Echocardiogram Results Research Articles

The incidence of Marfan syndrome and cardiac anomalies in patients presenting with pectus deformities

PurposeThe incidence of Marfan syndrome in the general population is 0.3%. Two-thirds of patients with Marfan syndrome have concurrent pectus deformity. However, incidence of Marfan syndrome and cardiac abnormalities in patients presenting with an isolated pectus deformity remains unknown. We sought to establish the degree of association between pectus deformities and these abnormalities, and whether referral of these patients for cardiac and genetic workup is warranted. MethodsOur pediatric surgery group refers patients with pectus deformities for genetic and cardiac evaluation. We examined 415 records from 2009 to 2016, and identified 241 patients with a chief complaint of a pectus deformity. Patient characteristics, echocardiogram results, Haller indices, and genetic results were analyzed. ResultsThe frequency of Marfan syndrome in our study was 5.3%. The incidence of Marfan was highest among patients with combined type pectus deformity (20%). Cardiac anomalies showed an overall incidence of 35%. Of those diagnosed with Marfan, 84% had cardiac abnormalities. ConclusionMore than 5% of patients presenting with a chief complaint of pectus deformity will have a diagnosis of Marfan syndrome, compared to 0.3% in the general population. Approximately a third of this population will have cardiac abnormalities. Referral of patients with pectus deformities for evaluation for Marfan syndrome and cardiac abnormalities is appropriate. Level of EvidenceLevel IV.

894: Can we predict yield of Chromosomal Microarray in intrauterine growth restriction according to clinical parameters?

Intrauterine growth restriction (IUGR) is a condition in which the fetus fails to achieve its full growth potential. There are various etiologies for IUGR including placental factors, infections, maternal chronic conditions and genetic causes. We aimed to evaluate the yield of Chromosomal Microarray Analysis in different clinical scenarios as well as in pregnancies in which short lone bones were the major finding. Our cohort included 246 cases of pregnancies. In 182 cases IUGR was the prominent feature while in 64 cases fetal short long bones were the prominent feature. CMA analysis was performed for all cases between January 2016 to March 2018. Data were retrieved from the Israeli national database and from patient medical records. In 130 cases data regarding the clinical and familial background and prenatal work-up performed during the pregnancy were available for sub analysis. Data collection is ongoing The mean gestational age at diagnosis was 31.5± 9.4 weeks. The mean measured percentile was 3.8 ± 2.4. In 14 out of 246 cases (5.7%) CMA result was pathogenic/likely pathogenic. In 3 cases (1.2%) a microdeletion/duplication with low penetrance was detected and in 23 cases (9.3%) variables of unknown clinical significance were detected. There were 2 cases of trisomy 18, one case of trisomy 21, one case of triploidy and 10 cases of microdeletions/microduplications 5 of which were detectable by karyotype. In pregnancies in which short long bones were the prominent finding, CMA was positive in 4 cases (6.25% ). In IUGR only cases there were 10 pathological CMA results (5.5%). The yield of CMA was significantly higher for cases with pathological echocardiogram (p=0.003).And was close to reaching clinical significance for IUGR pregnancies, in which the lowest measured percentile was below 1 (p=0.057). There was no significant difference for other parameters such as maternal illness, familial background of genetic conditions, obstetrics history, and prenatal work-up. The yield of CMA for IUGR is 5.7% and is higher in cases with pathological echocardiogram results and in pregnancies in which measured percentiles were below the 1. Other parameters did not reach clinical significance; however, data collection is ongoing, hence the power of such analysis will improve and may reflect additional contributing parameters. The incremental yield of CMA over karyotyping in our cohort karyotype was 64.28%.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Effect of Continuous-Flow Mechanical Circulatory Support on Microvasculature Remodeling in the Failing Heart.

Left ventricle (LV) unloading caused by a left ventricular assist device (LVAD) has been shown to enhance reverse LV remodeling in end-stage cardiomyopathy. Several reports consistently suggest that a pulsatile-flow LVAD has more profound effects compared to continuous-flow LVAD, though the responsible mechanisms are not fully understood. We hypothesized that arterial pulsatility, being affected by the type of LVAD, may affect microvasculature and functional/pathological LV remodeling in end-stage cardiomyopathy. The study included 18 patients with chronic heart failure who underwent LVAD implantation. Eight patients were implanted with pulsatile-flow LVAD, and 10 patients were implanted with continuous-flow LVAD. The results of serial echocardiograms and histopathological assessment of transmural LV tissues, which were collected during the implantation and removal of LVADs, were compared between the groups. The results of echocardiography showed that LV systolic dimension and LV ejection fraction improved greatly in the pulsatile-flow LVAD group compared to the continuous-flow LVAD group. Histological analysis showed that in both groups, increased microvasculature density and decreased cardiomyocyte size during LVAD support had no significant difference. In contrast, only the patients with continuous-flow LVADs had presented with significant increase in α-smooth muscle actin (α-SMA)-positive layer thickness and the number of proliferating cell nuclear antigen (PCNA)-positive cells of myocardial arterioles. We concluded that the use of long-term continuous-flow LVAD support, having less pulsatility, had induced more thickening to the medial layer of myocardial arterioles compared to the use of pulsatile-flow LVADs. Our findings suggest that the pathological impairment of myocardial microvascular structure during continuous-flow LVAD support may be a novel mechanism which accounts for the difference in LV remodeling depending on the type of LVAD.

Hypertrophic Cardiomyopathy in Liver Transplantation Patients

BackgroundHypertrophic cardiomyopathy (HCM) is an autosomal dominant disorder that presents with a hypertrophied nondilated left ventricle. In the absence of other known causes of cardiomyopathy, it is often associated with left ventricular outflow tract obstruction during systole, systolic anterior motion of the mitral valve, mitral regurgitation, and increased risk of sudden cardiac death. When HCM coexists with end-stage liver disease, it can be further complicated by cirrhosis-associated cardiovascular abnormalities, including hyperdynamic circulation, systolic and diastolic dysfunction, and electrophysiologic abnormalities. MethodsWe retrospectively examined patient characteristics, comorbidities, preoperative echocardiogram results, sudden cardiac death risk prediction model score, and 1-year postoperative mortality of patients with HCM who underwent liver transplantation at our institution from January 1, 2000, through January 1, 2015. ResultsOf the 2,812 liver transplantations performed during the study period, we identified 15 patients with a preoperative diagnosis of HCM. When comparing the patients who did vs did not survive the first year after orthotopic liver transplantation, we identified significant differences in maximal left ventricular wall thickness (P = .004) and resting left ventricular outflow tract gradient (P = .004). Preoperative left atrium size (measured by echocardiography; P = .66) and the sudden cardiac death risk prediction model score (P = .32) were not significantly associated with 1-year survival. ConclusionsPreoperative left ventricular outflow tract gradient exceeding 60 mm Hg was strongly associated with death during the first year after transplant. These results suggest that the severity of HCM influences patient outcomes.

Appropriateness vs value: Echocardiography in primary care.

Despite efforts targeting the growth of healthcare spending within the United States, the current increase in expenditures remains a widespread systemic issue. The overuse of healthcare testing has previously been identified as a modifiable contributing factor. One such test, echocardiography, has seen a continuous increase in its rate of use. This test is frequently ordered by primary-care physicians. In the setting of a low likelihood of disease, echocardiography does not substantially change cardiac therapy, even if appropriately ordered. We randomly identified 500 patients who received an echocardiogram ordered by a primary-care physician between January 1, 2014, and December 31, 2014. Of these, 239 patient charts were reviewed and the following extracted: primary indication for the test, echocardiogram results, and changes in patient medical management. In addition, appropriateness of the test was assessed using the appropriate use criteria guidelines for echocardiography. Nearly 97% of the studies within the ambulatory primary-care setting were appropriately ordered according to the appropriate use criteria. Among the 239 patients studied, only 52 had abnormalities and only 6 (2.5%) experienced a change in management that corresponded with the initial suspected diagnosis and echocardiographic findings. To ensure the greatest value and optimize use of diagnostic testing, it may be necessary to develop a more comprehensive set of guidelines to assist clinicians to readily identify patient populations at low, moderate, and high risk for the presence of disease and provide educational interventions, including feedback regarding individual ordering behaviors.

Effect of Body Mass Index on Exercise Capacity in Patients With Hypertrophic Cardiomyopathy

The objective of this study was to evaluate the relation between body mass index (BMI), exercise capacity, and symptoms in patients with hypertrophic cardiomyopathy (HC) and to utilize results of cardiopulmonary exercise tests (CPX) and transthoracic echocardiograms to understand the mechanism(s) of reduced exercise capacity across body mass index groups. Over a 6-year period, 510 consecutive patients with HC seen at a tertiary referral center underwent (CPX) and a transthoracic echocardiogram. Increasing BMI was associated with decreased exercise capacity as assessed by peak VO2 (ml/kg/min). However, the prevalence of cardiac impairment did not vary by BMI group. In conclusion, these findings suggest that in some patients with hypertrophic cardiomyopathy, cardiac impairment is not the primary cause of exercise limitation and weight loss may result in improved exercise capacity.

Emergency department point-of-care ultrasonography improves time to pericardiocentesis for clinically significant effusions.

ObjectiveOur objective was to determine the utility of point-of-care ultrasound (POCUS) to identify and guide treatment of tamponade or clinically significant pericardial effusions in the emergency department (ED).MethodsThis was a retrospective cohort study of non-trauma patients who were diagnosed with large pericardial effusions or tamponade by the ED physician using POCUS. The control group was composed of those patients later diagnosed on the medical wards or incidentally in the ED by other means such as a computed tomography. The following data were abstracted from the patient’s file: demographics, medical background, electrocardiogram results, chest radiograph readings, echocardiogram results, and patient outcomes.ResultsThere were 18 patients in the POCUS arm and 55 in the control group. The POCUS arm had a decreased time to pericardiocentesis (11.3 vs. 70.2 hours, P=0.055) as well as a shorter length of stay (5.1 vs. 7.0 days, P=0.222). A decreased volume of pericardial fluid was drained (661 vs. 826 mL, P=0.139) in the group diagnosed by POCUS.ConclusionThis study suggests that POCUS may effectively identify pericardial effusions and guide appropriate treatment, leading to a decreased time to pericardiocentesis and decreased length of hospital stay. Pericardial tamponade or a large pericardial effusion should be considered in all patients presenting to the ED with clinical, radiographic, or electrocardiographic signs of cardiovascular compromise.

208 - Characterization of Patients with Heart Failure with Recovered Ejection Fraction From an Urban, Inner City Teaching Hospital

Background: Heart failure with recovered ejection fraction (HFrecEF) is an emerging clinical subgroup of patients with previous heart failure with reduced ejection fraction (HFrEF) that have recovered their EF. It is important to identify predictors of recovery and the impact of contributing comorbidities to define the optimal medical management. The aim of this study was to identify clinical phenotypes of patients with HFrecEF in a large inner city teaching hospital. Methods: We conducted a retrospective chart review of patients admitted to the University of Florida Jacksonville hospital with a diagnosis of heart failure with reduced ejection fraction (HFrEF) from January 1, 2009 December 31, 2015. Patients 18 years or older had to have at least 2 echocardiograms within the study period with the initial EF <40%. The diagnosis of HFrecEF was defined as the most recent LVEF ≥40% and a previously documented LVEF <40%. Results of echocardiograms and etiology of HF as well as documentation of age, gender, race, body mass index, hypertension (HTN), hyperlipidemia, coronary artery disease (CAD), diabetes mellitus (DM) were analyzed. The diagnosis of ischemic cardiomyopathy was defined as a decrease in ejection fraction that can be explained by the presence of significant CAD diagnosed by catheterization or non invasive testing (functional or anatomic). Results: A total of 6459 patients were included in the study. Of these 921(14.2%) met criteria for HFrecEF. Twenty-one patients had missing data and were excluded from the analysis. The median age of patients with HFrecEF was 67.5 years, 58% (522 of 900) were male, 50.5% (545 of 900) were White and 45.5% (410 of 900) were Black, 36% (327 of 900) were diagnosed with ischemic cardiomyopathy. 36.3% had DM, 41.9% had CAD, 70.7% had HTN, with highest prevelence in Blacks (87%). 23.8% (214 of 900) received an implantable cardioverter defibrillator (ICD) for primary prevention. 3% (27 of 900) received cardiac resynchronization therapy (CRT). Conclusions: HFrecEF in urban, inner city teaching hospital is a diverse, heterogeneous group with different comorbidity profiles and etiologies of cardiomyopathy across different racial groups. Non ischemic etiology and hypertensive disease are most common in blacks whereas ischemic etiology is predominant in whites. Further investigations to determine the natural history, risk stratification and predictors of EF recovery are necessary to establish optimal medical management of this subgroup of patients.

Identification of mutations associated with coronary artery lesion susceptibility in Kawasaki disease by targeted enrichment of genomic region sequencing technique

Objective: To screen and identify the mutations in Kawasaki disease by targeted enrichment of genomic region sequencing technique and investigate susceptibility genes associated with coronary artery lesion. Method: This was a case-control study.A total of 114 patients diagnosed as Kawasaki disease treated in Shanghai Children's Hospital between December 2015 and November 2016 were studied and another 45 healthy children who were physically examined in outpatient department were enrolled as control group. Patients were divided into two groups based on the results of echocardiogram. Peripheral venous blood was obtained from patients and controls. Genomic DNA was extracted. SeqCap EZ Choice libraries were prepared by targeted enrichment of genomic region technology. Then the libraries were sequenced to identify susceptibility genes associated with coronary artery lesion in patients diagnosed as Kawasaki disease.Susceptible genes were identified by Burden test, Pearson chi-square test or Fisher's exact probability test. Result: There was statistically significant difference in TNFRSF11B(rs2073618)G>C(p.N3K)mutation and GG/GC/CC genotype between Kawasaki disease group and control group(χ(2)=15.52, P=0.00). There was statistically significant difference in TNFRSF13B(rs34562254)C>T(p.P251L)mutation(χ(2)=10.40, P=0.01)and LEFTY1(rs360057)T>G(p.D322A)mutation(χ(2)=8.505, P=0.01)between patients with coronary artery lesions and those without. Conclusion: Targeted enrichment of genomic region sequencing technology can be used to do primary screening for the susceptible genes associated with coronary artery lesions in Chinese Kawasaki patients and may provide theoretical basis for larger sample investigation of risk prediction score standard in Kawasaki disease.

136 Gp auscultation for diagnosing valvular heart disease

IntroductionCardiac auscultation is an important clinical skill used by physicians in assessing and diagnosing valvular heart disease (VHD). The widespread use of echocardiography in the last three decades has coincided...

Effect of echocardiogram prior to induction therapy for acute myeloid leukemia on detection of cardiac dysfunction and treatment modifications.

e18514 Background: Standard induction therapy for acute myeloid leukemia (AML) includes “cytarabine and anthracycline”. Anthracyclines are known to cause acute, subacute and chronic cardiac complications ( Lefrak , EA et al, Cancer 1973:32(2):302-314; Singal, PK et al, NEJM 1998;339(13):900-905). It is recommended to do base line cardiac function assessment with echocardiogram prior to induction therapy containing anthracycline. This study was done to find the frequency of changes made in avoiding anthracycline usage following this evaluation. Methods: The Mayo clinic data base was interrogated to identify patients with newly diagnosed AML who underwent echocardiogram prior to anthracycline containing induction chemotherapy. Echocardiogram results, including left ventricular ejection fraction (LVEF), diastolic dysfunction, valvular disease, and any resultant treatment alterations were reviewed. Results: Three hundred twenty six patients were identified. The median (range) age was 61 (17-82) years and 62% were male. The median (range) LVEF was 65% (30-87), and 3 (0.9%) patients had LVEF &lt; 50% (range 30-47%). Of these 3 patients, 1 had 4 vessel CABG a decade ago, his EF was 46% and treated with full dose idarubicin; 2 of them presented with blastic crisis, 1 had EF 46% and improved to 51% after 5 days and then given daunorubicin, the other one had an EF of 30% and treated with 50% dose reduced cytarabine alone. Sixty five (23%) patients had previous chemotherapy or radiation exposure, including 24 (7.4 %) with previous anthracycline, 14 (4.3%) had prior radiation to the chest wall. No patient with previous chemotherapy or radiation exposure had a reduced LVEF. Conclusions: Echocardiography prior to anthracycline therapy rarely detects abnormal LVEF. Screening echo may be helpful in those presented with leukemic blastic crisis or had previous exposure to chemo-radiation.

Midcavitary Tako-Tsubo syndrome in cancer patients.

e14011 Background:Variants of the classic Tako-tsubo syndrome or stress induced cardiomyopathy (SC) includes mid ventricular or basal left ventricular wall motion abnormalities. Midcavitary dyskinesia and ballooning is considered a unique presentation, and there is no published data showing midcavitary involvement in cancer patients. Methods: All cancer patients who fulfilled the diagnostic criteria for SC at MD Anderson Cancer Center over a 6–year period were included in the study. We selected and retrospectively reviewed the medical records of 8 patients who had midcavitary SC. Clinical presentation, ECG, laboratory data, transthoracic echocardiogram and left ventriculography results were reviewed. Results: Out of30 cancer patients who fulfilled the diagnostic criteria for SC, 8 patients (26.7%) (4 females, 4 men, mean age 57.37 yo) had midcavitary SC. 62,5 % patients were diagnosed with a solid malignancy. Trigger factors for midcavitary SC were: systemic infection (3 patients with neutropenia), emotional stress (2 patients), chemotherapy (1 patient undergoing treatment with Ibrutinib), and surgical interventions (3 patients). Clinical presentation included chest pain (37.5%), shortness of breath (50%) and non specific symptoms (12.5%). T wave inversion was the most common electrocardiographic presentation (37.5 %), followed by ST elevation (25 %). All patients had changes of the cardiac biomarkers (BNP mean 2224. 4 pg/dl, TN I mean 2. 8 ng/dl, CK-MB mean 14 ng/dl) and significant LV dysfunction (LVEF &lt; 50%). All patients underwent coronary angiography which showed no obstructive CAD; left ventriculography identified basilar and apical hyperkinesis and midventricular hypokinesia. Cancer therapy was interrupted; aspirin and beta blockers were initiated in all patients. The most common complications of midcavitary SC were: respiratory failure requiring intubation (37, 5%), pulmonary edema (25%), and hypotension (25%). No cardiac deaths were registered. None of the patients experienced recurrence of SC. Conclusions: Mid cavitary SC remains a rare entity, and raises further questions about the causal association between the mid cavitary involvement and cancer, and its impact on cancer therapy and overall survival in this cohort of patients.

Tako-tsubo syndrome and use of paclitaxel.

e14012 Background: Vasospasm and arrhythmias are the main cardiac toxic effects of cancer treatment with Paclitaxel. Chemotherapy induced stress cardiomyopathy (SC) (Tako-tsubo syndrome) has been linked to antineoplastic agents associated with abnormal vasoreactivity. We aimed to identify if there is a causal relationship between SC and Paclitaxel administration. Methods: All cancer patients who fulfilled the diagnostic criteria for SC at MD Anderson Cancer Center over a 6–year period were included in the study. We selected and retrospectively reviewed the medical records of all the patients who had chemotherapy induced SC. Clinical presentation, ECG, laboratory data, transthoracic echocardiogram and coronary angiography results were reviewed. Results: Out of30 patients who fulfilled the diagnostic criteria for SC, 5 patients (16.6%) had SC triggered by chemotherapy. Three patients (2 females, 1 male, mean age 71.3 yo) had Paclitaxel induced SC (60%); two patients received a combination of Paclitaxel and Carboplatin for ovarian cancer, and one patient had combination of Paclitaxel and Cyclophosphamide for prostate cancer. Two patients had cardiac manifestations in the first day of Paclitaxel administration. All three patients presented with chest pain; T wave inversion was the main finding on the electrocardiography. All patients had changes in the cardiac biomarkers (BNP mean 1459.7 pg/dl, TN I mean 1.36 ng/dl, CK-MB mean 8.6 ng/dl) and significant LV dysfunction (LVEF &lt; 50%). Characteristic apical ballooning pattern was identified in all cases from left ventriculogram. Chemotherapy was interrupted ; aspirin and beta blockers were initiated in all patients. Two patients were rechallenged with chemotherapy after 10 days, respectively 20 days after SC. None of the patients experienced recurrence of SC, nor arrhythmias while on aspirin and beta blockers. Conclusions: To our knowledge there are no published data on the association of Paclitaxel administration and SC. In cancer patients who develop acute chest pain after administration of Paclitaxel, evaluation for SC is important to exclude NSTEMI diagnosis, which can impact further cancer therapy. Cancer patients with SC whom have complete recovery may early resume cancer therapy.

Aetiologies and correlates of secondary mitral regurgitation in patients with dilated cardiopathy in Cameroon: a cross-sectional study

Background: Dilated cardiopathy is a heterogeneous group of heart disease in which there is progressive ventricular remodeling, with or without secondary functional mitral regurgitation (MR). MR has prognostic implications, and has not been studied in our setting. This work aimed at studying the occurrence, aetiologies and correlates of secondary MR in a group of patients with dilated cardiopathy in a resource limited setting in sub-Saharan Africa. Methods: We carried out a cross-sectional study in the echocardiography laboratories of three tertiary hospitals in the city of Yaounde, Cameroon. Participants were consecutively recruited over an eight month period, after results of echocardiograms. The severity of MR was assessed from the size of the regurgitant orifice and the mechanism of MR assessed with the Carpentier classification. Results: A total of 25 participants (13 males) with an echocardiographic dilated left ventricle were included in the study. Their mean age was 53.2 years (range: 22 to 84 years). All patients had MR, of whom 6 (24%) had severe MR (grade IV). Type I MR was seen in 14 (46%), type III in 10 (40%), and type I and III in 1 (4%) of patients. The baseline heart disease were primary 4 (16%), ischemic 10 (40%), hypertensive 10 (40%), and peri-partum cardiomyopathy. The left atrium was dilated in 22 (88%), raised filling pressure in 19 (76%), and raised pulmonary pressure in 15 (60%). The severity of MR significantly correlated with age (r=0.5, P=0.011), left ventricle end diastolic diameter (r=0.41, P=0.04), low ejection fraction (r=−0.378, P=0.031), and left atrial size (r=0.431, P=0.022). Conclusions: Secondary MR is almost always present in patients with dilated cardiopathy. The severity of MR correlated with age, low ejection fraction, left ventricular end diastolic diameter, and left atrial size.

Abstract 052: Improved Hospital Outcomes With Hypokalemia on Admission in Cardiac Arrest Survivors Treated With Therapeutic Hypothermia

Purpose: We hypothesized that advanced circulatory compromise, as manifested by acidosis and hyperkalemia should be associated with worsened clinical outcomes in cardiac arrest patients treated with therapeutic hypothermia. Methods: Results of initial admission laboratory studies, medical history, and echocardiogram in 203 consecutive cardiac arrest patients (59 females, 59+/- 15 years old) undergoing therapeutic hypothermia were reviewed. Mortality was ascertained through hospital records. ANOVA, chi-square, Kaplan-Meier, and logistic regression analyses were used. The study was approved by the institutional IRB. Results: Increased mortality was noted with older age, decreased admission pH, elevated admission lactate, lower admission hemoglobin, and pulseless electrical activity or asystole as presenting rhythms (Table). Admission hypokalemia and ventricular fibrillation/tachycardia were associated with improved hospital mortality (Table). Potassium was significantly lower in patients admitted with ventricular fibrillation/tachycardia (3.897+/-0.92) as compared to patients with asystole (4.674+/-1.377) or pulseless electrical activity (4.491+/-1.055 mEq/dL, p&lt;0.0001). In multivariate logistic regression analysis, independent predictors of increased hospital mortality included increased admission potassium (OR 2.0, 95%CI 1.291-3.170, p=0.002)), older age (OR 1.04, 95%CI 1.007-1.071, p=0.017), admission PEA (OR 3.7, 95%CI 1.358-10.282, p=0.011 when compared to ventricular fibrillation/tachycardia) or asystole (OR 17.2, 95%CI 4.423-66.810, p&lt;0.001 when compared to ventricular fibrillation/tachycardia); while decreased mortality was associated with higher hemoglobin (OR 0.8, 95%CI 0.665-0.997, p=0.047). Conclusions: Hyperkalemia, pulseless electrical activity, and asystole are predictive of increased hospital mortality in survivors of cardiac arrest. An association between low or low-normal potassium, observed VT-VF, and better outcomes is unexpected and may be used for prognostic purposes. More prospective investigations of mortality predictors in these critically ill patients are needed.

Suppression of Myocardial 18F-FDG Uptake Through Prolonged High-Fat, High-Protein, and Very-Low-Carbohydrate Diet Before FDG-PET/CT for Evaluation of Patients With Suspected Cardiac Sarcoidosis.

A major obstacle in using FDG-PET/CT to diagnose cardiac sarcoidosis (CS) is the unpredictable physiological myocardial FDG uptake. We hypothesized that a prolonged 72-hour pretest high-fat, high-protein, and very-low-carbohydrate (HFHPVLC) diet preparation could suppress physiologic myocardial uptake of FDG and thus help to identify active CS. This retrospective study included 215 FDG-PET/CT tests from 207 patients with biopsy-proven sarcoidosis and clinical suspicion for CS between July 2014 and December 2015. The patients were classified into 2 groups. Group 1 included 12 FDG-PET/CT scans from 12 patients who had 24-hour or less pretest HFHPVLC diet preparation. Group 2 included 203 FDG-PET/CT scans with 72-hour HFHPVLC diet before FDG-PET/CT. Nonadherent patients and patients with cancer were excluded. Cardiac FDG uptake was classified as: "none" and "ringlike diffuse at base" (negative for CS), "focal" (positive for CS), and "diffuse" (indeterminate for CS). FDG uptake in myocardial lesions was measured as SUVmax and compared with SUVmean of mediastinal blood pool. Final diagnoses were made with consensus among physicians in view of all available clinical information including cardiac MRI and echocardiogram results. In group 1, there were 1 (1/12, 8.3%) positive, 5 (5/12, 41.7%) indeterminate, and 6 (6/12, 50.0%) negative for CS. In group 2, 10 patients were excluded (6 patients because of noncompliance with diet, 2 patients with concurrent diagnosis of cancers, 2 patients because of insulin and steroid use within 4 hours before PET/CT); the remaining 185 patients had 193 FDG PET/CT tests (8 repeats), of which there were 19 (19/193, 9.8%) positive, 7 indeterminate (7/193, 3.6%), and 167 (167/193, 86.7.%) negative for CS. The SUVmax of PET-positive myocardial lesions ranges from 3.4 to 12.5, whereas mediastinal blood pool SUVmean ranges from 1.1 to 3.6. The indeterminate rate was significantly lower in group 2 compared with group 1 (P < 0.001). The prolonged 72-hour HFHPVLC diet preparation protocol successfully suppressed physiological myocardial FDG uptake and may permit a more sensitive and accurate method of diagnosing active CS using FDG PET/CT.

Predictors of left ventricular systolic function recovery in the setting of sinus tachycardia in patients with cancer.

To identify unique echocardiographic features that could be used to reliably predict LVEF recovery upon resolution of sinus tachycardia in patients with cancer. Sinus tachycardia may be a manifestation of underlying cardiomyopathy or can lead to a reversible form of dilated cardiomyopathy known as tachycardia-mediated cardiomyopathy. While distinguishing the two can be challenging, predicting recovery regardless of cause can be of significant clinical importance in the cancer population. Results of echocardiograms performed were collected. Patients with a repeat echocardiogram within 6months of the initial echocardiogram were included. Patients with structural heart disease, acute coronary syndrome, sepsis, and pericardial disease were excluded. A comparison between baseline echocardiogram and subsequent echocardiogram was made to determine whether specific echocardiographic parameters predicted LVEF recovery. Two groups of patients were defined at the outset of the study. The recovered group was comprised of patients with reduced LVEF in the setting of sinus tachycardia and normal LVEF with resolution of tachycardia to normal sinus rhythm (NSR). The unrecovered group was comprised of subjects with low LVEF in the setting of both sinus tachycardia and NSR. A total of 40 patients were included in the study. LVEF in the recovered group (n=18) was 42.8% with sinus tachycardia and increased to 58.3% with NSR. Average LVEF in the unrecovered group (n=22) was 35.1% with tachycardia and improved to 38.5% with NSR. Medial TDI (E') was significantly greater in the recovered group with both tachycardia (7.95cm/s versus 4.56cm/s, P<.001) and NSR (8.11cm/s versus 5.13cm/s, P<.001). Similarly, lateral TDI (E') was significantly greater in the recovered group than in the unrecovered group during tachycardia (8.97cm/s versus 5.13cm/s, P<.001) and NSR (9.05cm/s versus 5.13cm/s, P<.001). Multivariable logistic regression analysis showed that medial TDI >6.5cm/s (OR=30.9, P=.001) and lateral TDI >7.8cm/s (OR=52.5, P=.002) are positively associated with the probability of LVEF recovery. In conclusion, TDI (medial E'>6.5cm/s; lateral E'>7.8cm/s) appears to predict LVEF recovery in patients with sinus tachycardia upon resolution of the tachycardia in patients with cancer.

A5225 - The Impact of Cardiopulmonary Metabolic Exercise Test and Resting Echocardiogram Results Upon Bariatric Surgery Outcomes

A5225 - The Impact of Cardiopulmonary Metabolic Exercise Test and Resting Echocardiogram Results Upon Bariatric Surgery Outcomes

Diagnostic value of non-invasive cardiac output parameters in premature infants with patent ductus arteriosus

Objective To investigate the diagnostic value of non-invasive cardiac output parameters: cardiac index (CI) and minute distance (MD), in premature infants with patent ductus arteriosus (PDA) and determine the cut-off value. Methods Clinical data of 98 premature infants admitted to the neonatal intensive care unit from January 2015 to June 2015 were collected. These premature infants were divided into the treated PDA group (n=30), the untreated PDA group (n=28) and the normal premature group (n=40) based on the results of echocardiogram in the first three days after birth and the use of drugs. Non-invasive cardiac output parameters were measured in the first three days after birth. The data were analyzed by t test, analysis of variance and SNK-q test. The diagnostic value of CI and MD for PDA was analyzed by the receiver operating characteristic curve. Results By preliminary analysis of the ROC curve, CI and MD were the most representative parameters for the diagnosis of PDA which need to be treated clinically, we thus chose CI and MD in this study. The aortic and pulmonary arterial CI and MD in the treated PDA group were significantly higher than in the untreated PDA group and the normal premature group (all P 0.05). The cut-off value of the aortic CI and MD was 2.95 L/(min·m2) and 21.50 m/min, respectively, while that of the pulmonary arterial CI and MD was 4.55 L/(min·m2) and 26.50 m/min, respectively. The sensitivity and specificity of the combined aortic CI and MD for the treated PDA group were 0.90 and 0.82, and those of combined pulmonary arterial CI and MD were 0.87 and 0.82; and those of combined aortic and pulmonary arterial CI and MD were 0.80 and 0.88, respectively. Conclusions The non-invasive cardiac output parameters CI and MD have good diagnostic value for the PDA needing clinical treatment, and the combined use of the two parameters can improve specificity, and help formulate the early treatment strategy for premature infants with PDA. When aortic CI was ≥2.95 L/(min·m2) and MD was ≥ 21.50 m/min, a preliminary diagnosis of the PDA needing clinical treatment, can be made, and simultaneously when the pulmonary arterial CI was ≥ 4.55 L/(min·m2) and MD was ≥ 26.50 m/min, the arterial duct should be closed timely. Key words: hemodynamics; premature infants; PDA; non-invasive cardiac output parameters

Abstract 162: Heart Failure Phenotyping: A Set Theory Based Approach to Identify Patients With Heart Failure

Background: Electronic Health Records (EHRs) and other databases are increasingly used to identify patients with clinical conditions such as heart failure (HF). This process, called phenotyping, has a number of uses including in quality improvement measurement, observational studies, and targeted disease management interventions. To date, patients with HF have largely been identified through diagnosis codes; however, this approach has limitations in sensitivity and positive predictive value (PPV). We hypothesized that we could improve phenotyping of hospitalized patients with HF through use of three readily accessible EHR variables. Methods: We conducted a cohort study of all hospitalizations at NYU Medical Center for patients age≥18 in 2012-2014. Hospitalizations were categorized into eight mutually exclusive groups based on the presence or absence of three characteristics: discharge diagnosis of HF, an echocardiogram performed, and loop diuretic administered. To maintain simplicity, we did not use echocardiogram results which are in free text. We randomly sampled a minimum number of charts from each group and performed physician chart review for diagnosis of HF based on the Atherosclerosis Risk in Communities (ARIC) Study criteria. We used a set theory approach to calculate performance characteristics for pre-specified combinations of groups. We calculated variances using the delta method and compared algorithms using Z tests. Results: We included 41,349 hospitalizations in the study. Of 315 that were sampled for chart review, 47% (148 of 315) were adjudicated as having acute or chronic HF. Using this gold standard, we found that a discharge diagnosis of HF had a sensitivity of 71.4% and PPV of 92.2% (Table). The presence of at least one of the three characteristics was associated with a sensitivity of 95.9% but PPV of 37.4% (p&lt;0.001 for both when compared to discharge diagnosis only). Conclusions: We found a discharge diagnosis code for HF was associated with moderate sensitivity and high PPV. Related algorithms improved sensitivity but had lower PPV. These findings suggest that more complex algorithms are needed to improve EHR-based HF phenotyping.