Significant Cardiac Pathology Research Articles

COVID-19-induced cardiovascular complexities

This study aimed to investigate the features of the clinical course of COVID-19 in combination with the pathology of the cardiovascular system (CVS). A prospective study was carried out. The main group (n=150) consisted of patients with changes in the cardiovascular system associated with COVID-19, i.e. newly diagnosed CV pathology, and patients with exacerbation of cardiac pathology against the background of COVID-19. The comparison group (n=154) included patients with COVID-19, but without any significant concomitant cardiac pathology. The average age of patients in the main group was 67.7 years (from 47 to 86 years), in the comparison group of 66.1 years (from 48 to 88 years). The study groups were representative and did not differ statistically in the nature of COVID-19 symptoms and the degree of lung involvement. Among the cardiac pathology, progressing or first occurring against the background of infection with COVID-19, in most cases, arterial hypertension of II-III degree (60.0%), coronary heart disease (48.7%), arrhythmias (23.3%) were diagnosed. Echocardiographic abnormalities included right ventricular dysfunction (22.7%), left ventricular contractility disorders (18.7%), with decreased ejection fraction (17.3%), diastolic dysfunction (14.0%), and toxic myocarditis (7.3%). The most significant risk factors were the presence of a burdened medical history (RR=10.39), elevated body mass index over 30 (RR=2.63) and diabetes mellitus (RR=1.55). In patients with COVID-19 in combination with CVS pathology, a relatively high incidence of acute onset (64.0% vs. 44.2%; p<0.001), respiratory failure (83.7% vs. 62.0%; p<0.001), admission to the intensive care unit (25.3% vs. 11.7%; p=0.004), development of acute respiratory distress syndrome (20.0% vs. 9.1%; p=0.012), hospital mortality (10.7% vs. 2.7%; p=0.006). Cardiac manifestations of COVID-19 included focal or global myocardial inflammation, ventricular dysfunction, heart failure, and arrhythmias. A high frequency of acute onset of the disease, respiratory failure and hospital mortality is determined.

COVID-19-induced cardiovascular complexities

This study aimed to investigate the features of the clinical course of COVID-19 in combination with the pathology of the cardiovascular system (CVS). A prospective study was carried out. The main group (n=150) consisted of patients with changes in the cardiovascular system associated with COVID-19, i.e. newly diagnosed CV pathology, and patients with exacerbation of cardiac pathology against the background of COVID-19. The comparison group (n=154) included patients with COVID-19, but without any significant concomitant cardiac pathology. The average age of patients in the main group was 67.7 years (from 47 to 86 years), in the comparison group of 66.1 years (from 48 to 88 years). The study groups were representative and did not differ statistically in the nature of COVID-19 symptoms and the degree of lung involvement. Among the cardiac pathology, progressing or first occurring against the background of infection with COVID-19, in most cases, arterial hypertension of II-III degree (60.0%), coronary heart disease (48.7%), arrhythmias (23.3%) were diagnosed. Echocardiographic abnormalities included right ventricular dysfunction (22.7%), left ventricular contractility disorders (18.7%), with decreased ejection fraction (17.3%), diastolic dysfunction (14.0%), and toxic myocarditis (7.3%). The most significant risk factors were the presence of a burdened medical history (RR=10.39), elevated body mass index over 30 (RR=2.63) and diabetes mellitus (RR=1.55). In patients with COVID-19 in combination with CVS pathology, a relatively high incidence of acute onset (64.0% vs. 44.2%; p<0.001), respiratory failure (83.7% vs. 62.0%; p<0.001), admission to the intensive care unit (25.3% vs. 11.7%; p=0.004), development of acute respiratory distress syndrome (20.0% vs. 9.1%; p=0.012), hospital mortality (10.7% vs. 2.7%; p=0.006). Cardiac manifestations of COVID-19 included focal or global myocardial inflammation, ventricular dysfunction, heart failure, and arrhythmias. A high frequency of acute onset of the disease, respiratory failure and hospital mortality is determined.

Significance of electrocardiogram abnormalities in children presenting to the emergency department with acute COVID-19 infection

ObjectivesAcute COVID-19 infection may be associated with electrocardiogram (EKG) abnormalities in pediatric patients. We have anecdotally observed EKG abnormalities in patients without MIS-C or significant cardiac disease requiring intervention or further follow-up. Our aim was to determine the incidence of abnormal EKG findings and correlate with evidence of significant cardiac pathology in pediatric patients who present to the emergency department during an acute COVID-19 infection. MethodsWe conducted a retrospective chart review of 209 pediatric patients diagnosed in the emergency department with acute COVID-19 infection and had an EKG during the same encounter; patients with MIS-C were excluded. Primary objectives included determination of the incidence of EKG abnormalities in patients presenting to the emergency department (ED) with acute COVID-19 infection who did not require hospitalization. Secondary objectives included correlation of these findings with other concomitant testing of possible cardiac pathology (echocardiograms, biomarkers), and clinical outcomes. ResultsEKG abnormalities were identified in 84 (40%) patients. Echo was performed in 28 (13.4%) patients; only 1 was abnormal, and considered an incidental finding. The most common EKG abnormality involved nonspecific ST-T wave patterns, suggestive of but not diagnostic for underlying pericardial or myocardial disease. Serum troponin and BNP values were normal in all patients tested, either with a normal or abnormal EKG. A normal EKG had a 100% sensitivity and negative predictive value in predicting a normal echocardiogram. No patients were hospitalized and there was normalization of EKG abnormalities during short-term follow up. ConclusionsDespite a high incidence of abnormal EKG repolarization patterns in pediatric patients presenting with acute (non-MIS-C) COVID-19 infections, these patients generally do not have abnormal cardiac biomarkers or echocardiograms, and the risk for adverse cardiac events is low.

Prediction of Fluid Responsiveness Using Combined End-Expiratory and End-Inspiratory Occlusion Tests in Cardiac Surgical Patients.

End-expiratory occlusion (EEO) and end-inspiratory occlusion (EIO) tests have been successfully used to predict fluid responsiveness in various settings using calibrated pulse contour analysis and echocardiography. The aim of this study was to test if respiratory occlusion tests predicted fluid responsiveness reliably in cardiac surgical patients with protective ventilation. This single-centre, prospective study, included 57 ventilated patients after elective coronary artery bypass grafting who were indicated for fluid expansion. Baseline echocardiographic measurements were obtained and patients with significant cardiac pathology were excluded. Cardiac index (CI), stroke volume and stroke volume variation were recorded using uncalibrated pulse contour analysis at baseline, after performing EEO and EIO tests and after volume expansion (7 mL/kg of succinylated gelatin). Fluid responsiveness was defined as an increase in cardiac index by 15%. Neither EEO, EIO nor their combination predicted fluid responsiveness reliably in our study. After a combined EEO and EIO, a cut-off point for CI change of 16.7% predicted fluid responsiveness with a sensitivity of 61.8%, specificity of 69.6% and ROC AUC of 0.593. In elective cardiac surgical patients with protective ventilation, respiratory occlusion tests failed to predict fluid responsiveness using uncalibrated pulse contour analysis.

Беременность и роды после неокуспидализации аортального клапана аутологичным перикардом: альтернативное решение, не требующее антикоагулянтной терапии

With the development of cardiac surgery, more and more women with congenital heart disease undergo cardiac interventions and reach reproductive age. Therefore, the number of pregnant patients with significant cardiac pathology is increasing. This article presents a clinical case of successful surgical treatment of aortic stenosis (the Ozaki procedure) in a 31-year-old woman who subsequently became pregnant and delivered a child. Conclusion. Despite the debate among cardiac surgeons, the Ozaki procedure can be considered as a viable option for aortic valve replacement in women with the prospect of pregnancy and childbirth. However, a larger study in this population is needed. Key words: aortic valve, aortic stenosis, aortic valve neocuspidization with autologous pericardium, aortic valve replacement, Ozaki procedure, pregnancy

Pulmonary artery pressures and right ventricular dimensions of post-COVID-19 patients without previous significant cardiovascular pathology

BackgroundPulmonary hypertension is a significant complication of COVID-19, but follow-up data on pulmonary artery pressure after recovery from COVID-19 are limited. ObjectivesTo investigate pulmonary artery pressure and heart dimensions in post-COVID-19 patients without a history of significant cardiac pathology. MethodsData for 91 eligible adult patients were subjected to 2 analyses. First, patients were grouped according to where they received COVID-19 treatment: the ICU, COVID-19 ward, or outpatient clinic. Second, the severity of COVID-19 was grouped as no pulmonary involvement, non-severe pulmonary involvement, or severe pulmonary involvement based on thoracic computed tomography scores. Heart dimensions were measured and pulmonary artery pressure was estimated using transthoracic echocardiography. The correlation between transthoracic echocardiography findings and COVID-19 severity was assessed. ResultsPulmonary artery pressure and right-heart dimensions were significantly elevated in the post-COVID-19 patients without a history of risk factors for pulmonary hypertension that presented to the cardiology outpatient clinic with cardiac complaints. Both of these findings were correlated with the severity of COVID-19 and the extent of lung involvement based on thoracic computed tomography. ConclusionThe present findings confirm that increases in systolic pulmonary artery pressure and right ventricular dimensions persist 2-3 months after recovery from COVID-19 in patients without a history of risk factor for pulmonary hypertension. Furthermore, the increase in pulmonary artery pressure and right ventricular dimensions correlate with the severity of COVID-19 and the extent of lung involvement based on thoracic computed tomography.

Comprehensive clinical assessment identifies specific neurocognitive deficits in working-age patients with long-COVID.

There have been more than 425 million COVID-19 infections worldwide. Post-COVID illness has become a common, disabling complication of this infection. Therefore, it presents a significant challenge to global public health and economic activity. Comprehensive clinical assessment (symptoms, WHO performance status, cognitive testing, CPET, lung function, high-resolution CT chest, CT pulmonary angiogram and cardiac MRI) of previously well, working-age adults in full-time employment was conducted to identify physical and neurocognitive deficits in those with severe or prolonged COVID-19 illness. 205 consecutive patients, age 39 (IQR30.0-46.7) years, 84% male, were assessed 24 (IQR17.1-34.0) weeks after acute illness. 69% reported ≥3 ongoing symptoms. Shortness of breath (61%), fatigue (54%) and cognitive problems (47%) were the most frequent symptoms, 17% met criteria for anxiety and 24% depression. 67% remained below pre-COVID performance status at 24 weeks. One third of lung function tests were abnormal, (reduced lung volume and transfer factor, and obstructive spirometry). HRCT lung was clinically indicated in <50% of patients, with COVID-associated pathology found in 25% of these. In all but three HRCTs, changes were graded 'mild'. There was an extremely low incidence of pulmonary thromboembolic disease or significant cardiac pathology. A specific, focal cognitive deficit was identified in those with ongoing symptoms of fatigue, poor concentration, poor memory, low mood, and anxiety. This was notably more common in patients managed in the community during their acute illness. Despite low rates of residual cardiopulmonary pathology, in this cohort, with low rates of premorbid illness, there is a high burden of symptoms and failure to regain pre-COVID performance 6-months after acute illness. Cognitive assessment identified a specific deficit of the same magnitude as intoxication at the UK drink driving limit or the deterioration expected with 10 years ageing, which appears to contribute significantly to the symptomatology of long-COVID.

Pregnancy and childbirth in a patient with aortic coarctation

The article is devoted to one of the actual problems in obstetrics the pregnancy follow-up in patients with structural cardiac pathology. The presented clinical case demonstrates a patient with congenital heart disease, inherited obstetrical and gynecological history and the COVID-19 infection during pregnancy.&#x0D; Despite the clinically significant cardiac pathology, the patient delivered at full term of 37 weeks through the natural birth canal.&#x0D; The analysis of the clinical case allows us to conclude that a favorable prognosis of pregnancy and childbirth in women with aortic coarctation is possible with the pregnancy follow-up and delivery in specialized cardiology centers.

Syntopy of Pulmonary Vein Orifices in the Left Atrium of the Human Heart

INTRODUCTION: The syntopy of the left atrial (LA) structures is the least studied aspect of the normal heart anatomy. The morphometric data on the position of orifices of the pulmonary veins in the LA walls relative to the adjacent heart structures and heart vessels are important as reference parameters of heart morphology and are needed in the endovascular treatment of atrial fibrillations.&#x0D; AIM: To establish the general patterns and topospecific peculiarities of the location of the pulmonary vein orifices relative to the oval fossa and orifices of the venae cavae using morphometric methods of anatomical preparations of conventionally normal adult human heart.&#x0D; MATERIALS AND METHODS: Fiftyfour wet anatomical preparations of the heart without macroscopic signs of hemodynamically significant cardiac pathology were studied. The preparations were obtained from patients aged 3589 years who died from diseases not related to heart pathology. LA diastole was modeled by filling its cavity with silicone; after it hardened, the distances from the oval fossa and orifices of the venae cavae to the orifices of the pulmonary veins were measured using sliding calipers.&#x0D; RESULTS: The article presents variation, medians, and extreme values of distances from the oval fossa and orifices of the venae cavae to the orifices of the pulmonary veins at the site of their opening to LA. The significance of differences of morphometric parameters of the topography was evaluated, and their correlation and oneway regression analyses were implemented. The strongest regression dependence was found for LA width and distance from the orifice of the superior vena cava to the orifice of the left inferior pulmonary vein (Y) r2 = 0.45; Х = 19.94 + 0.545Y). The heart dimensions and LA length were not significant predictors for the studied parameters.&#x0D; CONCLUSION: The right pulmonary veins were located expectedly closer to the orifices of the venae cavae and the oval fossa than the left pulmonary veins. The narrowest was the space between the orifices of the superior vena cava and the right superior pulmonary vein. The farthest from the orifices of both venae cavae was the orifice of the left inferior pulmonary artery. The strongest correlation relationships were characteristic of the distances from the orifices of both venae cavae to the orifices of the homolateral pulmonary veins, which we propose to consider as one of the criteria of the harmoniousness of the structure of the atrial complex.

Role of open access echocardiography in detection of cardiac structural and functional abnormalities.

To evaluate the prevalence and incidence of significant structural heart disease in targeted patients with cardiac symptoms referred by general practitioners (GPs) using open access echocardiography, without prior clinical evaluation by a cardiologist. Data were derived from 488 subjects who underwent transthoracic echocardiography between January and April 2018. Patients were referred directly by GPs in East Berkshire, South England, through an online platform. Echocardiography was performed within 4-6 weeks of referral and all reports were assessed by a consultant cardiologist with expedited follow-up facilitated pro re nata. Results were analysed to determine the frequency of detection of structural abnormalities, particularly of the left ventricle and cardiac valves. Echocardiography was prospectively performed in consecutive subjects (50% male, mean (±SD) age 68.5±22 years; 50% female; mean (±SD) 64.6 (±19.1)). At least one abnormality likely to change management was found in 133 (27.3%) of all open access echocardiograms. Clinical heart failure with left ventricular systolic dysfunction (LVSD) and diastolic dysfunction was confirmed in 46 (9%) and 69 (14%), respectively. Of the 46 patients with LVSD, 33 were new diagnoses. Significant cardiac valve disease was found in 42 (8.6%) patients. 12 of these had known valvular disease or previous valvular surgery, and 30 were new diagnoses. Major structural and functional cardiac abnormalities are common in late middle-aged patients who present to GPs with cardiac symptoms and signs. Reported, unrestricted open access echocardiography enables early detection of significant cardiac pathology and timely intervention may improve cardiovascular outcomes.

Role of open access echocardiography in detection of cardiac structural and functional abnormalities

PurposeTo evaluate the prevalence and incidence of significant structural heart disease in targeted patients with cardiac symptoms referred by general practitioners (GPs) using open access echocardiography, without prior clinical evaluation...

Nonauscultatory clinical criteria are sensitive for cardiac pathology in low-risk paediatric heart murmurs.

Healthy children with likely innocent heart murmurs are frequently referred to cardiologists for reassurance. Existing guidelines that advise against these referrals are not consistently followed partly because they involve subjective auscultatory judgements with which many care providers are uncomfortable. Here, we investigate whether clinical criteria with no subjective auscultatory component are sensitive for cardiac pathology. A retrospective chart review was performed of all new patients seen in our paediatric cardiology clinic for assessment of a murmur from January 1, 2016 through June 30, 2018. Patients were characterized as "low-risk" if they met all of the following criteria: asymptomatic; normal physical examination other than the murmur; no risk factors for congenital heart disease; and age over 12 months. The primary outcomes were the sensitivity for ruling out pathology and the negative predictive value of the proposed criteria. Of 915 total patients, 214 met the low-risk criteria. The sensitivity of our criteria for ruling out pathology was 97.2% (95% confidence interval 94.1% to 99.0%) and the negative predictive value was also 97.2% (95% confidence interval 94.0% to 98.7%). Six of the 214 low-risk patients had pathology (2.8%; 95% confidence interval 1.3% to 6.0%), none of which has required intervention since diagnosis. Each of these six children had a murmur that sounded pathological to the auscultating cardiologist. Basic clinical criteria that do not require auscultation are highly sensitive for ruling out significant cardiac pathology in children over 12 months of age.

Evaluation of a Preparticipation Cardiovascular Screening Program Among 1,686 National Collegiate Athletic Association Division I Athletes: Comparison of the Seattle, Refined, and International Electrocardiogram Screening Criteria.

To: (1) analyze the results of 5 years of preparticipation cardiac screening including 12-lead electrocardiogram (ECG) of National Collegiate Athletic Association (NCAA) Division I athletes; and (2) assess the rates of ECG screening abnormalities and false-positive rates among 3 ECG screening criteria. Retrospective chart review. National Collegiate Athletic Association Division I University. One thousand six hundred eighty-six first-year athletes presenting for their preparticipation examination including 12-lead resting ECG. At the completion of the study period, all ECGs were retrospectively reviewed using the Seattle, Refined, and International Criteria. (1) Prevalence of pathologic cardiac conditions identified by screening; and (2) number of ECG screening abnormalities by criteria. Three athletes (0.2%) were found to have conditions that are associated with sudden cardiac death. Retrospective review of ECGs using Seattle, Refined, and International criteria revealed an abnormal ECG rate of 3.0%, 2.1%, and 1.8%, respectively. International criteria [odds ratios (OR), 0.58; P = 0.02] demonstrated a lower false-positive rate compared with the Seattle criteria. There was no significant difference in false-positive rates between the Seattle and Refined (OR, 0.68; P = 0.09) or the International and Refined criteria (OR, 0.85; P = 0.5). There was a low rate of significant cardiac pathology in this population, and no athletes were permanently restricted from play as a result of screening. Our results suggest that the International criteria have the lowest false-positive rate of athlete-specific ECG criteria, and thus, it is the preferred method for preparticipation ECG screening in NCAA athletes.

Heart Dysfunction Following Long-Term Murine Cytomegalovirus Infection: Fibrosis, Hypertrophy, and Tachycardia.

Human cytomegalovirus (HCMV) is associated with increased risk of chronic diseases of the heart and vasculature, including myocarditis, atherosclerosis, and transplant vasculopathy. To investigate CMV infection of the heart, murine cytomegalovirus (MCMV) was used to evaluate both acute and latent infection and the subsequent phenotypic and functional consequences of infection. Female BALB/c mice were intraperitoneally (i.p.) inoculated with 1 × 106 pfu of MCMV and evaluated at 14 and 50 days postinfection (dpi). At each time point, echocardiography was used to evaluate cardiac function and histology was conducted for phenotypic evaluation. MCMV replication in the heart was detected as early as 3 dpi and was no longer detectable at 14 dpi. Infected animals had significant cardiac pathology at 14 and 50 dpi when compared to uninfected controls. Histology revealed fibrosis of the heart as early as 14 dpi and the presence of white fibrous deposits on the surface of the heart. Functional evaluation showed significantly increased heart rate and muscle thickening in the latently infected animals when compared to the control animals. At 50 dpi, latent virus was measured by explant reactivation assay, demonstrating that MCMV establishes latency and is capable of reactivation from the heart, similar to other tissues such as spleen and salivary glands. Collectively, these studies illustrate that MCMV infection results in phenotypic alterations within the heart as early as 14 dpi, which progress to functional abnormalities during latency. These findings are similar to sinus tachycardia and hypertrophy of the heart muscle observed in cases of HCMV-induced acute myocarditis.

ISCHEMIC MITRAL REGURGITATION: PROBLEM EXTENT IN CARDIOVASCULAR SURGERY CLINIC

The aim of the study was to evaluate the prevalence, etiology, mechanisms and severety of all cases of MR, including IMR, in the patients population with suspected or proved CAD before coronary arteries evaluation and surgery or intervention. Materials and methods: The study prospectively included 370 patients with verified or suspected (angina pectoris suspicion or manifested CHF) CAD of all clinical forms (stable, unstable, post-AMI, prior revascularization, etc.). MR evaluation by TTE included examining type of MR (organic or functional, Carpentier type) and its severity by vena contracta (VC) width and establishing effective regurgitant orifice (ERO) and regurgitant volume (RVol) by PISA method according to existing guidelines. Additional criteria (left atrium (LA) dimensions, LV diastolic filling and filling pressure markers, pulmonary veins flow and secondary pulmonary hypertension and right chambers involvement, etc.) were also widely used. Results: Majority of all patients were men - 280 out of 370 pts (75.7%). Mean age of pts was 62.4±8.96 years, and men were in general significantly younger (61.5±9.2 vs. 65.3±7.6 years, p=0.0004). 145 (39.2%) pts had verified AMI previously (126 men and 19 women, p<0.0001). 22 (5.95%) pts previously underwent CABG surgery (19 men and 3 women, p<0.0001), and 99 patients - PCI with coronary stenting (81 men and 18 women, p<0.0001). 42 (11.3%) pts proved to have no significant CAD as per CAG results: 24 (57.1%) pts had no significant cardiac pathology at all, 12 (28.6%) pts had uncomplicated essential hypertension, 5 (11.9%) pts had non-coronary dilated cardiomyopathy (DCM) and 1 (2.4%) pt had non-obstructive hypertrophic cardiomyopathy (HCP) with clean coronary arteries. In patients with CAD MR is a frequent finding (up to one-half of the studied population) regardless of gender. Predominant majority (84.1%) of MR according to TTE findings is mild (grade I), without significant influence upon heart load and remodeling, and, thus, requiring no additional surgeon interventions. Most of cases of such pathological MR resolved after myocardial revascularization or sustained without dynamics being physiological (13.2% of all MR cases). Most of moderate-to-severe MR cases were classified as IMR, being accompanied by appropriate LV remodeling features, requiring revascularization and/or mitral valvuloplasty or replacement (all cases of severe IMR or organic MR). Correlations results of MR ERO and RVol with certain heart chambers remodeling and load indices seem to make them a "gold standard" for MR severity evaluation, especially in CAD patients with potential indications for MV surgery that should accompany surgeon revascularization, as it is widely accepted today. Conclusions: In the patients with various forms of chronic and acute CAD IMR is a frequent finding, but the majority of MR cases are mild and requiring no additional interventions. No gender difference in MR prevalence were found. Severe MR cases in all CAD patients population are rather rare (below 10%), but always require surgical repair. Moderate-to-severe IMR is the most frequent (approximately 75%) etiology for significant MR in CAD patients, requiring close TTE follow-up for optimal intervention timing on the basis of left and right chambers remodeling and load indices. MR ERO and RVol are trustworthy quantitative MR severity indices, significantly correlating with main LV and LA remodeling and load indices, as well as with some secondary right chambers overload predictors.

A013 Advanced Electrocardiography Accurately identifies Long QT Syndrome and Genetic Subtype

Diagnosis of congenital LQTS can be challenging if the QT interval is normal on conventional 12-lead ECG. Advanced-ECG (A-ECG) analysis uses pattern recognition of both conventional and advanced-ECG parameters, measures from derived vectorcardiography, and waveform complexity from singular value decomposition, to generate probabilistic scores for disease. We aim to validate an A-ECG score for LQTS in a case-control study. Conventional ECG digital files were retrieved from hospital database for LQTS cases (n=21) and age- and sex-matched controls (n=29). A-ECG analysis was performed using conventional and advanced-ECG parameters using logistic regression and linear discriminant analysis applying previously validated LQTS scores. Blinded A-ECG diagnoses were compared with a “crowd” average of three cardiologists. A-ECG had a sensitivity of 81% and specificity of 90% (AUC [95%CI] 0.87 [0.75–0.97]) compared to a single cardiologist (0.74 [0.6-0.86], p = 0.001) or crowd (0.80 [0.67–0.9], p<0.001) and QTc (0.76 [0.61–0.87], p<0.001) in discriminating LQTS from controls (Table 1). 67% of both carriers (n=15) and probands (n=6) had QTc<470ms. A-ECG diagnoses were provided for 3 of 4 asymptomatic gene carriers, labelled false negatives, providing a sensitivity of 95% for detecting cardiac pathology. Average LQTS probability in true versus false positives was 90% and 52% respectively, (95%CI 0.56 to -0.20, p<0.001). False positives had significant alternative cardiac pathology. 80% of A-ECG positive diagnoses of LQTS subtypes (1, 2 and 3), concurred with genetic results in 94% of cases. A-ECG is not only highly sensitive and specific for LQTS but also accurate in identifying genetic subtypes.

P308Utility of a prominent R wave in lead V1 of a resting electrocardiogram for detecting significant cardiac pathology in an unselected population of young males

Abstract Background Pre-participation electrocardiogram (ECG) screening is proposed as a means to detect cardiac pathology in asymptomatic individuals, and to select individuals for further cardiac investigation. Isolated ECG finding of Right Ventricular Hypertrophy (RVH) does not require further investigation based on the recent 2017 International Criteria. However, a prominent R wave in V1 has been described in cardiac abnormalities such as Wolff-Parkinson-White syndrome, hypertrophic cardiomyopathy, cardiomyopathy in Duchenne muscular dystrophy, arrhythmogenic right ventricular cardiomyopathy (ARVC), atrial septal defect and pulmonary hypertension. Purpose We sought to examine the utility of a prominent R wave in V1 as a screening criterion in an asymptomatic young male population of predominantly non-athletes, to detect significant structural cardiac pathology. Methods As part of the Singapore Armed Forces Electrocardiographic and Echocardiographic (SAFE) Protocol Study, pre-military enlistment screening ECG data was collected from 144,346 males between the ages of 16 to 22 from November 2009 to December 2014. Patients with ECGs with a prominent R wave, defined as an R wave ≥0.5mV in lead V1 with an R/S ratio of ≥1, were sent to a tertiary medical facility for a detailed transthoracic echocardiogram and subsequent cardiologist review. Any cardiac pathology identified was deemed significant if it led to the patient being excluded from participation in vigorous physical activity. Results 1,144 patients with an isolated prominent R wave in V1 were studied. The mean age was 18.2±1.09 years and 81% were of Chinese ethnicity. None of the patients had echocardiographic evidence of RVH, 5 patients had a dilated right ventricle and 3 individuals had an elevated pulmonary artery systolic pressure. 11 patients (0.96%) had significant structural heart disease known to be associated with a prominent R wave in V1 that excluded them from participation in physical activity. These included large atrial septal defects (n=8), pulmonary stenosis (n=1), total anomalous pulmonary venous return (n=1) and hypertrophic cardiomyopathy (n=1). The test has a sensitivity of 21.6%, specificity of 93.4%, positive predictive value of 0.96% and negative predictive value of 99.8%, Performance As Screening Criteria Number of Patients With Cardiac Pathology In Those Tested Positive Number of Patients With Cardiac Pathology In Those Tested Negative Positive Predictive Value (%) Negative Predictive Value (%) Sensitivity (%) Specificity (%) 11 40 0.96 99.8 21.6 93.4 Significant Cardiac Pathology Identified Conclusion A prominent R in V1 is not associated with echocardiographic RVH, or ARVC even in a large predominantly non-athletic male population. However, 0.96% of such patients would have other significant cardiac pathologies such as a large atrial septal defect.

1086P - N-terminal B-type natriuretic peptide (NT-proBNP) as an independed prognostic marker for patients with newly diagnosed multiple myeloma complicated by dialysis-dependent renal failure

BackgroundAbout 20-30% patients with newly diagnosed multiple myeloma (ND MM) experience damage to kidneys and in 2-4% of cases, hemodialysis is required. NT‐proBNP synthesize in atria and ventricles cardiomyocytes and excreted by the kidney. The purpose of this work was to analyze the predictive utility of NT-proBNP in patients with ND MM, complicated by severe dialysis-dependent renal failure (RF). MethodsBetween 10.2016 and 07.2017, 20 patients with ND MM and terminal RF enrolled in this prospective study. Exclusion criteria were diagnosed at AL-amyloidosis and a significant cardiac pathology. Samples for NT‐proBNP analysis were collected before antimyeloma chemotherapy and not earlier than 36hours after hemodialysis. The ROC analysis determined the area under the error curve as 0.75 (0.52-0.97), and the cut-off point for the OS was an NT-proBNP concentration of 7036pg/ml (sensitivity 79%; specificity 44%). According to these data, the patients were divided into two groups, depending on the NT-proBNP value less than (n=9) or more than (n=11) 7000pg/ml for the subsequent analysis. ResultsThe median age of the patients was 67 years (range, 63-76). Median of estimated glomerular filtration CKD-EPI rate was 4.0 (IQR 4.0-5.0) ml/min/1.73 m2. The only difference between the groups was the volume of residual diuresis 1250 (550-2500) vs. 50.0 (37.5-1038) ml/day (P=0.036). As induction therapies, 11 (55%) patients underwent a VCD regimen, 7 (35%) - VD), and 2 (10%) - VMP. The ASCT accomplished in 1 patient. The renal response was documented in 4 (25.0%) cases including one complete response. With a median follow-up of 17.3 months, the overall OS was 48.5±11.5%. The 18-month OS for comparison groups were 76.6±14.8% and 27.3±13.4% (P=0.020), respectively. There were no causes of death due to cardiovascular complications. ConclusionsAccording to our data, NT-proBNP > 7400pg/ml are associated with the severity of kidney damage and the risk of non-cardiac mortality in ND MM patients. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Managing a "New" Murmur in Healthy Children and Teens.

An asymptomatic child with a murmur can be challenging practice management conundrum. Some providers refer all patients with a "new" murmur to a cardiologist, likely resulting in excessive resource utilization and parental anxiety. This study examines whether the prevalence of significant cardiac pathology differs in asymptomatic patients aged 2 to 18 years who were referred for a murmur that was "new" versus those referred for a murmur that was known to exist and followed conservatively during the previous 2 years. Of 473 patients meeting inclusion criteria, 33/473 (7.0%) were diagnosed with cardiac pathology, with 21/357 (5.9%) occurring among "new" murmur referrals and 12/116 (10.3%) occurring among "known" murmur referrals. Notably, 34/357 (9.5%) patients referred for a "new" murmur had no murmur present when assessed by the cardiologist. This study suggests that asymptomatic children with a "new" murmur may be conservatively managed. This may lessen health care resource utilization rates and overall parental anxiety.

Chlorine inhalation-induced myocardial depression and failure.

Victims of chlorine (Cl2) inhalation that die demonstrate significant cardiac pathology. However, a gap exists in the understanding of Cl2-induced cardiac dysfunction. This study was performed to characterize cardiac dysfunction occurring after Cl2 exposure in rats at concentrations mimicking accidental human exposures (in the range of 500 or 600 ppm for 30 min). Inhalation of 500 ppm Cl2 for 30 min resulted in increased lactate in the coronary sinus of the rats suggesting an increase in anaerobic metabolism by the heart. There was also an attenuation of myocardial contractile force in an ex vivo (Langendorff technique) retrograde perfused heart preparation. After 20 h of return to room air, Cl2 exposure at 500 ppm was associated with a reduction in systolic and diastolic blood pressure as well echocardiographic/Doppler evidence of significant left ventricular systolic and diastolic dysfunction. Cl2 exposure at 600 ppm (30 min) was associated with biventricular failure (observed at 2 h after exposure) and death. Cardiac mechanical dysfunction persisted despite increasing the inspired oxygen fraction concentration in Cl2-exposed rats (500 ppm) to ameliorate hypoxia that occurs after Cl2 inhalation. Similarly ex vivo cardiac mechanical dysfunction was reproduced by sole exposure to chloramine (a potential circulating Cl2 reactant product). These results suggest an independent and distinctive role of Cl2 (and its reactants) in inducing cardiac toxicity and potentially contributing to mortality.