bluuebunny/crossref_metadata_2025_split huggingface dataset:
1231 Left atrial septal and lateral wall strains contain different pressure information: Utility in pulmonary hypertension
Authors: Khan F H , Inoue K , Andersen O S , Gude E , Skulstad H , Smiseth O A , Remme E W 
Published: January 2020

Abstract

Funding Acknowledgements
South-Eastern Norway Regional Health Authority

Background
Reduced left atrial (LA) reservoir strain is a marker of elevated LA pressure. Thus it could be a potential non-invasive marker to differentiate pre- and post-capillary pulmonary hypertension (PH) as the latter is defined by elevated pulmonary capillary wedge pressure (PCWP) &gt; 15 mmHg. However, in pre-capillary PH patients with elevated right atrial pressure (RAP), the atrial septal geometry may be abnormal. This could lead to lower regional LA septal strain, making LA lateral wall strain more accurately reflect PCWP.

Purpose
We investigated if LA lateral wall strain can differentiate between pre- and post-capillary PH, and how LA lateral wall strain and LA septal strain are both affected by elevated RAP in pre-capillary PH. Furthermore we investigated if LA septal strain can be used in pre-capillary PH patients to identify those with elevated RAP.

Methods
We analysed 63 patients with PH, 28 pre-capillary and 35 post-capillary, who underwent right heart catheterisation. Echocardiography was performed simultaneously with or within 24 hours of the invasive pressure measurements. Regional LA septal strain and lateral wall strain were measured from the apical four chamber view.

Results
Pulmonary artery pressure was 39.5 ± 11.1 mmHg (mean ± SD) in the pre-capillary PH patients and 37.0 ± 10.1 mmHg in the post-capillary PH patients (p = ns). Mean PCWP was 9.9 ± 2.5 mmHg and 24.5 ± 6.0 mmHg (p &lt; 0.001), respectively.
LA lateral wall strain was significantly lower in patients with post-capillary PH compared to pre-capillary PH (11.9 ± 7.7% vs 26.6 ± 9.9%, p &lt; 0.001) (Fig. a,b). At a cut-off value of 18.0%, LA lateral wall strain could predict elevated PCWP &gt; 15 mmHg with AUC = 0.88, sensitivity = 85.7% and specificity = 76.3%.
In the 28 patients with pre-capillary PH, we classified mean RAP ≥ 10 mmHg as elevated and &lt; 10 mmHg as normal. Seven of these patients had elevated RAP and showed significantly reduced LA septal strain compared to the 21 patients with normal RAP (13.0 ± 6.2% vs 22.1 ± 7.6%, p &lt; 0.01). LA lateral wall strain showed no difference in these groups of pre-capillary PH patients (25.8 ± 10.1% vs 28.9 ± 9.4%) (Fig. c).

Conclusions
LA lateral wall strain can be used for differentiating between pre- and post-capillary PH. In addition, LA septal strain may be used in pre-capillary PH patients to identify those with elevated RAP.
Abstract 1231 Figure
P1243 Nonbacterial thrombotic endocarditis (NBTE) of the aortic valve: incidental finding in hospitalized patients with advanced heart failure
Authors: Marin G G , Margineanu C , Penes D , Maresiu C , Boiangiu S , Stoica E , Radu R , Antohi E L , Chioncel O 
Published: January 2020

Abstract

Background
The presence of small mobile masses on the ventricular side of the aortic valves in the absence of valvular regurgitation and signs of systemic inflammation has been previously described as marantic endocarditis and is now referred to as nonbacterial thrombotic endocarditis (NBTE). It is thought to be associated with endothelial dysfunction and procoagulative status, as is the case of acute decompensated heart failure (HF).

Case description
We present a series of three male patients, with similar clinical characteristics, who were admitted for acute decompensated HF. All three patients had chronic HF, due to non-ischemic dilated cardiomyopathy with severe biventricular dysfunction, with resynchronization therapy, with elevated natriuretic peptides and previous HF hospitalizations in the past year requiring prolonged intravenous treatments. Other clinical, biological criteria for the definition of advanced HF were also met. All patients were under chronic anticoagulation treatment using a direct oral anticoagulant because of persistent atrial fibrillation. Thorough echocardiographic evaluation (both transthoracic and transoesophageal ultrasound) identified small mobile masses on the ventricular side of the aortic valves, centrally, on the line of cusp coaptation, with only minor central regurgitation. The lack of progression of valve lesion and the absence of gross signs of inflammation (no fever, normal hemoleucogram, normal CRP, repeated negative blood cultures) on serial examinations during several weeks follow-up allowed for the exclusion of infective endocarditis. In one case we also identified a left atrial appendage thrombus and presumably thrombotic masses attached to right side pacing leads. No clinically systemic embolic events were identified.

Conclusion
We consider this to be an incidental finding in the given subclinical prothrombotic and inflammatory predisposing milieu of advanced chronic HF and the increasing high quality echocardiography imaging. Its clinical significance is still unknown, while differential diagnosis from subacute or chronic endocarditis relies largely on clinical judgment.
P1249 Straight from the heart
Authors: Azul Freitas A , Ferreira J , Goncalves V , Ferreira C , Milner J , Bento L , Martinho S , Alves P , Marinho V , Jorge E , Goncalves L 
Published: January 2020

Abstract

Introduction
Infective endocarditis (IE) remains a diagnostic and therapeutic challenge and is still associated with high mortality. Systemic complications are frequently present, and an adequate assessment and management are needed.

Purpose
Our aim is to show the importance of an early recognition of IE complications.

Clinical case
We present a case of 54 years old women with a past medical history unremarkable. The patient presented to the hospital with high fever and was admitted with a diagnosis of a psoas abscess and staphilococus aureus bacteremia. After one week of antibiotic treatment the patient was transferred to an intensive care unit due to septic shock and respiratory failure. The patient needed to be intubated and ventilated and was on treatment with vancomycin and meropenem. During admission, several infectious loci were identified, including cerebral and pulmonar involvement. An echocardiography identified mild mitral regurgitation, moderate tricuspid regurgitation and confirmed the presence of two vegetations, one in tricuspid valve with 30mm and one in mitral valve with 5mm. Nevertheless, the patient improved clinically. After 15 days of treatment, the patient was extubated and was transferred to the cardiology ward for follow-up. Although clinically stable and without any complain, repeated echocardiographic evaluation identified left ventricular apical aneurysm and partial resolution of vegetations. A coronariography was performed and did not identified any coronary lesion. A magnetic resonance confirmed the ischemic aetiology of the lesions and a diagnosis of embolic myocardial infarction was made. Considering a good resolution of infection, and being the patient stable and asymptomatic, she was discharged after 6 weeks of antibiotic therapy for follow up in cardiology and neurosurgery consultations.

Discussion and conclusion
Despite appropriate antimicrobial treatment, embolic complications are common and usually develop during initial stage of IE. This case shows several embolic complications of IE, including embolic myocardial infarction and cerebral embolism. Although aggressive antibiotic administration was successful in this particular case and cardiac surgery was avoided, the identification of complications allowed a more strict follow up and was determinant for a good clinical result.
Abstract P1249 Figure.
P1251 Percutaneous closure of two mitral perivalvular leaks: when the imaging guides the hands during threatening complications
Authors: Cocco D , Melillo F , Pannone L , Ruggio A , Stella S , Ingallina G , Capogrosso C , Ancona F , Montorfano M , Agricola E 
Published: January 2020

Abstract
With the contemporary development of structural interventional cardiology the prevalence of perivalvular leaks (PVL) is expected to grow. Advanced multimodality imaging is necessary for the guidance of transcatheter closure of PVL. We describe the case of a 57 year-old woman who underwent transcatheter mitral PVL closure. Past clinical history included a lymphoma treated with chemio and radiotherapy. Six months before she underwent a surgical replacement of the aortic and mitral valves with two mechanical prosthesis for severe aortic and mitral stenosis. Because of the calcium burden in both the annuluses, undersized mitral valve prosthesis was implanted leading to the presence of two moderate mitral PVL. The patient subsequently required hospitalization for acute HF and hemolytic anemia and received multiple blood transfusions. TEE confirmed the presence of a large antero-lateral PVL and a small medial PVL (3D VCA 0,32 cm2 and 0,2 cm2 respectively, associated with reverse flow in the pulmonary veins) with an extension of 33% of the circumference of the prosthesis. The regurgitation was considered severe and a percutaneous closure was planned with 3D-TEE and fluoroscopy image fusion guidance. Under general anesthesia a transeptal puncture was performed and the medial leak was closed with two vascular plugs (6mm each). During the deployment of the plugs an intermittent blockage of the medial disk of the prosthesis was noticed, which resolved completely after the removal of the wires previously positioned for the engagement of the leak. The lateral leak was then engaged and a second plug (10mm) was advanced causing a discontinuous interference with the two disks. The direct interference with the lateral disk caused a blockage in the closing position (leading to moderate stenosis, medium gradient 7mmHg) and in the opening position (leading to a massive regurgitation). The medial disk was intermittently blocked in the closing position due to the bulky effect of the devices provoking a traction and displacement of the prosthesis towards the medial region of the valve. To avoid this interference the plug was released with a marked atrial protrusion. Notably, after the removal of the wires no malfunctioning of the disks was noticed and the mild residual shunts appeared further decreased. The procedure was considered successful and at follow-up no residual leak was found. The percutaneous closure of PVL is a safe and effective intervention. Multimodality imaging is essential for the diagnosis, planning and procedural guidance. The knowledge of possible complications is warranted for the achievement of an optimal result. This case clearly show the possibility of interference with the prosthesis and overestimation of residual leaks.
Abstract P1251 Figure. PVL closure:procedure and complications
P1259 When it rains, it pours: Late presentation STEMI in a patient with intricate symptomatology due to concomitant acute pancreatitis and pneumonia
Authors: Nicolae E , Aflorii R , Popescu A C 
Published: January 2020

Abstract

Background
ST segment elevation acute myocardial infarction and acute pancreatitis are diagnostic and therapeutic emergencies. The concomitance of these two pathologies produces intricate and confusing symptoms leading to late presentation.
Clinical Case Description- We present the case of a 62-year-old male patient, non-smoker, admitted in the emergency department for intense, continuous epigastric pain with posterior radiation and dyspnea, started four days before. On admission we found hemodynamic stability, lung crackles in the ½ inferior of the right lung, SaO2= 94% under 3l/min O2, normal cardiac sounds, HR 102/min, mitral systolic murmur, BP 145/80mmHg, abdominal pain on palpation. Lab tests revealed elevated cardiac troponin values and detection of a fall of cTn values in dynamics (hs-cTnI 30372ng/l, TnI 73ng/ml), but also high serum transaminases, amylase and lipase (1278 U/l), with high inflammatory markers, leukocytosis and neutrophilia.
ECG showed sinus rhythm, QRS axis 0 degrees, ST segment elevation in V1-V4, ST segment depression DI, aVL, negative and biphasic T waves in V5-V6, DI, DII, aVL, Q wave in DIII, aVF and poor R wave progression V1-V4.
Admission echocardiography revealed dilated left cavities with severe left ventricular systolic dysfunction (EF 20%), akinesia of the anterior and inferolateral walls, moderate mitral and tricuspid regurgitation, grade III diastolic dysfunction and possible pulmonary arterial hypertension. Coronary angiography revealed distal stenosis of the left main, involving the bifurcation, 80% ostial LAD stenosis, proximal LAD occlusion, 30% ostial LCX. PCI with DES of the proximal LAD, and left main–LDA junction with overlapping was performed successfully.
Abdominal echography showed increased volume of the pancreas and significant decrease in echogenicity. Abdominal CT scan assessed inflammatory changes in pancreas and peripancreatic fat (grade C Balthazar score), superior mesenteric artery partial thrombosis and alveolar consolidation in the right lung. Echocardiography reassessment four days later revealed a fresh apical thrombus of the left ventricle.
He received treatment with low molecular weight heparin, dual antiplatelet therapy statin, loop diuretic, aldosterone antagonist, digoxin, antibiotics and food restriction with gradual oral realimentation. He needed positive inotropic support for the first 4 days from a total of 28 days of hospitalization.

Conclusions
ECG changes and prothrombotic status can occur in patients with acute pancreatitis. The diagnosis and management of STEMI concomitant with acute pancreatitis can be challenging. The multimodality imaging and interdisciplinary approach individualized to the patient’s clinical situation is important, especially when having safety concerns about the revascularization therapy, antiplatelet and anticoagulant therapy.
Abstract P1259 Figure.
P1260 Chagas disease, a new challenge to the old continent
Authors: Dias Ferreira Reis J P , Mano T , Rio P , Galrinho A , Valente B , Silva Cunha P , Oliveira M , Moura Branco L , Ferreira R 
Published: January 2020

Abstract

Case Report
A 53-year-old female patient from the North Region of Brazil with a past medical history of Chagas Disease (CD) with esophageal involvement and permanent atrial fibrillation (AF) presented to the Emergency Department (ED) due to complaints of retrosternal discomfort and dizziness. The patient reported multiple recent syncopal episodes and had performed a recent 24-hour Holter monitoring revealing AF with predominantly slow ventricular rate and frequent ventricular premature beats. Her sister had recently been diagnosed with obstructive hypertrophic cardiomyopathy. During the ED stay, the patient developed a syncopal monomorphic ventricular tachycardia, requiring synchronized electrical cardioversion. Post cardioversion EKG revealed a sinus rhythm with a right bundle branch block, left anterior fascicular block and 1st degree AV block. The patient was admitted in the Cardiology Department for further investigation. Transthoracic echocardiogram revealed a dilated left ventricle with a reduced systolic function (LVEF of 38%, GLS of -7.1%), with an aneurysm of the basal inferior and posterior walls and a markedly dilated left atrium (68mL/m2). Cardiac magnetic resonance imaging showed a marked dilation of both atriums and ventricles, with biventricular systolic dysfunction, hypertrabeculation of the left ventricular wall and the presence of diffuse intramural and subepicardic fibrosis. These features were compatible with chagasic cardiomyopathy. Due to biventricular systolic dysfunction, the documentation of AV conduction disturbance, the natural history of the disease and the need for antiarrhythmic therapy, the patient underwent cardiac resynchronization therapy–defibrillator implantation. 1 week after the procedure, the patient experienced an arrhythmic storm with a total of 6 CRT-D shocks. Amiodarone was initiated and beta-blocker was titulated to the maximum tolerated dose, with no recurrence of ventricular tachycardia. On the 3 month follow-up visit the patient denied symptoms of congestive heart failure. Device interrogation revealed a high percentage of biventricular pacing and no arrhythmic events.

Conclusion
This case describes the most remarkable and characteristic features of chagasic cardiomyopathy. It is almost always progressive and is associated with a worse outcome comparing with other cardiomyopathies. The prevalence of CD is growing in traditionally nonendemic areas and its timely recognition is fundamental.
P1272 Echocardiographic evaluation of left ventricular filling pressure in patients with heart failure with preserved ejection fraction : usefulness of inferior vena cava measurement
Authors: Motiejunaite J , Jourdain P , Gellen B , Bailly M T , Bouchachi A A , Humbert M , Rouquette A , Damy T , Chemla D , Assayag P , Berthelot E 
Published: January 2020

Abstract

Context
Echocardiography is an essential tool for evaluation of left ventricular filling pressure (LVFP). We aimed to assess the usefulness of inferior vena cava (IVC) measurement and the 2016 ESC recommendations in patients with suspected heart failure with preserved ejection fraction (HFpEF).

Methods
Invasive hemodynamics and echocardiographic measurements were documented in 132 consecutive patients referred to our centre with dyspnea, left ventricular ejection fraction (LVEF) ≥50%, and suspected pulmonary hypertension on a previous echocardiogram. Echocardiographic measurements of mitral flow (E and A wave velocities), the E/e’ratio, indexed left atrial volume (LAV), tricuspid regurgitation velocity (TRV) and the IVC size and collapsibility were obtained. Increased LVFP was defined by an invasive pulmonary artery wedge pressure (PAWP) &gt; 15 mmHg.

Results
In sinus rhythm patients, the sum of the criteria (E/e’ ratio &gt; 14, TRV &gt; 2.8 m/s and indexed LAV &gt; 34 ml/m²) ≥ 2 had a positive predictive value (PPV) of 63% for PAWP &gt; 15 mmHg, whereas a dilated (&gt; 2.1 cm) and/or non collapsible (≤ 50%) IVC had a PPV of 83%. In atrial fibrillation (AF), a dilated and/or non collapsible IVC had an 86% PPV for increased LVFP. We found that 16% of patients with elevated LVFP were more accurately classified using IVC evaluation than using the current guidelines criteria (net reclassification improvement = 0.25, p &lt;0.05).

Conclusion
Echographic measurements of the IVC size and collapsibility outperformed the classic 2016 recommendations algorithm to evaluate LVFP in sinus rhythm patients with suspected HFpEF. The IVC study was also valuable in patients with atrial fibrillation.
P1273 Effects of surgical septal myectomy on left ventricular function in patients with hypertrophic obstructive cardiomyopathy
Authors: Furugen A , Doi H D , Hashimoto M H , Koshima R K , Mitsube K M 
Published: January 2020

Abstract

Introduction and Purpose
Surgical left ventricular (LV) septal myectomy in patients with obstructive hypertrophic cardiomyopathyhas been shown to reduce left ventricular outflow tract (LVOT) gradient and improve symptoms. We investigated changes in strain analysis, LA volume and LV systolic and diastolic function in patients with HOCM after surgical septal myectomy.

Methods
We enrolled consecutive 30 patients (age 63.7 ± 11.0 years, 47% Female), who underwent surgical LV septal myectomy for HOCM from 2012 to 2019.
We evaluated LV dimension, LVOTG, LV-stroke volume, LV in flow pattern (E wave, A wave, Dct), e’(septal and lateral), LA volume, mitral regurgitation (MR), systolic anterior motion of mitral valve (SAM) and Global longitudinal strain. These parameters were evaluated at baseline and after LV myectomy at medium term (at least 6 months after surgery).

Results
They are followed for a mean of 3.4± 1.9 years after surgery. Eight patients underwent concomitant procedure; mitral valve repair and annuloplasty in 3 patients (10%), Maze surgery in 1 patient, LV aneurysmectomy in 2 patients and aortic valve replacement in 3 patients (10%). Patients with concomitant procedure were excluded from LV function analysis. Postoperative LVOTG were controlled in 10mmHg or less.Global longitudinal strain (GLS) improved but no significant change. Otherwise LA volume index decreased (from 52.5 ± 16.7 to 32.9 ± 14.6 ml/m2, p = 0.01) and LV diastolic function improved with an increase in lateral e" velocity (from 4.5 ± 2.8 to 9.2 ± 3.4 cm/sec, p = 0.001) and improved E/e’ (from 18.9 ± 5.6 to 10.6 ± 5.2, p &lt;0.05). Symptoms of dyspnea, chest oppression and heart failure improved with reduction in the New York Heart Association functional class.

Conclusion
Excellent relief of LVOT obstruction in HOCM by surgical LV septal myectomy results in decreased LA volume and LV diastolic function with improved symptoms.
P1280 Vascular and left ventricular mechanics after surgical correction of aortic coarctation of children
Authors: Matanovskaia T , Sinelnikov U S , Orekhova E N 
Published: January 2020

Abstract

Background
The main cause of the suboptimal long-term outcome after surgical correction of aortic coarctation(CoA) is late correction, residual CoA or reCoA. Cardiovascular remodeling after correction CoA in neonatal period without residual CoA is not well established.

Purpose
Evaluation of global longitudinal strain of the left ventricle (LV) and circumferential mechanics common carotid artery in children 5 years after surgical correction of the CoA in the neonatal period.

Methods
We examined 58 children aged 5,2 ± 0,39 years after successful repair CoA in neonate period. We excluded children with residual CoA or reCoA. Echo was performed with using vector velocity imaging. We studied LV longitudinal strain (LS) and strain rate (LSR). In the left common carotid artery we estimated: carotid strain (CC S) and strain rate (CC SR), fraction area change (FAC CC), carotid β2-stiffness index (CC β2), and intima-media thickness (IMT). The obtained data were compared with the results of 25 healthy children.

Results
LS LV and SR LV are worse of children after CoA correction compare with healthy, even LV ejection fraction is similar to healthy children. We found correlation LV mass index (LV MI) with CC S and CC SR. CC β2 of children after Co A repair was higher than of control group. CC β2 correlated with LS LV, SR LV and with LV MI. IMT and FAC didn’t differ of operated and healthy children.

Conclusion
Parameters of the LS of the LV and CC β2 of children 5 years after CoA repair significantly differ from healthy children and reflect the ongoing process of cardiovascular remodeling. Assessment of the CC S allows timely confirmation of the presence of increased arterial stiffening.