bluuebunny/crossref_metadata_2025_split huggingface dataset:
P734 Feasibility and accuracy of the new automated software dynamic heart model in an unselected population
Authors: Manfredonia L , Fusini L , Muratori M , Tamborini G , Gripari P , Mantegazza V , Volpato V , Italiano G , Lombardo A , Crea F , Pepi M 
Published: January 2020

Abstract

Objective
Preliminary studies showed the accuracy of machine learning based automated dynamic quantification of left ventricular (LV) and left atrial (LA) volumes. We aimed to evaluate the feasibility and accuracy of this new Dynamic Heart Model (DHM) software in an unselected population undergoing transthoracic echocardiography (TTE). Methods. We enrolled 91 consecutive unselected patients (80% in sinus rhythm) referred for clinically indicated 2D TTE, who also underwent single 3D TTE image acquisition from the apical 4-chamber view. 2D images were analyzed to measure ejection fraction, LV and LA volumes; 3D images were analyzed using Dynamic Heart Model (DHM) software (Philips Healthcare), which automatically measures chamber volumes throughout the cardiac cycle, resulting in LV and LA volume-time curves. Average time of analysis, feasibility, image quality were recorded and results compared between the 2D and 3D techniques. Results. Quality of the 91 2D TTE images was graded as poor (N = 13), satisfactory (N = 45) and good (N = 33). The use of DHM was feasible in 79/91 cases (87%). The remaining 12 datasets could not be analyzed because of poor images (N = 10) or incorrect automated border detection (N = 2): in these cases, the software did not accurately identify endocardial borders due to LV cavity near obliteration or extreme LA enlargement. When feasible, the boundary position was considered accurate in 61/79 patients (77%), while minor manual correction of the LV/LA borders was needed in the remaining cases. In only 1 case the reconstruction was considered unreliable because it needed major corrections. The overall time required to obtain DHM data was approximately 45 seconds. In all cases in which DHM was used, not only shapes of LV and LA were very well defined, but also functional curves were physiologically plausible. Even in the 13 patients in whom the 2D image was suboptimal, the DHM was not only feasible but also accurate endocardial boundaries in 8 cases, without (N = 5) or with only minimal manual corrections (N = 3). As expected, 3D LV volumes were slightly hige than 2D ones ( EDV 153.9 ± 59.8 vs 121.4 ± 47.3 mL, respectively), while LV EF and LA volumes were similar (EF 58.8 ± 11.8 vs 59 ± 11.8% and LA volume 92 ± 39.3 vs 83.4 ± 32.1 mL, respectively). Conclusions. The new DHM software is quick, feasible and accurate in the majority of unselected patients, including those with suboptimal 2D images or in atrial fibrillation. Introduction of this automated analysis into clinical practice can reduce examination time, while providing reliable information not only on volumes but also on function of the left heart chambers.
P737 Left ventricular hemodynamic forces: towards establishing reference values for healthy adults
Authors: Capuano F , Cocchia R , Ferrara F , Lanero S , Russo V , Ranieri B , Contaldi C , Sepe C , Mirto G , Pedrizzetti G , Bossone E 
Published: January 2020

Abstract

Introduction
Left ventricular hemodynamic forces (LV-HDF) have been recently demonstrated to be promising markers of sub-clinical dysfunction and potential predictors of disease outcome. However, there is a lack of reference values in healthy subjects. Knowledge of physiologic ranges is mandatory towards the use of LV-HDF-based indices for disease assessment in future clinical applications.

Purpose
Aim of the current study is to define the normal reference values for LV-HDF parameters in a large cohort of healthy adults. Here we present preliminary results for the initial set of enrolled subjects.

Methods
We enrolled 82 healthy subjects [mean age 44 ± 13.2 years (range 18-88), 41 men]. All participants underwent standard transthoracic echocardiography (TTE) examination, as recommended by current guidelines, including apical two-, three- and four-chamber windows, acquired at a frame rate above 40 Hz. These were then analyzed by tri-plane tissue tracking, measuring LV volume and LV ejection fraction (EF) as reference parameters. The same tracking method was used to evaluate the global hemodynamic force by a novel mathematical calculation technique applied to the three-dimensional endocardial contour. Physical-based LV-HDF parameters were then extracted for clinical application; these included the amplitude (root mean square) of the longitudinal and transversal force components (FL and FT) and their alignment angle relative to the LV axis. Parameters were computed as average over the whole cardiac cycle as well as limited to the systolic phase. Forces were normalized with LV volume to reduce variability with LV dimension, and divided by specific weight to yield a dimensionless measure.

Results
Mean EF was 63 ± 9%. Whole cycle LV-HDF parameters were: FL = 16.0 ± 5.6%, FT = 2.3 ± 0.8%, with significant longitudinal alignment FT/FL = 0.15 ± 0.04, angle = 13.0°±3.1°. Systolic HDF parameters were: FL = 22.7 ± 8.2%, FT = 2.9 ± 1.1%, with longitudinal alignment FT/FL = 0.13 ± 0.04, angle = 11.2°±3.1°. Importantly, dimensionless physical-based LV-HDF parameters showed no significant variation with age, gender or BSA.

Conclusions
We report the physiologic range of LV-HDF parameters measured by TTE. Knowledge of age- and gender-specific reference values, for a combination of standard, mechanical and hemodynamic indices, can improve the global assessment of the LV function and may help to detect sub-clinical stages of LV dysfunction.
P740 Right ventricular function evaluated by conventional echocardiography and strain imaging: study in young adults born preterm with and without lung disease
Authors: Bolander V , Maret E , Um Bergstrom P , Skold M , Eriksson M J 
Published: January 2020

Abstract

Funding Acknowledgements
Stockholms

Background
In young adults born preterm, particularly those with bronchopulmonary dysplasia (BPD), chronic respiratory dysfunction is seen even later in Life, and may lead to pulmonary hypertension and right ventricular (RV) dysfunction. Little is known on RV function in young adult patients with BPD in comparison to healthy Controls . RV strain imaging based on 2D speckle tracking echocardiography (ECHO) allows analysis of myocardial deformation and may improve the assessment of RV function.

Aims
The purpose of this study was to evaluate RV function using conventional ECHO parameters and 2D-strain in young adults born preterm and with and without BPD, and in healthy controls.

Methods
43 patients born preterm (21 with BPD and 22 without BPD) and 20 healthy age-matched Controls with mean age 23 +/- 1.7 y. RV size and function were assessed using conventional parameters (RV diameters, fractional area change (FAC%), tricuspid annular plane systolic excursion (TAPSE), peak systolic velocity of tricuspid annulus (PSV), RV myocardial performance index (MPI)) and 2D-strain of the RV free-wall and Total (free-wall and septum).

Results
No significant differences were found between the groups in the RV size, RV 2D-strain free-wall or Total, TAPSE or FAC%. Only RV MPI differed significantly between groups, however all values were within normal range (Table 1). There were significant correlations between RV 2D-strain and TAPSE, PSV and RV MPI and, but no correlation between RV 2-D strain and FAC%. RV free-wall strain was higher than RV total strain in all Groups.

Conclusion
RV function in young patients born preterm, with BPD did not differ significantly from the controls and the subjects born preterm with normal lung function. 2D-strain for RV evaluation was within normal range, suggesting that cardiac complications are rare in young BPD patients. RV MPI combining systolic and diastolic function variables may be a more sensitive measure to distinguish between BPD patients and other groups.
Variables Controls mean (SD) without BPD mean (SD) with BPD mean (SD) p = value FAC, % 44 (4.4) 46 (5.6) 48 (5.7) 0.1 TAPSE, mm 23 (3.5) 24 (3.8) 25 (4.2) 0.25 RV MPI 0.2 (0.06) 0.3 (0.09) 0.4 (0.1) &lt;0.05 RV strain Total. % -22 (2.5) -22 (3.3) -22 (2.5) 0.8 RV strain free wall, % -29 (5.6) -27 (4.3) -28 (4.7) 0.57 PSV, cm/s 15 (2.3) 14 (2.0) 15 (2.2) 0.26 Differences in right ventricular (RV) function between the study groups, (BPD – bronchopulmonary dysplasia).
P743 Right ventricular function is important for exercise capacity in patients at risk of heart failure
Authors: Kikuchi S , Kitada S , Wakami K , Goto T , Sugiura T , Seo Y , Ohte N 
Published: January 2020

Abstract

Background and Purpose
It is important to evaluate exercise capacity to detect the development of heart failure (HF) in patients with heart disease. The pathology of exercise capacity is multi-factorial, and cardiac function is recognized as one of the most important determinants. However, the correlation between right ventricular (RV) function and exercise capacity is not fully understood in the subjects without HF. Therefore, we assessed the relationship between RV function and exercise capacity, both in patients with HF (HF+) and in patients with heart disease but not developed HF (HF-).

Methods
Two hundred and fifty-two patients with heart disease who underwent both Doppler echocardiography at rest and cardio-pulmonary exercise testing (CPET) for the assessment of heart function were enrolled (HF+: n = 142, HF-: n = 110). We measured left ventricular ejection fraction (LVEF), peak early diastolic transmitral flow velocity (E), peak late diastolic transmitral flow velocity (A), early diastolic mitral annular velocity (e’), left atrial volume (LAV), and tricuspid annular plane systolic excursion (TAPSE) by echocardiography. After echocardiographic examination, symptom-limited exercise testing was performed with simultaneous respiratory gas analysis, and peak oxygen consumption (pVO2) was determined. Blood examination including hemoglobin (Hb) and brain natriuretic peptide (BNP) was done on the same day.

Results
There were significant relationships between pVO2 and LVEF (r = 0.16, p = 0.005), e" (r = 0.51, p &lt; 0.0001), E/e" (r=-0.47, p &lt; 0.0001), LAV (r=-0.21, p = 0.0002), and TAPSE (r = 0.33, p &lt; 0.0001) in the whole subjects. In the multiple regression analyses, age, Hb, E/e" and TAPSE were selected as significant determinants for pVO2 both in HF+ (R²=0.39, p &lt; 0.0001) and HF- (R²=0.33, p &lt; 0.0001).

Conclusion
RV function is the prime determinant of exercise capacity in patients at risk of HF, as well as in patients with HF.
Abstract P743 Figure.
P754 Severe aortic stenosis with preserved ejection prognostic differences according to flow status and gradient fraction: a Spanish multicentre study
Authors: Galian-Gay L , Escalona Silva R A , Ferrer-Sistach E , Mitroi C , Mingo S , Saura D , Vidal B , Moral S , Calvo F , Sanchez-Sanchez V , Gonzalez A , Guzman G , Noris Mora M , Arnau Vives M A , Evangelista A 
Published: January 2020

Abstract

Background and objectives
Low-flow low-gradient (LFLG) aortic stenosis portends bad prognosis in different series. The objective of this study was to evaluate the evolution of this entity in our country.

Methods
We included 1394 consecutive patients evaluated between 2008-2016 with severe AS (AVA &lt;1 cm²) and ejection fraction&gt; 50% from 14 Spanish centres. The results (aortic valve intervention and mortality) were compared using the Kaplan-Meier survival analysis.

Results
Three groups based on gradient and flow status were established (high gradient: HG, normal flow under gradient: NFLG, low gradient low flow: LFLG). No significant demographic or clinical differences between groups were observed. After a follow-up of 61.52 months (IQR 43.5-86.5), 551 (73.8%) HG, 268 (35.4%) with NFLG and 81 (57.9%) LFLG received intervention, with a later surgery/TAVI indication in the LFLG group compared with HG group (p = 0.001) (Figure 1). The analysis of the Kaplan-Meier mortality curves showed no significant differences.

Conclusions
Patients with LFLG aortic stenosis with normal ejection fraction received less and later aortic valve intervention than the HG group with no significant differences in mortality.
Abstract P754 Figure. Time to surgery
P756 Paradoxycal restricted motion in diastole associated to mitral valve prolapse/dystrophy: a frequent finding
Authors: Le Tourneau T , Cueff C , Marrec M , Piriou N , Capoulade R , Le Scouarnec S , Merot J , Schott J J 
Published: January 2020

Abstract

Funding Acknowledgements
PHRCI mitral 2012

Background
Filamin-A mitral valve prolapse/dystrophy (FLNA-MVP) phenotype associates moderate MVP and a paradoxical restricted motion in diastole.

Purpose
We aimed to assess the association of MVP with restricted motion in diastole in MVP patients (restricted MVP).

Methods
We prospectively enrolled 433 MVP probands (57 ± 16 years). Patients underwent a clinical examination and a comprehensive echocardiographic analysis of mitral valve apparatus.
Results Among the 433 probands, 27 (6.2%, 95% CI 3.9-8.5) had both a MVP and a doming aspect in diastole. Patients with restricted MVP exhibited shorter posterior chordae tendinaes (24.8 ± 6.3 vs 27.2 ± 5.9 mm, P = 0.037), and a shorter distance between papillary muscle (PM) tips and mitral annulus (anterior PM: P = 0.0001; posterior PM: P = 0.009). Anterior mitral valve leaflet was lengthened (15.5 ± 2.4 vs 14.3 ± 2.6 mm/m², P = 0.018), but leaflet thickness, leaflet prolapse, and mitral valve annulus did not differ between the 2 groups. Bicuspid aortic valve was more frequent in patients with restricted phenotype (14.8 vs 2.9%, P &lt; 0.05). Familial recurrence of restricted MVP was identified even in the absence of Filamin-A mutation.

Conclusion
Restricted MVP is a quite frequent finding in MVP patients and is associated with PM tips location closer to mitral annulus. Restricted MVP can be regarded as a third type of MVP beside myxomatous Barlow disease and fibro-elastic deficiency MVP.
P757 Left atrial contractile function improves shortly after transcatheter aortic valve replacement. A speckle tracking echocardiography study
Authors: Calin A , Cadil D , Parasca C , Mateescu A , Rosca M , Beladan C C , Enache R , Ginghina C , Deleanu D , Chioncel O , Iliescu V , Popescu B A 
Published: January 2020

Abstract

Background
Transcatheter aortic valve replacement (TAVR) reverses LV remodeling and improves overall cardiac function, but data regarding its effect on left atrial (LA) function is scarce. Our aim was to evaluate the short-term effect of TAVR on LA myocardial deformation parameters and the relationship between the improvement of LA function and baseline echocardiographic parameters.

Methods
Fourty-eight consecutive pts (75 ± 6 yrs, 28 men) considered to be at increased risk for surgical aortic valve replacement were enrolled and examined before and 30 days after TAVR. All pts underwent a comprehensive echocardiogram, including speckle tracking echocardiography (STE) for deformation analysis. Longitudinal LA strain parameters were assessed from the apical 4-chamber view. Peak values of global longitudinal LA strain (LAε) and LA systolic strain rate (SSr, reservoir function) and early diastolic strain rate (ESr, conduit function) were measured in all. Contractile LA function (late diastolic strain rate, ASr) was assessed in patients in sinus rhythm (39 pts).

Results
Compared with baseline, the mean indexed LV mass was significantly reduced after TAVR (141 ± 26 vs 160 ± 37 g/m2, p = 0.009) but the mean increase in LVEF was not statistically significant (51 ± 14% vs 47 ± 15%, p = 0.2). There was a significant reduction in systolic pulmonary pressure after TAVR (34 ± 12 vs 42 ± 13, p = 0.004). Although there was no significant decrease in indexed LA volume (51 ± 22 vs 56 ± 20 ml/m2, p = 0.3), the contractile LA function significantly improved 30-days after TAVR (mean ASr, -1.1 ± 0.5 vs -0.8 ± 0.4 %, p = 0.02). There was a tendency of improvement in global longitudinal LA strain (15 ± 7 vs 12 ± 6%, p = 0.06) and global longitudinal LV strain (-13 ± 4 vs -11 ± 5%, p = 0.06) as well. Parameters of LV diastolic function, including TDI derived e’ and E/e’ ratios were not significantly improved 30 days after TAVI. While LA volumes and function parameters were not significantly different between genders at baseline, the improvement of LA function was more frequently found in male pts (p = 0.05). There were no significant correlations between the improvement of LA function parameters and baseline echocardiographic parameters in our study group. The only predictor of LA booster function improvement was the baseline value of ASr (p = 0.01).

Conclusions
TAVR is associated with a significant recovery of LA function as assessed by STE, suggesting a reverse cavity remodeling. This was accompanied by a significant reduction in LV mass and systolic pulmonary pressure. Men seem to show a more significant improvement in LA contractile function, suggesting a gender-related LA response to chronic afterload reduction.
P758 Should ECHO measurements be indexed to ideal BSA or actual BSA?
Authors: Cases M , Zhu T , Jurt U , Brouillard D , Matangi M 
Published: January 2020

Abstract

INTRODUCTION
A patient with aortic stenosis with an AVA of 1.22 cm2 who stands 5’ 6" and weighs 145 lb has a BSA of 1.76m2 (AV area index = 0.69 cm2/m2). If the same patient weighs 200 lbs, the BSA increases to 2.09 m2 (AV area index 0.58 cm2/m2). Their calculated AV area index therefore changes from the moderate range to the severe range.

PURPOSE
To determine from our ECHO database the effect the current obesity epidemic has on all ECHO variables that are indexed to BSA.

METHODS
Our ECHO database was searched for all patients with the required data variables, gender, age, height (cm)and body weight (kg) were required. Duplicate patients with multiple ECHO studies were removed, only the first ECHO entry being included. Obvious data entry errors were removed (e.g. height 1866 cm, or weight 8.6 kg). Ideal weight was calculated using the Devine formula, ideal weight = Constant + 2.3x[height in inches-60], where constant= 50kg in males and 45.5kg in females. Body surface area in m2 was calculated = [√(height in cm x weight in Kg)/3600]. The paired t-test was used to determine differences between means. A p value of &lt;0.05 was considered significant.

RESULTS
There were 47,761 ECHO studies entered into the database, of which 46,605 (98%) had all the required fields completed. Once duplicates were removed (-15,903) and erroneous data deleted (-158, 0.33%), 30,536 remained. There were 16,160 females aged 58.7 ± 19.2 years, with a mean height of 161.7 ± 7.2cm and 14,376 males aged 59.8 ± 19.2 years, with a mean height of 176.7 ± 7.6 cm. There were statistically significant differences in both men and women between actual and ideal weight and actual and ideal BSA, see Table 1.
CONLUSIONS. For all ECHO measurements where the value is frequently indexed a decision needs to be made to either use the actual BSA or the ideal BSA. It may be more practical to use the ideal BSA which will remain consistent throughout follow up. Using our data any such measurement for females could be multiplied by 1.16 and for males 1.11 (i.e. actual BSA/ideal BSA). It is disappointing to find that, on average, females are 20 kilograms and males 18 kilograms above their ideal weight.
Table 1. Weight females (kg) Weight males (kg) BSA females (m2) BSA males (m2) Number. 16,160 14,376 16,160 14,376 Actual. 73.2 ± 18.9 89.1 ± 19.3 1.80 ± 0.24 2.08 ± 0.24 Ideal. 53.4 ± 6.5 71.4 ± 6.9 1.55 ± 0.13 1.87 ± 0.3 P value. &lt;0.0001 &lt;0.0001 &lt;0.0001 &lt;0.0001 BSA = Body surface area.
P760 Stress echocardiography testing of a novel trans annular mitral bridge implantation for mitral regurgitation
Authors: Benesova M , Subramanian V A , Cerny S 
Published: January 2020

Abstract

Objectives
Indirect reduction of septal- lateral diameter (SLD) by circumferential cinching of the annulus with ring annuloplasty (RA) is the standard part of mitral valve repair surgery. Direct SLD reduction without circumferential annular cinching by a novel trans-annular Mitral Bridge with an infra-annular curvature has been used for functional mitral regurgitation (FMR) as a sole procedure and for mitral valve prolapse (MVP)as a part of valve repair. The aim of this study was to assess the functional and hemodynamic outcomes at rest and exercise at 2 yr. follow up in the patients with this novel type of annuloplasty.

Methods
30 of 34 patients with FMR who had trans annular Mitral Bridge as the sole treatment of their MR and 5 of 8 patients with MVP in a prospective trial underwent at 2yr F/U bicycle ergometer exercise echocardiography on a special semi-recumbent bicycle. Mitral regurgitation, mitral peak and mean gradient, mitral valve area, systolic pulmonary arterial pressure, systolic function of the left ventricle were assessed at rest and peak exercise.

Results
Mitral regurgitation was 0.3 ± 0.5 at rest and 0.4 ± 0.5 at peak exercise (p = 0.264). The resting mean mitral gradient was 2.3 ± 0.9 mmHg and peak 4.6 ± 1.9 mmHg (p &lt;.0001) and valve area was at rest 3.5 ± 0.7cm2 and at peak 3.9 ± 0.9 cm2 (p = 0.026). Pulmonary systolic arterial pressure was 25.8 ± 17 at rest and 36.9 ± 21.8 at peak exercise (P = 0.012). LVEF was 60,4± 10.5 at rest and at peak 66,4± 12.5 (p &lt;.0001).

Conclusion
Trans annular Mitral Bridge as a alternative to standard annuloplasty ring is effective. At 2 yr follow up there was only trace mitral regurgitation and no mitral stenosis. The stress test verified the durability of the mitral repair both in FMR and MVP. There was no mitral stenosis and no mitral regurgitation at exercise. The raise of the mean mitral gradient was statistically important, but the values remained within the normal range. The raise of gradients is in correlation with the presence of cardiac reserve and increased LVEF. There were no signs of pulmonary hypertension caused by the stress.
Abstract P760 Figure. Mitral Bridge