catheter-related right atrial thrombosis is a rare, but potentially life threatening complication in patients with central venous catheters (CVCs). Echocardiography is an indispensable tool in the diagnosis of right atrial thrombosis. We present a case of a young man with lymphoma, Staphylococcus aureus sepsis and a peripherally inserted central catheter (PICC) who had a septic thrombus in the right atrium.
Case summary
A 23-year-old male patient with recently diagnosed Hodgkin’s lymphoma had an inserted PICC for the purpose of chemotherapy application. Three days after the first chemotherapy application a thrombosis of the cephalic and subclavian veins at the site of PICC was found. The PICC was removed and the patient was treated with therapeutic doses of dalteparin. A day after the discovery of thrombosis, the patient became clinically septic, with high inflammatory markers and Staphylococcus aureus was isolated from his blood cultures. He was promptly treated with flucloxacillin. Due to pain in his left knee, a knee puncture was performed, and Staphylococcus aureus was isolated also from the knee synovial fluid. A transthoracic echocardiography revealed a 2.8 x 2.8 cm sessile thrombus on the lateral wall of the right atrium. There were no vegetations on the tricuspid or other valves. Due to increasing pain in his left knee and an increase in inflammatory markers a synovectomy was performed. After the operation the clinical status improved and the inflammatory parameters decreased. A magnetic resonance imaging of the heart was performed, which confirmed the thrombus described by echocardiography and excluded the presence of abscesses.
All the time the patient was treated in the intensive care unit with standard heparin, flucloxacillin, and piperacillin/tazobactam due to neutropenia. The inflammatory markers slowly decreased and all further blood cultures were negative. Follow-up echocardiography after 16 days of antibiotic and anticoagulant therapy revealed that the mass in the right atrium, attached on the lateral atrium wall, was slightly smaller than before. The mass was centrally un-echogenic with echogenic cover, appearing as a partial regression of the septic thrombus with a central colliquation. The heart valves remained free of vegetations. There was a minor pericardial effusion, with no signs of constriction. Due to improved clinical status the patient was able to start with chemotherapy again after a pause of three weeks.

Conclusion
The patient had three important risk factors for thrombosis: PICC, sepsis and malignancy.
Echocardiography is an important tool for mass diagnosis and the exclusion of vegetations in a septic patient. Often there is a need for further specification of the mass etiology or for the exclusion of other pathology, like abscesses in our case. Magnetic resonance is an important tool that can complement the echocardiographic examination.
Abstract P1498 Figure. Right atrial thrombus
P1504 Inter-vendor comparison of left atrial 2-dimensional strain using multilayer analysis
Authors: Ferkh A , Stefani L , Trivedi S , Brown P , Pathan F , Thomas L 
Published: January 2020

Abstract

BACKGROUND
Left atrial strain (LAS) is increasingly being accepted as a marker of left atrial function. Different vendors utilise different techniques of measuring LAS in echocardiography.

AIMS
To determine the difference between multilayer endocardial and mid-myocardial measurements of LA strain on General Electric (GE) Echopac compared to the TOMTEC system which tracks endocardial strain.

METHODS
Peak reservoir left atrial strain (LAS) was measured on 50 healthy controls using the two different echocardiographic software packages. GE Echopac (v201) 2D-speckle tracking echocardiography technique (LV package) was used to measuremid-myocardial (GE-mid) and endocardial (GE-endo) LAS. This was compared to LAS measurement using TOMTEC (v4.6) which uses an endocardial tracking technique. LAS was measured in 4ch and 2ch views and average biplane strain measurement was obtained.

RESULTS
The mean of GE-mid LAS was 36.3 ± 6.3%, GE-endo LAS was higher with a mean of 44.1 ± 8.0%, while TOMTEC LAS was 42.1 ± 6.3 %. GE-mid and GE-endo LAS correlated well with TOMTEC LAS (r = 0.9, p &lt; 0.001 for both). On Bland-Altman Analysis, GE-mid LAS measurements were systematically lower than TOMTEC LAS (mean difference -5.77), whereas GE-endo LAS had no systematic bias (mean difference 1.99).

CONCLUSIONS
Mid-myocardial peak reservoir left atrial strain, which is routinely measured using GE Echopac software, systematically underestimates LAS as compared to TOMTEC LAS or GE endocardial LAS. This suggests that serial follow up of LAS measurements for patients should be performed on the same software.
P1506 The correlation between left atrial volume index and cerebrovascular stroke
Authors: Almaghraby A , Abdelnabi M , Kemaloglu Oz T , Saleh Y , Shehata H , Shehata M , Badran H , Elgowelly M 
Published: January 2020

Abstract

OnBehalf
YIG-CVR

Introduction
Increased left atrial (LA) size was associated with poor cardiovascular outcomes such as the development of heart failure, atrial fibrillation (AF), and stroke in the elderly.

Aim of the work
To determine the relation between left atrial volume index (LAVI) and the occurrence of ischemic cerebrovascular stroke (CVS) in patients with sinus rhythm.

Patients and Methods
A prospective analysis of the data of patients admitted to a tertiary care center. Left atrial volume index (LAVI) was measured in 1222 patients admitted to our center with first attack of acute ischemic cerebrovascular stroke (CVS) and the data was matched with 1222 patients admitted by diagnoses other than acute ischemic stroke.
Patients with valvular heart diseases, history of AF and with known cardio-embolic source of stroke as left ventricular thrombi or masses were excluded from both groups.

Results
The mean age was 61.1 ± 14.4 years in the CVS group and 61.5 ± 12.4 years in the control group, males were 806 (71.43%) in the CVS group and 852 (73.47%) in the control group. LAVI was 35 ± 10.3 ml/m2 in the CVS group while it was only 25.8 ± 6.4 ml/m2 in the control group which was statistically significant (P value= 0.002).

Conclusion
LAVI is a strong parameter that can be used to predict the occurrence of CVS in patients with sinus rhythm.
Total (n = 2444) Acute CVS (n = 1222) No CVS (n = 1222) P-value Age (years) 61.1 ± 14.4 61.5 ± 12.4 0.75 Sex (Males) 806 (66%) 852 (70%) 0.65 Diabetes 655 (53.6%) 603 (49.3%) 0.6 Hypertension 702 (57.5%) 675 (55.2%) 0.55 Smoking 599 (49%) 564 (46.2%) 0.71 Dyslipidemia 310 (25.4%) 299 (24.5%) 0.81 Mean BP (mmHg) 122 ± 15 119 ± 17 0.88 Heart rate (bpm) 82 ± 16 85 ± 18 0.76 Hemoglobin (g/dl) 12.3 ± 1.3 12.9 ± 1.7 0.61 Platelets (103/l) 255 ± 110 235 ± 95 0.35 INR 1.15 ± 0.11 1.09 ± 0.18 0.75 Ejection fraction (%) 55 ± 12 51 ± 11 0.41 LAVI (ml/m2) 35 ± 10.3 25.8 ± 6.4 0.002* Results are represented as number (%) or mean ± standard deviation, BP = Blood Pressure, INR = International Normalization Ratio, * significant P value &lt; 0.05
Abstract P1506 Figure. Comparison between both groups
P1511 Comparison between echocardiographic right ventricular-pulmonary arterial coupling and right ventricular longitudinal strain to identify pulmonary hypertension in heart failure
Authors: Seidova N , Manouras A , Lund L H , Venkateshvaran A 
Published: January 2020

Abstract

Background
Both the ratio between tricuspid annular plane systolic excursion (TAPSE) and doppler estimated systolic pulmonary artery pressure (SPAP) and right ventricular longitudinal strain (RVSL) have been proposed as sensitive measures of RV contractile function and demonstrate important prognostic implications in heart failure (HF). However, a comparison between measurements to discern pulmonary hypertension (PH) in heart failure has not been adequately explored.

Methods
Consecutive subjects undergoing right heart catheterization (RHC) and simultaneous echocardiography to evaluate HF were enrolled. Subjects with atrial fibrillation, recent acute coronary syndrome and poor diagnostic images were excluded. RV-PA coupling was assessed based on the ratio between invasively derived RV elastance and arterial elastance (Ees/Ea) and correlated with TAPSE/RVSP and speckle-tracking derived RVSL. ROC analysis was performed to identify PH, defined as invasive PA mean pressure ≥25mmHg.

Results
99 subjects were analysed (age: 59 ± 14; 49% female). Both TAPSE/RVSP (r = 0.47; p &lt; 0.001) and RVSL (r = 0.48; p &lt; 0.001) demonstrated significant associations with invasive Ees/Ea. TAPSE/RVSP was significantly lower in PH when compared with non-PH subjects (0.42 ± 0.27 vs 0.65 ± 0.34mm/mmHg; p &lt; 0.001) and demonstrated strong differentiating ability (AUC = 0.80) for PH. RVSL, however, did not significantly differ between groups (p &gt; 0.05).

Conclusions
Both TAPSE/RVSP and RVSL demonstrate significant association with invasive measures of RV-PA coupling. The stronger ability of TAPSE/RVSP to distinguish PH as compared with RVSL may be attributed to the lower load-dependency of this measure.
P1512 Combination of mitral annular peak systolic and early diastolic velocities with early transmitral peak flow velocity: a new prognostic echo index in patients with acute coronary syndrome
Authors: Nakamura K , Yamada A , Kato M , Jinno S , Takahashi A , Sugimoto K , Sugimoto K , Ishikawa T , Ozaki Y , Ishii J 
Published: January 2020

Abstract

Background
One of the novel echocardiographic indices reflecting left ventricular (LV) diastolic filling is the combination of mitral annular peak systolic (s’) and early diastolic velocities (e’) with early transmitral peak flow velocity (E); E/(e’ x s’). This index is reported to be useful to predict a prognosis of heart failure patients regardless of their LV ejection fraction (LVEF).Purpose: The aim of this study was to examine whether or not E/(e’ x s’) could predict cardiac events in patients with acute coronary syndrome (ACS).Methods: We studies consecutive ACS patients hospitalized in our institution between December 2009 and February 2012. They underwent echo examination within 7 days after admission. By use of Doppler tissue imaging, e’ and s’ were respectively calculated by averaging the peak velocities measured at both septal and lateral mitral annulus in 4-chamber view. The exclusion criteria were as follows: atrial fibrillation, significant valvular diseases and inadequate echo images. Cardiac events were defined as re-hospitalization due to recurrent ACS and/or heart failure, and cardiac mortality.Results: In total, 168 patients were eligible for this study (mean age 67 ± 11 years, mean LVEF 51.7 ± 10.3 %). Median follow-up period was 22.5 months. During the follow-up, cardiac events occurred in 27 patients (16.1%). Between the patients with cardiac events and those without, there were significant differences in LV end-systolic volume (44.2 ± 29.1 vs 33.2 ± 13.6 ml, p &lt; 0.05), LV mass index (122.4 ± 38.9 vs 107.5 ± 26.4 g/m², p &lt; 0.05), left atrial volume index (31.7 ± 9.2 vs 27.6 ± 9.4 ml/m², p &lt; 0.05), LVEF (45.7 ± 13.5 vs 52.9 ± 9.2 %, p &lt; 0.05), s’ (5.1 ± 1.6 vs 7.1 ± 1.7 cm/sec, p &lt; 0.001), e’ (4.8 ± 1.3 vs 6.0 ± 1.9 cm/sec, p &lt; 0.05), E/e’ (16.4 ± 6.6 vs 12.5 ± 4.9, p &lt; 0.05), E/(e’ x s’) (3.78 ± 2.52 vs 1.94 ± 1.08, p &lt; 0.001), and serum B-type natriuretic peptide (334.7 ± 420.1 vs 113.8 ± 177.2 pg/ml, p &lt; 0.05). While Cox proportional hazard multivariate analysis detected that E/(e’ x s’) and E/e’ were independent predictors of cardiac events, E/(e’ x s’) was more powerful than E/e’ (p = 0.0002 vs p = 0.0072). ROC analysis revealed that 2.35 of E/(e’ x s’) was the optimal cutoff values to predict cardiac events in ACS patients (AUC 0.79). Patients with E/(e’ x s’) &lt;2.35 had significantly better prognosis than the rest (p &lt; 0.0001, Log-rank; Figure)Conclusion: E/(e’ x s’) could be a useful echo marker to predict cardiac events in ACS patients.
Abstract P1512 Figure.