bluuebunny/crossref_metadata_2025_split huggingface dataset:
160 Echocardiographic assessment of CRT candidates. Does additional scar evaluation by MRI improve prediction of response?
Authors: Duchenne J , Cvijic M , Larsen C K , Galli E , Aalen J M , Voros G , Beela A S , Unlu S , Penicka M , Hopp E , Bogaert J , Smiseth O A , Donal E , Voigt J U 
Published: January 2020

Abstract

Background
Myocardial scar presence and extent, has a considerable influence on response to cardiac resynchronization therapy (CRT). Apical rocking (ApRock) and septal flash (SF) are associated with favourable outcome after CRT. Little is known however to which extent visual assessment of mechanical dyssynchrony by ApRock, SF and scar predicts CRT response. We therefore investigated, if additional scar assessment by cardiac magnetic resonance imaging (MRI) adds to the predictive value of the visual evaluation of echocardiographic images in CRT candidates.

Methods
A total of 201 unselected patients referred for CRT, who fulfil the contemporary guidelines for CRT implantation, were enrolled in this prospective multicentre study. Two experienced observers visually assessed echocardiographic images before CRT implantation, focussing on the presence of ApRock, SF and location and extent of scar segments of the left ventricle (LV), resulting in a CRT response prediction (i.e. Integrative Prediction). A third observer provided a consensus reading in case of disagreement. All observers were blinded to all patient information other than the ischaemic aetiology of heart failure. Independent from that, segmental myocardial scar burden was objectified by late gadolinium enhancement (LGE) cardiac MRI (LGE &gt; 50%). CRT response was defined as ≥15% reduction in LV end-systolic volume on echocardiography, one year after device implantation.

Results
Overall, 69 (34%) patients had an ischaemic aetiology of heart failure. Before CRT, ApRock and SF were present in 129 (64%) and 136 (68%) patients, respectively. ApRock and SF alone predicted CRT response with an area under the curve (AUC) of 0.85 (95% CI: 0.79-0.91) and 0.84 (95% CI: 0.77-0.91) (Figure A), while the echocardiographic Integrative Prediction had an AUC of 0.90 (95% CI: 0.84-0.95), with a sensitivity of 93% and a specificity of 87% for the prediction of CRT response (Figure B) (p &lt; 0.05 vs. ApRock and SF alone). When combining information on ApRock, SF and the number of scarred segments on MRI in a statistical model, the AUC was comparable to the echocardiographic Integrative Prediction [0.90 (95% CI: 0.84-0.96)] as was sensitivity and specificity (91% and 83%, respectively, p = N.S. vs. Integrative Prediction) (Figure C).

Conclusions
An integrative visual assessment of LV function has an excellent predictive value for CRT response. Our data show, that the echocardiographic estimation of scar burden is sufficiently accurate and cannot be further improved by an additional MRI scar assessment.
Abstract 160 Figure.
P223 Cat bite with unexpected consequences
Authors: Moser M , Koenig A , Dannenberg V , Speidl W , Riesenhuber M , Bergler-Klein J , Binder T , Gabriel H , Schneider M 
Published: January 2020

Abstract
A 25 y/o female patient with corrected tetralogy of Fallot (1995), pulmonary valve bio-prosthesis (1999) with consequent stenosis, and finally implantation of a pulmonary valve Hancock-conduit (2005), presented to our department with night sweats, shortness of breath, and fever for the past three weeks. Leukocytes and CRP were elevated, transthoracic echocardiography revealed a large vegetation on the pulmonary valve prosthesis with relevant stenosis (peak gradient 70 mmHg). The patient reported to have an 18-year-old cat as a pet, which had bit her shortly before onset of symptoms.
Blood cultures remained negative, bacterial broad spectrum PCR revealed Bartonella species. PET-CT was ordered and confirmed pulmonary valve endocarditis.
The patient was treated with antibiotics and eventually transferred to cardiac surgery due to persistently high gradients over the valve in combination with exertional dyspnea.
Bartonella is a well-known cause of blood culture negative infective endocarditis, which must be tested for specifically. This case underlines the importance of taking complete patient history, including presence of pets and especially recent bites. Comprehensive imaging must be performed timely in every patient with known valve disease and unexplained symptoms.
Abstract P223 figure 1
P225 Carcinoid heart disease: report of a case in a patients with trombocytopenia absent radius
Authors: Quezada M , Ayala R , Ramos M , Villa Benayas Z , Calderon-Dominguez M , Toro R 
Published: January 2020

Abstract

Background
The carcinoid syndrome is characterized by extensive and several clinical manifestations. The diarrhea, the cutaneous flushing are the most frequents symptoms while cardiac manifestations (carcinoid heart disease) (CHD) occurs in a mean of 40%. Nowadays, the number of cases of CHD is lower than 20%, as a consequence of the widespread use of somatostatin analogues. At present, there is a mean delay in diagnosis of CHD of 1.5 years from the time of carcinoid syndrome detection. Hence, CHD is associated with a poor prognosis for clinical management.

Case report
We present a case of 45-years-old active woman, with Thrombocytopenia absent radius (TAR). This is characterized by a bilateral absence of the radio with the presence of both thumbs and thrombocytopenia. Our patient was attended for dyspnea of medium efforts, history of diarrhea, cutaneous flushing with tachycardia and elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) (89,6 mg/24 (2,0-9,0)). The Transthoracic echocardiography showed morphologic changes that affected the tricuspid valve: diminished curvature of the leaflets, altered dynamic motion of the leaflets during diastole, fused and shortened chordae retraction and reduced excursion of the valve. A moderate to severe tricuspid regurgitation and tricuspid stenosis with gradient media de 5 mmHg was observed. In addition, the right ventricle was dilated, a severe pulmonary hypertension, a right pleural effusion and a minor pericardial effusion circumference were detected. All these findings were consistent with CHD.

Conclusions
This report describes an unusual case of CHD in TAR patient. In fact, the interest of this case is the role played by the echocardiogram in the differential diagnosis for tricuspid valve diseases. Tricuspid stenosis is an infrequent condition and it is usually related with rheumatic disease associated with mitral valve disease. Although the carcinoid syndrome is infrequent, any changes in the anatomical structure of the tricuspid valve (thickening, fibrosis and rigidity associated with stenosis and tricuspid regurgitation) should alert us to the suspicion of CHD
Abstract P225 Figure.
P226 Caseous calcification of the mitral annulus: a silent cause of intracardiac mass
Authors: Campos I , Galvao Braga C , Costeira-Pereira A , Salome N , Vieira C , Pereira V H , Costa-Oliveira C , Marques Pires C , Medeiros P , Flores R , Mane F , Marques J 
Published: January 2020

Abstract

INTRODUCTION
Caseous calcification of the mitral annulus (CCMA) is a very rare variant of mitral annular calcification with a central liquefaction necrosis, being an uncommon echocardiographic finding (0.5 to 1%) which may be mistaken for an intracardiac tumor, thrombus or vegetation. This chronic degenerative process can occurs at advanced ages, particularly in women, and patients with hypertension, chronic renal failure or calcium metabolism abnormalities. Since patients often remain asymptomatic, conservative treatment for this lesion is generally sufficient.

CASE REPORT
DESCRIPTION
We report a case of an 86-year-old female with a known history of hypertension and diabetes, who was referred to our department in order to investigate the diagnosis of an intracardiac mass visualized through a routine transthoracic echocardiography. She reported effort dyspnea, but refused to have other cardiovascular symptoms.
In order to study this intracardiac mass, the patient was submitted to a transthoracic echocardiogram that showed a rounded mass of 16 × 22 mm in the anterior mitral annulus, mainly in P1 scallop, not causing valve stenosis and with a mild mitral regurgitation. This prompted the need for transesophageal echocardiography which revealed a spheroid mass of heterogeneous content with calcification points, regular edges and with faint central echo-lucent area without acoustic shadowing, attached to the anterior mitral valve leaflet. No communication with any cardiac chamber could be detected. The mass did not determine any restriction to the opening of mitral valve cusps. A cardiac MRI was requested to complete the diagnostic evaluation revealing that the lesion was located at the base of the anterior leaflet. In the T1 and T2 sequences the mass was hypointense, whereas in the perfusion sequence, no contrast penetration was detected in the mass and in the late enhancement. These findings, as well as the presence of a calcified envelope in the cardiac computed tomography scan, confirmed the suspicion of caseous calcification of the mitral annulus.

DISCUSSION
AND CONCLUSIONS
We present an unusual case of caseous calcification of the mitral annulus in which the multi-modal approach was crucial to confirme the diagnosis. Although transthoracic echocardiography can be sensitive in the diagnosis of this entity, the diagnosis may sometimes still be inconclusive. Thus, multi-modality with transesophageal echocardiography, cardiac MRI or CT can lead to a definitive diagnosis, avoiding an mistaken diagnosis with the need of a surgical approach. Since this pathology is most frequently detected in asymptomatic patients, the patients should be treated medically and monitored clinically and echocardiographically for an early recognition of possible complications.
Abstract P226 Figure. Caseous calcification of mitral annulus
P1583 Usefulness of remote intrathoracic impedance alerts for echo-guided CRT optimization
Authors: Appignani M , Salvatore T , Di Girolamo E 
Published: January 2020

Abstract

Background
Cardiac resynchronisation therapy (CRT) is a strong recommendation in heart failure (HF) patients having sinus rhythm, left bundle branch block, QRS duration ≥ 120 ms and left ventricular (LV) ejection fraction (EF) ≤ 35%, despite optimized medication. Echocardiographic parameters still have a controversial role in the selection of patients ongoing CRT, and no single parameter is recommended to identify a positive CRT response. Even their role in the management after implantation remains still troubleshooting. Atrioventricular (AV) and interventricular (VV) delay reprogramming could be a variable that may influence CRT outcome and, although a systematic AV and VV optimization is not required, it could be useful in selected patients. Remote monitoring networks allow HF patients having a CRT device to be constantly monitored, and notifications of some intrathoracic impedance indexes, may be helpful in the management of HF patients.

Purpose
To evaluate the usefulness of intrathoracic impedance notifications in the selection of HF patients to have echo-guided AV and/or VV delays optimization, the following study was undertaken.

Methods
27 CRT patients having an intrathoracic impedance enabled remote monitoring, with at least one impedance notification during the first six months from implantation, were considered for study. The primary endpoint was a composite of improvement in NYHA functional class and EF, reduction of LV end-systolic volume and rehospitalization for decompensated HF. Secondary endpoint was the effectiveness of echo-guided dealys optimization based on intrathoracic impedance alerts. The AV delay optimization was mainly driven by mitral inflow pattern, whereas VV delay optimization was guided by the assessment of LV synchrony using color Tissue Doppler Imaging (TDI). Patients were weekle evaluated through remote monitoring network over a six-month follow-up. LVEF and LV end-systolic volume were determind at baseline and after six months.

Results
After the six-month follow-up, an improvement of at least 1 NYHA functional class was obtained in 23 patients (85%), while 2 patients (7.4%) experienced an improvement of two NYHA classes. In 21 Patients (77.7%) LVEF increased at least 5%. Optimization was associated with an average 11.9 ± 6.4% increas in EF, from a mean baseline of 28.2 ± 3.2% to 37.8 ±6.2%. End-systolic volume decreased from 161.56 ± 9.87 ml to 143.22 ± 15.83 ml. Among the 27 patients with impedance alerts at baseline, only 6 (22.2%) reported new notifications during follow-up, with a significant reduction (p &lt; 0.03) after optimization.

Conclusions
Intrathoracic impedance monitoring improved the selection of non responders feasible to have echo-guided AV and/or VV delays optimization. Functional status and LVEF increased. Although time-consuming, this multidisciplinary network may increase close cooperation between electrophysiologist and HF physicians to better manage HF patients having a CRT system implanted.
P1584 Characteristics of a new subgroup in chronic heart failure: heart failure with mid-range ejection fraction (HFmrEF)
Authors: Alberts V , Weytjens C , Cosijns B 
Published: January 2020

Abstract

Introduction
Classification of patients with heart failure is based on left ventricular ejection fraction (LVEF). Until recently, two types of patients had been distinguished based on LVEF: those with reduced ejection fraction (HFrEF) and those with HF with preserved ejection fraction (HFpEF). The ESC guidelines of 2016 introduced a third separate subgroup for patients with a LVEF in the range of 40-50%: Heart failure with mid-range ejection fraction (HFmrEF).

Purpose
The goal of this study is to characterize and compare this subgroup (HFmrEF) to the other two subgroups (HFpEF and HFrEF). Secondly, mortality rates were studied and compared, depending on LVEF classification and global longitudinal strain (GLS).

Methods
All patients with Chronic Heart Failure (CHF) seen at the heart failure clinic, during a 1-year period were enrolled in this retrospective study. As an inclusion criterion in our study population, we only allowed patients with chronic heart failure, who were treated at least once with diuretics or a cardiac resynchronization therapy for heart failure. After gathering data of the HF population, the 3 subgroups (HFrEF, HFpEF and HFmrEF) were compared on the basis of different parameters like comorbidities, lab results, medication, ECG and echocardiography.

Results
HFmrEF significantly differed from HFpEF concerning the following parameters: higher prevalence of male gender and ischemic aetiology, lower prevalence of valvular and hypertensive aetiology, more dilated left ventricles and higher usage of ACE inhibitors and betablockers. HFmrEF was similar to HFpEF concerning older age, high prevalence of tachyarrhythmia, low use of device therapy and aldosterone antagonists.
The survival rate after 853 days was 81,6% in HFrEF, 76,3% in HFmrEF and 81,1% in HFpEF (p = 0,634). When looking at the whole patient population, the Kaplan Meier estimation was significant (p &lt; 0,001) with a survival rate after 853 days of 33,3% for the group with lower absolute values than 6,3% for GLS and 85% for group with higher absolute strain values.

Conclusion
Patients with HFmrEF didn’t really differentiate as one class apart from HFrEF or HFpEF, but some characteristics were similar to HFrEF, and some others to HFpEF. Finally some characteristics of HFmrEF were more in a grey zone with none of the characteristics of both HFrEF nor HFpEF.
The all cause survival rate in 853 days among the 3 LVEF based groups, were quite similar. While the Kaplan Meier estimation indicated a lot higher mortality when GLS&gt;-6,3% compared to GLS &lt;-6,3%.
Classifying chronic HF patients is probably more complex than simply stratifying patients by LVEF cut-off values. One must not forget to take comorbidities and aetiology in mind while managing heart failure.
Abstract P1584 Figure. Aetiology in LVEF based groups
P1603 Changes of cardiac function in cirrhotic patients after liver transplantation
Authors: Kim H M , Kim H K , Lee J H , Park E A , Park J B , Lee S P , Kim Y J , Sohn D W , Lee Y B , Kim Y J , Yoon J H 
Published: January 2020

Abstract

Funding Acknowledgements
This study was supported by the grant of CJ healthcare 2016 research fund.

Background
Liver cirrhosis (LC) has been known to affect cardiovascular performance. Limited study have evaluated the alteration of myocardial function in patients with LC after liver transplantation (LT).

Purpose
The aim of study was to evaluate changes of cardiac function in patients with cirrhosis following LT using conventional and speckle-tracking echocardiography and late gadolinium enhancement (LGE) of cardiac magnetic resonance (MR).

Methods
Thirty-five patients with cirrhosis (mean age, 57.1 ± 9.0; male, 75%) who were listed for LT were prospectively enrolled. Patients underwent conventional, speckle-tracking echocardiography, and cardiac MR imaging with LGE. Echocardiography and cardiac MR were performed at pre and 1 year after LT. Cirrhotic patients were compared with normal control (n = 20, mean age, 65.0 ± 14.8; men, 11(55%)) and echocardiographic and cardiac MR data were compared pre and post LT.

Results
Conventional and speckle-tracking echocardiography and Cardiac MR imaging demonstrated hyperdynamic left ventricular (LV) function in patients with cirrhosis (LV ejection fraction (EF) with cardiac MR 67.8 ± 7.0% in LC vs. 63.4 ± 6.4% in control, P = 0.028; global longitudinal strain (GLS) -24.3 ± 2.6% in LC vs. -18.6 ± 2.2% in control, P &lt; 0.001). There were no LGE in patients with cirrhosis and no significant differences in LV size, LV wall thickness, LV mass index, and diastolic function between cirrhotic patients and control group (all P &gt; 0.1). Corrected QT interval (QTc) in electrocardiogram was prolonged in LC patients (P &lt; 0.001). One-year after LT, LV end-diastolic diameter and LV end-diastolic volume significantly decreased (P = 0.016 and 0.022, respectively). Although LVEF showed no significant changes 1 year post-LT (P = 0.362), LV-GLS (from -24.7 ± 1.8% to -20.8 ± 3.4%, P &lt; 0.001) significantly decreased. QTc interval also decreased 1 year after LT (from 470.4 ± 29.6msec to 428.2 ± 31.6msec, P = 0.001).

Conclusions
The present study demonstrated that cirrhotic patients showed hyperdynamic circulation and prolonged QTc interval compared with normal controls. After 1 year LT, LV size reduced and augmented LV function was normalized. Given that no LGE in cardiac MR and normalized GLS and QTc after LT, cardiac dysfunction in LC patients could be reversed by LT.
1638 A case of capturing changes in interatrial blood flow and anatomical structure during percutaneous PFO closure with platypnea orthodeoxia syndrome using intra-cardiac echocardiography
Authors: Hashimoto G , Ide S , Hayama H , Makino K , Otsuka T , Suzuki M , Iijima R , Hara H , Moroi M , Nakamura M 
Published: January 2020

Abstract

Background
Platypnea–orthodeoxia syndrome (POS) is an uncommon condition characterized by positional dyspnea and hypoxemia due to intracardiac right-to-left shunting through a patent foramen ovale (PFO). The most commonly associated conditions included pneumonectomy, ascending aortic dilation, and arch surgery, as previously reported. Percutaneous closure of PFO is useful treatment for POS.

Case
A 76 year old man used home oxygen therapy because of unexplained hypoxemia. A decrease in blood oxygen saturation was observed in sitting and standing positions. The patient was diagnosed as "POS" because a shunt blood flow with PFO and atrial septal aneurysm (ASA) and eustachian valve was observed at transesophageal echocardiography. He was admitted for the purpose of percutaneous PFO closure.
He was treated with intra-cardiac echocardiography (ICE) guidance under local anesthesia because of poor lung function.
PFO closure was performed successfully with 30mm AMPLATZER Cribriform. The ICE findings prior to PFO closure showed a right-to-left shunt blood flow through the PFO in the sitting position but almost disappeared after closure. Furthermore, it was observed that the aortic artery compression was stronger in the sitting position than in the supine position with right-to-left shunt blood flow. After PFO closure, hypoxia associated with postural change improved and patient’s symptom as shortness of breath also significantly improved.

Discussion
POS is a position-dependent condition of dyspnea and hypoxemia due to right-to-left shunting. It often remains unrecognized in clinical practice, possibly because of its complex underlying pathophysiology. It is considered that the cause of POS in this patient was multiple factors such as ASA, aortic displacement, and venous valve remnant. In addition, being able to observe the change of the atrium due to compression from the aortic artery using ICE during the operation was very significant to explain the mechanism of POS.
Abstract 1638 Figure. Intra-cardiac echocardiography
1677 Global longitudinal strain during dobutamine stress echocardiography can predict left ventricular remodeling after anterior wall acute myocardial infarction
Authors: Onishi T , Iwakura K , Okamura A , Koyama Y , Inoue K , Iwamoto M , Tanaka K , Nagai H , Hirao Y , Oka T , Tanaka N , Fujii K 
Published: January 2020

Abstract

Background
Although dobutamine stress echocardiography (DSE) at the early stage of acute myocardial infarction (AMI) is useful for the prediction of functional and clinical prognosis, the interpretation requires expertise. In this study, we sought to investigate if global longitudinal strain (GLS) during DSE after AMI can predict left ventricular remodeling (LVR).

Methods
Consecutive 30 patients with anterior wall AMI (18 male, age = 58 ± 13 years) were performed DSE 3 days after AMI. GLS was calculated as an averaged value of peak longitudinal strain in the apical 4- and 2-chamber views at baseline echocardiography, low-dose DSE (10 μg/kg/min) using available software (QLAB, Philips Medical Systems). Left ventricular remodeling (LVR) was defined as an echocardiographically determined increase in both EDVI and ESVI of 20% or more from baseline to the 6 month follow-up echocardiography.

Results
12 patients (40%) evolved with LVR. The change in GLS during low-dose DSE was significantly different between the remodeling and non-remodeling group (8 ± 5% v.s. 27 ± 20%, p &lt; 0.05). Interestingly, it predicted LVR with sensitivity of 88%, specificity of 92% at the cut-off value of 12% (Area under the curve = 0.94, p &lt; 0.0001).

Conclusion
The change in GLS during low-dose DSE can be used as a predictor for the LVR after AMI. This observation has promise for clinical applications.
Abstract 1677 Figure.