bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1796 Three dimensional echocardiograhy navigation of mitral valve in patients with left ventricular dysfunction and functional mitral regurgiation
Authors: Darweesh R , Farrag AZZA , Hassan A M R , Mesak JULIET 
Published: January 2020

Abstract

OnBehalf
cairo university

Background
Mitral valve MV apparatus is a dynamic three-dimensional system that allows a unidirectional heart pump function. Functional mitral regurgitation (FMR) is a common complication that adversely affects the prognosis in patients with congestive heart failure. Accurate assessment of the interaction of the LV and MV apparatus is crucial for surgical correction of FMR.

Purpose
Evaluation of MV deformity indices in patients with Left ventricle (LV) dysfunction and varying severity FMR using 3D transoesophageal echocardiography and MV navigation (MVN) software

Methods
96 patients were selected with echocardiographic evidence of dilated LV dimensions, EF ≤ 45%,and at least mild MR . A standard comprehensive transthoracic echocardiographic assessment of : 1. LV diameters and volumes with calculation of LVEF , LV shape, sphericity index, 2. Mitral leaflets morphology including anterior mitral leaflet length ,Mitral annular (MA) diameter , mid-systolic mitral annular area (MAA) , The coaptation height (CH) or distance , MV tenting area, leaflet-tethering distance for anterolateral papillary muscle (Tethering-AL) and posteromedial papillary muscle (Tethering-PM), 3.Quantification of MR : MR jet area , vena contracta (VC) width, effective regurgitant orifice area (EROA), , regurgitant volume, 4. 2D speckle-tracking imaging for LV strain analysis,5.MV morphology and dynamics were analysed using MVN for assessment of : Annular geometry including diameters, circumference ,height , annular ellipticity .

Results
MV deformation (AML and PML tethering distance) was negatively correlated with GLS (r= -0.408, p = 0.009),and (r= -0.428, p = 0.006) as well as 2D and 3D MAA were negatively correlated with the GLS (r= -0.469, p = 0.002) and (r= -0.477, p = 0.002). MR severity parameters as MR volume and EROA were associated with increased MAA (r = 0.38, p = 0.015), (r = 0.469, p = 0.002) respectively. Severity of MR was strongly correlated with MVA indices including AP diameter, 3D MA circumference, MAA, MV tenting height and volume and annular ellipsicity.

Conclusion
Mitral annular enlargement appears to be more closely linked to occurrence of FMR in patients with LV dysfunction. 3D imaging modalities will help assessment of complicated, dynamic, three-dimensional and non-planar mitral annulus
P1798 Determinants of increased mitral mean diastolic gradient after transcatheter edge-to-edge mitral valve repair
Authors: Oguz D , Padang R , Pislaru S V , Nkomo V T , Mankad S V , Malouf J F , Guerrero M , Reeder G S , Eleid M F , Rihal C S , Thaden J J 
Published: January 2020

Abstract

Background
Transcatheter edge-to-edge mitral valve repair (TMVR; MitraClip, Abbott Vascular) is clinically approved for treatment of severe, symptomatic mitral regurgitation (MR) in high or prohibitive surgical risk patients. Iatrogenic mitral stenosis is a known complication of TMVR, but determinants of increased post-procedure mean diastolic gradient are not well defined.

Purpose
We aimed to investigate the determinants of increased mitral mean diastolic gradient after TMVR.

Methods
We retrospectively reviewed 59 patients. 2D and 3D TEE data sets acquired before and immediately after procedure were analyzed. 4D Cardio-View and 4D MV-Assessment (TomTec, Germany) were used for the analysis of the 3D volume data set. Quantitative mitral valve analysis was done at the end of systole. Increased mitral mean diastolic gradient after TMVR was correlated with pre-procedure 2D and 3D echocardiographic data.

Results
34 patients had primary MR, 25 patients had mixed/secondary MR. Baseline mean mitral diastolic gradient was 2.0 ± 0.9mmHg and increased to 3.9 ± 1.8mmHg post-TMVR and the mean 3D planimetric mitral valve area decreased from 5.3 ± 1.5cm2 to 2.6 ± 1.0cm2. Implantation of multiple clips was performed less frequently in patients with smaller baseline mitral valve area; 8% vs 47% in the lowest quartile vs all others (p = 0.006). 12(20%) of patients had a mean diastolic gradient &gt;5mmHg post-TMVR and 15(25%) of patients had a post-TMVR mitral valve area &lt;2.0 cm2. There was no significant difference in post-procedure heart rate between patients with mean diastolic gradient ≤5mmHg vs &gt;5mmHg (p = 0.08). Patient characteristics according to post-TMVR mean diastolic gradient are shown in the Table. Post-TMVR mean diastolic gradient &gt;5mmHg was more common in patients with increased pre-procedure mean diastolic gradient(p = 0.006), post-TMVR mitral valve area &lt;2.0 cm2(40% vs 14%, p = 0.03), and ≥moderate residual mitral regurgitation(38% vs 11%, p = 0.02). Post-TMVR mitral valve area &lt;2.0cm2 was present in 50% vs 19% of patients with vs without a mean gradient &gt;5mmHg(p = 0.04).

Conclusions
Elevated post-TMVR mean diastolic gradient is multifactorial and related to mitral stenosis, but residual mitral regurgitation also appears to be an important contributor to increased gradients in some patients. Larger cohorts are likely needed to assess the concurrent impact of mitral annular calcification, leaflet calcification, and other variables on post-TMVR mean gradient.
Abstract P1798 Figure. 2D and 3D Echocardiographic Parameters
P1804 Phenotypic overlap between Brugada syndrome and arrhythmogenic cardiomyopathy
Authors: Scheirlynck E , Droogmans S , Sieira J , De Asmundis C , Motov A , Edvarsen T , Koulalis J , Lie ØH , Chivulescu M , Chierchia G B , Brugada P , Cosyns B , Haugaa K H 
Published: January 2020

Abstract

Background
Brugada syndrome (BrS) and arrhythmogenic cardiomyopathy (AC) are genetic cardiac diseases characterized by high risk for sudden cardiac death. Although BrS and AC are different clinical entities, experimental research and clinical cases suggest a phenotypic overlap.

Purpose
We aimed to assess the prevalence of structural and electrical AC diagnostic criteria in BrS patients.

Methods
In this multicentre study we acquired electrocardiograms (ECG) and transthoracic echocardiography in BrS patients between May and September 2018. We assessed the right ventricular outflow tract (RVOT) diameter, fractional area change (FAC) from echocardiography, and depolarization and repolarization criteria from ECG using parameter cut offs and definitions according to 2010 AC Task Force criteria.

Results
We included 123 BrS patients [54 (40-62) years old, 63 (51%) women]. Although, by definition, no akinesia, dyskinesia or aneurisms were present, 61 (50%) BrS patients had major criteria for dilated RVOT and/or reduced FAC, and 39 (32%) had at least one minor RVOT or FAC criterion (Figure). ECG showed minor repolarization and/or depolarization criteria in 30 (24%) BrS patients. No epsilon waves or major T-wave inversions were observed.

Conclusion
Half of BrS patients had evident major RVOT dilation and/or reduced FAC and one quarter had minor electrical features of AC. These findings suggest a significant phenotypical continuum between BrS and AC.
Abstract P1804 Figure.
P1824 Feature tracking strain values of noncompaction cardiomyopathy patients: differences in the light of ejection fraction
Authors: Kiss A , Szucs A , Gregor Z S , Toth A , Furak A , Horvath M , Czimbalmos C S , Dohy Z S , Szabo L , Suhai F I , Merkely B , Vago H 
Published: January 2020

Abstract
Feature tracking (FT) is a new cardiac magnetic resonance (CMR) technique for strain measurement which may give additional information about the progression of noncompaction cardiomyopathy (NCMP).
First in the literature, we compared the strain and functional parameters of NCMP patients with reduced (R) and good (G) ejection fraction (EF) using CMR-FT.
From the total of 164 CMR proven R NCMP patients, who were examined between 2009 and 2018 at the Heart and Vascular Center of Semmelweis University, we selected 26 non-ischaemic, contrast agent-free examinations (age: 56 ± 10.6 years; EF: 32.7 ± 10.0%; male = 19). According to their EF they were divided into medium (M; EF: 35-50%; n = 10) and significantly reduced EF (SR; EF &lt;35%; n = 16) subgroups. We searched 25 NCMP patients with good EF (age: 37 ± 14.4 years; EF: 65.9 ± 5.3%; male = 16) and 26 control persons (age: 52 ± 10.7 years; EF: 70.8 ± 5.1%; male = 16) to the above mentioned groups.
The Medis Suite program was used for analysis and the MedCalc software for statistics, (p &lt; 0.05).
Significant differences were found between the functional parameters of R and G patients. The global longitudinal strain (GLS) and global circumferential strain (GCS) values of the R group were decreased significantly compared to G and C groups. (R vs G; GLS: -9.5 ± 4.3 vs -20.9 + 3.2%; GCS: -12.5 ± 6.1 vs -30.5 ± 5.0%, p &lt; 0.0001; R vs C; GLS: -9.5 ± 4.3 vs -23.3 ± 4.4%; GCS: -12.5 ± 6.1 vs -35.6 ± 5.1%, p &lt; 0.0001).
All the segmental strain values of R group were decreased compared to G and C groups, moreover this significancy was observed between the M and SR subgroups as well.
The strain values of the R group in all the basal, mid and apical part of the left ventricle (LV) were reduced equally.
The average longitudinal strain values of the apical part of the LV in the SR subgroup were significantly reduced compared to the average strains of the basal part (apical vs basal: -8.9 ± 3.0 vs -11.9 ± 4.4 %, p &lt; 0.05). In addition, we found positive correlation in the R subgroup between the GCS and the mass of trabeculated muscle (r = 0.58, p = 0.002) .
Our study shows that the global and segmental strain values decreased significantly in proportion to the reduction of the EF which describes well the progression of heart failure in NCMP. However, the decreased strain values of the hypertrabeculated apical part might be specific to NCMP.
P286 Inverse relation between systolic blood pressure variability and global longitudinal strain in patients with Parkinson"s disease and autonomic dysfunction
Authors: Caminiti G , D"antoni V , Morsella V , Torti M , Grassini P , Vacca L , Selli S , Volterrani M 
Published: January 2020

Abstract

Background
Parkinson"s disease (PD) patients often present cardiac blood pressure (BP) derangement as a result of autonomic dysfunction. However their echocardiography pattern have been poorly investigated yet . Study aim: to evaluate the correlation between indices of left ventricular function ad 24/h blood pressure pattern in patients with PD
Methods We evaluated 20 patients with diagnosed PD and autonomic dysfunction and 15 hypertensive age-matched subjects. All patients performed 24/h blood pressure monitoring (ABPM) and echocardiography. Left ventricular systolic function was evaluated through ejection fraction (EF), tissue doppler S wave and global longitudinal strain (GLS). BP variability (BPV) was evaluated through average real variability.

Results
GLS (17.6 vs 22.8; p = 0.04) was reduced in the PD group compared to hypertensive patients. Conversely EF and S wave was similar between the two groups. Patients with PD had an inverse significant correlation between GLS and 24/h systolic BPV (r= -0.64; p = 0.003) and a trend through significance between S wave and systolic BPV (r= -0.31; p = 0.07). sNocturnal diastolic BP was inversely related to GLS (r= -0.44; p = 0.001) . There were no correlation between GLS and BPV and values in hypertensive patients.

Conclusions
In PD patients GLS is related to indices of poor BP control. GLS appears to be an early detector of LV dysfunction in patients with PD and autonomic dysfunction.
P287 Assessment of mitral regurgitation and mitral geometry in patients after transcatheter aortic valve implantation
Authors: Sorysz D , Krawczyk-Ozog A , Tokarek T , Zawislak B , Stapor M , Dudek D 
Published: January 2020

Abstract

Introduction
Mitral regurgitation is often found in conjunction with aortic stenosis and the prevalence of both valvular lesions increases with age.

Purpose
The aim of this study was to evaluate mitral regurgitation, left ventricle and left atrium in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI).

Methods
A total of 31 patients (29% males) with severe aortic stenosis and moderate or severe mitral regurgitation, who underwent TAVI were included in this study. Clinical and echocardiographic characteristics were performed at baseline and in 6, 12 months observation.

Results
After TAVI, decrease of vena contracta width of mitral regurgitation (p = 0.00002, p = 0.00004), aorto-mural mitral annulus diameter (p = 0.00008, p = 0.02), increase mitral annular plane systolic excursion (p = 0.0004, p = 0.0003), left ventricular stroke volume (p = 0.0003, p = 0.0004), ejection fraction (p = 0.0004, p = 0.01) and decrease major dimension of left ventricle in three chamber view (p = 0.05, p = 0.002) was observed in patient in both time points, respectively. Additionally, we observed decrease of distance between head of papillary muscles (p = 0.003) at 6 months and decrease of left atrium indexed volume (p = 0.01) and grade of tricuspid regurgitation (p = 0.03) at 12 months follow up.

Conclusions
Patients with moderate or severe mitral regurgitation after TAVI procedure achieved significant reductions of mitral regurgitation and improvement of some parameters assessing mitral annulus, left ventricle and left atrium geometry.
P292 The risk of adverse outcome with ischemic mitral regurgitation at 6-month after myocardial infarction: possible benefit of early intervention by transcatheter mitral-valve repair
Authors: Kimura T , Watanabe N , Nishino S , Kuriyama N , Ashikaga K , Nishihira K , Furugen M , Shibata Y 
Published: January 2020

Abstract

Background
The latest study has demonstrated the better outcomes of transcatheter mitral-valve repair in patients with decompensated heart failure (HF) and left ventricular (LV) dysfunction. However, it is unknown whether earlier intervention for mitral regurgitation (MR) can improve the outcome of myocardial infarction (MI).

Purpose
The aim of this study was to investigate the prognostic value of ischemic MR (IMR) at 6-month after MI for the later incidence of HF and death.

Methods
We retrospectively examined 723 MI patients who were admitted to our hospital. 95.5% of the patients were treated by primary coronary intervention. Patients were clinically followed-up at 6-month after the onset of MI, and divided into 3 groups according to the degree of IMR, i.e. No/Trivial IMR group (n = 528), Mild IMR group (n= 154) and ≥Moderate IMR group (n= 41). We compared the later incidence of hospitalization for HF and all-cause death at 3-year for each group.

Results
The studied population had preserved ejection fraction (EF) (56.9 ± 10.7%, average) and mostly asymptomatic at 6-month after MI. All-cause mortality within 3-year was higher in patients with ≥Moderate IMR (p &lt; 0.001), and the incidence of hospitalization for HF was significantly higher depends on the degree of IMR at 6-month (p &lt; 0.001). Multivariate analysis showed EF and the degree of IMR were the independent predictor for the hospitalization for HF.

Conclusions
IMR at 6-month after MI was associated with the later adverse events despite relatively preserved LV contraction without heart failure symptoms at the index examination. Early intervention for IMR potentially benefit for the better outcome.
Abstract P292 Figure. Caplan-Meier estimates on adverse events
P296 The effect of ideal BSA in patients with moderate aortic stenosis?
Authors: Cases M , Zhu T , Jurt U , Brouillard D , Matangi M 
Published: January 2020

Abstract

INTRODUCTION
The current obesity epidemic has an impact on calculated BSA. Obesity significantly increases the calculated BSA from what the ideal BSA would be if based on a patient’s ideal body weight.

PURPOSE
To determine the effect of ideal BSA on AV area index in patients with moderate aortic stenosis and normal left ventricular function.

METHODS
Our ECHO database was searched for all patients with an LVEF &gt;50% and moderate aortic stenosis based on a mean aortic gradient of 20-39 mmHg and an AV area &gt;1.00 cm2. Patients with more than mild aortic regurgitation, previous valvular repair or replacement, significant mitral valve disease or any LV wall motion abnormalities were excluded. Ideal weight was calculated using the Devine formula = Constant + 2.3 x [height in inches-60], where constant= 50Kg in males and 45.5Kg in females). Body surface area in m2 was calculated using the formula = [√ (height in cm x weight in Kg)/3600]. The paired t-test was used to determine differences between means and the Fisher’s exact test was used to determine differences between proportions. A p value of &lt;0.05 was considered significant.

RESULTS
There were 210 females (mean age 75.4 ± 11.9 years, mean AV gradient 25.3 ± 4.8 mmHg, mean AVA 1.28 ± 0.27 cm2) and 385 males (mean age 72.7 ± 11.3 years, mean AV gradient 25.9 ± 5.2 mmHg, mean AVA 1.32 ± 0.28 cm2). Other important variables are seen in table 1. There were highly significant differences between actual and ideal measurements of weight, BSA and AV area index. Based on the actual BSA there were 151 of 385 male patients (39.2%) with severe aortic stenosis (&lt;0.60 cm2/m2), which dropped to 66 of 385 patients (17.1%) when the ideal BSA was used in the calculation (P &lt; 0.0001, Fisher’s exact test). For females there were 44 of 210 patients with severe aortic stenosis (21.0%) which dropped to 3 (1.4%) when the ideal BSA was used in the calculation (P &lt; 0.0001, Fisher’s exact test).

CONCLUSIONS
Use of the ideal BSA, based on ideal weight, significantly reclassifies women in terms of AS severity and will be consistent throughout time. All mean aortic gradients and AV areas, by definition, and 98.6% of the ideal AV area indices being in the moderate AS range. The data is less compelling in males but is still significantly improved with 82.9% of AV area indices being correctly assigned.
Table 1. Weight/kg (Females) Weight/kg (Males) BSA/m2 (Females) BSA/m2 (Males) AVAI (Females) AVAI (Males) Actual. 77.5 ± 21.4 90.1 ± 16.9 1.79 ± 0.23 2.04 ± 0.20 0.72 ± 0.16 0.65 ± 0.14 Ideal. 51.6 ± 6.2 69.3 ± 7.1 1.51 ± 0.12 1.83 ± 0.14 0.85 ± 0.17 0.73 ± 0.16 P value. &lt;0.0001 &lt;0.0001 &lt;0.0001 &lt;0.0001 &lt;0.0001 &lt;0.0001 AVAI = Aortic valve area index (cm2/m2). BSA = Body surface area (m2).
P307 Trajectories of Myocardial Strain Across the Spectrum of Aortic Stenosis
Authors: Alfuhied A , Alfarih M , Kumar M P , Captur G , Nihoyannopoulos P 
Published: January 2020

Abstract

Introduction
Optimal timing of intervention in aortic stenosis (AS) is key. Left ventricular deformation parameters are sensitive markers of myocardial wellbeing in AS, but data is sparse so strain does not currently feature in the clinical decision-making process governing timing of AS intervention. We explore the trajectory of myocardial strain in AS of varying severity to potentially identify the most sensitive periods for valve intervention.

Methods
50 patients from across the spectrum of isolated AS were prospectively recruited: mild AS n = 10; moderate AS n = 10; and severe AS n = 30 of which n = 10 in each of 3 ejection fraction (EF) groups: EF &gt; 50%, EF = 40-49% and EF &lt; 35%. Longitudinal, circumferential, and radial strain were measured by speckle tracking echocardiography (STE) using TomTec software.

Results
Strain parameters and EF were not significantly different between mild and moderate AS groups but almost all parameters (except for global circumferential strain (GCS)) showed significant deterioration with progression to severe AS, even in spite of preserved EF (&gt;50%; Table1). In patients with severe AS, strain parameters showed no significant differences between hearts with EF &gt; 50% and EF 40-49%, but they continued to deteriorate significantly (p &lt; 0.05) as hearts transitioned from 40-49% to &lt;35% (Figure 1, a&b).

Conclusion
The heart can maintain its deformation and global systolic function throughout mild and moderate AS but strain deteriorates significantly in severe AS, irrespective of EF. Tracking the precise timings of strain deterioration in severe AS could help refine optimal timings of AS intervention.
LVEF and strain in varying AS severity Left ventricle ejection fraction and strain values in varying severity of AS Mild (n = 10) Moderate (n = 10) Severe (n = 10) P-value Mean (SD) Mean (SD) Mean (SD) EF (%) 65.4 (6.1) 65.8 (9.0) 60.4 (3.6)*§ 0.15 GLS (%) -14.2 (2.1) -13.6 (2.3) -11.8 (2.9)* 0.09 GCS (%) -30.3 (9.1) -31.0 (11.4) -26.5 (8.2) 0.55 GRS (%) 55.9 (15.5) 52.6 (24.0) 35.9 (13.5)*§ 0.05 EF: ejection fraction; GLS: global longitudinal strain; GCS: global circumferential strain; GRS: global radial strain; SD: standard deviation. Severe (n = 10): Severe AS with preserved EF &gt;50%. P-value: ANOVA-single factor; comparison in-between groups was performed using unpaired t-test (parametric) and Mann Whitney test (non-parametric). *significant difference P &lt; 0.05 mild vs severe. §significant difference P &lt; 0.05 moderate vs severe.
Abstract P307 Figure.
P325 Inadequate inhibition of platelet function after exercise in patients with ischemic mitral regurgitation qualified for cardiosurgery treatment
Authors: Piatkowski R , Kochanowski J , Budnik M , Huczek Z , Scislo P , Kosior D A , Opolski G 
Published: January 2020

Abstract

Purpose
Human platelets play a major role in the pathophysiology of cardiovascular diseases. The aim of our study was to determine the relationship between exercise and level of platelet inhibition in patients (pts) after myocardial infarction (MI) with at least moderate ischemic mitral regurgitation (IMR) qualified for cardiosurgical treatment - coronary artery bypass grafting alone (CABG) or CABG with mitral reconstruction (CABGmr).

Methods
We collected venous blood samples from 70 pts (M 41, 66 ± 9 years) with at least moderate IMR, 3-24 weeks after MI. Platelet reactivity was estimated with the use of rapid, point-of-care platelet analyzer as the time for flowing whole blood to occlude a collagen-epinephrine ring, with shorter closure times (CEPI-CT), indicating greater activity. CEPI-CT was evaluated before (CEPI-CT rest) and 20 min after ExE (CEPI-CT ExE). Inadequate inhibition of the TXA2-dependent activation pathway was defined as CEPI-CT &lt; 193 seconds. All the patients received 75-100 mg of aspirin daily (without clopidogrel treatment). Effective regurgitation orifice (ERO) was used for quantitative IMR assessment (moderate ≥10-20, severe ≥ 20 mm²). In all pts symptom-limited echocardiography (echo) semi-supine exercise test (ExE) was performed with Schiller system. All the pts were referred for CABG (multivessel coronary disease, ejection fraction (EF) 42,6 ± 10,1%, wall motion score index (WMSI) 1.65 ± 0.36).

Results
We observed inadequate platelet in 26 (37%) pts at rest (CEPI-CT &lt; 193 sec., despite regular aspirin therapy) and in 48 (68%) pts in 20 min. after exercise. We observed a significant decrease in CEPI–CT in all analyzed group (rest vs exe: 202 sec. vs 124 sec., respectively; p &lt; 0,0001) and also in pts with moderate IMR as well as with severe IMR. We didn’t observe a significant change in platelet count and mean platelet volume (MPV) between rest and exercise. Conclusions:
1. Inadequate antiplatelet effect of aspirin at rest was observed in 37% pts after MI with IMR.
2. Symptoms limited exercise test has revealed inadequate platelet inhibition (TXA2 –dependent activation pathway) in 68% of patients after MI with IMR.
3. Aspirin may have a limited antithrombotic effect after physical exercise in patients after MI with significant IMR.