bluuebunny/crossref_metadata_2025_split huggingface dataset:
1100 When multimodality imaging is needed to understand the etiology of diffuse negative t waves
Authors: Giuca A , Bica R , Rosca M , Stanciu S , Popescu B A , Jurcut R 
Published: January 2020

Abstract

Introduction
We present the case of a 50 year old woman, active smoker, hypercholesterolemic, nondiabetic, with normal body mass index, referred to our cardiology department for atypical chest pain and ECG changes (diffuse negative T waves in V1-V6, DII, DIII) (Panel A), also present on a resting ECG recorded 4 years previously.

Purpose
To highlight the fact that even though the most frequent cause of negative T waves remains coronary artery disease (CAD), the cause could be related to other more rare medical conditions.

Methods
After clinical examination and ECG, 2D echocardiography was performed. It revealed a normal sized left ventricle (LV) with perserved global and regional function, normal global longitudinal strain, nondilated atria and no significant valvular disease. The subcostal view suggested a hypertrophied right ventricle (RV) free wall (10 mm thickness, with apparent homogeneous echogenicity) (Panel B, arrow), with normal longitudinal function and no regional wall motion abnormalities.
Cardiac magnetic resonance (CMR) was performed for a better tissue characterization. The CMR examination found normal cardiac cavities, normal wall thickness of both ventricles (RV free wall of 3 mm), no late gadolinium enhancement, but described a large amount of fat with concentric disposition, maximum thickness of 9 mm anterior of RV, 3 mm posterior of LV (Panel C).
Since this was not fully explaining the ECG changes and the patient presented with a low-intermediate pretest probability for CAD, an angio-CT coronary scan was performed and showed a calcium score of 7 AU, no significant coronary atherosclerosis, and a hypoplastic circumflex artery (Panel D, arrow). A total volume of 149 ml. of pericardial fat was measured (Panel E).
Stress echocardiography was performed with maximal workload achieved (145 bpm, 85% predicted, 100 W); no chest pain was reported, no regional wall motion abnormalities were seen and there was normal contractile reserve.

Results
Using multimodality imaging a differential diagnosis was followed, which included: arrhythmogenic cardiomyopathy (negative T waves, apparent changes of RV free wall on echo, but no family history of sudden cardiac death), CAD (atypical angina, cardiovascular risk factors, negative T waves), and pericarditis (but negative inflammatory markers, no pericardial fluid). The final hypothesis is that the ECG changes are related to the abnormal pericardial adipose tissue deposit, which acts similar to pericarditis.

Conclusions
The present case report is, to our knowledge, the first to describe an association between large pericardial fat deposit and ECG changes, when other causes were excluded. Even if the current findings are benign, the patient should be followed closely, and risk factors should be thoroughly controlled, as several studies have shown that pericardial fat is associated with poorer cardiovascular prognosis
Abstract 1100 Figure. Multimodality imaging in our patient
1106 Twins with uncertain significant mutations, slightly different cardiomyopathies and different oucmes
Authors: Blasco Turrion S , Guillen Rodriguez I , Moruno Tirado A , Mendez A , Valverde Perez I 
Published: January 2020

Abstract
Dilated cardiomyopathy (DCM) is defined as left ventricle (LV) dilatation and dysfunction in the absence of abnormal loading conditions or coronary artery disease enough to cause global systolic impairment. It is the leading cause of heart failure and sudden cardiac death, and even in the early stages of life 5,7/1.000.000 children are diagnosed each year. Lately, genetic screening has revealed that 30-50% of the cases have a familial origin, with a high genetic heterogeneity.
We present the case of a 4-month-old boy (case A) referred to our Hospital with high suspicion of dilated cardiomyopathy. He had a twin brother, pregnancy went without complications, pre-birth ultrasound and blood tests were completely normal and a caesarean birth was planned at 37 weeks of pregnancy. He also has an older sibling with no medical history. Our patient was the first to be born and was admitted to the neonatal-ICU due to tachypnea, labored breathing and desaturation. In the physical exam a 5cm hepatomegaly was detected and on the X-Ray a cardiomegaly and enlarged mediastinum were confirmed. ECG showed no electrical abnormalities besides vague repolarization changes. A TTE was done, showing remarkable left cavities enlargement with severe left ventricle dysfunction and moderate mitral regurgitation, comprising the right filling and therefore the right cardiac output. These findings were confirmed by MRI, not detecting enhancement patterns compatible with myocarditis. A genetic test was performed in the index case detecting the presence of a mutation in the desmin gene (Des C.568 + 10c) and the myosin heavy chain 7 gene (Myh7p - glu883Ala) both associated either with dilated and noncompaction cardyomiopathies. Due to the elevated chances of a familiar-DCM his twin brother was admitted to study (case B), with no symptoms or clinical signs besides an isolated bronchitis episode. The clinical examination and EKG were normal, detecting in the TTE a slightly dilated left ventricle with non-compactation morphology in the LV lateral wall, but no left ventricle dysfunction. Also, a TTE was performed in their father with similar findings: mild LV dilatation with minor systolic disfunction and uncertain non-compactation morphology in the LVl apex.
Abnormalities of specific genes are now known to be responsible for different types of congenital heart diseases with important implications in genetic counseling. We want to emphasize the different manifestation of a single mutation on different members of a family, even in this two twin-brothers that, under the same probable conditions during preganancy, had slightly different cardyomyopathies but very different severity, and probable mid to long term prognosis.
Abstract 1106 Figure.
1112 Discovering the origin of a mysterious heart cavity
Authors: Vidal Urrutia V , Garcia Gonzalez P , Perez Bosca J L , Escribano Alarcon D , Simon Machi J M , Gradoli Palmero J , Abdala Lizarraga J , Fernandez Diaz C , Vano Bodi J , Sanchez Alvarez S , Cardenas Tealdo J P , Paya Serrano R 
Published: January 2020

Abstract
Left atrial appendage aneurysm is an infrequent cardiac malformation, with less than 150 cases reported in the literature. It is a congenital anomaly in the majority of cases, related to a dysplasia of pectinate muscles and atrial muscle bands, which tends to grow with age. At the present time, and despite of being not considered in current guidelines, surgical resection is the standard of treatment in the current literature, even in asymptomatic cases, based on cardiovascular morbidity and mortality by predisposing to atrial tachyarrhythmia, thromboembolism, and other rare conditions as coronary or left ventricular compression and rupture of the aneurysm.
We report the case of a 53-year-old male patient presenting an episode of supraventricular paroxysmal tachycardia with the casual finding of a mysterious cavity in the transthoracic echocardiography. We found out the presence of a 50 mm cavity adjacent to the left atrium and left ventricle, with a bidirectional blood flow between the left atrium and the cavity when applying Doppler color and with contrast echocardiography.
Given this finding, several differential diagnosis had to be considered, including vascular and structural disorders. In order to clarify the diagnosis, a cardiac magnetic resonance was performed. It revealed the presence of a huge aneurysm of the left atrial appendage (50 x 53 mm) causing a mild compression of the left ventricle, with no thrombus and no other significant findings.
Due to its size, the compression of the left ventricle and the history of atrial arrhythmia we decided to manage it with an invasive approach by performing a middle thoracotomy, in order to prevent potentially serious complications.
Abstract 1112 Figure. CMR 3D reconstruction; echocardiography
1114 NSTEMI originated from an insulin injection needle
Authors: Kim J H 
Published: January 2020

Abstract
A fifty-eight-old previously healthy woman presented to the emergency department with chest pain radiating to the retrosternal area on her way to work. Initial ECG showed no ST-T segment change, but the troponin level was elevated.
Urgent coronary angiography demonstrated normal coronary arteries. Ergonovine provocation was also undergone, and no coronary spasm was provoked. During angiography, a fine mobile artifact near the distal portion of left anterior descending artery was observed (Figure A and B, yellow arrow). Her chest wall was fully clear without recent injury. She didn"t receive any acupuncture treatment or is not an intravenous drug user. She is a factory worker making insulin injection needle.
Echocardiography showed a hyperechogenic sharp foreign body penetrating interventricular septum with color jet (Figure C and D, yellow arrow). No pericardial effusion was observed.
She underwent surgery to remove the foreign object. A fresh fine needle approximately 23 mm-long was entirely removed without extensive dissection under fluoroscopic guidance (Figure E and F).
Her symptom was fully resolved after removing the needle and she discharged without further event.
Abstract 1114 Figure.
1165 Anomalous origin of the coronary artery arising from the opposite sinus: clinical impact and prognosis
Authors: Vallejo Garcia V , Martin Garcia A C , Blanco Fernandez F , Martin Garcia A , Castro Garay J C , Sanchez Fernandez P L 
Published: January 2020

Abstract
Anomalous origin of the coronary artery arising from the opposite sinus (ACAOS) is an infrequent congenital heart disease (CHD). Clinical presentation is variable and there is controversy over its treatment in relation to the affected coronary artery and the type of path. Our objective was to analyze the anatomical characteristics of ACAOS, their clinical impact and prognosis.
We selected all patients with diagnosis or confirmation of diagnosis of ACAOS by computerized tomography (CT) in our center between 2014-2019, excluding complex CHD. Their baseline characteristics, tests for ischemia and follow-up were analyzed.
40 patients were diagnosed of ACAOS, and 26 had a simple coronary anomaly (mean age 54 years, 65% male). The most prevalent ACAOS was the right coronary artery (47%) followed by left main (27%). 42% had an inter-arterial path. Figure. Atherosclerosis on the ACAOS was similar to native arteries (p= &gt;0,05). 11 of 18 (61%) patients with follow-up in our center had ischemia testing (23 tests). Only 22% were positive. 6 patients had a revascularization procedure (3 surgical, 3 percutaneous) and 83% included an intervention on the ACAOS. During follow up there were 13 major cardiovascular events (MACE). We observed a tendency to a higher number of MACE in patients with an interarterial path, although it was not statistically significant (p = 0,06). One patient died of a non-cardiac cause during follow-up. Only 4/18 patients (22%) had follow-up in the Adult CHD clinic.
In our population ACAOS did not have statistically significant differences in the development of atherosclerosis compared to native arteries, tests for ischemia were mostly negative but there was a significant number of MACE so it is necessary to implement patient follow up in the specialized Adult CHD clinic.
Baseline characteristics Hypertension 8 (35%) Type II diabetes mellitus 5 (22%) Dyslipidemia 9 (31%) Smoking history 10 (46%) Alcohol abuse 5 (22%) Previous symptoms 20 (80%) Ischemia on complementary tests 1 (8%) Diagnosis by coronariography 5/26 (19%) Diagnosis by computerised tomography 21/26 (81%) Anomalous artery atherosclerosis Moderate to severe atherosclerosis 10/26 (38,5%) 5/10 (50%) Native artery atherosclerosis Moderate to severe atherosclerosis 11/26 (42,3%) 6/11 (54,6%)
Abstract 1165 Figure.
1173 Additional role of FFRct and stress CT perfusion in the management of patients with stable chest pain compared to cCTA alone
Authors: Baggiano A , Guglielmo M , Muscogiuri G , Fusini L , Del Torto A , Andreini D , Mushtaq S , Conte E , Annoni A D , Formenti A , Mancini E , Guaricci A I , Bartorelli A L , Pepi M , Pontone G 
Published: January 2020

Abstract

Background
Computed tomography-derived fractional flow reserve (FFRCT) and stress computed tomography perfusion (stress-CTP) are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using coronary computed tomography angiography (cCTA).

Purpose
This study sought to determine the effect of adding FFRCT and stress-CTP to cCTA alone for assessment of lesion severity and patient management of patients
referred for chest pain.

Methods
289 patients with stable chest pain scheduled for clinically indicated invasive coronary angiography (ICA) plus invasive FFR were evaluated with cCTA, FFRCT, and stress-CTP. Of 289 patients, 147 underwent static stress-CTP, while 142 were evaluated with dynamic stress-CTP.
Management plan with optimal medical therapy (OMT) or percutaneous coronary intervention (PCI) for each patient according to results of each non-invasive technique was recorded, and then compared to what effectively applied according to results of reference standard technique (ICA + FFR). The primary endpoints for the study were the correct allocation of patients to OMT or PCI using cCTA, cCTA + FFRCT and cCTA + stress-CTP, and the correct assessment of non-invasive techniques for all three vessels in relation to angiographically and FFR-defined significance.

Results
Compared to cCTA alone, the addition of FFRCT and stress-CTP to cCTA alone increased the agreement in allocating patients to OMT from 24% to 38% and 44%, respectively, while the addition of FFRCT and stress-CTP to cCTA alone increased the agreement in allocating patients to PCI from 29% to 32% and 36%, respectively. Using ICA + FFR as standard reference, cCTA showed agreement for all three vessels in 56% of patients, while combined approaches of cCTA + FFRCT and cCTA + stress-CTP showed agreement in 66% and 82% of patients, respectively.

Conclusions
The addition of functional assessment with FFRCT or Stress-CTP to cCTA has a substantial effect on the evaluation of the relevance of coronary artery disease and therefore on the management of patients compared to cCTA alone.
1176 Coronary inflammation by CT peri-coronary fat attenuation in MINOCA and Tako-Tsubo syndrome
Authors: Gaibazzi N , Martini C , Botti A , Pinazzi A , Bottazzi B , Rendina R , Palumbo A A 
Published: January 2020

Abstract

Funding Acknowledgements
Nothing to declare

OnBehalf
None

Background
Peri-coronary fat attenuation index (pFAI) has emerged as a clinical marker of coronary
inflammation, which is measurable from standard coronary CT angiography (CCTA). It compares
well with gold-standard methods for the assessment of coronary inflammation and can predict future
cardiovascular events. pFAI could prove invaluable to differentiate an inflammatory from noninflammatory coronary artery status, helping unravel the mechanisms subtending an event classified as myocardial infarction with nonobstructive coronary arteries (MINOCA) or Tako-Tsubo syndrome (TTs).

Methods and Results
Patients admitted with MINOCA and TTs diagnosis between 2011 and 2018,
who had both CCTA and CMR performed during or shortly after the acute phase, were selected and
pFAI measured in their index CCTA. pFAI was also measured in a control subjects who had CCTA
for atypical chest pain work-up, no obstructive coronary artery disease found in their CCTA and no
cardiac events at a minimum 2-year follow-up.
In the n = 106 MINOCA/TTs patients selected, mean pFAI averaged for the 3 coronary arteries was -68.37 ± 8.29 vs -78.03 ± 6.20 in the n = 106 controls (p &lt; 0.0001) and the statistical difference was
confirmed also when comparing mean pFAI in each single coronary artery between MINOCA/TTs
and controls (p &lt; 0.0001). Non-obstructive coronary plaques at CCTA, and high-risk plaques in
particular, were also more frequently found (p &lt; 0.01) in the MINOCA/TTs group compared with
controls.

Conclusions
In MINOCA and TTs patients, CCTA is not only able to detect otherwise angiographically invisible atherosclerotic plaques, but its diagnostic yield can be further expanded using the simple off-line measurement of pFAI for the characterization of peri-coronary fat tissue. In MINOCA/TTs mean pFAI clearly demonstrates higher values in comparison with controls, a finding which has been previously associated with coronary artery inflammation. We speculate that this newly-available diagnostic tool in the future may help select patients for new therapies, for example therapies targeting coronary inflammation.
I was able to build a table.
Abstract 1176 Figure.
1178 High coronary wall shear strain developed more vulnerable plaque compared to low shear strain: a systematic review and meta-analysis
Authors: Bajraktari A B , Bytyci I B , Elezi S E , Henein M Y H 
Published: January 2020

Abstract

Background and Aim
Arterial wall strain has been proposed to impact the features of developed plaques. The aim of this meta-analysis is to assess the impact of different types of wall shear strain (WSS) on the changes of vulnerable plaque in coronary artery disease (CAD).

Methods
We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, from 1989 up to May 2019 in order to select clinical trials and observational studies, which assessed the relationship between WSS measured by intravascular ultrasound (IVUS) and morphology of plaque in CAD.

Results
In 7 studies, a total of 724 patients with 32,083 segments were recruited, with mean follow up 8.4 months. The pooled analysis showed that low WSS was associated with larger baseline lumen area WMD 2.55 [1.34 to 3.76, p &lt; 0.001], smaller plaque area WMD -1.16 [-0.1.84 to -0.49, p = 0007] and necrotic core area WMD -0.45 [-0.78 to 0.14, p = 0.004], dense calcium score WMD -0.18 [-0.46 to 0.10, p = 0.01], and fibrous area WMD -0.79 [-1.84 to 0.30, p = 0.02] as well as smaller fibro-fatty area WMD -0.22 [-0.57 to 0.13, p = 0.02] compared to high WSS.
At follow-up, the high WSS had regression of fibrous area, WMD -0.12 [-0.22 to -0.02, p = 0.02] and fibro-fatty area WMD -0.11 [-0.23 to -0.01, p = 0.04], reduction of plaque area WMD -0.09 [-0.17 to -0.02, p = 0.01] and increased dense calcium WMD 0.08 [0.02 to 0.14, p = 0.006] and necrotic core area WMD 0.07 [0.01 to 0.13, p = 0.03] compared to low WSS (Figure 1). The high WSS developed more profound remodeling compared to low WSS (40 vs. 18%, p &lt; 0.05) with more constructive remodelling with low WSS (78%vs. 40 %, p &lt; 0.01). Conclusions. Baseline high WSS is associated with higher necrotic core, calcium, fibrous and fibro-fatty area compared with low WSS, and during follow up the high WSS resulted in the development of more profound remodeling compared with low WSS. These findings highlighted the role of IVUS in detecting the vulnerable plaque in CAD.
Abstract 1178 Figure 1. Mean change of plaque morpholo
1180 2D and 3D assessment of the left ventricle volume and ejection fraction in a general population
Authors: Ericsson F , Tayal B , Hay Kragholm K , Zaremba T , Holmark Andersen N , Mogelvang R , Hagendorff A , Soegaard P 
Published: January 2020

Abstract

Introduction
In standard practice, LV volumes and EF are estimated by 2D technique. 3D echocardiographic assessment seems more reliable; however, this method has not yet been validated in the general population.
Purpose
To validate 3D echocardiography in a large population sample and investigate differences between 2D and 3D LVEF and volumes
Methods
In The Copenhagen City Heart Study, 4466 echocardiograms were available for analysis. The echocardiograms were obtained during four consecutive heartbeats in both 2D and 3D with GE Vivid E9. Offline analysis was performed on EchoPac v. 201. LVEF was calculated by the modified Simpsons Biplane Auto EF for 2D and by the 4LVQ method for 3D.
Results
The study included 2090 echocardiograms. The mean 2D LVEF was 57.3 ± 6.1% (IQR 54 - 61%) and 51.7 ± 7.9% (IQR 47 - 57%) by 3D. The mean end-diastolic volume (EDV) and end-systolic volume (ESV) by 2D and 3D techniques were: EDV 2D 106.1 ± 29.6 ml vs EDV 3D 128.2 ± 32.3 ml , ESV 2D 45.7 ± 15.6 ml vs. ESV 3D 45.7 ± 20.7 , p &lt; 0.05 among all variables.
The average difference of means between 2D and 3D LVEF was 5.6 ± 11.2%, -22.1 ± 56.8 ml for EDV, and -16.9 ± 32.9 ml for ESV.
The correlation coefficient for LVEF was 0.42, EDV 0.76 and for ESV 0.70.

Conclusion
In our study, we found a significant difference in both LVEF and ventricular volumes when comparing 2D echocardiograms with 3D. 3DE had, in general, lower LVEF, higher EDV and ESV compared to 2D.
Table 1: Summary of results Table 1 - Summary of results n = 2090 Variable Min Max Mean IQR (25-75) p-value LVEF, 2D (%) 18 76 57.3 ± 6.1 54-61 &lt; 0.05 LVEF, 3d (%) 13 77 51.7 ± 7.9 47-57 &lt; 0.05 EDV, 2D (ml) 13 275 106.1 ± 29.6 85-123.8 &lt; 0.05 EDV, 3D (ml) 50 270 128.2 ± 32.3 106-148 &lt; 0.05 ESV, 2D (ml) 15 150 45.7 ± 15.6 35-54 &lt; 0.05 ESV, 3D (ml) 13 185 45.7 ± 20.7 48-74 &lt; 0.05 LVEF: left ventricle ejection fraction, EDV: end-diastolic volume, ESV: end systolic volume, IQR: Inter-quartile range
Abstract 1180 Figure 1: Correlation and BA-plot
1230 The atrial stiffness index in hypertensive women with indeterminate diastolic function
Authors: Kolesnyk M Y , Sokolova M V 
Published: January 2020

Abstract

Background
Despite new 2016 ASE/EACVI guidelines on diastolic function (DF), there is still significant amount of patients with indeterminate results. The left atrial (LA) longitudinal strain could provide additional information in case of inconclusive results. Recenty, a new LA stiffness index was proposed as ratio between E/e" and LA global longitudinal strain (GLS). The purpose of this study was to test the diagnostic utility of LA stiffness index in hypertensive women with inderterminate DF.

Methods
The study enrolled 100 postmenopausal women (mean age 57 ± 4 years) with uncomplicated arterial hypertension, divided into 3 groups (normal DF, indeterminate DF, diastolic dysfunction). The DF was assessed with both 2009 and 2016 ASE/EACVI algorithms. LA longitudinal strain was measured as peak of deformation curves with R-wave variant of ECG triggering. The LA GLS was measured by averaging 12 segmental values. The atrial stiffness index was calculated as E/e" ratio to LA GLS.

Results
The prevalence of indeterminate DF was higher with assessment by 2016 algorithm (53 % vs 38 %). The E/e" ratio was significantly increased in patients with indeterminate DF compared to normal function (Table). LA GLS was decreased only in patients with inconclusive resuts by 2009 algorithm. LA stiffness index was increased gradually according to diastolic abnormalities severity. The significant difference between three groups was only found with categorization of patients by 2016 algorithm.

Conclusions
The novel LA stiffness index could be additional parameter of DF assessment in case of indeterminate results. However, it needs further validation in simultaneous echo-invasive studies.
LA mechanics in diastolic dysfucntion Parameter Normal diastolic function Indeterminate function Diastolic dysfunction p 2009 guidelines Prevalence, % 31 38 31 E/e" ratio 8,07 (7,36-9,6) 9,91 (8,44-11,6)* 11 (10,52-13)*^ p &lt; 0,0001 LA GLS, % 34,8 (30,2-39,9) 30,8 (26,5-34,9)* 28,9 (24,2-36)* p = 0,028 LA stiffness index 0,24 (0,18-0,31) 0,32 (0,27-0,39)* 0,37 (0,31-0,46)* p &lt; 0,0001 2016 guidelines Prevalence, % 40 53 7 E/e" ratio 8,8 (7,74-10,1) 10 (8,6-11,7)* 14 (12-14,9)*^ p &lt; 0,0001 LA GLS, % 34,2 (28,4-39,1) 30,8 (26,5-34,8) 29,6 (25,1-37,8) p = 0,18 LA stiffness index 0,27 (0,2-0,34) 0,33 (0,27-0,4)* 0,47 (0,38-0,59)*^ p = 0,001 The values are given as median and interquartile range. * - compared to normal function ^ - compared to indeterminate result