bluuebunny/crossref_metadata_2025_split huggingface dataset:
1177 The additive prognostic value of end-systolic pressure-volume relation by CMR in patients with with known or suspected coronary artery disease
Authors: Cavallaro C , De Luca A , Meloni A , Nugara C , Cappelletto C , Grigoratos C , Aquaro G , Barison A , Todiere G , Novo G , Di Sciascio G , Sinagra G , Pepe A 
Published: January 2020

Abstract

Background
The variation between rest and peak stress end-systolic pressure-volume relation is an afterload-independent index of left ventricular contractility. This index is easily obtained during routine stress echocardiography but can be derived also during a stress cardiovascular magnetic resonance (CMR) exam, that is the gold standard for the quantification of biventricular volumes.

Purpose
The aim of this study was to assess for the first time the prognostic value ofdelta rest-stress ESPVR (DESPVR) by dipyridamole stress-CMR in patients with known or suspected coronary artery disease (CAD).

Methods
One hundred and sixty-six consecutive patients (37 females, main age 61.96 ± 10.05 years) who underwent dipyridamole stress-CMR in a high volume CMR Laboratory were considered. Abnormal wall motion and perfusion at rest and after dipyridamole were analysed. Macroscopic myocardial fibrosis was detected by the late gadolinium enhancement (LGE) technique. The ESPVR was evaluated at rest and peak stress from raw measurement of systolic arterial pressure by cuff sphygmomanometer and end-systolic volume by biplane Simpson method.

Results
An abnormal stress CMR was found in 39 (23.5%) patients; 24 patients had a reversible stress perfusion defect in at least one myocardial segment and 15 a reversible stress perfusion defect plus worsening of stress wall motion in comparison with rest. Myocardial fibrosis was detected in 69 patients (41.6%). A DESPVR &lt; 0.009 was detected in 74 patients (44.6%).
During a median follow up of 55.51 months (IQ range 33.20 months), 54 patients (32.5%) experienced major cardiac events: 5 deaths, 2 ventricular arrhythmias, 18 coronary syndromes, and 29 heart failure hospitalization.Reversible perfusion deficit, DESPVR &lt; 0.009, diabetes and family history were significant univariate prognosticators. In the multivariate analysisthe independent predictive factors were reversible perfusion deficit (hazard ratio-HR = 2.17, P = 0.010), DESPVR &lt; 0.009 (HR = 1.92, P = 0.028) and diabetes (HR = 2.42, P = 0.004). The Kaplan–Meier curve for DESPVR is shown in Figure 1. The log-rank test revealed a significant difference (P = 0.003).

Conclusions
DESPRV assessed by CMR provides a prognostic stratification in patients with known or suspected coronary artery disease, in addition to that supplied by reversible perfusion deficit and diabetes.
Abstract 1177 Figure 1
1182 Clinical evidence of the mitral valve leaflet remodeling after st-elevation acute myocardial infarction: longitudinal observation using real-time 3D echocardiography
Authors: Nishino S , Watanabe N , Kimura T , Ashikaga K , Kuriyama N , Shibata Y 
Published: January 2020

Abstract

Background
Mitral valve (MV) leaflet remodeling after acute myocardial infarction (AMI) has been proposed as biological and physiological reaction under the ischemic environment mainly by animal experiments. Clinical evidence of leaflet growth after AMI is lacking.

Purpose
We aimed to assess the clinical evidence of the mitral valve leaflet remodeling after acute myocardial infarction by serial 2D/3D transthoracic echocardiography.

Methods
Sixty-six patients with first-onset ST-elevation MI (33 anterior and 33 inferior) were serially examined by 2D/3D-transthoracic echocardiography. MV complex geometry including leaflet surface area and leaflet thickness was quantitatively analyzed in acute phase and 6-month follow-up.

Results
3D-leaflet surface area was significantly increased in 6-month follow-up (anterior MI; 5.58 [4.93-6.00] versus 5.98 [5.68-6.40] cm²/m²; P &lt; 0.001, inferior MI; 5.48 [4.69-6.07] versus 5.79 [4.74-6.37] cm²/m²; P &lt; 0.001). In anterior MI, both anterior and posterior leaflet lengths significantly increased (anterior leaflet; 12.78 [11.55-13.55] versus 13.63 [12.52-14.15] mm/m²; P = 0.001, posterior leaflet; 9.61 [8.73-10.77] versus 9.84 [8.94-10.96] mm/m²; P = 0.037). In inferior MI, posterior leaflet length significantly increased (9.18 [8.50-10.38] versus 10.00 [8.56-10.85] mm/m²; P = 0.029), while there was no significant change in anterior leaflet length (12.54 [11.61-13.56] versus 12.56 [12.08-14.06] mm/m²; P = 0.214). Leaflet thickness was found to become greater in both groups in 6-month follow-up (anterior MI; 1.08 [0.92-1.21] versus 1.32 [1.25-1.45] mm; P &lt; 0.001, inferior MI; 1.14 [0.98-1.25] versus 1.32 [1.21-1.49] mm; P &lt; 0.001) (Figure).

Conclusions
In six months from the onset of AMI, MV enlarged in area and increased in thickness. Anterior leaflet mainly enlarged in anterior MI, while posterior leaflet enlarged in inferior MI. This is the first clinical evidence of the MV remodeling after AMI, and long-year follow-up should contribute to assess the course of valve growth with relation to ischemic mitral regurgitation.
Abstract 1182 Figure. 3D analysis of the mitral valve
1186 Three-dimensional analysis of right ventricle strain in transplanted hearts and rejection: an ongoing prospective study
Authors: Costa RCPLD , Rodrigues A C T , Fischer C H , Lira-Filho E B , Monaco C G , Afonso T R , Vieira M L C , Caixeta A M , Morhy S S 
Published: January 2020

Abstract

Background
The main obstacle for success after heart transplantation is graft rejection, since is mainly asymptomatic and diagnosed by endomyocardial biopsy (EMB). New echocardiographic technologies could bring benefits to that population if subtle changes in heart mechanics were related to an incipient state of rejection.

Purpose
To quantify echocardiographic parameters of right ventricle strain and volumes by a semi-automated offline software and to identify the presence of any relation between those findings and the histopathologic diagnose of rejection.

Methods
a prospective cohort of 35 postoperative heart transplant patients who were submitted to echocardiographic evaluation up to six hours after EMB, including two-dimensional chamber quantification of left ventricular (LV) volumes and ejection fraction; conventional and tissue Doppler measurements were used for flow and functional analysis. Offline assessment of the right ventricle (RV) was made by TOMTEC software, with the acquisition of RV volumes (EDV, ESV, SV) and ejection fraction, TAPSE, FAC and three-dimensional(3D) RV free wall and septal strain using speckle tracking. EMB results were classified as positive for cellular rejection if graded as 2R (two or more interstitial infiltrate spots and myocyte damage) and positive for humoral rejection if they show any response by immunofluorescence assay.

Results
We studied 35 patients, aged 50 ±11, 21 male (67%), totaling 58 examinations, and then we made two analysis of EMB: one in two groups regarding cellular rejection (53 negative and 5 positive) and other regarding humoral rejection (50 negative and 8 positive). RVEDV was higher in the cellular rejection group (112,5 ± 29,6 ml) compared to those with negative biopsy (86,8 ± 24,7 mL; p = 0,01). RV stroke volume showed a similar behavior (53,5 ± 22,3 mL vs. 34,5 ± 11,3 mL; p &lt; 0,01). Regarding humoral rejection by immunofluorescence, patients who tested positive showed lower RVEDV (79,5 ± 10,5 mL vs. 90,57 ± 27,31 mL; p = 0,02) and RVESV (45,53 ± 6,33 mL vs. 53,87 ± 19,87 mL; p = 0,01). RV free wall strain was lower in the group with positive immunofluorescence (-18,35 ± 2,79% vs. -15,34 ± 5,35%; p = 0,01). Regarding 2D measurements , interventricular septal (11,5 ± 1,06 mm vs. 10,56 ± 1,38 mm; p = 0,02) and left ventricular posterior wall (10,75 ± 1,03 mm vs. 10,04 ± 1,1 mm; p = 0,05) were also thicker in the group with positive immunofluorescence for rejection.

Conclusion
Both cellular and humoral rejection after heart transplantation are associated to increased 3D RV volumes whereas a decrease in RV free wall strain is only observed in humoral rejection; in patients with positive immunofluorescence results a significant increase is seen for septal and posterior wall thickness.
1227 Risk stratification of patients with asymptomatic moderate mitral regurgitation: the prognostic value of left atrial strain
Authors: Cameli M , Pastore M C , Righini F M , Mandoli G E , D"ascenzi F , Lisi M , Nistor D , Sparla S , Curci V , Di Tommaso C , Marino F , Stricagnoli M , Mondillo S 
Published: January 2020

Abstract

Background
In asymptomatic moderate mitral regurgitation (MR), the criteria for risk stratification are still uncertain. Therefore, in these patients, optimal time of surgery remains controversial.

Purpose
Our aim was to compare left atrial (LA) strain to other echocardiographic parameters for the prediction of cardiovascular (CV) events in patients with asymptomatic moderate MR.

Methods
401 patients with primary degenerative asymptomatic moderate MR was enrolled and prospectively followed for the development of CV events (i.e. atrial fibrillation, stroke/transient ischemic attack, acute heart failure, CV death). Patients with history of atrial fibrillation, myocardial infarction, heart failure, cardiac surgery or heart transplantation, severe MR, mitral valve surgery during follow-up were excluded.

Results
During a mean follow up of 3.4 ± 2 years, of the 326 patients eligible (mean age 65 ± 9 years), 122 patients had 149 new events. There were no significative differences in mean age and sex, clinical and therapeutic characteristics between the two groups. The event-group presented reduced global peak atrial longitudinal strain (PALS), LA emptying fraction, LV strain at baseline, and larger LA volume indexed (p &lt;0.0001). Receiver operating characteristics curves proved the greatest predictive performance for global PALS &lt; 35% (AUC 0.88). Bland-Altman analysis demonstrated good intra- and inter-observer agreement and Kaplan Meier analysis showed a graded association between PALS and event-free-survival.

Conclusions
Speckle tracking echocardiography could provide a useful index, global PALS, to estimate LA function in patients with asymptomatic moderate MR in order to optimize surgical timing before the development of irreversible myocardial dysfunction.
Echo-data of our study population Variable No CV events (n = 204) CV events (n = 122) LV ejection fraction (%) 59 ± 9 58 ± 10 LV global longitudinal strain (%) - 18.5 ± 3.4 -17.6 ± 3.6* LA volume indexed (ml/m2) 32.5 ± 6.7 36.4 ± 7.1* LA emptying fraction (%) 68 ± 13 62 ± 15* Mitral E/A ratio 0.94 ± 0.14 0.95 ± 0.16 Mitral E/E’ ratio 11.2 ± 6.5 12.4 ± 7.1 Mitral regurgitant fraction (%) 38.9 ± 8.1 39.1 ± 9.4 End regurgitation orifice area (cm2) 0.34 ± 0.05 0.34 ± 0.06 Global PALS (%) 32.5 ± 8.5 19.7 ± 8.1* *Significative variation between groups. Cardiovascular, CV; Left atrial, LA; Left ventricular, LV; Peak atrial longitudinal strain, PALS
Abstract 1227 Figure. Event-free survival according to PALS
P1244 Mitral valve abscess caused by Klebsiella pneumoniae in a patient with diabetes melitus
Authors: Mekhryakov S , Kulesh A , Syromyatnikova L 
Published: January 2020

Abstract

Introduction
Infective endocarditis (IE) still leads to high mortality, despite the achievements of modern medicine. Particular attention should be paid to the group of patients in whom the occurence of IE is caused by rare atypical bacteria, such as Klebsiella pneumoniae. It is known that Klebsiella is the cause of IE in only 1.2% of cases in patients with native valves (Anderson MJ, Janoff EN, 1998), at the same time disease proceeds extremely aggressive.
Case presentation
Patient M., 47 years old, complained of shortness of breath, fever up to 40 degrees Celcius and general weakness. In medical history patient had diabetes melitus (DM) for a 15 years. 10 days before hospitalization the patient was subjected to hypothermia, after that he noted the appearance of fever, chills and general weakness. 4 days after the symptoms appears he turned to a general practitioner and was diagnosed with acute respiratory viral infection. Since the patient did not notice the effect of treatment for 5 days (general weakness and fever persisted, shortness of breath appeared), he called an ambulance and was taken to our clinic with suspected pneumonia. Conducted computer tomography (CT) revealed no signs of pneumonia. During hospitalization, transthoracic echocardiography (TTE) was performed. There was no heart disease in the patient"s medical history. TTE revealed the hyperechoic mobile mass (15x15 mm) on the posterior cusp of a mitral valve. Mitral regurgitation was within physiological range. For the verification, patient was recommended to undergo transesophageal echocardiography (TEE), but he categorically refused this examination. Against the background of ongoing antibiotic therapy fever persisted. Subsequently, the patient was consulted by a neurologist about a complaint of double vision, and a brain CT was performed and revealed acute infarction in the right occipital lobe. Stroke was regarded as cardioembolic. The patient"s condition progressively worsened, miltiple organ failure was increasing, he was intubated and transferred to the intensive care unit. We performed an ultrasound as heart murmur appeared. TEE revealed a large hyperechoic formation 30x30 mm with anechoic collapsing cavity in the center and defect in the posterior cusp up to 20 mm, mitral regurgitation reached 4 degrees. Despite adequate therapy the patient"s condition progressively worsened, and the next morning biological death was diagnosed. The autopsy results confirmed IE caused by Klebsiella pneuminiae.

Conclusion
Our clinical case shows that we cannot neglect a small percentage of cases of IE caused by such atypical bacteria as Klebsiella. The disease in this case was extremely severe and difficult to treat, which can be explained by the tendency of patients with DM to the occurence of infections.
Abstract P1244 Figure.
P1250 Thymoma invading the right atrium - multimodality imaging and its importance for managing and therapeutics
Authors: Ferreira V , Bravio I , Moura Branco L , Ranchordas S , Duarte X , Pedro C , Abecasis N , Neves J , Castelo A , Garcia Bras P , Cruz Ferreira R 
Published: January 2020

Abstract

Introduction
Thymoma is the most common primary neoplasm of the anterior mediastinum. Most invasive thymomas are limited to the pericardium. Only few cases of transcaval extension with intracardiac involvement have been reported.

Case report
We present the case of a 15-year-old boy with previous history of infectious cerebelitis without neurologic sequelae. He presented with interscapular pain for 6 weeks (not improving with symptomatic therapy) and fever for 3 days. On admission, chest radiograph exhibited an opacification in the right hilum (Figure A). He was discharged with antibiotic prescription for presumptive pneumonia. Due to persistence of complaints he was revaluated after 5 days. Signs of superior vena cava (SVC) syndrome were noted. A computerized tomography showed a large soft tissue mass of the anterior mediastinum, in right antero-lateral topography, measuring 12.5x10x9.5 cm with central calcification and extension to the right lung (Figure B). Transthoracic and transoesophageal echocardiography showed an anterior mass compressing the pulmonary artery branch (PA) and SVC with marginal invasion of the right atrium (RA) (Figure C and D). Cardiac MRI confirmed a large mass of the anterior mediastinum with extension and invasion of the right superior lobe, invasion of the superior vena cava with extension into the RA (Figure E). Transthoracic core-needle biopsy was performed and histopathological diagnosis confirmed an invasive thymoma. The case was discussed at joint cardiothoracic surgery and oncology multidisciplinary meeting and it was agreed to neoadjuvant chemotherapy regimen followed by surgery. Intraoperatively, a large tumor invading the SVC and proximal RA was found, in accordance with the echocardiographic and MRI findings. Due to unforeseen metastatic implants on the adventitia of the main PA and ascending aorta, resection of the tumor was not performed. Palliative decompression of the venous system was performed with interposition of a ringed vascular prosthesis between the left brachiocephalic vein and the right atrial appendage. (Figure F). The patient received postoperative radiotherapy and is asymptomatic without signs of SVC syndrome for 3 months.

Discussion and conclusion
This report illustrates a rare case of an invasive thymoma with extension to cardiac structures. Multimodality imaging for quality decision-making was imperative in the management and for surgical planning of this case. Transthoracic and transoesophageal echocardiography remain the exams of choice for the diagnosis of intracardiac disease. As demonstrated, a high index of suspicion is needed because clinical symptoms are unspecific and late diagnosis of potentially resectable tumors are associated with a poor prognosis.
Abstract P1250 Figure. Multimodality imaging
P1252 Left ventricular dysfunction masking symptoms of acute aortic dissection in a postpartum woman with peripartum cardiomyopathy: a case study
Authors: Wahjoepramono N , Hasan M , Prameswari H S , Dewi T I , Martanto E 
Published: January 2020

Abstract
Acute aortic dissection carries a high mortality rate if left unrecognized and untreated, however only 60-70% of cases are accurately diagnosed in the early stages of hospital admission. This condition rarely occurs in young women but may manifest in the presence of predisposing factors such as pregnancy and preeclampsia; in which hormonal and hemodynamic alterations, exacerbated by high blood pressure, may adversely affect the aortic intima. Acute chest pain in pregnancy may caution physicians and warrant further examination, but left ventricular dysfunction can mask symptoms commonly associated with aortic dissection and delay timely diagnosis.
We present a 27-year old woman with acute aortic dissection confounded by peripartum cardiomyopathy. The patient was admitted for respiratory distress ten days after delivery by caesarean section due to severe preeclampsia. She had no complaints of chest or interscapular pain, and initially assessed with peripartum cardiomyopathy. Plain chest radiography showed cardiomegaly without mediastinal widening. Trans-thoracal echocardiography revealed severely reduced left ventricular function and a regurgitant, dilated aortic root with a visible intimal flap. Computed Tomography examination confirmed an aortic dissection Stanford Classification A extending up to the renal arteries.
Patients with acute aortic dissection may not always demonstrate classic signs or symptoms, especially when a different entity obscures the progression of disease. Nonetheless, acute aortic dissection is a life-threatening disease, and require immediate recognition. Pregnant women are at a risk towards developing a dissected aorta and different imaging modalities must be promptly utilized, even when present with atypical symptoms, to exclude such catastrophic events.
P1263 Acute cerebrovascular infarct in a young adult with double septal defect and double outlet ventricle
Authors: Nacional K , Lorilla R , Bagaoisan K E 
Published: January 2020

Abstract

Introduction
Double outlet right ventricle is a rare cause of acute cerebrovascular disease among young adults.
Case. We report a case of a 21 year old male who presented with aphasia and left sided weakness. This was associated with cyanosis, easy fatigablity, recurrent epistaxis and loss of consciousness since childhood. On admission, patient’s vital sign was stable at 100/60, 90 bpm regular, 20 cycles per minute afebrile 80% oxygen saturation on room air. Patient is conscious, aphasic but follows simple commands. He had central cyanosis, clubbing of the upper and lower extremities, adynamic precordium, single s2, right ventricular heave, grade 3/6 systolic ejection murmur at the 2nd left intercoastal space parasternal line, 4/6 holosystolic murmur at the 4th intercoastal space parasternal line, and clear breath sounds. Neurologic examination revealed a 0/5 motor response on both left upper and lower extremity. Cranial MRI showed acute ischemic infarcts at the right frontal centrum semiovale and left cerebral hemisphere. During his admission, cardiac work up was done to investigate cardioembolic cause of the acute cerebrovascular disease. Transesophageal echocardiogram revealed congenital heart disease situs solitus with atrioventricular discordance; double outlet right ventricle, pulmonic valve stenosis, interatrial septal aneurysm with atrial septal defect and persistent left superior vena cava syndrome. During his hospital course, patient was started on aspirin, citicholine and atorvastatin for his cerebrovascular disease which was noted to improve after 2 days. Patient was also referred to the thoracovascular surgery team for comanagement who did modified Blalock Tausig shunting. Patient was referred to cardiac rehabilitation post procedure. His vital signs remained to be stable, his oxygen saturation increased to 90% at room air, and his functional capacity improved. Patient was discharged stable.

Discussion
Double outlet right ventricle is a rare complex congenital heart disease characterized by a conotruncal malseptation from which more than or equal to 50% of each great artery arises from the morphologic right ventricle. Associated defects like atrial septal defect and persistent left superior vena cava were reported in some literature. Cerebrovascular infarcts in complex cyanotic congenital heart disease might be secondary to polycythemia and/or paradoxical emboli bypassing the interatrial defect. Prompt prophylaxis such as periodic phlebotomy and/or anticoagulation in patients high risk for deep vein thrombosis must be evaluated for each patient.
P1271 Systolic dysfunction in obese and extreme obese patients and preliminary results after bariatric surgery
Authors: Tsonev S , Kuneva Z , Grozdev K , Gateva A , Kamenov Z , Vasilev D 
Published: January 2020

Abstract

Background
Obesity is known to be associated with left ventricular (LV) diastolic dysfunction, heart failure and some risk factors for early atherosclerosis: diabetes mellitus, arterial hypertention, dyslipidemia. Very few studies investigate extremely obese patients and how this condition impairs LV systolic function.
The aim of the study is to explore the effect of obesity and extreme obesity on LV systolic function in patients without diabetes mellitus and the effect of bariatric surgery on that function.

Methods
We prospectively investigated 55 patients with obesity class 1 and 2 and 23 patients with extreme obesity who underwent bariatric surgery. The participants were grouped according to body mass index (obesity class 1 and 2 BMI ≥ 30 ≤ 40 kg/m2 and extreme obesity ≥ 40 kg/m2). Systolic function was assessed by ejection fraction by Simpson and Teicholz, global longitudinal strain, Tei index.

Results
In the studied groups statistical analysis proved the relation between all investigated echographic parameters and BMI. The mean left ventricular ejection fraction and GLS values were 55% (±10%) vs. − 17.3% (±3.3%) for obese and 51% (±8%) vs. − 16.5% (2.3%) for extreme obese (p &lt; 0.05).
Patiets with extreme obesity, who underwent bariatric surgery increased LV ejection fraction faster and more than patients who underwent only diatry and medical treatment. 5.0 (9.0) % vs. 3.0 (10.0) % (p &lt; 0.05).

Conclusion
Obesity and extreme obesity impair all studied parameters for LV systolic function. Bariatric surgery is treatment option for extreme obesity patients and a possibility for significant and fast improvement of LV systolic parameters.