bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1354 Prognostic value of the left ventricular longitudinal and circumferential function in patients with takotsubo syndrome during the acute phase
Authors: Koshino K , Yamaguchi N , Oshima T , Hiroe K , Ohta Y , Okada S , Ohta T , Tanabe K 
Published: January 2020

Abstract

Background
Takotsubo syndrome is generally considered a benign disease with a reversible condition; however, hemodynamic and electrical instability during the acute phase exposes patients to the risk of serious adverse in-hospital events. The purpose of this study was to investigate the prognostic value of the left ventricular longitudinal and circumferential function in patients with TTS during the acute phase.

Methods
We divided the 27 patients with TTS (77.4 ± 10.2 years old, 21 females) into two groups; the severe group (SG) of 9 patients (in-hospital death, mechanical assist devices such as IABP or ECMO, oozing rupture) and non-severe group (NSG) of 18 patients. The echocardiographic examination on admission, catheter hemodynamic assessment, and laboratory data, and ST-T change in electrocardiogram were compared between two groups.

Results
There were no differences in age, laboratory data, electrocardiogram findings between the two groups. The LVEF was lower in SG (35.3 ± 6.1% vs. 45.9 ± 13.5%, p = 0.03). The index of Ballooning, the ratio of the systolic left ventricular diameter of ballooning segments to that of basal segments, was higher in SG (2.07 ± 0.61% vs.1.60 ± 0.32%, p = 0.016). The circumferential fractional shortening (CFS) of ballooning segments was lower in SG (4.6 ± 3.2% vs. 18.2 ± 8.2%, p = 0.00007), CFS of basal segments was not different between the two groups, and the ratio of CFS of ballooning segments to CFS of basal segments (CFS imbalance index) was lower in SG (5.60 ± 3.84 vs. 10.83 ± 3.92, p = 0.00003). The left ventricular longitudinal fractional shortening was lower in SG (0.12 ± 0.09 vs. 0.46 ± 0.19, p = 0.00003). The absolute value of GLS was lower in SG (7.6 ± 4.3% vs. 13.0 ± 3.6%, p = 0.002). In all three cases of in-hospital death, the CFS imbalance index was lower than 0.14.

Conclusion
In patients with TTS, left ventricular longitudinal and circumferential function could be related to serious adverse in-hospital events.
P1357 Left atrial function decreases with age in patients with repaired tetralogy of Fallot decrease
Authors: Hosono Y , Takahashi K , Akimoto S , Ifuku M , Iso T , Yazaki K , Yamada M , Matsui K , Akimoto K , Nakanishi K , Nii M , Kawasaki S , Kishiro M , Shimizu T 
Published: January 2020

Abstract

BACKGROUND
Left ventricular function has been shown to be an important prognostic indicator in patients with repaired tetralogy of Fallot (rTOF) and tends to decrease with age. In recent years, left atrial (LA) function was reported to be a useful prognostic indicator more than or equal to left ventricular function in acquired heart diseases. However, atrial function in rTOF has not yet been sufficiently examined.

PURPOSE
The aim of this study was to investigate the relationship between LA dysfunction and age in rTOF using strain analysis.

METHODS
In order to assess the relationship between LA function and age, we recruited 59 patients with rTOF ranging in age from 5-40 years. We stratified the patients into 3 groups (T1: 5-10 years, T2: 11-20 years, T3: 21-40 years) and divided 54 controls of similar age into 3 corresponding groups (N1, N2, and N3). Two-dimensional speckle tracking images (2D-STI) obtained from four- and two-chamber views were used to assess LA functions by measuring reservoir, conduit, and pump strain. Additionally, we measured the strain rate (SR) in the systole, early diastole, and late diastole.

RESULTS
LA reservoir strain (37.4 ± 2.2% vs. 47.9 ± 1.7%, P= 0.004), LA pump strain (8.3 ± 1.4% vs. 14.1 ± 2.7%, p &lt;.001), atrial systolic LA-SR (1.5 ± 0.4% vs. 2.4 ± 0.6%, p &lt;.001), and systolic LA-SR (1.5 ± 0.3% vs. 2.1 ± 0.4%, p = 0.003) were significantly decreased in T3 compared with N3. Although only LA conduit strain decreased with aging (r = -0.3204, p = 0011) in controls, all of the LA reservoir (r = -0.325, p = 0.020), conduit (r = -0.314, p = 0.025), and pump strain (r = -0.481, p &lt; 0.001) in rTOF decreased with aging.
Early diastole SR was significantly decreased in the T1 and T3 groups compared with the N1 and N3 groups (T1 vs N1, 3.00 ± 0.63% vs. 4.03 ± 0.0.80%, p &lt;.0.001, T3 vs N3, 2.31 ± 0.57% vs.3.31 ± 0.47%, p &lt; 0.001). Both systolic SR and late diastole SR decreased in T3 group compared with the N3 (1.54 ± 0.32% vs. 2.08 ± 0.42%, p = 0.003, 1.42 ± 0.32% vs.2.42 ± 0.61%, p &lt; 0.001), respectively. Although only early diastole SR decreased with aging (r = -0.415, p &lt; 0.001) in controls, all of the systole (r = -0.287, p = 0.041), early diastole (r = -0.337, p = 0.019), and late diastole SR (r = -0.407, p = 0.003) in rTOF decreased with aging.

CONCLUSIONS
In rTOF, most of the LA functions assessed by strain analysis decreased compared to normal controls in over 20 years old age. Furthermore, all measured functions decreased with age in rTOF while only two parameters decreased with age in normal controls. These results suggest that LA function may be an important indicator in long-term rTOF follow-up. These are new insights into LA function in patients with rTOF.
P1365 Different response of myocardial contractility by layer following acute pressure unloading after transcatheter aortic valve implantation
Authors: Cimino S , Maestrini V , Monosilio S , Luongo F , Neccia M , Birtolo L I , Petronilli V , Cantisani D , Salvi N , Filomena D , Mocci M , Quaranta S , Mancone M , Fedele F , Agati L 
Published: January 2020

Abstract

Background
Transcatheter aortic valve implantation (TAVI) is an effective therapeutic option for severe symptomatic aortic stenosis (AS) with intermediate/high surgical risk. Aim of this study was to examine the acute effect of TAVI in terms of pressure unloading, on left ventricular (LV) mechanics using multilayer global longitudinal strain (GLS) by 2D speckle-tracking echocardiography (ST-E).

Methods
A total of 44 patients (mean age 81.8 ± 2, 34% male) with severe symptomatic AS and preserved LV ejection fraction (LVEF) underwent 2D echocardiography at baseline and 5 ± 2 days after TAVI. GLS was measured from the endocardial layer (Endo-LS), epicardial layer (Epi-LS) and full thickness of myocardium before and after the procedure. Analysis included other parameters such as age, sex, LV volumes and ejection fraction (LVEF), type of prosthesis implanted, right ventricular (RV) dimension and function.

Results
By dividing patients in two groups accordingly with LV geometry assessed with regional wall thickness measurement (concentric vs eccentric hypertrophy), better values of Endo-LS were recorded at baseline, in patients with concentric hypertrophy (-12.9 ± 2 vs -11 ± 3, p = 0.048). After TAVI, a significant improvement in Endo-LS was observed, but only in patients with concentric hypertrophy (-12.9 ± 2 vs -14.2 ± 2, p = 0.003).

Conclusion
The improvement in LS was more prominent in the endocardium, which was evident even immediately after TAVI only in patients with concentric hypertrophy. Evaluation of multilayer strain may provide new insights into the positive effects of unloading in patients with AS and may be potentially useful to predict patients with better outcome after TAVI.
Parameter RWT &gt; 0.42 31 pz (70%) RWT ≤ 0.42 13 pz (30%) p Male sex (n, %) 8 (25%) 7 (53%) NS Age (y.o) 81 ± 6 83 ± 7 NS CAD (n, %) 3 (9%) 8 (61%) NS LVEDV (ml) 97 ± 29 134 ± 14 0.002 LVESV (ml) 43 ± 15 72 ± 38 0.001 LVEF(%) 56.2 ± 6 50 ± 12 NS AVA (cm2) 0.8 ± 0.2 0.8 ± 0.3 NS GLS (%) -11.4 ± 3 -10.5 ± 3 NS Endo-LS (%) -12.9 ± 2 -11 ± 3 0.048 Epi-LS (%) -10.8 ± 4 -9.9 ± 3 NS
Abstract P1365 Figure.
P1374 Clinical outcomes of patients with solid left atrial appendage thrombi. Predictors of thrombus resolution and impact of anticoagulation regimens
Authors: Nelles D , Lambers M , Schafigh M , Schueler R , Vij V , Schrickel J W , Nickenig G , Hammerstingl C , Sedaghat A 
Published: January 2020

Abstract

OBJECTIVE
Current guidelines recommend vitamin k antagonist (VKA) therapy with a therapeutic international normalized ratio of 2.0 to 3.0 for at least 3 weeks upon detection of an LA/LAA thrombus in patients with atrial fibrillation (AF). Reported thrombus resolution rates with VKAs vary between approximately 50% and 90%. Data on thrombus resolution after a therapy with a direct-acting oral anticoagulant (DOAC) are scarce but efficacy data on DOAC indicate on potential favorable outcomes.

METHODS
We analyzed 78 patients diagnosed with a solid LA thrombus by transesophageal echocardiography and compared baseline characteristics, the anticoagulatory regime and the clinical outcomes of patients with and without thrombus resolution.

RESULTS
Mean age of the population was 76 ±8 years old. Patients were male in 61.5% and presented with a high risk for thromboembolism (CHA2DS2-VASc 4.3 ± 1.1). At the time of thrombus diagnosis 44,9% (35/78) patients were treated with a DOAC, 47,4% (37/78) were under therapy with a VKA and only 14,1% (11/78) of the patients had no prior DOAC or VKA treatment. Mean thrombus size was 1,63 ± 0,61cm x 0,98 ± 0,31cm. Complete thrombus resolution was achieved after a mean 116 ± 79 days in a total of 48,2% (40/78) of patients. There was no statistically significant difference in the rate of LAA thrombus resolution between VKA and DOACs (41,2% vs. 57,1%), but in cases in which therapy with a DOAC led to a complete thrombus resolution, the time needed for the resolution was significantly shorter than with VKA (81 ± 38 days vs. 129 ± 46 days, p = 0,03).

CONCLUSIONS
There was difference in the rate of LAA thrombus resolution between VKA and DOACs, the resolution time was shorter in patients prescribed a DOAC. In clinical practice the individual risk for thrombus persistence can not be predicted. 80,1% of patients were prescribed, what would be considered, an appropriate anticoagulant regimen, but only 48,2% had thrombus resolution at any point of follow up documented via TEE. Switching to DOAC after prior VKA therapy is an effective and valid alternative to patients presenting with LAA thrombi.
P1377 Predicting the presence of coronary artery disease by transesophageal echocardiography
Authors: Heidari H , Ran H , Roth C , Hengstenberg C , Binder T , Goliasch G , Schneider M 
Published: January 2020

Abstract

Introduction
The accuracy of ultrasound signs as predictors for the presence of coronary artery disease (CAD) has been evaluated extensively in the 1990s and 2000s. Imaging quality has improved tremendously over the last decades.

Hypothesis
High-end ultrasound systems allow for accurate prediction of presence or absence of CAD.

Methods
We retrospectively evaluated all patients who received transesophageal echocardiography examination (TEE) between 2007 and 2016 and who had coronary angiography within 24 months before or after the TEE.

Results
A total of 242 patients fulfilled the inclusion criteria, 60% were male. Mean age was 70 (SD ±13) years. In multivariate regression analysis, plaque in the aortic arch (OR 2.53, 95%CI 1.01-6.35, p = 0.048), plaque in at least one of the thoracic aortic segments (OR 2.44, 95%CI 1.21-4.9, p = 0.012), the presence of mitral annular calcification (MAC) (OR 1.87, 95%CI 1.03-3.39, p = 0.038), and any two of the three (aortic stenosis (AS), MAC, aortic plaque) in combination (OR 2.05, 95%CI 1.08-3.88, p = 0.028) were predictors of significant CAD. The isolated findings MAC (OR 1.91, 95%CI 1.00-3.65, p = 0.049) and AS (OR 2.45, 95%CI 1.22-4.92, p = 0.012) were significant predictors for the absence of normal coronary arteries.

Conclusion
With a negative predictive value of 80%, the absence of MAC, AS, and aortic plaque makes the presence of significant CAD unlikely. If CAD must be excluded and MAC or AS are present, there is high likelihood for at least mild CAD. Coronary angiography rather than coronary CT angiography should be applied in these patients.
P1388 LA and LV strains are closely linked in patients with diastolic dysfunction and preserved ejection fraction
Authors: Malaescu G , Capota R , Petrescu A , Duchenne J , Voigt J-U 
Published: January 2020

Abstract

Introduction
Left atrial (LA) strain has been proposed as an independent parameter for the assessment left ventricular (LV) diastolic function. However, there is increasing evidence of impaired LV longitudinal function in patients with diastolic dysfunction(DD) and preserved ejection fraction (EF).

Purpose
To assess the relationship between LA and LV strain parameters with different grades of LV diastolic dysfunction in patients with preserved EF.

Methods
We included 95 patients with EF &gt; 50% and good image quality. Patients with a mobile interatrial septum, more than mild valvular regurgitation and previous heart surgery were excluded. Standard echocardiographic measurements and the assessment of the diastolic function were performed according to current guidelines. LA and LV strains were assed using speckle tracking in 4 and 2 chambers apical views, using R-R gating. Strain values from LA and LV strain curves were derived in every phase of the cardiac cycle (peak systolic, early and late diastole strain).

Results
26 patients had normal diastolic function, 23 had grade 1, 19 grade 2 and 13 grade 3 DD. Fourteen patients with indeterminate DD grade were excluded. Both peak LA and LV strain decreased significant with the degree of DD (Fig.). LA and LV early diastole strain were significantly higher in patients with normal diastolic function than any degree of DD. LA and LV late diastole strain increased in grade 1 DD.
LA and LV strain parameters changes correlated significantly in systole, early and late diastole (r = 0.81,p &lt; 0.0001; r = 0.64, p &lt; 0.0001; r = 0.76, p &lt; 0.0001, respectively). Other standard parameters of DD were not capable to differentiate between grades of DD.

Conclusion
LA and LV strain parameters show similar changes with increasing diastolic dysfunction. Diastolic dysfunction was regularly associated with reduced longitudinal strain in both LA and LV despite preserved EF. This suggest that both LA or LV strain could be used for the assessment of diastolic function.
Abstract P1388 Figure. LA and LV strain parameters by DD
P1396 Three-dimensional cardiac mechanics for prediction of events in Chagas disease
Authors: Hotta V T , Abduch M C D , Vieira M L C , Ianni B M , Mady C , Bocchi E A 
Published: January 2020

Abstract

Introduction
Chagas disease (CD) is an endemic infectious disease that still remains a great economic burden. Three-dimensional speckle tracking (3D STE) may play a role in the evaluation of CD. We assessed the hypothesis that 3D STE may predict clinical events in patients with CD.

Methods
This was a convenience sample. Patients with any systemic disease were excluded. Eight hundred and eight patients with CD were evaluated but only seventy-two were included. Clinical, electrocardiographic and comprehensive conventional and 3D echocardiography were performed. Patients were followed up for thirty-six up to sixty months. Clinical events were defined as hospitalization for heart failure, ventricular arrhythmias and cardiovascular death.

Results
Seventy-two patients were enrolled in three groups: Group 1 (G1), patients with left ventricular ejection fraction (LVEF) &lt; 0.35 (N = 22); Group 2 (G2), LVEF between 0.35 and 0.55 (N = 22); Group 3 (G3), normal LVEF (N = 28). Gender distribution, mean age, anthropometric variables and risk factors were similar between the groups. 2D STE feasibility was 99.5, 99 and 100% in G1, G2 and G3. 3D Longitudinal strain feasibility was 93, 89 e 88% in G1, G2 and G3. Interobserver and intraobserver variabilities (Blant-Altman) for longitudinal (2D and 3D GLS), circumferential (3D GCS), radial (3D GRS) and area strain (3D AS) are displayed in Table 1.
Hospitalization was related do indexed left atrium volume (p = 0,03) in G1. In G2, non-sustained ventricular tachycardia were related to 2D GLS values (p = 0,04); all clinical events were related do diastolic function (p = 0,30). In G1 and G2, hospitalization was related do indexed left atrium volume (p = 0,01); all clinical events were related do diastolic function (p = 0,004) and 3D LVEF (p = 0,02). 3D STE parameters were not related to clinical events.

Conclusions
In conclusion, 3D STE in patients with CD appears to be an accurate, reproducible and promising method but was not related to clinical events.
Table 1 INTEROBSERVER INTRAOBSERVER 2D GLS 0.96 ± 0.04 0.90 ± 0.08 3D GLS 0.92 ± 0.07 0.93 ± 0.10 3D GCS 0.88 ± 0.07 0.82 ± 0.15 3D AS 0.93 ± 0.05 0.90 ± 0.05 3D RS 0.85 ± 0.05 0.84 ± 0.11 Table 1. Interobserver and intraobserver variabilities for longitudinal (2D and 3D GLS), circumferential (3D GCS), radial (3D GRS) and area strain (3D AS).
P1405 3D echocardiographic assessment of right ventriculo-arterial coupling in mitral valve prolapse
Authors: Filippetti L F , Huttin O H , Venner C V , Aubert R A , Juilliere Y J , Selton-Suty C S S 
Published: January 2020

Abstract

Background
Both pulmonary artery pressure (PAP) and right ventricular (RV) function have shown their value in the prognostic evaluation of patients with mitral valve prolapse (MVP). Echocardiography which allows simultaneous pressure estimation and volume measurement by 3D allows an approach of arterial (Ea) and ventricular elastance (Emx) and of right ventriculo-arterial coupling (RVAC), usually derived from pressure-volume loops, and could be of interest in the assessment of the RV-PA unit.

Methods
Thirty normal patients (group Nl, mean age 52.7 ± 15.9) and 75 patients with stable MVP (mean age 52.4 ± 15.4 (ns for age), 39 (group MVP1) with no or mild mitral regurgitation (MR) and 36 (group MVP2) with moderate to severe MR) underwent echocardiography including 3D RV acquisition. RV end-systolic volume (ESV), end-diastolic volume (EDV), stroke volume (SV) (mL) and ejection fraction (EF) (%) were obtained 3D echo (3DE) volumetric analysis (GE, EchoPac). mPAP was estimated from echo using Chemla’s formula (mPAP = 0.61 x sPAP + 2mmHg). Pulmonary artery effective elastance (Ea) was estimated as mPAP/SV (mmHg/mL), RV maximal end-systolic elastance (Emax) as mPAP/ESV (mmHg/mL), and RVAC as Ea/Emax. Ea, Emax and RVAC were compared between the 3 groups of patients using ANOVA.

Results
Mean LVEF was similar in the 3 groups. There was a significant differences in mPAP (Nl: 15.6 ± 3.0; MVP1: 16.3 ± 3.3; MVP2: 22.9 ± 11.1, p = 0.001).
RVEDV (Nl: 81.3 ± 19.2; MVP1: 80.1 ± 22.0; MVP2: 96.1 ± 28.6, p = 0.09), RVEF (Nl: 50.4 ± 4.4; MVP1: 49.3 ± 5.5; MVP2: 46.6 ± 6.6, p = 0.02) and RVESV (Nl: 39.9 ± 9.8; MVP1: 40.8 ± 12.8; MVP2: 52.0 ± 19.5, p = 0.01) were significantly different among the 3 groups. There was a non significant trend toward progressive increase in Ea (Nl: 0.41 ± 0.12; MVP1: 0.45 ± 0.15; MVP2: 0.53 ± 0.30, p = 0.07) and E max (Nl: 0.42 ± 0.11; MVP1: 0.45 ± 0.17; MVP2: 0.53 ± 0.31, p = 0.11) among the 3 groups but RVAC was not significantly different (Nl: 0.99 ± 0.17; MVP1: 1.04 ± 0.22; MVP2: 1.05 ± 0.37, ns).

Conclusion
3D echocardiography allows a complete analysis of the RV-PA unit and is able to reveal subtle changes in its equilibrium. Together with an increase in RV volumes and decrease in RVEF, our study reveals a progressive increase in arterial elastance in parallel with the severity of MR, compensated by an increase in ventricular elastance to maintain RV – PA coupling in those stable patients with MVP.
P1406 Normal reference values of right atrial strain parameters using three-dimensional speckle-tracking echocardiography in healthy adults
Authors: Nemes A , Kormanyos A , Domsik P , Kalapos A , Ambrus N , Lengyel C , Forster T 
Published: January 2020

Abstract

Introduction
Classic echocardiographic methodologies offer limited opportunities in assessing right atrial (RA) morphology and function. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is a novel imaging method with objective 3D capability in assessing volumetric and functional properties of heart chambers. Normal reference values of different 3DSTE-derived RA strains are not available, therefore the aim of this prospective study was to establish these parameters in healthy subjects.

Methods
The present study comprised 295 healthy volunteers, from which 110 were excluded due to inadequate image quality. The final population consisted of 185 healthy subjects in the present study (mean age: 32.1 ± 12.2 years, 89 males). Complete two-dimensional echocardiography and 3DSTE have been performed in all cases.

Results
While radial strain (RS) does not change significantly over the years in males, RS increases with age most significantly between 40-49 years, and it starts to decline at the age of 50 years in females. While females have higher circumferential strain (CS) and area strain (AS) values, RS decreases with age in both gender. While longitudinal strain (LS) remains almost unchanged in females until 40-49 years and declines above the age of 50 years in females, it decreases over decades in males. 3D strain (3DS) increases with ages in both gender, but almost doubles in females in older ages. While RS at atrial contraction does not change over decades in males, an obvious increase could be seen in females with a higher value between 40-49 years and a decline over 50 years. A decrease could be seen in CS at atrial contraction in males over decades, it is almost tripled in value between 40-49 years in females. Although LS at atrial contraction is higher in females, it decreases over decades in both genders. AS decreases over decades in males, while females have almost doubled AS values at the ages 40-49 years. 3DS is almost unchanged in males, while doubled in older ages in females. During evaluations, 110 subjects were excluded due to inferior image quality from the total of 295 enrolled subjects, therefore the overall feasibility of 3DSTE-derived RA quantification was 185 out of 295 (63% overall feasibility).

Conclusion
3DSTE-derived RA normal reference values with age- and gender-dependency are demonstrated in a healthy population.