Presence Of Pericardial Effusion Research Articles

Sex-related differences in early morphological and clinical outcomes in patients with type A intramural haematoma: an observational cohort study.

To investigate sex-based differences in presenting characteristics and early outcomes of type A intramural haematoma. Patients with type A intramural haematoma in an institutional cohort were consecutively enrolled between December 2013 and July 2022. Presenting characteristics, morphological progression and all-cause death during hospitalization were evaluated according to patient sex. Among 473 patients, 48.0% were female. Females were older (65.9 ± 9.1 vs 58.5 ± 11.5 years, P < 0.001) with larger ascending aortic diameters (52.2 ± 6.6 vs 48.3 ± 6.1 mm, P < 0.001), thicker haematomas (11.5 ± 4.9 vs 9.5 ± 3.4 mm, P < 0.001) and more frequent focal intimal disruptions (45.4% vs 29.7%, P < 0.001). Within 30 days of initial medical therapy, 89.8% of males vs 70.1% of females showed morphological regression or stable condition on repeat computed tomography angiography. The in-hospital mortality was 9.7% in females (n = 22) and 2.8% in males (n = 7). Kaplan-Meier analysis revealed higher early mortality in females (P = 0.002). Multivariable Cox regression showed female sex as an independent risk factor for early death (hazard ratio: 2.8, 95% confidence interval: 1.2-6.8, P = 0.021). Subgroup analysis revealed no heterogeneity according to subgroups including older age (71-90 years), ascending aortic diameter ≥50 mm, presence of focal intimal disruption, presence of pericardial effusion, haematoma thickness ≥11 mm and hypertension. Female patients with type A intramural haematoma presented with worse characteristics, higher early morphological progression and an increased risk of early death compared to males.

Efficacy and determinants of response to inhaled treprostinil in pulmonary hypertension - interstitial lung disease

Inhaled treprostinil has shown to improve exercise capacity in patients with pulmonary hypertension-interstitial lung disease (PH-ILD). We evaluated the efficacy and determinants of favorable response to inhaled treprostinil at six months. MethodsOf the 106 patients screened, 42 were eligible for this retrospective single-center study. Assessments included rate of patients who achieved ≥30m improvement on 6-min walk test (6MWT), and death or transplantation rates at 6 months of treatment initiation. ResultsPatients were predominantly female (n = 26, 62 %) with autoimmune PH-ILD (n = 23, 55 %), and a median age of 68 (61, 75) years. Ten (38.5 %) patients achieved a distance increase ≥30 m in 6MWT. No statistically significant determinants of walking ≥30 m were noted on univariate analysis; however, responders had a lower right ventricular (RV) tissue Doppler S' velocity (9.2 [7.0, 11.0] vs. 11.9 [10.0, 14.4], p = 0.018) cm/s and evidence of pericardial effusion on baseline echocardiogram (82 % vs. 26 %, p = 0.003). PH-ILD patients who died or underwent transplantation were more likely to have progressive pulmonary fibrosis (PPF) (95 % vs 50 %, p < 0.001) ConclusionsIn real-world setting, treatment with inhaled treprostinil for six months increased the 6MWT by ≥ 30 m in about a third of PH-ILD patients. Lower RV tissue Doppler S' velocity and presence of pericardial effusion at baseline were associated with favorable response to inhaled treprostinil. PPF portends a poor survival in PH-ILD.

The Correlation between Cardiac Magnetic Resonance Findings and Post-COVID-19: The Impact of Myocardial Injury on Quality of Life.

In the post-COVID-19 era, there is growing concern regarding its impact on cardiovascular health and the following effects on the overall quality of life of affected individuals. This research seeks to investigate cardiac magnetic resonance (CMR) findings following COVID-19 and their impact on the quality of life of affected individuals. An observational, cross-sectional study was conducted in consecutive patients with persistent cardiovascular symptoms after COVID-19 who were referred to CMR due to suspected myocardial injury. In addition, patients completed a questionnaire about symptoms and the quality of life during the post-COVID-19 period. In this study, 85 patients were included. The study population consisted of patients with a mean age of 42.5 ± 13.4 years, predominantly women, who made up 69.4% of the study population, while men made up 30.6%. CMR findings showed non-ischemic myocardial injury in 78.8% of patients and myocardial edema in 14.1% of patients. Late pericardial enhancement was present in 40% of patients and pericardial effusion in 51.8% of patients. Pericardial effusion (p = 0.001) was more prevalent in patients who reported more pronounced symptoms in the post-COVID-19 period compared to the acute infection phase. Predictors of lower quality of life in the post-COVID-19 period were the presence of irregular heartbeat (p = 0.039), cardiovascular problems that last longer than 12 weeks (p = 0.018), and the presence of pericardial effusion (p = 0.037). Acute myocarditis was observed in a minority of patients after COVID-19, while non-ischemic LGE pattern and pericardial effusion were observed in the majority. Quality of life was worse during the post-COVID-19 period in patients with CMR abnormalities, primarily in patients with pericardial effusion. Also, irregular heartbeat, cardiovascular symptoms that last longer than 12 weeks, as well as pericardial effusion were independent predictors of lower quality of life during the post-COVID-19 period.

Pleural and pericardial effusions as prognostic factors in patients with acute pulmonary embolism: a multicenter study.

The prognostic role of pleural and pericardial effusion in patients with acute pulmonary embolism (PE) is still unclear with a trend for worse clinical outcome. The aim of the present study was to demonstrate the prognostic role of pleural and pericardial effusion in patients with acute PE in a large multicentre setting. The investigated patient sampled was retrospectively comprised of 1082 patients (494 female, 45.7%) with a mean age of 63.8 years ± 15.8. In every case, contrast enhanced computed tomography (CT) pulmonalis angiography was analyzed to diagnose and quantify the pleural and pericardial effusion. The 30-day mortality was the primary endpoint of this study. A total of 127 patients (11.7%) died within the 30-day observation period. Pleural effusion was identified in 438 patients (40.5%) and pericardial effusion was identified in 196 patients (18.1%). The presence of pleural effusion was associated with 30-day mortality, HR = 2.78 (95%CI1.89-4.0), p < 0.001 (univariable analysis), and HR = 2.52 (95%CI1.69-3.76), p < 0.001 (multivariable analysis). The pleural effusion width and density were not associated with 30-day mortality. The presence of pericardial effusion was not associated with 30-day mortality in multivariable analysis, HR = 1.28 (95%CI 0.80-2.03), p = 0.29. Pleural effusion is a common finding in patients with acute pulmonary embolism, occurring in 40.5% of cases, and is a prognostic imaging finding associated with 30-day mortality. The presence of pleural effusion alone, regardless of volume or density, has been shown to be prognostic and should be included in CT reports. The prognostic role of pericardial effusion is limited.

The Application of Point of Care Ultrasound to Screen for Pulmonary Hypertension: A Narrative Review.

Pulmonary Hypertension (PH) is a condition with several cardiopulmonary etiologies that has the potential of progressing to right heart failure without proper intervention. After a history, physical exam, and investigations, cases of suspected PH typically undergo imaging via a transthoracic echocardiogram (TTE). This is a resource-intensive procedure that is less accessible in remote communities. However, point of care ultrasound (POCUS), a portable ultrasound administered at the bedside, has potential to aid in the diagnostic process of PH. The MEDLINE, Embase, and CENTRAL databases were searched to screen the intersection of POCUS and PH. Studies involved adult patients, and only English articles were accepted. Reviews, case reports, unfinished research, and conference abstracts were excluded. Our aim was to identify primary studies that correlated POCUS scan results and additional clinical findings related to PH. Nine studies were included after our search. In these studies, POCUS was effective in identifying dilatation of inferior vena cava (IVC); internal jugular vein (IJV); and hepatic, portal, and intrarenal veins in patients with PH. The presence of pericardial effusion, pleural effusion, or b-lines on POCUS are also associated with PH. This review suggests important potential for the use of POCUS in the initial screening of PH. IVC and basic cardiopulmonary POCUS exams are key for PH screening in patients with dyspnea. Right-heart dilatation can be visualized, and peripheral veins may be scanned based on clinical suspicion. POCUS offers screening as an extension of a physical exam, with direct visualization of cardiac morphology. However, more studies are required to develop a statistically validated POCUS exam for PH diagnosis. More studies should also be conducted at the primary-care level to evaluate the value of screening using POCUS for PH in less-differentiated patients.

Prognostic Factors and Construction of Nomogram Prediction Model of Lung Cancer Patients Using Clinical and Blood Laboratory Parameters.

This work aimed to explore the prognostic risk factors of lung cancer (LC) patients and establish a line chart prediction model. A total of 322 LC patients were taken as the study subjects. They were randomly divided into a training set (n = 202) and a validation set (n = 120). Basic information and laboratory indicators were collected, and the progression-free survival (PFS) and overall survival (OS) were followed up. Single-factor and cyclooxygenase (COX) multivariate analyses were performed on the training set to construct a Nomogram prediction model, which was validated with 120 patients in the validation set, and Harrell's consistency was analyzed. Single-factor analysis revealed significant differences in PFS (P<0.05) between genders, body mass index (BMI), carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), squamous cell carcinoma antigen (SCCA), treatment methods, treatment response evaluation, smoking status, presence of pericardial effusion, and programmed death ligand 1 (PD-L1) at 0 and 1-50%. Significant differences in OS (P<0.05) were observed for age, tumor location, treatment methods, White blood cells (WBC), uric acid (UA), CA125, pro-gastrin-releasing peptide (ProGRP), SCCA, cytokeratin fragment 21 (CYFRA21), and smoking status. COX analysis identified male gender, progressive disease (PD) as treatment response, and SCCA > 1.6 as risk factors for LC PFS. The consistency indices of the line chart models for predicting PFS and OS were 0.782 and 0.772, respectively. Male gender, treatment response of PD, and SCCA > 1.6 are independent risk factors affecting the survival of LC patients. The PFS line chart model demonstrates good concordance.

Relationship of right ventricular functions with in-hospital and 1 year later mortality in patients hospitalized for COVID-19 pneumonia.

The aim of this study was to determine the association of right ventricular function with in-hospital mortality and mortality 1 year after discharge in patients hospitalized for COVID-19 pneumonia. The study was conducted in Van Yuzuncu Yil University Faculty of Medicine hospital between February 10, 2021 and August 10, 2022. A total of 156 patients hospitalized in intensive care and wards due to COVID-19 pneumonia were included in this study. Echocardiography was performed in all patients. Among the demographic findings of the patients included in the study, male gender, patients hospitalized in the intensive care unit (ICU), patients receiving O2 support, and smokers were found to have higher mortality rates during hospitalization. At the end of 1 year, the mortality rate was higher in patients who were hospitalized in the ICU received O2 support and had diabetes mellitus. Among echocardiographic findings, those with a low left ventricular ejection fraction had higher early and 1-year mortality rates. Of the right ventricular functions, low fractional area change, high systolic pulmonary artery pressure (SPAP), shortened pulmonary acceleration time, low right ventricle systolic wave S' velocity, increased right atrium area, and inferior vena cava diameter were found to be associated with high mortality. Increased right atrial area and inferior vena cava diameter, increased SPAP, and shortened pulmonary acceleration time were found to be significant in 1-year mortality. The presence of pericardial effusion was associated with mortality during hospitalization but not with 1-year mortality. B-type natriuretic peptide, D-dimer, and hemoglobin levels were significantly correlated with both hospital mortality and 1-year mortality. In the follow-up of COVID-19 pneumonia, right ventricular function is considered to be an important factor in early and late mortality. It could be helpful to establish a follow-up program for discharged patients from the parameters involved in mortality.

Electrocardiographic Prognostic Marker in Pulmonary Arterial Hypertension: RS Time.

Pulmonary hypertension is a condition that involves the remodeling of the right ventricle. Ongoing remodeling is also associated with disease prognosis. During the restructuring process, complex changes such as hypertrophy and dilatation may also be reflected in electrocardiographic parameters. Our study aimed to investigate the relationship between prognosis and electrocardiographic parameters in patients with pulmonary arterial hypertension. The study was designed retrospectively and included patients diagnosed with pulmonary arterial hypertension between 2010 and 2022. The patients were divided into two groups based on their survival outcome. Various parameters, including electrocardiographic, demographic, echocardiographic, catheter, and blood parameters, were compared between the two groups. A p-value of <0.05 was considered statistically significant. In the multivariate Cox analyses, the parameters that were found to be independently associated with survival were the 6-minute walk test, mean pulmonary artery pressure, presence of pericardial effusion, and time between the beginning of the QRS and the peak of the S wave (RS time) (p<0.05 for each). Of all the parameters, RS time demonstrated the best diagnostic performance (AUC:0.832). In the survival analysis, a significant correlation was found between RS time and survival when using a cut-off value of 59.5 ms (HR: 0.06 [0.02-0.17], p < 0.001). According to the results of our study, a longer RS time is associated with poor prognosis in patients with pulmonary arterial hypertension. We can obtain information about the course of the disease with a simple, non-invasive parameter.

Critical care echocardiography in shock: A comprehensive review

Bedside transthoracic echocardiography is a valuable tool for assessing cardiac morphology and function in critically ill patients. It provides real-time information and aids in making prompt clinical decisions. This article aims to explore the role of critical care echocardiography, especially during shock resuscitation, focusing on basic image acquisition and interpretation. The review discusses the evaluation of left ventricular function, right ventricular function, preload responsiveness, the presence of pericardial effusion, and tamponade.

A Contemporary Approach to the Diagnosis and Management of Constrictive Pericarditis.

CMR provides valuable anatomical information, including pericardial thickness and the presence of pericardial effusion, enables a comprehensive cardiac function assessment, hemodynamics, myocardial characteristics, and above all, assessment for pericardial inflammation.(2, 4) Ventricular interdependence is demonstrated by abnormal diastolic septal motion observed on steady-state free precession images (81% sensitive and 100% specific for constriction)(supplemental-video-1)(3, 4), while pericardial-myocardial tethering can be demonstrated using myocardial tagging sequences.

New 2022 ESC/ERS definition of pulmonary hypertension: can we rely on the same non-invasive echocardiographic parameters?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The hemodynamic definition of pulmonary hypertension (PH) has been updated, with lowering of the mean pulmonary arterial pressure (mPAP) threshold from 25 to 20 mmHg according to the new 2022 ESC/ERS Guidelines. Although there is no single echocardiographic parameter that reliably informs about PH status, some of the echocardiographic parameters cut-offs remained the same, including a peak tricuspid regurgitation velocity (PTRV) &amp;gt;2.8m/s. The potential underdiagnosis of PH has not been evaluated. Objectives To evaluate the screening power of the standard echocardiographic parameters to detect PH according to the new guidelines and to establish new predictors. Methods A prospective registry of consecutive intermediate-high- and high-risk PE pts submitted to CDT in a single tertiary center was used. 3 months after the procedure, the patients were submitted to a right heart catheterization and echocardiogram to screen chronic thromboembolic pulmonary hypertension (CTEPH). According to new PH criteria, patients were divided in two groups, and echocardiographic parameters were analyzed regarding their predictive power. A ROC curve analysis was performed to evaluate optimal cut-offs in predicting PH according the new guidelines. Results 17 pts (60% women, mean age 59 ± 16 years) were included. Among these, 7 pts (41,2%) were diagnosed with pre-capillary PH by RHC at 3 months of follow-up. Among echocardiographic parameters, PTRV (p 0.015), presence of tricuspid regurgitation (0.034) and right ventricle-pulmonary artery (RV-PA) coupling (p 0.041) were significantly different between groups (Fig 1 A). Other parameters, such as right ventricle dilation (p 0.849), TAPSE (p 0.100), annular tricuspid s’ velocity (p 0.646), right ventricle outflow tract acceleration time (p 0.229) and the presence of pericardial effusion (p 0.849) did not show significant differences. Regarding the PTRV, a ROC curve analysis revealed an PTRV optimal cut-off of 2.6 m/s (pressure gradient 27mmHg) in our population (AUC 0.911, p 0.030, Sn 71.4%, Sp 100%), compared to the conventional cut-off of 2.8 m/s (pressure gradient 31 mmHg) (p 0.470, Sn 28.6%, Sp 100%). The use of PTRV &amp;gt; 2.6 m/s allows to reduce false negatives without losing specificity (Fig 1 B, C and D). Conclusion With the recent update in PH criteria, the use of the conventional PTRV cut-off leads to a significant underdiagnosis in our population. Lowering the PTRV threshold seems to increase sensitivity, without losing specificity. Other standard echocardiographic parameters did not seem to predict accurately the presence of PH.

C84 OUTCOME AND MORPHO–FUNCTIONAL CHANGES ON CARDIAC MAGNETIC RESONANCE IN PATIENT WITH ACUTE MYOCARDITIS FOLLOWING MRNA COVID 19 VACCINATION

Abstract Background MessengerRNA (mRNA) COVID–19 vaccination has been associated with a higher–than–expected occurrence of acute myocarditis. Scarce information is available on mid–term prognosis and changes in cardiac function, volumes, and tissue characterization on cardiac magnetic resonance (CMR). Methods Retrospective, multicenter study including patients with a definite diagnosis of acute myocarditis within 30 days from mRNA COVID–19 vaccination. The diagnosis is based on endomyocardial biopsy (EMB) or autopsy or by the coexistence of positive biomarkers (troponin &amp;gt;99th upper reference limit or elevated creatine kinase myocardial band [CK–MB]) and cardiac MRI findings consistent with AM according to the 2018 updated Lake Louise Criteria. Results 77 patients (median age 25 years [IQR 20–35], 15% female) were included and followed–up for 147 days [IQR 74–215]. Follow–up CMR was available in n=49 patients and showed no changes in biventricular ejection fraction (EF) as compared to CMR at diagnosis (left ventricular EF: 59%[55–65]vs. 60%[57–64], p=0.507, right ventricular EF: 56%[52–62]vs. 57%[52–61], p=0.563, respectively). Late gadolinium enhancement was present in all patients at diagnosis and persisted in only n=39 (79.6%) at follow–up (p=0.001), generally sparing the anterior wall and the septum. N=10 (20.4%) had a persistent edema based on T2–weighted short tau inversion recovery (STIR) sequences, with predominant involvement of inferior or inferior–lateral walls. The proportion of patients with increased T1 and T2 mapping signals significantly decreased at follow–up (n=13 (68%) vs. n=4 (13%),p&amp;lt;0.001, and n=21 (84%) vs. n=3 (10%),p&amp;lt;0.001, respectively), as well as the presence of pericardial effusion (n=16 (33%) vs. n=3 (6%),p=0.004). No differences in morpho–functional CMR parameters based on the type of vaccine administered were found (BNT162b2 Pfizer/BioNTech®, n=36, 73.5%, m–RNA–1273 Moderna®, n=13, 26.5%). Among patients with available follow–up (N=75, 97.4%), no major adverse cardiovascular events nor myocarditis recurrence or death were reported. Conclusions At mid–term follow–up, patients who experienced an acute myocarditis after a mRNA COVID–19 vaccine had preserved biventricular EF. The rate and localization of residual scar or edema on CMR is in line with classic viral myocarditis with a good prognosis. This new piece of information should further reassure patients who experience acute myocarditis after mRNA COVID–19 vaccination.

Describing our experience with the effects of multisystem inflammatory syndrome in children with COVID-19 on the cardiovascular system.

Cardiac involvement with multisystem inflammatory syndrome in children can include coronary artery abnormalities, ventricular dysfunction, conduction abnormalities, arrhythmias, pericarditis, and myocarditis. We report the cardiac findings in 34 patients with multisystem inflammatory syndrome in children admitted to a single institution. We looked at patient age, sex, brain natriuretic peptide levels, troponin levels, ejection fraction, presence of pericardial effusion, valvular changes, need for inotropic agents, and electrocardiogram findings. Our data showed that elevated brain natriuretic peptide did not predict troponin elevation and vice versa. Additionally, troponin rise was not a reliable marker for decreased left ventricular ejection fraction. All changes tracked were proven to be transient and resolved after initiating steroids, Intravenous immune globulin (IVIG), and occasionally anakinra.

The use of handheld ultrasound device in cardiac examination of patients with history of COVID-19

Abstract Background Clinical usefulness of Handheld Ultrasound Device [HUD] was previously confirmed in numerous clinical scenarios. During the previous two years Covid-19 patients become a focal point of healthcare worldwide. The assessment of long term consequences of this infection is bound to overload already burdened healthcare system. Purpose To assess clinical usefulness of HUD as an adjunct to physical cardiac examination of patients with history of COVID-19. Methods Study population consisted of randomly selected patients with no symptoms of cardiovascular pathology, who had been hospitalized due to COVID-19 one year prior to examination. Physical examination and clinical assessment was augmented with short examination with the use of HUD, which included: visual evaluation of the global and regional LV function, measurement of RV size, screening for the significant valve defects and the presence of pericardial effusion. Subsequently full echocardiographic examination with the use of high-end workstation was performed, which results were treated as reference. Results 54 patients (35 men, mean age 63±13 years) were enrolled into the study. In clinical examination no significant cardiovascular abnormalities were discovered. In 30 [56%] of patients cardiac abnormalities in HUD examination were detected. In 18 patients [33%] LV function assessment was not performed, due to insufficient quality of registered view. In the remaining group significant impairment of LV ejection fraction (&amp;lt;50%) was detected in HUD examination in 3 [6%] patients (2 confirmed in full examination, positive predictive value [PPV] 57%, negative predictive value [NPV] 97%, AUC 0,82±0,17, P 0,057). WMA were diagnosed in 6 [11%] patients (4 confirmed in full examination, PPV 84% NPV 78%, AUC 0,69±0,17, P 0,02). RV enlargement was identified in 21 [39%] patients (PPV 57%, NPV 97%, AUC 0,85±0,05, P&amp;lt;0,0001), mild pericardial effusion in 3 [6%] patient (1 confirmed in full echocardiographic examination; 2 false positive, no false negative), at least moderate mitral/tricuspid/aortic valve insufficiency in 7 [13%] patients (3 confirmed, 4 false positive cases, no false negative). A total mean time of the heart and lungs HUD examination was 2,1±0,6 minute. Conclusion Cardiac abnormalities exposed in brief assessment with the use HUD are a relatively common finding in asymptomatic patients previously hospitalized due to COVID infection in a 1-year follow-up, despite normal physical examination. Normal HUD examination excludes the presence of significant cardiac abnormalities with high probability. However one should keep in mind a relatively high percentage of false positive results, which may lead to an exceeding number of patients referred for a full echocardiographic examination. Funding Acknowledgement Type of funding sources: None.

1016 CARDIAC MAGNETIC RESONANCE IMAGING IN DIFFERENTIAL DIAGNOSIS OF CARDIAC MASSES

Abstract Background Differential diagnosis of cardiac masses represents a challenging issue with important implications for therapeutic management and patient's prognosis. Cardiac Magnetic Resonance (CMR) is a non-invasive imaging technique used to characterize morphologic and functional features of masses. Integration of these information can lead to an accurate diagnosis. Purpose To evaluate the diagnostic role of CMR in defining the nature of cardiac masses. Methods One hundred-fourteen patients with cardiac masses evaluated with CMR were enrolled. All masses had histological certainty. CMR sequences allowed a qualitative morphologic description as well as tissue characterization. Evaluation of masses morphology included localization, size and borders assessment, detection of potential multiple lesions and pericardial effusion. Tissue characterization resulted from an estimation of contrast enhancement - early gadolinium enhancement (EGE) and late gadolinium enhancement (LGE) sequences - and tissue homogeneity in T1 and T2 weighted acquisitions. The descriptive analysis was carried out by comparing benign vs malignant lesions as well as dividing patients into 4 subgroups: primitive benign tumours, primitive malignant tumours, metastatic tumours and pseudotumours. Results The descriptive analysis of morphologic features showed that diameter &amp;gt; 50 mm, invasion of surrounding planes, irregular margins and presence of pericardial effusion were able to predict malignancy (p &amp;lt; 0.001). As for tissue characteristics, heterogeneous signal intensity - independently from T1 and T2 weighted acquisitions - and EGE were more common in malignant lesions (p &amp;lt;0.001). When analysing the four subgroups, CMR features did not discriminate between primitive malignant masses and metastasis. Conversely, hyperintensity signal in T2 w-TSE, EGE and heterogeneity after gadolinium enhancement were more common in benign primitive lesions compared to pseudotumours. Furthermore, using classification and regression tree (CART) analysis, we developed an algorithm to differentiate masses: invasion of surrounding planes was a common characteristic of malignancy and identifies itself malignant tumours. In the absence of invasive features, gadolinium enhancement was evaluated: the lack of contrast uptake was able to increase the probability of a pseudotumour. Last step of decision algorithm included ejection fraction assessment to discriminate between benign tumours: a reduced ejection fraction increased the probability of pseudotumour diagnosis and reduced the probability of primary benign tumour diagnosis. Conclusions Cardiac magnetic resonance is a very powerful diagnostic tool for differential diagnosis of cardiac masses as it correctly addresses malignancy. Furthermore, an accurate evaluation of the several CMR features may discriminate primary benign masses and pseudotumours.

138 OUTCOME AND MORPHO-FUNCTIONAL CHANGES ON CARDIAC MAGNETIC RESONANCE IN PATIENT WITH ACUTE MYOCARDITIS FOLLOWING MRNA COVID 19 VACCINATION

Abstract Background MessengerRNA (mRNA) COVID-19 vaccination has been associated with a higher-than-expected occurrence of acute myocarditis. Scarce information is available on mid-term prognosis and changes in cardiac function, volumes, and tissue characterization on cardiac magnetic resonance (CMR). Methods Retrospective, multicenter study including patients with a definite diagnosis of acute myocarditis within 30 days from mRNA COVID-19 vaccination, with a confirmed myocarditis diagnosis based on endomyocardial biopsy (EMB) or autopsy or by the coexistence of positive biomarkers (troponin &amp;gt;99th upper reference limit or elevated creatine kinase myocardial band [CK-MB]) and cardiac MRI findings consistent with AM according to the 2018 updated Lake Louise Criteria. Results 77 patients (median age 25 years [IQR 20-35], 15% female) were included and followed-up for 147 days [IQR 74-215]. Follow-up CMR was available in n=49 patients and showed no changes in biventricular ejection fraction (EF) as compared to CMR at diagnosis (left ventricular EF: 59%[55-65]vs. 60%[57-64], p=0.507, right ventricular EF: 56%[52-62]vs. 57%[52-61], p=0.563, respectively). Late gadolinium enhancement was present in all patients at diagnosis and persisted in only n=39 (79.6%) at follow-up (p=0.001), generally sparing the anterior wall and the septum. N=10 (20.4%) had a persistent edema based on T2-weighted short tau inversion recovery (STIR) sequences, with predominant involvement of inferior or inferior-lateral walls. The proportion of patients with increased T1 and T2 mapping signals significantly decreased at follow-up (n=13 (68%) vs. n=4 (13%),p&amp;lt;0.001, and n=21 (84%) vs. n=3 (10%),p&amp;lt;0.001, respectively), as well as the presence of pericardial effusion (n=16 (33%) vs. n=3 (6%),p=0.004). No differences in morpho-functional CMR parameters based on the type of vaccine administered were found (BNT162b2 Pfizer/BioNTech®, n=36, 73.5%, m-RNA-1273 Moderna®, n=13, 26.5%). Among patients with available follow-up (N=75, 97.4%), no major adverse cardiovascular events nor myocarditis recurrence or death were reported. Conclusions At mid-term follow-up, patients who experienced an acute myocarditis after a mRNA COVID-19 vaccine had preserved biventricular EF. The rate and localization of residual scar or edema on CMR is in line with classic viral myocarditis with a good prognosis. This new piece of information should further reassure patients who experience acute myocarditis after mRNA COVID-19 vaccination.

The effect of short-course point-of-care echocardiography training on the performance of medical interns in children.

Point-of-care ultrasound (POCUS) can add complementary information to physical examination. Despite its development in several medical specialties, there is a lack of similar studies on children by medical interns and cardiologists. Therefore, investigators aimed to assess the effect of short-course training on the performance of medical interns in point-of-care echocardiography in children. This analytic cross-sectional study was conducted on 161 hospitalized children in 17 Shahrivar children's hospital, Iran, from January 2021 to May 2021. Seven interns (trainees) participated in a short course of point-of-care echocardiography to assess left ventricular ejection fraction (LVEF), inferior vena cava collapsibility index (IVCCI), and the presence of pericardial effusion (PEff). Each patient underwent point-of-care echocardiography by one of the trainees. Then, in less than one hour, the echocardiography was performed by a single cardiologist. Agreement between the cardiologist and trainees was examined using Cohen's kappa coefficient and Prevalence-Adjusted Bias-Adjusted Kappa (PABAK). For numerical variables, the agreement was examined using the concordance correlation coefficient (CCC) and intraclass correlation coefficient (ICC). Results showed that the cardiologist and trainees detected LVEF >50, IVCCI >50%, and the absence of PEff in most of the participants. A good agreement in terms of ICC and CCC for LVEF (0.832 and 0.831, respectively) and a good agreement in terms of ICC and CCC for IVCCI (0.878 and 0.877, respectively) were noted. Using categorical scoring of LVEF and IVCCI showed 94.4% and 87.6% complete agreement, respectively. Furthermore, using categorical scoring of LVEF and IVCCI, Cohen's kappa coefficient was 0.542 (moderate) and 0.619 (substantial), respectively. The PABAK for LVEF and IVCCI were 0.886 (almost perfect) and 0.752 (substantial), respectively. For PEff, Cohen's kappa and PABAK were 0.797 (moderate) and 0.988 (almost perfect), respectively, and the complete agreement was noted in 160 patients (99.4%). This study showed that a short teaching course could help medical interns to assess LVEF, IVCCI, and PEff in children. Therefore, it seems that adding this course to medical interns' curricula can be promising.

Abstract 15534: Pericardial Effusion in People With HIV in the Era of Antiretroviral Therapy

Introduction: Pericardial effusion was previously described as one of the most common forms of cardiovascular involvement in People with HIV (PWH). The presence of pericardial effusion was considered a marker of advanced HIV infection and associated with a low CD4 cell count. This study describes the incidence and association of pericardial disease with HIV-related factors in an era of wider availability of antiretroviral therapy (ART). Methods: A retrospective chart review was performed of patients who received HIV care at the University of Miami/Jackson Memorial Hospital between 2017-2019 with an available echocardiogram (n=396). We stratified patients according to the presence (n=51) or absence of pericardial effusion (n=345) and compared demographic, clinical, imaging, and laboratory data. A p-value &lt;0.05 was considered statistically significant. Results: We found a prevalence of pericardial effusion in PWH of 4.5%. There was no statistically significant difference in age, gender, or race between groups. PWH with pericardial effusion had higher creatinine (2.1 mg/dL vs. 1.6 mg/dL, p=0.025) and pro-BNP (12,088 pg/mL vs. 6364 pg/mL, p=0.021) levels, were more likely to have chronic kidney disease (43.1% vs. 18%, p&lt;0.001), tricuspid regurgitation (64.6% vs. 44.2%, p=0.009), and mitral regurgitation (60.8% vs. 35.9%, p&lt;0.001) compared to PWH without pericardial effusion. There was no difference in CD4 count, CD8 count, viral load, length on ART, or history of tuberculosis between groups. Conclusions: We report a lower prevalence of pericardial effusion in PWH than previous results before the wide availability of ART (around 11%). In PWH with pericardial effusion, we found no association with HIV-related factors or length on ART. In this population, pericardial effusion was associated with comorbidities like chronic kidney disease and valvular abnormalities.

The use of handheld ultrasound device in cardiac examination of patients with history of COVID-19

Abstract Background Clinical usefulness of Handheld Ultrasound Device [HUD] was previously confirmed in numerous clinical scenarios. During the previous two years Covid-19 patients become a focal point of healthcare worldwide. The assessment of long term consequences of this infection is bound to overload already burdened healthcare system. Purpose To assess clinical usefulness of HUD as an adjunct to physical cardiac examination of patients with history of COVID-19. Methods Study population consisted of randomly selected patients with no symptoms of cardiovascular pathology, who had been hospitalized due to COVID-19 one year prior to examination. Physical examination and clinical assessment was augmented with short examination with the use of HUD, which included: visual evaluation of the global and regional LV function, measurement of RV size, screening for the significant valve defects and the presence of pericardial effusion. Subsequently full echocardiographic examination with the use of high-end workstation was performed, which results were treated as reference. Results 54 patients (35 men, mean age 63±13 years) were enrolled into the study. In clinical examination no significant cardiovascular abnormalities were discovered. In 30 [56%] of patients cardiac abnormalities in HUD examination were detected. In 18 patients [33%] LV function assessment was not performed, due to insufficient quality of registered view. In the remaining group significant impairment of LV ejection fraction (&amp;lt;50%) was detected in HUD examination in 3 [6%] patients (2 confirmed in full examination, positive predictive value [PPV] 57%, negative predictive value [NPV] 97%, AUC 0,82±0,17, P 0,057). WMA were diagnosed in 6 [11%] patients (4 confirmed in full examination, PPV 84% NPV 78%, AUC 0,69±0,17, P 0,02). RV enlargement was identified in 21 [39%] patients (PPV 57%, NPV 97%, AUC 0,85±0,05, P&amp;lt;0,0001), mild pericardial effusion in 3 [6%] patient (1 confirmed in full echocardiographic examination; 2 false positive, no false negative), at least moderate mitral/tricuspid/aortic valve insufficiency in 7 [13%] patients (3 confirmed, 4 false positive cases, no false negative). A total mean time of the heart and lungs HUD examination was 2,1±0,6 minute. Conclusion Cardiac abnormalities exposed in brief assessment with the use HUD are a relatively common finding in asymptomatic patients previously hospitalized due to COVID infection in a 1-year follow-up, despite normal physical examination. Normal HUD examination excludes the presence of significant cardiac abnormalities with high probability. However one should keep in mind a relatively high percentage of false positive results, which may lead to an exceeding number of patients referred for a full echocardiographic examination. Funding Acknowledgement Type of funding sources: None.

Human herpesvirus 8-negative effusion-based large B-cell lymphoma: a distinct entity with unique clinicopathologic characteristics

AbstractRare cases of human herpesvirus 8 (HHV8)-negative effusion-based large B-cell lymphoma (EB-LBCL) occur in body cavities without antecedent or concurrent solid mass formation. In contrast to HHV8 + primary effusion lymphoma (PEL), EB-LBCL has no known association with HIV or HHV8 infection. However, the small sample sizes of case reports and series worldwide, especially from non-Japanese regions, have precluded diagnostic uniformity. Therefore, we conducted a retrospective, multi-institutional study of 55 cases of EB-LBCL and performed a comprehensive review of an additional 147 cases from the literature to identify distinct clinicopathologic characteristics. In our study, EB-LBCL primarily affected elderly (median age 80 years), immunocompetent patients and manifested as lymphomatous effusion without a solid component. The lymphomatous effusions mostly occurred in the pleural cavity (40/55, 73%), followed by the pericardial cavity (17/55, 31%). EB-LBCL expressed CD20 (53/54, 98%) and PAX5 (23/23, 100%). Most cases (30/36, 83%) were of non-germinal center B-cell subtype per the Hans algorithm. HHV8 infection was absent (0/55, 0%), while Epstein-Barr virus was detected in 6% (3/47). Clinically, some patients were managed with drainage alone (15/34, 44%), while others received rituximab alone (4/34, 12%) or chemotherapy (15/34, 44%). Eventually, 56% (22/39) died with a median overall survival (OS) of 14.9 months. Our findings were similar to those from the literature; however, compared to the non-Japanese cases, the Japanese cases had a significantly higher incidence of pericardial involvement, a higher rate of chemotherapy administration, and longer median OS. Particularly, we have found that Japanese residence, presence of pericardial effusion, and absence of MYC rearrangement are all favorable prognostic factors. Our data suggest that EB-LBCL portends a worse prognosis than previously reported, although select patients may be managed conservatively. Overall, EB-LBCL has distinct clinicopathologic characteristics, necessitating the establishment of separate diagnostic criteria and consensus nomenclature.