bluuebunny/crossref_metadata_2025_split huggingface dataset:
P924 Benefits of bariatric surgery on subclinical myocardial function using global longitudinal strain in severely obese individuals with and without diabetes
Authors: Piche M , Clavel M A , Pibarot P , Poirier P 
Published: January 2020

Abstract

Background/Introduction: The presence of subclinical myocardial disease confers an increased cardiovascular disease risk. The effects of bariatric surgery on subclinical myocardial function assessed using left ventricular (LV) global longitudinal strain (GLS) in severely obese individuals with preserved LV ejection fraction is unclear.

Purpose
To evaluate changes in subclinical LV myocardial function following bariatric surgery in obese individuals with and without diabetes.

Methods
Thirty-eight severely obese individuals [body mass index (BMI) &gt;35kg/m2] with preserved LV ejection fraction (≥ 50%) who underwent bariatric surgery (Surgery group) (BMI 48 ± 7 kg/m2), 19 obese individuals managed conservatively (Cons. group) (BMI 47 ± 9 kg/m2), and 18 age and sex-matched non-obese controls (Non-obese group) were included. Echocardiography with GLS measurements was performed at the beginning of the study and at 6 months. Abnormal myocardial function was defined as a GLS &gt;-17%.

Results
Mean age of obese patients was 42 ± 11, BMI 48 ± 8 kg/m2, and 82% were female. The percentage of total weight loss at 6 months after bariatric surgery (Surgery group) was 26.3 ± 5.2%. Body weight remains unchanged at 6 months in the Cons. group. Proportions of hypertension (61 vs. 30%, P = 0.0005), dyslipidemia (42 vs. 5%, P = 0.0001) and type 2 diabetes (40 vs. 13%, P = 0.002) were reduced in the Surgery group. At the beginning, severely obese patients (Surgery group) displayed subclinical myocardial dysfunction vs. non-obese controls (LV GLS, -17.3 ± 2.5 vs. -19.6 ± 1.7%, P = 0.003). Six months after bariatric surgery, the subclinical myocardial function was comparable between both groups (LV GLS, -19.2 ± 2.1 vs. -19.6 ± 1.7%, P = NS). 22 severely obese individuals (58%) in the Surgery group showed abnormal GLS, which normalized in 82% after bariatric surgery (P = 0.0001). On the contrary, half of severely obese individuals managed conservatively (n = 10, 53%) worsened their GLS during the follow-up (P = 0.002). Remission of type 2 diabetes 6 months after bariatric surgery was associated with improvement in GLS (-17.5 ± 2.6 vs. -18.6± 1.8%), whereas obese individuals with type 2 diabetes managed conservatively showed a worsening in their subclinical myocardial function during the follow-up (-18.0 ± 2.4 vs. -17.4 ± 1.7%).

Conclusions
A great proportion of severely obese individuals with preserved LV ejection fraction have subclinical myocardial dysfunction. Bariatric surgery in obese individuals was associated with significant improvements in the metabolic profile and in subclinical myocardial function.
P939 Global longitudinal myocardial strain: an independent predictor of cardiovascular events in patients with hematopoietic stem cell transplantation
Authors: Martin Garcia A , Vallejo Garcia V , Lopez Corral L , Martin-Garcia A C , Castro Garay J C , Cabanillas Cabral A , Diaz-Pelaez E , Castillo Y , Barreiro Perez M , Rodriguez Estevez L , Sanchez Pablo C , Cambronero Cortinas E , Dorado Diaz P I , Caballero Barrigon D , Sanchez P L 
Published: January 2020

Abstract

BACKGROUND
Hematopoietic stem cell transplantation (HSCT) increases the likelihood of potentially serious cardiovascular complications. The scientific evidence on prognostic predictors is limited and cardiac monitoring of these patients is not systematized.
Our aim was to analyze cardiovascular prognosis and identify echocardiographic factors predicting cardiovascular events in the context of HSCT.

METHODS
An observational, retrospective study was designed, including 243 patients (mean age 54 ± 16yo, 60%males, 13% hypertension, 5% diabetes) undergoing a HSCT (60% Allogeneic/40% Autologous) with previous echocardiography, from December 2016 to the present. Clinical data, echocardiographic findings, mortality and cardiovascular events (CVE) were collected and analyzed.

RESULTS
After a median follow-up of 18 [12] months, 22 patients (9%) suffered CVE (54% arrhythmias, 40% heart failure, and 9% ischemic heart disease). Patients with Allogeneic-HSCT (13% vs. 3%; p: 0.007), left ventricular dilatation (40% vs. 8.5%, p = 0.02) or hypertrophy (33% vs. 8%, p: 0.01), dilated left atrium (33% vs. 9%, p:0.03), or pericardial effusion (33% vs. 9%, p: 0.04) in the echocardiographic study performed prior to HSCT suffered significantly more CVE at follow-up. Patients with CVE had significantly higher global longitudinal strain (GLS) (-19 ± 3% vs. -21 ± 3%, p= 0.001). Patients were divided into quartiles based on GLS, those belonging to the fourth quartile (&gt;-19.4%) suffered more frequently CVE (log Rank: 9.6; 18% vs. 6%, p = 0.002) with a significantly lower time to event (27 ± 1.8 vs. 32 ± 0.6 months) (Figure).
In multivariate analysis (Cox regression), Allogeneic-HSCT (HR: 5.6; p = 0.02) and the fourth quartile of GLS (HR: 4.3; p = 0.004) were maintained as independent predictors of cardiovascular event.

CONCLUSION
GLS before HSCT is an independent predictor of cardiovascular events at follow-up. This parameter could allow the identification of high-risk patients who could benefit from intensive protocolized cardiac follow-up.
Abstract P939 Figure. Survival analysis (Kaplan Meier)
P945 Should children, with exercise induced intra-ventricular gradients, be treated with beta blockers?
Authors: Cotrim C , Joao I , Guardado J , Cordeiro P , Sampaio M ANA , Marques A , Cafe H , Martins R , Cotrim H , Baquero L 
Published: January 2020

Abstract

Background
In our experience, treadmill exercise echocardiography (SE) is feasible and safe in children (C). Regional wall motion abnormalities (RWMA) are of limited usefulness, but Doppler often - (in 39% from 258 previously studied C) - documents significant intraventricular gradients (IVG), occult at rest, and allowing to document a possible explanation for exercise related symptoms, or abnormal resting or stress-ECG findings.
Purpose - To assess the effect of ß blockers on the occurrence of IVG, in C, with symptoms or abnormal resting or stress-ECG findings.
Methods – We repeated SE in 66 of the 101 C – (with normal echocardiogram at rest) - that developed IVG on exertion, under treatment with ß blockers. These 66 C who repeated the SE under treatment with ß blockers are the study group. 15 (23%) of them were female and the mean age of the group was 14,6 ± 1,7 years old (11 to 17).
They all underwent SE with 2D and Doppler echocardiographic evaluation of, and during treatment with ß blockers.

Results
Mean IVG in those 66 C submitted to SE was 105 ± 38 mmHg in the first SE evaluation. In SE evaluation performed under ß blockers, 37 of them didn’t develop IVG and in 29 of them IVG was significantly reduced to a mean IVG of 58 ± 32 mmHg (p&lt; 0,0001). The mean heart rate attained at peak exercise was 178 ± 15 bpm in the first SE evaluation and 157 ± 9 bpm in the evaluation performed under treatment with ß blockers (p &lt; 0, 0001). 47 of these C reproduced clinical symptoms (that were indication to SE) of beta-blockers, and only 7 reproduced the symptoms under treatment with beta blockers (p&lt; 0,0001).

Conclusions
In C with symptoms, abnormal rest or exercise ECG on medical evaluation and IVG on exertion, treatment with oral ß blockers prevented the occurrence of IVG or significantly reduced its magnitude. These changes were associated to significant clinical improvement in 85 % of the symptomatic population.
Abstract P945 Figure. SE without and with beta-blockers
P955 left ventricle cardiac remodeling among lithuanian football versus basketball players
Authors: Aldujeli A , Laukaitiene J , Unikas R 
Published: January 2020

Abstract

Background
Regular physical exercise causes a continuous gradual increase of the cardiac left ventricular (LV) mass known as physiological adaptive hypertrophy. The extent of LV remodeling depends on the type, amount, and intensity of the exercise.

Purpose
The aim of this study was to compare structural changes of the heart among Lithuanian football, basketball players and unathletic controls.

Methods
A total of 50 Lithuanian males aged between 20-29 years volunteered to participate in the study. Football players (n = 15) playing for local II league football clubs,and Basketball players (n = 15) playing for local minor league basketball teams. All athletes had been regularly engaged in their sport for at least three years. Inactive healthy volunteers (n = 20) of similar age served as controls. Routine transthoracic echocardiographic examinations to measure end-diastolic LV dimensions were performed by cardiology fellow under the supervision of a fully licensed cardiologist. Statistical analyses were performed using the SPSS 20.0 software. The value of p &lt; 0,05 was considered as statistically significant.

Results
No structural or functional pathologies were evident during the echocardiographic examination in any of the subjects. Absolute interventricular septum (IVS) thickness and LV posterior wall thickness, but not LV diameter, were higher in athletes than in inactive controls (P &lt; 0,001). Indexed LV diameter was higher in football players as compared with non-athlete controls and basketball players (P &lt; 0,05). Left ventricular mass of all athletes were higher as compared with controls (p &lt; 0.001). Relative wall thickness was not increased in football players but was higher in basketball players as compared with controls (p &lt; 0.05).

Conclusion
Cardiac remodeling in Lithuanian football players resulted in left ventricle eccentric hypertrophy due to the LV dilation, increased LV mass and relatively normal relative wall thickness. However in Lithuanian basketball players we noticed an increase in both relative wall thickness and LV mass resulting in LV concentric hypertrophy.
Echocardiographic characteristics Groups n End-diastolic LV diameter(mm) End-diastolic Interventricular septum (mm) End-diastolic LV posterior wall LV mass Football Players 15 56.9 10.8 10.8 242 Basketball players 15 53.6 11.5 11.3 254 Inactive individuals 20 53.2 9.1 9.5 182 P value 0.01 &lt;0.001 &lt;0.001 &lt;0.01
Abstract P955 Figure.
P978 Acute myocardial infarction in young women without atherosclerotic disease
Authors: Sozzi F B , Schiavone M , Gherbesi E , Malanchini G , Mircoli L , Colombo F , Bonanomi C , Vicenzi M , Ciulla M , Lombardi F 
Published: January 2020

Abstract

INTRODUCTION
Spontaneous coronary artery dissection (SCAD) is an established cause of acute myocardial infarction (AMI), with an incidence in young women ranging from 22% to 43%. The increased use of coronary angiography contributed to better recognise this condition. Nonetheless, the presentation remains challenging mainly due to the atypical clinical onset.
AIMS AND METHODS
A very homogeneous case series of 10 young women (age 36 ± 9 years) admitted at our Institution over a period of 10-years with ST-elevation myocardial infarction (STEMI) or non-ST elevation myocardial infarction (NSTEMI) were analysed. All women had no congenital, coronary, cardiac and/or atherosclerotic disorders. The clinical and angiographic data were evaluated and correlated to the outcome that lasted 5 ± 5 years.
RESULTS
The clinical presentation was typical in 70% of cases and 30% of them developed ventricular arrhythmias and cardiogenic shock. An atypical presentation was documented in 30%. STEMI accounted for 70%, NSTEMI for 30%. Among the predisposing factors, pregnancy was related in 20%, connective tissue disorders in 30% and acute emotional stress associated to smoke habit in 50% of cases. On coronary angiogram all women were affected by distinctive pattern of non-atherosclerotic single vessel disease: LAD dissection (50% of cases with proximal localization), first obtuse marginal branch dissection in 3 cases, proximal RCA dissection in 1. Medical therapy was the first choice in 40%, while 60% were treated with PTCA-stent (multiple in 30%). The ejection fraction early after AMI was normal in 70%, mildly reduced in 1 case and moderately reduced (&lt;45%) in 2 cases. Follow-up was negative for events in all cases, 3 underwent pregnancy at distance.

CONCLUSION
A high proportion of subjects presented with atypical challenging symptoms, while 30% were complicated with ventricular arrhythmias. This might be related to the high prevalence of proximal LAD dissection and anterior AMI in our subjects. An equal distribution of risk factors was recorded. No mortality events and no SCAD-recurrence were documented during follow up.
Abstract P978 Figure. Image 1
1098 Atrial thickening: a surprisingly "gouty" heart
Authors: Rocha B , Lopes Da Cunha G J , Lopes P M , Saraiva M , Albuquerque C , Cristina S , Proenca G , Abecasis J , Trabulo M , Andrade M , Ramos S , Mendes M 
Published: January 2020

Abstract
Case Presentation
A 49 year-old male presented to the emergency department with fever and lower limb myalgia for 5 days. His past history was notable for acute episodes of microcrystalline pyrophosphate oligoarthritis for which he was receiving allopurinol 100mg, colchicine 1mg and prednisolone 5mg. Physical examination was unrevealing. Laboratory workup showed normocytic normochromic anemia (Hb 12.8g/dL), leukocytosis (22 490 /mm3), neutrophilia (86.8%), increased C-reactive protein (CRP
26mg/dL), low procalcitonin (0.82ng/mL) and mildly elevated creatinine-kinase (83 UI/L). The patient was admitted with fever of unknown origin and started on ceftriaxone after blood and urine cultures.
He remained febrile with persistently heightened inflammation. Cultures, infectious and auto-immune tests, bone marrow biopsy, myelogram and abdominopelvic CT scan were negative. Three weeks later, syncope due to complete atrioventricular (AV) block led to temporary pacemaker implantation. Transoesophageal echocardiography (TOE) revealed a left atrial (LA) wall thickening,
evident on MRI as an 8-10mm T2-hyperintensity sign, with right atrial (RA) and ventricular sparing. PET/CT scan showed an 18F FDG uptake exclusively in the LA. As a neoplasia was highly suspected, a transspeptal biopsy was attempted, yet the sample was scarce for analysis. Thus, a biopsy via sternotomy was performed, now sampling both the LA and RA. Indeed, repeated TOE showed de novo RA involvement with a prominent nodular finding (19x24mm) in the lateral wall.
Myocyte inflammation and necrosis accompanied with granulocyte infiltration (mostly neutrophils but also eosinophils) was observed in all samples. There were no findings suggestive of neoplasia. The patient was still on allopurinol, which has been reported to involve the myocardium in a late (type IV) hypersensitivity reaction (the so-called DRESS syndrome), even in the absence of systemic inflammation. Thus, allopurinol was stopped and 1mg/Kg prednisolone was started. The patient
significantly improved and was discharged home with negative CRP the following two weeks. After 1 month, MRI was repeated and no atrial inflammation was found. After 4 months follow-up, he is doing well on 2.5mg of prednisolone and febuxostat 80mg.
1107 An unusual vegetation on a prosthetic pulmonary valve
Authors: Fusco F , Scognamiglio G , Colonna D , Palma M , Granata G , Russo M G , Sarubbi B 
Published: January 2020

Abstract

Patient presentation
During a routine check up, a 47yo man with Tetralogy of Fallot and congenital absence of left pulmonary branch was found to have a vegetation on his prosthetic pulmonary valve. His surgical history included TOF repair with left pulmonary branch bypass aged 4 years and a redo surgery for pulmonary valve replacement 3 years earlier. Before last surgery, CMR showed severe pulmonary regurgitation, dilated RV with mildly impaired systolic function (EF 40%) and absent flow in left pulmonary branch due to bypass occlusion.
Diagnostic work-up
The patient reported increasing shortness of breath (NYHA class III) over the last months. He reported one single fever peak two months before.He was on Apixaban and Amiodarone for previous history of AF. He was afebrile and an ejective systolic 4/6 murmur was heard. He was in sinus rhythm at 70 bpm. The TTE showed dilated RV with severely reduced systolic function (FAC 12%), severe pulmonary stenosis (peak gradient of 70 mmHg) with mild regurgitation, and a mobile and echogenic vegetation of 10 X 9 mm was seen on the prosthetic pulmonary valve. His blood tests at the admission demostrated raised WBC (9.460/uL) and PCR 11.7 mg/dl (n.v. &lt; 3.0). The PCR remained stable during the following days. Serial blood samples for cultures were obtained, but all resulted negative. Uncommom causes of negative blood culteres infective endocarditis were investigated with specific serological tests for research of fastious agents, but all resulted negative. Antinuclear and antiphospholipid antibodies were also tested. A total-body CT was performed and it showed several liver formations. A FDG PET-CT was requested and it demostrated active marked glucose uptake by a mediastinic node, as well as by liver, brain and prosthetic pulmonary valve.
Diagnosis and outcome
After a careful review of all the clinical and imaging data, our opinion was that the most probable diagnosis was non infective thrombotic endocarditis in patient with metastatic cancer. In this situation, the valvular glucose uptake was likely due active thrombus formation rathen then being a sign of inflammatory response. Unfortunately, the patient died suddenly two weeks after the PET-CT and it was impossible to confirm the diagnosis with biopsy.

Conclusion
Differential diagnosis of cardiac vegetations is a challenging process including microbological tests, multi modality imaging and clinical reasoning. It is always necessary to consider alternative diagnosis, even when traditional imaging tests seem to suggest infective endocarditis.
Non infective thrombotic endocarditis are a rare form of negative blood culteres endocarditis related to systemic hypercoagulable state (i.e. antiphospholipid syndrome, systemic lupus, behcet syndrome, cancer). Malignancies can be considered an unusual cause of cardiac vegetation and they must be taken into account on differential diagnosis.
Abstract 1107 Figure. FDG uptake in pulmonary position
1115 Ultra-slow low-dose thrombolytic therapy as an option of treatment in intracardiac thrombus: a case report
Authors: Alves Pinto R , Torres S , Formigo M , Resende C X , Proenca T , Carvalho J M , Grilo P D , Nunes A , Araujo P M , Sousa E , Neves A , Coentrao L , Honrado T , Maciel M J , Macedo F 
Published: January 2020

Abstract
We present a case of a 57-year-old male with previously known primary severe mitral regurgitation, who was admitted to the ICU due to massive venous thromboembolism with associated right ventricle dysfunction and with two large mobile right atrial thrombi (2.4 x 1.5 cm and 3.6 x 3.7 cm). Despite of five days with a therapeutic aPTT achieved with unfractionated heparin (UFH), a TTE showed deterioration of the right ventricle systolic function, persistence of the right atrial masses with similar dimensions together with new mobile thrombi on the coronary sinus and on the right pulmonary artery. Due to deterioration of his clinical condition and given the refractoriness to the classical treatment with UFH, it was decided to administer an ultra-slow low-dose thrombolysis protocol, which consisted in a 24-hour infusion of 24 mg of alteplase at a rate of 1 mg per hour, without bolus. The treatment was continued by 48 consecutive hours, with clinical improvement and important reduction of the right atrial masses with resolution of the coronary sinus and right pulmonary artery thrombi. The patient started hypocoagulation with warfarin bridging with low molecular weight heparin (LMWH). Seven days after alteplase discontinuation there was complete resolution of the intracardiac thrombi. One month after ICU admission a successful mitral valve replacement surgery was conducted. Three months after discharge, the patient is in functional New York Heart Association (NYHA) class I with no cardiovascular events or hospitalizations. This case demonstrates that ultra-slow low-dose thrombolysis is a valid bailout treatment option in patients with large intracardiac thrombi refractory to anticoagulation.
Abstract 1115 Figure. TTE showing right atrial masses
1161 Baseline echocardiographic parameters associated with reintervention in children with aortic valve stenosis following balloon aortic valvuloplasty
Authors: Papneja K , Blatman Z , Kawpeng I D , Wheatley J , Osce H , Li B , Manlhiot C , Fan C P S , Lafreniere-Roula M , Benson L N , Mertens L 
Published: January 2020

Abstract

Introduction
Aortic valve (AV) stenosis is the most common type of congenital left ventricular outflow tract obstruction. Short-term outcomes following balloon aortic valvuloplasty (BAV) including residual aortic stenosis, aortic insufficiency, and procedural complications have been established. The impact of pre-intervention AV characteristics on long-term outcomes has not been well studied.

Purpose
The aim of this study was to determine the relationship between the initial parameters on baseline echocardiogram and the time to reintervention in children with AV stenosis following BAV.

Methods
Children from the newborn period to 18 years of age with AV stenosis who underwent BAV from 2004-2012 were included. Patients with aortic insufficiency prior to BAV, complex congenital heart lesions, or less than two accessible follow-up echocardiograms were excluded. Baseline and serial echocardiographic data pertaining to aortic valve and LV size and function was retrospectively collected until December 2017 or until the first reintervention. Time to reintervention or death was evaluated.

Results
Among the 98 enrolled patients, the median [IQR] age at BAV was 2.8 months [0.2-75]. The median [IQR] duration of follow-up was 6.8 [1.9-9.0] years. Eighty-nine (83%) patients had bicuspid valve morphology and the median [IQR] peak-to-peak catheterization gradient prior to BAV was 49 [34-65] mmHg. The cumulative proportion [95% CI] of reintervention at 5 years following BAV was 33.7% [23.6%, 42.4%]. Primary indications for reintervention were aortic stenosis (57%), aortic insufficiency (14%), or mixed valve disease (30%). Reinterventions included repeat BAV (49%), AV repair (15%), and AV replacement (36%). Increased LVEF at baseline as well as increased mean LV circumferential strain at baseline were associated with decreased risk of reintervention (HR [95% CI] (1 unit increments): 0.974 [0.959-0.989], p &lt; 0.001; 0.939 [0.884-0.997], p = 0.041 respectively). Increased AV annulus z-score was also associated with decreased risk of reintervention (HR [95% CI] (1 unit increments): 0.806 [0.698-0.93], p = 0.003).

Conclusions
Our results demonstrate that better left ventricular function at baseline, measured by LVEF and mean LV circumferential strain, is associated with a decreased risk of reintervention in neonates and children following BAV. We have also shown that a bigger AV annulus prior to BAV is associated with a decreased risk of reintervention.