bluuebunny/crossref_metadata_2025_split huggingface dataset:
692 THE USE OF ULTRASOUND ENHANCING AGENTS (UEA) IN THE EVALUATION OF LEFT ATRIAL APPENDAGE (LAA) THROMBUS IN PATIENT CANDIDATE TO PERCUTANEOUS LAA CLOSURE
Authors: Roccabruna Alessandra , Fanti Diego , Bonvicini Eleonora , D´onghia Giovanni , Sarao Emanuele , Guarracini Fabrizio , Bonmassari Roberto , Luciano Ribichini Flavio 
Published: December 2022

Abstract

Introduction
Left atrial appendage closure (LAAC) is an emerging option in patients with atrial fibrillation (AF) and contraindication for oral anticoagulation (OAC) therapy. Patients with left atrial thrombus are usually excluded from this strategy. Therefore, pre-procedural transesophageal echocardiography (TEE) is usually performed for LAA thrombus exclusion. The application of second-generation lipid microspheres ultrasound enhancing agents (UEA) is of growing interest. The following clinical cases reports describe the benefit from UEA implication on subsequent decision-making regarding with LAAC procedure.

Case report num.1
an 88-year-old male with history of symptomatic AF and post – traumatic cerebral bleeding was referred to LAAC because of high risk of bleeding in using OAC. Transthoracic echocardiography (TTE) documented a severely dilatated left atrium and preserved left ventricular systolic function. Pre – operative TEE revealed a “chicken wing” shaped LAA with severe spontaneous echo-contrast and sludge effect. Echo-contrast medium “SonoVue” showed an early filling defect with late but complete LAA opacification, excluding thrombus. Of note, ECG-gated cardiac CT (CCT) could not exclude filling defect with certainty. Consecutively, the patient was candidate to LAAC in a short time.

Case report num.2
a 75-year-old man with valvular permanent AF and multi-territory ischemic ictus despite being on adequate prophylactic OAC (Warfarin). At TTE a dilated left ventricle with mildly reduced ejection fraction was documented. ECG – gated CCT with delayed phases imaging showed a possible filling defect in LAA, however imaging was suboptimal due to a reverb of voluminous hiatal hernia. TEE revealed a “windstock” shaped LAA with incomplete distal opacification when echo-contrast medium “SonoVue” was used, confirming thrombus. The patient was therefore referred for LAAC procedure with concomitant use of cerebral embolic protection devices (CEPDs).

Discussion
Transesophageal echocardiography is the test of choice for the exclusion of LAA thrombus. However technical difficulty, spontaneous echo contrast (SEC) and prominent pectinate musculature within the appendage may make the exclusion of LAA thrombus not easy. ECG – gated cardiac CT may be conclusive as well. UEA use is associated with higher diagnostic power for LAA thrombus exclusion and recent study have shown its utility also in terms of LAA sizing. Thus, the most recent guidelines of American Society of Echocardiography mention echo contrast use for the delineation of LAA thrombi and differentiate between them with SEC.

Conclusion
The use of ultrasound enhancing agents is useful and increases the interpretative confidence in exclusion of LAA thrombus.
1087 QUANTITATIVE CHANGES IN INTRACARDIAC FLOW PARAMETERS DURING HEMODIALYTIC SESSIONS
Authors: Rosa Romano Letizia , Sabatino Jolanda , Calvelli Pierangelo , Bolignano Davide , Coppolino Giuseppe , Presta Pierangela , Strangio Antonio , Leo Isabella , Maglione Marco , Troilo Fabio , Loliva Giuseppe , Critelli Claudia , Andreucci Michele , Salvo Giovanni Di , Indolfi Ciro , Rosa Salvatore De 
Published: December 2022

Abstract

Background
Hemodialysis sessions exert an acute impact on cardiac geometry and mechanics. The recent development of quantitative measurement of intracardiac fluid-dynamics offers a new opportinuty to better understand the fine changes in intracardiac cardiac hemodynamics associated with hemodialysis sessions. Our aim was to assess the impact of an hemodialytic session on intracardiac flow dynamics.

Methods
We included 26 consecutive patients on chronic hemodialysis in clinically stable phase. They underwent echocardiography including intracardiac fluid-dynamic analysis by Color Vector Flow Mapping (Hyperdoppler) before and after a single dialysis session. Patients with hemodynamically relevant valvular disease were excluded. A complete fluid-dynamics evaluation included the measurement of multiple parameters such asvortex area (VA); vortex length (VL); vortex depth (VD). Bland Altman Plot has been used to assess intra and inter-observer variability. Changes in fluidodynamics after dialysis sessions were tested using the Wilcoxon matched-pairs test.

Results
Mean Vortex Area (VA) (p=0.034), Vortex Depth (VD) (p=0.024) and Vortex Length (VL) (p=0.037) were significantly reduced after the dialysis session. A similar trend towards the reduction of Direct Flow (DF) parameter after the session was found, which was significantly larger for patients with larger baseline left ventricular (LV) end-diastolic diameter (r=0.446; p=0.037). On the other hand, mean Vortex Intensity (VI) was significanlty increased after dialysis (p=0.046). Among energy parameters, the intradialytic change in Kinetic Energy Fluctuation (KEF) (r=0.4; p=0.058) and Shear Stress Fluctuation (SSF) (r=0.435; p=0.038) were most closely correlated with intradialytic weigth change. Some fluid-dynamic parameters had similar trends of intradialytic change, with stonger correlations among geometric parameters. Delta changes in VA were closely related to changes in VI (p&lt;0.001) or LV (p&lt;0.001). VI was also correlated with VL (p&lt;0.001) and with Kinetc Energy Dissipation (KED) (p=0.030), which was also correlated with VL (p=0.044). KEF was correlated with KED (p=0.001) and SSF (p=0.022). Finally, chenges in SSF were correlated with those in Flow Force Parameter (p=0.033) and Flow Force Angle (p=0.034), that were very closely correlated each other (p&lt;0.001).

Discussion
This is the first study assessing the impact of hemodialytic sessions on intracardiac flow dynamics. Measurement of hyperdoppler indices on hemodialysis chair was feasible and reliable in the whole population. Our results uncovered quantitative chenages of echocardiographic parameters of vortex geometry and energy during hemodialysis.
708 PATTERNS OF BIOLOGICAL AGING OF THE HEART AND THEIR PROGNOSTIC VALUE: THE SARDI-NIA STUDY
Authors: Saba Pier Sergio , Orrù Marco , Sanna Giuseppe , Delitala Alessandro , Lakatta Edward , Fiorillo Edoardo , Cucca Francesco , Ganau Antonello 
Published: December 2022

Abstract

Background
As people age at different rates, the concept of biological age has been introduced as a measure of functional deterioration. Associations of echocardiographic traits with age were analyzed to detect different biological aging rates of the heart and their prognostic value.

Methods
Echocardiographic left ventricular mass, geometry, left atrial volume, diastolic function, and aortic root size were measured in 3817 adults (58% females). Sex-specific correlations of age with six cardiac traits were assessed in 2614 healthy subjects. According to two-sided 95% tolerance intervals, three patterns of heart aging rates were identified in the whole cohort: slow aging pattern (n=287), normal aging pattern (n=2669), and accelerated aging pattern (n=796). The phenotypic (biological) age of the heart (HeartPhAge) was estimated from the cardiac traits by multiple linear regression. Cardiovascular and non-cardiovascular incident events at follow-up (46 months (IQR 34–64 months) were grouped into three endpoints and analyzed in survival analyses.

Results
Compared to chronological age, HeartPhAge was nine years younger (p&lt;0.0001) in the slow aging pattern, similar in the normal pattern, and three years older (p&lt;0.0001) in the accelerated pattern. The incidence of all endpoints was higher in the accelerated pattern than in the normal and slow aging patterns (p&lt;0.0001 to p=0.0003). In Cox proportional-hazards analysis, the heart aging patterns significantly predicted all endpoints in both the whole cohort and the healthy subset, independent of chronological age and risk factors.

Conclusion
Heart aging patterns reflect the rate of biological aging and independently predict cardiovascular and non-cardiovascular events.
701 LEFT ATRIAL APPENDAGE CONGENITAL ABSENCE AND ATRIAL FIBRILLATION
Authors: Sforna Stefano , Bardelli Giuliana , Mengoni Anna , Zuchi Cinzia , Lauciello Rosanna , Crusco Federico , Carluccio Erberto , Ambrosio Giuseppe 
Published: December 2022

Abstract

Introduction
Left atrial appendage (LAA) is a finger-like muscular extension of the left atrium (LA). It acts as blood reservoir, modulates LA pressure and elicits adaptive responses to stress. Several LAA shapes and variants have been described. We report a case of congenital absence of LAA diagnosed by transesophageal echocardiography (TEE) and confirmed by computed tomography (CT).

Case report
A 55-year-old male patient with history of hypertension was admitted to our hospital for an episode of atrial fibrillation (AF). TEE was performed and showed normal LA volume, absence of thrombi and spontaneous echo contrast in the LA, but, despite acquiring three-dimensional (3D) en-face views, we were unable to identify LAA. Congenital absence of LAA was suspected and multidetector cardiac CT confirmed the abnormality.

Discussion
Congenital absence of LAA is an extremely rare condition: only eighteen cases were described on a review of the literature published in 2020. Associations with other congenital abnormalities or with atrial fibrillation have been reported, but a causal relationship cannot be established. Multiple imaging modalities can be used to define the anatomy and function of LAA, to detect or rule out in situ thrombosis and to guide catheter-based therapies, but the most widely used technique is TEE. Among intracardiac thrombi in patients with non-valvular atrial fibrillation, more than 90% are identified in the LAA, meaning that the remaining 10% may develop in other sites of the LA. The congenital absence of LAA could be considered similar to LAA percutaneous occlusion or surgical exclusion; because of the few published randomized controlled trials, the current ESC guidelines on atrial fibrillation are unclear about the true thrombotic risk in these cases. Since LAA percutaneous occlusion is actually indicated only in cases of contraindications for long-term anticoagulant treatment, in our opinion in patients with non-valvular AF, LAA congenital absence, high stroke risk and low bleeding risk, anticoagulant therapy should be considered.

Conclusion
Congenital absence of LAA is an extremely rare condition and its pathophysiological role, especially with regard to antithrombotic therapy in patients with AF, is still not well defined.
511 INCREMENTAL VALUE OF RIGHT ATRIAL STRAIN ANALYSIS TO PREDICT ATRIAL FIBRILLATION RECURRENCE AFTER CARDIOVERSION
Authors: Tomaselli Michele , Cannone Vincenzo , Muraru Denisa , Oliverio Giorgio , Gavazzoni Mara , Heilbron Francesca , Radu Noela , Perelli Francesco , Stucchi Davide , Pece Cinzia , Camponetti Virginia , Rizzo Salvatore , Battista Perego Giovanni , Caravita Sergio , Baratto Claudia , Parati Gianfranco , Brasca Francesco , Paolo Badano Luigi 
Published: December 2022

Abstract

Background
In patients with paroxysmal atrial fibrillation (AF), left atrial (LA) mechanics has been reported to be important to predict recurrences after cardioversion. However, the potential additive role of right atrial (RA) function in this setting remains to be tested. Accordingly, the aims of our study was to assess the added role of right atrial reservoir longitudinal strain (RARS) for prediction of AF recurrence after electrical cardioversion.

Methods
we prospectively studied 130 (mean age 69±14, 55% men) consecutive patients with persistent AF who underwent electrical cardioversion, acquired between June 2020 and December 2021. Exclusion criteria were: presence of pacemaker, more than moderate mitral and tricuspid regurgitation, left or right ventricular dysfunction, prior cardiac surgery, and, inadequate acoustic window. LA and RA 2D-speckle-tracking echocardiography analyses were obtained from dedicated, non-foreshortened 4-ch and RV-focused apical 4-ch views respectively, using a dedicated software package (AFI LA, EchoPAC 204, GE Vingmed, Horten, Norway). The primary endpoint was AF recurrence.

Results
after a follow-up period of 12 months, 60 patients (45%) reached the primary endpoint. The mean left ventricular ejection fraction (LVEF) was 56.5±8%, for all patients. No significant difference in LA (98±31 vs 94±30 mL, p= 0.333) and RA (68±26 vs 65±26 mL, p=0.286) volumes was detected between patients with and without AF recurrence, while left atrial reservoir strain (LARS, 10±6 vs 14±7%, p&lt;0.001) and RA reservoir strain (RARS, 14±10 vs 16±8%, p&lt;0.001) were significantly lower in patients with recurrent AF. Receiving operator characteristics curve analysis showed that the predictive power of LARS (AUC 0.68 [IC 95% 0.58-0.78]), was lower than RARS (AUC 0.75 [IC 95% 0.66-0.84]) (p&lt;0.001, for all), with cut-off of 10.5% (sensitivity 62%, specificity 70%) and, 15.5% (sensitivity 75%, specificity 75%), respectively. Kaplan-Meier curve for time to primary endpoint showed that patients with LARS≤10.5% and RARS ≤15.5% had a significant risk for AF recurrences (log rank,p&lt;0.001), even after correcting for confounding variables. However, at multivariable Cox regression RARS (HR 3.42 [CI 95% 1.72-6.8], p&lt; 0.001) was the only parameter independently associated with the primary endpoint.

Conclusions
RARS is an independent predictor of the recurrences of AF after electrical cardioversion and provides an incremental prognostic value over LARS. This study highlights the pivotal role of the assessment of bi-atrial remodeling in patients with AF.
631 THE IMPACT OF BMI ON MYOCARDIAL WORK AND LEFT ATRIAL STRAIN IN YOUNG OVERWEIGHT PATIENTS WITH PRESERVED LEFT VENTRICULAR EJECTION FRACTION
Authors: Taverna Giovanni , Trimarchi Giancarlo , Lofrumento Francesca , Mancinelli Anna , Teresi Lucio , Alagna Giulia , Carerj Scipione , Zito Concetta , Di Bella Gianluca 
Published: December 2022

Abstract

Introduction
Overweight and obesity are a health problem of growing significance all over the world with increasing prevalence in both developed and developing countries. Numerous studies have demonstrated a relationship between obesity and cardiovascular diseases, underscoring the need to early treat this pathological condition. Overweight and obesity cause structural and functional changes on left ventricular (LV) and left atrial (LA) performance, which lead to heart failure. In this context we aimed to evaluate the impact of BMI on myocardial work parameters and left atrial strain to early detect LV and LA performance changes in overweight patients.

Methods
80 young individuals were prospectively enrolled, distinguishing between overweight patients with BMI greater than or equal to 25 to 29.9 kg/m^2 (n= 36; 45±11 years) and normal weight patients with BMI greater than or equal to 18.5 to 24.9 kg/m^2 (n=44; 43±9 years). All patients underwent transthoracic echocardiogram to calculate global longitudinal strain (GLS), global work index (GWI), global work efficiency (GWE), global wasted work (GWW), global constructive work (GCW) and left atrial strain.

Results
Overweight patients have higher BSA (1,9±0,16 vs 1,6±0,17 mq; p&lt;0,0001), Diastolic Blood pressure (81±12 vs 74±10 mmHg; p= 0,01) mean arterial pressure (98±15 vs 91±11 mmHg; p = 0,01), Heart Rate (71±13 vs 70±12 bpm; p= 0,02) and Global Longitudinal Strain (-19,3% ±1,7 vs -20,3% ±1,8; p = 0,02). With respect to myocardial work parameters, in overweight patients GWE (93% vs 95%; p=0,01) is significantly reduced, whereas GWW (132 vs 102 mmHg%; p=0,03) is significantly increased. Left atrial reservoir (LAres) (36% vs 40%; p=0,04) and conduit (-19% vs -24%; p=0,005) function are significantly reduced in overweight patients. BMI inversely correlates with GWE (r=-0,36; p=0,005) and LAres (r=-0,33; p=0,007), whereas it directly correlates with GWW (r=0,31; p = 0,006).

Conclusions
Overweight induces early LV and LA performance changes that can be precociously detected by myocardial work and left atrial strain, in order to better characterize individual cardiovascular risk profile.
1017 CLINICAL AND HEMODYNAMIC CHARACTERISTICS ASSOCIATED WITH LATENT PULMONARY VASCULAR DISEASE IN HEART FAILURE WITH PRESERVED LEFT VENTRICULAR EJECTION FRACTION
Authors: Caravita Sergio , Baratto Claudia , Filippo Aurora , Soranna Davide , Battista Perego Giovanni , Muraru Denisa , Badano Luigi P , Parati Gianfranco 
Published: December 2022

Abstract

Background
Among patients with heart failure and a preserved left ventricular ejection fraction (HFpEF), a distinct hemodynamic phenotype has been recently described, with potential clinical implication, i.e. latent pulmonary vascular disease (PVD). HFpEF patients with latent PVD have been shown to have worse outcome after creation of an interatrial septal shunt. However, the pathophysiological significance of latent PVD in HFpEF has not been thoroughly investigated.

Methods
We retrospectively analyzed our cohort of consecutive patients with HFpEF who have undergone a right heart catheterization at rest and during exercise between 2016 and 2020. HFpEF was defined based on a resting and/or exercise hemodynamics: pulmonary artery wedge pressure (PAWP) &gt; 15 mmHg at rest; PAWP during exercise &gt;= 25 mmHg; PAWP/cardiac output (CO) slope &gt; 2 mmHg/L/min. Latent PVD was defined based on exercise pulmonary vascular resistance (PVR) &gt; 1.74 WU.

Results
Out of 199 exercise right heart catheterization, 86 patients had a hemodynamic diagnosis of HFpEF. Of these, 68 (79%) qualified as HFpEF without PVD (HFpEF-PVR-) and 16 (21%) qualified as latent PVD (HFpEF-PVR+). HFpEF-PVR+ were older, presented more frequently with diabetes mellitus or glucose intolerance, had higher H2FPEF and HFA-PEFF scores, slightly lower LVEF, had more frequently a history of atrial fibrillation and had more frequently at tricuspid regurgitation ≥ moderate (p&lt;0.05). HFpEF-PVR+ had more frequently high PVR (&gt; 2 WU) also at rest (72% vs 10%, p&lt;0.001). At rest and only in HFpEF-PVR+, PVR was directly associated with PaCO2 (R2=0.21), while at peak exercise PVR was inversely associated with PvO2 as well as with stroke volume index (R2=0.32 and 0.31, respectively). HFpEF-PVR+ presented with a lack of decrease in PVR during exercise, higher mPAP both at rest and during exercise (p&lt;0.05) in spite of non-different mean PAWP, and lower CO increase during exercise (p&lt;0.05) in spite of similar CO at rest (Figure). HFpEF-PVD presented more frequently with exercise-induced tall V waves in the right atrium (50% vs 16%, p=0.002), indicating severe tricuspid regurgitation.

Conclusions
HFpEF-PVR+ is associated with peculiar clinical and hemodynamic characteristics, reflecting a more advanced and polycomorbid HFpEF profile, characterized by heightened pulmonary vascular reactivity and overt cardiac limitation to exercise.
724 AN UNUSUAL CASE OF ECHOCARDIOGRAPHY-ESTIMATED PULMONARY HYPERTENSION
Authors: Menna Alessandro , Sganzerla Paolo , Bilo Barbara Maria , Caravita Sergio , Giannattasio Cristina , Parati Gianfranco 
Published: December 2022

Abstract

Case Presentation
48-years-old woman was diagnosed with severe pulmonary hypertension at transthoracic echocardiography during cardiological evaluation for bariatric surgery.
PAPs was estimated 110 mmHg, mild-moderate tricuspidal insufficiency with no dilatation of right chambers and LVEF preserved (65%).
The patient had history of heart murmur since childhood and now presented with type 2 diabetes mellitus on metformin treatment, third grade obesity (BMI 55) and dyslipidemia (LDL col. 120 mg/dL).
Diagnostic Workup: The patient was symptomatic dyspnea for mild-moderate exertion (NYHA II-III). Heart-beat was rhythmic with 4/6 ubiquitous systolic sharp murmur. Lung auscultation was normal. Bilateral pretibial edema was noted.
The cardiac catheterization showed:
A transesophageal echocardiography confirmed post-tricuspidal right intraventricular obstruction due to mid-ventricular fibro-muscular rims and disclosed a small restrictive membranous defect on interventricular septum with minimum left-to-right shunt.
A cardiac-MRI confirmed an hypertrophic moderator band with obstruction of the outflow tract.
The patients was discharged with a program of sleeve-gastrectomy and after surgical correction of cardiac congenital defects.

Conclusion
The double-chambered right ventricle (DCRV) is an uncommon congenital anomaly: the right ventricle (RV) is divided into two chambers due to the presence of an abnormally located muscular band or anomalous muscle hypertrophy in the sub-infundibular part of RV outflow tract, with a variable grade of obstruction. This anomaly may be missed by the estimation of high pulmonary pressure through tricuspidal regurgitation. Due to limitations of echocardiography in adult patients additional imaging methods, such as MRI, combined with cardiac catheterization data are required for a definitive diagnosis.
121 RELEVANCE OF COMORBIDITIES ON INITIAL COMBINATION THERAPY IN PULMONARY ARTERIAL HYPERTENSION
Authors: Papa Silvia , Badagliacca Roberto , D´alto Michele , Ghio Stefano , Argiento Paola , Brunetti Natale , Casu Gavino , Cedrone Nadia , Confalonieri Marco , Corda Marco , Correale Michele , D´agostino Carlo , Galgano Giuseppe , Manzi Giovanna , Mercurio Valentina , Mulè Massimiliano , Paciocco Giuseppe , Romeo Emanuele , Scelsi Laura , Stolfo Davide , Vitulo Patrizio , Vizza Carmine Dario 
Published: December 2022

Abstract

Rationale
Demographic characteristics of pulmonary arterial hypertension (PAH) patients have changed over time, but the effects of cardiovascular risk factors on risk status and pulmonary vascular resistance (PVR) reduction with initial oral combination therapy are not known. Therefore, we tested the relevance of cardiovascular comorbidities in this setting.

Methods
The study enrolled 181 treatment-naive PAH patients with a 6- months (IQR 144-363 days) right heart catheterization and risk assessment after initial oral combination therapy.

Results
Group-A, 96 (53.0%) patients without cardiac comorbidities; Group-B, 54 (29.8%) patients with one cardiac comorbidity; Group-C, 31 (17.1%) patients with ≥2 cardiac comorbidities. Group-C patients were older with a balanced gender distribution. There was a significant difference in PVR reduction moving from the absence to one or ≥2 cardiac comorbidities, respectively, median -45.0%, -30.3%, -24.3%. A ERS/ESC low-risk status was present at first follow-up in 50 (52.0%) patients in Group-A, 19 (35.1%) in Group-B, and 9 (29.0%) in Group-C; a REVEAL 2.0 low-risk status was present at first follow-up in 41 (42.0%) patients in Group-A, 15 (27.7%) in Group-B, and 7 (22.6%) in Group-C. Group-A patients were 2.3 times more likely to achieve/maintain a low risk status compared with Group-B and -C (OR 2.27, 95% C.I. 1.15-4.54, p=0.02). No significant difference was observed between patients with non-cardiac comorbidities and those without comorbidities.

Conclusion
Initial oral combination therapy seems associated with a less effective response for patients with cardiovascular comorbidities compared with the others, related to the magnitude of treatment- induced decrease in PVR.