bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1838 Defining the Optimal Temporal and Spatial Resolution for Cardiovascular Magnetic Resonance Imaging Feature Tracking
Authors: Backhaus S J , Metschies G , Billing M , Kowallick J T , Gertz R J , Lapinskas T , Pieske-Kraigher E , Pieske B , Bigalke B , Kutty S , Hasenfus G , Kelle S , Schuster A 
Published: January 2020

Abstract

Background
Myocardial deformation analyses using cardiovascular magnetic resonance feature tracking (CMR-FT) have incremental value in the assessment of cardiac function beyond volumetric analyses. Since guidelines do not recommend specific imaging parameters, we aimed to define optimal spatial and temporal resolutions for CMR cine images to enable reliable post-processing.

Methods
Intra- and inter-observer reproducibility was assessed in 12 healthy volunteers. Cine images were acquired with differing temporal (20, 30, 40 and 50 frames/cardiac cycle) and spatial resolutions (high in-plane 1.5x1.5mm through-plane 5mm, standard 1.8x1.8x8mm and low 3.0x3.0x10mm). CMR-FT analyses comprised left ventricular (LV) global longitudinal strain (GLS) and systolic strain rate (SRs) as well as LV circumferential and radial strains (GCS and GRS) and right ventricular (RV) GLS. Intra- and inter-observer reproducibility was assessed in all subjects.

Results
Temporal but not spatial resolution did impact absolute strain and SR. Maximum absolute changes between lowest and highest temporal resolution were as follows: 2.3% LV GLS, 2.2%
GCS, 7.2% GRS, 1.7% RV GLS and 0.32s-1 SRs. Changes of time-integrated (strain) values occurred predominantly comparing 20 and 30 frames/cardiac cycle including LV GLS, GCS and GRS (p = 0.034, p = 0.008 and p = 0.034) in highest spatial resolution settings. In contrast, time-derivatives values (SRs) changed significantly from lower temporal resolutions to 40 frames/cardiac cycle and beyond (20 to 30 p = 0.002; 30 to 40 p = 0.018; 40 to 50 frames/cardiac cycle p = 0.075) in highest spatial resolution settings. Strain reproducibility was not affected by either temporal or spatial resolution. SRs variability as assessed by coefficient of variation decreased with higher temporal resolutions.

Conclusion
Temporal but not spatial resolutions significantly affect strain and SR in CMR-FT deformation analyses. Clinical CMR-FT strain and SR analyses require minimum temporal resolutions of 30 and 40frames/cardiac cycle, respectively to ensure precise quantification of myocardial function.
P1839 Extracardiac findings in cardiac CT and MRI - a Maltese perspective
Authors: Sapiano K , Borg A 
Published: January 2020

Abstract

Background
Cardiac CT and MRI are relatively new, non-invasive modalities of cardiac imaging, obtaining excellent image quality mainly pertaining to the heart. However, both these modalities also obtain diagnostic quality images of extracardiac structures. International studies quote varying rates of positive extracardiac findings (ECF) ranging from 20-30% in cardiac MRI and 30-40% in CT.

Purpose
To evaluate the prevalence of incidental ECF in cardiac imaging in the Maltese Islands and assess for any differences in prevalence between sexes and age groups.

Methods
All patients having performed cardiac CT and cardiac MRI scans performed in the year 2017 in the Maltese Islands (n = 733) were enrolled. Imaging reports of these scans were retrospectively reviewed, making a note of the patient’s age and sex and any positive ECF. ECF were then subdivided according to clinical significance and anatomical site.

Results
Positive ECF were present in 219 (29.9%), whilst 514 (70.1%) had no ECF of note. When subdivided, 14.6% of MRI and 35.0% of CT were positive for ECF, p &lt; 0.001. There was a propensity for older patients to have more positive findings, with these present in 11.9% of patients aged &lt;20, 8.1% of patients aged 20-29, 18.2% of patients aged 30-39, 21.9% of patients aged 40-49, 30.1% of patients aged 50-59 and 40.5% of patients aged ≥60, p= &lt;0.001. Females had a higher proportion of positive findings (38.1%) despite having less total scans (n = 312) when compared to men (23.8%, n = 421), p= &lt;0.001. Of the positive findings, 72.1% were newly discovered. These were classified according to clinical significance with 17.7% of these findings classified as definitely resulting in a change in management, 19.0% most likely resulting in a change in management, 46.8% possibly resulting in a change in management and 16.5% being normal variants or expected post-operative changes. Findings were most commonly lung pathologies (28.8%) followed by gastrointestinal pathologies (21.5%) and liver and gall bladder pathologies (14.6%).

Conclusions
ECF in cardiac imaging are common in the Maltese islands with around a third of all scans having a positive finding. CT was the imaging modality that was more likely to pick up ECF. ECF are increasingly frequent in older patients and also more likely to be found in females, despite less women having been scanned than males. Most findings were newly discovered with a large proportion being of clinical relevance.
410 Early cardiac reverse remodeling in a large cohort of patients with HFrEF treated with Sacubitril/Valsartan
Authors: Sassi V A , Mapelli M , Salvioni E , Mattavelli I , Mantegazza V , Volpato V , Vignati C , De Martino F , Paolillo S , Fusini L , Muratori M , Pepi M , Agostoni P G 
Published: January 2020

Abstract

Background
Despite the widespread use of Sacubitril/valsartan (Sac/Val) in patients with reduced ejection fraction (HFrEF), definite data on cardiac remodeling under treatment are still lacking.

Methods
We conducted a retrospective analysis on a large cohort of 201 consecutive HFrEF ambulatory patients who started Sac/Val in our HF unit between Sept. 2016 and Dec. 2018 on top of optimal medical treatment. Patients with both basal and follow up (at least 3 months) echocardiographic assessment (TTE) were included.

Results
A follow up TTE was performed in 100 patients (male 76%; mean age 67.4 ± 11.1 years; medium follow-up 309 ± 182 days). Baseline characteristics are shown in Tab.1. 34% of the patients reached the maximal dose (97/103 b.i.d.) while 18 interrupted the treatment. We observed an overall significant improvement in ejection fraction (EF), end-diastolic and end-systolic ventricular volumes (EDV/ESV), while just a trend in pulmonary pressures (PAPs) and mitral regurgitation (MR) reduction was noted (p = 0.06 and 0.09 respectively). Non ischemic etiology and high dose of Sac/Val were predictors of better remodeling (Fig.1).

Conclusion
In our study Sac/Val led to an early favorable ventricular remodeling assessed by echocardiography. The observed benefit was greater in patients on higher dose of the drug and non ischemic etiology.
Table 1 n = 100 Clinical characteristics Systolic blood pressure (mmHg) 116 ± 11 Diastolic blood pressure (mmHg) 70 ± 9 Hemoglobin (g/dL) 13 ± 2.0 MDRD (ml/min/1.73 m2) 63 ± 21.4 Potassium (mmol/L) 4.26 ± 0.50 NYHA class II (n;%) 59 (59%) NYHA class III (n;%) 41 (41%) Ischemic etiology (n;%) 58 (58%) ICD (n;%) 41 (41%) CRT (n;%) 32 (32%) Beta-blockers (n;%) 94 (94%) ACEi or ARBs (n;%) 92 (92%) MRA (n;%) 77 (77%) Baseline clinical characteristics
Abstract 410 Figure. Fig. 1
412 Sacubitril/valsartan promotes cardiac reverse remodeling and preserves renal function in a real-world heart failure and reduced ejection fraction (HFrEF) population
Authors: Polito M V , Rispoli A , Vitulano V , D"auria F , Silverio A , De Angelis E , Loria F , Citro R , Galasso G , Iaccarino G , Ciccarelli M 
Published: January 2020

Abstract

Funding Acknowledgements
none
Aims. To evaluate the effects of Sacubitril/Valsartan (S/V) on clinical, laboratory and echocardiographic parameters and outcomes in a real-world population with heart failure with reduced ejection fraction (HFrEF).
Methods and results. Prospective study enrolling consecutive patients with HFrEF treated with S/V.The primary outcome was HF rehospitalization;secondary outcomes were all-cause death, cardiac death and the composite of cardiac death and HF rehospitalization at 12 months follow up.The clinical outcome was compared with a retrospective cohort of 90 HFrEF patients treated with standard medical therapy by using propensity score weighting. At 6 months follow-up, changes in symptoms, echocardiographic parameters, eGFR and furosemide dose were also evaluated. The study population consisted of 90 patients (66.1 ± 11.7 years). At 6 months FU, a significant improvement in NYHA class, LVEF (from 31.0% to 34.0%; p = 0.001), LVESV (from 115.0 to 101.0 mL; p = 0.033) and sPAP (from 31.0 to 25.0 mmHg; p = 0.024) was observed. Moreover, S/V did not affect negatively eGFR and was associated with a significantly lower dose of furosemide prescribed. The propensity score weighting adjusted regression analysis showed a significantly lower risk for HF rehospitalization (HR, 0.131; 95% CI, 0.034-0.503; p = 0.003) and the composite outcome (HR, 0.162; 95% CI, 0.053-0.492; p = 0.001) among patients treated with S/V as compared to the standard therapy group.

Conclusions
In this real-world HFrEF population, S/V reduced HF rehospitalization and cardiac death at 1 year. Moreover, S/V improved significantly NYHA class, LVEF, LVESV and sPAP at 6 months, preserving renal function and reducing the need of furosemide.
Table Study outcomes Unadjusted model HR 95% CI p-value HF rehospitalization 0.273 0.101-0.740 0.011 Cardiac death 0.443 0.137-1.440 0.176 Composite outcome 0.331 0.155-0.710 0.005 All-cause death 0.666 0.272-1.628 0.372 Adjusted model HR 95% CI p-value HF rehospitalization 0.131 0.034-0.503 0.003 Cardiac death 0.259 0.047-1.415 0.119 Composite outcome 0.162 0.053-0.492 0.001 All-cause death 0.713 0.201-2.529 0.601 Adjusted and unadjusted HR for the study outcomes.
Abstract 412 Figure.
P773 Can strain imaging predict viability in ST segment elevation myocardial infarction patient
Authors: Mghaieth Zghal F , Habboubi S , Boudiche S , Ben Halima M , Rekik B , Farhati A , Ouali S , Mourali M S 
Published: January 2020

Abstract

Background
In the acute phase of ST elevation myocardial infarction (STEMI), the main objective is to recanalize the guilty artery, but it is important to know whether myocardium with severely compromised function is permanently injured or reversibly dysfunctional indicating myocardial viability. On the other hand, viability tests such as scintigraphy, magnetic resonance imaging with delayed enhanced (DE-MRI) or dobutamine stress echography are either not validated or unavailable in the acute phase of STEMI. The assessment of myocardial deformation by bidimensional strain (2D) is a technique that has emerged in recent years with good correlation with MRI for viability assessment. An important question remains : Is myocardial viability can be determined by 2D strain parameters at the acute phase of STEMI ?
Aim : To assess myocardial viability in the acute phase of STEMI by 2D strain echocardiographic parameters in comparison with 3 month DE-MRI as a reference method.

Methods
A total of 31 first STEMI patients treated with successful primary or elective percutaneous coronary intervention (PCI) were included with an akinetic area on echocardiography corresponding to the infarct segments. Doppler strain values from left ventricular basal, mid and apical segments (n= 527) were obtained at the acute phase of STEMI and checked up after 3 months. The scar was assessed for viability by DE-MR as reference method, 3 months after the acute phase. Viability was defined by a DE &lt; 50% of wall thickness in the scar zone.

Results
Mean age of the study population was 59,29 ±9,96 years , 27 (87%) being males. Nine patients (29%) showed post-PCI improvement of left ventricule (LV) function. Regional peak systolic strain of the infarct segments and global longitudinal strain (GLS) after 3 months. At the acute phase, wall motion score index (WMSI), regional and global strain values were signficantly better in the viable than in the non viable segments. GLS was -10,92 ± 2,48 in patients with MRI non viable myocardium and -14,45 ±2,91 in patients with MRI viable myocardium . A pre-PCI strain value of -2,9% as a cutt off predicted segmental function recovery after PCI and myocardial viability with a sensitivity 82% of and a specificity 84%.
Conclusion : This monocenter study confirms that 2D strain imaging can be a usueful and accurate method to predict myocardial viability and recovery of segmental and global LV function after PCI in STEMI patients.
P1452 A rare case of embolic blindness in an adult patient with univentricular heart after fontan operation
Authors: Lewek J , Bielecka-Dabrowa A , Banach M , Maciejewski M 
Published: January 2020

Abstract

Background
Thromboembolic complications following Fontan procedure are one of the major causes of mortality and morbidity among patients with univentricular heart. We may classify thromboembolic complications into two groups: systemic- and nonsystemic. We present a case of a patient with a manifestation of both.

Case report
24-year old female, foreign student was admitted to Ophthalmology Department due to sudden blindness of the left eye. Performed studies revealed embolus in the left central retinal artery. Because the patient had the history of congenital heart defect she was referred to our department. Analysis of medical documentation showed that the patient has combined congenital heart defect including right ventricle hypoplasia, tricuspid atresia, pulmonic stenosis, ventricular septal defect, atrial septal defect and persistent ductus arteriosus. She had a history of two surgeries: modified left-side Blalock-Tausing connection (in 4th month of life) and total cavo-pulmonary connection with the closure of Blalock-Tausing and excision of interatrial septum (in 2,5 year of life). On admission she presented with left-eye blindness. She had no dyspnoea or palpitations. However she reported very severe migraines from a few days preceding the admission to hospital. Echocardiography revealed tricuspid atresia, hypoplastic right ventricle, preserved systolic and diastolic function of left ventricle, atrial septal defect with no restriction. We observed enlarged diameter of vena cava inferior with no respirophasic variations and massive thrombus in inside with very low flow. The connection between inferior vena cava and right pulmonary artery was working properly with no visible fenestration. We also observed a winding vessel between ascending aorta and truncus pulmonalis/pulmonary artery with continuous flow of blood from left to right side. Computer tomography confirmed the diagnosis of massive thrombosis of vena cava inferior. Patient had anticoagulation started. Two days later we the flow in inferior vena cava returned – we did not observe any thrombus. Patient was referred to catheterization and had chronic anticoagulation initiated.
Three months follow-up revealed no changes in clinical condition of a patient.

Discussion
The palliative Fontan operation predispose to the increased risk of thromboembolic complication. Despite the risk factors of such complications have been identified, there are no guidelines about prophylactic anticoagulation in that group of patients. As a result, chronic anticoagulation is initiated in patients who have other indications e.g. atrial fibrillation. It seems that it would be beneficial to define the group of patients after Fontan procedure with indications to chronic anticoagulation therapy despite arrhythmias.
P288 Prognostic role of hemoglobin levels in patients with severe tricuspid regurgitation
Authors: Garcia Martin A , Hinojar R , Gonzalez Gomez A , Plaza Martin M , Pascual Izco M , Alonso Salinas G , Monteagudo Ruiz J M , Abellas Sequeiros M , Casas Rojo E , Moya Mur J L , Jimenez Nacher J J , Ruiz Leria S , Barrios Alonso V , Fernandez-Golfin C , Zamorano Gomez J L 
Published: January 2020

Abstract

Background
Patients with severe tricuspid regurgitation (TR) frequently develop heart failure (HF) and their surgical therapeutic options are limited because of very high or prohibitive risk. According to the 2016 ESC guidelines for HF, anaemia and iron deficiency are associated with worse prognosis and intravenous iron therapy should be considered in symptomatic patients with HF reduced ejection fraction (HFrEF) in order to alleviate symptoms, improve exercise capacity and quality of life. The effect of treating iron deficiency in HF preserved ejection fraction (HFpEF) is unknown. The purpose of this study was to analyze the correlation between levels of hemoglobin (Hb) and the prognosis in patients with severe TR and preserve EF.

Methods
Consecutive patients with significant TR (moderate to severe or severe by echocardiography) evaluated in the Heart Valve Clinic between 2015-2018 were included. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure.

Results
A total of 70 patients were included (mean age was 74± 8 years, 71% females). According to aetiology, 94% were functional TR (60% due to left valve disease, 27% due to tricuspid annulus dilatation, 13% others). Mean left ventricular ejection fraction was 56,5% ±6,7%. During a median follow up of 18 months [IQR: 4-28], 35% of the patients reached the combined end-point (n = 16 developed right HF, n = 17 underwent tricuspid valve surgery, and n = 3 died). Patients with events showed lower Hb values (p = 0.04). The level of anaemia was a prognostic factor of the combined endpoint (per gr/dl, HR 0.77 [0-61-0.98], p = 0.036).

Conclusion
Hemoglobin is predictive of poor outcomes in patients with significant TR. According to these preliminary results, iron deficiency could be a therapeutic target in this subgroup of patients with limited therapeutic options.
P298 The long-term impact of persistent pulmonary hypertension in patients undergoing TAVR with a self-expanding valve
Authors: Drakopoulou M , Soulaidopoulos S , Oikonomou G , Toskas P , Xanthopoulou M , Stathogiannis K , Toutouzas K , Tousoulis D 
Published: January 2020

Abstract

Background
Persistent severe pulmonary hypertension (PH) is considered to negatively affect early and late outcomes of patients undergoing aortic valve surgery. There is limited data however, cincerning the incidence of persistent PH after transcatheter aortic valve replacement (TAVR) and its impact on outcome is limited.

Purpose
We sought to investigate the impact of persistent PH on clinical outcomes of patients undergoing TAVR with a self-expanding valve.

Methods
Consecutive patients with severe symptomatic aortic stenosis scheduled for TAVR in our tertiary center were included in the study. Prospectively collected data before and after TAVR were retrospectively analyzed in all patients. Severe PH was defined as systolic pulmonary arterial pressure (sPAP) ≥45mmHg as assessed by echocardiography. For analysis purposes, patients with a sPAP decrease after TAVR to below 45mmHg were compared to patients with persistent PH following TAVR. All outcomes were evaluated according to the VARC-2 criteria.

Results
In total, 258 patients were included in this study (mean age 80.06 ± 7.50 years old, logEuroscore 24.50 ± 9.70%, NYHA III/IV Class 98.6%). Of these, 149 (57.8%) had sPAP less than 45mmHg and 109 (42.2%) had sPAP above or equal to 45mmHg at baseline. Patients with severe PH were older (81.1 ± 7.0 vs 79.1 ± 7.7, p = 0.034), presented with higher logEuroscore (26.9 ± 9.3% vs 22.5 ± 9.9%, p&lt; 0.001), lower ejection fraction (47.9 ± 9.3% vs 52.2 ± 8.5%, p&lt; 0.001) and higher rates of at least moderate mitral regurgitation (36.7% vs 16.2%, p = 0.002) compared to the group without PH. After TAVR, 161 (62.4%) patients had sPAP less than 45mmHg and 97 (37.6%) had sPAP above 45mmHg. There was a significant decrease of 2.4 ± 12.2mmHg in sPAP post TAVR (p &lt; 0.01). Multivariable analysis (univariate analysis: age, logEuroscore, pre TAVR mitral regurgitation, pre TAVR ejection fraction below 40%) identified pre TAVR ejection fraction below 40% to be the most powerful predictor for persistent PH after TAVR (odds ratio 2.4, 95% confidence interval 1.0.9 – 5.26, p = 0.028). During a mean follow up period of 26.6 ± 26.8, the presence of pre TAVR severe PH was not found to be predictive of cumulative mortality[Hazard Ratio(HR) : 1.57, 95% Confidence Intervals (CI) 0.92 – 2.66, p = 0.09). However, in the same follow up period, patients with persistent PH after TAVR had higher cumulative risk of death compared to patients with sPAP &lt; 45mmHg after TAVR (Hazard Ratio 0.49, 95% Confidence Intervals 0.29-0.82, p = 0.007) (Figure).

Conclusions
Our data suggest that TAVR is associated with a significant reduction in sPAP. Persistent PH post TAVR seems to be a predictor of higher cumulative mortality post TAVR.
Abstract P298 Figure.
P301 The prognostic value of preoperative left atrial volume after surgical aortic valve replacement in patients with isolated severe aortic stenosis and preserved left ventricular ejection fraction
Authors: Mateescu A D , Calin A , Rosca M , Beladan C C , Enache R , Cadil D , Parasca C A , Botezatu S , Ginghina C , Popescu B A 
Published: January 2020

Abstract

Background
Left atrial (LA) volume is an important cardiovascular prognostic marker. However, data regarding the prognostic value of LA volume in severe AS patients (pts) after surgical aortic valve replacement (AVR) are scarce. Moreover, the predictive role of LA function in AS pts after AVR has not yet been studied. Our study aimed to assess the relationship of LA volume index (LAVi) and function with outcome, in terms of mortality, in severe AS pts who underwent surgical AVR.

Methods
A total of 360 consecutive pts with isolated severe AS (aortic valve area index ≤ 0.6 cm2/m2) referred to our echocardiography laboratory were prospectively screened. Two hundred and seventeen pts with preserved left ventricular (LV) ejection fraction (≥50%) and in sinus rhythm were enrolled. All patients underwent a baseline comprehensive echocardiogram, including speckle tracking analysis of both LV and LA strain. Symptomatic pts (142 pts, 65%) that were subject to AVR were followed for a median period of 4 years (IQR 3-6 years). The endpoint was all-cause mortality after AVR. The last update of the survival status was obtained in January 2019. Outcome data were available in 116 severe AS pts that underwent AVR (mean age 63 ± 10 yrs, 56% men), who formed the final study population.

Results
Seventeen (14%) pts died during follow-up. No significant differences were found between nonsurvivors and survivors after AVR in terms of age and cardiovascular risk factors. Nonsurvivors had higher BNP plasma values (p=.04) at baseline compared with surviving pts. Survivors and nonsurvivors alike exhibited similar preoperative AS severity and LV systolic function parameters (ejection fraction and global longitudinal strain). Moreover, there were no significant differences between the two groups regarding baseline valvuloarterial impedance, average E/e’ ratio, and LA longitudinal deformation parameters. Nonsurvivors had a tendency toward higher LV mass index (p=.08). Nonsurvivors had higher preoperative LA volume index (LAVi)(50 ± 12 vs. 44 ± 10 ml/m2, p=.003). In a multivariable Cox regression analysis adjusted for age, LAVi emerged as the only independent predictor for death in our population study (HR 1.06, 95% CI 1.01-1.11, p=.02). A cut-off value for LAVi derived from ROC curve analysis was used to construct Kaplan-Meier survival curves. A value of 43 ml/m2 for LAVi predicted all-cause mortality after AVR in severe AS pts with 71% sensitivity and 54% specificity.

Conclusions
In our study, preoperative LAVi predicted death in severe AS pts after surgical AVR. LAVi assessment may improve preoperative risk stratiﬁcation in patients with severe AS, however further larger prospective studies are needed.
Abstract P301 Figure.