Initial Echo Research Articles

Fetal Diagnosis of Supravalvular Aortic Stenosis and Pulmonary Stenosis in a Family with Non-Syndromic Elastin Mutation.

Supravalvular aortic stenosis (SVAS) has been well described in Williams-Beuren Syndrome and non-syndromic elastin (ELN) mutations. Non-syndromic ELN mutations are inherited in an autosomal dominant pattern with incomplete penetrance and variable expressivity. ELN haploinsufficiency leads to progressive arteriopathy, typically affecting the aortic sinotubular junction. Multi-level pulmonary stenosis has also been reported and biventricular obstruction may portend a worse prognosis. Fetal presentation of ELN mutation with SVAS has not been previously reported in the literature. We present a case of fetal diagnosis of SVAS and multi-level pulmonary stenosis in a family with a known pathogenic ELN mutation (Exon 6, c.278del [p.Pro93Leufs*29]). On the fetus' initial fetal echo, there was only mild flow acceleration through the aortic outflow tract, however, she went on to develop progressive bilateral obstruction. In the early post-natal period, the child was clinically asymptomatic and showed similar mild SVAS and mild valvar and supravalvular pulmonary stenosis. Our case highlights the need for serial monitoring of fetuses with suspected or confirmed ELN arteriopathy.

Left ventricular speckle tracking echocardiography in predicting of fibrosis in children after correction of anomalous origin of the left coronary artery from the pulmonary artery in the late postoperative period

The aim of our study is a comprehensive echo assessment of the LV function using the speckle tracking technique in children with abnormal origin of the left coronary artery from the pulmonary artery in the late postoperative period аnd a comparative analysis segmental longitudinal and circumferential LV deformation with cardiac magnetic resonance late enhancement of myocardium. Methods. The search is a prospective observational study. We examined and analyzed 25 children with AOLCA from PA in late postoperative period. Obtained morphofunctional LV and RV echo parameters were compared with LV ejection fraction and dimensions, the grade of mitral insufficiency and age at the time of operation. CMR was performed in 15 patients (60%; n = 15/25) using Avanto 1.5T. The average age of children at the time of the study was 8.8 ± 3.5 years.Results. 1) Reduce of LV segmental longitudinal deformation is unique in each patient’s case. The largest number of segments with reduced longitudinal deformation was detected in the 2d (anteroseptal basal); in 4th (inferior basal); 5th (inferolateral basal), 6th (anterolateral basal), 11th (inferolateral middle) segments of LV myocardium. 2) There is no relationship between LV global longitudinal and circumferential deformation in children in the late postoperative period after correction of AOLCA from PA and initial LV morphological and functional echo data (at the time of defect correction). 3) Segmental LV longitudinal deformation Area Under the Curve is 0.64 (0.56–0.72) with “cut-off” 9.5% with a sensitivity of 92% and a specificity of 85% and circumferential segmental deformity Area Under the Curve is 0.48 (0.40–0.56) in the predicting of fibrosis according to CMR data.

Abstract 15148: How Reassuring is an Initial Echocardiogram With Normal Coronary Arteries for Patients Presenting With Acute Kawasaki Disease?

Background: We sought to determine the utility of current echocardiography surveillance recommendations for coronary artery (CA) involvement for children with Kawasaki disease (KD) with normal baseline studies. Methods: The International KD Registry enrolled 1200 patients (36 sites, 7 countries) with a site diagnosis of KD from 01/2020 to 01/2023; 139 with positive/possible COVID-19 infection/exposure and 174 with no echo within 10 days of admission were excluded, leaving 887 patients for analysis of results of serial echos and associated factors. Results: An initial echo was performed within 5 days of admission for 96% and within 10 days of symptom onset for 83% of patients; the max Z score in any CA branch at initial echo was normal (Z <2) 78.9%, dilation (Z 2-<2.5) 6.6%, small aneurysm (CAA; Z 2.5-<5) 10.5%, medium CAA (Z 5-<10) 2.9% and large CAA (Z ≥10) for 1.2% of patients. Higher CA Z score/Z score category were both significantly related to greater time from symptom onset to echo (p<0.001). For those with initial normal CAs, a second echo (median of 16 days after admission) was normal for 94.2%, dilation 1.9%, small CAA 2.7%, medium CAA 0.6%, and large CAA for 0.6%. For those with 2 normal echos, a third echo (median of 44 days after admission) was normal for 97.6%, dilation 1.4%, small CAA 0.5%, and 1 patient each with medium and large CAA. Additionally, after up to 6 normal echos, 3 patients had developed small CAA, 1 medium and 1 large CAA. Overall, a total of 24 (2.8%) patients had large CAA (13 admitted >10 days after symptom onset). Of these, 10 had large CAA evident at initial echo performed at day 0-3 after admission, 9 had lesser involvement at initial echo that then progressed to large CAA, and 5 had normal initial and subsequent echos and then were noted to have large CAA at an echo performed 14, 17, 21, 23 and 53 days after admission (the patient with a large CAA first detected at 53 days had no interim echos performed since their first normal echo). Conclusions: Current recommendations for serial echo assessment are effective in detecting all patients with large CAA. For rare patients, despite a normal initial echo large CAA may nonetheless develop. Additionally, important CA involvement may be evident at presentation (often delayed presentation), precluding prevention.

Abstract 17201: Referral Patterns and Clinical Outcomes in Patients With Severe Aortic Stenosis

Introduction: Once aortic stenosis (AS) becomes severe, close clinical follow-up by cardiac specialists and timely aortic valve replacement (AVR) are necessary to optimize patient outcomes. Discrepancies exist in the care of AS. Hypothesis: Provider specialty impacts referral for AVR after an initial echocardiogram (echo) revealing severe AS, with greater referral by cardiac specialists vs. non-cardiologists. Methods: Patients were identified based on an echo finding of new severe AS from Jan 2019 to Dec 2022 in an academic health system and were compared based on the ordering provider’s specialty (cardiology or cardiac surgery specialist vs. non-cardiologist). The primary endpoint was the rate of AVR after the initial echo. Univariable and multivariable logistic regression were used to identify characteristics associated with referral for AVR. Results: The study cohort included 2,131 patients: 630 (30%) were referred to echo by a non-cardiologist, 992 (46%) by cardiology, and 509 (24%) by cardiac surgery specialists (Table). Patients referred to echo by non-cardiologists were older, more frequently Black, and more symptomatic, with a lower rate of vascular diseases and a higher rate of heart failure and kidney disease. Thirty-four percent of patients referred by non-cardiologists, 62% of patients referred by cardiology and 81% of patients referred by cardiac surgery specialists underwent AVR at a median time of 58, 64 and 24 days after their echocardiogram, respectively (P<0.001). Echo referral by cardiology (OR: 2.76, P<0.001), echo referral by cardiac surgery (OR: 7.50; P<0.001), age (OR: 0.96, P<0.001), Black race (OR: 0.60, P<0.001), presence of >=2 CV risk factors (OR: 1.99, P<0.001), and >=2 comorbidities (OR: 1.54, P=0.001) were independent factors associated with AVR. Conclusion: Provider specialty impacts referral to AVR after an echo with new severe AS despite baseline characteristic adjustment, with higher AVR rates by cardiac specialists.

Abstract 17064: Reversible Myocardial Depression and Dilatation in COVID-19 Shock Patients

Introduction: A characteristic pattern of bacterial and fungal septic shock is decreased left ventricular ejection fraction (LVEF) and modest dilatation of the left ventricle. In survivors, the myocardial depression and dilatation are reversible within several days. Using echocardiography, we have previously reported a cohort of COVID-19 shock patients with reduced LVEF. We now report serial studies of COVID-19 shock patients. Hypothesis: Myocardial dysfunction and dilatation associated with COVID-19 are reversible. Methods: In COVID-19 patients with shock requiring vasopressors who underwent echocardiography, left ventricular ejection fraction (LVEF) by Simpson’s rule and stroke volume by doppler were analyzed. Based on the LVEF and CI, patients were categorized into groups with low or normal values using EF 45% and CI 2.2 liters/minute/meter as the respective thresholds. A subset of 18 patients underwent serial echocardiography which were performed at a median of 13(9,39) days after the initial. The LVEF and LV volumes recorded during initial and follow-up echo were analyzed retrospectively using paired t-testing. Results: Comparing initial with follow-up values, the mean LVEF was 34.7(2.0) vs 43.8(3.47), p=0.01, indexed stroke volume 29.6(1.9) ml vs 31.7(2.3) ml, p=0.52, LV end-diastolic volume 182(14.1) ml vs 152.1(12.9) ml, p=0.03 and LV end-systolic volume 120.2(13.1) ml vs 90.1(12.1) ml, p=0.03 respectively (see Figure). Conclusions: Serial echocardiographic studies of COVID-19 shock patients with reduced LVEF and ventricular dilatation demonstrate reversibility of myocardial depression and dilation with no change in stroke volume, a finding strikingly similar to that seen in bacterial and fungal induced septic shock. Thus, COVID-19 (viral) induced septic shock may have a similar pathogenetic mechanism of myocardial dysfunction to that seen with bacterial or fungal sepsis.

SAT325 Recurrent Pericardial Effusion As Initial Presentation Of Primary Adrenal Insufficiency

Abstract Disclosure: S. Ward: None. A.L. Champion: None. A. Mrkaic: None. Recurrent Pericardial Effusion as Initial Presentation of Primary Adrenal Insufficiency: Background: Primary adrenal insufficiency (PAI) is a rare but serious endocrinopathy. High clinical suspicion is important to avoid delay in diagnosis and treatment. We present a rare case of recurrent pericardial effusion as initial presentation. Clinical Case: 63 year old male with hypertension and diabetes presented to ED complaining of SOB and chest pain. Workup revealed pericardial effusion causing cardiac tamponade treated with emergent pericardiocentesis. He was admitted to ICU for hypotension. He was also diagnosed with COVID-19 and acute kidney injury. Labs showed hyperkalemia ranging from 5.3 to 7.2 mmol/l (n= 3.5-5.1 mmol/l) and hyponatremia 132 mmol/L (n= 136-145 mmol/L). He was started on dexamethasone for COVID-19 infection. Etiology of pericardial effusion was unclear; infectious disease workup was unremarkable, cytology showed no malignant cells, autoimmune panel was negative. Initial echo showed EF >55%. After initiation of steroids, symptoms improved with normalization of electrolytes and improvement of hypotension, however was discharged on midodrine 2.5 mg TID. Seven days after discharge patient called 911 complaining of worsening shortness of breath. He was found to be severely hypotensive with BP 67/40. Echo showed moderate to large pericardial effusion causing tamponade. Emergent pericardial window was performed. Labs showed hyponatremia 123 mmol/L and potassium ranging from 4.9-5.4 mmol/L. Patient remained hypotensive requiring pressors despite pericardial effusion drainage. With persistent hypotension, hyperkalemia, and hyponatremia there was strong suspicion for adrenal insufficiency and workup was consistent with PAI. Labs showed 8:00 am cortisol 2.7 ug/dl (n= 3.7-19.4 ug/dl), ACTH 256.0 pg/ml (n=7.2-63.3pg/ml), aldosterone <1.0 ng/dL, renin 4.216 ng/mL/hr (n= 0.167-5.380 ng/mL/hr). Due to his critical illness patient was started on stress dose hydrocortisone 50 mg Q6 hr. With initiation of steroids, hyponatremia, hypokalemia, and hypotension resolved. Patient was weaned to physiological doses of hydrocortisone and started on fludrocortisone at time of discharge. Conclusion: Timely diagnosis of PAI is essential and can be lifesaving, if untreated it can lead to adrenal crisis with high mortality. Having a high clinical suspicion is crucial to a prompt diagnosis. Pericardial effusion should prompt clinical suspicion for PAI as multiple cases have now been reported in the literature. Our patient has multiple potential causes of pericardial effusion including PAI, acute kidney injury, and COVID-19 infection. Although we cannot show definitive causation from PAI, it most certainly contributed and prompt diagnosis and treatment may have prevented recurrence. It is important to raise awareness of PAI as a differential in pericardial effusion. Presentation: Saturday, June 17, 2023

Synthetic aperture radar radio frequency interference suppression technology

Radio frequency interference (RFI) can easily hinder the data collection, imaging and interpretation of the initial echo of synthetic aperture radar, which has always been a difficult problem affecting the accuracy of synthetic aperture radar. In this paper, the radio frequency interference suppression technology of synthetic aperture radar is analyzed and studied. It can be concluded that in todays complex and changeable electromagnetic environment, although many literature have proposed and established different objective functions and constraints for more specific application environments, there is still room for further improvement. Therefore, the future SAR system needs to select the most appropriate interference suppression method according to the dynamic changes of RFI environment. The development trend of interference suppression technology in the future is obtained from the comprehensive analysis of the RFI interference sources, RFI models and existing SAR interference suppression technologies, which provides a certain reference for future research.

NONISCHEMIC CARDIOMYOPATHY AND CARDIAC ARREST ATTRIBUTABLE TO ANABOLIC-ANDROGENIC STEROIDS

NONISCHEMIC CARDIOMYOPATHY AND CARDIAC ARREST ATTRIBUTABLE TO ANABOLIC-ANDROGENIC STEROIDS

April 2022 Medical Image of the Month: COVID Pericarditis

No abstract available. Manuscript truncated after 150 words. A 76-year-old patient presented with fatigue and shortness of breath after missing one session of dialysis. Past medical history included end stage renal disease on hemodialysis and atrial fibrillation on anticoagulation. Initial labs showed that she was COVID positive with mild elevation in troponin and a BNP 1200. While an inpatient, she had received a few sessions of dialysis and treatment for COVID (including dexamethasone and remdesivir). Initial echo showed an ejection fraction of 60-65% with a small generalized pericardial effusion, a thickened pericardium with calcification. A few days after admission patient was suddenly noted to be hypotensive with systolic blood pressure in the 70s and altered mental status. Repeated labs showed a D-Dimer of 17,232, leukocytosis, lactic acidosis, troponin 0.556 ng/ml and arterial blood gas with metabolic acidosis. With a worsening clinical picture, repeat imaging was obtained. CT angiography of the chest was negative for pulmonary embolism; however, it …

Patient, physician and geographic predictors of cardiac stress testing strategy in Ontario, Canada: a population-based study

ObjectivesTo identify patient, physician and geographic level factors that are associated with variation in initial stress testing strategy in patients evaluated for chest pain.DesignRetrospective cohort study.SettingPopulation-based study of patients undergoing...

An atrioventricular septal defect with an Ebsteinoid right atrioventricular valve

Abstract Funding Acknowledgements Type of funding sources: None. The combination of an atrioventricular septal defect (AVSD) with an Ebsteinoid atrioventricular valve is incredibly rare with only a handful of cases being described in the literature (1, 2). In this poster we describe the diagnosis of this anatomy in a neonate born at our centre. The baby was antenatally diagnosed with a chromosome 8p23.1 microdeletion which is associated with congenital heart disease and developmental delay (3). Although fetal echo had revealed a high suspicion of congenital heart disease, maternal BMI had prevented a precise diagnosis. The baby was born in good condition at thirty-nine weeks gestation weighing 2.4kg. She had been admitted to the neonatal unit where she was self-ventilating in room air with saturations above 90%. The echocardiogram was performed at one hour of age. The initial echo revealed a normal atrial arrangement with the heart in the left chest and the apex pointing to the left. There was normal pulmonary and systemic venous drainage. There was a complete AVSD with sizeable atrial and ventricular components. The left atrioventricular valve was dysplastic with at least moderate regurgitation. The right atrioventricular valve was displaced caudally and rotated into the right ventricular outflow tract. The right atrioventricular valve was also regurgitant. The right ventricle above the displaced atrioventricular valve was atrialized with the true right ventricle limited to the outlet portion. The great arteries were normally related. The ventricular component of the AVSD opened into the sub-pulmonary area along with two smaller muscular ventricular septal defects. These findings raised many clinical concerns including the insufficiency of the right ventricle to support a biventricular repair. Similarly, the severe left atrioventricular valve regurgitation precluded single ventricle palliative surgical techniques. After discussion between the multidisciplinary team and a second opinion sought from another centre, the family was counselled that this was a complex and life limiting form of congenital heart disease. Although surgical options were discussed with the family, the family opted for comfort care and the baby passed away at three weeks of age. Image 1: A complete AVSD with an Ebsteinoid right atrioventricular valve displaced caudally (a) resulting in an atrialized right ventricle (b). In addition, the left atrioventricular valve which straddles the ventricular septum is severely dysplastic (c) and regurgitant (d). Abstract Figure. Image 1: An Ebsteinoid AVSD

Abstract 13893: In an Aortic System of Care Model, Adherence to Guideline Based Care Ii Hampered by Gaps in the Collection, Reporting, and Communication of Echocardiogram Data

Introduction: Aortic Stenosis (AS) is one of the most common and serious valve diseases, affecting 5% of Americans age 65 or older. Currently, there lacks a national system of care addressing the AS care continuum. The American Heart Association (AHA) has a history of success in systems of care and seeks to apply this experience to create similar for the AS patient through the program, Target: AS. Hypothesis: A key step in an Aortic Stenosis system of care is the identification of the patient’s diagnosis echocardiogram (echo). In some cases, the echo is initially performed at a location other than the tertiary hospital, and a consistent method of reporting the results to valve center does not currently exist. This inconsistency impacts guideline-based care. Methods: Target: AS pilot measures, following current guidelines, were developed with guidance from the AHA’s aortic stenosis scientific advisory group. Hospitals entered 2020 baseline data into the Target: AS data collection tool. Data elements were collected towards the measure: “Percentage of moderate aortic stenosis patients receiving a follow-up echocardiogram during the measurement period that is within 24 months of prior echocardiogram.” Sites reviewed data 24 months prior to the baseline year for the initial echo data. Results: 123 patients in 8 pilot hospitals met inclusion criteria. Overall performance - 53% of patients had a follow-up echo with 24 months. Range was 0% - 65%. All but one patient that failed the measure was due to missing or unavailable prior echo. Engagement with sites through 1:1 interviews, data abstractor calls, and quarterly learning collaboratives revealed that hospitals are not able to find initial echo data in medical records, or that the information is not provided in a discrete manner. Conclusions: The 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease states that patients diagnosed with moderate aortic stenosis should have a follow-up echo within 24 months of the diagnostic echo. Early data demonstrates that in all but one case, when hospitals cannot meet this guideline, it is due to not having the initial echo results. A hospital cannot monitor its adherence with guideline-based care when it does not have access to necessary data.

Abstract 11170: In an Aortic System of Care Model, Adherence to Guideline Based Care is Hampered by Gaps in the Collection, Reporting, and Communication of Echocardiogram Data

Introduction: Aortic Stenosis (AS) is one of the most common and serious valve diseases, affecting 5% of Americans age 65 or older. Currently, there lacks a national system of care addressing the AS care continuum. The American Heart Association (AHA) has a history of success in systems of care and seeks to apply this experience to create similar for the AS patient through the program, Target: AS. Hypothesis: A key step in an Aortic Stenosis system of care is the identification of the patient’s diagnosis echocardiogram (echo). In some cases, the echo is initially performed at a location other than the tertiary hospital, and a consistent method of reporting the results to valve center does not currently exist. This inconsistency impacts guideline-based care. Methods: Target: AS pilot measures, following current guidelines, were developed with guidance from the AHA’s aortic stenosis scientific advisory group. Hospitals entered 2020 baseline data into the Target: AS data collection tool. Data elements were collected towards the measure: “Percentage of moderate aortic stenosis patients receiving a follow-up echocardiogram during the measurement period that is within 24 months of prior echocardiogram.” Sites reviewed data 24 months prior to the baseline year for the initial echo data. Results: 123 patients in 8 pilot hospitals met inclusion criteria. Overall performance - 53% of patients had a follow-up echo with 24 months. Range was 0% - 65%. All but one patient that failed the measure was due to missing or unavailable prior echo. Engagement with sites through 1:1 interviews, data abstractor calls, and quarterly learning collaboratives revealed that hospitals are not able to find initial echo data in medical records, or that the information is not provided in a discrete manner. Conclusions: The 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease states that patients diagnosed with moderate aortic stenosis should have a follow-up echo within 24 months of the diagnostic echo. Early data demonstrates that in all but one case, when hospitals cannot meet this guideline, it is due to not having the initial echo results. A hospital cannot monitor its adherence with guideline-based care when it does not have access to necessary data.

Abstract 14352: Echocardiographic Findings With Troponemia and Its Correlation in COVID-19 Patients

Introduction: Echocardiogram findings with Troponemia and its correlation in COVID 19 patients are not well studied Methods: Mean and standard deviation (SD) for continuous variables with normal distribution were reported. Pearson chi-square was performed to see the clinical correlation of dependent variables including regional wall motion abnormalities (RWMA), diastolic dysfunction (DF), paradoxical septal wall motion (PSWM) and pericardial effusion in COVID-19. The primary outcome was to observe the effect on in-hospital mortality and 1 year mortality of echocardiographic findings. Our secondary outcome was to retrospectively see the association of gender with echocardiographic findings. Results: In this small, retrospective, single-center study from an epicenter city of COVID-19 at the Detroit Medical Center. We included a total of 122 patients with confirmed COVID-19. The mean age of the cohort was 67.3 years SD= 14. The mean troponin (Tn) at baseline admission was 173 ng/l SD±762 (normal=3-17 ng/l), while the peak Tn were 693 SD±2941. The baseline RSVP was 16 SD±20, while the peaked RSVP was 4 SD±13. Statistically significant associations of RWMA are shown in figure 1. We also found statistically significant differences in DF with presence of MVR (21/35; p<0.05), and RWMA (event/total; 14/35; p<0.05). We also found significance for RV dilation on initial echo for RVH (11/31; p<0.05), and peaked MVR (6/31; p<0.05). We also found statistically significant differences of PSWM for inpatient mortality (3/3; p<0.05), RVH ( 2/ 3; p <0.05), and LTVMV (3/3 ; p <0.05). We found statistical significance of pericardial effusion and LTVMV (3/14; p <0.05). We found statistical significant correlation of gender and RVH on admission echocardiogram: (Male 15/79; Female 2/43; p<0.05), and RWMA (Male 7/79; Female 0/43; p<0.05). Conclusion: COVID-19 patients have high mortality in the presence of RWMA and PSWM

Evolution of cardiac function in COVID 19 patients in the intensive care unit: insights from machine learning

Funding AcknowledgementsType of funding sources: None.BackgroundRepeated echocardiographic assessment of cardiac function is integral in management of intensive care units (ICU) patients. Machine learning (ML) can assist by integrating whole-cardiac cycle echo data derived from flow assessment and deformation imaging, and grouping patients on the basis of patterns of cardiac dysfunction and its evolution over time. Cardiac involvement has been suggested to be important in COVID-19 outcome and echo evaluation can inform on cardiac status. We use unsupervised ML to investigate and integrate longitudinal data from the COVID-HO study (NCT04371679) to determine the potential of tracking changes in cardiac function during ICU hospitalization. MethodsIn a single-centre, COVID-19 patients (n = 38) were prospectively followed with echocardiography as part of ICU management. The endpoint was defined as death or ICU discharge. LV myocardial deformation, as well as aortic, mitral and pulmonary artery blood-pool Doppler velocity profiles were used as input for ML. Clinical data was used to validate the ML derived phenotypes. Echo data from the initial and final echo examination were used to create an output space where participants were positioned based on cardiac function blinded to outcome status. Regression was used to estimate the echo and clinical characteristics of different regions in the space. Patient trajectories in the output space were investigated for each patient.ResultsEndpoint was not reached in 24% (n = 9) at the time of analysis. The cohort was 68% male, aged 65 ± 12 years, and with an ICU mortality 21% (n = 8). The median spent in ICU was 10 (IQR 7-18) days. The ML analysis demonstrated a heterogeneous output space (Fig 1A) we could define a gradual change in the shape of the pulmonary outflow velocity profile, from a normal towards pulmonary hypertension (Fig 1A, x axis). Jointly with differences in diastolic function (mitral inflow fusion and A wave accentuation) defined two regions: with signs of pulmonary hypertension (gray); and with normal pulmonary pressures but LV diastolic dysfunction (yellow). Investigation of patient trajectories (Fig 1B) demonstrated the feasibility of tracking changes during ICU hospitalization, showing a shift of a patient that died in the ICU, from initial diastolic dysfunction towards pulmonary hypertension (red), and a patient shifting from a region with normal diastolic function towards pulmonary hypertension, but with a positive outcome (blue). Echo data concurs with observed dynamics (Fig 1C and 1D).ConclusionML can integrate complex, whole-cardiac cycle echo data to group heterogeneous patients based on similarity of cardiac function. Patient trajectories across the output space demonstrate the feasibility of ML for echo data-based follow-up of patients during ICU hospitalization. Further echo and clinical data integration can improve characterisation of the output space regions and better define changes in cardiac function during hospitalization. Figure 1

Cardiac function during COVID-19 intensive care unit hospitalisation - deformation analysis and outcomes

Funding AcknowledgementsType of funding sources: Public grant(s) – EU funding. Main funding source(s): Horizon 2020 European Commission Project H2020-MSCA-ITN-2016BackgroundAlthough the cardiac burden of COVID-19 has been demonstrated, follow-up imaging studies are scarce. The aim was to use speckle-tracking deformation imaging (STE) to prospectively assess cardiac function during intensive care unit (ICU) hospitalisation, comparing ventricular and atrial function of COVID-10 patients that died and those that were discharged.MethodsIn a single-centre, COVID-19 patients (n = 41) (71% male, aged 65 ± 11 years) were prospectively followed with echocardiography as part of ICU treatment. The left and right ventricles (LV, RV, respectively) were studied with STE in the 4-chamber cardiac view. The endpoint was defined as death or ICU discharge. Average values of the strain parameters from the first and final scans in the ICU, respectively, were calculated for the two outcome groups.ResultsEndpoint was not reached in 15% (n = 6) at the time of analysis. The remaining patients (n = 32) were 69% male, aged 66 (interquartile range (IQR) 60-72) years, and with an ICU mortality 26% (n = 9). The median spent in ICU was 24 (IQR 15-43) days. On average, echocardiography was performed three times during ICU hospitalisation, amounting to 103 examinations. The changes in cardiac strain are shown in Table 1. The change in LV longitudinal strain during ICU hospitalisation is shown in Figure 1.ConclusionWorsening of LV strain and lack of improvement of RV strain is linked to higher mortality in the ICU. The assessment of cardiac function might contain prognostic information in COVID-19 patients that are admitted to the ICU. Patients discharged from thee OCU (n = 23)Patients that died in the ICU (n = 9)P valueInitial echo in the ICULV strain, % (IQR)18.00 (15.6-19.95)14.4 (10.56-20.42)0.158RV strain, % (IQR)16.00 (14.70-20.05)15.50 (10.38-23.70)0.712Final echo before dischargeLV strain, % (IQR)17.35 (15.13-18.98)13.20 (10.75-15.40)0.007RV strain, % (IQR)17.65 (16.83-19.60)15.75 (10.68-20.43)0.438ICU - intensive care unit; IQR-inter-quartile range Figure 1

Developing Digital Home Assistant User Guides for Older Adults With and Without Long-Term Mobility Disabilities

The aim of the current study was to understand how to integrate digital home assistant technologies and smart appliances into older adults’ homes by developing supportive user guides that facilitate adoption and continued use. We conducted a series of interviews among older adults, with and without mobility disabilities, to understand their attitudes towards digital assistants and to identify needs for instructional support and user guides. Subsequently, we developed and tested specific user guide modules for older adults aimed at addressing the identified concerns and desired instructional support. Specifically, we developed and field-tested user guides for the initial Amazon Echo device setup, basic device use (e.g., playing music and checking the weather), and separate modules for other domestic use cases (e.g., how to pair an Alexa enabled device with smart lights or appliances). Our results provide guidance for implementation of smart voice technologies to support older adults with long-term mobility disabilities.

ACHY BREAKY HEART

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Acute pericarditis accounts for about 5% of presentations of acute chest pain. Of those cases of pericarditis an etiology is found in about 22% of cases. Etiologies commonly include neoplasms, tuberculosis, infections, collagen diseases and thyroid disorders. CASE PRESENTATION: Our patient is a 16 year old healthy female that presented to the hospital with six days of fever, sore throat, cough, pleuritic chest pain and progressive dyspnea. She was sent to the emergency department (ED) by her pediatrician due hypotension. Upon arrival her blood pressure (BP) while supine was 70/40 and 50/30 with standing, with a heart rate (HR) of 121 bpm. In the ED she received 3 liters of normal saline. On admission BP was 107/63, HR 90, respiratory rate 33 and oxygen saturation was 80% on room air. The patient appeared drowsy. Her hands were cold and her lower extremities were warm; capillary refill was 4 seconds. Cardiovascular exam was normal with no pericardial friction rub. Lung exam was significant for diffuse inspiratory and expiratory crackles and decreased breath sounds at the left lung base. Initial laboratory work was significant for hemoglobin 10.5 g/dl, Sodium 128 mEq/L, creatinine 1.3 mg/dl, AST 129 U/L, ALT 72 U/L and Albumin 2.7 gm/dl. Troponin peaked at 0.682 ng/ml. BNP 141 pg/ml. Electrocardiogram showed nonspecific T wave abnormalities. Respiratory viral panel and rapid strep were negative. Chest radiograph showed patchy left lower lobe airspace disease that progressed bilaterally within 24 hours. Initial echo showed normal biventricular function with trivial pericardial effusion. She was diagnosed with acute perimyocarditis and treated with Ketorolac and IV Furosemide. Over her hospital course her respiratory distress worsened and she developed a moderate to large pericardial effusion 2 days after her initial echo. Work up included positive ANA (1:5120, speckled pattern), positive lupus anticoagulant, smith antibody and RNP antibody. Our patient was diagnosed with lupus (SLE) pericarditis and she was treated with high dose Methylprednisolone and Hydroxychloroquine which improved her pericardial effusion. DISCUSSION: This is a case of a female diagnosed with SLE perimyocarditis with pericardial effusion. This patient did not initially meet criteria for lupus, but by the end of her hospital course she met 4/11 criteria. Cardiac disease is rarely a presenting manifestation of SLE and only 1% of cases of SLE, in children and adults, present with pericarditis. While it is rare to present with cardiac symptoms, most patient with SLE develop cardiovascular manifestations at some point. Asymptomatic pericarditis is found in >50% of patients with SLE. Myocarditis, endocarditis and CAD are rare manifestations. CONCLUSIONS: This case highlights the importance of having a high index of suspicion for lupus in a patient that is not responding to initial treatment for viral myocarditis. Reference #1: Ansari, A., Larson, P. H., & Bates, H. D. (1985). Cardiovascular manifestations of systemic lupus erythematosus: Current perspective. Progress in Cardiovascular Diseases, 27(6), 421–434. doi: 10.1016/0033-0620(85)90003-9 Reference #2: Zayas, R., Anguita, M., Torres, F., Gime´nez, D., Bergillos, F., Ruiz, M., … Valle´s, F. (1995). Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis. The American Journal of Cardiology, 75(5), 378–382. doi: 10.1016/s0002-9149(99)80558-x Reference #3: Durrance, R. J., Movahedian, M., Haile, W., Teller, K., & Pinsker, R. (2019). Systemic Lupus Erythematosus Presenting as Myopericarditis with Acute Heart Failure: A Case Report and Literature Review. Case Reports in Rheumatology, 2019, 1–7. doi: 10.1155/2019/6173276 DISCLOSURES: No relevant relationships by Alejandra Grana, source=Web Response

Right Ventricular Infarction Associated with Pulmonary Embolism.

Background:Since the introduction of heparin as part of the management of acute coronary syndrome, the occurrence of pulmonary embolism (PE) as a complication of myocardial infarction (MI) have somewhat been unheard of. Given this rarity, its recognition is now a formidable challenge.Case Description:We present a case of a previously well 56-year-old male who presented with typical chest pain radiating to the left arm and dizziness. Initial vital signs revealed a blood pressure of 95/65 mmHg and his heart rate was 42 bpm. Physical exam revealed a middle-aged male in no acute distress with cool extremities, normal heart sounds, no murmurs and flat neck veins. His chest was clear to auscultation, abdomen benign and clinically, he was euvolemic. His first electrocardiogram (EKG) was significant for bradycardia with heart block and junctional escape rhythm and ST depressions in the anteroseptal leads. Subsequent right sided EKG showed sinus bradycardia with ST segment elevations in leads II, III and aVF. Troponin I was 0.95 ng/L [normal <0.04 ng/L] and initial transthoracic echo (TTE) was unremarkable with an ejection fraction (EF) of 55–60%. He was given loading doses of aspirin and clopidogrel, heparin drip initiated, and he proceeded to cardiac catheterization which revealed a 60 % stenotic lesion of the mid LAD and a large filling defect with 100% stenosis of the mid RCA consistent with thrombus. Post procedure TTE revealed an EF of 40%, septal and posterior hypokinesis, right ventricular regional wall motion abnormality of the basal and mid free wall with apical hypercontractility (McConnell’s sign) suggestive of PE. CT pulmonary angiography revealed bilateral pulmonary emboli and anticoagulation therapy was initiated.Conclusion:This case illustrates that pulmonary embolism is a potential complication of RV infarction and its early identification is critical for implementation of anticoagulation therapy for this potentially fatal condition if left undiagnosed and untreated.

643. Coronary Artery Aneurysms Are Found on Blindly Read Echocardiograms From Febrile Patients with and Without Kawasaki Disease

BackgroundIn 2017, the American Heart Association published new Kawasaki disease (KD) guidelines including echocardiographic (echo) criteria for diagnosis of incomplete KD (iKD). Echo is positive if 1 or more coronary arteries (CA) show aneurysmal dilation (Z score of ≥ 2.5), or if a CA has milder dilation (Z score of 2–2.49) plus ≥2 of the following: decreased left ventricular function, mitral regurgitation, and pericardial effusion. While CA dilation is seen commonly in KD and iKD, specificity of this finding is unclear because patients with systemic febrile illnesses may have CA dilation. To assess specificity of the American Heart Association criteria, blinded readers measured CA dimension in patients with KD and iKD and in febrile and healthy patient controls.MethodsThis is a single-center retrospective study. De-identified echo clips of CA from patients age 0–10 years were interpreted blindly and independently by six pediatric cardiologists. KD and iKD diagnoses were based on clinical data and IVIG treatment. Control groups were healthy patients evaluated for a benign murmur and febrile patients with fever ≥72 hours without a KD diagnosis or IVIG treatment. Detection of left ventricular dysfunction, mitral regurgitation and effusion was recorded. An echo was considered positive if the reading from at least one reader met AHA criteria for iKD.ResultsEchos from 29 KD, 30 iKD, 28 febrile, and 27 healthy patients were reviewed. The initial echo of 41% of KD and 43% of iKD groups met echo criteria for diagnosis of iKD and 55% and 57%, respectively, had CA dilation or aneurysm. Among febrile patients, 7 (25%) had an abnormal CA size of which 4 (14%) met echo criteria for iKD. In the healthy patients, four (15%) had abnormal CA of which two (7.4%) met echo criteria for iKD. Among patients with a positive echo read, the median number of readers who read a CA as dilated was similar for each group. Furthermore, of all patients meeting echo criteria for iKD, 90% had aneurysmal CA dilatation.ConclusionAlthough CA abnormalities diagnostic of KD were commonly present at time of diagnosis in patients with KD or iKD, these findings were also present in some healthy and some febrile patients. Diagnosis of iKD in febrile children using echo criteria may result in an over-diagnosis of KD.Disclosures All authors: No reported disclosures.