bluuebunny/crossref_metadata_2025_split huggingface dataset:
1163 Diagnostic performance of a new echocardiographic method for coronary arteries abnormalities assessment
Authors: Bianco F , Colaneri M , Bucciarelli V , Surace F C , Iezzi F V , Giusti G , Primavera M , Biasi A , Gallina S , Pozzi M 
Published: January 2020

Abstract

Background
The echocardiographic assessment of coronary arteries abnormalities (CCA) has always been challenging. In this view, we aimed to assess the performance of a new echocardiographic-based diagnostic method for CAA in pediatric and young adults’ population.

Methods
over 5 years, we examined all the outpatients undergoing routine echocardiography in our department. Our method consisted of 4-focused specific view scan: parasternal short-axis, parasternal long-axis, both left and right outflow tract, and apical 5-chamber view. Coronary-CT confirmed the CAA diagnosis. Two independent physicians retrospective reviewed the echocardiographic images, in a double-blinded fashion (coronary-CT and diagnosis), for performance analysis.

Results
in 2014-18, 5,998 outpatients underwent echocardiography (median age 14 years [6, 21 - IQR]). A total of 27 CAA were diagnosed: overall prevalence 0.0045%, 0.022% of incidence. N = 17/27 were anomalous aortic origin of coronary arteries (AAOCA), N = 3/27 anomalous coronary arteries from the pulmonary artery (ACAPA), and 7/27 fistulas. After the implementation, we found a progressive increment of CAA diagnosis (P for Trend = 0.038), in particular of AAOCA: both left and right coronaries (P-trend = 0.021 and P = trend 0.010, respectively). Our method showed better sensitivity than traditional CAA echocardiographic evaluation: 85% vs 55%, P = 0.032 [AUC 0.77, 95% CI (0.68, 0.87) and AUC 0.92, 95% CI (0.85, 0.99), respectively], with a good interobserver agreement for the adjudicated double-blinded retrospective diagnosis (99.75%, K = 0.73, P &lt; 0.001).

Conclusions
the application of a new echocardiographic-based method for CAA-detection led to a significantly increased rate of identified anomalies. This approach demonstrated better sensitivity than traditional echocardiographic assessment. Implementing this protocol in clinical practice may improve the CAA diagnosis, and probably reduce the occurrence of CAA-related sudden cardiac death.
1164 Echocardiographic diagnosis and clinical significance of Eustachian valve hyperplasia
Authors: Legkonogov A 
Published: January 2020

Abstract

Introduction
Eustachian valve (EV) is an embryological valve residue of the inferior vena cava. Currently, the persistence of an unusually elongated or hyperplastic EV is considered as a stigma of dysembryogenesis.

Purpose
Determine the frequency of detection and clinical significance of EV hyperplasia.

Methods
The analysis and clinical evaluation of 37577 transthoracic and transesophageal Doppler-echocardiographic examinations.

Results
EV hyperplasia was discovered in 97 cases out of 37577 studies, which accounted 0.25% of the total number of patients examined. EV hyperplasia was found to be significantly more common in people younger than 18 years (1.12%), while those which were over 18 years in age, the detection rate of EV hyperplasia was only 0.16% (p &lt;0.001). In those examined, isolated EV hyperplasia was detected in 28 patients, including 20 men and 8 women, with an average age of 16.1 ± 2.2 years. The isolated EV hyperplasia was essentially an echocardiographic finding and was not accompanied by any obvious clinical symptoms. Furthermore, EV hyperplasia was also detected in patients with congenital heart defects - 28 patients, including 13 men and 15 women, with an average age of 30.6 ± 3.5 years. In this category of patients, atrial septal defect prevailed (18 patients), with concomitantly atrial septum aneurysm (3), partial abnormal pulmonary vein drainage (1 patient). Less frequently observed were stenosis of the pulmonary artery (3), ventricular septal defect (2), complete atrioventricular canal (2), Ebstein"s anomaly (1), aortic coarctation (1), bicuspid aortic valve (1). In 17 patients (15 men and 2 women, mean age 20.0 ± 3.1 years), EV hyperplasia was combined with other small heart abnormalities in the context of connective tissue dysplasia syndrome - abnormalities of the chordal apparatus of the left ventricle (9 patients), mitral valve prolapse (3 patients), atrial septal aneurysm (2); in 3 cases, combined small anomalies of heart development occurred. EV hyperplasia was also discovered in 23 patients (12 men and 11 women, mean age 54.9 ± 4.1 years) with various pathologies of the cardiovascular system of ischemic and non-coronargenic origin - 9 patients with chronic ischemic heart disease, post-infarction cardiosclerosis (3), arterial hypertension (2), myocardiofibrosis (2), aortic valve prosthesis (2), infective endocarditis with aortic valve disease (1), mitral valve stenosis (1), aortic aneurysm (1), Kawasaki (1) and WPW syndrome (1).

Conclusion
EV hyperplasia is a rare usually asymptomatic congenital malformation of the heart, occurring predominantly in the young. The most frequent combination of EV hyperplasia is with an interatrial communication. This may indicate a postnatal delay in the closure of the foramen ovale associated with a persistent EV. Echocardiographic features of a hyperplastic EV require differential diagnosis with intra right atrial echo masses, blood clots, vegetations, embryological rudiments.
1174 Coronary flow velocity assessment in routine echocardiography predicts adverse outcomes in three-year period in different subgroups
Authors: Zagatina A , Zhuravskaya N , Guseva O , Kalinina E , Drozdova Y , Yurkin D , Shmatov D 
Published: January 2020

Abstract

Background
The previous diagnostic study had demonstrated high correlation of maximal coronary flow velocity with significant stenoses by invasive methods. There is a lack of information about the prognostic value of local high velocity in coronary arteries during echocardiography. The present study was aimed at investigating the three-year prognostic value of coronary flow assessment in all patients were referred for routine echocardiography examination in different subgroup.

Methods
The prospective study comprises 747 consecutive patients (380 males; age 58 + 13 years) referred to echocardiography. Routine echocardiography was added with coronary flow velocity assessment in the left main (LM), left anterior descending (LAD) or circumflex (Cx) coronary arteries measured by Doppler method. Death, nonfatal myocardial infarction (MI), acute coronary syndrome (ACS) and/or revascularization were defined as major adverse cardiac events (MACE).

Results
During a median follow-up of 36 months, 192 patients experienced 224 MACE. Twenty-six deaths, 16 non-fatal MI, 2 ACS, 180 revascularizations were observed. The value of 67 cm/s maximal coronary flow velocity in the left main/proximal LAD/proximal LCX arteries was the best predictor for death (area under curve 0.79, 95% CI 0.76-0.82), p &lt; 0.0001, and 66 cm/s was the best predictor for death/MI (area under curve 0.81, 95% CI 0.78-0.84), p &lt; 0.0001. A value of 64 cm/s in left main/proximal LAD/proximal LCX arteries was a significant predictor of all MACE (area under curve 0.83, 95% CI 0.79-0.85), sensitivity 73%, specificity 84%, p &lt; 0.0001.
Death/MI/ACS syndrome were observed in the main group in 17% vs. 1% patients with coronary velocity more than 65 cm/s the left main/proximal LAD/proximal LCX arteries vs. patients with less than 65 cm/s, respectively, p &lt; 0.0001.
Arterial hypertension subgroup. Deaths occurred in 9% vs. 1%, p &lt; 0.003. Death/MI/ACS were observed in 11% vs. 1%, p &lt; 0.004.
Subgroup with known CAD. Deaths occurred in 11% vs. 3%, p &lt; 0.04. Death/MI/ACS were observed in 20% vs. 3%, p &lt; 0.0006.
Subgroup of patient with unknown origin chest pain. Deaths occurred in 3% vs. 1%, p – non significant. Death/MI/ACS observed in 9% vs. 0, p &lt; 0.04.
Subgroup with valve disease. Deaths occurred in 17% vs. 0%, p &lt; 0.02. Death/MI/ACS were observed in 17% vs. 0%, p &lt; 0.02.

Conclusion
The coronary velocity parameters give long-term prognostic information that can be used to identify persons with a high risk of MACE in non-selected patients, also as in patients with arterial hypertension, known or suspected CAD, valve disease.
Abstract 1174 Figure.
P1256 Salvage mitraclip implantation for postmyocardial infarction mitral regurgitation: 2 case reports
Authors: Dias Ferreira Reis J P , Mano T , Mendonca T , Portugal G , Ferreira L , Galrinho A , Fiarresga A , Cacela D , Moura Branco L , Ferreira R 
Published: January 2020

Abstract

Introduction
Acute mitral regurgitation (MR) secondary to AMI is associated with a poor clinical outcome. The role of MitraClip implantation (MCI) in this population is still not well established. We report two successful cases of salvage MCI in acute ischaemic MR.
Case Report 1: A 66-year-old diabetic woman was admitted to our institution due to extensive anterior STEMI with cardiogenic shock. Urgent cardiac catheterization (CC) revealed 100% occlusion of the left anterior descending and critical stenosis of the obtuse marginal artery, with successful PCI of both vessels and implantation of an intra-aortic balloon pump. Early transthoracic echocardiogram (TTE) revealed a dilated left ventricle with severe systolic dysfunction (LVEF – 35%), apical and anterior wall akinesia and functional grade IV MR (EROA - 40mm2 and regurgitant volume - 45mL), that was later confirmed by transesophageal echocardiography (TEE). 48h after AMI, the patient developed an arrhythmic storm requiring multiple shocks and a prolonged period of mechanical ventilation. Due to an extremely slow clinical improvement, with the need for prolonged inotropic support and refractory pulmonary congestion (NYHA IV), she was submitted to MCI, resulting in post-procedural grade I MR (EROA 7mm2 and regurgitant volume 11mL) and a marked clinical and hemodynamic improvement. An ICD for secondary prevention was implanted. At the 3 month follow-up the patient presented in NYHA II functional class without congestive symptoms.
Case Report 2: An 82-year old female patient was admitted with an inferior STEMI, with CC documenting severe 3 vessel disease with a calcified occlusion of the right coronary artery, not amenable to PCI, so the patient was submitted to emergent CABG. There was a prolonged period of post-operatory mechanical ventilation with an extremely difficult weaning process, including the need for re-intubation due to acute pulmonary edema. TTE revealed LVEF of 39% with a large inferobasal aneurysm and severe eccentric MR due to tendinous cord rupture. The patient was submitted to MCI with immediate significant improvement of the MR, allowing successful extubation 36 hours after the procedure. In the end of first month of follow-up, the TTE revealed a well-positioned clip with mild-to-moderate MR (EROA – 21.5mm2 and regurgitant volume – 38mL) with the patient being completely asymptomatic.

Conclusion
Treatment of acute MR following AMI with MCI may be a safe and effective approach in critically ill patients. In our experience, it can lead to a rapid clinical recovery and resolution of cardiogenic shock.
P1274 Early surgery versus watchful waiting in patients with moderate aortic stenosis and left ventricular systolic dysfunction
Authors: Moon I , Lee S P , Kim M K , Park J B , Kim H K , Kim Y J , Sohn D W 
Published: January 2020

Abstract
Background
Aortic stenosis (AS) induces significant pressure overload to the left ventricle (LV) and its burden may increase if there is concomitant LV systolic dysfunction. Severe AS with LV systolic dysfunction is a class I indication for aortic valve replacement (AVR) irrespective of symptoms, however, this recommendation is not well established in those with moderate AS and LV systolic dysfunction. In this study, we sought to investigate the clinical impact of surgical AVR among patients with moderate AS and LV systolic dysfunction.
Methods
From 2001 to 2017, we retrospectively but consecutively identified patients with moderate AS and LV systolic dysfunction from a single tertiary hospital. Moderate AS was defined as aortic valve area between 1.0 and 1.5cm2 and LV systolic dysfunction as LV ejection fraction less than 50%. The primary outcome was all-cause death and we additionally analyzed cardiac death as a secondary endpoint. The outcomes were compared between those who underwent early surgical AVR at the stage of moderate AS versus those who were followed without AVR at the outpatient clinic.
Results
Among a total of 257 patients with moderate AS and concomitant LV systolic dysfunction (70.0 ± 11.3 years, 63.4% of male), 34 patients received early AVR. Patients in the AVR group was younger than the observation group (64.2 ± 8.1 vs. 70.9 ± 11.5, respectively), and had a lower prevalence of hypertension and chronic kidney disease. During a mean of 3-year follow up, 112 patients (47.5%) died and the overall death rate was 15.367 per 100 person-year (PY). The AVR group showed a significantly lower rate of all-cause death than the observation group (5.241PY vs. 18.160PY, p-value = 0.002). After multivariable Cox proportional hazard regression adjusting for age, sex, comorbidities and laboratory data, early AVR at the stage of moderate AS significantly reduced the risk of all-cause death (hazard ratio [HR] 0.340, 95% confidence interval [CI] 0.117 - 0.985, p-value = 0.047). However, there was no risk reduction of cardiac death (HR 0.578 95% CI 0.150 - 2.231, p-value = 0.426).
Conclusions
In patients with moderate AS and LV systolic dysfunction, AVR reduces the risk of all-cause death. A prospective design study is warranted to confirm our findings in the near future.
Abstract P1274 Figure. Kaplan-Meier curves for deaths
P1306 A large cardiac mass of left sections in a young man
Authors: Scheggi V , Stefano P L , Alterini B 
Published: January 2020

Abstract

Background
Heart tumors are very rare lesions. Their prevalence is about 0.001 to 0.03 % in an autopsy series.
In most cases, primitive lesions are benign, with atrial myxomas that represent up to 2/3 of cases. Malignant neoplasms have a high mortality; sarcomas are the most frequent typologies. The most aggressive tumors are characterized by greater size, muscle invasion and pericardial effusion.

Clinical case
A 39-year-old man with recent history of worsening dyspnea went to the emergency room because of an aggravation of the symptoms.
An echocardiogram showed a large atrial inhomogeneous mass, adherent to the mitral ring and involving both left atrial and ventricle, causing a severe valvular stenosis, suggestive for malignancy. Thus the patient performed a cardiac-MRI, confirming the neoplasm localization with parietal infiltration, pericardial extension and effusion. A total-body CT scan ruled out metastasis. The patient underwent heart surgery and a partial excision was performed. Macroscopically the tumor had a scirrhous consistency and a diameter of about 5 cm. The histologic examination showed a high-grade sarcoma with fused cells and with condrosarcomatous areas.

Discussion
The study of heart massesincludes the execution of echocardiographies as first-line examinations, while the in-depth diagnostics (necessary in the anticipation of surgery) require cardiac-MRI or CT. Malignant lesions are characterized by an inomogeneous appearance, with a wide plant base and sizes larger than 5 cm, they are also able to take contrast medium during diagnostic examinations. High grade neoplasms are rapidly evolving with a very severe prognosis. The symptoms are essentially due to the localization and the mass bulk. In our case, its development on the mitral valve caused severe hemodynamic impairment, requiring immediate intervention. The treatment of these lesions is necessarily surgical. The only positive prognostic factor is a complete excision of neoplasm with free resection margins. As the diagnosis is often not early, chemotherapy or radiotherapy are often required after surgery.

Conclusion
Cardiac masses are rare entities and their evaluation may be a diagnostic challenge. Myxoma represent the most common primary cardiac neoplasm in adults, while about 25% of other primary ones are malignant. Our patient was suffering from a sarcoma, whose incomplete debulking made further therapies necessary. The correct interpretation of instrumental findings together with a possible radical surgery are mandatory for a successful therapeutic strategy.
Abstract P1306 Figure.
P1318 Clinical utility of global longitudinal strain in acute myocarditis: a case report
Authors: Lai Chin Kon D , Mcconnell O , Andrade I , Simpson A , Luckie M 
Published: January 2020

Abstract
The role of conventional 2D echocardiography in the setting of acute myocarditis is limited as often it reveals no significant changes in global systolic function. Published studies have demonstrated the usefulness of myocardial deformation imaging in acute myocarditis with global longitudinal strain (GLS) being more sensitive in the recognition of myocardial dysfunction even in preserved systolic function and its strong correlation to the amount of myocardial oedema found on cardiac MRI. It also has the advantage of being more readily available, requiring a shorter interpretation time and is significantly cheaper as compared to cardiac MRI. GLS has also been shown to play a role in risk stratification with a lower GLS being associated with a higher rate of major adverse cardiac events (MACE) among all myocarditis cases independent of LV ejection fraction.
We describe a case where there was strong correlation between GLS and myocardial oedema on CMR T1 weighted imaging. A 26 year old with no relevant past medical history presented to hospital complaining of pleuritic sounding chest pain. ECG showed ST segment changes suggestive of pericarditis. White blood cell count and troponin levels were elevated. Echocardiography performed on the same day showed apical akinesia and reduced longitudinal LV function. Global longitudinal strain was an average of -8% and was notably reduced in the apical, inferior, posterior and lateral regions. The overall left ventricular function was normal (55% by bi-plane Simpson"s method).
Cardiac MRI showed normal LV size and function with myocardial oedema in the mid inferolateral, apical inferior and apical anterior segments. These findings were consistent with acute myocarditis affecting the involved segments.
Our case demonstrates that the global longitudinal strain reduction correlated very similarly to the pattern of myocardial oedema in the affected segments and is consistent with similar findings from published studies. GLS by 2D speckled imaging may therefore play an important role in the assessment of acute myocarditis especially in patients with preserved ejection fraction and may help in risk stratification.
Abstract P1318 Figure. combined GLS CMR
P1325 Lymphoma encasing the heart: intra-cardiac or extra-cardiac mass?
Authors: Ahmad S , Lashein M , Khan W 
Published: January 2020

Abstract
A 70-year-old gentleman was referred to our department for atypical chest pains and night sweats. He had an unremarkable past medical history and denied any history of familial disease. There were no complaints of dyspnoea, dizziness or palpitations. A routine echocardiogram showed a suspicious right atrial mass, seemingly extra cardiac in origin. Clinical examination was entirely unremarkable and further investigations were arranged as a matter of urgency.
Contrast echocardiography confirmed a lesion wrapping around the right atrium with possible myocardial infiltration. Trans-oesophageal echocardiography showed extension of the mass into the adjacent atrioventricular groove. The appearances were of a compressive, non-vascular lesion measuring 4.8cm x 5.6cm. Overall cardiac systolic function remained preserved with no significant intra-cardiac abnormalities.
A CT Thorax with contrast was the next step in investigation. This demonstrated nodular soft tissue infiltration of the entire pericardium, mainly involving the right heart chambers with encasement of the aortic root and coronary arteries. Significant lymphadenopathy was also identified suggesting a malignant process.
Cardiac MRI was then performed and this substantiated the findings on CT, raising concern for encasement and external compression of the right coronary artery. Urgent transfer to a tertiary cardiac centre was arranged and subsequent biopsy confirmed histological diagnosis of Stage 4 Lymphoma. After a multi-disciplinary meeting, a non-operative approach was decided. Treatment with steroids and chemotherapy was commenced without delay leading to a significant reduction in the size of the mass.
Abstract P1325 Figure.
P1328 A bridge to sucess
Authors: Ranchordas S , Oliveira P , Madeira M , Marques M , Nolasco T , Aguiar C , Andrade M J , Sousa Uva M , Abecasis M , Neves J P 
Published: January 2020

Abstract
A 36-old-man was admitted in hospital with fever and cough, fatigue, rapidly progressive exertional dyspnoea and orthopnoea. Transthoracic echocardiogram (TTE) revealed a mildly dilated left ventricle (LV) with very low ejection fraction (EF), normally sized right chambers, severe right ventricular dysfunction, moderate tricuspid regurgitation and pulmonary artery systolic pressure (PASP) of 52mmHg. The diagnosis of myocarditis was suspected, and he was transferred to the ICU in our centre to proceed the diagnostic work up. Cardiac magnetic resonance showed a severely dilated LV with an EF of 13% and a transmural fibrotic scar on the lateral wall, without signs of myocardial oedema. There was an apical thrombus. Right ventricular EF was 25%. Coronary angiography showed thrombotic occlusion of the circumflex artery with delayed filling of marginal branches. Endomyocardial biopsy was performed but no myocardial lesion was seen. Temporary inotropic support was needed for low cardiac output. Optimized therapy for heart failure and anticoagulation were given and he received an implantable cardioverter defibrillator before discharge in NHYA class II. Two months later, he was re-admitted in his local hospital, complaining of cough with sputum, fever and shortness of breath. He was hypotensive, tachycardic and cyanotic. Blood workup revealed renal failure, coagulopathy and liver dysfunction with C-reactive protein of 10 mg/dL, but no leucocytosis. NT pro-BNP was 2459 pg/mL. Empirical antibiotics and inotropes were started. TTE revealed an EF of 10-15%, moderate functional mitral regurgitation, right ventricular dysfunction, moderate tricuspid regurgitation, and a PASP of 50 mmHg. He was transferred back to our centre. On admission, he was hemodynamically stable with perfusions of dobutamine and noradrenaline. Work up for inclusion in heart transplant waiting list was initiated. However, he deteriorated rapidly. It was decided to implant a biventricular assist device (BiVAD) for circulatory support as bridge to transplant. A short/medium term assist device was chosen as it was expected that a donor would be found in less than a month, and if this was not the case, it could be upgraded to a medium/long term device. Cannulas for LVAD were introduced on the LV apex and ascending aorta and for RVAD in the femoral vein and pulmonary artery. Good flows were achieved on both devices and there were no complications in the immediate post-operative period. He was extubated and weaned off inotropes on day 2. On day 9, a heart donor was found, and he was transplanted. No complications occurred in the post-operative period. He was discharged home on day 24, and resumed an active life.
This case illustrates the usefulness of temporary devices to bridge critically ill candidates to heart transplantation. Also, it emphasizes the importance of identifying patients who definitely need a BiVAD when end-stage heart failure involves both ventricles.
Abstract P1328 Figure.