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European Heart Journal Cardiovascular Imaging logoLink to European Heart Journal Cardiovascular Imaging
. 2014 Dec 5;15(Suppl 2):ii168–ii195. doi: 10.1093/ehjci/jeu256

Poster session 4

Friday 5 December 2014, 08:30–12:30: Location: Poster area

PMCID: PMC4453636
Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

GENERAL PRINCIPLES: P954: Clinical utility of Magnetic Resonance-conditional pacemaker in patients with A-V nodal block caused by cardiac sarcoidosis

M Orii 1, T Tanimoto 1, M Yokoyama 1, S Ota 1, T Kubo 1, K Hirata 1, A Tanaka 1, T Imanishi 1, T Akasaka 1

Abstract

Purpose: Although delayed-enhancement magnetic resonance imaging (DEMRI) is essential for diagnosis of cardiac sarcoidosis (CS), the test was not available when pacemaker was implamted. Recently, MR-conditional pacemaker has become avilable and we hypothesized that this device would be useful for diagnosis and management of CS. The aim of this study was to assess the diagnostic ability of MR-conditional pacemaker about CS in patients with advanced A-V nodal block (AAVB).

Methods: Twenty-seven AAVB patients (14 men, 13 women; mean age, 69 ± 11 years) who were implanted MR-conditional pacemaker were studied. DEMRI was performed 6 weeks after implantation of permanent pacemaker. In patients with positive for DE, additional examinations like echocardiography, radioisotope imaging, biopsy, and coronary computed-tomography were performed due to confirm the diagnosis of CS and exclude coronary artery disease.

Results: DE was observed in 12 patients (44 %). Out of 12 patients, 2 patients were excluded for having prior myocardial infarction. Seven of 10 (70 %) patients were diagnosed of CS by the consensus criteria. Compared with non-CS group, CS group had significantly lower age (61 ± 12 years vs. 72 ± 9 years p = 0.017). There was no significant difference about sex, angiotensin-converting enzyme, brain natriuretic peptide, and left ventricular ejection fraction between 2 groups. Six patients had started corticosteroid therapy and 5 patients (83%) recovered A-V nodal conduction.

Conclusion: MR-conditional pacemaker was useful for diagnosis and management of patients with AAVB caused by CS.

Figure.

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Cardiac MRI in patient with AV block

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

The imaging examination: P955: Feasibility and quality assessment of coronary flow reserve measured by transthoracic echocardiography in an unselected patient sample

MM Michelsen 1, A Pena 2, ND Mygind 3, NB Hoest 1, E Prescott 1

Abstract

Purpose: Coronary flow reserve (CFR) can be used as a non-invasive measure of microvascular function but has not achieved widespread use partly due to concerns of difficulty in obtaining valid measures. The aim of this study is to assess feasibility of CFR assessment and, furthermore to describe a newly developed quality assessment index in terms of interobserver reproducibility and relation to factors thought to influence echocardiographic visualization.

Methods: Coronary flow reserve was measured in 597 women with angina and no obstructive coronary artery disease. All CFR measurements were quality graded in 3 Quality index: low, medium and high quality. Evaluation was based on 1) maintained probe position throughout examination 2) visibility of vessel in 2D modus, and, 3) characteristic flow curves in pulsed-wave modus. Clinical data was obtained. Quality of 30 coronary flow assessments were evaluated independently by two observers.

Results: Mean age (standard deviation) was 62.2 (9.6) years and mean BMi 27.3 (5.4) kg/m2. CFR was successfully measured in 579 (97%). 337 (58%) had CFR assessment with high, 210 (36%) with medium and 32 (6%) with low quality index. No factors traditionally thought to be related to echocardiographic visusalisation were related to the quality index (table 1) although there was a tendency towards low CFR being associated with lower quality (p=0.06). Quality assessment was reproducible with a pearsons correlation r=0.59 (p<0.01) and limits of agreement from -3.5 to 2.8. There was no systematic difference between rater assessment (p=0.26).

Conclusion: in an unselected patient sample, transthoracic measurement of CFR was feasible and reliable (quality index medium to high) in 91% of patients.

Quality index
Low n=32 Medium n=210 High n=337 p
Age 60.0 (13.6) 62.3 (10.1) 62.2 (8.9) 0.46
BMi 28.3 (6.7) 27.2 (5.8) 27.1 (4.9) 0.51
Diabetes type ii 6/26 (23.1) 26/208 (12.5) 32/329 (9.7) 0.096
Lung disease 7/25 (28.0) 31/124 (25.0) 53/216 (24.5) 0.93
Severity of sideeffects 5.5 (3.2) 6.0 (2.5) 5.6 (2.6) 0.28
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Continous variables are listed as mean (standard deviation). Categorical variables are listed as frequency/total (%). Difference between groups was tested by one-way ANOVA and chi-squared test, respectively.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P956: Assessment of left ventricular volume and function using real-time 3-D echocardiogrphy versus angiocardiography in children with Tetralogy of Fallot

SOHA Abd El Dayem 1, AHMED Battah 2, FATEN Abd El Azzez 3, AZZA Ahmed 4, AYA Fattoh 3, REEM Ismail 3

Abstract

Objective: To validate a new non-invasive cardiac imaging method for measurement of left ventricular volumes by Real time 3 D echocardiography (RT3DE) using cardiac angiography as the reference. Also to compare the accuracy, feasibility and reproducibility of RT3DE versus cardiac angiography in children with tetralogy of Fallot (TOF).

Patients and Methods: The study included forty TOF patients diagnosed previously by clinical examination and 2-D echocardiography who presented to catheterization laboratory for assessment of LV prior to surgery. Estimation of LV volume was done using Biplane cineangiography (by cardiac catheterization) and RT3DE. Finally, the LV volumes estimated by both methods were compared.

Results: Concerning LVEDVI measured by 2DE, it ranged from 17-65 ml3/m2 with a mean value of 35.4±9.8 ml3/m2. The mean was 32±7 ml3/m2 in infants and children £ 2 years and it was 38.7±10 ml3/m2 in children > 2 years. Statistical analysis showed that there was significant under estimation of LVEDVI by 2DE as compared with biplane cineangiography (P <0.05). There was a good correlation between RT3DE and cineangiography for estimation of LVEDVI in all studied patients (r = 0.97, P = 0.0001), in infants and children < 2 years (r = 0.9 and P = 0.0001) and in children above 2 years (r = 0.9 and P = 0.0001).

Conclusion: RT3DE is suitable for LV volumetry in children with TOF. There was a strong correlation between Biplane cineangiography and RT3DE.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P957: Role of echocardiography in prediction of Heart Failure in adults with congenital heart disease

K Andjelkovic 1, D Kalimanovska Ostric 1, I Nedeljkovic 1, I Andjelkovic 2

Abstract

Purpose: Heart failure (HF) is common and one of the most severe complications in adults with congenital heart disease (ACHD). Transthoracic echocardiography is usually the first-line modality for cardiovascular imaging in these patients, although windows of access that are possible during transthoracic echocardiography are rarely adequate for analysis of all regions of interest. The aim of this study is to see whether the echocardiographic parameters are better predictors of heart failure than clinical parameters, in ACHD.

Methods: A retrospective study was performed and enrolled 201 adult patient with CHD (88 males and 113 females), of various complexity, among those followed-up at the department for congenital heart disease in adults, cardiology clinic, since 2008. Heart failure was diagnosed according to the current Guidelines. All patients underwent clinical examination and transthoracic echocardiography. Analyzed clinical parameters were dyspnea, palpitations, syncope, leg edema, and cyanosis. Analyzed echo parameters were enlargement of the left and right atrium, left and right ventricle diameters, as well as left and right ventricular hypertrophy, determined by transthoracic echocardiography. Stepwise multivariate logistic regression was conducted with Hosmer-Lemeshow goodness-of-fit statistics for model calibration and receiver operating characteristic (ROC) curve for model discrimination.

Results: HF was diagnosed in 50 patients (25%). Two logistic regression models for heart failure prediction were analyzed, for two different subsets of parameters, one for clinical parameters and the other for echocardiographic parameters. Clinical factors associated with increased risk of heart failure in ACHD were dyspnea (p=0.002) and leg edema (p<0.001). The model discriminated well with a ROC of 0.91 (95% confidence interval: 0.86-0.96). Echocardiographic factors associated with increased risk of heart failure in ACHD were: enlargement of the left atrium (p=0.001), right atrium (p=0.002) and left ventricle diameter (p<0.001) as well as right ventricle hypertrophy (p=0.03). The model discriminated well with a ROC of 0.86 (95% confidence interval: 0.80-0.91).

Conclusion: It appears that both models, clinical and echocardiographic discriminate well, high risk ACHD patients for HF. Hence, clinical findings followed by transthoracic echocardiographic examination should be sufficient and reliable to identify ACHD patients at high risk of heart failure.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P958: The predictive value of Tissue Doppler for Left Ventricular recovery and remodeling after primary percutaneous coronary intervention

HESHAM Rashid 1, HESHAM Abuel Enien 1, MAHER Ibraheem 2, Tissue Doppler echocardiography research work

Abstract

Background: The main goal in the management of ST segment elevation myocardial infarction (STEMI) is an early restoration of coronary artery flow in order to preserve viable myocardium. Doppler tissue imaging (DTI) is a simple modality that measures tissue velocity during cardiac cycle.

Objective: To assess the role of DTI in evaluation of LV recovery after PCI.

Methods: Fifty patients were included in this study with STEMI, and were candidate for primary PCI. Cardiac enzymes and ECG were done during admission and 12 hours after PCI for assessment of noninvasive criteria for reperfusion. Echocardiography with DTI was performed for all patients to assess LV recovery and remodeling at baseline and one month after PCI. Primary PCI was performed and patients were divided into two groups: Group A with good reperfusion, and group B with poor reperfusion.

demographic data among the st

Group A Group B P value
N= 39 N= 11
Mean Age ±SD 50.4±9.8 51.7±14.2 >0.05
Female Male 14(35.9%) 25(64.1%) 8(72.7%) 3(27.3%) <0.05*
DM 19 (48.72%) 11 (100 %) <0.001*
HTN 19 (48.72%) 8 (72.73 %) <0.05*
dyslipidemia 23 (58.97%) 6 (54.55 %) >0.05
Smoking 14 (35.90%) 2 (18.18 %) >0.05
Family history 15 (38.46%) 8 (72.73%) <0.05*
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Results : In patients of group A (78%), there was a statistically significant improvement of the LV EF more than 5% one month after primary PCI (LV recovery) (p <0.001), while in group B, there was a statistically significant increase in LVED volume more than 20% (LV remodeling) (P < 0.01). The mean systolic (S) velocity showed a cutoff value of 4.83cm/sec or more for prediction of recovery of global systolic function with a sensitivity and specificity of 100% and 90% respectively. Out of 11 patients in group B, 3 patients (27.27%) developed MACE and admitted to CCU, 2 of them with heart failure, while other one needed revascularization.

Conclusions: LV recovery occurs in STEMI patients treated with primary PCI and it is an important for favorable outcome.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P959: Athletic Left Ventricular parameters corrected with trabecular mass

H Vago 1, A Toth 1, I Csecs 1, CS Czimbalmos 1, F I Suhai 1, K Kecskes 1, D Becker 1, T Simor 2, B Merkely 1

Abstract

Introduction: The cardiac magnetic resonance (CMR) examination is an in vivo reference method to determine ventricular volumes, ejection fractions and masses. A new cardiac software enables quantitative analysis of myocardial trabecules.

Study aims: Our goal was to determine left ventricular MR parameters of top athletes and examine the impact of the new trabecular measurement method on the left ventricular parameters of athlete hearts.

Methods: CMR examination was performed on 126 top athletes (107 male, 19 female) and on 54 healthy volunteers (40 male, 14 female). Groups of male kayak-canoe (n=35), rowing (n=10), water-polo (n=24), cycling (n=7), football (n=6), kickboxing (n=8), handball (n=6), ultra-marathon runners (n=5) and goalball (n=6) were isolated. The Medis QMass MR version 7.5 and version 7.6 quantification softwares were used to determine normal values. With the new version 7.6 software it is possible to analyze myocardial trabecules quantitatively compared to version 7.5.

Results: The male and female athletes groups' left ventricular volumes and myocardial mass indexes (LVMi) were higher, than control group's. Comparing the left ventricular parameters in different sports, kickboxing and goalball were not significantly different from the control group. The LVM index corrected with trabecular mass (TrM) was higher in kayak-canoe compared to water-polo players.

The LVMi considering TrM was significantly higher both in athletes and control group compared to LVMi without TrM (athletes:male:110.3±18.9 vs 88.4±16.5g, female:92±11.6 vs 75.1±8,6g/m2; control:male:87.6±11.1 vs 69.6±8g, female:66.8±6.5 vs 53.1±4.6g). The new quantification method resulted lower left ventricular end-diastolic, end-systolic, stroke volumes and indexed values. The TrM of male athletes exceeded the control group's TrM (42.7±10.3 vs. 38.0±7.8 g, p= 0.01). The TrM% (trabecular (g)/LVM(g) *100) was higher in the control group (21.3±7.8 vs 12±3.5). Conclusion: The new method of myocardial trabecular measurement could fundamentally alter the normal left ventricular parameters.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

Assessment of diameters, volumes and mass: P960: Changes in Left Atrial total, reservoir, conduit, and active volumes in top-level athletes during the season

F D'ascenzi 1, A Pelliccia 2, BM Natali 1, M Cameli 1, M Lisi 1, M Focardi 1, D Corrado 3, M Bonifazi 4, S Mondillo 1

Abstract

Purpose: Left atrial (LA) enlargement is a component of athlete's heart. However, LA total and phasic volumes have not been yet investigated and longitudinal data collected within the season are not available. We sought to investigate whether differences in LA reservoir, conduit, and active function exist between athletes and controls and whether they vary with training.

Methods: Twenty-six top-level athletes and 23 controls were enrolled. In athletes, LA volumes were measured at pre-, mid-, end-season, and post-detraining time point.

Results: Maximum, minimum, and pre-P LA volumes were greater in athletes than in controls (p<.0001). Total emptying and passive emptying volumes were higher in athletes (p<.05) while active emptying volume was comparable between athletes and controls. During the season, maximum, minimum, and pre-P volumes (p<.0001), LA total (p<.005) and passive (p<.05) emptying volumes increased while LA active emptying did not vary. E/e' ratio did not change. After detraining, no differences were observed between pre-season and post-detraining data. Mid-season and end-season left ventricular (LV) mass indexes (β=0.55, p<.05; β=0.74, p<.005) were independent predictors of mid-season and end-season maximum volumes. Δ LV stroke volume was independent predictor of Δ minimum LA volume (β=0.65, p<.05).

Conclusions: The left atrium of top-level athletes exhibits a peculiar mechanical function, with higher reservoir and conduit volumes as compared with controls. Furthermore, maximum, minimum, pre-P, and phasic LA volumes did change during the season. Exercise-induced LA adaptation is accompanied by LV remodeling and regresses after detraining, suggesting a physiological adaptation to intensive training.

Figure.

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Comparison between athletes and controls

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P961: Assessment of the role of metabolic signaling kinases LKB1 and AMPK in the control of atrial size and development of atrial fibrillation

VG Zaha 1, GE Kim 1, KN Su 1, J Zhang 1, N Mikush 1, J Ross 1, M Palmeri 1, LH Young 1

Abstract

Both hemodynamic and metabolic stress can induce atrial remodeling and fibrillation. The purpose of this study was to use echocardiography (VisualSonics 2100) to assess the role of metabolic signaling protein kinases in atrial remodeling in the mouse heart. Liver kinase B1 (LKB1) is highly expressed in the heart and activates the AMP-activated protein kinase (AMPK) and 12 other downstream AMPK-related kinases. We found that mice with transgenic expression of a catalytically inactivated alpha-2 AMPK subunit had diminished atrial and ventricular AMPK pathway activity, but similar LA diameter (1.5 ± 0.15 mm vs. 1.6mm ± 0.05 mm), LV wall thickness (0.67 ± 0.03 mm vs. 0.66 ± 0.03 mm), and LVEF (48.9 ± 2.3% vs 47.8 ± 2.4%) at 12 weeks compared to wild type. in contrast, mice with cardiac LKB1 deletion had left atrial enlargement (2.1 ± 0.1 mm vs. 1.4 ± 0.2 mm, p<0.05), progressive LV hypertrophy (0.78 ± 0.03 mm vs. 0.67 ± 0.03 mm, p<0.05) and contractile dysfunction (LV ejection fraction: 40.3 ± 2.1% vs. 48.9 ± 2.3%) and developed spontaneous atrial fibrillation as early as 2 weeks. To explore whether hemodynamic stress might induce atrial remodeling and fibrillation, we submitted wild type mice to aortic banding. Transverse aortic constriction increased peak aortic velocity (3.9 ± 0.16 m/s vs. 0.6 ± 0.03 m/s sham, p<0.05), and caused progressive left ventricular hypertrophy (LV mass 141 ± 11.6 mg vs. 107 ± 2.2 mg SHAM, P<0.05); however, left atrial size did not change in response to aortic banding (LA diameter 1.6 ± 0.14 mm vs. 1.6 ± 0.09 mm SHAM) and mice did not develop atrial fibrillation. Thus, echocardiographic assessment shows that cardiac deletion of LKB1 has an important action to induce atrial remodeling and this action is not replicated by inactivation of alpha-2 AMPK or hemodynamic stress.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P962: Biatrial atrial phasic function and mechanics are impaired in untreated subjects with prediabetes and type 2 diabetes mellitus

M Tadic 1, SI Ilic 2, VC Celic 3

Abstract

Purpose: To investigate phasic function and mechanics of the left atrium (LA) and right atrium (RA) in subjects with prediabetes and type 2 diabetes mellitus.

Methods: This cross-sectional study involved 43 untreated normotensive subjects with prediabetes, 52 recently diagnosed normotensive diabetic patients and 48 healthy controls matched by sex and age. Laboratory analyses and comprehensive echocardiographic examination including two-dimensional speckle tracking analysis were done to all participants.

Results: LA and RA reservoir function, evaluated by total emptying fraction, was lower in diabetic patients than in controls; whereas biatrial reservoir function of prehypertensive subjects was similar with controls and diabetics. Biatrial conduit function, assessed by passive emptying fraction, gradually decreased from the healthy controls, throughout the prediabetics, to the diabetics; whereas biatrial booster pump function, measured by active emptying fraction, increased in the same direction. Speckle tracking analysis of atrial phasic function showed progressive deterioration of biatrial total and passive function, and gradual increment of biatrial active function from controls to diabetics. In the whole study population HbA1c correlated with LA passive emptying fraction (r=-0.35, p<0.01), LA active emptying fraction (r=0.3, p=0.04), LA longitudinal strain during systole (r=-0.38, p<0.01), RA passive emptying fraction (r=-0.44, p<0.01), RA active emptying fraction (r=0.36, p<0.01), and RA longitudinal strain during systole (r=-0.34, p=0.02). However, only LA passive emptying fraction (β=-0.34, p<0.01) and LA longitudinal strain during systole (β=-0.31, p=0.03) were independently associated with HbA1c between the LA parameters; whereas solely RA passive emptying fraction (β=-0.34, p=0.01) and RA active emptying fraction (β=0.33, p<0.01) were independently associated with HbA1c between the RA parameters.

Conclusion: Biatrial phasic function is significantly impaired in prediabetics and diabetics. The marker of glucose control (HbA1c) correlated with biatrial reservoir, conduit and pump atrial function in the whole study population.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P963: Left Atrial Volumen and function in different cardiomyopathies. Geometry and left atrial function. Should we measure both?

C Jaimes 1, J Gonzalez Mirelis 1, M Gallego 1, J Goirigolzarri 1

Abstract

There is growing interest in the measurement of the left atrium as a relevant prognostic parameter. However, although it is common to measure left atrial volume, it is not so common to evaluate its contractility. The study compared different variables of the left atrium in a heterogeneous group of patients with heart disease.

Methods: Patients where selected from those who where sent to the MRI unit of our center (1.5 T Philips), for evaluation of their cardiopathy. Left atrial volume (LAV) and LA function (LAF) were measure by cardiac MRI with the biplane method (4-chamber and 2-chamber). Results from different heart diseases were compared.

Results: 186 patients were included (age 51 ± 17 years, 123 males, 14 in AF). The indexed LAV and LAF where different between pathologies. The group of valvulopathies and pulmonary hypertension had the highest indexed LAV (61 ± 24 ml/m2). The group of myopericarditis had the lowest indexed LAV (42 ± 14 ml/m2), and this values where similar to the normal group (42 ± 13 ml/m2) (p = 0.837) . The LAF of the group with myopericarditis (47 ± 13 %) was similar to the LAF of the control group (52 ± 10%) (p = 0.104). The lowest LAF was measured in the group of cardiomyopathies, and within this, the subgroup of restrictive cardiomyopathy (7/8 amyloidosis, 8 SR during CMR), with a LAF of 21 ± 5 % (p = 0.020).

Conclusion: The maximum dilation and worst left atrial function is not seen in the same pathological groups, showing the importance of measuring these two parameters. The group of cardiomyopaties had the worst left atrial contractility, which is associated with its poor prognosis.

CMR ATRIAL SIZE AND FUNCTION

Normal (n=54) CM Ischemic (n=32) Myopericarditis (n=19) Pre-PV ablation Other Valvular, PHT p
LVEF (%) 63 ± 6 55 ± 13 46 ± 13 60 ± 7 60 ± 5 63 ± 11 65 ± 7 0,000
3cLAd 3,1 ± 0,6 3,8 ± 0,9 3,7 ± 0,9 3,2 ± 0,4 4,2 ± 0,5 3,2 ± 0,5 3,8 ± 1 0,000
BP LAVi (ml/m2) 42 ± 14 55 ± 32 47 ± 21 42 ± 13 58 ± 14 39 ± 13 61 ± 24 0,010
LAF (%) 47 ± 13 34 ± 17 41 ± 16 52 ± 10 36 ± 25 38 ± 15 43 ± 23 0,001
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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P964: Effect of Uric Acid serum levels on carotid arterial stiffness and Intima-Media Thickness: a high resolution echo-tracking study

M Pellegrinet 1, S Poli 2, G Prati 2, O Vriz 3, V Di Bello 4, S Carerj 5, C Zito 5, A Mateescu 1, BA Popescu 6, F Antonini-Canterin 1

Abstract

Background: Serum uric acid (UA) has been shown to be a predictor of cardiovascular (CV) morbidity and mortality and it may play a role in the pathogenesis of CV disease affecting vascular structure and function. However, there is limited evidence of its specific association with carotid artery stiffness and structure. The aim of our study was to evaluate whether UA is associated with early signs of atherosclerosis, namely local carotid arterial stiffness and intima-media thickening.

Methods and Results: We evaluated 698 consecutive asymptomatic patients, referred to the cardiovascular department for risk factor evaluation and treatment. All patients underwent carotid artery ultrasonography with measurement of common carotid intima-media thickness (IMT) and echo-tracking carotid artery stiffness index Beta. Patients with hyperuricemia (defined as serum uric acid >=7 mg/dL in men and >=6 mg/dL in women) had higher IMT (0.97±0.22 vs. 0.91±0.18, p<0,001) and stiffness index Beta (8.3±3.2 vs. 7.5±2.7, p=0,005). UA levels correlated with both IMT (r=0,225; p<0,001) and stiffness index Beta (r=0,154; p<0,001); correlations were statistically significant both in males and females. In a multivariate model with age, arterial pressure, serum glucose and LDL cholesterol, serum UA emerged as an independent explanatory variable of IMT and Beta, both in men and women.

Conclusions: Carotid IMT and local arterial stiffness are related to UA independently of established CV risk factors; UA may play a role in the early development of atherosclerosis.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P965: Renal resistance as a determinant of blood pressure phenotype cardiovascular system pathophysiology

E Chatzistamatiou 1, G Moustakas 2, G Memo 1, D Konstantinidis 1, I Mpampatzeva Vagena 1, K Manakos 1, K Traxanas 1, N Vergi 1, A Feretou 1, I Kallikazaros 1

Abstract

Objective: We sought to determine the relationship between renal resistive index (RI) and the type of hypertension in patients with essential hypertension.

Design and Method: We studied 275 consecutive, never treated, essential hypertensive patients (mean age 51±14 year, 55% male). Based on office and ambulatory blood pressure (BP) levels, the population was split in four groups: masked (17%), isolated systolic (ISH, 15%), isolated diastolic (IDH, 13%) and mixed (systolic-diastolic, SDH, 55%) hypertension.

Results:Patients with ISH were older, predominantly male, with more severe OD, less fit and with the highest RI (Table). Patients with IDH were younger, predominantly female with excellent OD profile, physically active and with the lowest RI. Patients with masked and SDH were middle-aged with intermediate OD profile, moderately active and intermediate RIs. Multinomial logistic regression analysis (reference category IDH) revealed that RI (ISH vs. IDH: OR 1.24 with 95%CI 1.08-1.40 - p=0.001, Masked vs. IDH: OR 1.13 with 95% CI 1.03-1.25 - p=0.008, SDH vs. IDH: OR 0.94 with 95%CI 0.84-1.04 - p=0.263), pulse pressure and HR were independent determinants of hypertension type after adjustment for age, gender, abdominal obesity and glomerular filtration rate.

Conclusions: RI is closely associated both with systolic and diastolic BP and is an independent determinant of hypertension phenotype.

Masked ISH IDH SDH p-value
Age, years 53±17 59±14 44±12 49±12 <0.001
Abdominal obesity, % 35 51 22 50 0.008
Office systolic blood pressure, mmHg 131±7 147±8 135±4 158±16 <0.001
Office diastolic blood pressure, mmHg 80±7 82±7 95±4 111±9 <0.001
Office heart rate, bpm 70±10 72±13 84±12 81±12 <0.001
24-hour systolic blood pressure, mmHg 121±7 126±9 122±11 129±12 <0.001
24-hour diastolic blood pressure, mmHg 70±8 69±9 78±8 79±8 <0.001
24-hour heart rate, bpm 69±8 69±9 79±9 74±8 <0.001
GFR, ml/min 104±40 97±43 115±30 116±37 0.027
LVMI, kg/m2 79.9±15.8 82.8±18 83.8±19.3 88.9±19.8 0.015
Mean common carotid IMT, mm 0.69 (0.60-0.82) 0.72 (0.63-0.83) 0.56 (0.53-0.67) 0.63 (0.56-0.74) <0.001
RI 0.64±0.06 0.67±0.06 0.58±0.05 0.60±0.06 <0.001
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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

Assessments of haemodynamics: P966: Hemodynamic assessment of cardiovascular patients: comparison of echocardiography and invasive measurements

B Hewing 1, L Theres 1, H Dreger 1, S Spethmann 1, K Stangl 1, G Baumann 1, F Knebel 1

Abstract

Purpose: Evaluation of hemodynamics is crucial in cardiovascular medicine. Right heart catheterization represents the current gold standard for the assessment of filling pressure (PCWP), cardiac index (CI) and systolic and mean pulmonary artery pressure (sPAP and mPAP); but hemodynamic parameters can also be estimated non-invasively. Therefore, the goal of this study was to assess hemodynamic parameters non-invasively by echocardiography using advanced modalities such as tissue Doppler and speckle tracking in comparison to invasive measurements in a representative cardiovascular patient cohort.

Methods: 48 consecutive non-intubated patients of our cardiology department with clinical indication for invasive hemodynamic assessment were included. Invasive parameters were obtained by left and right heart catheterization (Swan Ganz catheter using Fick formula). Examination by transthoracic echocardiography was performed under the same hemodynamic conditions.

Results: Left ventricular (LV) global longitudinal peak systolic strain moderately correlated with invasively measured CI (Spearman's ρ=0.534, p<0.05). There was a moderate correlation between Doppler- and catheter-derived values for cardiac index (ρ=0.498, p<0.05) and cardiac output (ρ=0.519, p<0.05). Sensitivity and specificity of echocardiography to predict an elevated PCWP (defined as >15 mmHg) was highest (75.9% and 66.7%, respectively) using an E/E' ratio (based on averaged lateral and septal E') cut-off value of >11.1 in the ROC analysis. There was a strong correlation between echocardiographic and invasively derived sPAP (ρ=0.756, p<0.05) and mPAP (ρ=0.728, p<0.05). The Bland-Altman graph showed good agreement of invasive and non-invasive measurements of mPAP (k=0.604, p<0.05).

Conclusions: Non-invasive assessment of LV systolic function, LV-filling and pulmonary artery pressure by advanced echocardiographic methods correlates well with invasive measurements in a broad spectrum of cardiovascular patients. Thus, echocardiography is a feasible, reliable and fast method for the global assessment of hemodynamics in these patients.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P967: Diastolic filling dynamics in the normal left ventricle: a study from the VFM international collaboration group

T Uejima 1, K Itatani 2, S Nakatani 3, P Lancellotti 4, Y Seo 5, JL Zamorano 6, N Ohte 7, K Takenaka 8, VFM international collaboration group

Abstract

Purpose: Vector Flow Mapping (VFM, Hitachi-Aloka Tokyo) estimates 2-dimensional flow vectors from colour Doppler data, allowing depiction of flow structures and quantification of flow energetics. Before it can be incorporated into clinical researches, flow dynamics inside the normal left ventricle (LV) needs to be characterised.

Methods: 162 healthy subjects, aged 20-76 years old, were recruited at 6 centres in Europe and Japan. LV diastolic filling was assessed in the apical long axis view with VFM. The development of vortex during early diastole was evaluated by area and circulation as a measure of strength. Energy loss by viscous dissipation was quantified and plotted over the diastolic period.

Results: A clockwise rotating vortex was formed at the LV base immediately after diastolic filling started and then it grew linearly in size and strength (figure A, B). The degree of energy loss changed over the diastolic period, depending on LV inflow (figure C). The average energy loss was 20±24% of LV inflow kinetic energy.

Conclusion: VFM demonstrated that there were a linear growth in vortex and a significant energy loss occurred during the LV filling.

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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

Assessment of systolic function: P968: Impact of paced heart rate on left ventricular dyssynchrony in heart failure patients treated with Cardiac Resynchronization Therapy

J Naar 1, L Mortensen 2, J Johnson 3, R Winter 2, K Shahgaldi 3, A Manouras 2, F Braunschweig 2, M Stahlberg 2

Abstract

Purpose: To quantify and contrast the effect of different paced heart rates (pHR) on left ventricular dyssynchrony in (i) synchronous pacing (cardiac resynchronization therapy, CRT) and (ii) dyssynchronous pacing (AAI + wide QRS activation) in patients with heart failure.

Methods: Echocardiography was performed in 14 CRT recipients in 2 different pHRs (70 and 90 bpm) in 2 different pacing modes (CRT and AAI + wide QRS activation). The 12-segment standard deviation model (Ts-SD) using Tissue Doppler Imaging was used to quantify left ventricular dyssynchrony. Cardiac cycle intervals were assessed using state diagram. Stroke volume (SV) was measured as LVOT-VTI and E/e' was used as an estimate of cardiac filling pressures.

Results: Ts-SD decreased significantly with CRT at 90 bpm (25.3±12.2 ms) compared to at 70 bpm (35.0±14.7 ms, p=0.004), whereas it was unchanged with AAI pacing at 90 bpm compared to at 70 bpm (Fig. 1 A). Indexed to RR interval, Ts-SD was unchanged with CRT at 90 bpm compared to at 70 bpm, while it increased with AAI-pacing at 90 bpm (55.0±25.9 ms) compared to 70 bpm (42.4±17.8 ms, p=0.02) (Fig. 1B). Pre-ejection, ventricular ejection and post-ejection phases increased significantly, while diastole shortened, with increased pHR in both pacing modes. SV decreased at 90 bpm (37.3±11.6 ml) compared to 70 bpm (43.5±13.8 ml, p=0.02) with AAI, but was unchanged with CRT at different pHRs. E/e' ratio decreased significantly with CRT at 90 bpm (12.5±6.1) compared to 70 bpm (15.3±7.8, p<0.05), and was unchanged with AAI-pacing.

Conclusions: This study shows that the dyssynchrony-response to increased pHR is different in synchronous compared to dyssynchronous pacing. The findings imply that remaining dyssynchrony after CRT delivery may be ameliorated with increased pHR.

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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P969: Mechanical dispersion after acute myocardial infarction using strain echocardiography. Is the timing of the assessment important?

D Coisne 1, A-M Al Arnaout 1, C Tchepkou 1, P Raud Raynier 1, C Diakov 1, B Degand 1, L Christiaens 1

Abstract

It has been recently demonstrated that the mechanical dispersion (MD) assessed after an acute myocardial infraction (AMI) may give important information about susceptibility for ventricular arrhythmias. Early and late myocardial remodelling after AMI may introduce a signification variation of the MD and the best timing of the MD calculation is unknown. Aim. Evaluation of the temporal variability of the MD during the first 6 weeks after an AMI.

We prospectively included 15 AMI patients treated by primary PCI.(Ant:7, Inf:7, Lat:1: mean age:54,2+/-10,2 y, QRS width: 90,2+/-14,6 ms). Echo exam was performed à 48 hours(TTE1), 4 (TTE2) and 50 (TTE3) days after the acute phase. MD was calculated using the SD of time to maximum myocardial strain of the 16 segments (akinetic segment >-3% of strain was excluded). Basal parameters were: EF: 48,2+/-12,1 %; Total art res: 2810+/-772 dyn/cm-5. EF and GLS improve significantly between TTE1 and TTE2 (GLS(TTE1): -13,8+/-4,4 % vs GLS(TTE3): -16,9+/-4,0; p<0,003). Temporal variation demonstrates a biphasic evolution with a significant lower value for TTE2 (MD(TTE1) 59,4+/- 13,5 ms; MD(TTE2) 51,4+/- 11,0; p<0,01). Nevertheless there was no significant difference between TTE1 and TTE3 results (fig)

To conclude: we found a significant variation of the MD during the first 6 weeks after an AMI, with a lower MD at 1 week. This fact may be related to the early myocardial-remodelling phenomenon.

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MD temp var CoisneD

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P970: Reliability of longitudinal AFI global and segmental strain compared with 2D Left Ventricular volumes and ejection fraction: intra and inter-operator, test-retest, and inter-cycle reproducibility

P Barbier 1, O Mirea 2, C Cefalu 1, G Savioli 3, M Guglielmo 1, A Maltagliati 1

Abstract

Purpose: Echocardiographic evaluation of 2D longitudinal peak systolic strain (LPSS) can detect initial impairment of left ventricular (LV) function in heart disease. Global LPSS (GLPSS) variability has been assessed in small groups and segmental LPSS has not been determined. We compared variability of GLPSS and segmental LPSS with that of 2D LV volumes and ejection fraction (EF) in patients with and without heart diseases.

Methods: 2D speckle tracking analysis was performed on LV apical views using AFI software (GE Healthcare, v112). Intra-operator, inter-cycle and test-retest variability (bias and CR, coefficient of reproducibility; MPE, mean percent error; CV, coefficient of variation) was assessed for GLPSS, 18 segments of LPSS, and LV volumes and EF in 40 patients (740 segments), and inter-operator variability in 250 patients (4500 segments).

Results: Feasibility of segmental tracking was 92%. Variability of GLPSS increased from a minimum intra-operator CV= -2.6%, to a maximum test-retest CV= -3.8% and was lower than that assessed for volumes and EF. Segmental intra-operator LPSS CV ranged -5.6% to -14.7%, and test-retest -8% to -22%, and was at worst similar to variability of end-systolic volume. In the 8.3% of segments with the highest variability, this was related to suboptimal imaging, minor changes in scan angulation and insufficient ROI width.

Conclusions: Overall reproducibility of GLPSS is excellent and superior to that of 2D EF, whereas segmental LPSS reproducibility is good and similar to that of LV volumes. Both are suitable for diagnosis and follow-up of LV global and regional systolic function.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P971: Exploration of bias in the visual estimation of Left Ventricular ejection fraction using 2D echo

L O'neill 1, K Walsh 2, J Hogan 1, T Manzoor 1, B Ahern 1, P Owens 1

Abstract

Background: Left ventricular ejection fraction (EF) is most commonly assessed visually and is subject to bias. Echo technicians (ETs) who perform a majority of normal scans may score EFs significantly lower than cardiologists, who largely review abnormal scans (professional bias). We postulate that an abnormal scan, when seen in the context of a series of normal scans would be scored lower than the same scan in the context of scans showing severely reduced EF (contextual bias).

Methods: Twenty-three subjects, comprising physicians and cardiac technicians, were enrolled from two departments. Subjects reviewed a series of 65 anonymised scans in sequence, without clinical information, and estimated the EF for each scan. The exercise was repeated at four weeks. Three key scans, with moderately impaired EF, were placed at positions 10 (T1), 20 (T2) and 30 (T3) in the sequence; then followed 10 scans with severely impaired EFs, followed by T1, T2 and T3 sequentially; after a further random sequence of scans, a run of ten normal scans was placed, followed by a repeat of T1, T2, T3 sequentially.

Results: Intra-observer variability. The agreement for the first thirty scans (consistent from the first sitting to the second) varied from poor to excellent, with a median kappa value of 0.54. There was no difference between doctors and technicians (0.54 (0.2) vs. 0.43 (0.21), p = 0.2). Inter-observer variability. The estimated EF for the first thirty scans was compared between each observer. The inter-rater agreement was low, with a median kappa value of 0.28. Professional bias. This was explored by comparing the average EF obtained by physicians and technicians for each case on the first series of scans. Physicians scored ejection fractions systematically higher than technicians, by 4.4% (±0.77, p<0.0001). Contextual bias. After the ‘severe’ sequence, T1 was scored higher in 68% of cases (p<0.0001); T2 was scored higher in 51% (p=0.01); T3 was scored higher in 27% (p=ns, p<0.001 for trend), suggesting that EFs in the moderately impaired range were biased upwards when evaluated in the context of a preceding ‘conditioning’ sequence of severely abnormal scans.

Conclusion: We found evidence of professional bias in EF reporting, with physicians reporting scans more optimistically than technicians. EF values were biased upwards when preceded by a series of severely impaired scans, suggesting a contextual bias effect. Relatively poor inter-rater agreement was found, and the clear clinical importance of the variable being measured requires wider use of more objective measures of LVEF.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P972: Automated Function Imaging-derived strain rate evaluation of Left Ventricular systolic function

G Savioli 1, M Guglielmo 2, O Mirea 3, C Cefalu 2, P Barbier 2

Abstract

Purpose: Speckle-tracking Automated Function Imaging (AFI) offers a fast "on board" echocardiographic method to calculate left ventricular (LV) global peak longitudinal systolic strain, proposed as an index of global systolic function with the advantage to detect "subclinical" (normal ejection fraction) LV systolic dysfunction. In contrast, the utility of AFI-derived LV global peak systolic strain rate (SRs) has not been assessed.

Methods: We studied 427 consecutive patients with (339) and without (88) heart diseases undergoing echocardiography (ranges, age: 14-93 y., HR: 40-130 bpm, systolic arterial pressure: 90-180 mmHg, EFb: 15-78 %), using GE Vivid 7/9 systems (offline analysis on Echopac v12). AFI-derived peak maximum SRs and time to peak SRs (SRstp) were obtained offline by averaging the first derivatives of the systolic strain curve measured in the 3 apical views.

Results: Both peak SRs and SRstp showed a normal distribution and were respectively -1.39±.37s-1(95% CI= -1.31, -1.47) and 159±31ms(95% CI= 153, 166) in normals and -1±.47 and 186±62 in patients (both, p <.001). Compared to normals, SRs and SRstp were unchanged in athletes (n= 12; -1.73±.77, 159±31), and decreased in dilated cardiomyopathy (n= 35; -.65±.28, 252±89; p<.001), CAD with normal preload (n= 30; -.77±.33, 207±69; p .001), and aortic stenosis (n= 23; -.97±.31 p<.001, 178±31; p=ns). At multiple regression analysis, adjusted for LV preload, filling pressures, stroke volume, LV mass index and left atrial volume, SRs was positively determined by LV ejection fraction and tricuspid annular excursion, and negatively by wall motion score index and pulmonary systolic hypertension (r= .72, p<.001), whereas SRstp was positively determined by LV end-systolic volume index and myocardial performance index, and negatively by heart rate (r= .58, p<.001).

Conclusions: Whereas AFI-derived peak maximum longitudinal systolic strain rate is related to both LV and right ventricular (mediated by the interventricular septum) mechanical systolic functions, our analysis suggests that time to peak strain rate may approximate LV contractility. These findings, if confirmed by experimental data, may expand the clinical utility of AFI in the evaluation of LV systolic function.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P974: Does the parietal jet impact of aortic regurgitation affects regional longitudinal myocardial strain of the Left Ventricle?

L Marta 1, J Abecasis 1, C Reis 1, R Ribeiras 1, MJ Andrade 1, M Mendes 1

Abstract

Introduction: In recent years we have seen an overspread use of myocardial deformation by speckle tracking (2D-ST) for the evaluation of myocardial function and contractility. Regarding longitudinal strain (LS), currently there are no identified extrinsic factors that can influence this parameter. In the context of moderate or severe aortic regurgitation, evaluation of left ventricular function (LV) is particularly important for therapeutic decision.

Purpose: We aimed to determine whether the parietal wall impact of the aortic regurgitation jet (RJ) affects regional LS in patients (pts) with chronic moderate or severe aortic regurgitation (AR) without known coronary disease.

Methods: We studied pts with chronic moderate and severe isolated AR, referred for echocardiographic evaluation. This included quantitative and semi-quantitative assessment of the AR severity, as well as its effect on LV size and function. We selected pts whose RJ directly impacted on 1-2 specific wall segments, through visual impression of the area of RJ wall impact with greater turbulence, confirmed in multiple planes. We defined the RJ pattern in accordance with the region of impact. We assessed LGS by 2D-ST, as well as regional longitudinal strain in the RJ impact segments (LSRJ) and in the segments free of jet impact (LSFJ). We compared the difference in longitudinal strain between regions with and without impact of the RJ.

Results: We studied 42 pts (mean age 56 ± 16 years, 86% male) in whom it was possible to clearly identify the wall region of RJ impact in 14. The etiologies for AR included degenerative disease (43%), bicuspid valve (29%), leaflet non-coaptation (21%) and rheumatic disease (7%). The predominant RJ patterns were: basal inferior-septum (36%), mid anterolateral (21%) and mid antero and infero-lateral (14%). Average LGS was -16.4 ± 2.1%. We found a significant difference between average LSRJ and LSFJ (respectively, -5 ± 8.2% and -16.8 ± 2.3 %, p <0.001). The average of absolute difference between LSFJ and LSRJ was -10 ± 7% and LSRJ/LSFJ ratio ranged between -0.86 and 0.79.

Conclusions: Our study suggests that factors extrinsic to myocardial function and contractility may affect LV longitudinal deformation. In particular, the pressure and volume overload caused by the regional wall impingement of an AR jet can significantly reduce the longitudinal myocardial deformation in that location.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P975: Right Ventricular structure and function in Idiopathic Pulmonary Fibrosis with or without Pulmonary Hypertension

A D'andrea 1, A Stanziola 2, E Di Palma 1, M Martino 2, M Lanza 2, V Betancourt 1, M Maglione 1, R Calabro' 1, MG Russo 1, E Bossone 3

Abstract

Background: Idiopathic pulmonary fibrosis (IPF) can lead to the development of pulmonary hypertension (PH), which is associated with an increased risk of death. In PH, survival is directly related to the capacity of the right ventricle to adapt to elevated pulmonary vascular load.

Objectives: The aims of the present study were to elucidate right ventricular (RV) function and structure in patients with IPF with or without PH, and their relation to other instrumental features of the disease.

Methods: Clinical evaluation, standard Doppler echo, Doppler Myocardial Imaging (DMI) and X-strain echocardiography of RV longitudinal deformation in RV septal and lateral walls were performed in 52 IPF patients (mean age: 66.5± 8.5 years; range 42 – 80; 27 males) and in 45 age- and sex-comparable controls using a commercial US system. Pulmonary artery systolic and mean pressure (mPAP) were estimated by standard echo-Doppler formulas. RV global longitudinal strain (RVGLS) was calculated by averaging local strains along the entire right ventricle. The IPF patients were divided into 2 groups by non-invasive assessment of PH: no PH (mPAP <25 mm Hg; 36 pts) and PH (mPAP ≥25 mmHg; 16 pts).

Results: Left ventricular diameters, ejection fraction and TAPSE were comparable between the two groups, while RV end-diastolic diameter was mildly increased in IPF (p<0.01). Tricuspid inflow E/A ratio was decreased in IPF (p<0.01), while mPAP was increased (p<0.001). Pulsed DMI detected in IPF impaired myocardial RV early-diastolic (Em) peak velocity (p<0.0001), and comparable systolic velocity at tricuspid annulus level. In IPF, peak systolic RV strain was reduced in basal, middle and apical RV lateral free walls, and also RVGLS was impaired (14.3±5.3 vs 22.4±6.1 %; p<0.001). The impairment in RV wall strain was more evident when comparing controls with the no PH group than comparing the no PH group with the PH group.

By multivariate analysis, independent association of RV lateral wall strain with both 6-minute walking test distance (p<0.001), mPAP (p<0.01), as well as with forced vital capacity % (<0.005) in IPF patients were observed. A RV GLS cut-off value of 0.16% differentiated controls and IFP with an 85% sensitivity and a 90 % specificity.

Conclusions: The present study showed that impaired RV diastolic and systolic myocardial function were present even in IFP patients without PH, which indicates an early impact on RV function and structure in patients with IF. RV strain is a valuable non-invasive and easy-repeatable tool for detecting early RV myocardial involvement caused by IPF.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P976: How to assess right ventricular systolic function in Ebstein anomaly: a comparative study of echocardiographic parameters with CMR-derived ejection fraction in 49 patients

M O Vogt 1, CH Meierhofer 1, TH Rutz 1, S Fratz 1, P Ewert 1, CH Roehlig 1, A Kuehn 1

Abstract

Background: In congenital heart disease, right ventricular (RV) dysfunction is frequently present either due to abnormal loading conditions and/or abnormal geometry, and has a direct influence on patient outcome. The Ebstein anomaly (EA) is a good example of pathology of the inflow tract and dysfunction of the right ventricle. Data on echocardiographic quantification of RV function in this anomaly are however rare. We therefore compared 8 non-volumetric echocardiographic indices of RV function with the gold standard measure of RV fraction: cardiovascular magnetic resonance (CMR). The aim was to determine which non-volumetric echocardiographic index of global systolic RV function correlates well with CMR-derived RV ejection fraction.

Methods and results: 49 patients with an Ebstein anomaly and a mean age of 32 ± 18 years were examined. Tricuspid annular plane systolic excursion (TAPSE), tissue Doppler myocardial velocities (peak S and IVA) and 2D strain measures for the RV were compared with CMR-derived ejection fraction values. Of the 8 echocardiographic parameters investigated, only 2D global strain showed a significant correlation with CMR-derived RVEF (p=0.01; R= -0.4).

Conclusions: The only non-volumetric echocardiographic parameter which correlates well with CMR derived RV ejection fraction in patients with the Ebstein anomaly was RV 2D global strain. TAPSE and myocardial velocities correlated poorly and should not be used.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P977: Reduced septal shortening in patients with transposition of the great arteries: a reflection of reduced septal curvature?

P Storsten 1, M Eriksen 1, EW Remme 2, E Boe 1, OA Smiseth 3, H Skulstad 3

Abstract

Purpose: In patients with transposition of the great arteries (TGA) and atrial switch, the right ventricle (RV) becomes the systemic ventricle. As a result the septum is curved into the left ventricle (LV) instead of into the RV. We hypothesised that this abnormal septal geometry is associated with changes in septal shortening.

Methods: The study included 6 patients (30±6 years, mean±SD) with systemic RV due to atrial Switch a.m. Senning or Mustard and 14 controls (30±7 years) with normal hearts. Myocardial shortening was measured as circumferential strain by speckle tracking echocardiography in short axis views of the systemic ventricles. Septal geometry was expressed at the ratio between radius of curvature of the septum and the RV free wall in patients and septum to LV free wall in controls (Rs /Rfw)

Results: In the TGA patients, septal shortening was markedly reduced compared to the RV free wall (11±3 vs. 19±5 %, P<0.01) and compared to septum in controls (11±3 vs.27±3 %, P<0.01). The Rs /Rfw ratio was higher in TGA compared to controls, demonstrating a flatter septum (1.39±0.17 vs.1.09±0.11, P<0.01). In addition, a positive correlation between Rs /Rfw ratio and septal shortening was seen in TGA (r2=0.68, P<0.05), while it was absent in controls (r2=0.07, NS) (Figure).

Conclusions: In TGA-patients the septal curvature and the septal shortening was reduced. According to the law of LaPlace, flattening of the septum leads to higher local afterload. The correlation between septal shortening and radius of curvature suggests that the reduction in septal shortening is partly due to abnormal geometry and the impairment in myocardial function may therefore be overestimated.

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Results from TGA-patients and controls

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P978: Changes of Right Ventricular function after mitral valve and additional tricuspid valve repair

E Ereminiene 1, R Ordiene 1, V Ivanauskas 1, J Vaskelyte 1, N Stoskute 1, E Kazakauskaite 1, R Benetis 1

Abstract

Purpose: To evaluate changes of right ventricular (RV) function early and late after mitral valve (MV) repair and to determine if tricuspid valve (TV) repair in addition to MV surgery has impact on RV function.

Methods: 37 patients (pts.) (mean age 58±7 years) with severe MV regurgitation due to MV prolapse underwent successful MV repair. Additional TV repair due to moderate – severe TV repair was performed in 18 pts (TV+group), isolated MV repair was performed in 19 pts (TV- group). 2D speckle tracking and tissue Doppler echocardiography was performed before, 7 days and 6 months after surgery.

Results: After isolated MV repair RVEDD decreased significantly and didn't change in late follow up. After additional TV repair RVEDD decreased early after surgery and more markedly 6 months later. After isolated MV repair indices of RV systolic longitudinal function decreased early after surgery and had tendency to increase after 6 months. Longitudinal strain of the lateral RV wall (S mid, S bas) decreased early after surgery and improved following 6 months. After additional TV repair decrease of longitudinal systolic RV function was the same as in isolated MV repair group and longitudinal strain had tendency to decrease. Mean pulmonary artery pressure (PAP mean) didn't change significantly in both groups (Table 1).

Conclusions: Additional TV repair in patients undergoing MV repair more markedly reduces RV dimensions and doesn't have negative impact on RV systolic function in comparison to isolated MV repair.

TV (+) TV (-)
01 02 12 01 02 12
ΔTAPSE(mm) -8.9±1.4* -7.7±1.3* 2.8±1.2 -11±1.7* -10.6±1.4* 1.9±1.1
ΔS’(cm/s) -6.2±0.5* -6.2±1.6* 1.6±1.1 -5.7±0.9* -3.6±0.9* 2.6±0.6
ΔRVEDD (mm) -4.0±0.8* -5.6±0.8* -1.6±0,6* -2.6±0.4* -2.2±0.9* -0.07±0.5
ΔS mid (εS,%) -4.8±3.0 -3.4±4.2 2.1±0.1 -9.1±2.2* -2.9±3.4 3.2±2.3
ΔS bas (εS%) -4.0±3.2 -2.2±1.3 3±1,6 -7.6±2.3* -1.4±2.8 6.1±2.4*
ΔPAP mean (mmHg) -1.8±2.0 -6.6±3.2 -3.0±1.2 -2.5±2.3 -2.6±2.4 -1.1±2.6
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Δ - paired differences, ± standard error; *p < 0.05;0 – preoperatively; 1 – early postop.; 2 – 6 months after op.d

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

Assessment of diastolic function: P979: Tissue Doppler imaging in relation with MiR-21 and miR-133 levels in patients with heart failure with preserved ejection fraction

M Marketou 1, F Parthenakis 1, J Kontaraki 1, E Zacharis 1, S Maragkoudakis 1, J Logakis 1, K Roufas 1, D Vougia 1, P Vardas 1

Abstract

Purpose: MicroRNAs (miRs) are essential regulators of gene expression implicated in cardiovascular function and disease. MiR-21 and miR-133 have been shown to play a role in heart hypertrophy and fibrosis. They have also been shown to regulate proliferation and phenotypic switch of vascular smooth muscle cells. However, there are limited data regarding their role in left ventricular (LV) diastolic dysfunction. The aim of this study is to investigate miR-21 and miR-133 levels in peripheral blood mononuclear cells in patients with heart failure with preserved ejection fraction (HFPEF).

Methods: We included 36 patients with symptoms and signs of heart failure who had an LVEF >50% and evidence of HFPEF (22 males, aged 58 ± 10 years. Blood samples were also obtained from 29 healthy volunteers for comparison (17 males, aged 52 ± 8 years). All subjects underwent a complete echocardiographic study with tissue-doppler imaging. Peripheral blood mononuclear cells (PBMCs) were isolated and microRNA levels were determined by quantitative real time reverse transcription PCR.

Results: MiR-21 levels were found to be higher (3.6 ± 0.41 versus 2.05±0.31, p < 0.05), while miR-133 levels were found to be lower (11.26 ± 4.9 versus 37.03±8.18, p<0.05) in patients with HFPEF compared to healthy controls. MiR-21 levels showed strong negative correlations with E/e' (r=-0.42, p<0.001) while miR-133 levels showed strong positive correlations with E/e' (r=0.40, p<0.001)

Conclusions: Diastolic dysfunction in patients with HFPEF was shown to have a strong relationship with miR-21 and miR-133 levels. Our findings contribute to the understanding of pathogenesis of HFPEF and might offer a future therapeutic target.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P980: The role of pulmonary artery acceleration time as an estimate of pulmonary artery pressure in patients with acute diastolic dysfunction of left ventricle due to acute myocardial infarction

E Dado 1, E Dado 2, G Knuti 1, J Djamandi 1, E Shota 1, I Sharka 2, J Saka 1

Abstract

Purpose: In patient with acute left ventricle(LV) diastolic dysfunction due to acute myocardial ischemia, evidence of increased pulmonary artery pressure (PAP), in the absence of co-morbities responsible for elevated PAP, reflects increased LV filling pressure. In the absence of tricuspid and pulmonary regurgitation, pulmonary artery acceleration time (PAAT) and its variation can be used as an estimate of PAP and its amelioration in follow up.

Methods: 94 patient with acute myocardial infarction receiving primary percutaneous intervention (PCI) during one year were included in the study. Patients with pulmonary disease, organic mitral valve disease, right ventricle myocardial infarction, atrial fibrillation were excluded from the study. Pulsed wave Doppler at the level of pulmonary valve was used to measure PAAT. Early diastolic velocity (E) to early diastolic annular velocity (E') ratio (E/E'), isovolumetric relaxation time (IVRT) and deceleration time of early filling velocity (DTE) were also measured. E' was calculated as an average of lateral and septal mitral annulus tissue velocity. Results of echocardiography performed within 12 h after procedure (echo1), at dismissal (echo2) and after one month (echo 3) were compared.

Results: Adequate measurement of PAAT was achieved in all the patients. There was significant increase of PAAT (P<0.0001, 95% confidence interval 8.43 to 10.31) between the echo2 (88.77 ±9.96) and echo1 (79.4 ± 11.82) and also between echo 3 (110.04 ±10.28) and echo2 (95% confidence interval 20.00 to 22.55 ; P<0.0001). There was a strong negative correlation between PAAT echo 1 and E/E'(R = - 0.88), a moderate positive correlation, between PAAT echo1 and DTE (R = 0.71.) and PAAT echo1 and IVRT. The increase of PAAT from echo 1 to echo 3 was strongly correlated with E/E' decrease(r 0,86) and DTE increase (R= 0,88).

Conclusion: PAAT is a very simple and reproducible technique. Its role in identifying elevated PAP especially in the setting of raised vascular resistance is almost universally accepted. In this study we conclude that PAAT is also sensitive to elevated PAP due to acute diastolic LV dysfunction and subsequent elevated capillary wedge pressure. The relationship of PAAT with diastolic indices and its variation during the time course helps in understanding clinical presentation in patient with expected diastolic dysfunction and for follow up.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P981: Acute myocarditis and early diastole: abnormal recoil behaviour?

L Halmai 1, A Nemes 2, A Kardos 1, S Neubauer 3

Abstract

The clinical presentation of viral myocarditis varies from non-specific symptoms and ECG changes to sudden cardiac death. Making the diagnosis is challenging as conventional 2D and Doppler echocardiographic indices are neither sensitive, nor specific for detection of cases with preserved LV systolic function. 3-D Speckle Tracking Echocardiography (3D-STE) can quantify myocardial deformation reproducibly. We proved earlier reduced Strain (S) and Strain Rate (SR) indices in affected segments, but data on early diastolic properties have been scarce in this population.AiMS: To investigate if patients with acute myocarditis, but preserved systolic function will have abnormalities of early diastole, determined by restoring forces. We also investigated if the focal myocardial oedema in these patients had effects on LV recoiling properties.METHODS: 15 consecutive patients with acute myocarditis were examined (age 35.5±17.0). Diagnosis was based on clinical data and confirmation by cMRi (T-2 weighted study with focal hyperenhancement on LGE). Conventional 2D- and Doppler analysis and 3D-STE were done on Toshiba Artida 4D. Diastolic indices: Untwisting rate (UTR) measured at 25% of diastole, Untwisting Time (UTT) measured from aortic valve closure to peak untwist. Corrected Recoil Rate (REC) as [(TwistES–TwistMVO/ TwistES) x 100]/iVRT was calculated. Peak basal and apical rotation (Rot), their differences as Twist (T) measured. A "Planar index" calculated at each segment as relative change from the mean of actual plane= [(actual – mean)/mean)]x100, to compensate for the basal-to-apical differences in degree of deformation.RESULTS: patients had normal LV size and systolic function (EDV:105.9±14.8,ESV:45.7±15ml, EF:56.2±15.5%). Basal Rot reduced (-5.1±5.0), with preserved apical values (9.3±2.2o), leading to increased Twist by +13.1% (14.4±3.1o). UTT lengthened to 181±48ms (by 22.9%, p<0.02), while UTR slowed down by 34.8±31.9% (basal: 65.2±5.6 o/s, p<0.005), 26.7±2.8% (mid: 73.3±4.9 o/s, p<0.01) and -3.5±1.9% (apical: 104o/s, p=ns). The REC was reduced in affected segments (by -33.1%, at 30.9±13.7 o/s, p<0.03). The conventional diastolic parametres were within normal limits in all patients. CONCLUSiONS: Patients with acute myocarditis and normal LVEFs showed signs of dysfunction of early diastolic indices at basal and mid regions with inflammatory changes on cMRi examination. The deranged recoil probably imply oedematous changes in affected segments. 3D deformation parameters have the potential to improve the detection of patients with myocarditis and preserved LVEFs.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P982: Usefulness of standard echo parameters of Left Ventricular diastolic function, particularly lateral mitral annulus velocity for prognosis in young morbidly obese women after bariatric surgery

K Kurnicka 1, J Domienik-Karlowicz 1, B Lichodziejewska 1, S Goliszek 1, K Grudzka 1, M Krupa 1, O Dzikowska-Diduch 1, M Ciurzynski 1, P Pruszczyk 1

Abstract

Purpose: Cardiovascular diseases contribute to high mortality in morbid obese patients. Aim of study was to evaluate the changes of left ventricular diastolic function after weight reduction (WR) in morbidly obese women half year after bariatric surgery.

Methods: We studied 60 women (mean age 37, BMI 47,5) in III obesity class, without overt heart disease, with well controlled BP, with sinus rhytm and good ejection fraction, before and 6 months after gastric bypass or vertical gastric banding. Clinical parameters, cardiac dimensions and wall thickness, mitral E/A ratio, E' velocities and E/E'ratio of the septal and lateral mitral annulus, velocities of systolic (S), diastolic (D) and atrial reversal (Arev) pulmonary venous flow, S/D ratio and left atrial area (LAa) were assessed. Additionally plasma NT-pro-BNP level, reflecting ventricular filling pressure was measured.

Results: Average WR was 35,7kg (26,9%) and BMI decreased to 34,8. Reduction of systolic and diastolic blood pressure, correlating with WR (r=0,42,p=0,01) was observed. After surgery mitral E/A and pulmonary diastolic velocity D were higher (1,15±0,26 vs 1,27±0,32, p=0,03/ 0,44±0,09 vs 0,49± 0,12m/s, p=0,02) and S/D was lower (1,41±0,27 vs 1,28±0,43, p=0,04) than before. LA area decreased after WR (17,3±2,6 vs 16,2±2,4cm2, p= 0,02). Postoperative lateral annulus velocity E' was especially significantly higher (12,7±3,0 vs 15,7±3,6 cm/s, p<0,001) and lateral E/E'was lower (7,5±2,2 vs 6,6±2,1, p=0,04) than preoperative, what indicates better LV relaxation. A negative correlation between WR and E' velocity was found. Pre- and postoperative EF, Arev, septal E' and E/E' and NT-pro-BNP values didn't differ signifficantly.

Conclusion: The lateral mitral annulus velocity E' is especially useful and easy obtained standard parameter reflecting the improvement of left ventricular relaxation in morbidly obese women shortly after bariatric surgery.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P983: Left Ventricular filling pressure as a determinant of Atrial Fibrillation recurrence after cardioversion

H Chung 1, JY Kim 1, YW Yoon 1, PK Min 1, BK Lee 1, BK Hong 1, SJ Rim 1, HM Kwon 1, EY Choi 1

Abstract

Purpose: Left ventricular (LV) filling pressure is associated with left atrium (LA) fibrillation and affects atrial fibrillation (AF) recurrence after chemical or electrical cardioversion. We investigate the predictors of AF recurrence in patients undergoing continued antiarrhythmic drug (AAD) therapy after cardioversion.

Methods: Sixty-six patients (57 males, mean 58±12 years) with newly diagnosed persistent AF were prospectively enrolled. All the patients were converted to sinus rhythm by either chemical or electrical cardioversion. Flecainide was administered continuously to maintain sinus rhythm after cardioversion. We evaluated the differences between the patients with (group 1) and without AF recurrence (group 2) during the follow up period and assessed predictors of AF recurrence after cardioversion.

Results: Group 1 showed larger LA diameter, larger LA volume index, and increased E/E' compared to group 2 (all p<0.05). During a mean follow-up period of 25±19 months, the recurrence rate of AF after cardioversion was 60.6% (40/66). Multivariate logistic regression analysis revealed that E/E' [odds ratio (OR): 1.332, 95% confidence interval (CI): 1.004–1.767, p=0.047] was an independent predictor for AF recurrence after cardioversion. The area under the Receiver Operating Characteristics (ROC) curve of E/E' for AF recurrence was 0.780 (95% CI: 0.657–0.903, p=0.000).

Conclusion: Baseline LV filling pressure predicts the risk of AF recurrence in patients with persistent AF after cardioversion.

Figure.

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ROC curve for E/E' for AF recurrence

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P984: Diastolic wall strain: assessment in comorbid patients with arterial hypertension and chronic obstructive pulmonary disease

OV Soya 1, OV Kuryata 1

Abstract

Background: The traditional non-invasive parameters of left ventricular (LV) diastolic function have limitation during the pseudonormal and restrictive LV filling patterns. The recent studies in patients with heart failure provided data concerning novel echocardiographic index of LV function – so called diastolic wall strain (DWS) index, which could represent a less load-dependent measure of LV diastolic wall stiffness. But there is no data about DWS index in comorbid patients with arterial hypertension and chronic obstructive pulmonary disease (COPD). The aim of our study was to assess DWS index in patients with arterial hypertension and COPD.

Methods: Observed 49 patients with Hypertension (39 male, mean age 55.3 +/- 4.1 years) and 56 hypertensive patients with COPD (43 male, mean age 57.1 +/- 4.3 years; FEV1 = 61,7+/-4.9%). Twenty healthy age-matched non-smokers served as a control group. Echocardiography were performed for all patients with assessment LV filling pattern and DWS as difference between posterior wall thickness (PWT) at end-systole and end-diastole divided by the PWT at end-systole.

Results: Diastolic wall strain was lower in controls (0.19 ± 0.08) than in patients with arterial hypertension and COPD (0.29 ± 0.09, P < 0.001). There were no difference found between patients with AH and hypertensive patients with COPD (0.28 ± 0.08 vs 0.31 ± 0.09, P > 0.05). DWS correlated with mitral E/A ratio in hypertensive patient (p=0.03), because of close relation between DWS and LV stiffness. The patients in both groups had higher LV mass index and relative wall thickness compare with controls.

Conclusion: The patients with arterial hypertension and hypertensive patients with COPD had increasing of DWS, which could reflect growth of LV diastolic wall stiffness. The increasing of DWS could be predictive for future cardiovascular events.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

Ischemic heart disease: P985: Experimental studies of whether echocardiographical strain and strain rate indexes are as reliable as invasive indexes to detect 75% coronary stenosis

R Kakihara 1, C Naruse 1, A Inayoshi 2

Abstract

Purpose: We conducted animal experiments to confirm significant 75% coronary artery stenosis (CAS) causes segmental left ventricular wall dysfunction and significant myocardial ischemia. We also tested how significant 75% CAS behaves hemodynamically. We collected indexes using both echocardiography and invasive devices. All procedures were performed in accordance with the Declaration of Helsinki of the World Medical Association.

Methods: Twenty coronary arteries of ten pigs anesthetized with 100% O2 were divided into two groups: normal coronary artery group (grN) and single 75% stenosis group (gr75). Ultrasonic systems used in this experiment were Vivid S5 Bt13 and EchoPAC PC Bt13. 1.5/4.0 MHz active-matrix array (AMA) probe was used. As non-invasive indexes, peak systolic strain value (PSS) and Z value of strain rate z variable we created (SRZ) were used. Z variable was: Z = 4.91+ 1.02×(100-ms SR value)+1.23×(200-ms SR value)–0.46×(minimum SR value)+4.83× (mean SR value). As invasive indexes, coronary blood flow (CBF) and fractional flow reserve (FFR) were measured. Blood flow probes (t-402M Transonic System, Inc, USA) to measure coronary blood flow (CBF) and vascular occluders (DOCXS Occluder, BIOMEDICAL PRODUCTS & ACCESSORIES, Inc, USA) were placed on the LAD #6 and/or 7, and on the LCX #11 and/or 13. Fractional flow reserve (FFR) were measured with Primewire Prestige® PLUS Pressure Guide Wire. 75% CAS produced by vascular occluders was confirmed by measuring the diameters of coronary arteries using coronary angiography. The grN and gr75 of the four indexes were compared by a paired t-test.

Results: The results of ROC analysis of the four indexes were as follows. PSS(%): grN -17.78±3.54, gr75 -14.98±2.23, sensitivity(Sn); 0.71, specificity(Sp); 0.67, accuracy(Ac); 0.75, discriminant probability(Dp); 0.682 (cut-off value -16.38≤). SRZ: grN -1.85±0.53, gr75 1.87±0.83, Sn; 1.00, Sp; 0.96, Ac; 0.98, Dp; 0.926 (cut-off value 0.13≤). CBF(ml/min.): grN 54.83±5.54, gr75 17.41±6.56. Sn; 1.00, Sp; 1.00, Ac; 1.00, Dp was 0.998 (cut-off value ≤31.4). FFR(%): grN 0.99±0.01, gr75 0.81±0.14, Sn; 0.38, Sp; 1.00, Ac; 0.69, Dp; 0.806 (cut-off value ≤0.75). There was significant difference between grN and ge75 of each index (PSS, SRZ and CBF: p<0.0001, FFR: p<0.01).

Conclusion: The results proved decreased CBF of 75% CAS caused segmental LV wall systolic dysfunction. The non-invasive strain rate value of Z valiable is more reliable than the invasive index of FFR and is almost the same as CBF to detect 75% CAS.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P986: Validity of postsystolic shortening velocity detected by Tissue Doppler Echocardiography for prediction of coronary artery disease in patients with normal resting wall motions

MAHA El Sebaie 1, ABDEL Frer 1, MAGDY Abdelsamie 1, AHMED Eldamanhory 1

Abstract

Background: Postsystolic shortening (PSS) is a delayed ejection motion of the myocardium occurring after the aortic valve closure during a prolonged isovolumic relaxation time, previous studies had shown the relation between PSS and myocardial ischemia.

Aim of the work: To assess the value of PSS detected by tissue Doppler imaging (TDI) in prediction of coronary artery disease (CAD) in patients with chest pain and normal resting wall motions.

Patients and Methods: The study included 80 subjects, 41females (51%) & 39 males (49%),who were enrolled for coronary angiography because acute chest pain,non diagnostic ECG and normal resting wall motion .All patient subjected to standard 2-D echocardiography, and (TDI) with measurement of :peak velocity of Systolic ejection phase (S'), postsystolic shortening (PSS), Early diastolic relaxation phase (E'), Atrial contraction phase (A') and Isovolumic contraction phase (VIC).

Results: According to coronary angiography, Patients were divided into 2 groups, group A (patients with CAD) It included 60 patients and group B (patients without CAD) It included 20 patients: PSS was found more frequent in group A compared group B (32 % vs 13 % P<0.01). At mid LV level the PSS velocity was significantly higher in ischemic segments compared to non-ischemic segments: mid anterior wall (4.1±3.5 VS 1.1±2.8,P<0.05),mid lateral wall (4.6±3.7 VS 2.6±0.85,P<0.001), mid septal wall (4.3±3.4 VS 4±1.6, p<0.05), and mid inferior wall(5.3±3.5 ±VS 1±4.9, P<0.001). Kappa agreement test showed significant association between positive PSS velocity and angiographic evidence of significant CAD(P<0.001). Left ventricular wall analysis of the association between the presence of postsystolic shortening and obstructive lesions of the related arteries showed strong correlation by a General Liner Model analysis (p<0.001) . ROC curve showed cut off value of PSS velocity for prediction of CAD(anterior wall 4.1 cm/sec,lateral wall 4.8cm/sec,septal wall 4.4cm/sec, and inferior wall 4.2cm/sec).with sensitivity(63.3%,69.5%, 63.3%, and 73.3)and specificity of (80%, 85%,85%, and 80%)respectively.

Conclusion: Detection of PSS by TDI may be a useful noninvasive, non provocative indicator of CAD in patients with chest pain and normal left ventricular wall motion.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P987: Echocardiographic predictors of in-hospital events in patients with Acute Coronary Syndrome

Q Ciampi 1, L Cortigiani 2, A Simioniuc 2, C Manicardi 1, B Villari 1, E Picano 3, R Sicari 3

Abstract

Background: Aim of our study was to evaluate the role of echocardiography performed at admission in the risk stratification of patients with acute coronary syndrome (ACS).

Methods: 173 patients were prospectively enrolled (mean age 67±13 years, 127 men) for ACS (91 STEMI and 82 NSTEMI). Of the STEMI patients, 68 (74%) were treated with primary PCI and 20 (21%) with thrombolysis. Rest echocardiography was performed at hospital admission, before any treatment. Assessment of lung water was performed by determining the presence of ultrasound B-lines (at least 5 detectable in lung examination).

Results. During hospitalization 39 events occurred: 13 acute heart failure, 10 cardiogenic shock, 8 ventricular fibrillation and 8 deaths. Patients with events were older (75±12 vs 64±11 years, p<.001), showed longer hospitalization (10±11 vs 6±2 days, p<.001), higher end-systolic volume (61±34 ml vs 50±23, p=.024), left atrial volume index (38±16 ml/m2 vs 30±11 ml/m2, p<.001), and E/e'(15.8±6.9 vs 10.5±5.3, p<0.001), lower TAPSE (16±5 mm vs 21±4 mm, p<.001), and lower ejection fraction (42±11% vs 52±9%, p<.001), higher incidence of moderate-severe mitral regurgitation (38% vs. 9%, p<.001), restrictive transmitral pattern (71% vs 5%, p<.001), and presence of B-Lines (78% vs 21%, p<.001). Univariate and multivariate predictors of in-hospital events are reported in the Table 1. At Cox multivariable regression analysis, the presence of B-Lines and restrictive transmitral pattern, were independent predictors of in-hospital events

Conclusions: Chest ultrasound imaging plays an important role in the identification of patients with in-hospital events.

Univariate analysis
 Multivariate analysis
HR (95% CI) p value HR (95% CI) p value
Age (years) 1.026 (0.997-1.057) 0.082
Sex (male) 0.931 (0.449-1.934) 0.849
STEMI (%) 1.614 (0.789-3.299) 0.190
LV end-systolic volume (ml) 1.001 (0.991 -1.010) 0.909
LV ejection fraction (%) 0.986 (0.958 -1.015) 0.346
Restrictive transmitral pattern (%) 4.784 (2.181-10.493) <0.001 3.259 (1.360-7.812) 0.008
Mitral regurgitation (moderate to severe) 2.470 (1.253-4.867) 0.009
B-lines (>5) 3.737 (1.480-7.687) 0.004 2.659 (1.036-6.827) 0.042
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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P988: Assessment of Left Ventricular twist and untwist rate in a rat model of Myocardial Infarction

V Ferferieva 1, D Deluyker 1, I Lambrichts 2, JM Rigo 1, V Bito 1

Abstract

Purpose: Left ventricular (LV) twist and untwist rate (UR) are known to be strongly related to LV systolic and diastolic function, respectively. Although these parameters are emerging as important tools to evaluate LV function, yet their assessment and physiological significance in small animals remain challenging. The study was designed to investigate how twist and UR, measured by speckle tracking imaging (STI), relate to LV function and extent of fibrosis in a rat model of chronic myocardial infarction (MI).

Methods: 23 Sprague-Dawley rats were subjected to LAD ligation (MI; n=14) or sham surgery (SHAM; n=9). 2D echocardiography at baseline (BL), day 1, day 3 and 2 months post-surgery was used to calculate LV dimensions, volumes (EDV, ESV) and global functional parameters. STI was applied to measure circumferential strain (Scirc), twist and UR. LV fibrosis was estimated from Sirius Red staining at day 1, day 3 and 2 months post-surgery.

Results: Progressive cardiac failure evaluated during 2 months was characterized by a gradual increase in EDV and ESV respectively (0.2±0.04 mL to 0.8±0.2mL, and 0.04±0.02mL to 0.5±0.1 from BL to 2 months post-surgery, p<0.05) along with depressed ejection fraction (76±9 to 32±11%, p<0.05). Peak LV twist and UR progressively decreased over time and were associated respectively with a decreased Scirc (r=-0.58, p<0.001) and an increased myocardial fibrosis (r=-0.70, p<0.001) (fig.1).

Conclusion: Assessment of LV twist and UR is feasible in small animals. Worsening of these parameters is associated with a progressive impairment of LV function in rats with chronic MI and correlates with the amount of fibrosis present in the tissue.

Figure.

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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P989: Factors associated with Right Ventricular dilatation in patients with prior Q-wave myocardial infarction

VA Kuznetsov 1, EI Yaroslavskaya 1, DV Krinochkin 1, GS Pushkarev 1, EA Gorbatenko 1

Abstract

Detection of right ventricular (RV) dilatation in patients with coronary artery disease is very important to identify subjects at high risk for adverse cardiovascular events. Data about factors associated with RV dilatation in patients with prior Q-wave myocardial infarction (MI) are insufficient.

Purpose: To reveal factors associated with RV dilatation in patients with prior Q-wave MI.

Methods: Out of 16839 patients from coronary angiography database we selected patients with prior Q-wave MI without congenital or acquired valvular heart disease: 1263 patients without RV dilatation (end-diastolic RV outflow tract diameter measured by echocardiography ≤27 mm) and 99 patients with RV dilatation (RV outflow tract diameter ≥30 mm).

Results: There were more male patients in the group with RV dilatation (97.0% vs 89.6%, p=0.018). Body mass index (BMI) was higher in this group (31.0±5.1 kg/m2 vs 29.4±4.6 kg/m2, p=0.003). Patients with RV dilatation more often had a higher NYHA functional class (III/IV - 50.5% vs 17.4%) and arrhythmias (45.5% vs 17.8%, both p<0.001). There were no differences in prevalence of high CCS angina classes (III/IV) and coronary angiographic parameters between the groups. Mean left ventricular (LV) mass index determined by echocardiography was higher in patients with RV dilatation (168.4±44.5 g/m2 vs 136.0±31.0 g/m2), reduced LV systolic function (LV ejection fraction <50%) and significant mitral regurgitation were more often in those patients (71.7% vs 32.9% and 52.5 vs 12.4%, all p<0.001, respectively). According to multivariate analysis RV dilatation was independently associated with male gender (OR=4.75; 95% CI 1.37-16.47; p=0.014), higher index of LV mass (OR=2.80; 95% CI 1.37-5.74; p=0.005), significant mitral regurgitation (OR=2.67; 95% CI 1.72-4.16; p<0.001), reduced LV systolic function (OR=2.41; 95% CI 1.38-4.23; p=0.002), arrhythmias (OR=1.79; 95% CI 1.05-3.03; p=0.031), higher NYHA functional class (OR=1.70; 95% CI 1.15-2.51; p=0.008) and higher BMI (OR=1.07; 95% CI 1.02-1.13; p=0.011).

Conclusions: RV dilatation in patients with prior Q-wave MI was predominantly associated with male gender, higher BMI and parameters describing severity of LV dysfunction and remodeling.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P990: Recovery of left ventricular function among patient after mycordial infarction - the significance of serum leptin and resistin concentration and metabolic syndrome

P Trzcinski 1, BW Michalski 1, P Lipiec 1, E Szymczyk 1, L Peczek 2, B Nawrot 2, L Chrzanowski 1, JD Kasprzak 1

Abstract

Aim: The aim of the study was to evaluate the association between improvement of the left ventricular function and the concentration of the selected adipokines in long term follow-up among patients with ST-segment elevation acute myocardial infarction (STEMI) in regard to the presence of the metabolic syndrome (MeS).

Material and Methods: The study population comprised 69 patients (49 male; mean age 59±10 years) with first STEMI treated with primary percutaneous coronary intervention (pPCI). In this group 33 patients (18 male; mean age 60±15years) had MeS. Within 72 hours after STEMI an echocardiographic examination with the estimation of the left ventricular ejection fraction (LVEF) was performed. Additionally baseline clinical evaluation included clinical examination, evaluation of blood level of C-reactive protein, leptin, resistin, fasting glucose and lipid profile (blood samples were taken within 24 hours). Wall motion score index (WMSI) was also assessed. The complete clinical evaluation was repeated after 12 months (mean 11.1±2.7 months).

Results: The mean baseline concentration of leptin in patients without MeS was statistically significant lower than in patients with MeS (75±77ng/ml vs 205±210ng/ml; p<0.05). Also after 12 months of follow-up in both groups the concentration of leptin has increased, however was lower in group without MeS (158±129ng/ml vs 341 ± 308ng/ml; p< 0.05, respectively). The concentration of leptin >52,18 pg/ml had a very good predictive value (AUC= 0.81, p<0.001) for the improvement of LVEF in patients without MeS. Also the concentration of resistin > 4419,27 ng/ml had a good predictive value (AUC = 0.67, p=0.049) for the improvement of LVEF in patients without MeS. WMSI has improved in both groups from 1.41± 0.27 to 1.29± 0.33. The concentration of resistin has decrased in 12 months of follow-up in both groups (patients without MeS: 5220 ± 2945ng/ml vs 4039 ± 21744039 ± 2174,p <0.05 and in patients with Mes: P>0.05), but only in patients without MeS it was statistically significant. LVEF in patients with MeS after STEMI was 43±8% and 50±8% after 12 months, whereas in patients without MeS it was 44±8% and 52±7%, respectively. Among patients with MeS none of the adipokines has reached the statistically significant values.

Conclusions: The improvement of the LVEF after 12 months follow-up was observed only in patients without metabolic syndrome with increased concentration of leptin and resistin. The concentration of leptin in patients with STEMI treated with pPCI increased in 12 month of follow-up, regardless to the presence of metabolic syndrome.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

Heart valve Diseases: P991: Atrial mechanics and stiffness as predictors of prognosis in asymptomatic severe Aortic Stenosis

MC Todaro 1, C Zito 1, BK Khandheria 2, M Cusma-Piccione 1, S La Carrubba 3, F Antonini-Canterin 4, V Di Bello 5, G Oreto 1, G Di Bella 1, S Carerj 1

Abstract

The purpose of the present study was to evaluate the prognostic value of left atrial (LA) mechanics and stiffness in a prospective cohort of 82 asymptomatic patients (31 men, mean age 73±10 years) with severe aortic stenosis (AS) and normal left ventricular ejection fraction.

Methods: By the use of 2-dimensional speckle tracking echocardiography, LA reservoir, strain rate and stiffness, LV strain, rotations, and twist were evaluated. The predefined end points were the occurrence of symptoms,aortic valve replacement and death.

Results: At study entry, all patients had reduced LA reservoir (19.6±5%) and LV global longitudinal strain (LVGLS) (-15.3±3%), enhanced Zva (7.3 ±0.7 mm Hg/ml/m2) and LA stiffness (0.9±0.1). During follow-up (17.2±15.3 months) 53 patients (64.6%) reached the predefined end-points. No difference was found between symptomatic and asymptomatic patients as regards LV ejection fraction, LA volumes and AS severity. On the contrary, patients with events had lower indexed stroke volume p=0.001), LVGLS (p<0.001), LA reservoir (p<0.001) and higher LV mass (p=0.007), Zva (p<0.001) and LA stiffness (p<0.001), than those asymptomatic. Patients with lower LA reservoir (≤ 19.3%, median value) and higher LA stiffness (≥ 0.89, median value) had significantly worse event-free survival (figure 1). When the global population was split according to the median of LVGLS and Zva (GLS ≥ -15.2% and Zva ≤ 6.26 mmHg/ml/m2), amoung patients with minor impairment of LVGLS and Zva, the subgroup with events had significantly lower LA reservoir (p=0.01 and p=0.02, respectively) and higher LA stiffness (p=0.02 and p=0.02, respectively) if compared to the asymptomatic;

Conclusion: LA mechanics may be a relevant contributor to the prognostic stratification of patients with asymptomatic severe AS.

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event-free survival curves

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P992: How many patients would be reclassified to non severe Aortic Stenosis when measuring pressure recovery?

E Gunyeli 1, C Oliveira Da Silva 1, A Sahlen 1, A Manouras 1, R Winter 1, K Shahgaldi 1

Abstract

Background: Patients having severe aortic valve stenosis (AS) based on pressure gradients, effective orifice area (EOA) and peak velocity have class I indication for aortic valve replacement when having symptoms or left ventricular ejection fraction <50%. When assessing the AS severity using transvalvular pressure gradient or EOA the extent of pressure recovery downstream the AS is not accounted. Energy Loss Index (ELI) is a concept which takes pressure recovery in account when evaluating the severity of AS. We aimed to study the prevalence of pressure recovery measuring ELI in patients classified as severe AS and to investigate how many patients would be reclassified to non-severe AS when taking pressure recovery in account.

Methods: Fifty patients (20 women and 30 men, mean age 77±8.3 years) were retrospectively included in this study. All patients had severe aortic valve stenosis according to EOA (0.7±0.2 cm2), mean pressure gradient (49.5±15.5mmHg) and peak transvalvular velocity (4.4±0.6 m/s). ELI was calculated according to the following equation: EOA×Aa/(Aa-EOA)/m2, where Aa is the aortic area at the level of the sinotubular junction. A cutoff >0.6cm2/m2 was used for diagnosing non severe aortic valve stenosis by ELI.

Results: Using the ELI concept to measure pressure recovery 13 patients (6 women and 7 men) were reclassified having non severe AS. There were no significant differences regarding age in the non severe AS ELI group in comparison to the severe AS ELI group (78.7±6.9 year vs. 79.3±9.2 year, p=ns). ELI in the 2 groups differed significantly (0.7±0.04cm2/m2 vs. 0.4±0.1cm2/m2, p<0.05). No statistical significant differences were observed between groups regarding the ST junction dimension (2.4±0.2cm vs. 2.6±0.4 cm, p=0.098). The non severe AS ELI group had significant higher EF compared to the severe AS ELI group (62.9±6.9% and 56.7±4.3% respectively, p<0.05). The ventricular septum dimension was significantly smaller in the non severe AS ELI group compared to the severe AS ELI group (10.8±0.8mm vs. 12.5±0.8mm, p<0.0001.

Conclusion: Our study demonstrates that pressure recovery in AS is common and occurs in 27% of the patient population leading to overestimation of the AS severity. We therefore recommend ELI to be measured routinely for accurate AS assessment when quantifying the severity of AS.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P993: Metabolic burden is associated with more pronounced impairment of the longitudinal strain in patients with severe aortic stenosis referred for valve surgery: 2D speckle tracking analysis

RA Spampinato 1, M Tasca 1, JG Roche E Silva 1, E Strotdrees 1, V Schloma 1, Y Dmitrieva 1, M Dobrovie 1, MA Borger 1, FW Mohr 1

Abstract

Background: Recently it was demonstrated that metabolic syndrome (MetS) is associated with more pronounced left ventricle (LV) dysfunction in patients with asymptomatic aortic stenosis (AS), assessed by tissue Doppler. The aim of this study was to examine the relationship between the combination of risk factors related with MetS and LV longitudinal strain in patients with severe AS referred for valve surgery (AVR).

Method: A comprehensive echocardiogram was prospectively performed on 137 consecutive patients (70±9.6years; 79 men) with severe AS (valve area -AVA- index 0.36±0.09cm2/m2) referred for AVR to a tertiary center. The LV ejection fraction (EF) and the global longitudinal peak systolic strain (GLPS) were determined at the time of admission. Patients were considered to have a combination of risk factors: "metabolic burden" (MetB) when at least 3 of the 4 following criteria were present: body mass index (BMI) >30; dyslipidemia (known altered LDL / HDL cholesterol, or under treatment); elevated blood pressure (>130/85 mm Hg or use of medications for hypertension); and diabetes or a random plasma glucose >200mg/dl.

Results: Patients were divided in two groups: 39 (28.5%) with MetB, and 98 without MetB. Patients with a MetB had higher body surface area (2.05±0.2 vs. 1.87±0.2 m2; p <0.001) with higher BMI (33.4±5.6 vs. 26.5±4 Kg/m2; p <0.001) but similar height (166±10 vs. 168±9.7 cm; p 0.28). They also were more likely to have previous history of stroke (5 [13%] vs. 3 [3%]; p 0.04), renal injury (14 [36%] vs. 8 [8%]; p <0.001), and carotid artery lesions >mild (12 [31%] vs. 13 [13%]; p <0.001), but comparable coronary artery disease (13 [33%] vs. 28 [29%]; p 0.70). They had similar AS severity (AVA 0.69±0.17 vs. 0.69±0.16 cm2; p 0.92), but higher valvulo-arterial impedance (Zva: 6.5±2 vs. 5.6±1.5 mmHg/ml.m2; p 0.008), trans-tricuspidal gradient (40±12 vs. 32±9.5 mmHg; p 0.001), E/é ratio (18.6±7.6 vs. 15.6±5.8; p 0.01), worse GLPS (-13.7±4.1 vs. -16.1±3.3%; p 0.001), and a trend to have a higher LV mass index (75±22.5 vs. 67.5±20 g/m2.7 ; p 0.07) and operative mortality (3 [7.7%] vs. 1 [1%]; p 0.07) compared to patients without a MetB. Finally, after adjustment for age, sex, CAD, history of renal injury, AS severity, and Zva, the presence of a MetB remained independently associated with worse GLPS (p=0.003).

Conclusions: MetB is independently associated with more pronounced impairment of the LV longitudinal strain in patients with severe AS, regardless of aortic valve area and afterload imposed on LV, which may, in turn, predispose them to worse postoperative outcomes.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P995: Left Ventricular torsional dynamics in symptomatic versus asymptomatic patients with severe Aortic Stenosis and preserved Left Ventricular ejection fraction

A Calin 1, M Rosca 1, CC Beladan 1, A Mirescu Craciun 2, MM Gurzun 2, A Mateescu 2, R Enache 1, C Ginghina 1, BA Popescu 1

Abstract

In patients (pts) with severe aortic stenosis (AS) and normal left ventricular ejection fraction (LVEF) the occurence of heart failure symptoms is related not only to AS severity but to a variety of other factors including LV function. Although apical rotation and LV torsion are increased and LV untwisting is delayed in pts with severe AS, their role in the progression of AS to the symptomatic state is not clear yet.

Purpose: To comparatively assess LV torsional deformation in asymptomatic versus symptomatic pts with a similar degree of AS and normal LVEF (>50%).

Methods: We studied 27 consecutive asymptomatic pts (63±10 years, 17 men) and 27 age, gender and AS severity matched symptomatic pts (63±13 years, 17 men), all with severe AS (indexed aortic valve area<0.6 cm2/m2, 0.45±0.09 and 0.44±0.09 cm2/m2, respectively) and preserved LVEF, without coronary artery disease and no more than mild aortic or mitral regurgitation. A comprehensive echocardiogram was performed in all, including LV longitudinal and torsional deformation analysis by speckle tracking echocardiography.

Results: All symptomatic pts had exertional dyspnea (NYHA class 2 in 24 and class 3 in the remaining 3 pts), 12 pts had chest pain and one patient presented a syncope. There were no differences between asymptomatic and symptomatic pts regarding the presence of arterial hypertension and diabetes mellitus (p>0.2 for all). Valvuloarterial impedance was not significantly different between groups (p=0.8). We found no significant differences between asymptomatic and symptomatic pts regarding LV relative wall thickness (p=0.9), indexed LV volumes and mass (p=0.8), LVEF (p=0.3), septal and lateral peak systolic myocardial velocities (p>0.6 for both). Global longitudinal LV strain was not significantly different between groups (-15.6±3.1 vs. -16.1±3.2%, p=0.5). The degree of LV diastolic dysfunction and E/e' ratio were similar in both groups, although symptomatic pts tended to have larger left atria (13.9±3.2 vs. 12.3±2.4 cm2/m2, p=0.05). Peak apical rotation was significantly higher in asymptomatic vs symptomatic pts (25.4±6.2 vs 21.9±4.7°, p=0.03). Peak basal rotation, LV torsion and untwisting parameters were all similar between groups (p>0.4 for all).

Conclusion. Left ventricular apical rotation is significantly higher in asymptomatic pts with severe AS compared to symptomatic pts with the same degree of valvular and global LV load, despite similar changes in LV geometry and function. This suggests a possible implication of a progressive loss of increased LV apical rotation in the transition to the symptomatic state in pts with severe AS.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P996: Exercise test, Nt proBNP and echocardiographic paramaters in asymptomatic ptc. with severe valvular aortic stenosis

E Antova 1, LJ Georgievska Ismail 1, E Srbinovska 1, V Andova 1, I Peovska 1, J Davceva 1, M Otljanska 1, M Vavulkis 1

Abstract

Aim: Assess the significance of the echocardiographic, exercise test (ET) parameters as predictors of occurrence of symptoms and/or death, and relation of the Nt – proBNP value to the echo and ET parameters in asymptomatic ptc with severe AS (ASAS).

Material: 58 ASAS ptc with normal left ventricle function EF>50%., monitored for 02-36 months with median follow up period of 19.5±10 months.

Results Echocardiography: LVEDd (mm) 50.9±5.5; LVEDs (mm) 29.3±5.5; EF (%)69.5±5.2; AV_Vmax (m/s) 4.3±0.5; AV_Max Grad (mmHg) 75.5±20.6; AVA (cm2) 0.7±0.2; IVSd (mm) 14.6±1.8; LVPWd (mm) 11.5±1.8. Ptc with AVA<0.7 cm2 had 6.7 times greater chances to get abnormal answer SBP in ET vs ptc with AVA≥0.7cm2. 25% have annual progression rate of the AV_Vmax≥0.3 m/sec/year. Median Nt - proBNP in ASAS ptc was 404±425 (pg/ml). Exercise test (symptom limited, modified standard Bruce protocol treadmill test performed to ptc age≤70): 44 ptc (76%) – positive ET and 14 ptc (24%)- negative ET. Occurrence of event in 30% and they all are in the group with positive ET. Out of 44 ptc with positive ET, symptoms occurred in 27.3%. Analysis of predictors of events showed that only occurrence of symptoms during ET with OR 4.63 (95%CI 1.16-18.56) was confirmed as statistically significant (SS) predictor which increases the chances for event by 4.63 times. (p=0.03). Event free survival for a median follow up period of 19±10 months (2-36) was found in less than 5% of ptc with symptoms at ET and in 50% of ptc without symptoms at ET. 69% of ptc had abnormal SBP response during ET (if the increase of SBP was less and/or equal to 20 mmHg or in case of SBP drop) and 31% had normal SBP response during ET (where BPS increase is greater than 20 mmHg). There is SS negative correlation between higher values of Nt-proBNP and small BPS increase during ET (r=-0.21, p=0.03). Nt–proBNP has positive correlation with: occurrence of ST-segment depression during ET (r=0.28, p<0.03) and occurrence of positive exercise test (r=0.38, p<0.003). After 36 months, only 21% of the ptc with abnormal SBP response to ET will have event free survival vs. 75% of the ptc with normal BPS response to ET. The change of SBP during ET with OR 0.95 (95% CI 0.91-0.99) proved as SS predictor in making the decision for referral of ASAS ptc to aortic valve replacement (AVR). (p=0.01).

Conclusion: in addition to the echo parameters, Nt-proBNP from serum and ET parameters only in real ASAS ptc with severe AS have enormous predictive significance in revealing of the risk group that will experience rapid worsening and possible death in order to refer them to AVR in time.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P997: Significance of longitudinal strain and strain rate for prediction of symptomatic status in severe aortic stenosis

H Tsuruta 1, S Kohsaka 1, M Murata 1, R Yasuda 1, M Dan 1, F Yashima 1, T Inohara 1, Y Maekawa 1, K Hayashida 1, K Fukuda 1

Abstract

Background: The cardiac function related to the symptomatic status has remained unclear in severe aortic stenosis (AS). The purpose of this study was to evaluate the relationship between the symptom and the longitudinal systolic and diastolic function of left ventricle via two-dimensional speckle tracking strain analysis (2DS) in patients with severe AS.

Methods: We studied 90 consecutive patients with severe AS (indexed aortic valve area (AVA) 0.6) and LVEF 50%. Symptomatic status was determined according to careful history. Global longitudinal LV strain (GLS) and strain rate (SR) parameters (systolic: SRs, early diastolic: SRe, late diastolic: SRa) were assessed by 2DS.

Results: There were no significant differences in mean PG, indexed AVA, and valvuloarterial impedance between symptomatic (n=63) and asymptomatic patients (n=27). In contrast, stroke volume index, GLS, LV-SRs and LV-SRe were significantly lower in symptomatic patients compared with asymptomatic patients (46.4±8.1 vs 50.6±9.1, p<0.05; -13.1±2.7 vs -15.4±2.8, p<0.001; -0.77±0.17 vs -0.89±0.18, p<0.001; 0.64±0.21 vs 0.87±0.30, p=0.001). By multivariate analysis controlling for clinical factor (age, prevalence of CAD) and parameters of AS severity, GLS and LV-SRe (OR 1.374, p=0.001; OR -1.744, p=0.001) were independently associated with symptomatic status in severe AS. Especially, patients with syncope demonstrated significantly reduced GLS and LV-SRs compared with patients without syncope (-11.6±2.9 vs -14.0±2.9, p<0.05; -0.66±0.17 vs -0.83±0.17, p<0.05), and patients with dyspnea on effort demonstrated significantly reduced GLS and LV-SRe compared with patients without (-13.0±2.9 vs -14.8±2.7, p=0.003; 0.64±0.21 vs 0.80±0.30, p=0.006).

Conclusion: Decreased longitudinal strain and strain rate were associated with symptomatic status in severe AS, and may therefore be important markers of disease severity in AS.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P998: Diastolic heart failure in severe aortic stenosis: the role of left atrial function and arterial stiffness

R Migliore 1, ME Adaniya 1, MA Barranco 1, G Miramont 1, S Gonzalez 1, H Tamagusuku 1

Abstract

Purpose: Heart failure (HF) in severe aortic stenosis (AS) is more common in patients with low ejection fraction (EF). However patients with preserved EF could present HF (HFpEF). We hypothesized that many abnormalities in patients with HFpEF would be shared by patients without HF but that other changes would be observed more selectively in HFpEF. Objective: To evaluate differences in patients with severe AS and preserved EF with and without HF.

Methods: We studied 61 patients, age average 72 ± 12 years, 42 men, with severe AS (AVA < 1 cm2) and preserved EF (>50%) with Doppler echocardiography. LV diastolic function was assessed by E/E'ratio, left atrial (LA) function by LA volume index, total emptying fraction and conduit volume (CV). CV was calculated as a percentage of LV filling: (stroke volume – (LA maximal volume – LA minimal volume)) / stroke volume x 100. Arterial stiffness was estimated by effective aortic elastance (Ea) LV systolic function was assessed by midwall shortening fraction (mFS) and S wave obtained by Doppler tissue imaging. Geometry was assessed by relative wall thickness and LV mass index. According to the presence of HF (NYHA III-IV) patients were divided in two groups: HFpEF (n= 10) and without HF (n=51).

Results: see Table

Conclusions: Patients with severe AS and HFpEF were older than patients without HF and presents more LA dysfunction, aortic stiffness and LV longitudinal systolic dysfunction (S wave) despite similar EF, mFS and geometric changes.

HFpEF Without HF p Value
Age (yrs) 76 ± 10 67 ± 11 0.03
EF (%) 63 ± 3 66 ± 8 0.275
AVA (cm2) 0.57 ± 0.25 0.68 ± 0.21 0.163
E/É 17 ± 7 13 ± 5 0.269
LA volume index (ml/m2) 56 ± 17 44 ± 12 0.012
LA emptying fraction (%) 33 ± 12 43 ± 13 0.023
CV (%) 60 ± 12 37 ± 19 0.001
Ea (mmHg/ml) 1.9 ± 0.5 1.5 ± 0.4 0.021
mFS (%) 18 ± 4 20 ± 6 0.361
S wave (cm/s) 5.8 ± 1 7.1 ± 1.5 0.04
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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P999: Echographic assessment of right ventricle function in patients with rheumatic mitral stenosis: 2D speckle tracking imaging study

L Abid 1, S Ben Kahla 1, S Charfeddine 1, D Abid 1, S Kammoun 1

Abstract

Background and objective: Does rheumatic mitral stenosis (RMS) distort right ventricle function (RV). We aim to assess RV function in patients with RMS by 2D speckle tracking imaging and to depict correlation with the severity of valvulopathy.

Methods: Thirty two patients with isolated RMS were assessed for RV function by two dimensional (2D) longitudinal strain imaging and compared with that from eleven healthy age matched controls.

Results: Patients with RMS didn't experienced significantly lower global RV systolic strain (-20.5 vs. -22.5 %; p= 0.3); as well as segmental strain at mid, apical septum and basal, mid and apical RV free wall. However, only segmental strain at basal septum was significantly lower (-14.7 vs. -18.5%; p= 0.04). Mean mitral valve area (MVA) (according to planimetric method) was 1.3 cm2 (vs. 3.7 cm2 in controls; p<0.0001). in addition, they had higher estimated pulmonary artery systolic pressure (ePASP) (43.7 vs. 20.2 mmHg; p< 0.0001). Neither tricuspid annular plane systolic excursion (TAPSE) nor peak systolic velocity at lateral tricuspid annulus was significantly changed between 2 groups. There was a correlation between global RV longitudinal systolic strain in the septum (all segments basal, mid and apical) and heart rhythm (p=0.005; r= 0.44), mitral surface (p= 0.07; r=-0.3) and ePASP (p=0.01; r=0.43). This finding was more illustrated in the regional RV strain in the basal septum segment which was disproportionately correlated to MVA (p=0.017; r= -0.4) and also significantly correlated to ePASP (p=0.013; r=0.43), mean MV gradient (p= 0.05; r= 0.33) and left atrium area (p=0.023; r=0.36). TAPSE was correlated in mid segments in both septum and RV free wall (p= 0.003; r=- 0.47 and p= 0.039; r= -0.34 respectively).

Conclusions: RV systolic function is impaired in patients with RMS and can be assessed by global and segmental RV strain.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1000: Natural history and predictors of aortic regurgitation after surgical repair of subarterial infundibular ventricular septal defect ; long-term follow-up data

M Amano 1, C Izumi 1, M Miyake 1, T Tamura 1, H Kondo 1, K Kaitani 1, Y Nakagawa 1

Abstract

Objectives: Patients with subarterial infundibular ventricular septal defect (VSD) are recommended to undergo early surgery because of development of aortic regurgitation (AR) with aortic valve prolapse or herniation and rare closure of the defect in the natural course. AR progression after surgical VSD repair has been reported and some patients undergo aortic valve surgery for the progressive AR. However, there are few reports about frequency and predictors of AR progression after VSD repair.

Methods: We retrospectively investigated 122 consecutive patients with repair for subarterial infundibular VSD since 1972, and picked up 99 patients with follow-up echocardiography for more than 3 years after VSD repair. Preoperative clinical background, Qp/Qs, diameter of VSD, mean pressure of pulmonary artery (m-PA), operative procedure, chronological changes of AR after VSD repair, and existence of aortic valve surgery for progressive AR were evaluated.

Results: The mean follow-up period after VSD repair was 13.3±6.6 year, and there were 9 patients with aortic valve surgery at VSD repair (group A) and 90 patients with VSD repair alone (group B). During the follow-up period, moderate or severe AR developed after VSD repair in 6 patients in group A (66.7%) and 7 patients in group B (7.8%), and time interval between development of moderate or severe AR and VSD repair was 6.7±3.7 year in group A and 13.1±7.2 year in group B (p=0.07). In group B, 7 patients showed increase in AR (group P) and 83 patients did not (group N), and clinical and echocardiographic data was compared between 2 groups. There were no differences in preoperative age, Qp/Qs, VSD size, m-PA and severity of AR between 2 groups. However, the incidence of residual VSD leak after VSD repair was higher in group P than group N (42.9% vs 2.4%; p<0.05). All patients in group P showed either of sclerosis, constriction or deformation of valve cusp or leaflet in right coronary cusp resulting in the limited motion, and 6 patients revealed eccentric regurgitant jet toward anterior mitral valve.

Conclusion: Among patients with subarterial infundibular VSD, incidence of AR progression was high in patients who underwent aortic valve surgery at VSD repair, but 7.8% of the patients also showed AR progression even in patients with VSD repair alone. Existence of postoperative VSD leak may be a risk factor of AR progression in patients after VSD repair alone, which may be caused by limited motion of valve leaflet in the right coronary cusp.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1001: New insights in the morphology and detailed echocardiographic analysis of mitral leaflets in patients undergoing mitral valve repair

S Ghulam Ali 1, L Fusini 1, G Tamborini 1, M Muratori 1, P Gripari 1, V Bottari 1, F Celeste 1, C Cefalu' 1, F Alamanni 1, M Pepi 1

Abstract

Purpose: Morphology and detailed analysis of the mitral valve (MV) apparatus has a central role in the preoperative evaluation of patients with MV prolapse (MVP) undergoing repair. A recent study focused on histological features of MVP (on resected central scallop-P2) showed that chordae tendinae may be missing or hidden in the superimposed fibrous tissue of the leaflets, contributing to their thickening. The aim of this study was to analyze morphology of MV leaflets focusing on thickness of the prolapse segments and coexistence of rupture chordae (RC).

Methods: A total of 101 patients (age 63±13 years, 79 male) with isolated P2 prolapse and 11 age-matched patients (age 61±5 years, 8 male, control group NL) with normal MV,were enrolled. Transthoracic echocardiography were retrospectively analyzed to quantify the length and the proximaland distal thickness of the central scallop of both anterior (A2) and posterior (P2) leaflets. Measures were performed at end diastole in the apical 3-chamber and/or parasternal long axis views.

Results: MV leaflets measures were feasible in all patients. Concerning chordae visualization, 71 patients has one or more RC (group A), 13 has no RC (group B), and 17 has an uncertain diagnosis (group C). No differences were found among group A, B, and C, while all pathological groups showed significant thickening and elongation of involved leaflets vs NL (Table).

Echocardiographic results

Group A
 Group B
 Group C
 NL
A2 P2 A2 P2 A2 P2 A2 P2
Proximal thickness [mm] 3.2±0.8† 3.8±0.9*† 3.1±0.8† 3.8±0.8*† 3.0±0.7† 4.1±0.9*† 2.3±0.5 2.4±0.5
Distal thickness [mm] 3.9±1.3† 4.2±1.2† 3.7±1.7† 4.0±1.2† 3.5±1.3† 4.4±1.2*† 2.0±0.0 1.9±0.3
Length [mm] 27.0±3.6† 21±3.4† 25.6±3.5 20.8±3.7† 25.2±2.5 19.8±2.9 23.6±3.2 18.0±2.4
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*p<0.05: proximal/distal A2 vs proximal/distal P2 thickness;†p<0.05: vs NL

Conclusions. The majority of patients undergoing MV repair has RC, and presented with marked thickening of the prolapsed segment. These findings are in agreement with recent new histological studies showing the presence of hidden chords included in MV leaflets. This may also explain the fact that,in cases without RC, thickness of the leaflet is markedly increased (hidden chordae?). A comprehensive evaluation of MV morphology and detailed analysis of MV apparatus may further improve knowledge of these patients and may influence surgical timing.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1003: Usefulness of the right atrium stiffness index in chronic tricuspid regurgitation, a pilot study

R Teixeira 1, R Monteiro 2, J Garcia 1, M Ribeiro 1, N Cardim 3, L Goncalves 4

Abstract

Introduction: The non-invasively assessed right atrium (RA) stiffness index (RASI) is a promising tool to evaluate the atrial performance.

Purpose: To assess the relationship between chronic functional tricuspid regurgitation (TR) and the RASI.

Methodology: We included 55 consecutive patients referred for transthoracic echocardiography during a 2 month period with optimal apical and parasternal views for precise quantification of TR, and for the study of RA myocardial mechanics. The RASI was calculated as: (RA E/e') / (rɛR). The RA E/e' reflected right ventricle (RV) filling pressures; and rɛR was the RA reservoir phase strain (ɛR), assessed with 2D-speckle tracking echocardiography. The TR volume (TRV) was calculated according to the PISA method.

Results: The median age of the population was 78.0 (64.0 – 84.0) years, with female gender predominance (63.6%). The median RASI was 0.35 (0.17 – 0.49). RASI correlated significantly with heart rate, RA systolic area (RASA) (r=0.46, p<0.01), RV diastolic diameter, IVC collapsibility (r=-0.45, p<0.01), RV S' wave, pulmonary artery systolic pressure and pulmonary vascular resistance (PVR) (r=0.53, p<0.01). We noted a significant positive correlation between RASI and TR volume (r=0.56, p<0.01). RASI was significantly higher for the atrial fibrillation in comparison with the sinus rhythm patients [0.39 (0.23-0.63) vs 0.26 (0.14 -0.40, p<0.01]. Contrary to the RA reservoir phase – and strain rate, RASI correlated significantly with heart failure symptoms (NYHA class). In a multivariate linear regression model adjusted to heart rate, RASA and PVR, both TRV (β 0.36, p<0.01) and RV S' (β-0.44, p<0.01) were independent predictors of the RASI.

Conclusions: In our population RASI was significantly influenced by the TRV and it had an important correlation with the patient symptomatic status.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1004: Three-dimensional tricuspid annulus surface area is a better predictor of functional tricuspid regurgitation severity than conventional 2D-echocardiography diameters

MH Miglioranza 1, D Muraru 2, G Cavalli 2, K Addetia 3, U Cucchini 3, S Mihaila 4, M Tadic 2, F Veronesi 5, RM Lang 3, L Badano 6

Abstract

Background: Development of functional tricuspid regurgitation (FTR) is caused by tricuspid annulus (TA) enlargement. Despite the complex 3D geometry of TA, current guidelines recommend measuring the TA diameter using two-dimensional echocardiography (2DE) to select patients for tricuspid annuloplasty However, the accuracy of 2DE vs three-dimensional echocardiography (3DE) in assessing the TA size remains to be established.

Objective: Since there is no perfect gold standard in humans, we compared the role of 2DE diameters and 3DE TA surface area (TASA) to predict the severity of FTR.

2DE vs 3DE TA geometry and TR severity

3DE TR severity parameters 3DE TASA 2DE TA diameter (4-CH) 2DE TA diameter (PLAX)
3D Effective ROA (mm2) 0.78 0.408 0.114
3D PISA (cm2) 0.727 0.418 0.105
3D Regurgitant volume (ml) 0.754 0.453 0.03
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2DE, two-dimensional echocardiography; 3DE, three-dimensional echocardiography; 4-CH, 4-chamber view; PISA, proxymal isovelocity surface area; PLAX, parasternal long-axis view; ROA, regurgitant orifice area; TA, tricuspid annulus; TASA, tricuspid annulus surface area; values are reported as Pearson's r coefficients.

Methods: A prospective cross-sectional study of 24 patients (66±15 years, 58% women) with severe (30%) and non-severe (70%) FTR was performed. All patients underwent a complete 2DE and 3DE study with a Vivid E9 scanner (GE Vingmed, Horten, N). TA diameters in 4-chamber and in parasternal long-axis RV inflow (PLAX) views were obtained, and 3D TASA was quantified using a prototype software dedicated for transthoracic 3DE datasets. FTR severity was quantified using 3D eSie PISA (Acuson SC2000, Siemens).

Results: In comparison with 2DE TA diameters, TASA showed tighter correlations (p<0.0001) with 3D parameters of FTR severity (Table). Considering the FTR severity as outcome, ROC curve analysis revealed that TASA has a greater predictive power to discriminate severe from non-severe FTR (area under curve, AUC=0.84, 95% CI: 0.64 – 1) than 2DE TA diameters measured in 4-chamber view (AUC=0.63, 95%CI: 0.23 – 1) or PLAX (AUC=0.51, 95%CI: 0.07-0.75).

Conclusion: FTR severity is more closely related to 3DE TASA than to conventional 2DE TA diameters. Our results suggest that the quantification of 3DE TASA by dedicated software could be favoured over conventional 2DE linear measurements when assessing TA remodelling.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1005: Transcatheter aortic valve implantation in patients with left ventricular dysfunction: Does basal two-dimensional strain have predictive value?

L Galian Gay 1, MT Gonzalez Alujas 1, G Teixido Tura 1, L Gutierrez Garcia 1, JF Rodriguez-Palomares 1, A Evangelista Masip 1

Abstract

Introduction: Severe aortic stenosis associated with left ventricular systolic dysfunction posses a risk for conventional aortic valve replacement. Transcatheter aortic valve implantation (TAVI) is an alternative treatment for these patients. The aim of the study was to analyse changes in left ventricular ejection fraction (LVEF) and left ventricular longitudinal systolic strain (GLS) and ascertain which parameters predict LVEF improvement after TAVI.

Methods and Results: 130 patients were selected for TAVI because of inoperable severe aortic stenosis. Left ventricular systolic dysfunction (LVEF < 55%) was present in 33 (25.4%). Technical approach was transfemoral, transapical and transaortic in 51.5%, 36.4% and 12.1% of cases, respectively. LVEF was measured using the biplane Simpson's method and GLS was obtained by speckle-tracking analysis. Before implantation, LVEF was 39.1 ± 9.2% and GLS -9.9 ± 2.8%. Immediately after the TAVI procedure, LVEF improved significantly (43.9 ± 9.7%; p=0.001) but GLS did not (-10.3 ± 2.9%; p=0.538). After a mean follow-up period of 1.81 ± 1.4 years, LVEF also showed a significant improvement compared to the basal situation (46.7 ± 11; p= 0.008), but was not significant compared with the immediate post-implantation (-10.3 ± 2.9; p=0.538). GLS improved significantly compared to basal situation (-12.9 ± 4.3%; p= 0.006), and also to the immediate postoperative exam (-13.5 ± 4.5%; p=0.044). Comparison of basal GLS > 9% (N=19) versus GLS ≤9% (N=14) showed the results of the table.

Conclusions: Patients with aortic stenosis with left ventricular systolic dysfunction presented a significant improvement in GLS one year after TAVI. Pre-TAVI basal GLS>9% was associated with a greater increase in left ventricular ejection fraction after the procedure. Thus, GLS may provide additional information for TAVI candidate selection.

LVEF and GLS according to basal GLS

GLS ≤9% (n:14) GLS >9% (n:19) p
LVEF (%) before TAVI 33.35±8.33 42.79±6.71 0.0001
GLS (%) before TAVI -7.32±1.65 -11.48±1.85 0.0001
LVEF (%) immediate post-TAVI 36.96±9.07 47.58±6.34 0.0001
GLS (%) immediate post-TAVI -8.81±1.74 -11.71±3.05 0.003
LVEF (%) long-term follow-up 40.27±12.71 50.42±6.75 0.006
GLS (%) long-term follow-up -11.05±5.24 -14.49±2.63 0.019
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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1006: Different patterns of remodelling predict different outcomes after tavi-potential role of non-invasive estimation of left ventricular capacitance

L Conte 1, I Fabiani 1, C Giannini 1, S La Carruba 1, M De Carlo 1, V Barletta 1, AS Petronio 1, V Di Bello 1

Abstract

Purpose: The evaluation of the prognostic impact of Left ventricular capacitance (LVC) in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). TAVI is a new technique for aortic valve replacement, even if the high incidence of paravalvular leak (PVL) has a detrimental role. We describe a non-invasive method to estimate end-diastolic pressure volume relationship (EDPVR).

Material and Methods: 240 patients affected by aortic valve stenosis (AS) undergoing TAVI were divided in groups according to EF value (A: 160 pts; EF >50%/ B: 80 pts; EF < 50%). Group A was stratified in sub-groups according to LVC (C: 124 pts, preserved/ D: 36 pts, reduced). Patients performed echocardiography before TAVI. For the estimation of EDPVR the single beat method was used. Haemodynamic data were invasively determined with a fluid-filled catheter. Angiographic method to grade PVL was used. Primary end-point was 1 year all- cause death.

Results: Overall, NYHA class, AVAi, EF and significant PVL after TAVI were associated with all- cause mortality (NYHA:HR 1.816;p=0.0245;AVAi:HR 2.480;p=0.0038;PVL:HR 2.622;p=0.0025). Group B had the worst prognosis but only AVAi was associated with outcome (AVAi:HR 3.4;p=0.0011). In Group A PVL (HR 5.1;p=0.0002), NYHA class (HR 2.4;p=0.013) and EDV20 mmHg (HR 0.94;p=0.006) were independent risk factors for all-cause mortality. EDV20mmHg<78 ml carried an increased 1 year all-cause mortality risk (HR 4.2;p=0.0001). One year mortality risk related to PVL is further stratified by LVC (Chi-squared: X2=6.73;p=0.008).

Conclusions: A significant PVL has a negative impact only in patients with a preserved EF. A reduced LVC is associated with a worst outcome in patients with a preserved EF. A significant PVL after TAVI in presence of reduced LVC has an incremental prognostic role.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1007: Imaging of the inter-atrial septum using three-dimensional trans-esophageal echocardiography during trans-catheter mitral valve edge-to-edge & annuloplasty repair

H Mahmoud 1, M Al-Ghamdi 2, A Ghabashi 2

Abstract

Purpose: Two-dimensional trans-esophageal echocardiography (2DTEE) has a crucial role in monitoring trans-septal puncture & coronary sinus (CS) cannulation. The purpose of the study was to detect the incremental value of real-time three dimensional trans-esophageal echocardiography (RT-3DTEE) in imaging of the interatrial septum (IAS) during these procedures.

Methods: Using a 3DTEE matrix-array transducer, twenty studies were done over a period of three months. Among those 20 patients who underwent trans-catheter mitral valve repair for symptomatic severe mitral regurgitation, 10 patients had trans-catheter mitral edge-to-edge repair & 10 patients had trans-catheter mitral annuloplasty using CS ring. Starting from the 2D mid-esophageal bi-caval view, the 3D zoom mode was activated to acquire a RT-3D volume for the IAS, then the whole volume was anatomically oriented to provide the en-face view of the IAS septum from the right atrial perspective. By reducing the gain to a certain level we were able to create a drop-out artifact in the middle of the septum that correlated to the fossa (the thin septum).

Results: An informative en-face view of the IAS from the right atrial perspective was acquired in all of the 20 patients. However, CS identification was only possible in 7 out of the 10 patients underwent trans-catheter mitral annuloplasty. We were able to guide the puncture catheter to the proper puncture site and the CS catheter during CS cannulation.

Conclusions: RT-3DTEE has an incremental value in guiding the trans-septal puncture as well as CS cannulation during trans-catheter mitral valve repair procedures. It created a common language between the echocardiographer & the interventionist by providing an anatomically oriented en-face view of the IAS that made the procedure easier & faster.

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En-face view of the IAS from the RA side

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1008: Hemodynamic and regurgitation after TAVI. An in vitro study

E Salaun 1, AS Zenses 2, M Evin 2, F Collart 1, P Pibarot 3, G Habib 1, R Rieu 2

Abstract

Background: Observations of EDWARDS SAPIEN prosthesis (ED SA) once deployed in vivo, shows a frequent elliptic geometry, which can cause inadequate transvalvular hemodynamic and the occurrence of valvular regurgitation (intra and/or para). Objectives : This study aims to quantify in vitro, hemodynamic and valvular regurgitation of ED SA in circular and elliptic deployment conditions.

Methods: A pulsed simulator reproducing the human circulation was used. ED SA 23 and 26 were implanted in circular annulus with increasing diameter (18, 20, 22 mm for the size 23 and 21, 23, 25 mm for 26) and in 4 elliptic annulus for each size prosthesis (3 annulus with increasing Eccentricity Index (EI) at 0.17, 0.26, 0.33 starting to a small fixed diameter and 1 with the smallest and biggest diameters of circular annulus). The Effective Orifice Area (EOA) was calculated by the continuity equation and mean transvalvular gradient (TVG) were obtained by Doppler. The performance index (PI=100x(EOA/annulus area)) was calculated. The ultrasound allowed the research of regurgitation, quantified by flow measurement.

Results: The highest TVG were observed for circular annulus 18 and 20 mm, respectively 17.7 and 12.2 mmHg, which was correlated with the lowest EOA (1.27 and 1.44 cm2). We observed a mismatch leaflets-stent for annulus 18 with plicature of leaflets. Hemodynamic parameters and mean PI (48.5 vs 43.2) were better with elliptic geometry than circular. No significant intraprosthetic regurgitation was observed. Just 1 paraprothetic regurgitation occured for the ED SA 26 in the elliptic annulus with largest EI (0.33), due to a gap beetween the stent of ED SA and the annulus. Conclusions : Hemodynamic parameters of ED SA obtained in vitro with elliptic geometry appear to be better than those with circular. A "leaflets-stent mismatch" ca occur in the case of undersizing in annulus with smaller area. No intra-prothetic regurgitation occured in circular and elliptic deployment.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

Cardiomyopathies: P1009: Prognostic impact of late gadolinium enhancement and noninvasive estimation of pulmonary vascular resistance by Cardiac Magnetic Resonance in patients with chronic heart failure

O Fabregat Andres 1, J Estornell Erill 2, A Cubillos-Arango 1, B Bochard-Villanueva 1, N Chacon-Hernandez 1, L Higueras-Ortega 1, L Perez-Bosca 1, R Paya-Serrano 1, F Ridocci-Soriano 1, J Cortijo-Gimeno 3

Abstract

Purpose: Pulmonary hypertension is associated with poor prognosis in heart failure (HF). Recent studies have demonstrated that pulmonary vascular resistances (PVR) could be accurately measured by cardiac magnetic resonance (CMR). Our objective was to evaluate the prognostic value of both late gadolinium enhancement (LGE) as high PVR in HF patients.

Methods: Prospective registry of patients admitted for acute decompensated HF from July 2011 to April 2014. Readmission for HF and all-cause mortality were considered as primary endpoint at follow-up.

Results: 149 patients (65.3 years, LVEF 34.8%, ischemic 39%) were included. Patients with primary event had higher RVP: 6.65±2.9 vs. 4.29±1.7 Wu (p<0.001); and a tendency to more frequent presence of LGE: 71.4 vs. 28.6% (p=0.074). Kaplan-Meier curve using both factors allowed stratify patients into groups with remarkably different prognosis (Figure). Multivariable analysis identified high PVR as the only independent predictor (Table).

Conclusions: Combined use of noninvasive estimation of PVR and LGE presence by CMR might be useful in risk stratification of patients with chronic HF.

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Kaplan-Meier survival curve

Multivariate Cox regression analysis

Variable HR (95% CI) p value
Left ventricular ejection fraction 0.99 (0.97-1.01) 0.68
Right ventricular ejection fraction 1.01 (0.99-1.03) 0.27
Presence of LGE on CMR 2.17 (0.99-4.74) 0.053
PVR by CMR > 5.2 Wu 4.52 (1.91-10.71) 0.001
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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1010: Left atrial peak systolic strain predicts ventricular arrythmia in non-ischemic dilated cardiomyopathy

K Mzoughi 1, I Zairi 1, M Jabeur 1, F Ben Moussa 1, K Mrabet 1, S Kamoun 1, S Fennira 1, A Ben Chaabene 1, S Kraiem 1

Abstract

Background: In patients presenting with non-ischemic dilated cardiomyopathy, we investigated the relation between left atrial (LA) deformational parameters evaluated by two-dimensional speckle tracking imaging (2D-STI) with the occurrence of complications such as acute heart failure or ventricular arrythmia.

Methods: Forty patients presenting with non-ischemic cardiomyopathy were included. These patients had echocardiographic examination. In addition to conventional echocardiographic parameters, LA strain curves were obtained for each patient. Average peak LA strain values during left ventricular (LV) systole (LAs-strain) were measured.

Results: The average age of patients was 60 years ± 10. The sexe ratio was 4/1. Sixty percent of patients were smokers. Half of the population had hypertension. Only thirty percent of them had diabete mellitus which was insulino-dependant in the majority of cases. The average of ejection fraction of left ventricle (SIMPSON BP) was 35,7% ± 9. Only twenty percent of the patients have presented ventricular arrythmia during six months of follow. The mean atrial peak systolic strain was altered (24%). Comparing the peak LA strain in the group that has presented ventricular arrythmia to the group that has not presented ventricular arrythmia, we noted a significant difference between them (23,4 ± 4,5 vs. 24,1 ± 8,2 ; p=0,000). Las-strain had significant correlation with the occurrence of ventricular arrythmia (p=0,000). Also significant correlation between LAs-strain and LA volume (p=0,003) was detected. Thirty-two percent of the population have presented acute heart failure during six months of follow. There was no relation beween LAs-strain and acute heart failure (the average peak LA in the group that has presented acute heart failure= 23,3 ± 3,1 vs. 24,7 ± 4,7 In the group that has not presented heart failure, p= 0,56).

Conclusion: Our study showed that LAs-strain decreased consistently with deteriorating systolic function. LAs-strain is also a predictor of ventricular arrythmia in patients with non-ischemic dilated cardiomyopathy.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1011: Understanding alteration of longitudinal deformation in hypertrophic cardiomyopathy: insights from multimodality imaging

F Schnell 1, J Betancur 2, M Daudin 3, A Simon 2, PA Lentz 4, F Tavard 2, A Hernandes 2, F Carre 1, M Garreau 2, E Donal 3

Abstract

Purpose: Previous studies have described an alteration in left ventricular (LV) strain in patients with hypertrophic cardiomyopathy (HCM). One hypothesis is that alteration in systolic function is related to myocardial fibrosis. The aim of the study was to compute the regional mechanical characteristics of the myocardium by using speckle-tracking echocardiography (STE) with the structural tissue information obtained by CMR late-gadolinium-enhancement (LGE-MR), and to describe their relationship at a global and regional level.

Methods: In 28 HCM patients, regional and global longitudinal strain, LV mass/m2 and % of LGE were measured. A registration was performed between the 4CH- and 2CH- longitudinal STE contours and the endocardial surfaces of the left ventricle (LV) extracted from the cine-MR short-axis view sequences. The LGE-MR image were then registrated to the corresponding STE contours. The alignment of STE contours and LGE-MR image was assessed for each segment.

Results: There was a significant correlation between global longitudinal strain (GLS) and LV mass/m2 and % of LGE (respectively r=0.487, p=0.018; r=0.489, p=0.013). Regional 2D longitudinal strain value in the segments with fibrosis was dramatically decreased in comparison with the segments without fibrosis (-12.3±5.7% vs. -17.0±5.8%, p<0.0001).

Conclusions: In HCM patients, myocardial fibrosis is associated with a decrease in longitudinal 2D strain on both global and regional level. STE could be used to select patients in whom a further CMR would be warranted to detect myocardial fibrosis.

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Fusion of LGE-CMR and STE images

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1012: Is fluid mechanics impaired in patients with non-obstructive hypertrophic cardiomyopathy compared with healthy subjects? Analysis of vortex formation time by 2D and 3D echo

MCD Abduch 1, MLC Vieira 1, M Antunes 1, W Mathias 1, C Mady 1, E Arteaga 1, AM Alencar 2

Abstract

During diastole, blood enters the ventricles in a vortical pattern that promotes optimization of diastolic filling, decreasing the energy demand and properly positioning the jet to be ejected at systole. Vortex formation time (VFT), a dimensionless measurement of the optimal vortex development inside the ventricles during the early diastolic filling, is a universal number related to the fluid impulse and thrust; normal values varies from 3.5-4.5. Patients with non-obstructive hypertrophic cardiomyopathy (NOHCM) have, at first, diastolic dysfunction with normal LVEF. Hypothesising that VFT is an earlier marker of myocardial injury, this study aimed to compare VFT analysed by 2DE and 3DE between patients with NOHCM and healthy controls.

Methods: VFT was measured in 35 patients with NOHCM (60% males) and in 35 age and gender matched healthy controls by pulsed wave Doppler, 2D and 3DE as 4(1-β)/p x α3 x LVEF, where 1-β is related to the E wave contribution to the LV filling and α3 expresses the mitral valve (MV) opening. Statistical level was settled on 5%. Results: see Table.

Conclusion: VFT is diminished in patients with NOHCM and normal LVEF when compared with healthy volunteers, by both 2D and 3DE, indicating impairment of the myocardial function entirely, and suggesting that this is an earlier marker of systolic dysfunction amongst this population. Alterations in this parameter of fluid mechanics may imply the need of treatment in this group of patients, even in the presence of normal LVEF.

Parameter Healthy Volunteers Patients with NOHCM P
Age (years) 37 (9) 36 (12) 0.807
Septal thickness (mm) 8 (1) 20 (5) <0.001
LV wall thickness (mm) 7 (1) 9 (2) <0.001
2D iLAV (ml/m2) 21 (5) 42 (15) <0.001
2D LVEF (%) 62 (4) 62 (5) 0.723
3D LVEF (%) 56 (5) 55 (11) 0.362
E/é 6 (1) 9 (3) <0.001
3D iLV mass (g/m2) 73 (8) 83 (11) <0.001
2D VFT 3.35 (1.11) 2.25 (1.13) <0.001
3D VFT 4.40 (0.86) 2.96 (1.02) <0.001
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Results expressed in mean (SD);iLAV- indexed left atrial volume; LVEF- left ventricular ejection fraction. P<0.05 (Student's t test).

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1013: Influence of haemodynamic values and morphologic characteristics on basal coronary flow velocity in patients with hypertrophic cardiomyopathy with or without obstruction

M Tesic 1, A Djordjevic-Dikic 1, B Beleslin 1, V Giga 1, D Trifunovic 1, O Petrovic 1, I Jovanovic 1, M Petrovic 1, J Stepanovic 1, B Vujisic-Tesic 1

Abstract

Background: Impairment of coronary flow velocity reserve in patients (pts) with hypertrophic cardiomyopathy (HCM) is predominately due to increased basal diastolic coronary flow velocity (BCFV). Also elevated LV filling pressure and wall stress (as a result of diastolic dysfunction and elevated rate pressure product (RPP)) might additionally increase BCFV. The aim of the study was to compare BCFV of left anterior descending coronary artery (LAD) in HCM with or without obstruction, and control group, as well as to evaluate the relationship between BCFV with echocardiographic parameters, plasma levels of NT-pro-BNP, and E/e' ratio as predictors of the LV wall stress and LV filling pressure.

Methods: In 61 pts (27 men; mean age, 49±16 years) with asymmetric HCM (20 pts with and 41 pts without LV outflow tract (LVOT) obstruction) and in 20 healthy age- and sex-matched subjects, transthoracic echocardiographic examination with measurement of BCFV in LAD was done. E/e' ratio was measured to estimate LV filling pressures. LV RPP was calculated as ([peak LVOT gradient+systolic blood pressure] x heart rate).

Results: There was significant difference in BCFV between HCM and control group (0.35±0.08 vs. 0.25±0.03, p<0.001), and between HCM patients with and without LVOT obstruction (0.40±0.09 vs. 0.33±0.07, p=0.002). Values of interventricular septal thickness (IVS) thickness, LV mass, LVOT gradient, RPP, plasma levels of NT-pro-BNP and the ratio of E/e' were significantly higher in HCM with obstruction compared to both controls and HCM without obstruction. BDFV correlated with IVS thickness (r=0.449; p<0.001), LV mass (r=0.404, p<0.001), LVOT gradient (r=0.416, p=0.001), RPP (r=0.506, p<0.001), NT-pro-BNP (r=0.428, p=0.001), and ratio of E/e'(r=0.340, p=0.013).

Conclusion: BCFV was significantly higher in HCM with obstruction compared to the HCM without obstruction and control group, confirming the influence of HCM morphology on coronary hemodynamics. In addition there was a significant positive relation between BCFV and filling pressures, IVS thickness, LV mass and wall stress.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1014: Diverse geometric changes related to dynamic left ventricular outflow tract obstruction without overt hypertrophic cardiomyopathy

EY Choi 1, JJ Cha 1, H Chung 1, KH Kim 1, YW Yoon 1, JY Kim 1, BK Lee 1, BK Hong 1, SJ Rim 1, HM Kwon 1

Abstract

Background: Dynamic left ventricular (LV) outflow tract (LVOT) obstruction (DLVOTO) is not infrequently observed in older individuals without overt hypertrophic cardiomyopathy (HCM). We sought to investigate associated geometric changes and then evaluate their clinical characteristics.

Method: A total of 168 patients with DLVOTO, which was defined as a trans-LVOT peak pressure gradient (PG) higher than 30 mmHg at rest or provoked by Valsalva maneuver (latent LVOTO) without fixed stenosis, were studied. Patients with classical HCM, acute myocardial infarction, stress induced cardiomyopathy or unstable hemodynamics which potentially induce transient-DLVOTO were excluded.

Results: Their mean age was 71±11 years and 98 (58%) patients were women. Patients were classified as pure sigmoid septum (n=14) if they had basal septal bulging but diastolic thickness less than 15 mm, sigmoid septum with basal septal hypertrophy for a thickness ≥15 mm (n=85), prominent papillary muscle (PM) (n=20) defined by visually large PMs which occluded the LV cavity during systole, or as having a small LV cavity with concentric remodeling or hypertrophy (n=49). The prominent PM group was younger, had a higher S'and lower E/e' than other groups. In all groups, a higher peak trans-LVOT PG was related to E/e', right atrial pressure and pulmonary arterial systolic pressure. In multivariate analysis, resting trans-LVOT PG correlated to pulmonary arterial pressure (β=0.200, p=0.016) after adjustment for E/e', septal thickness and right atrial pressure.

Conclusion: DLVOTO develops for various reasons, and patients with prominent PMs have distinct characteristics. DLVOTO-relieving medication may potentially reduce pulmonary pressure in this group of patients.

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Diverse types of LVOTO

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1015: Cardiotoxic effects of different anthracyclines compared to liposomal doxorubicin in an experimental study with echocardiography and magnetic resonance imaging

J Bergler-Klein 1, C Geier 2, G Maurer 1, M Gyongyosi 1

Abstract

Introduction: Anthracycline chemotherapy is a cornerstone in malignancies such as breast cancer or lymphomas. Cardiotoxicity with LV dysfunction is a major concern in cancer survival. Liposome encapsulation limits the cytostatic delivery to healthy tissues. Aim of this experimental study was to investigate the cardiotoxic effects of 3 chemotherapeutics, doxorubicin (DOX), Epirubicin (EPI) and a liposome–encapsulated doxorubicin–citrate complex (Myocet, MYO) using echocardiography, cardiac magnetic resonance imaging (cMRI), biomarkers and histology.

Methods: Twenty-four pigs were randomised to human dose-equivalent of either conventional DOX, or EPI, or MYO in 3 cycles. Transthoracic echocardiography and cMRI with late gadolinium enhancement was performed before treatment start and at 3 weeks after the last dose. The left and right ventricular systolic ejection fraction (EF), and diastolic (peak filling rate, PFR) function were calculated. Myocardial fibrosis was assessed as hyperintensity in LE diastolic phase images. Plasma NT-proBNP was determined using porcine-specific ELISA at baseline and final follow-up. Blood hematology, liver and kidney parameters at each treatment cycle and final follow-up were obtained. Left and right myocardial segments were stained with Picrosirius red to quantify histologic cardiac fibrosis.

Results: The baseline echocardiographic and laboratory parameters did not differ between groups. After 3 cycles of chemotherapy, the EPI group was excluded from the final analysis due to low survivals (2/9 EPI vs 5/6 DOX, 6/9 MYO). The final LV and RV end-diastolic, and left and right atrial diameter were similar in all groups. Trend towards smaller LV end-systolic diameter was measured in the MYO group. Animals with MYO had significantly better systolic LV function (FS: 43.8±5.7 vs 36.2±4.5%, p=0.039; LV EF: 74.3±6.3 vs 66.0±5.7%, p=0.048). The diastolic average E/E` ratio remained significantly lower in MYO (6.1±1.3 vs 8.6±1.6, p=0.02) as compared with DOX. A trend towards lower NT-proBNP was measured in MYO compared to DOX (184±96 vs 342±299 pg/mL). In MRI, LV EF (56.4±5.6 vs 41.9±13.5%, p=0.039) and RV EF (42.1±2.8 vs 28.9±8.9%, p=0.009) were significantly higher in animals receiving MYO vs DOX, with trends towards better LV diastolic function in MYO (PFR 10.7±4.8 vs 7.9±2.5 ml/s). Myocardial fibrosis was found in 33% vs 60% of animals in MYO vs DOX. Histology confirmed the presence of fibrosis.

Conclusion: The encapsulation of doxorubicin in liposome resulted in less cardiac adverse effects with better LV systolic and diastolic function in an experimental model of cardiotoxicity.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1016: Diagnostic value of rigid body rotation in the differential diagnosis of non-compaction and dilated cardiomyopathy

M Cortes Garcia 1, MR Oliva 1, MA Navas 1, M Orejas 1, R Rabago 1, ME Martinez 1, S Briongos 1, AM Romero 1, M Rey 1, J Farre 1

Abstract

Introduction: The diagnosis of non-compaction cardiomyopathy (NCCM) remains subject of controversy. Analysis of left ventricular (LV) rotation by speckle-traking imaging have reported abnormal results in patients (pts) with NCCM. The resultant LV rigid body rotation (RBR) has been proposed for differential diagnosis of NCCM and dilated cardiomyopathy (DC). Our study assesses the diagnostic value of RBR in this differential diagnosis.

Methods: We have included all pts that fulfilled criteria for NCCM and ejection fraction (EF) <50% measured by echocardiography and magnetic resonance in the non-invasive cardiology laboratory of a tertiary hospital between January 2012 and February 2014. The control group of pts with DC was created after gender and age adjustment. Speckle-tracking echocardiography was performed in both groups and morphologic, functional, strain and rotation variables were analysed.

Results: We identified 10 pts fulfilling current criteria for NCCM with EF<50%. The mean age of these pts was 54±15 years with a mean EF of 33±11%. After creating the control group of patients with DC, a comparative analysis of the clinical, echocardiographic and electrocardiographic variables was performed. With an exception of a significantly higher mean left ventricular end-diastolic diameter (LVED) (59±5 vs 52±7 mm, p<0.05) in DC patients, no other difference was observed between the two study groups. Regarding strain variables obtained by speckle-tracking echocardiography only LV rotation demonstrated difference in the two groups. With an exception of one patient, all NCCM patients presented RBR. Surprisingly this RBR was also observed in two DC patients (20 %). In the subgroup analysis of these DC pts with RBR comparing them to the rest of the control group, a significant difference was observed in the EF (13±4 vs 27±12%, p<0.05), global longitudinal strain (-4±0 vs -12±2, p<0.01), LVED (64±1 vs 58±5 mm, p<0.05) and left atrial supero-inferior diameter (62±9 vs 51±4 mm).

Conclusions: The diagnosis of NCCM is still controversial, and the differential diagnosis with other cardiomyopathies can be challenging. RBR has been proposed to be an objective and reproducible criterion, thus useful in the differential diagnosis of NCCM and DC. Our results demonstrate a clear relationship between RBR and NCCM, nevertheless RBR can also be observed in a noteworthy part of DC, probably in those with a major functional impairment, hence RBR is not exclusive for NCCM. RBR has a potential role in the diagnosis of NCCM, but as an additional data to the conjunct of the morphological and functional diagnostic criteria.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1017: Two-dimensional speckle tracking may detect myocardial dysfunction in young adults with psoriasis

C Ruisanchez Villar 1, L Ruiz Guerrero 1, S Rubio Ruiz 1, P Lerena Saenz 1, FJ Gonzalez Vilchez 1, JL Hernandez Hernandez 1, S Armesto Alonso 1, R Blanco Alonso 1, R Martin Duran 1, MA Gonzalez-Gay 1

Abstract

Background: The possible deleterious effect of psoriasis (Ps) on myocardial function has been poorly investigated. Our aim was to study the utility of two dimensional (2D) speckle tracking to detect subclinical left ventricular (LV) myocardial dysfunction in young adults with Ps without known cardiovascular (CV) risk factors.

Methods: 37 young adults with Ps and no CV risk factors were compared with 58 healthy volunteers. The groups were matched by age and sex (mean age 36 vs. 37 years; 57% vs.59% women, respectively). Patients and volunteers were normotensive and had a normal lipid profile. All participants underwent a full conventional echocardiographic study including tissue Doppler imaging. Left ventricular ejection fraction (LVEF) was estimated using the Simpson biplane method. We used 2D-speckle tracking to analyse longitudinal myocardial strain (LS) as a surrogate of LV systolic function, and peak transmitral early diastolic inflow strain rate (SR E) to assess diastolic performance.

Results: There were no significant differences in body mass index, blood pressure and lipid profile between both groups. LVEF was similar in patients with Ps and volunteers (0.61± 0.4 vs. 0.60±0.5, p=0.98). Patients with Ps showed normal diastolic function compared with controls on conventional echocardiography, evidenced by no significant differences in mitral inflow early diastolic velocity-E wave (78.6 ± 15 cm/s vs. 79.0± 17cm/s, p=0.88), lateral and septal peak mitral annular velocity-Ea wave (13.6±3.2 cm/s vs.14.6±2.7 cm/s, p=0.09; 10.2±2.6 vs. 11.0±2.7 cm/s, p=0.1 respectively). Nevertheless, both longitudinal strain (-20.4 ±1.9% vs. -21.8±1.7%, p<0.001) and E SR (1.5±0.3s-1 vs. 1.7 ±0.2 s-1, p<0.001) were significantly lower in the Ps group compared with healthy volunteers.

Conclusion: 2D speckle tracking appears to be able to detect early stages of myocardial affectation, both systolic and diastolic, in young adults with Ps and no CV risk factors, even in the presence of an apparently normal conventional echocardiographic study.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1018: Usefulness of the measurement of epicardial fat in risk stratification of obese patients

G Novo 1, I Marturana 1, V Bonomo 1, L Arvigo 1, V Evola 1, G Karfakis 1, M Lo Presti 1, S Verga 1, S Novo 1

Abstract

Purpose: To measure by transthoracic echocardiography the thickness of epicardial fat in a population of obese patients and to evaluate its role as an indicator of increased cardiovascular risk.

Methods: We enrolled obese patients (BMI ≥ 30 kg/m2) without significant valvular disease, with normal ejection fraction (FE > 55%) and acoustic window suitable for the evaluation of epicardial fat . All patients were subjected to an anamnestic and clinic evaluation for the detection cardiovascular risk factors and previous cardiovascular events, cardiological examination, electrocardiogram, transthoracic echocardiography and Doppler ultrasound of Supra Aortic Trunks (SAT). The epicardial fat was evaluated in end-diastole in the parasternal long axis view.

Results: The studied patients were 113 (52.7% male, mean age 49.43 ± 11.63 years), with a mean BMI of 41.22 ± 7.82 kg/m2.

16,96 % of patients had a previous cardiovascular event (7% had a myocardial infarction, 6.4% had at least one episode of unstable angina and 2.6% pulmonary embolism). The mean epicardial fat thickness was 6.43 ± 2.50 mm. 41,6% of patients them had normal diastolic function, while 58.4 % of patients had diastolic dysfunction (E ' <8 and atrial enlargement). 47,32 % of the patients had carotid plaque or intima thickening (IMT > 0.9mm) the .We observed a significant relationship between the thickness of the epicardial fat and: diastolic dysfunction (p = 0.001, F- ratio 11,769) ; carotid atherosclerosis (p <0.001, F- ratio 25.302) and previous cardiovascular adverse events (p = 0.002, F- ratio 10.029).

Conclusions: Our study confirms that the epicardial fat, a simple parameter to be measured during a standard echocardiographic examination, adds information about cardiovascular risk in obese patients.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1019: Echocardiographic evaluation of Left Atrial dysfunction as an early index of cardiomyopathy

R Petroni 1, A Acitelli 1, S Bencivenga 1, M Cicconetti 1, M Di Mauro 1, A Petroni 1, S Romano 1, M Penco 1

Abstract

Purpose: Given the lack of information about the possibility to use left atrial (LA) function as index for primary prevention in subjects with risk factors for atherosclerosis, the present prospective study was aimed to identify a relationship between prevalence of risk factors and LA dysfunction.

Methods: From October to December 2013, 124 were prospectively enrolled a tour outpatient clinic. All these patients underwent to a good quality echocardiographic examination. In all of them, left atrial shortening fraction (LASF) was measured by M-Mode in a parasternal long-axis view, in order to assess the atrial function. Left ventricular (LV) dimensions, systolic and diastolic function were also recorded. Median value of LASF was 45%, thus the entire population was split into 2 groups (62 each group): Group A (LASF<45%) and Group B (LASF>=45%). The two groups were similar for age and gender. Risk factors for atherosclerosis were also collected: hypertension, hypercholesterolemia and diabetes. The primary end-point was to evaluate if patients with risk factors showed lower LASF, as early index of heart disease. Furthermore, LASF and LV diastolic dysfunction relationship were also investigated.

Results: No difference was found regarding LV volumes and ejection fraction (EF). Overall prevalence of hypertension, hypercholesterolemia and diabetes were 52%, 30% and 13%, respectively. The patients with LASF lower than 45% showed higher prevalence of hypertension (A: 65% vs B: 40%, p=0.007), hypercholesterolemia (A: 42 % vs B 18%:, p=0.003) and diabetes (A: 21% vs B: 5%, p=0.007). The presence of at least one risk factor was 73% in group A versus 50% in group B, p=0.01. Left ventricular dysfunction: E/A ratio was significantly lower in group A (0.9±0.3 vs 1.2±0.5, p=0.025); E deceleration time was significantly longer (221±50 vs 200±42, p=0.045); E/E' (12±3 vs 8±3, p=0.035).

Conclusions: In patients with risk factors for atherosclerosis, LASF might be an early index of heart disease, as mirror of LV diastolic dysfunction.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1020: Left atrial dysfunction in tako-tsubo cardiomyopathy: more than ventricular dysfunction?

SM Park 1, SA Kim 1, MN Kim 1, WJ Shim 1

Abstract

Background: The clinical presentation of Tako-Tsubo Cardiomyopathy(TTC) mimics that of acute myocardial infarction(AMI). It is little known about left atrial(LA) function in TTC.

Methods: We prospectively enrolled patients with newly diagnosed TTC and AMI. Echocardiography was performed on day 1 or within 24 hours of primary percutaneous coronary intervention. Peak global LA longitudinal strain(PLAS), strain during late diastole(LAS-a) and peak global left ventricular(LV) longitudinal strain(GLS) were measured.

Results: Ten patients with TTC and 20 patients with AMI(74±10 vs 58±14 years; P=0.02) were enrolled. LV ejection fraction was not different between TTC and AMI patients(38.7±7.6% vs 38.0±8.3%; P=0.82). Right ventricular involvement was more frequent in TTC than in AMI(5/10 vs 1/20; P=0.009). LVGLS was similar (-10.1±3.0% vs -9.9±3.0%, P=0.91) and no difference of LA volume was found (30.7±6.6 vs 31.7±6.9 mL/m2; P=0.69) between TTC and AMI. However, PLAS was significantly lower in TTC than AMI(12.0±4.0% vs 20±4.9%; P=0.001). PLAS was moderately related to LVGLS in all patients(r=0.446, P=0.029), however, this relationship was not maintained in TTC patients only(r=0.386, P=0.167). Moreover, both PLAS and LVGLS were not related to age(r=-0.284, P=0.178; r=-0.097, P=0.61, respectively). LAS-a was also significantly lower in TTC than in AMI(6.4±2.3% vs 11.2±3.7%; P=0.004). Both LVGLS and PLAS were improved in TTC patients in 6weeks.

Conclusion: LA function assessed by strain was more impaired in TTC patients than in AMI patients even LV function was similar in two groups. Both LV and LA function were recovered in TTC patients, which may mean not only ventricular but also atrial transient dysfunction. In addition, this finding may help differentiating TTC from AMI in clinical practice.

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Comparison of LVGLS and PLAS

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

Systemic diseases and other conditions: P1021: Two- and three-dimensional Right Ventricular remodeling is associated with heart rate variability in hypertensive patients

M Tadic 1, AM Majstorovic 1, BI Ivanovic 2, VC Celic 1

Abstract

Purpose: To investigate right ventricular (RV) remodeling (structure, function and mechanics), and heart rate variability (HRV), as well as their relationship, in untreated hypertensive patients.

Methods: This cross-sectional study included 67 recently diagnosed untreated hypertensive patients and 48 subjects with no risk factors, similar by gender and age. All participants underwent a 24-h Holter monitoring and comprehensive 2D and 3D echocardiography examination (2DE and 3DE).

Results: All time and frequency domain HRV variables were reduced in the hypertensive subjects. RV wall thickness was increased in hypertensive subjects (3.9 ± 0.4 vs. 4.3 ± 0.5 mm, p<0.01). Tricuspid E/e' ratio was increased in hypertensive group (4.5 ± 1.2 vs. 5.5 ± 1.4, p<0.01). 3DE RV ejection fraction was decreased among hypertensives (58 ± 4 vs. 55 ± 3 %, p<0.01), as well as 2DE RV global longitudinal strain (-26 ± 3 vs. -22 ± 3 %, p<0.01). Systolic and early diastolic strain rates were decreased, whereas late diastolic strain rate was increased in hypertensive patients. In the whole study population SDNN (standard deviation of all normal RR intervals) correlated with tricuspid E/e' ratio (r=-0.35, p<0.01), RV global strain (r=0.43, p<0.01) and 3DE RV ejection fraction (r=0.32, p<0.01); whereas 24-h low-frequency domain correlated with RV wall thickness (r=-0.28, p=0.03), tricuspid E/e' ratio (r=-0.42, p<0.01), RV global strain (r=0.48, p<0.01) and 3DE RV ejection fraction (r=0.36, p<0.01).

Conclusions: RV structure, systolic and diastolic function, as well as RV longitudinal deformation are significantly impaired in recently diagnosed untreated hypertensive patients. HRV variables are also decreased in hypertensive subjects. 2DE and 3DE echocardiographic parameters that demonstrate RV remodeling are independently related with cardiac autonomic nervous system parameters in the whole study population.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1022: Differential survival in children versus adults with pulmonary hypertension: impact of RV function and ventricular-ventricular interactions

M M P Driessen 1, FJ Meijboom 2, L Mertens 3, A Dragulescu 3, MK Friedberg 3

Abstract

Introduction: Survival in children with pulmonary hypertension (PH) is markedly lower than in adults with PH. As right ventricular (RV) failure is a major cause of mortality in PH, we hypothesized that RV geometry and function are worse in children compared with adults with PH.

RV function in children & adults with PH

Children (n=18) Adults (n=16) p-value
RVSP (ex RA; mmHG) 97.6±24.8 71.0±13.8 0.001
RV dimensions: - RVEDb (mm) 48.6±10.3 (z 3.6±0.8) 49.1±9.6 -
- RV/LV ratio 1.62±0.45 1.13±0.30 0.001
RV systolic: - TAPSE/RVl (mm) 0.25±0.090 0.25±0.06 0.77
- FAC (%) 18.5±7.3 18.8±5.0 0.91
- TEI RV 0.50±0.13 0.60±0.15 0.09
RV-LV interaction: - LV eccentricity index 0.46±0.18 0.57±0.12 0.05
RV diastolic*: - EA ratio / TDI E' 1.4 [0.8-1.7] / 10.5±3.1 0.8 [0.3-3.8] / 9.7±3.5 0.55 / 0.98
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*missing in 5 pediatric patients; p-value with Student T test or Mann whitney U test

Methods: Patients with idiopathic or thromboembolic PH on PH-specific treatment were identified. RV and left ventricular (LV) dimensions, LV eccentricity index, fractional area change (FAC), TAPSE / ventricular length (TAPSE/RVL), tricuspid pulsed wave tissue Doppler (for TDI S' and E') and pulsed and continuous wave interrogation of tricuspid valve inflow and regurgitation were analyzed. Mean and SD or median and range were calculated.

Results: Eighteen children (age 10.8±5.6 yrs) and 16 adults (age 48.0±16.2 yrs) were retrospectively studied. Use of ET-receptor antagonist, PDE-5 inhibitor and prostaglandins was 13/18 (72%), 7/18 (39%), 9/18 (50%) in children and 14/16 (88%), 12/16 (75%), 5/16 (31%) the adults. Measurements of systolic – TAPSE, TDI S' and FAC – and diastolic – EA ratio, E/E'ratio – RV function were comparable (p>0.05). RV/LV dimension ratio and LV eccentricity index were worse in children (p=0.001; table 1).

Conclusion: Echocardiographic parameters of systolic and diastolic RV function in children were similar to those in adults. However, RV dilation and LV eccentricity were more severe in children, likely because pulmonary pressures were higher, despite PH treatment. These results reflect important adverse ventricular-ventricular interactions in children, either a marker of higher pressure on the right side or in itself contributing to a worse prognosis.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1023: Comparison of right ventricular function in sleeping apnoea syndrome and pulmonary thromboembolism: different impact of chronic and acute pressure overload using advanced echocardiography

F De Stefano 1, C Santoro 1, A Buonauro 1, R Muscariello 1, F Lo Iudice 1, P Ierano 1, R Esposito 1, M Galderisi 1

Abstract

Purpose: It is conceivable that chronic and acute right ventricular (RV) overload could induce a different hemodynamic impact on RV function. Aim of the study was to assess this issue by comparing standard echo Doppler, RV Speckle Tracking Echocardiography (STE) and real-time 3D echocardiography (3DE) in patients with sleeping apnoea syndrome (SAS) and pulmonary thromboembolism (PTE).

Methods: Eighteen normal controls, 18 patients with SAS and 18 with mild to moderate TPE at hospital discharge, matched for sex and age, were assessed by standard echo-Doppler, RV STE and 3DE. RV internal diameters, tricuspid annular plane systolic excursion (TAPSE), tricuspid inflow E/A ratio and the ratio of tricuspid E velocity to pulsed Tissue Doppler e' velocity of lateral tricuspid annulus (RV E/e') were determined according to the standard methods. 3DE RV volumes were estimated off-line (Tomtec software) and RV ejection fraction (EF) derived. STE was used to estimate RV global longitudinal strain (GLS) and regional (6 segments) longitudinal strain. Septal longitudinal strain (average of 3 septal regions, SLS) and lateral wall longitudinal strain (average of 3 lateral wall segments, LLS) were also calculated.

Results: The 3 groups were comparable for blood pressure whereas heart rate (HR) was higher in PTE (p<0.001) and body mass index (BMI) in SAS patients (p=0.003). Estimated pulmonary arterial systolic pressure (PASP) was 26.8 ± 8 mm Hg in SAS and 32.7 ± 13.8 mm Hg in PTE (p=NS). RV internal longitudinal diameter was higher in SAS (p=0.008) and TAPSE lower in PTE (p=0.03), without difference of RV E/A ratio and E/e' ratio. 3DE derived RV end-diastolic and end-systolic volumes were greater in SAS (p<0.001 and p<0.02 respectively) than in the other two groups while EF was lower in PTE (p=0.004). GLS (p=0.03) and LLS (p<0.02), but not SLS, were lower in PTE. PASP was negatively related with TAPSE (r = -0.54, p<0.02), GLS (r = -0.87), LLS (r = -0.88) and SLS (r = -0.80) (all p<0.0001), even after adjusting for HR and BMI in separate multiple linear regression analyses. The same relations were not significant in SAS group.

Conclusions: Our findings demonstrate the different impact of chronic and acute pressure overload on RV longitudinal function. SAS induces an increase of RV internal size without a significant alteration of both RV chamber (EF) and longitudinal function (TAPSE and GLS). PTE exerts a negative impact on both RV EF and longitudinal function (TAPSE and GLS). This impact is greater on RV lateral wall and is proportionally related to the degree of pulmonary arterial hypertension.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1024: Evaluation of bi-ventricular and atrial mechanics in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy

M Sunbul 1, T Kivrak 1, E Durmus 1, B Yildizeli 2, B Mutlu 1

Abstract

Objective: Bi-ventricular and atrial functions in chronic thromboembolic pulmonary hypertension (CTEPH) and it's response to successful pulmonary thromboendarterectomy (PTE) has not been widely assessed. Previous studies have demonstrated that two-dimensional (2D) speckle tracking echocardiography (STE) is a useful method determining ventricular and atrial function. The aim of the present study was to evaluate of bi-ventricular and atrial functions by 2D STE in CTEPH patients before and after PTE.

Methods: Forty consecutive CTEPH patients (mean age: 49.3±13.5 years, 27 female) who were referred to our center for PTE were included. 2D STE were performed to all patients before and 3 months after the PTE operation.

Results: Postoperative six minute walk test (6MWT) distances were significantly longer compared to preoperative values (410.5±61.5 meters versus 216.6±131.4 meters, p<0.001). Postoperative left ventricular (LV) and right ventricular (RV) systolic functions (LV EF, TAPSE, RVS) were similar compared to preoperative values. While postoperative RV, right atrial (RA) and systolic pulmonary artery pressure measurements were significantly lower, LV and left atrial (LA) measurements were higher compared to preoperative values. Postoperative LV and RV global longitudinal strain (GLS) measurements were significantly higher compared to preoperative values (p=0.017, p<0.001). Postoperative LV global radial and circumferential strain measurements were similar compared to preoperative values. While postoperative RA reservoir and conduit functions were significantly higher (p=0.022, p=0.023), postoperative LA reservoir and conduit functions were similar compared to preoperative values. Correlation analysis revealed that baseline 6MWT distances were correlated with LV GLS, RV GLS, RA reservoir and conduit functions in both periods.

Conclusions: Two-dimensional STE provides valuable information on the quantitative assessment of biventricular and atrial functions before and after PTE operation in patients with CTEPH. 2D STE indices may help the clinician to assess the effect of successful PTE on cardiac functions and also use for follow-up data in CTEPH patients.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1025: Evaluation of deformation parameters by three dimensional speckle tracking echocardiography in competitive athletes

AC Rodrigues 1, E Daminello 1, LS Echenique 1, A Cordovil 1, W Oliveira 1, CH Monaco 1, E Lira 1, CH Fischer 1, M Vieira 1, S Morhy 1

Abstract

Regular training determines different patterns of cardiovascular adaptation; we aimed to evaluate the effect of exercise on deformation parameters in young elite athletes with three-dimensional speckle tracking echocardiography (3DSTEcho).

Methods: We studied highly trained athletes (boxers) with echocardiography with tissue Doppler and real time 3DSTEcho to assess left ventricular (LV) diameters and volumes, LV mass indexed for body mass area and ejection fraction (Teichholz); diastolic function was assessed with conventional and tissue Doppler; finally, global LV longitudinal(GLS), circumferential (GCS) and radial (GRS) strain, three dimensional (3D) strain and area tracking, as well as twist and torsion measurements were evaluated with 3DSEcho. These measurements were compared with measurements from healthy untrained age and sex-matched controls.

Results: We enrolled 16 athletes (14 male) and 15 controls with similar age age (23 ± 4 years vs 23.±4, p = NS) and sex (12 male controls). Systolic function (ejection fraction) and diastolic functional assessment was normal and similar for both groups. LV mass index was higher for athletes (83±21 vs 65±15 g/m2, p = 0.04), though still within normal reference limits. Both global LV radial strain and 3D strain were higher in athletes (p < 0.05); however, there were no differences for all the other three-dimensionally derived parameters, including twist, torsion, and area tracking (table).

Conclusion: Athletes and untrained hearts have comparable LV deformation parameters; however, an enhanced radial function was observed only in athletes.

Deformation 3 dimensional parameters

GRS v(%) GCS (%) GLS (%) Twist Torsion 3D strain (%) Area tracking
control 16.3±7.2 28±6 17±3 3.7±1.9 2.0±0.8 41±6 41±6
Athletes 24.7±5.2 26±2 16±2 3.1±1.3 1.4±0.4 37±14 37±4
p p = 0.007 NS NS NS NS 0.01 NS
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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1026: Relationship between Left Ventricular myocardial deformations and morphological athlete's heart: an ultrasound speckle tracking two-dimensional strain study in professional rugby and soccer players

A Mignot 1, J Jaussaud 1, L Chevalier 1, S Lafitte 2

Abstract

Purposes: Athlete's heart is currently associated with cardiac remodeling regarding aerobic or anaerobic exercise. When comparing healthy athletes involved in high aerobic training with nonathletes, this includes left ventricle (LV) dilatation, significant reduction of global longitudinal strain (GLS) and increase of global radial strain (GRS). We hypothesize that eccentric LV remodeling in healthy elite athletes could induce changes in wall stress.

Methods: A total of 70 elite athletes engaged in national championship (soccer and rugby) were prospectively enrolled (38 soccer players and 32 rugbymen). Conventional echocardiography including doppler tissular imaging (DTI) and three components of two dimensional strain using speckle tracking imaging was performed, (GLS, GRS, and circumferential global strain, GCS).

Results: As expected, rugbymen were taller and heavier than soccer players (100 +/- 12 Kg vs. 77 +/- 6 Kg; p <0.001 and 185 +/- 6 cm vs. 182 +/- 5 cm ; p<0,001).In rugbymen group, left ventricular end diastolic diameter (LVEDD) (56 +/- 4 mm vs. 53 +/- 5 mm; p<0.05) and left ventricular end diastolic volume (LVEDV) (172 +/- 30 ml vs. 129 +/- 22 ml; p<0.05) were significantly increased compare to soccer players. Left ventricular ejection fraction (LVEF) and GLS were similar in both groups (64 +/- 6 % vs. 62 +/- 4; p=0.1 and -19 +/- 2 % vs. -19,1 +/- 1,7; p=0,7, respectively). Cardiac output (6,35 +/- 2 l/min vs. 4,7 +/- 1 l/min, p=0.02), GRS (35 +/- 7% vs. 31 +/- 7%, p<0.001) and GCS (20 +/- 2% vs. -18 +/- 1%; p=0.001) were significantly increased in rugbymen compare to soccer players. When related to LVEED, GRS and GRC were similar in both group (p=NS).

Conclusions: Our study shows that rugbymen have more important cardiac eccentric remodeling and an increase cardiac output compared to soccer players. Additionally, while global longitudinal deformation is similar in both groups, radial and circumferential components are significantly higher in rugbymen which could be related to LV dilatation. This shows the potential impact of cardiac physiological remodeling induced by high aero-anaerobic training on LV deformations in professional athletes.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1027: Training-induced right ventricular morphological and functional adaptations in top-level athletes during the season

F D'ascenzi 1, M Cameli 1, V Curci 1, F Alvino 1, M Lisi 1, M Focardi 1, D Corrado 2, M Bonifazi 3, S Mondillo 1

Abstract

Purpose: Recent data suggest a possible exercise-induced right ventricular (RV) dysfunction in highly trained athletes. Although previous studies have determined the acute effects of endurance exercise, longitudinal data investigating the in-seasonal adaptations of the RV are not yet available. The aim of this prospective study was to analyzed the in-seasonal changes in RV morphology and function in top-level athletes, using 2D speckle-tracking echocardiography, a new tool to estimate myocardial deformation dynamics.

Methods: Thirty top-level players were enrolled in this study. Echocardiographic measurements were performed at the beginning of the study, after 3, and after 6 months of training, corresponding to pre-season, mid-, and pre-end-season periods.

Results: At mid-season time point RV end-diastolic basal diameter (p<.05), RV end-diastolic area (p=0.001), and RV end-systolic area (p<0.001) increased in comparison with pre-season data, with a slight reduction at pre-end-season time point. RV fractional area change did increase at mid-season time point (p≤.005 vs. pre-season data). Conversely, E/A ratio and E/e' ratio did not significantly vary. Both RV sphericity index and ratio between RV and left ventricular end-diastolic volume did not significantly change (overall p=.073 and =.176, respectively), suggesting a global and physiological remodeling of the heart. Free wall global strain and strain rate remained stable during the season (overall p= .522 and =.227, respectively). However, when differences in regional myocardial deformation were analyzed, while basal and middle free wall strains did not change, an increase of apical free wall strain was observed (p≤.005 vs. pre-season time point). None of the participants experienced a pathological reduction of RV strain values.

Conclusions: This study demonstrated that changes in RV myocardial morphology and deformation occur in top-level athletes during the season. However, in this study none of the athletes experienced a marked asymmetric dilatation of the right ventricle or a pathological reduction of RV strain values, suggesting that the observed training-related changes can be interpreted as a physiological response to training load and considered as complementary features of athlete's heart.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1028: Endothelial glycocalyx is similarly impaired in diabetic patients and first degree relatives and is linked with abnormal aortic elastic properties and myocardial deformation

I Ikonomidis 1, G Pavlidis 1, V Lambadiari 1, F Kousathana 1, H Triantafyllidi 1, M Varoudi 1, G Dimitriadis 1, J Lekakis 1

Abstract

The integrity of endothelial glycocalyx plays a vital role in vascular permeability, inflammation and elasticity. The association between damage of endothelial glycocalyx, impaired arterial elastic properties, and LV function in diabetics and first degree relatives has not been explored.

Methods: In 40 untreated patients (age:51±12 years) with newly diagnosed type II diabetes,20 first degree relatives with normal oral glucose tolerance test and 25 controls of similar age and sex we measured a) carotid-femoral pulse wave velocity (PWVc m/sec), central systolic blood pressure (cSBP -mmHg),augmentation index (AI %), reflection time (RT-ms) and diastolic reflection area (DRA) of the aortic pulse wave, an index of coronary perfusion b) S',E' (m/sec) and E'/A' of mitral annulus by Tissue Doppler c) LV longitudinal strain (GLS -%), systolic (LongSr-l/sec) and diastolic (LongSrE-l/sec) strain rate, using speckle tracking echocardiography d) perfusion boundary region (PBR- micrometers) of the sublingual arterial microvessels (ranged from 5-25 micrometers) using Sideview, Darkfield imaging (Microscan, Glycocheck). The PBR in microvessels is the cell-poor layer which results from the phase separation between the flowing red blood cells (RBC) and plasma.The PBR includes the most luminal part of glycocalyx that does allow cell penetration. Increased PBR is considered an accurate index of reduced endothelial glycocalyx thickness because of a deeper RBC penetration in the glycocalyx

Results: Compared to controls, diabetics and relatives had higher PBR (2.1±0.25 vs. 2.05±0.25 vs.1.89±0.1) AI (27±16 vs. 24±15 vs. 17±14) and DRA (44±12 vs. 49±13 vs. 68±27,) (p<0.05 for all comparisons). Diabetics and relatives had similar PBR, AI and DRA (p=ns).Compared to controls, diabetics had also higher PWV (10.9±2 vs. 8.9±2,), cSBP (137±19 vs. 116±17), reduced RT (118±26 vs. 151±14), GLS (-16±4 vs. -20±3), LongSr (-0.8±0.2 vs. -1.1±0.3), LongSrE (0.8±0.2 vs. 1.3±0.5,), S' E' and E'/A' (p<0.05 for all comparisons). Reduced endothelial glucocalyx thickness as assessed by increased PBR was related with increased PWV (r=0.35), reduced RT (r=-0.42) and DRA (r=-0.36) in diabetics (p<0.05 for all associations). Increased PWV were related with reduced S' (r=-0.48), E' (r=-0.63), E'/A' (r=-0.63), GLS (r=0.48,) LongSr (r=0.35), LongsrE (r=-0.51) respectively (p<0.05 for all associations)

Conclusion: Endothelial glucocalyx is impaired in newly diagnosed diabetics and first degree relatives and is related with abnormal aortic elastic properties leading to impaired LV longitudinal deformation in diabetics.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1029: Myocardial mechanics in rat model with banding and de-banding of the ascending aorta

J S Cho 1, EJ Cho 1, HJ Yoon 1, SH Ihm 1, JH Lee 1

Abstract

Background: Aortic banding and debanding model have provided useful information regarding the development and regression of LVH. Materials and methods: Minimally invasive ascending aorta banding was performed rats (10 SD rats, 7 weeks). 10 rats were experienced sham operation. Thirty-five days later, the band was removed. Echocardiographic and histopathologic analysis was assessed at pre-banding, banding 35days and debanding 14days.

Results: Banding of the ascending aorta created the expected increase in aortic velocity and gradient which normalized with relief of the constriction. Pressure overload resulted in a robust hypertrophic response as assessed by gross and microscopic histology, transthoracic echocardiography (IVS; 1.37±0.13mm vs. 2.22±0.50 vs.1.65±0.24, P<0.05) (LVESD; 4.3±0.48mm vs. 3.7±0.73mm vs. 4.8±0.53mm, P<0.05) (LV mass-c; 120±15mg vs. 148±17 mg vs. 134 ±14mg, P<0.05). However, myocardial fibrosis was minimal in banding and debanding group. Circumferential(Sc) and radial strain(Sr) were not different among groups (Sc; -25.7.1±6.0% vs.-23.7±5.8% vs. -23.7±5.0%, P=NS) (Sr; 29.8 ±7.9% vs. 29.0±8.6% vs. 32.6±9.5%, P=NS) (fibrosis; 0.1±0.2% vs. 4.18±2.06 vs. 3.38±3.63, P <0.05). Global circumferential strain was not correlated with myocyte hypertrophy but fibrosis severity in banding model (r=0.438, P=0.052).

Conclusions: In this animal study simulating severe LV pressure overload state, significant increase of LV mass index did not result in significant reduction of LV mechanical parameters. Left ventricular fibrosis, developed with pressure overload was significantly related with magnitude of left ventricular mechanics.

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Histopathologic findings

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1030: Higher prevalence of aortic regurgitation and dominant shared environmental effects on aortic annulus diameter in twins

A A Molnar 1, A Kovacs 2, A Apor 2, AD Tarnoki 3, DL Tarnoki 3, T Horvath 2, P Maurovich-Horvat 2, GY Jermendy 4, RG Kiss 1, B Merkely 2

Abstract

Purpose: The heritability of aortic root and ascending aorta diameters is less known even though their prognostic value is well acknowledged. The aim of our study was to estimate the extent of genetic and environmental effects determining these parameters.

Methods: Two-dimensional transthoracic echocardiographic measurements of aortic annulus and ascending aorta diameters were performed in 82 adult twin pairs (44 monozygotic and 38 same-sex dizygotic pairs, 29 male and 53 female pairs, mean age 54±12 years). The aortic annulus diameter was measured from parasternal long-axis view between the hinge points of aortic valve leaflets. The presence of aortic regurgitation was assessed using Color Doppler and CW Doppler techniques.

Results: The sex and age adjusted univariate heritability (A), shared (C), and unshared (E) environmental effects model has shown 60.8% shared environmental effect on aortic annulus diameter (95% CI, 47.5 to 80.6%). However, regarding ascending aorta 59.9% (95% CI, 8.5% to 80.3%) genetic effect was found. The prevalence of mild to moderate aortic regurgitation was high (18.9%) in our twin population with no significant difference between monozygotic and dizygotic twin pairs. The aortic regurgitation was usually detected only in one of a twin pair (the discordant rate was 71.4% between monozygotic and 81.8% between dizygotic twin pairs). The aortic annular dimensions were normal in all of the twins and no congenital defect of the aortic valve was found.

Conclusion: The approximately three-fold higher prevalence of aortic regurgitation in twin population compared to the Framingham Heart Study and the dominant shared environmental effect on aortic annulus diameter suggest that the intrauterine environment and hemodynamics during twinning process might play a role in the development of valve disease even in cases without twin-to-twin transfusion syndrome. Nevertheless, the higher heritability of ascending aorta diameter support further investigation of potential candidate genes that contribute to the variation of aortic diameters.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1032: Pericardial effusion as a prognostic marker in Heart Failure - easy obtainable but more easily forgotten

S Petrovic-Nagorni 1, S Ciric-Zdravkovic 1, D Stanojevic 1, R Jankovic-Tomasevic 1, V Atanaskovic 1, V Mitic 1, L Todorovic 1, S Dakic 1

Abstract

Introduction and purpose: Heart failure (HF) is an escalating problem worldwide, with more than 20 million people affected. The overall prevalence of HF in the adult population in developed countries is 2%.

Despite many recent advances in the evaluation and management of HF, the development of symptomatic HF still carries a poor prognosis. Community based studies indicate that 30-40% of patients die within 5 years, mainly from worsening HF or as a sudden event.

Pericardial effusion is one of the signs of HF easily obtainable with multiple pathogenesis (water overload mainly), however with uncertain prognostic implications.

The aim of our study was to investigate the prognostic role of pericardial effusion in patients hospitalized due to decompensation of chronic HF.

Methods and Results: The study included 201 patients, mean age 71.5 ± 10.3 years of whom 60.7 % were male, and the average left ventricular ejection fraction (LVEF) was 37.4±13.7%. 19.5% of patients had NYHA class I, 46% had NYHA class II, 29.9% had NYHA class III and 4.6% of patients had NYHA class IV. The average duration of HF was 3.41±4.3 years. The main causes of HF were coronary artery disease (49.4%), arterial hypertension (20.7%), valvular disease (10.4%) and dilated cardiomyopathy (in 19.5% of patients). The mean value of BNP was 777.45±1168.75 pg/mL at the admission. 45 patients (22.4%) had pericardial effusion during the initial echocardiographic examination. During 12 months of follow-up 42.8% of patients died due to worsening HF (10% died during the initial hospitalization). 70% of patients who died during the initial hospitalization had pericardial effusion (χ2=28.9, p<0.001) and only 25.7% of patients who died during the next 12 months (χ2=37.4, p<0.001).

Conclusions: In our study the majority of HF patients who died during the initial hospitalization had pericardial effusion and significantly less number of patients who died during the next 12 months of follow up. This marker of worse prognosis in HF patients is easy obtainable by standard echocardiography therefore widely available, low-cost, but widely underestimated. We need more studies about prognostic role of pericardial effusion on short and long term prognosis in HF.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

Congenital heart disease: P1034: Doxorubicin cardiomyopathy is prevented by the administration of ranolazine at the end of antineoplastic treatment: in vitro and in vivo study

C Coppola 1, G Piscopo 1, F Galletta 1, C Maurea 1, E Esposito 2, A Barbieri 1, N Maurea 1

Abstract

Purpose: Anthracyclines (A) are first line drugs against cancer, but produce a well-known cardiomyopathy; the main mechanism that determines this damage is the production of reactive oxygen species (ROS) that hyperactivate protein kinase 2 calcium-calmodulin-dependent (CaMKII) and inhibite SERC2a; by this mechanism they activate the late sodium current (INa), target of Ranolazine (R), that results in calcium overload. Here, we aim at assessing whether R, diminishing intracellular Ca2+ through its inhibition of late INa, blunts A cardiotoxicity.

Methods: To assess for toxicity in vitro, rat H9C2 cardiomyoblasts were pretreated with R (1 and 10 μM) for 72 hours and then treated with Doxorubicin (D, 1 μM) for additional 72 hours. To evaluate cardiac function in vivo, fractional shortening (FS) and ejection fraction (EF) were measured by M/B mode echocardiography and radial and longitudinal strain (RS and LS) were measured using 2D speckle-tracking echocardiography, in C57/BL6 mice, 2-4 mo old, at day 0, and after 2 and 7 days of daily administration of D (2.17 mg/kg/day, ip). These measurements were repeated after 5 days of R treatment (305 mg/Kg/day, gavage, dose comparable with that used in humans of 750 mg twice) initiated at the end of D treatment.

Results: Our in vitro studies demonstrate that R reduces cardiotoxicity due to D in rat H9C2 cardiomyoblasts as evidenced by higher viability rate of cells treated with R+D than cells treated with D alone. In our in vivo studies, after 7 days with D, FS decreased to 50.5±8.4%, p<0.05 vs 61.5±1% (sham), EF to 82.2±8.1%, p<0.05 vs 91.3±0.5% (sham), RS to 14.3±4.7%, p<0.01 vs 40.5±4.8% (sham), and LS to -16.6±7.9%, p<0.01 vs -38.8±6% (sham). In mice treated with R for 5 days after D treatment, the indices of cardiac function recovered: FS was 61.5±1.1%, EF was 91.25±1.1%, p<0.01 vs mice treated with D for 7 days and reevaluated after 5 days post the end of treatment with the aim to exclude a spontaneous recovery (FS 52.3+7, EF 83.1+8.3); RS was 29.5±3.4%, p<0.05 vs mice treated with D for 7 days and reevaluated after 5 days post the end of treatment (15.2+4.9); however the alteration of LS persists after treatment with R (-25.5±6.3%, p=0.16), but the LS was better than LS 5 days post D alone (-17.2+7.7, p<0.05) . Conclusions: R post-treatment blunts cardiotoxic effects due to A, as demonstrated by the normalization of the values of FS, EF and RS. The explanation for the persistent abnormalities of LS could be that the subendocardial fibers, responsible for the alteration of LS, are the first to impair and may be the last to recover.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1035: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), a treatable "cardiomyopathy"

M Kaldararova 1, P Tittel 1, A Kantorova 1, V Vrsanska 1, E Kollarova 1, V Hraska 2, M Nosal 1, M Ondriska 3, J Masura 1, I Simkova 4

Abstract

Purpose: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly (0.25-0.5% of all) with the left ventricle (LV) being perfused by desaturated blood and under low pressure, leading to myocardial ischemia and steal syndrome. Due to this ALCAPA may be indistinguishable from cardiomyopathy and without surgery it comes within first months of life in up to 90% to severe congestive heart failure. If substantial collateral circulation develops clinical manifestation may be less prominent and patients (pts) may even reach adulthood; but still having a high risk of sudden cardiac death (SCD). Performed was a retrospective study of ALCAPA managed at our institution.

Patients and Methods: Analyzed were 19 pts (11F/8M) with median age at surgery 1.1 year (2 months - 17 years); median follow-up 7.5 years. In 16 pts transfer of the left coronary artery back to aorta and in 3 pts Takeuchi procedure was performed. Pre-/postsurgical evaluation was performed. Compared were 11 (57.9%) pts with infant type (INFANT) and 8 (42.1%) pts with adult type (ADULT).

Results: Five (26.3%) pts were first misdiagnosed as cardiomyopathy. In 1 pt ventricular septal defect was present and ALCAPA manifested after defect closure. In 78.9% echocardiography (ECHO) was able to detect ALCAPA; in 21.1% was ECHO false negative. In 36.8% no other diagnostic tool was needed but in 63.2% conventional or CT angiography was performed to confirm ALCAPA. Comparing INFANT/ADULT significant difference was in: age at surgery (median 4 months / 5.5 years, P=0.0003), clinical heart failure symptoms (in 100/37.5% pts, P=0.0023), ECHO LV dilatation (in 100/62.5% pts, P=0.03), severity of LV dilatation (median 46.6/13% above upper limit, P=0.0044), LV dysfunction (in 81.8/37.5% pts, P=0.04), LV EF (median 43/66%, P=0.05). Pathological ECG findings (LV overload/ischemia) were almost regularly present, with no difference in both groups (in 90.9/87.5% pts, P=0.8). LV recovery time after surgery also did not differ (median 9 / 8 months, P=0.7).

Conclusions: In ALCAPA the ability to develop systemic collateral coronary circulation is crucial. In ADULT form less frequently and less severe LV affection was found, resulting in milder clinical symptoms. However, pathological ECG findings were present in most patients, indicating LV ischemia with a high risk of SCD. As ALCAPA is a very rare disease, it can be misdiagnosed as cardiomyopathy. It is therefore very important to identify correctly the origin of the left coronary artery, as ALCAPA is treatable with good postsurgical long-term prognosis.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1036: Diabetic cardiomyopathy in young normotensive patients with type 1 diabetes mellitus: evaluation of left ventricular systolic function by strain analysis by speckle tracking

I Tadeu 1, O Azevedo 2, M Lourenco 2, F Luis 3, A Lourenco 2

Abstract

Introduction: Diabetic cardiomyopathy is defined as ventricular dysfunction secondary to diabetes mellitus (DM) that is not explained by arterial hypertension or coronary heart disease. Diastolic dysfunction has been suggested as the earliest marker of diabetic cardiomyopathy. Most echocardiography studies have been performed in patients with type 2 DM. Myocardial deformation is less studied in patients with type 1 DM and a reduction of global longitudinal strain has been reported in patients with type 1 DM with 40 years of evolution.

Purpose: To evaluate the impact of diabetes in left ventricular systolic function of young normotensive patients with type 1 DM and without other comorbidities, through echocardiography with longitudinal strain analysis by speckle tracking.

Methods: Prospective study including 30 young normotensive patients with type 1 DM and without other comorbidities and 24 healthy controls. Demographic and clinical data were obtained. All participants underwent a transthoracic echocardiogram that included evaluation by conventional echocardiography and tissue Doppler imaging and strain analysis by speckle tracking.

Results: Patients with type 1 DM were mainly males (63%). They were young (mean age 26 years) and presented diabetes for a mean duration of 10 years (mean glycosylated hemoglobin 9.3%). Patients with type 1 DM had normal diastolic function that was similar to the one of controls. Systolic function, evaluated by ejection fraction and tissue Doppler imaging, was also normal and did not differ between diabetic patients and controls. However, left ventricular global longitudinal strain at peak-systole was significantly lower in patients with type 1 DM than in controls (-19.6±2.5 vs. -21.4±1.9%; p=0.005). DM was identified as an independent predictor of global longitudinal strain (p=0.032). This study found a trend to correlation between diabetes duration and global longitudinal strain (r=0.357; p=0.057) and a correlation between the levels of glycosylated hemoglobin and global longitudinal strain (r=0.413; p=0.023).

Conclusions: Young normotensive patients with type 1 DM with only 10 years of evolution already present a reduction of global longitudinal strain, and therefore subclinical systolic dysfunction, which appears earlier than the diastolic dysfunction that is detected by conventional and tissue Doppler imaging. Global longitudinal strain seems to be correlated to the degree of glycemic control.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1037: Potential long term effects of low birth weight- influences on cardiac shape and susceptibility to heart failure

i Planinc 1, G Bagadur 2, B Bijnens 3, J Ljubas 1, Z Baricevic 1, B Skoric 4, V Velagic 1, D Milicic 4, M Cikes 4

Abstract

Purpose: in our previous studies we showed on a small number of heart failure (HF) pts that postmyocarditic cardiomyopathy (CMP) patients have lower average birth weights (BW) compared to other HF etiologies, and that BW negatively correlates with NT-proBNP and positively correlates with echocardiographic sphericity index (SPHi) of left ventricle (LV). Obtaining those data was a basis for a larger single center observational study on potential long-term effects of low birth weight (LBW).

Methods: Between 2012. and 2013. 628 adult pts with different causes of HF were hospitalized in our center. We obtained BW data for 130 pts, included those in our study. The pts were categorized according to the CMP etiology (table 1.). All pts underwent a full echocardiographic study from which we extracted LViDd, LVEDV and biplane EF, as well as E/E' and MVDecT. SPHi of LV was calculated as base-to-apex length/maximum short axis diameter in the apical 4 chamber view. We also sought to obtain NT-proBNP values for pts in our study.

Results: Postmyocarditic CMP group of pts had the lowest average BWs, and their BWs were significantly lower than average BWs in iDCM and iCM groups. Furthermore, maximum BNP values among all LBW pts were significantly higher than maximum BNP values among all normal BW patients. Considering the echocardiographic LV morphology measures, the SPHi had a negative weak correlation with BNP values in normal BW pts (r= -0.19, p=0.02), but moderate to strong negative correlation in LBW pts (r=-0.49, p=0.03).

Conclusion: in this study, we have confirmed on a larger number of pts that LBW is more prevalent in postmyocarditic pts and may be a relevant cause of HF. importantly, we established a moderate to strong correlation between LV shape and BNP values among LBW HF patients. These data emphasize the potential long term effects of intrauterine growth restriction.

BW/g BNPmax/pg/ml LViDd/cm EF/% SPHi
iDCM 3547.0±846 5780±5734 7.27±0.94 24.5±7.3 1.3±0.1
Myoc. 3135.9±743 6216±3879 6.88±1.1 28.6±8.4 1.4±0.2
iCM 3543.2±852 3473±3708 6.82±0.9 30.0±8.7 1.5±0.2
sDCM 3763±568 2695±2098 6.58±1.1 31.9±6.3 1.6±0.2
ARVD 3930±980 1719±1027 4.58±0.35 72.5±6.5 2.5±0.3
HCM 3414±250 1487±2033 5.14±0.6 50.8±20.8 1.8±0.3
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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1038: Prevalence of rheumatic heart disease (RHD) in young children of north Madagascar: preliminary results from a clinical and echocardiographic screening project

C M Campanale 1, S Di Maria 1, S Mega 1, A Nusca 1, F Marullo 1, G Di Sciascio 1

Abstract

Purpose: Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) are significant public health concerns around the world. Despite decreasing incidence in western countries, there is still a significant disease burden in developing nations, as RHD they causes high morbidity and mortality among young people. Few data are reported about the prevalence of RHD in Madagascar. Echocardiographic screening is able to detect a higher number of asymptomatic affected individuals, compared to clinical screening. Thus, we sought to estimate the prevalence of RHD in children aged from 5 to 19 years in North-Malagasy population through a portable echocardiography.

Methods: we screened 96 students from 3 schools in the region of Antsiranana ranging from 5 to 19 years old for signs and symptoms of ARF and/or RHD. Each pupil underwent clinical questionnaire, with the aid of a local interpreter, physical and cardiac examination, oropharyngeal swab with rapid kit analysis system and transthoracic echocardiogram focused on the evaluation of the 4 valves by a portable ultrasound machine. Criteria for diagnosis of ARF and/or RHD were drawn from the "Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease", published in 2012, which distinguished definite and borderline diagnosis of RHD in young < 20 years old.

Results: women were 71% of the population, mean age was 13.1±3.8 years, mean weight 38.9±11.5, with a mean body mass index of 19.3±6.7. The percentage of children with history of probable exposure to Group A β-hemolytic streptococcus was 48.9%. The echocardiographic screening showed a prevalence of 4.1% (4 cases) of RHD. For one case the diagnosis was definite, since the disease severely involved three valves (aortic, mitral and tricuspid valve), with signs and symptoms of chronic cardiac failure. Three cases were borderline diagnosis affecting the mitral valve. Among these, 75% had positive swab, and same percentage had positive history of ARF.

Conclusion: this is the first study collecting data about RHD in the region of North Madagascar in a young population at high risk of GABHS infection. The use of echocardiography, as an advanced screening technique in the setting of a developing country, permits to identify children with subclinical rheumatic heart disease, thus giving a more realistic dimension of the problem and supporting therapeutic and preventive strategies.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1039: New ECG parameter comparable with echocardiographic data to detect successful balloon pulmonary valvuloplasty

M El Tahlawi 1, M Abdallah 1, M Gouda 1, MARWA Gad 1, M Elawady 1

Abstract

Introduction: The gold standard for diagnosis of pulmonary stenosis (PS) is echocardiography. Pressure gradients can simultaneously be estimated by continuous wave Doppler. P wave dispersion (PWD) indicates the spreading of the sinus stimulus in the atria. PWD and hence the probability of atrial fibrillation are increased in pathological conditions that increase the left atrial pressure or right atrial pressure.

Aim: To study the effect of PS and its treatment by balloon pulmonary valvuloplasty (BPV) on PWD.

Patient & Methods: Patients with moderate or severe valvular PS was enrolled in the study.Twelve-lead surface ECG was obtained . P wave duration and PWD were measured. The pulmonary valve and peak systolic pressure gradients (SPG) over the pulmonary valve were obtained. All cases were underwent BPV. ECG parameters and SPG by echocardiography were done immediately and one month later.

Results: Thirty patients were recruited .Their age ranged from 3-38 years .Eighteen patients had sever PS and 12 had moderate PS. PWD before BPV had mean±SD 0.06±0.017. It decreases significantly immediately after BPV to 0.04±0.017. One month after BPV it was 0.04±0.013 with a high significant difference, p value (0.001). The SPG had mean± SD before BPV 59.86 ± 13.05. It was 40.13 ± 11.77 1 month after BPV with p value (0.001). there was a significant correlation between SPG and PWD with p value (<0.05).

Conclusion: PWD decreases significantly with BPV. PWD significantly correlated with SPG across pulmonary valve. The study demonstrated for the first time a very simple ECG parameters; PWD, that may predict the success of BPV on the short term.

Figure.

Figure

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correlation between drop in SPG and PWD

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1040: Predictive factors of aortic dilatation in patients with Aortic Valve Disease insights of Cardiac Magnetic Resonance

B Igual Munoz 1, AMG Maceira Gonzalez Alicia 1, JEE Estornell Erill 1, LDB Donate Betolin 2, AVS Vazquez Sanchez Alejandro 2, FVM Valera Martinez 2, PSS Sepulveda- Sanchez 3, ACZ Cervera Zamora 3, MPG Piquer Gil Marina 3, AMA Montero- Argudo 2

Abstract

In patients with aortic valve disease (AVD) some genetic and hemodynamic factors have been involved in the aethiology of ascending aorta dilatation (AAD) but the impact of each one is not fully established. We aim to study in this setting predictors of AAD and aortic root disease (ARD).

Methods: 122 consecutive patients with any degree of pure aortic regurgitation (AR) or stenosis (AS) who underwent CMR study were included. Patients with complex congenital heart disease or combined AVD were excluded. CMR was performed analyzing :a)valve phenotype in gradient echo sequences considering bicuspid (BAV) type I or II by Schaefer clasification or tricuspid (TAV) b) diameters of the aortic root, sino-tubular junction and tubular portion were quantified by CRM in gradient echo sequences in oblique sagittal plane and indexed by body surface area. The presence of diameters two standard deviations over the mean for the patient age and gender was considered dilatation c) AVD: AS with an area by planimetry lesser than 0,99cm2/m2 and AR with a range of regurgitant fraction of 5 to 90% were included. Logistic regresion model was used adjusting by age and presence of arterial hypertension.

Results: 90 males (75%), 6 (3%) BAV type II and 21 (17%) BAV type I. 71patients (58,%) had pure AR and 51 (42%) AS. Univariate models for AAD and ARD are shown in the table. In multivariate analysis for AAD AR was an independent predictor (Odds 2.58 P=0,012) and AS was an independent protector factor (Odds 0.38 p=0.012) and for ARD AR was and independent predictor (Odds 4.37 p=0,002) and AS was an independent protector factor (Odds 0.2 p=0,002).

Conclusions: 1. In the setting of AVD the type of valvulopathy is the most powerfull predictor of aortic dilatation. 2.AR is an independent predictor factor of AAD and ARD and AS is an independent protector factor.

Univariate analysis

Ascending aorta dilatation
 Aortic root disease
p wald Odds p wald Odds
AR 0.012 6.3 2,58 0.001 14 4.37
AS 0.012 6.3 0,38 0.001 14 0.2
BAV I 0,55 0.35 1,3 0.67 0.17 1.2
BAVII 0.66 0.18 1.2 0.03 4.5 0.19
TAV 0.5 1.6 0.5 0.3 1.03 1.5
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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

Stress echocardiography: P1041: Dipyridamole-induced changes in diastolic function are differentially related to changes in longitudinal and rotational systolic function indices in hypertensives

KK Naka 1, D Evangelou 1, L Lakkas 1, R Kalaitzidis 2, A Bechlioulis 1, I Gkirdis 1, G Tzeltzes 1, G Nakas 1, K Pappas 1, LK Michalis 1

Abstract

Objectives: Dipyridamole (DIP) is commonly used with conventional 2D echocardiography as a stress inducer, especially for the measurement of coronary flow reserve. Speckle tracking echocardiography (STE) is a novel technique used for the assessment of deformation parameters of left ventricular (LV) myocardium. The aim of the study was to investigate potential changes in novel diastolic and systolic indices during DIP stress test and their interrelation.

Design and Methods: Forty-one hypertensive male patients (aged 57±9 years) without known cardiovascular disease were studied using conventional, tissue Doppler (TD) and 2D speckle tracking echocardiography before and after DIP intravenous infusion (0.84 mg/kg/min for 6 mins). Beta-blockers were discontinued for 2 half-lives before the test. In addition to classic echocardiographic indices of systolic and diastolic function, TDI systolic and diastolic velocities, global longitudinal strain (GLS), global circumferential strain (GCS), apical twist (AT) and peak untwisting velocity (PUV) as novel markers of cardiac deformation were measured. Changes with DIP were assessed using paired t-test and Pearson's correlation coefficients between indices were also assessed.

Results: DIP infusion was associated with significant changes (p<0.05 for all); LV EF, MAPSE septal, MAPSE lateral, Sm, Sl, E, A, DecT, IVRT, GLS, and AT increased, while PUV decreased. No wall motion abnormalities were seen with DIP. There was no relation to changes in HR. DIP-induced changes in early TDI diastolic velocity at the mitral annulus (E') were positively related to changes in EF, MAPSE septal, Sm, Sl, and inversely related to changes in AT (p<0.05 for all). DIP-induced changes in E/E' were also positively related to changes in Sm, Sl, and inversely related to changes in AT (p<0.05 for all).

Conclusions: Dipyridamole-induced changes reflecting improvement in diastolic function are associated with changes consistent with improved longitudinal systolic function, while an increase in AT was associated with a worsening in diastolic function. The pathophysiological significance of these changes and their association needs to be further studied.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1042: Prevalence of atrial fibrillation during dobutamine stress echocardiography

N Mansencal 1, F Bagate 1, M Arslan 1, V Siam-Tsieu 1, J Deblaise 1, R El Mahmoud 1, O Dubourg 1

Abstract

Background: Dobutamine stress echocardiography (DSE) is a widely used echocardiographic examination for assessment of coronary ischemia, but several complications or side effects of DSE have been reported. The aim of this study was to assess the prevalence of atrial fibrillation (AF) during DSE.

Methods: Over a 9-year period (from November 2001 to October 2010) we reviewed all patients (n =2,224) referred for DSE. Criteria for selection included patients >18 years old who underwent DSE. We systematically analyzed all ECG performed during DSE to detect AF during the examination.

Results: DSE was completely performed in 2,179 patients (mean age: 62.4 ± 11.6 y.o.): 694 positive DSE and 1,485 negative DSE. AF was observed in 18 patients (14 men, mean age: 79.6 ± 9.0 y.o.): 4 patients (22%) had a previous history of paroxysmal AF and 16 patients (89%) hypertension. Prevalence of AF during DSE was 0.8%. AF was more frequently observed in case of positive DSE (p<0.0005). Patients with AF during DSE were significantly older (p<0.0001) and prevalence of AF during DSE increased with age: 0.45% in patients 60 to 69 years, 1.3% in patients 70 to 79 years and 4% in patients >80 years.

Conclusion: Prevalence of atrial fibrillation during DSE is 0.8% and its occurrence increases with age.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1043: Heterogeneity of regional deformation during stress echocardiography - quantitative assessment with dispersion indices

K Wierzbowska-Drabik 1, M Plewka 1, JD Kasprzak 1

Abstract

Purpose: The systolic longitudinal strain and strain rate (SLS and SLSR) is proposed for the assessment of regional myocardial function, especially during echocardiographic stress tests. Although some studies documented dispersion of segmental deformation of the left ventricle (LV) with higher absolute values of SLS in apical part or inferior wall there is little quantitative data describing this problem.

Our aim was to compare peak systolic longitudinal strain and strain rate dispersion indices among basal, mid and apical region of LV at rest and at peak stage of dobutamine stress echocardiography (DSE) in subjects without coronary artery disease (CAD).

Methods: We analyzed a group of 111 patients with angiographically excluded coronary stenosis ≥50% in left main and ≥70% in other epicardial arteries (68 female, mean age 60±10 years, mean heart rate at baseline 66±10, at the peak 143±12) in whom regional values of SLS and SLSR in 18 segments of LV were measured during baseline and peak stage of DSE. The deformation was assessed by speckle tracking echocardiography: 2D-strain (2DS) and automated function imaging (AFI). Strain or strain rate dispersion index (DI) was calculated as the mean of standard deviations for strain/strain rate from segments building the assessed region.

Results: SLS DI at baseline for all segments was 5.29 rising to 6.5 at peak stress as calculated by 2DS and 5.7 and 7.4 respectively, by AFI. SLSR DI was 0.33 at rest and 0.87 at peak stage, with p<0.001 for all. The table displays DI in defined parts of LV. At the peak stage the SLS heterogeneity was significantly higher in apical segments than in basal and mid part of LV and SLSR heterogeneity was the lowest in mid segments, see Table.

Conclusions: Segmental heterogeneity of longitudinal strain and strain rate observed at rest increases at the peak stage of DSE. The mid segments of LV presenting the most homogenous SLS and SLSR at both stages of DSE may be the best candidates for analysis of ischemia during stress echocardiography.

Comparison of dispersion indices

Parameter Basal segments Mid segments Apical segments p value
SLS0 5.35 4.85 5.7 ns
SLS1 6.3 6.0 7.3 =0.016
SLSR0 0.35 0.28 0.37 ns
SLSR1 0.93 0.73 0.95 =0.004
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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1044: Role of right ventricle and pulmonary hypertension on determining delta vo2/delta work rate flattening: insights from cardiopulmonary exercise test combined with exercise echocardiography

F Bandera 1, G Generati 1, M Pellegrino 1, E Alfonzetti 1, V Labate 1, S Villani 2, M Gaeta 2, M Guazzi 1

Abstract

Background: several cardiovascular diseases are characterized by an impaired O2 kinetic during exercise. The lack of a linear increase of ΔVO2/ΔWork Rate (WR) relation, as assessed by expired gas analysis, is considered an indicator of abnormal cardiovascular efficiency. We aimed at describing the frequency of ΔVO2/ΔWR flattening in a symptomatic population of cardiac patients, characterizing its functional profile and testing the hypothesis that dynamic pulmonary hypertension and right ventricular contractile reserve play a major role.

Methods and Results: We studied 136 patients, with different cardiovascular diseases, referred for dyspnoea during effort. Cardiopulmonary exercise test (CPET) combined with simultaneous exercise-echocardiography were performed using a symptom-limited protocol. ΔVO2/ΔWR flattening was observed in 36 patients (Group A, 26.5% of population) and was associated with a globally worse functional profile (reduced peak VO2, anaerobic threshold 11.4±3.3 vs 13.8±4.4 mL/kg/min, O2 pulse 8.2±2.3 vs 10.9±3.1 mL/beat, impaired VE/VCO2). At univariate analysis, exercise EF, exercise mitral regurgitation, rest and exercise TAPSE, exercise systolic pulmonary artery pressure (SPAP) and exercise cardiac output (7.7±2 vs 9.0±2.8 L/min) were all significantly (p <0.05) impaired in Group A. The multivariate analysis identified exercise SPAP (OR 1.06; CI 1.01 -1.11; p= 0.011) and exercise TAPSE (OR 0.88; CI 0.8 -0.97; p= 0.013) as main cardiac determinants of ΔVO2/ΔWR flattening.

Conclusion: In patients symptomatic for dyspnea, the occurrence of ΔVO2/ΔWR flattening reflects a significantly impaired functional phenotype whose main cardiac determinants are the impaired SPAP response and the reduced peak RV longitudinal systolic function.

Flattening
 No flattening
 Univariate P value
 Multivariate P value
Rest Peak Rest Peak Reast Peak Peak
Peak VO2, mL/Kg/min -- 13.4±3.9 -- 18±6.6 -- <.0001 --
VE/VCO2 -- 33.2±8 -- 29.8±6.8 -- .02 --
LV EF, % 47±14 47±17 52±16 55±17 .12 .03 NS
Mitral regurgitation ≥3/4+, % 14 39 14 20 .9 .025 .013
TAPSE, mm 20±5 22±5 22±5 25±6 .05 .0029 .011
SPAP, mmHg 37±17 61±19 33±14 51±18 .22 .0009 .013
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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1045: Exercise echocardiographic adaptations of Right Ventricular performance and pulmonary pressures in combination with gas exchange analysis in Heart Failure

F Bandera 1, G Generati 1, M Pellegrino 1, V Labate 1, E Alfonzetti 1, M Guazzi 1

Abstract

Background: Tricuspid annular systolic plain excursion (TAPSE) is a non-invasive indicator of right ventricular (RV) systolic function, with prognostic value in heart failure (HF) patients. Rest TAPSE combined with pulmonary artery systolic pressure (PASP), as TAPSE/PASP ratio, gives additional prognostic information.

Aim: We aimed at describing the association between RV-pulmonary circulation (PC) behavior at rest and peak exercise, looking at functional phenotypes in HF patients.

Methods: 91 patients (age 65±11y, male 70%, ischemic etiology 69%, LVEF 33±10%) underwent a maximal CPET (tiltable cycle-ergometer, incremental ramp protocol) combined with exercise-echo.

Results: Population was divided into three groups: Group A had favorable RV-PC coupling at rest and peak exercise (TAPSE/PASP>0.35), B unfavorable only during exercise (peak TAPSE/PASP <0.35), C RV-PC uncoupling at rest (rest TAPSE/PASP<0.35). Group C patients had more advanced cardiac remodeling and steeper VE/VCO2 slope. Group B patients had intermediate phenotype, with more severe exercise mitral regurgitation, exercise oscillatory ventilation, reduced LV contractile response (peak cardiac output) and exercise tolerance.

Conclusions: In HFrEF patients a low TAPSE/PASP ratio is associated with worse cardiac remodeling and exercise ventilatory inefficiency. An impaired RV-PC response during exercise is characterized by more severe dynamic MR and worse functional phenotype. These findings suggest that non-invasive assessment of RV-PC exercise response is meaningful and better help to categorize HF severity.

A (n=45) B (n=22) C (n=24) P (A vs B) P (B vs C)
Rest Peak Rest Peak Rest Peak Rest Peak Rest Peak
TAPSE/PASP, mm/mmHg 0.72±0.19 0.49±0.12 0.5±0.09 0.29±0.04 0.25±0.07 0.21±0.06 0.00 0.00 0.00 0.00
LV end diastolic volume indexed, ml/m2 90±22 96±27 107±33 ns ns
LVEF, % 35±10 37±12 35±7 37±7 29±9 33±11 ns ns 0.02 ns
MR ≥3/4+, n (%) 3 (6.7) 9 (20) 6 (27) 14 (64) 16 (67) 17 (71) 0.01 0.00 0.00 ns
Cardiac output, L/min 4±1 7.5±2.6 3.8±1.3 6.3±2.1 3.2±1.2 4.7±1.7 ns 0.06 ns 0.01
Workload, Watt 73±21 55±18 48±22 0.00 ns
Peak VO2, ml O2*Kg-1*min-1 14.3±3.5 12.2±2.1 10.9±3.3 0.00 ns
Exercise oscillatory ventilation, n (%) 11 (24) 12 (55) 18 (75) 0.02 ns
VE/VCO2, slope 32±6.9 32±5.8 44±11.8 ns 0.00
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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1046: Circulatory power and exercise phenotypes: insights on disease severity in Heart Failure reduced ejection fraction

G Generati 1, F Bandera 1, M Pellegrino 1, V Labate 1, E Alfonzetti 1, M Guazzi 1

Abstract

Background: Cardiopulmonary exercise testing (CPET) provides several indexes of functional capacity. Circulatory power (CP= peak systolic BP X peak VO2) shows prognostic value in heart failure (HF) patients. Ventilatory power (VP= peak systolic BP/VE/VCO2, ≥/<3) combined with CPET CP (≥/<1750) better stratifies HF population.

Aim: We aimed at describing the relationship between peak exercise CP and VP functional and echo phenotypes in HF patients.

Methods: 94 HFrEF patients (mean age 64±12; male 70%; ischemic etiology 56%; NYHA class I, II, III, IV 28, 32, 31, 9; mean EF 39±9%) underwent maximal symptoms limited CPET (tiltable cycle-ergometer, personalized incremental ramp protocol) combined with exercise echocardiography.

Results: Data were analyzed dividing patients into three groups according to peak VP and CP (cutoff value of 3 W and 1750 mmHg* ml2*kg−1*min−1): Group A=preserved VP (5.5±1.3) and CP (2426±454), B=impaired CP (1421±195), C=impaired both VP (2.8±1) and CP (1081±187). Group C had worse cardiac remodeling and bi-ventricular function already at rest. Group B showed lower right ventricular systolic function (peak TAPSE) and dynamic pulmonary hypertension (higher peak PASP) compared to group A, associated with more severe degree of dynamic mitral regurgitation (MR). These echo-data corresponded to impaired exercise tolerance (lower peak VO2, workload and O2 pulse) and ventilatory efficiency.

Conclusions: Assessment of CP and VP, seems very useful to unmask different degree of impaired functional phenotypes. Patients exhibiting a combined CP and VP impairment are those with the worse phenotype of RV-pulmonary circulation uncoupling.

Variables A (n=62) B (n=14) C (n=16) P (A vs B) P (B vs C)
Rest Peak Rest Peak Rest Peak Rest Peak Rest Peak
LV end diastolic volume indexed, ml/m2 87±25 94±17 130±39 ns 0.003
LVEF, % 36±9 39±11 30±8 36±8 27±8 31±12 0.02 ns ns ns
MR ≥3/4+, n (%) 8 (13) 18 (29) 4 (29) 8 (57) 10 (63) 12 (75) ns 0.05 0.05 ns
TAPSE, mm 19±4 22±4 17±4 19±5 15±3 15±5 ns 0.06 ns ns
Systolic PAP, mmHg 31±9 53±13 40±19 69±25 52±18 65±18 ns 0.04 ns ns
Workload, Watt 76±21 55±20 39±13 0.001 0.04
Peak VO2, ml O2*Kg-1*min-1 15±2.6 9.7±2.2 9.1±1.6 0.000 ns
VE/VCO2, slope 31±6 35±6 46±12 0.03 0.003
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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

Transesophageal echocardiography: P1047: Efficacy of Rivaroxaban in patients with persistent atrial fibrillation undergoing elective direct current cardioversion

T Grycewicz 1, K Szymanska 1, W Grabowicz 1, A Lubinski 1

Abstract

introduction: Rivaroxaban is one of the new oral anti-coagulants (NOAC), which offers fixed dose regimen without the need of coagulation monitoring and may represent beneficial alternative to conventional anticoagulation therapy. However the evidence for NOAC use in direct current (DC) cardioversion is still limited.

Objective: The aim of this study was to evaluate the efficacy of anticoagulation using Rivaroxaban in patients with non valvular persistent atrial fibrillation (AF) undergoing elective DC cardioversion.

Material and Methods: The study group consisted of 18 patients (7 females and 11 males, mean age 64,45 ± 12.31 years) with non valvular persistent AF. All patients were subjected to 4 to 6-week Rivaroksaban therapy at the dose of 20 mg/d. The mean duration of arrhythmia was 13 weeks. The risk of thromboembolic events was high in all patients, mean CHA2DS2-VASc 3,8 ±1,3. Baseline demographic and echocardiographic characteristics, renal and liver function indices and coagulation status were recorded. The patients underwent TOE examination directly before DC cardioversion was performed. The presence of thrombi, spontaneous echo contrast (SEC), velocity of left atrial appendage (LAA) emptying were evaluated. All patients completed a questionnaire concerning compliance.

Results: LAA thrombus was not identified in any of the patients, in 2 patients (11%) TOE showed left atrial SEC, peak left atrial appendage emptying velocities on Doppler evaluation were low < 20 cm/sec in 3 patients (16,5%). Compliance was high 86,6 ± 7,1%.

Conclusions: Rivaroxaban was found to be effective in the prevention of LAA thrombi formation in patients with non-valvular atrial fibrillation undergoing elective DC cardioversion.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

Real-time three-dimensional TTE: P1048: Segmentation and quantification of the anatomic regurgitant orifice from transeshopageal 3D echo images in patients with mitral regurgitation

M Sotaquira 1, M Pepi 2, G Tamborini 2, EG Caiani 1

Abstract

Purpose: Since the anatomic regurgitant orifice (ARO) has a 3D shape and it's not circular, it cannot be accurately represented by vena contracta (VC) and effective regurgitant orifice area (EROA) from 2D color Doppler flow velocity, thus affecting the proper classification of patients with mitral regurgitation (MR). Our aim was to develop a semi-automated method for 3D ARO quantification from TEE images, and to validate it against manual planimetry.

Method: TEE images (Philips) from 25 patients (63±8 years old) with mild to severe MR were analyzed. On the systolic frame, an initial supervised segmentation of the region including the ARO was performed, followed by an automated graph-based extraction of ARO 3D contour, from which 3D surface and 2D projected areas, circularity (CI) and planarity (PI) indices were computed. Comparison between 2D parameters with those obtained by gold standard (GS) manual planimetry was performed for validation.

Results: Comparison with GS ARO 2D area and CI resulted in high correlation (y=1.15x, r2=0.77 and y=0.9x, r2=0.9), no bias and narrow limits of agreement (±2SD=±0.15 cm2 and ±0.13 a.u.). As expected, computed 2D projected area was underestimating 3D surface area by 23%. In 19/25 pts ARO PI was <0.9 (range 0.5-0.94 a.u.), confirming its 3D morphology. Only 1/25 pts exhibited an almost circular ARO (CI 0.92), while 24/25 pts had more elongated ARO (CI<0.8).

Conclusions: The proposed semi-automated method resulted in accurate detection of ARO when compared to manual planimetry. 3D ARO assessment showed underestimation of 2D measures, together with generally non-circular and non-planar orifices, highlighting the limitations of current clinical approach in the assessment of MR severity .

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3D ARO semi-automated segmentation

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1049: Usefulness of real-time three-dimensional transesophageal echocardiography in the diagnosis and treatment of mitral periprosthetic leaks: a single-center study

B Bochard Villanueva 1, N Chacon-Hernandez 1, O Fabregat-Andres 1, P Garcia-Gonzalez 1, A Cubillos-Arango 1, R De La Espriella-Juan 1, C Albiach-Montanana 1, A Berenguer-Jofresa 1, JL Perez-Bosca 1, R Paya-Serrano 1

Abstract

Purpose: Periprosthetic mitral valve regurgitation is a diagnostic and therapeutic challenge in patients who underwent mitral valve replacement. The aim of this study was to analyze the usefulness of real-time three-dimensional transesophageal echocardiography (RT3D TEE) in the diagnosis and treatment of mitral periprosthetic leaks.

Methods: We studied 26 patients (p) (17 women, 69.6 ± 9.4 years) with significant mitral periprosthetic leak in transthoracic echocardiography between March 2011 and February 2014. Two dimensional (2D) and RT3D TEE were performed in all patients and we analyzed: number of leaks, location, the effective regurgitant orifice area (EROA) by proximal convergence method (2D) and direct planimetry using multiplanar reconstruction software (3D). The sphericity index (EI) was obtained by the ratio between the largest and smallest diameter of the leak.

Results: The most common leak location was posterior (13p) followed by septal (6p), lateral (5p) and anterior (2p). The EROA could not be calculated in 9 patients with 2D TEE while it was possible in all cases with RT3D TEE and it was greater than calculated with 2D TEE (0.31 ± 0.19 cm2 vs. 0.24 ± 0.13 cm2, p <0.01). The major and minor diameters were 7.9 ± 5.1 mm and 2.8 ± 1.0 mm respectively. Only 2 patients had a sphericity index lower than 1.5. Percutaneous closure of the leak was performed in 8 patients and RT3D TEE allowed us to guide the procedure. Major diameter was used for choosing the size of the device.

Conclusions: RT3D TEE was superior to 2D TEE in the assessment of patients with mitral periprosthetic leaks. This allowed us to make an accurate diagnosis of the EROA dimensions enabling us to properly choose the closure device. In addition, RT3D TEE was very useful to guide percutaneous closure.

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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1050: Real time 3D transesophageal echocardiography: assessment of left ventricular global systolic function

H-L Cheng 1, C-H Huang 1, Y-C Wang 1, W-H Chou 1

Abstract

Introduction: With real-time 3D transesophageal echocardiography (RT-3D-TEE), we can assess heart structure precisely. However, unlike RT-3D transthoracic echocardiography, clinical validation of RT-3D-TEE in left ventricular (LV) function has not been done. Our aim is to demonstrate that cardiac output (CO) measured by RT-3D-TEE is highly-correlated with CO measured by thermodilution (TD). As a result, during cardiac surgery, we can consider to use "RT-3D-TEE only" instead of "TEE and TD" for more patient.

Methods: We retrospectively reviewed all cardiac surgery patients during 2009/09-2010/09 in our hospital. Informed consent was waived by REC. We insert a pulmonary artery catheter (PAC) via internal jugular vein, CO measurement was repeated 3 times in 5 minutes to record the average. RT-3D-TEE images were recorded in Full Volume mode (ECG-gated) with ventilator temporally stopped. Offline analysis was done blinded to PAC data by an anesthesiologist with 6-year cardiac anesthesia experience and extra software training. There are 2 methods in Philips Qlab 7.1, 3DQ is to manually trace LV border in 4-/2-chamber views, 3DQA is to automatically trace 3D data set after reference points selected by user. Both methods could calculated stroke volume and CO.

Results: There were 685 patients underwent intraoperative TEE, 35 had RT-3D-TEE assessment of LV, 7 had no PAC data and 2 had no RT-3D-TEE image before pericardiotomy. Finally, 26 patients were included. The mean CO by PAC, 3DQ, 3DQA were 3.27, 4.03, 3.77. The correlation coefficient between CO(PAC) and CO(3DQ) is 0.55 (p-value 0.004). The correlation coefficient between CO(PAC) and CO(3DQA) is 0.33 (p-value 0.098). If PAC data and RT-3D-TEE image were sampled in the same stage of surgery, we can get better correlation. If data/image were both sampled before skin incision, the mean CO by PAC, 3DQ, 3DQA were 3.12, 3.42, 3.46. The correlation coefficient between CO(PAC) and CO(3DQ) is 0.81 (p-value 0.005). The correlation coefficient between CO(PAC) and CO(3DQA) is 0.34 (p-value 0.329). If data/image were both sampled before after incision, the mean CO by PAC, 3DQ, 3DQA were 2.76, 3.65, 3.53. The correlation coefficient between CO(PAC) and CO(3DQ) is 0.74 (p-value 0.152). The correlation coefficient between CO(PAC) and CO(3DQA) is 0.57 (p-value 0.319).

Conclusion: The CO measure by RT-3D-TEE is significantly highly correlated with CO by TD (PAC) if data/image were sampled in the same stage of cardiac surgery. Automatic method (3DQA) showed poorer correlation than manual method (3DQ), thus better software/algorithm is needed.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1051: Assessment of super-response to Cardiac Resynchronisation Therapy including 3D echocardiography in patients with congestive heart failure

VA Kuznetsov 1, NN Melnikov 1, DV Krinochkin 1, GV Kolunin 1, TN Enina 1

Abstract

Purpose: To reveal clinical and morphofunctional features in patients with congestive heart failure (CHF) and super-response to cardiac resynchronisation therapy (CRT).

Methods: The study included 59 subjects (88% men, mean age 52.9±9.0 years): 33 patients with ischemic and 26 patients with nonischemic cardiomyopathy. There were the following main criteria of patients selection for CRT: CHF NYHA II-IV functional class; reduced left ventricular ejection fraction (LVEF) <35%; signs of mechanical dyssynchrony assessed by 3D echocardiography, and duration of QRS complex. All patients received guideline-directed medical therapy. 39 subjects had sinus rhythm and 20 patients had permanent atrial fibrillation. Combined CRT/ICD devices were implanted in 40 patients. 3D echocardiography with assessment of systolic dyssynchrony index (SDI) was performed at baseline and 6 months after CRT. Patients were divided into two groups: I (n=18) with increase in LV end-systolic volume (ESV) >30% (super-responders); II group (n=41) with increase in LV ESV <30%.

Results: At baseline no significant differences in major clinical and functional characteristics were observed between the groups. 6 months after implantation both groups demonstrated significant reduction in NYHA functional classes (in group I from 2.69 to 2.00, p=0.001; in group II from 2.70 to 2.18, p=0.007). In the group of <<super-responders>> significant increase in the mean distance during 6-minute walk test was observed (from 327±95 m to 407±46 m, p=0.013), while in group II increase in mean distance was not significant (from 329±106 m to 370±127 m, p=0.126). Significant improvement of cardiac hemodynamic parameters, such as increase in LVEF and decrease in end-diastolic volume and ESV was found in both groups during CRT. Before the implantation SDI was significantly higher in patients of group I compared to group II (9.8±3.5% vs 7.4±4.4%; p=0.035, respectively).

Conclusion: In the group of patients with super-response to CRT clinical improvement and exercise tolerance were detected along with LV reverse remodeling. More significant LV mechanical dyssynchrony in patients with CHF was associated with super-response to CRT.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1052: Right Ventricle function in patients with tricuspid insufficiency. Combined assessment by two-dimensional echocardiography, speckle tracking and three-dimensional echocardiography.

W Sierraalta 1, D Le Bihan 1, RBM Barretto 1, JE Assef 1, M Gospos 1, M Buffon 1, AIO Ramos 1, A Garcia 1, IMF Pinto 1, AGMR Souza 1

Abstract

Aim: The interest about detection of right ventricle (RV) dysfunction in patients with significant tricuspid insufficiency (TI) has increased since it has been considered one of the indications for surgical repair. Newest echocardiography techniques such as two-dimensional (2D) strain and three dimensional (3D) ejection fraction (RVEF) have allowed a more accurate assessment of ventricular function. We sought to compare these techniques for RV function evaluation

Methods: Thirty four patients with significant TI and twenty healthy volunteers were studied. Free wall and global longitudinal strain, 3D RVEF, fractional area change (FAC), tissue Doppler systolic wave velocity of the tricuspid annular plane (S'), and tricuspid annular plane systolic excursion (TAPSE) were measured. RVEF was also measured by computed tomography (TC) in thirty one patients.

Results: FAC, 3D RVEF and systolic free wall and global longitudinal strain were lower in patients compared to the controls. However, 3D RVEF were still within the normal range in patients: FAC: 41.8% ± 10.5% vs. 50.05% ± 5.8%, p=0.009; 3D RVEF: 49.9% ± 6.9% vs. 58.3% ± 5.7%, p<0.0001; 2D free wall strain: -20.4% ± 9.9% vs. -26.14% ± 4.9%, p=0.008; 2D global strain: -19.08% ± 3.3% vs. -20.5% ± 10.2%, p=0.006). S' was also lower in patients: 10.06cm/seg ± 3cm/seg vs. 12.3cm/seg ± 2cm/seg, p<0.001. TAPSE did not show significant difference between groups: 20.15mm ± 5.6mm vs. 21.0 ± 3.1mm, p=0.06. There was no correlation between 3D RVEF and 2D strain measurements, but 3D RVEF correlated well with TC RVEF (r=0.87).

Conclusions: Patients with significant TI have lower FAC, RVEF, as well as decreased free wall and global strain. TAPSE might not be an accurate technique for RV function assessment in these patients. Possibly, RV strain showed more sensitivity in detecting RV dysfunction in patients.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1053: Measurement of left and right atrial volume: comparison of different semi-automatic algorithms of real-time 3D echocardiography

H Mueller 1, S Reverdin 1, G Ehret 1, L Conti 1, S Dos Santos 1

Abstract

Purpose: Real-time full-volume 3D echocardiography (3DE) allows rapid and non-invasive measurement of left (LA) and right atrial (RA) volume without making geometric assumptions. Different algorithms from different commercial providers are available. Recently software with semiautomatic endocardial contour finding algorithms has become available, which considerably speeds up the procedure. Our aim was to compare LA and RA volume determined by different semiautomatic contour detection algorithms from different commercial providers.

Methods: 50 patients were studied by real-time 3DE. Atrial volumes were measured with semiautomatic software (4D AutoLVQ, EchoPAC). These volumes were compared with atrial volumes determined by the QLAB 9.1 software using also a semiautomatic border detection method.

Results: Linear regression showed for both LA and RA a good correlation between volumes determined by EchoPAC and QLAB software (r2 =0.84 and 0.87 respectively, p<0.001). Bland-Altman analysis of AutoLVQ versus QLAB volume determination showed narrow 95% limits of agreement (-9.1 to +13.1 ml for LA volume and -8.9 to +13 ml for RA volume) with a minimal bias of 2 + 5.7 ml and 2.1 + 5.6 ml respectively by the AutoLVQ method.

Conclusions: The QLAB 9.1 semiautomatic border detection method shows good correlation and agreement for left and right atrial volume determination compared to the semiautomatic 4D AutoLVQ software (EchoPAC). The results indicate that values of left and right atrial volume obtained by either algorithm can be compared, for example during follow-up examinations.

Left atrium (LA) Mean ± SD (Range)
LA EchoPAC volume (ml)
LA QLAB volume (ml)		 40.6 ± 13.6 (14 -70)
38.5 ± 13.8 (13 -79.4)
Right atrium (RA) Mean ± SD (Range)
RA EchoPAC volume (ml)
RA QLAB volume (ml)		 37.4 ± 15.2 (11 - 79)
35.2 ± 14.7 (10.8 -78.1)
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Atrial volumes

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1054: Left ventricular systolic function in Metastatic Renal Cell Cancer patients treated with Sunitinib or Pazopanib therapy: multimodality analysis of left ventricular ejection fraction over 6 months

S S Abdel Moneim 1, L F Nhola 1, R Huang 1, M Kohli 1, S Longenbach 1, M Green 1, H R Villarraga 1, K A Bordun 2, D S Jassal 2, S L Mulvagh 1

Abstract

Background: Sunitinib & Pazopanib are oral multi-targeted tyrosine kinase-inhibitors (TKI), approved to treat patients with metastatic renal cell carcinoma (mRCC). We evaluated serial left ventricular (LV) systolic function with LV ejection fraction (LVEF) as measured by 2- dimensional biplane Simpson's methods (2-DE)–& 3-dimensional echocardiography (3-DE) with & without cardiac-ultrasound contrast enhancement up to 6- months after TKI therapy.

Methods: 12 consecutive patients at a single tertiary center with mRCC were evaluated with serial 2-DE and 3-DE with & without Definity infusion (200 ml/hr) at four time points [33 echos:baseline,1,3 & 6 months after TKI therapy].Repeat-measure analyses were used to compare LVEF across imaging modalities and over time.

Results : 12 patients (males n=10; mean age 62±9 years; 75% hypertensive; 75% hyperlipidemic; 67% smokers; 8% diabetics) receiving Sunitinib (n=10) or Pazopanib (n=2) were studied. None developed clinically evident congestive heart failure. At 1 month of Sunitinib therapy,n=1 developed hypertension requiring antihypertensive initiation & n=1 pre-existing hypertension required antihypertensive medication augmentation. LVEF remained unchanged across all 4 imaging modalities, Figure 1. LVEF showed a non-significant reduction from baseline to 6 months (mean EF difference (SE) for 2DE-unenhanced, 3DE-unenhanced, 2DE-enhanced, & 3DE-enhanced[-2.2 (2.9), P=.49;-2.9 (3.6),P=.48;-2.2(0.78),P=.07;& -1.9 (2.3),P= .46, respectively].

Conclusions: In this pilot study of mRCC patients with echocardiographically monitored LV systolic function, no significant temporal changes were found for LVEF despite a trend for reduction during 6 month TKI therapy, suggesting non-cardiotoxic profile in the short term for this class of anticancer therapy.

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Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1055: Assessment of Left-Atrial three dimensional speckle tracking strain and time to peak strain parameters in patients with hypertrophic cardiomyopathy

A Evangelista 1, A Madeo 2, P Piras 2, F Giordano 2, G Giura 2, L Teresi 3, S Gabriele 3, F Re 4, P Puddu 2, C Torromeo 2

Abstract

Purpose: Hypertrophic cardiomyopathy (HCM) affects left atrial function becoming an important risk factor for atrial arrhythmias. Reduced left atrial (LA) function was demonstrated in HCM by different methods.

The aim of the study is to investigate the effects of HCM on LA function using three dimensional speckle tracking echocardiography (3DSTE) to measure LA strain parameters vs healthy controls.

Methods: The study enrolled 16 consecutive HCM patients (mean age: 46 ± 12.9 years, 11 men) and 15 age- and gender-matched healthy controls. 3DSTE was performed in all cases.

Results: The LA global longitudinal strain parameters were significantly different. Global peak atrial longitudinal strain (PALS) (17.3 ± 10.2 vs. 32.12 ± 8.1, p = 0.000) and peak atrial contraction strain (PACS) (6.9 ± 6.8 vs. 13.6 ± 4.8, p = 0.001) were significantly lower whereas time to peak longitudinal strain (TPLS) was significantly longer [503 ± 196.7 vs. 141± 44.7 p = 0.000] in the HCM group. LV mass derived by 3DSTE was correlated with TPLS (r = 0.46, p = 0.000). PALS and PACS were negatively correlated with LV mass (r = -0.68, p = 0.000 and r = -0.63, p = 0.00, respectively).

Conclusions: LA functions were more affected in HCM pts, which worsened by increasing LV mass. Three-dimensional speckle tracking echocardiography allows detailed evaluation of LA function in HCM by strain measurements and might be a useful clinical tool.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

Tissue Doppler and speckle tracking: P1056: impacts of diabetes mellitus on left ventricular function detected by two dimensional speckle tracking echocardiography EGAT study

S Suwannaphong 1, P Vathesatogkit 1, O See 1, S Yamwong 1, W Katekao 1, P Sritara 1

Abstract

Background: Diabetic cardiomyopathy is a condition that leads to cardiac failure and premature mortality. 2D speckle tracking strain is a method to detect subclinical myocardial dysfunction. This study aims to identify the impact of diabetes mellitus on subclinical myocardial changes that underlie diabetic cardiomyopathy.

Method: Participants were drawn from the Electricity Generating Authority of Thailand (EGAT) study in 2012. Echocardiogram was obtained using a standard protocol. Global longitudinal LV strain were measured. Data on diabetes including duration, awareness, treatment and control were traced back to previous visits in 2002 and 2007. Linear regression was made to determine the association between strain and diabetes. In those who had diabetes in 2002, numbers of controlled diabetes out of three visits (2002, 2007 and 2012) were tested against global strain.

Results: 329 participants were enrolled (mean age 68, 72.6% were male). No difference in mean global longitudinal strain between diabetic compared to non-diabetic (mean -18.9 (standard deviation 3.7) versus -19.1 (3.8) respectively) and those who had diabetes for more than 10 years compared to lesser (-18.8 (3.8) versus -19.0 (3.9) respectively) were observed. In those who had diabetes since 2002 (n=64), strain increased monotonically with numbers of uncontrolled diabetes in the past 3 visits (p=0.038). (SHOW GRAPH)

Conclusion: Better glycemic control over a 10 years-period resulted in a better 2D speckle tracking strain parameter. Better control of diabetes might decelerate the progression of subclinical myocardial changes that lead to diabetic cardiomyopathy.

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Association between number of visits wit

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1057: Echographic predictors for new-onset and recurrent post-operative atrial fibrillation in patients undergoing aortic valve replacement

L Iliuta 1

Abstract

Aim: (1). To define the echographic predictors for new-onset post-operative atrial fibrillation (POAF) in patients undergoing aortic valve replacement (AVR) and their adjusted value for calculation of a preoperative risk score. (2). To assess the prognostic value of the restrictive LV diastolic filling pattern (LVDFP) and left atrium (LA) dilatation for POAF development in these patients. (3). To identify the echographic parameters which can predict recurrent atrial fibrillation and their implications for postoperative course in AVR patients

Material and Method: Prospective study on 802 patients who underwent AVR for aortic stenosis (456pts) or aortic regurgitation (AR) (346pts), echographically evaluated (including TDI) preoperatively and postoperatively at 10, 20 and 30 days. All were in sinus rhythm and had no history of atrial fibrillation. Statistical analysis used SYSTAT and SPSS programs. Multivariable analysis were adjusted for age and gender and included left ventricular ejection fraction(LVEF)≤35%, restrictive LVDFP, renal insufficiency and logistic EuroSCORE ≥20%.

Results: POAF occurred in 320 of 862 patients (39.9%). (1). The independent echographic predictors for POAF occurrence were: restrictive LVDFP (RR=23.42), preoperative AR (RR=10.31), LA dimension index>30mm/m2 (RR=13.92), LVEF≤35% (RR=9.5) and LV endsystolic diameter (LVESD)>55mm (RR=10.3). (2). The presence of a restrictive LVDFP increased the POAF risk by 23.42 fold, regardless of the presence of other known parameters that increased POAF rate in patients undergoing AVR(p=0.001) and the rate of POAF increased exponentially with diastolic dysfunction severity (p<0.001). (3). Simple linear and multivariate logistic regression analysis showed the echographic predictors of recurrent POAF (occurred at 44.69% of POAF patients): restrictive LVDFP, LA dimension index>30mm/m2, LV end-systolic volume (LVESV)>85cm3, moderate mitral regurgitation (MR) and severe pulmonary hypertension (PHT).

Conclusions: (1). The echographic predictors for POAF initiation in AVR patients were: restrictive LVDFP, preoperative AR, LVESD>55mm and LVEF≤35%. (2). Restrictive LVDFP and LA dilatation have a strong independent and incremental predisposing value for POAF initiation in patients undergoing AVR and their evaluation may be very useful during risk stratification of patients undergoing cardiac surgery. The diastolic dysfunction severity had a exponentially increased prognostic value for the risk of POAF. (3). The only independent predictors for recurrent POAF after AVR were: restrictive LVDFP, LA dimension index>30mm/m2, LVESV>85cm3, moderate MR and severe PHT.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1058: Regional myocardial function in Brugada Syndrome - speckle tracking echocardiography study.

M Szulik 1, W Streb 1, A Wozniak 1, R Lenarczyk 1, A Sliwinska 1, Z Kalarus 1, T Kukulski 1

Abstract

Rationale: The association between abnormal electrical repolarization (long QT) and mechanical myocardial dyssynchrony as measured by longitudinal strain has been already documented. Moreover, exercise induced mechanical dyssynchrony has been also proposed as a valuable outcome predictor.

Aim of the Study: To explore, if this association exists in patients with Brugada syndrome (BS), we investigated RV and LV function at rest and during exercise.

Methods: 14 patients underwent rest and bicycle stress echocardiography. SD of time to maximum myocardial longitudinal strain (shortening) – measured by speckle tracking – was calculated as a parameter of mechanical dispersion for LV: in a 16-segment model (or 6-segment model for each apical view); for RV – the SD of 6 RV segments (in apical 4-chamber view). 13 healthy individuals served as controls.

Results: Are presented in table. RV and LV dispersion changes during exercise are presented in figure (* - p < 0.05 vs. BS)

Conclusions: 1. Compared to the healthy controls, Brugada patients are characterized by greater interventricular delay, lower global LV and RV strain and more pronounced LV dispersion. 2. Both rest and exercise induced mechanical LV and RV dispersion was higher than in healthy controls.

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Dispersion changes during exercise

Brugada Syndrome Controls
QRS duration [ms] 105 ± 13 99 ± 4
interventricular delay [ms] 17.6 ± 11 5.5 ± 5.9 **
RV medial strain [%] -25.95 ± 6 -32.1 ± 6 *
E’ septal [cm/s] -9.0 ± 1.7 -11 ± 2.4 *
GLS LV [%] -16.7 ± 2 -18.9 ± 1 **
GLS RV [%] -19.5 ± 4 -21.5 ± 3
LV dispersion [ms] 42 ± 10 26 ± 7 **
RV dispersion [ms] 40 ± 13 33 ± 26
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* - p < 0.05 vs. BS; ** - p < 0.005 vs. BS

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1059: Quantification of left to right shunting in Neonatal VSD by 3D PISA

K-P Weng 1, C-C Lin 1

Abstract

Purpose: The 2D proximal isovelocity surface area (PISA) has some technical limitations, mainly the geometric assumptions of PISA shape required to calculate effective defect area of ventricular septal defect (VSD). Recently developed 3D echocardiography allows the direct measurement of PISA without geometric assumptions. The purpose of the study is to test the value of 3D PISA in neonatal VSD.

Methods: Twenty-one neonates (22±6 days of age) with VSD were prospectively studied. They underwent 2 D and 3D echocardiography. Effective defect area (EDA) and shunt volume (SV) were measured and calculated. 3D transthoracic planimetry was used as the reference method.

Results: EDA assessed using the 3D PISA had better correlation with the reference method than using 2D PISA (r=0.95 vs r=0.87). Bland-Altman analysis showed better agreement between 3D PISA derived EDA and the reference method. 3D PISA derived SV had better correlation with the reference method than did the 2D PISA method (r=0.92 vs r=0.83). Good intraobserver and interobserver agreement for 3D PISA measurements was observed, with intraclass correlation coefficients of 0.88 and 0.84 respectively.

Conclusions: These data suggest that the 3D PISA method is a reliable non-invasive investigation for the quantitative assessment of VSD shunt flow and more accurate than the conventional 2D PISA method.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1060: Implementation of modern speckle-tracking based strain analysis in adult zebrafish combined with classical echocardiography reveals delayed functional healing after myocardial injury

S Hein 1, L Lehmann 1, M Kossack 1, L Juergensen 1, HA Katus 1, D Hassel 1

Abstract

Purpose: Zebrafish is a well-established model in cardiovascular research and has repeatedly contributed to elucidate genetically caused human cardiac illnesses. Furthermore, adult zebrafish with its potent cardiac regenerative capability became a valuable model to investigate molecular mechanisms driving cardiac regeneration. However, protocols to assess cardiac performance in adult zebrafish are still largely missing. We here present the first standardized protocol to accurately assess global and regional cardiac performance in high spatio-temporal resolution by combining conventional echocardiography with speckle tracking analysis in adult zebrafish.

Methods: We used high frequency ultrasound system to visualize adult zebrafish heart function with pulse-wave Doppler and B-Mode recordings. We further applied speckle tracking algorithms to achieve more detailed insights into regional myocardial motion and deformation.

Results: According to standards in echocardiography in humans, we defined three examination planes specifically adapted to zebrafishs anatomic characteristics. Using conventional echocardiography techniques, we were able to reliably evaluate systolic and diastolic function as well as heart rate changes. To gain further and deeper insights into myocardial mechanics, we applied highly sensitive speckle tracking analysis. Thereby, we were able to precisely detect regional changes in cardiac function within the range of some micrometers. In a first attempt to apply our method on a scientific question, we excecuted speckle tracking on cryoinjured zebrafish hearts and conducted follow-up measurements during cardiac regeneration process. By combining radial velocity, displacement, strain, strain rate and opposing wall delays, we were able to precisely detect injured myocardial regions and observed continuous progress of cardiac functional healing. We thereby found delayed restitution of cardiac displacement as well as delayed resynchronization of injured and non-injured myocardial regions until 120 days post infarction (dpi) whereas basic echocardiographic parameters and cardiac histomorphological appearance have already been rebuild at 30dpi.

Conclusion: We firstly established a cardiac examination procedure to globally and regionally assess cardiac function in adult zebrafish in a reliable, easily reproducible way with high spatio-temporal resolution and high throughput potential. Our study thereby contributes to further establish adult zebrafish as a potent genetic model to evaluate novel human cardiac disease genes and mechanisms and regeneration research.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1061: Tissue Doppler measurement of cardiac cycle's time intervals in healthy and cardiovascular patients: a possible new diagnostic parameter

F Turrini 1, S Scarlini 1, P Giovanardi 1, R Messora 1, C Mannucci 1, M Bondi 1

Abstract

Aims: Cardiac function is usually described by the velocity of ejection (EJ) or filling and the extent of EJ. An alternative approach to its evaluation is measurement of time intervals. Tissue Doppler allows an accurate measurement of cardiac phases generated by movement of the myocardium. We aimed to measure time intervals derived by TDI in healthy and unhealthy subjects.

Methods: 27 healthy patients and 55 with stable cardiovascular disease (hypertension, diabetes or heart failure) in sinus rythm, underwent echocardiography. TDI tracings were obtained from apical view at atrioventricular plane on left side (LS) and right side (RS). Cardiac cycle was divided into 6 phases: pre EJ, EJ, post EJ, rapid filling, slow filling and atrial contraction (AC). Duration was normalized to cardiac rate.

Results: Diastole of healthy subjects was significantly shorter in RS, with a shorter slow filling and a longer rapid filling and AC with respect to LS. This profile is maintained in sick patients. No differences were due to age. In patients with hypertension there was a longer left AC compared to healthy. No significant changes were found in diabetes. Heart failure patients presented a longer LS post EJ time; heart failure with normal EJ showed also a shorter LS EJ. Patients with reduced MAPSE had longer LS post EJ whereas patients with reduced TAPSE had longer RS post EJ.

Conclusions: Cardiac cycle's time intervals show a shorter diastole in RS not influenced by age or disease. Post EJ time clearly identifies systolic disfunction both in LS and RS. Further studies could identify differences between stable and acute patients or be applied to stress testing.

Healthy subjects (27) Hypertension (21) Diabetes (9) Heart Failure (25) MAPSE (12) TAPSE (22)
msec EJ>45% EJ<45% < 11 mm < 20 mm
LS RS LS RS LS RS LS LS LS RS
Pre EJ 103±35 † 89±45 † 102±47 § 80±43 § 90±51 ¥ 77±33 ¥ 125±75 111±47 132±73 104±59
EJ 320±74 322±80 322±108 330±103 302±83 323±66 248±54• 332±93 295±108 313±109
Post EJ 98±45 91±30 114±43 109±44 91±36 95±47 138±25• 117±21• 142±42• 117±45•
Rapid filling 168±52 ¤ 251±62 ¤ 177±57 * 271±100 * 188±60 § 268±85 § 149±52 183±118 141±72 174±71
Slow filling 272±192‡ 189±191‡ 297±210** 201±177** 234±185 º 180±171 º 202±123 224±167 213±177 286±161
AC 103±25†† 135±39†† 124±29 π • 154±43 π 112±30 ¶ 135±14 ¶ 115±32 129±28 130±28 114±30
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All symbols stand for p <0.05;· means significant when compared to all other groups

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

P1062: Neonatal arterial layer morphology in fetal growth abnormality

R Olander 1, JKM Sundholm 1, TH Ojala 1, S Andersson 1, T Sarkola 1

Abstract

Purpose: Fetal growth abnormalities are related with cardiovascular disease later during adulthood. Very little is known about the effect of fetal growth abnormalities on the cardiovascular phenotype during the newborn stage. The objective was to study the regional arterial morphology with respect to gestational age and newborn body morphometrics.

Methods: We studied the arterial morphology of 175 newborns born between 31 and 42 weeks of gestation, including neonates small, large and appropriate for age birth weights, with very-high resolution vascular ultrasound (35-55 MHz).

Results: Statistically significant associations were observed between carotid, brachial and femoral arterial lumen dimension (LD), wall thickness (intima-media-adventitia thickness (IMAT), intima-media thickness (IMT)) and end-organ circumference, male gender, gestational age, body weight, and body surface area. In linear multiple regression models these explained a large proportion of the arterial variance (R2 range 0.39 to 0.48 for LD; R2 range 0.24 to 0.35 for IMAT; and R2 range 0.06 to 0.15 for IMT; all models p<0.001). After adjustments, gestational age and male gender remained significant for all arterial LDs (p<0.01).

Conclusion: These preliminary results suggest that fetal arterial lumen growth is primarily related to gender and gestational age.

Eur Heart J Cardiovasc Imaging. 2014 Dec 5;15(Suppl 2):ii168–ii195.

Computed Tomography & Nuclear Cardiology: P1063: Coronary plaque quantification without training: does iterative reconstruction help?

M Karolyi 1, I Kocsmar 1, R Raaijmakers 2, PH Kitslaar 3, T Horvath 1, B Szilveszter 1, B Merkely 1, P Maurovich-Horvat 1, MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary

Abstract

Aims: To evaluate the effect of experience with coronary computed tomography angiography (CCTA) on the plaque quantification using a semiautomatic software tool and different image reconstruction algorithms.

Methods: Data of 25 patients present with significant coronary artery disease on CCTA were randomly selected. CCTA images were acquired on a 256-slice CT scanner. Images were reconstructed with standard filtered-back projection (FBP) and hybrid iterative reconstruction (IR) techniques. Proximal 40 mm of the left anterior descending (LAD) artery of all patients were analyzed and by a reader with 5 years of experience in CCTA (Reader 1 – R1) and a medical student with minimal practice in CCTA (Reader 2 – R2) using a semiautomated plaque quantification software. Coronary segmentation, lumen and vessel wall delineation was performed automated, and corrected manually, if necessary. Time for automated segmentation of the coronaries and segmented length of the LAD was registered. Plaque burden and plaque components (calcified, non-calcified) were quantified using an adaptive threshold setting.

Results: Coronary segmentation was faster with IR as compared to FBP (58.6 s vs. 54.9 s, p<0.0001), while automated segmentation could not be performed in 5/25 cases with FBP and in 1/25 case using IR. Longer path of the LAD was segmented automatically with IR, than with FBP (121,9 mm vs. 144,7 mm, p<0,05). The mean plaque burden by Reader 1 versus Reader 2 in FBP were: 0.40 vs. 0.44 (p<0.005; bias 10.0%); in IR: 0.39 vs. 0.40 (p=0.15; bias 4.0%). Whereas, corresponding plaque volumes were 193.4 vs. 214.6 mm3 (p<0.005, bias 19.7%) and 193.5 vs.196.3 mm3 (p= 0,11, bias 1.4%), respectively. The non-calcified volumes by R1 versus R2 in FBP were: 64.9 vs. 76.6 mm3 (p< 0.05; bias 16.5%); IR: 59.6 vs. 63.9 mm3 (p= 0.06; bias 7.1%). The mean dense calcium volumes by R1 versus R2 in FBP were: 33.4 vs. 47.3 mm3 (p<0.0001; bias 34.5%); IR: 36.0 vs. 40.8 mm3 (p<0,05; bias 12.5%).

Conclusion: Coronary segmentation was more robust using IR, than with FBP. The medical student with no experience in CCTA was able to perform coronary plaque analysis after minimal training. However, she has systematically overestimated the plaque burden and plaque components. Importantly, the overestimation was smaller using IR as compared to FBR.

Articles from European Heart Journal Cardiovascular Imaging are provided here courtesy of Oxford University Press

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