TY - JOUR
AB -   P1450 Left atrium morphological changes as early predictor of trastuzumab cardiotoxicity M Dal Porto M Dal Porto University of Verona, Cardiology, Verona, Italy C Bergamini C Bergamini University of Verona, Cardiology, Verona, Italy LF Cerrito LF Cerrito University of Verona, Cardiology, Verona, Italy G Benfari G Benfari University of Verona, Cardiology, Verona, Italy G Dolci G Dolci University of Verona, Cardiology, Verona, Italy E Setti E Setti University of Verona, Cardiology, Verona, Italy A Comunello A Comunello University of Verona, Cardiology, Verona, Italy A Rossi A Rossi University of Verona, Cardiology, Verona, Italy L Carbognin L Carbognin University of Verona, Department of Oncology, Verona, Italy E Fiorio E Fiorio University of Verona, Department of Oncology, Verona, Italy FL Ribichini FL Ribichini University of Verona, Cardiology, Verona, Italy University of Verona, Cardiology, Verona, Italy University of Verona, Department of Oncology, Verona, Italy Background: Left atrial morphological changes over time assessed by echocardiography have been used to evaluate prognosis in many cardiomyopathies. They have never been evaluated in predicting cardiotoxicity in Her2 positive breast cancer patients treated with trastuzumab. Aim: to assess the role of left atrial volume indexed (LAVI) dilation over time as an early predictor of the development of trastuzumab (TZ) cardiotoxicity (CT). Methods: HER-2 positive breast cancer patients receiving TZ were retrospectively recruited from the two largest university hospitals of our city. Patients underwent consecutive transthoracic echocardiography at baseline and then every three months. Only patients with both LA volumes at baseline and at three months were included in database. Results: Eligible patients were 193; mean age was 56 ± 13 years; mean follow-up was 14 ± 5 months. Overall CT occurred in 59 patients (31%). A dilation in left atrial volumes was detectable over time, this appeared to be small on average, but became more significant in patients with subsequent CT. This increasing trend has been evident since the very beginning (at three months) but continued over time at six months and even afterwards. Early LAVI dilation (0-3 months) was able to predict CT (echo based criteria) OR 1.22 (CI 1.03-1.47) p = 0.02 per 5 ml/mq increase. Even when adjusted for baseline LAVI, age, and systolic arterial pressure, early LAVI dilation was an independent predictor of CT, OR 1.31 (CI 1.07-1.58), p = 0.004. In patients who faced LAVI dilation and had mitral regurgitation (MR) at baseline, there was no significant worsening of MR after 3 months of TZ therapy. Conclusion: This is the first report of repeated LAVI measurements over time. LAVI dilation begins before ejection fraction decreases, and hence anticipates the development of left ventricular dysfunction. Even if LAVI is a simple and well known echocardiographic measurement, it could be used in this newborn context to stratify patients after validation with prospective studies. View largeDownload slide Abstract P1450 Figure. View largeDownload slide Abstract P1450 Figure. P1451 Aortic elasticity properties after stent implantation of patients with aortic coarctation FA Pac FA Pac Turkiye Yuksek Ihtisas Hospital, Pediatric Cardiology, Ankara, Turkey D Eris D Eris Turkiye Yuksek Ihtisas Hospital, Pediatric Cardiology, Ankara, Turkey S Koca S Koca Turkiye Yuksek Ihtisas Hospital, Pediatric Cardiology, Ankara, Turkey MM Zabun MM Zabun Turkiye Yuksek Ihtisas Hospital, Pediatric Cardiology, Ankara, Turkey Turkiye Yuksek Ihtisas Hospital, Pediatric Cardiology, Ankara, Turkey Introduction: Patients with aortic coarctation are known to have intrinsic aortic wall abnormalities and these abnormalities cause increased ascending aortic stiffness, which persist even after aortic coarctation repair. The aim of this study was to determine effects of stenting on the aortic stiffness and left ventricular systolic functions. Method: Echocardiographic examination was used on patients treated with intravascular stenting for the coarctation of the aorta (Coarctation group; n = 12) and healthy matched controls (Normal group; n = 12). We analyzed left ventricular wall thickness, systolic and diastolic functions and stiffness index, distansibility index, strain of descending aorta andascending aorta. Results: Age range was 10-42 (mean 20) years. Age at time of stent implantation was 6-38 (mean 17) years. Time since stent implantation was 2-6 (mean3.9) years. There was no significant difference in blood pressure, heart rate and sistolic functions of left ventricle between the groups. At diastole; interventricular septum diameter(coarctation group:11 ± 1.6 mm; normal group: 9 ± 1.4 mm; p < 0.05), posterior wall thickness (PWd) (coarctation group:9.9 ± 0.9mm; controlgroup: 8 ± 1.4 mm; p < 0.05), left ventricle mass index (coarctation group: 42.4 ± 10.6 gr/m2; control group:33.2 ± 8.1 gr/m2; p < 0.05)were found increased in coarctation group compared with normal group. Compared with normal subjects; patients with stent implanted aort coarctation had increased aortic stiffness index in the proximal ascending aorta (coarctation group:5.9± 2.5; control group:3.5 ± 1.3; p < 0.05) and descending aorta(coarctation group:6 ± 3.6; control group:2.9 ± 1; p < 0.05). In addition to this; aortic distensibility of stent implanted patients was found decreased in the proximal ascending aorta(coarctation group:5.8± 3.2; control group:7.4 ± 3; p < 0.05) and descending aorta(coarctation group:5.3 ± 3.2; normal group:8.8 ± 3; p < 0.05). Conclusion: In conclusion children who undervent stent implantation for aort coarctation have abnormal aortic elasticity compared with control group. Vascular structural abnormalities of aortic coarctation or stenting may be the cause of increased aortic stiffness index. View largeDownload slide Abstract P1451 Table 3 View largeDownload slide Abstract P1451 Table 3 P1452 Changes in cardiac morphology and function after normalization of plasma volume in untrained individuals exposed to 10 weeks of supervised endurance training AW Bjerring AW Bjerring Oslo University Hospital, Center for Cardiological Innovation, Oslo, Norway Ø Skattebo Ø Skattebo Norwegian School of Sport Sciences, Oslo, Norway M Auensen M Auensen Norwegian School of Sport Sciences, Oslo, Norway KH Haugaa KH Haugaa Oslo University Hospital, Center for Cardiological Innovation, Oslo, Norway J Hallen J Hallen Norwegian School of Sport Sciences, Oslo, Norway C Capelli C Capelli Norwegian School of Sport Sciences, Oslo, Norway T Edvardsen T Edvardsen Oslo University Hospital, Center for Cardiological Innovation, Oslo, Norway SI Sarvari SI Sarvari Oslo University Hospital, Center for Cardiological Innovation, Oslo, Norway Oslo University Hospital, Center for Cardiological Innovation, Oslo, Norway Norwegian School of Sport Sciences, Oslo, Norway Funding Acknowledgements: South-Eastern Norway Regional Health Authority OnBehalf: Center for Cardiac Innovation Background: Cardiac changes occur in response to endurance exercise. However, due to training induced blood volume expansion, it has been difficult to examine the heart under identical loading conditions after a period of endurance training. Purpose: We aimed to assess how high-intensity endurance training affects cardiac morphology and function when controlled for physiological increase in blood volume. Methods: Eleven healthy participants underwent 10 weeks of supervised, high-intensity endurance training. Blood volume was assessed by the CO-rebreathing method at baseline and post-exercise, allowing for normalization of blood volume by phlebotomy. Echocardiography and cardiopulmonary exercise testing were performed and blood pressure, as a surrogate for afterload, was assessed at baseline and post-exercise and phlebotomy. Results: Participants had increased indexed VO2 max, blood volume and LV mass after the training period. There were no differences in LV volumes, LV function and blood pressure before and after the training period and phlebotomy (Table). Conclusion: After ten weeks of intensive training, and after normalizing preload by phlebotomy while afterload was unchanged, our subjects had unchanged LV volumes and function but increased LV mass, supporting the hypothesis of an initial concentric remodelling as a response to endurance training. Baseline (n = 11) Post training (n = 11) p-value  VO2 max indexed, mL/kg/min 44 ± 6 50 ± 6 <0.001 Blood volume before phlebotomy, L 4.97 ± 0.98 5.16 ± 1.00 <0.05 Systolic blood pressure, mmHg 121 ± 10 119 ± 12 0.55 IVSd, mm 7.5 ± 0.7 8.4 ± 1.1 <0.05 LVPWd, mm 7.4 ± 0.8 7.9 ± 0.9 0.17 LV Mass, g 123 ± 37 142 ± 45 <0.05 3D LV end-diastolic volume, ml 124 ± 35 117 ± 39 0.10 3D LV end-systolic volume, ml 49 ± 15 46 ± 17 0.10 3D LV ejection fraction, % 61 ± 3 61 ± 4 0.91 LV global longitudinal strain, % -22.3 ± 1.4 -21.3 ± 1.7 0.12 LV global circumferential strain, % -23.8 ± 1.7 23.0 ± 2.4 0.24 Baseline (n = 11) Post training (n = 11) p-value  VO2 max indexed, mL/kg/min 44 ± 6 50 ± 6 <0.001 Blood volume before phlebotomy, L 4.97 ± 0.98 5.16 ± 1.00 <0.05 Systolic blood pressure, mmHg 121 ± 10 119 ± 12 0.55 IVSd, mm 7.5 ± 0.7 8.4 ± 1.1 <0.05 LVPWd, mm 7.4 ± 0.8 7.9 ± 0.9 0.17 LV Mass, g 123 ± 37 142 ± 45 <0.05 3D LV end-diastolic volume, ml 124 ± 35 117 ± 39 0.10 3D LV end-systolic volume, ml 49 ± 15 46 ± 17 0.10 3D LV ejection fraction, % 61 ± 3 61 ± 4 0.91 LV global longitudinal strain, % -22.3 ± 1.4 -21.3 ± 1.7 0.12 LV global circumferential strain, % -23.8 ± 1.7 23.0 ± 2.4 0.24 Data expressed as mean ± SD. Right column shows P-values for the paired samples t-test. All parameters in “post training” were measured after phlebotomy, except “blood volume” which is reported pre-phlebotomy. IVSd, interventricular septum in diastole; LV, left ventricle; LVPWd, left ventricular posterior wall in diastole; RV, right ventricle. View Large Baseline (n = 11) Post training (n = 11) p-value  VO2 max indexed, mL/kg/min 44 ± 6 50 ± 6 <0.001 Blood volume before phlebotomy, L 4.97 ± 0.98 5.16 ± 1.00 <0.05 Systolic blood pressure, mmHg 121 ± 10 119 ± 12 0.55 IVSd, mm 7.5 ± 0.7 8.4 ± 1.1 <0.05 LVPWd, mm 7.4 ± 0.8 7.9 ± 0.9 0.17 LV Mass, g 123 ± 37 142 ± 45 <0.05 3D LV end-diastolic volume, ml 124 ± 35 117 ± 39 0.10 3D LV end-systolic volume, ml 49 ± 15 46 ± 17 0.10 3D LV ejection fraction, % 61 ± 3 61 ± 4 0.91 LV global longitudinal strain, % -22.3 ± 1.4 -21.3 ± 1.7 0.12 LV global circumferential strain, % -23.8 ± 1.7 23.0 ± 2.4 0.24 Baseline (n = 11) Post training (n = 11) p-value  VO2 max indexed, mL/kg/min 44 ± 6 50 ± 6 <0.001 Blood volume before phlebotomy, L 4.97 ± 0.98 5.16 ± 1.00 <0.05 Systolic blood pressure, mmHg 121 ± 10 119 ± 12 0.55 IVSd, mm 7.5 ± 0.7 8.4 ± 1.1 <0.05 LVPWd, mm 7.4 ± 0.8 7.9 ± 0.9 0.17 LV Mass, g 123 ± 37 142 ± 45 <0.05 3D LV end-diastolic volume, ml 124 ± 35 117 ± 39 0.10 3D LV end-systolic volume, ml 49 ± 15 46 ± 17 0.10 3D LV ejection fraction, % 61 ± 3 61 ± 4 0.91 LV global longitudinal strain, % -22.3 ± 1.4 -21.3 ± 1.7 0.12 LV global circumferential strain, % -23.8 ± 1.7 23.0 ± 2.4 0.24 Data expressed as mean ± SD. Right column shows P-values for the paired samples t-test. All parameters in “post training” were measured after phlebotomy, except “blood volume” which is reported pre-phlebotomy. IVSd, interventricular septum in diastole; LV, left ventricle; LVPWd, left ventricular posterior wall in diastole; RV, right ventricle. View Large P1453 Validation study of upper limit of normal values for proximal aortic diameters in patients with thoracic aortic disease L Campens L Campens Ghent University Hospital (UZ), Department of Cardiology, Ghent, Belgium A Lips A Lips Ghent University Hospital (UZ), Ghent, Belgium K De Groote K De Groote Ghent University Hospital (UZ), Department of pediatric cardiology , Ghent, Belgium L Demulier L Demulier Ghent University Hospital, Department of Cardiology, Ghent, Belgium J De Backer J De Backer Ghent University Hospital, Department of Cardiology, Ghent, Belgium Ghent University Hospital (UZ), Department of Cardiology, Ghent, Belgium Ghent University Hospital (UZ), Ghent, Belgium Ghent University Hospital (UZ), Department of pediatric cardiology , Ghent, Belgium Ghent University Hospital, Department of Cardiology, Ghent, Belgium Background Thoracic aortic dilatation (TAD) requires accurate and timely detection in order to prevent progression to aortic dissection. The detection of TAD necessitates the availability of cut-off values for normal aortic diameters. Initially published nomograms used to predict normal proximal thoracic aortic diameters obtained by echocardiography were mostly based on small reference populations with varying age groups and/or applicable for the sinuses of Valsalva (SoV) only. To overcome this problem we previously developed gender and BSA specific formulas for upper limit of normal (ULN) calculation for both SoV and ascending aorta (AA) based on established guidelines and applicable in a wide age range. We now aimed to validate different available ULN formulas in a cohort of TAD patients. Methods We selected six articles establishing ULN formulas using the ASE- and EACVI guidelines for measuring proximal aortic diameters and subsequently applied them on a cohort of 593 TAD patients (3-90y) including bicuspid aortic valve (BAV, N = 280, female 31.8%), Marfan syndrome (MFS, N = 193, female 47%) and Turner syndrome (TS, N = 120). ULN values are compared separately for subjects <18y (N = 109) and >18y (N = 484) as most formulas include different age ranges. Differences between the various ULN values were obtained by subtracting the ULN calculated with our formulas from those of literature. Results In subjects <18y our ULN values provide equivalent information about dilatation of the SoV compared to two other available formulas in 82 and 86% of cases, resp. (median difference -1.29mm (IQR -1.8; -0.87mm) and 1.9mm (IQR 1.19; 2.3mm), resp.). Only one other study provide ULN formulas for the AA in children and yields a strong agreement in classification of dilated and non-dilated AA with our formulas of about 98% (median difference 0.05mm (IQR -0.44; 0.43mm)). The importance of gender becomes apparent above the age of 15y resulting in large scattering in ULN values not accounting for gender above 15y. In adults >18 years differences in ULN values of the SoV were smallest when comparing to ULN formulas that account for gender and use age as a continuous variable (median difference 0.67mm (IQR -0.14; 1.41mm), with 94% agreement in classification in dilated and non-dilated SoV). For the AA, only one other study was available for comparison, but showed incongruent results with our values due to categorization in small age groups. Conclusion: ULN values obtained with our previously published formulas correlate well and lie within the range of those calculated with the other available formulas. ULN formulas implementing gender, age as a continuous variable and BSA provide equivalent information on aortic dilatation in about 86 to 94%. Gender should be taken into account due to its impact on aortic dimensions from adolescence on. P1454 Aortic root dimensions in adolescent athletes K Yiangou K Yiangou The Cardio Clinic Heart Center, Nicosia, Cyprus A Malhotra A Malhotra St George"s University of London, London, United Kingdom M Papadakis M Papadakis St George"s University of London, London, United Kingdom MT Esteban Tome MT Esteban Tome St George"s University of London, London, United Kingdom S Sharma S Sharma St George"s University of London, London, United Kingdom The Cardio Clinic Heart Center, Nicosia, Cyprus St George"s University of London, London, United Kingdom Introduction Regular physical exercise is associated with a magnitude of positive effects on health whereas at the same time is responsible for structural, electrical and functional changes in the heart, a condition termed ‘athletes heart’. It has been hypothesized that the hemodynamic load during exercise may also lead to aortic remodeling. The rest of the cardiac adaptations induced by athletic conditioning have been the subject of numerous studies, but investigations of the aorta in athletes have been limited and is rather vague whether the hemodynamic overload during chronic exercise training affects aortic root dimensions, or at least to the extent that the rest of the cardiac chambers are affected. Adolescent athletes (14 to 17 years old) comprise the largest cohort of exercise individuals throughout the world. At the same time they are the most vulnerable subgroup of athletes to exercise-related sudden cardiac death. Methods 1035 individuals, males and females were included in the study. These individuals were footballers, scholars, and trained from 7 to 11 years. Transthoracic echocardiography was performed by either a trained sonographer or a cardiologist. All views obtained and measurements performed were according to the protocols specified by the British Society of Echocardiography, the European Association of Cardiovascular Imaging and the American Society of Echocardiography. With regards to aortic dimensions, images were obtained from a parasternal long axis view and measurements were performed from two-dimensional images. The aortic root diameters were measured in 2-dimensional mode at two levels (ie the sinuses of Valsalva and the ascending aorta). Results Male footballers were 945 (91.31%) while female footballers were 90 (8.69%). The mean value and the standard deviation of the age, the morphologic parameters, the aortic root diameters and two basic left heart dimensions (left ventricular end diastolic diameter and left atrium size) are presented in table 1. The mean values of age, height, weight, BMI, BSA were significantly lower in females than in males. The mean values of the two aortic diameters as well as the LA volume and LV end diastolic diameter were also greater in males than in females. There was statistically significant difference in all the parameters. Nomograms allowing determination of the Z score for the aortic diameters as a function of gender and BSA, at the level of the sinuses of Valsalva and at the level of the ascending aorta were plotted. Conclusion: We have proposed a new tool for the recognition of aortic root dilatation in adolescent athletes from 14 to 17 years old. It can be used at the levels of the sinuses of Valsalva and the ascending aorta. Nomograms for these diameters are of utmost importance for diagnostic purposes, for the differentiation of normal growth from pathologic aortic dilatation and for decision making including the determination of the optimal time for surgical intervention View largeDownload slide Abstract P1454 Figure. plot example View largeDownload slide Abstract P1454 Figure. plot example P1456 Consolidating the role of left atrium volume as a simple predictor of cardiotoxicity LF Cerrito LF Cerrito University of Verona, Cardiology, Verona, Italy C Bergamini C Bergamini University of Verona, Cardiology, Verona, Italy M Dal Porto M Dal Porto University of Verona, Cardiology, Verona, Italy G Benfari G Benfari University of Verona, Cardiology, Verona, Italy G Dolci G Dolci University of Verona, Cardiology, Verona, Italy E Setti E Setti University of Verona, Cardiology, Verona, Italy A Comunello A Comunello University of Verona, Cardiology, Verona, Italy A Rossi A Rossi University of Verona, Cardiology, Verona, Italy L Carbognin L Carbognin University of Verona, Department of Oncology, Verona, Italy E Fiorio E Fiorio University of Verona, Department of Oncology, Verona, Italy FL Ribichini FL Ribichini University of Verona, Cardiology, Verona, Italy University of Verona, Cardiology, Verona, Italy University of Verona, Department of Oncology, Verona, Italy Background: It is crucial to detect Trastuzumab (TZ) cardiotoxicity (CT) patients with HER2-positive breast cancer. There are no well-defined echo parameters predictive of cardiac dysfunction. An isolated pivotal study suggested that baseline left atrium (LA) dilation might be associated with subsequent development of cardiotoxicity. Aim: to define the role of increased baseline LA indexed volumes (LAVI) as predictor of TZ-related CT in a larger and well characterized cohort. Methods: HER-2 positive breast cancer patients receiving TZ were retrospectively recruited from the two largest university hospitals of Verona. A comprehensive transthoracic echocardiography was performed at baseline and every three months. LA volume was assessed using Simpson biplane method at baseline. Results: Eligible patients were 280, mean age 56 ± 12 years, baseline LAVI 27 ± 8 ml/mq. Baseline LAVI was dilated (≥34 ml/mq) in 35 patients (12,5%). Mean follow-up (FU) was 15 ± 5 months. Overall CT occurred in 64 patients (22,9%) during entire FU; among these 15 patients (43%) had a dilated atrium at baseline. Basal dilated LAVI (≥34 ml/mq) showed to be associated with subsequent development of CT. Baseline LAVI predicted CT, odds ratio per 5 ml/mq LAVI increase 1,32 (95% CI 1,07: 1,62) , p= 0,006. Even after multivariate adjustment (age, systolic arterial pressure, anthracycline treatment) baseline LAVI remained an independent predictor of CT, OR 1,25 (95% CI 1,00-1,56), p= 0,04. Conclusion: Baseline LAVI, as assessed by routine practice, provides useful hints about CT risk over time. It provides an incremental predictive value over the other known clinical features. It is therefore important to properly measure LA chamber at baseline evaluation. Population parameters at baseline General Population N: 280 Cardiotoxicity + N: 64 Cardiotoxicity - N: 216 P value Age at baseline, years 56 ± 12 58 ± 11 56 ± 12 0.17 BSA, m&sup2; 1.69 ± 0.17 1.72 ± 0.21 1.69 ± 0.16 0.04 Hypertension (%) 90 (32) 30 (46) 60 (28) 0.004 Diabete mellitus (%) 16 (6) 7 (11) 9 (4) 0.04 Anthracyclines (%) 177 (63) 45 (70) 132 (61) 0.18 Basal LAVI ≥ 34 ml/mq 32 (12,5) 15 (23) 20 (9) 0.003 Ejection Fraction % 64 ± 5 65 ± 5 64 ± 4 0.15 Mitral regurgitation (%) 123 (44) 26(41) 97 (45) 0.54 General Population N: 280 Cardiotoxicity + N: 64 Cardiotoxicity - N: 216 P value Age at baseline, years 56 ± 12 58 ± 11 56 ± 12 0.17 BSA, m&sup2; 1.69 ± 0.17 1.72 ± 0.21 1.69 ± 0.16 0.04 Hypertension (%) 90 (32) 30 (46) 60 (28) 0.004 Diabete mellitus (%) 16 (6) 7 (11) 9 (4) 0.04 Anthracyclines (%) 177 (63) 45 (70) 132 (61) 0.18 Basal LAVI ≥ 34 ml/mq 32 (12,5) 15 (23) 20 (9) 0.003 Ejection Fraction % 64 ± 5 65 ± 5 64 ± 4 0.15 Mitral regurgitation (%) 123 (44) 26(41) 97 (45) 0.54 Data are presented as n (%) or mean ± SD. LAVI: Left atrial indexed volume. View Large Population parameters at baseline General Population N: 280 Cardiotoxicity + N: 64 Cardiotoxicity - N: 216 P value Age at baseline, years 56 ± 12 58 ± 11 56 ± 12 0.17 BSA, m&sup2; 1.69 ± 0.17 1.72 ± 0.21 1.69 ± 0.16 0.04 Hypertension (%) 90 (32) 30 (46) 60 (28) 0.004 Diabete mellitus (%) 16 (6) 7 (11) 9 (4) 0.04 Anthracyclines (%) 177 (63) 45 (70) 132 (61) 0.18 Basal LAVI ≥ 34 ml/mq 32 (12,5) 15 (23) 20 (9) 0.003 Ejection Fraction % 64 ± 5 65 ± 5 64 ± 4 0.15 Mitral regurgitation (%) 123 (44) 26(41) 97 (45) 0.54 General Population N: 280 Cardiotoxicity + N: 64 Cardiotoxicity - N: 216 P value Age at baseline, years 56 ± 12 58 ± 11 56 ± 12 0.17 BSA, m&sup2; 1.69 ± 0.17 1.72 ± 0.21 1.69 ± 0.16 0.04 Hypertension (%) 90 (32) 30 (46) 60 (28) 0.004 Diabete mellitus (%) 16 (6) 7 (11) 9 (4) 0.04 Anthracyclines (%) 177 (63) 45 (70) 132 (61) 0.18 Basal LAVI ≥ 34 ml/mq 32 (12,5) 15 (23) 20 (9) 0.003 Ejection Fraction % 64 ± 5 65 ± 5 64 ± 4 0.15 Mitral regurgitation (%) 123 (44) 26(41) 97 (45) 0.54 Data are presented as n (%) or mean ± SD. LAVI: Left atrial indexed volume. View Large P1457 Right atrium volume index and stress induced right ventricle diastolic dysfunction in non-severe chronic obstructive pulmonary disease patients ZH Cherneva ZH Cherneva Medical University of Sofia, Department of Internal Medicine-Cardiology, Sofia, Bulgaria MG Gospodinova MG Gospodinova Medical University of Sofia, Department of Internal Medicine-Cardiology, Sofia, Bulgaria SD Denchev SD Denchev Medical University of Sofia, Department of Internal Medicine-Cardiology, Sofia, Bulgaria RCH Cherneva RCH Cherneva University Hospital Saint Sofia, Department of Internal Medicine, Clinic of Respiratory diseases, Sofia, Bulgaria Medical University of Sofia, Department of Internal Medicine-Cardiology, Sofia, Bulgaria University Hospital Saint Sofia, Department of Internal Medicine, Clinic of Respiratory diseases, Sofia, Bulgaria Funding Acknowledgements: no OnBehalf: no Background:Right atrium volume index (RAVI) has recently been reported as a quantitative echocardiographic parameter associated with right ventricle systolic dysfunction (RVSD) in patients with pulmonary arterial hypertension (PAP) due to chronic obstructive pulmonary disease (COPD). Aim: The aim of the current study was to assess right atrium remodeling in COPD patients without echocardiographic parameters of RVSD or PAP at rest and to analyse its association with stress induced right ventricle diastolic dysfunction (RVDD). Methods: The study was conducted on 104 COPD patients. Pulmonary function tests, blood gas analysis, ramp cardio-pulmonary test (CPET) protocol and detailed echocardiographic examinations before and at peak CPET were applied. The cut-off values for RVDD were E/A <0.8 and E/e’ >6.0. Results: Patients were divided into two groups: patients with stress induced RVDD (82/104 – 78%) and those without stress RVDD (22/104 – 22%), E/e’>6 (6,9 ± 0,8 vs 4,8 ± 1,1). The two groups did not differ regarding age (60,4 ± 7,84 vs 62,9 ± 7,5y), sex, BMI (27,3 ± 4,69 vs 27,02 ± 6,3kg/m2), FEV1% (58,06 ± 18,26 vs 56,27 ± 12,53), or pack years. RAVI was significantly higher in the group with stress associated RVDD (37 ± 5,8 ml/m2 vs 23,8 ± 6,5ml/m2) in comparison to those without it. Multivariate regression analysis showed that RAVI correlated to stress induced RVDD parameters- E/e’, independent of age, sex, BMI or degree of airway obstruction (R – 0,42, p < 0,01). Conclusions: Stress induced RVDD parameters (E/e’) are associated with right atrium volume index in COPD patients without right ventricle systolic dysfunction and pulmonary hypertension at rest. P1458 Heart in sickle cell-beta thalassemia: echocardiograpic appearance of an extremely rare disease G Malanchini G Malanchini University of Milan, Milan, Italy E Gherbesi E Gherbesi University of Milan, Milan, Italy M Squillace M Squillace University of Milan, Milan, Italy C Gobbi C Gobbi University of Milan, Milan, Italy M Schiavone M Schiavone University of Milan, Milan, Italy L Diehl L Diehl IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy P Perolo P Perolo IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy G Graziadei G Graziadei Fondazione IRCCS Cà Granda, Rare Diseases Centre, Department of Medicine and Medical Specialities, Milan, Italy M Giuditta M Giuditta Fondazione IRCCS Cà Granda, Rare Diseases Centre, Department of Medicine and Medical Specialities, Milan, Italy FB Sozzi FB Sozzi IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy F Lombardi F Lombardi University of Milan, Milan, Italy University of Milan, Milan, Italy IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy Fondazione IRCCS Cà Granda, Rare Diseases Centre, Department of Medicine and Medical Specialities, Milan, Italy Background: Sickle Cell Disease (SCD) is a multisystem disease, associated with episodes of acute illness and progressive organ damage and is one of the most common severe monogenic disorders worldwide. Sickle-beta thalassemia is a genetic variant that occurs when βS is inherited with a β-thalassaemia allele, causing HbS/β-thalassaemia. It is a very rare disease, one tenth less common than beta-thalassemia. There is no conclusive knowledge on left ventricular and right ventricular function in patients with such a rare disease. The aim of this cross-sectional study to describe the echocardiographic characteristics of patients suffering from sickle-beta thalassemia, secondly to compare this population with thalassemic patients. Methods: We collected echocardiographic data of all patients referred to our echocardiographic laboratory, between 1/3/2015 and 31/3/2018 with a diagnosis of sickle cell-beta thalassemia and thalassemia. Standard echocardiographic parameters acquired by bi-dimensional and Doppler echocardiography were considered. We used Stata 12.0. Results: We identify 39 echocardiograms. Patients were on average 41.2 years old. Mean BSA was 1.75 mq. Mean left ventricular diameter were 47 mm for LVEDD, 8 mm for wall thickness. Patients have normal left ventricular mean volume (LVEDV/BSA : 56,5 ml/mq) and systolic function (mean LVEF : 61.3%). Right ventricular function was also found to be normal with an averaged TAPSE of 25.7± xx mm) and a mean pulmonary pressure (PAPs) of 25.2± xx mmHg. Only in one patients we observed a modest increase of pulmonary pressure (33 mmHg). Two patients had mild-to-moderate mitral regurgitation, the relatively most common valvular abnormality. Left atrial dilatation was present in nine patients and was the most prevalent cardiac abnormality. No-one in the cohort showed right atrial or aortic dilatation. Comparisons with Thalassemic patients are shown in the table. Conclusions: patients with sickle-beta thalassemia seem to have a good cardiac function of both right and left ventricle. The most prevalent (23%) cardiac abnormality in this population is left atrial enlargement. This population differs from thalassemic patients for the presence of lower PAPs values. LV and RV size and function Variable Sickle cell-beta thalassemia (N = 39) Thalassemia (N = 856) p value LA Volume (ml/sqm) 31.17 ± 9.46 32.65 ± 11.76 0.51 LV Volume (ml/sqm) 56.58 ± 14.21 55.21 ± 11.60 0.55 LVEF (%) 61.2 ± 3.49 62.3 ± 4.75 0.10 PAPs(mmHg) 25.24 ± 3.36 28.41 ± 7.33 0.03 TAPSE (mm) 25.76 ± 3.36 25.72 ± 4.21 0.95 Variable Sickle cell-beta thalassemia (N = 39) Thalassemia (N = 856) p value LA Volume (ml/sqm) 31.17 ± 9.46 32.65 ± 11.76 0.51 LV Volume (ml/sqm) 56.58 ± 14.21 55.21 ± 11.60 0.55 LVEF (%) 61.2 ± 3.49 62.3 ± 4.75 0.10 PAPs(mmHg) 25.24 ± 3.36 28.41 ± 7.33 0.03 TAPSE (mm) 25.76 ± 3.36 25.72 ± 4.21 0.95 Data are presented as mean ± standard deviation View Large LV and RV size and function Variable Sickle cell-beta thalassemia (N = 39) Thalassemia (N = 856) p value LA Volume (ml/sqm) 31.17 ± 9.46 32.65 ± 11.76 0.51 LV Volume (ml/sqm) 56.58 ± 14.21 55.21 ± 11.60 0.55 LVEF (%) 61.2 ± 3.49 62.3 ± 4.75 0.10 PAPs(mmHg) 25.24 ± 3.36 28.41 ± 7.33 0.03 TAPSE (mm) 25.76 ± 3.36 25.72 ± 4.21 0.95 Variable Sickle cell-beta thalassemia (N = 39) Thalassemia (N = 856) p value LA Volume (ml/sqm) 31.17 ± 9.46 32.65 ± 11.76 0.51 LV Volume (ml/sqm) 56.58 ± 14.21 55.21 ± 11.60 0.55 LVEF (%) 61.2 ± 3.49 62.3 ± 4.75 0.10 PAPs(mmHg) 25.24 ± 3.36 28.41 ± 7.33 0.03 TAPSE (mm) 25.76 ± 3.36 25.72 ± 4.21 0.95 Data are presented as mean ± standard deviation View Large P1459 Alterations in left atrial parameters associated with cardioembolic stroke and embolic stroke of undetermined source A Ferkh A Ferkh Westmead Hospital, Department of Cardiology, Sydney, Australia E O"keefe E O"keefe Westmead Hospital, Department of Cardiology, Sydney, Australia A Evans A Evans Westmead Hospital, Department of Geriatrics, Sydney, Australia S Duma S Duma Westmead Hospital, Department of Neurology, Sydney, Australia A Duggins A Duggins Westmead Hospital, Department of Neurology, Sydney, Australia P Brown P Brown Westmead Hospital, Department of Cardiology, Sydney, Australia S Sivapathan S Sivapathan University of Sydney, Sydney, Australia G Gan G Gan University of New South Wales, Sydney, Australia A Thiagalingam A Thiagalingam Westmead Hospital, Department of Cardiology, Sydney, Australia M Altman M Altman Westmead Hospital, Department of Cardiology, Sydney, Australia J Chong J Chong Westmead Hospital, Department of Cardiology, Sydney, Australia AR Denniss AR Denniss Westmead Hospital, Department of Cardiology, Sydney, Australia E Kizana E Kizana Westmead Hospital, Westmead Institute of Medical Research, Sydney, Australia L Thomas L Thomas Westmead Hospital, Department of Cardiology, Sydney, Australia Westmead Hospital, Department of Cardiology, Sydney, Australia Westmead Hospital, Department of Geriatrics, Sydney, Australia Westmead Hospital, Department of Neurology, Sydney, Australia University of Sydney, Sydney, Australia University of New South Wales, Sydney, Australia Westmead Hospital, Westmead Institute of Medical Research, Sydney, Australia Background: Cardioembolism comprises a third of all ischaemic strokes. Left atrial (LA) parameters may identify an ‘atrial myopathy’ in such patients, which may additionally contribute to a significant proportion of embolic stroke of undetermined source (ESUS). Aims: To determine LA structure and function parameters on transthoracic echocardiogram (TTE) in ischaemic stroke patients. Methods: We prospectively recruited ischaemic stroke patients (March-August 2017) and TTEs were performed. Strokes were classified by TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria into cardioembolic and other aetiologies. ESUS patients were also identified among the stroke subtypes. LA size (indexed left atrial maximum and minimum volumes (LAVImax and LAVImin)) and volumetric functional parameters (LA emptying fraction (LAEF), expansion index (LAEI) and function index (LAFI)) were evaluated and compared to a group of healthy controls. Results: 103 stroke patients (63 male (61%), mean age 70yrs) were prospectively recruited. Ischaemic strokes were classified as cardioembolic (N = 31, 30%), and other causes (N = 72, 70%). 33 (32%) patients were identified as having ESUS and were compared to 40 healthy controls (mean age 70yrs). LAVImax and LAVImin were increased (53 ± 21 vs 34 ± 12 and 36 ± 21 vs 15 ± 11 ml/m2 respectively, p < 0.001), while LAEF, LAEI and LAFI were reduced in the cardioembolic group versus other causes (35 ± 18 vs 58 ± 12%, 69 ± 57 vs 153 ± 63% and 0.17 ± 0.16 vs 0.38 ± 0.16 respectively, p < 0.001). E/E’ was also elevated in the cardioembolic group (14 ± 6.6 vs 10 ± 3.9, p = 0.002), suggesting elevated left ventricular filling pressures in this group. In the ESUS group, LAVI min was increased (17 ± 12 vs 8.5 ± 4.2 ml/m2, P = 0.048) while LAEF and LAEI were significantly reduced (56 ± 13 vs 72 ± 10% and 144 ± 55 vs 286 ± 142% respectively, P < 0.001) compared to normal controls. Conclusions: Alterations in LA metrics (increased LA size and reduced LA function) was associated with cardioembolic stroke. Interestingly, altered LA parameters were also seen in the ESUS group, suggesting a possible undiagnosed atrial myopathy in this group. Evaluation of LA parameters may assist in stroke risk stratification and aid with therapeutic decisions on anticoagulation. P1460 Pure aging change of diastolic function of the heart, a report from New Guinea A Isotani A Isotani Kokura Memorial Hospital , Department of Cardiology, Kitakyushu, Japan M Fujisawa M Fujisawa Kyoto University, Center for Southeast Asian Studies, Kyoto, Japan A Ishida A Ishida Ryukyu University, Department of Cardiovascular medicine, Nephrology and Neurology, Nakagami-gun, Japan E Garcia Del Saz E Garcia Del Saz Kochi University, The Center for International Collaboration, Kochi, Japan M Indrajaya M Indrajaya Wamena General Hospital, Department of Neurology, Wamena, Indonesia Y Kimura Y Kimura Osaka University, Graduate School of Human Sciences, Osaka, Japan K Okumiya K Okumiya Kyoto University, Center for Southeast Asian Studies, Kyoto, Japan AL Rantetampang AL Rantetampang Cenderawasih University, Department of Public Health, Jayapura, Indonesia M Ferry Kareth M Ferry Kareth Cenderawasih University, Department of Public Health, Jayapura, Indonesia T Wada T Wada Kyoto University, Center for Southeast Asian Studies, Kyoto, Japan K Ando K Ando Kokura Memorial Hospital , Department of Cardiology, Kitakyushu, Japan R Sakamoto R Sakamoto Kyoto University, Center for Southeast Asian Studies, Kyoto, Japan K Matsubayashi K Matsubayashi Kyoto University, Center for Southeast Asian Studies, Kyoto, Japan Kokura Memorial Hospital , Department of Cardiology, Kitakyushu, Japan Kyoto University, Center for Southeast Asian Studies, Kyoto, Japan Ryukyu University, Department of Cardiovascular medicine, Nephrology and Neurology, Nakagami-gun, Japan Kochi University, The Center for International Collaboration, Kochi, Japan Wamena General Hospital, Department of Neurology, Wamena, Indonesia Osaka University, Graduate School of Human Sciences, Osaka, Japan Cenderawasih University, Department of Public Health, Jayapura, Indonesia Background; Diastolic dysfunction is said to gradually progress as age, however, such reports derive from data studied mainly in civilized countries. In civilized environment, potential effects of lifestyle disease such as hypertension are unavoidable. Purpose; In this study, we investigated 61 people who live in Soroba village in New Guinea in oder to elucidate natural course of cardiac diastolic function by aging. Methods; We performed medical checkup to people in Soroba village. Standard echocardiography using Vivid-iq (GE) was also performed to them to evaluate left ventricular, left atrial and right ventricular systolic and diastolic function. Valvular heart disease was also investigated. People were devided into 3 groups; young age groups (20-39 years of age), middle age group (40-59) and high age group (60 years of age or more). Data were compared according to this three groups. Results; Mean age was 43 ± 10 years, 33 people (54%) were female, mean height was 157 ± 8 cm and mean weight was 53 ± 10 kg. All had sinus rhythm. Left ventricular end-diastolic diameter was 43 ± 5mm, left ventricular end-systolic diameter 29 ± 4mm, left ventricular ejection fraction 60 ± 5%. As shown in the table, Blood pressure was not significantly different among three age groups. In these groups, left ventricular diastolic function evaluated by transmitral flow, pulmonary venous flow and tissue Doppler showed spontaneous decrease by age as described in the EAE recommendations. E/A decreased, deceleration time extended, S/D ratio increased and E/e’ decreased by age. On the other hand, left atrial volume didn’t increase and cardiac index and left ventricular global longitudinal strain were maintained. There were no clues which shows elevation of left ventricular end-diastolic pressure. Conclusions; Our echocardiographic data from people live in undeveloped area revealed spontaneous decrease of left ventricular diastolic function despite no blood pressure elevation by age. On the other hand, left atrial volume, left ventricular stiffness and overall cardiac performance were maintained. Diastolic dysfunction by age is a global phenomenon, however, it can be compensated by left atrial function. View largeDownload slide Abstract P1460 Figure. Echocardiographic parameters View largeDownload slide Abstract P1460 Figure. Echocardiographic parameters P1461 Impact of new recommendations on non-invasive evaluation of left ventricular diastolic function in oncologic patients R Sorrentino R Sorrentino University Hospital Federico II, Naples, Italy L La Mura L La Mura University Hospital Federico II, Naples, Italy A Vaccaro A Vaccaro University Hospital Federico II, Naples, Italy M Scalamogna M Scalamogna University Hospital Federico II, Naples, Italy L Esposito L Esposito University Hospital Federico II, Naples, Italy G Arpino G Arpino University Hospital Federico II, Naples, Italy R Esposito R Esposito University Hospital Federico II, Naples, Italy B Trimarco B Trimarco University Hospital Federico II, Naples, Italy M Galderisi M Galderisi University Hospital Federico II, Naples, Italy University Hospital Federico II, Naples, Italy Background: Left ventricular (LV) diastolic dysfunction (DD) is a possible determinant of cancer therapy related cardiotoxicity. In 2016 an updated version of the previous recommendations (Rec) for the evaluation of DD was released. Purpose: To assess LV diastolic function according to the 2009 and 2016 Rec and to test their concordance in the estimation of DD and LV filling pressures (LVFP) in oncologic patients. Methods: In a prefixed period of 3 months, consecutive oncologic patients referring to our echo lab within standard protocols, underwent an echo Doppler exam including non-invasive assessment of diastolic function (DF) according to 2009 and 2016 Rec. Concordance was tested by calculating K coefficient and overall proportion of agreement. Results: In the pooled population (n = 402, F/M: 270/132, age 55 ± 15 years), concordance between the Rec was 66.9% for DF and 85.3% for non-invasive estimate of LVFP (K 0.32 and 0.50, respectively). Estimates of DF, LVFP and DD grading are presented in Table. The use of 2016 Rec resulted in a lower rate of DD, increased LVFP and, thus, grade II DD, but also higher rate of "indeterminate "DF and "cannot determine" DD grade. DD reclassification rate was 33.1%, with most patients (n = 61, 15.2%) being reclassified from DD to normal DF according to 2016 Rec. In these reclassified patients, septal and lateral e" were higher and E/e’ (8.3 ± 2.3 vs 12.6 ± 4.8), left atrial volume index (24.9 ± 4.4 vs 35.2 ± 10.1 ml/m²) and tricuspid regurgitation velocity (2.4 ± 0.28 vs 2.7 ± 0.35) (all p < 0.0001) were lower compared to patients in which the Rec concordantly assigned normal DF. LVFP reclassification rate was 14.7%, with no significantly more frequent reclassifications. Conclusions: ln the oncologic setting the use of the 2016 recommendations results in a lower rate of DD and increased LVFP compared to the previous version. The higher rate of inconclusive diagnosis could be variously interpreted. 2009 vs 2016 DF estimates 2009 rec. 2016 rec. p value Normal DF 61.2% 68.2% =0.04 DD 35.6% 24.9% <0.001 Indeterminate 3.2% 7.0% =0.02 Normal LVFP 83.1% 83.8% =0.84 Grade I DD 21.4% 15.7% =0.04 Grade II DD 14.2% 8.7% <0.01 Grade III - - - Cannot Determine 3.2% 7.5% <0.01 2009 rec. 2016 rec. p value Normal DF 61.2% 68.2% =0.04 DD 35.6% 24.9% <0.001 Indeterminate 3.2% 7.0% =0.02 Normal LVFP 83.1% 83.8% =0.84 Grade I DD 21.4% 15.7% =0.04 Grade II DD 14.2% 8.7% <0.01 Grade III - - - Cannot Determine 3.2% 7.5% <0.01 View Large 2009 vs 2016 DF estimates 2009 rec. 2016 rec. p value Normal DF 61.2% 68.2% =0.04 DD 35.6% 24.9% <0.001 Indeterminate 3.2% 7.0% =0.02 Normal LVFP 83.1% 83.8% =0.84 Grade I DD 21.4% 15.7% =0.04 Grade II DD 14.2% 8.7% <0.01 Grade III - - - Cannot Determine 3.2% 7.5% <0.01 2009 rec. 2016 rec. p value Normal DF 61.2% 68.2% =0.04 DD 35.6% 24.9% <0.001 Indeterminate 3.2% 7.0% =0.02 Normal LVFP 83.1% 83.8% =0.84 Grade I DD 21.4% 15.7% =0.04 Grade II DD 14.2% 8.7% <0.01 Grade III - - - Cannot Determine 3.2% 7.5% <0.01 View Large P1462 Noninvasive left ventricular myocardial work: The effect of age and gender I Armenis I Armenis Onassis Cardiac Surgery Center, pireaus Greece, Greece E Demerouti E Demerouti Onassis Cardiac Surgery Center, pireaus Greece, Greece G Athanassopoulos G Athanassopoulos Onassis Cardiac Surgery Center, pireaus Greece, Greece Onassis Cardiac Surgery Center, pireaus Greece, Greece A novel noninvasive method for measuring global as well as regional left ventricular (LV) myocardial work (MW) has been recently proposed, based on 2D speckle tracking strain analysis combined with estimated pressure curve. Aim of the study was to assess the range of the global LV work indices in a normal population and the potential effects of age and gender. Methods: 59 normals, males (M)/females(F): 27/32, age: 50 + 15, range 25-75 years /similar age between M/F: 48 + 13 / 52 + 16) were selectively studied, provided that they had an efficient image quality in order to apply AFI analysis (EchoPac GE). Overall body mass index (BMI) was 34 + 4, body surface area (BSA) was 1.9 + 0.2, greater both, as expected, for M. Estimated pressure curve was generated by adjusting the profile of a reference LV pressure curve according to the duration of isovolumic and ejection phase measured by echo timing of aortic –mitral events. Peak LV pressure was estimated by brachial artery cuff pressure. The following indexes of MW were estimated: GWI (global wall index = total work from mitral valve closure to mitral valve opening), GCW (global contructivework = total work contributing to pump function), GWW (global wasted work = elongation during systole and shortening against a closed aortic valve), GWE (global work efficiency = fraction of GCW/GWI). Results: GWE and GWW were similar between M/F (95,7%+1,7%/95,9%+1,9% and 72,8+ 36/81,4 + 45 respectively, p = ns). Females had greater both GWI and GCW (2062 + 409/1798 + 328 and 2373 + 455/2060 + 354 respectively p = 0.009 and p = 0.005). BSA and BMI were not related to any of GWE, GWW, GWI, GCW. Age was related with GWI (r = 0.32, p = 0.013) and GCW (r = 0.26, p = 0.47). The effect of age for both CWI and GCW was prominent above age 55 : (group > 55/ n = 21 vs group age 41-55/n = 21 vs group age 25-40/n = 17: GWI 2127 + 443 vs 1879 + 326 vs 1790 + 332, p = 0.019, GCW 2419 + 532 vs 2138 + 349 vs 2111 + 341, p = 0.45). Conclusion: Noninvasive LV MW by echo may be currently estimated in clinical practice. There is a gender effect in the GWI/GCW, with female gender having greater values independently from either BSA or BMI. Aging is related to an increased GWI/GCW, more prominently in the age group >55. GWE and GWW do not seem to be affected by either age or gender. These characteristics should be considered when LV MW is clinically applied. P1463 Influence of race in the cardiac phenotype on professional footballers MR Lourenco MR Lourenco Hospital Senhora da Oliveira, Cardiology Department, Guimaraes, Portugal F Castro F Castro Hospital Senhora da Oliveira, Cardiology Department, Guimaraes, Portugal P Von Hafe P Von Hafe Hospital Senhora da Oliveira, Cardiology Department, Guimaraes, Portugal B Faria B Faria Hospital Senhora da Oliveira, Cardiology Department, Guimaraes, Portugal I Nogueira I Nogueira Hospital Senhora da Oliveira, Cardiology Department, Guimaraes, Portugal O Azevedo O Azevedo Hospital Senhora da Oliveira, Cardiology Department, Guimaraes, Portugal A Lourenco A Lourenco Hospital Senhora da Oliveira, Cardiology Department, Guimaraes, Portugal Hospital Senhora da Oliveira, Cardiology Department, Guimaraes, Portugal Purpose: Comparison of various echocardiographic parameters regarding size and function in professional footballers between athletes of african origin and causasians. Methods: Prospective study including 60 professional footballers, 16 of them of african origin and 44 caucasians. Transthoracic echocardiogram was performed with evaluation of conventional 2D parameters, Doppler and tissue Doppler and left ventricular (LV) strain by 2D speckle tracking, Results: No statistically significant differences were found regarding age (p = 0,84), height (p = 0,081), weight (p = 0,116) or body surface area (BSA) (p = 0,186) between causasian footballers and footballers of african origin. LV size was significantly bigger in footballers of african origin in both diameters (p = 0,005), volumes (p = 0,015) and volumes normalized for BSA (p = 0,02). Despite these differences in LV dimensions there was no statistically significant differences in stroke volume (p = 0,057), stroke volume index (p = 0,123), cardiac output (p = 0,21) and cardiac index (p = 0,194). Neither in ejection fraction (p = 0,055), global longitudinal strain (p = 0,243) or global longitudinal strain rate (p = 0,437). E/E" was however higher in footballers of african origin (p = 0,019) despite no statistically significant differences in both left atrial diameter (p = 0,323) and volume (p = 0,631). Conclusion: LV size was significantly bigger in professional footballers of african origin when compared to caucasian footballers, however no differences were found in various parameters of LV function between these two groups of athletes. E/e" was also significantly higher in footballers of african origin despite no significant differences in both left atrial diameter and volumes between these two groups. P1464 Incremental value of myocardial work over global longitudinal strain for the diagnosis of oncotherapy-related cardiotoxicity W Kosmala W Kosmala Wroclaw Medical University, Wroclaw, Poland T Negishi T Negishi University of Tasmania, Menzies Research Institute Tasmania, Hobart, Australia P Thavendiranathan P Thavendiranathan University of Toronto, Toronto, Canada J Lemieux J Lemieux Centre de Recherche du CHU de Quebec, Quebec, Canada M Penicka M Penicka Cardiovascular Center Aalst, Aalst, Belgium S Aakhus S Aakhus Oslo University Hospital, Oslo, Norway GY Cho GY Cho Seoul National University Hospital, Seoul, Korea Republic of K Hristova K Hristova National Heart Hospital, Sofia, Bulgaria BA Popescu BA Popescu University of Medicine and Pharmacy Carol Davila, Bucharest, Romania D Vinereanu D Vinereanu University of Medicine and Pharmacy Carol Davila, Bucharest, Romania S Miyazaki S Miyazaki Juntendo University, Tokyo, Japan K Kurosawa K Kurosawa Gunma University, Gunma, Japan M Izumo M Izumo St. Marianna University, Kawasaki, Japan K Negishi K Negishi University of Tasmania, Menzies Research Institute Tasmania, Hobart, Australia TH Marwick TH Marwick Baker IDI Heart and Diabetes Institute, Melbourne, Australia Wroclaw Medical University, Wroclaw, Poland University of Tasmania, Menzies Research Institute Tasmania, Hobart, Australia University of Toronto, Toronto, Canada Centre de Recherche du CHU de Quebec, Quebec, Canada Cardiovascular Center Aalst, Aalst, Belgium Oslo University Hospital, Oslo, Norway Seoul National University Hospital, Seoul, Korea Republic of National Heart Hospital, Sofia, Bulgaria University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Juntendo University, Tokyo, Japan Gunma University, Gunma, Japan St. Marianna University, Kawasaki, Japan Baker IDI Heart and Diabetes Institute, Melbourne, Australia Longitudinal myocardial deformation outperforms conventional echocardiographic measures, including ejection fraction (EF), in the identification of left ventricular (LV) dysfunction during chemotherapy. However, global longitudinal strain (GLS) is afterload-dependent. The estimation of myocardial work allows correction of GLS for changes in systolic blood pressure (SBP). Aim: To compare the utility of myocardial work parameters and GLS in the detection of chemotherapy-induced cardiotoxicity. Methods: 36 asymptomatic pts undergoing anthracycline therapy in combination with other cardiotoxins or heart failure risk factors [age >65 years, diabetes, hypertension, previous cardiac injury e.g.: post-infarct]) participating in the SUCCOUR trial underwent echocardiography before anticancer treatment and after 3-12 months follow-up (FU). Cardiotoxicity was evidenced by reduction of 3D LVEF. In addition to GLS, the following parameters of myocardial work were assessed: global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE). Results: Pts were divided into 3 subsets: (CTX+ BP-) with cardiotoxicity and no changes in LV afterload (n = 10); (CTX- BP+) no cardiotoxicity, but with an elevation of LV afterload, as evidenced by increase in SBP >20 mmHg (n = 11), and (CTX- BP-) no cardiotoxicity or afterload changes (n = 15). No significant between-group differences were noted for change in GLS at FU. Larger increases in GWI and GCW at FU were found in CTX- BP+ than in the other 2 groups. CTX+ BP- demonstrated a significantly larger decrease in GWI than CTX- BP- (Table). ROC analysis revealed no significant differences between GLS and myocardial work parameters in the detection of chemotherapy-related cardiotoxicity (AUC for GLS 0.72, for GWI 0.81, for GCW 0.77, for GWW 0.61, for GWE 0.64, all p = NS). However in multivariable logistic regression analysis, the only significant predictor of cardiotoxicity was GWI (OR 0.99; p < 0.02). GWI and GCW were more useful for identification of LV functional changes in response to increased afterload with no true cardiotoxicity (defined as the CTX- BP+ group membership; AUC 0.93 and 0.97, respectively) than GLS, GWW and GWE (AUC 0.61, 0.60 and 0.50, respectively, all p values <0.001). Conclusions: Measurement of myocardial work might be helpful in cardio-oncology. Given the load-dependence of LV deformation, myocardial work outperforms GLS in the serial assessment of cardiac function. The increase in GWI and GCW, even with decreased GLS, indicates the impact of elevated afterload on LV performance in the absence of actual myocardial impairment. On the other hand, a profound decrease especially in GWI may suggest the presence of cardiotoxicity. View largeDownload slide Abstract P1464 Table View largeDownload slide Abstract P1464 Table P1465 Echocardioscopy in the emergency department: negative predictive value to rule out left ventricular dysfunction P Guardia Martinez P Guardia Martinez Regional University Hospital of Malaga, Cardiology, Malaga, Spain MI Navarrete Espinosa MI Navarrete Espinosa Regional University Hospital of Malaga, Department of Cardiology, Malaga, Spain AL Aviles Toscano AL Aviles Toscano Regional University Hospital of Malaga, Department of Cardiology, Malaga, Spain Regional University Hospital of Malaga, Cardiology, Malaga, Spain Regional University Hospital of Malaga, Department of Cardiology, Malaga, Spain Background/ Introduction: Focused cardiac ultrasound with a pocket-size device is an imaging technique widely used in the emergency department for the initial assessment of patients with suspected heart disease, in order to perform a first diagnostic orientation. It is also very common to be performed and interpreted by personnel in training in the specialty of cardiology during the guards. Purpose: The aim of our work was to evaluate the capacity of the pocket-size echocardiography to rule out left ventricular dysfunction, comparing the initial diagnosis established by this technique with respect to the transthoracic echocardiogram performed during admission. Methods: Retrospective analysis of 164 patients admitted to the Cardiology department of our center, who were initially submitted to assessment by echocardiography in the emergency department and later to a ruled transthoracic echocardiogram during admission. Differences between both techniques were evaluated in terms of systolic function of the left ventricle, estimating the negative predictive value of pocket-size echocardiography. Results: Of the total number of patients (164 p), 108 (65%) were classified with LVEF qualitatively preserved by echocardiography in the emergency department using a pocket-size device, corroborating this diagnosis with transthoracic echocardiography in 92 patients (negative predictive value to rule out ventricular dysfunction 85.1%). The remaining 16 patients had mild (13 patients) or moderate (3 patients) systolic dysfunction.Among patients with severely depressed ejection fraction confirmed by transthoracic echocardiography (20 patients), 16 had been previously detected by the pocket-size device (80%). Conclusions: Our results suggest that pocket-size echocardiography is a technique that, despite its limitations, has a good diagnostic concordance with transthoracic echocardiography, with a negative predictive value to rule out ventricular dysfunction of 85.1%. This result supports the usefulness of these devices in the emergency area, together with the clinical evaluation of the patient and the rest of complementary tests, fundamentally when ruling out serious structural heart disease. P1466 Deterioration in the mechanics of left ventricular diastolic filling one year after coronary artery bypass grafting J Norderfeldt J Norderfeldt Karolinska Institute, Stockholm, Sweden MG Sundqvist MG Sundqvist Karolinska Institute, South Hospital, Stockholm, Sweden M Corbascio M Corbascio Karolinska Institute, Stockholm, Sweden C Linde C Linde Karolinska Institute, Stockholm, Sweden HE Persson HE Persson Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden E Maret E Maret Karolinska Institute, Stockholm, Sweden M Eriksson M Eriksson Karolinska Institute, Stockholm, Sweden M Ugander M Ugander Karolinska Institute, Stockholm, Sweden Karolinska Institute, Stockholm, Sweden Karolinska Institute, South Hospital, Stockholm, Sweden Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden Funding Acknowledgements: Astra Zeneca, Stockholm County Council, Swedish Research Council, Swedish Heart and Lung Foundation, Karolinska Institute BACKGROUND: Ischemic heart disease is presumed to affect left ventricular (LV) diastolic function, but little is known about which mechanical properties of diastolic function, if any, improve or deteriorate following surgical revascularization by coronary artery bypass grafting (CABG). The mechanics of diastolic function can be evaluated using the parameterized diastolic filling (PDF) method, which uses the shape of the transmitral early inflow wave (E-wave) recorded by pulsed wave (PW) Doppler echocardiography to mathematically describe the mechanical characteristics of LV filling in terms of stiffness, and the forces and energy of filling. PURPOSE: We sought to explore if and how the mechanics of LV filling change following CABG. METHODS: Patients underwent transthoracic echocardiography before and one year after elective CABG. PW Doppler recordings of mitral inflow E-waves for 30 seconds (22 ± 9 E-waves per exam) were analyzed using freely available software for PDF analysis. RESULTS: In patients (n = 54, 11% female, age 68 ± 8 years), baseline bi-plane LV ejection fraction was 58 ± 8% and LV end-diastolic diameter was 49 ± 5 mm. Compared to before CABG, patients after CABG increased in LV stiffness (p < 0.001), peak driving force of filling (p < 0.001), peak resistive force of filling (p = 0.002), and filling energy (p = 0.02), see Table. By comparison, there was no change in LV viscoelasticity, filling efficiency, the estimated time constant of isovolumic pressure decay (tau), or in the load-independent index of diastolic filling (p≥0.16 for all). CONCLUSIONS: Mechanistic evaluation of the changes in diastolic function one year after CABG show deterioration in both LV stiffness, and the forces and energy involved in LV filling. Revascularization with CABG does not have a beneficial effect on diastolic LV function estimated by PDF one year after CABG. The causes of these changes remain to be investigated. PDF parameter 95% normal reference limits from our laboratory Before CABG (n = 54) One year after CABG (n = 54) P-value Before vs After Stiffness, g/s&sup2; 115-295 217 ± 58 260 ± 64 <0.001 Peak driving force, mN 12-32 24 ± 6 29 ± 7 <0.001 Peak resistive force, mN 6-20 16 ± 5 19 ± 5 0.002 Filling Energy, mJ 0.4-2.2 1.5 ± 0.6 1.7 ± 0.6 0.02 PDF parameter 95% normal reference limits from our laboratory Before CABG (n = 54) One year after CABG (n = 54) P-value Before vs After Stiffness, g/s&sup2; 115-295 217 ± 58 260 ± 64 <0.001 Peak driving force, mN 12-32 24 ± 6 29 ± 7 <0.001 Peak resistive force, mN 6-20 16 ± 5 19 ± 5 0.002 Filling Energy, mJ 0.4-2.2 1.5 ± 0.6 1.7 ± 0.6 0.02 View Large PDF parameter 95% normal reference limits from our laboratory Before CABG (n = 54) One year after CABG (n = 54) P-value Before vs After Stiffness, g/s&sup2; 115-295 217 ± 58 260 ± 64 <0.001 Peak driving force, mN 12-32 24 ± 6 29 ± 7 <0.001 Peak resistive force, mN 6-20 16 ± 5 19 ± 5 0.002 Filling Energy, mJ 0.4-2.2 1.5 ± 0.6 1.7 ± 0.6 0.02 PDF parameter 95% normal reference limits from our laboratory Before CABG (n = 54) One year after CABG (n = 54) P-value Before vs After Stiffness, g/s&sup2; 115-295 217 ± 58 260 ± 64 <0.001 Peak driving force, mN 12-32 24 ± 6 29 ± 7 <0.001 Peak resistive force, mN 6-20 16 ± 5 19 ± 5 0.002 Filling Energy, mJ 0.4-2.2 1.5 ± 0.6 1.7 ± 0.6 0.02 View Large P1467 Impact of transcatheter aortic valve replacement on left ventricular diastolic function F Velasquez F Velasquez Hospital Clinic de Barcelona, Cardiovascular institute, cardiology department, Barcelona, Spain L Sanchis Ruiz L Sanchis Ruiz Hospital Clinic de Barcelona, Cardiovascular institute, cardiology department, Barcelona, Spain A Regueiro A Regueiro Hospital Clinic de Barcelona, Cardiovascular institute, cardiology department, Barcelona, Spain R Andrea R Andrea Hospital Clinic de Barcelona, Cardiovascular institute, cardiology department, Barcelona, Spain C Falces C Falces Hospital Clinic de Barcelona, Cardiovascular institute, cardiology department, Barcelona, Spain B Vidal B Vidal Hospital Clinic de Barcelona, Cardiovascular institute, cardiology department, Barcelona, Spain X Freixa X Freixa Hospital Clinic de Barcelona, Cardiovascular institute, cardiology department, Barcelona, Spain S Brugaletta S Brugaletta Hospital Clinic de Barcelona, Cardiovascular institute, cardiology department, Barcelona, Spain M Sabate M Sabate Hospital Clinic de Barcelona, Cardiovascular institute, cardiology department, Barcelona, Spain M Sitges M Sitges Hospital Clinic de Barcelona, Cardiovascular institute, cardiology department, Barcelona, Spain Hospital Clinic de Barcelona, Cardiovascular institute, cardiology department, Barcelona, Spain Background: Left ventricular (LV) diastolic dysfunction is common in patients with aortic stenosis, as a consequence of the increased ventricular filling pressures, left ventricular (LV) hypertrophy and increased myocardial stiffness. A lack of improvement in LV diastolic function (DF) after aortic valve replacement is associated with increased mortality. Data regarding the influence of transcatheter aortic valve replacement (TAVR) on DF is scarce. Purpose: Our purpose was to analyze the impact of TAVR on changes in LV diastolic function. Methods: Patients who underwent transfemoral TAVR with a balloon expandable valve (Edwards Sapien), in sinus rhythm and who were followed-up in our center were analyzed. Standard 2-D and Doppler measurements were performed; DF was assessed based on the 2016 ESC recommendations. Results: 32 patients (mean age 78 ± 6.8 years, 45.9% females) with Sapien Edwards prosthesis implantation were included. Table summarizes the echocardiographic findings at baseline and at 1 year follow-up. A reduction on LV dimensions (thickness and volumes) with an increased LV ejection fraction was observed at 1 year follow-up. No significant changes were observed in left atrial volumes. A generalized improvement on DF was observed; initially 13 (40.6%) patients had DD grade ≥ II, while only 6 (18.7%) patients remained with DD grade II after TAVR (Figure). Conclusions: TAVR with the Sapien Edwards valve had a beneficial impact on LV diastolic dysfunction at one year follow-up in patients with severe aortic stenosis. Baseline Follow-up P  Left Ventricle Septal thickness (mm) 14.24 ±1.26 13.41 ± 1.19 <0.001  End-systolic left ventricular diameter (mm) 48.68 ± 6.79 47.11 ± 6.49 <0.001 End-diastolic left ventricular volume (mL) 108.24 ± 38.8 99.54 ± 34.3 <0.001 End-systolic left ventricular volume (mL) 57.3 ± 35.82 43.86 ± 24.41 <0.001 Left ventricular ejection fraction (%) 49.86 ± 13.14 57.65 ± 8.04 <0.001 Left atrial volume (mL) 74.67 ± 19.69 70.97 ± 18.55 0.10  Aortic valve Maximum systolic gradient (mmHg) 79.52 ± 21.84 22.19 ± 9.76 <0.001 Mean systolic gradient (mmHg) 46.95 ± 12.62 11.23 ± 5.87 <0.001 Aortic valve area / Effective orifice area (cm2) 0.65 ± 0.12 2.48 ± 1.37 <0.001 Maximal tricuspid regurgitation (cm/seg) 2.72 ± 0.47 2.58 ± 0.40 0.45  Baseline Follow-up P  Left Ventricle Septal thickness (mm) 14.24 ±1.26 13.41 ± 1.19 <0.001  End-systolic left ventricular diameter (mm) 48.68 ± 6.79 47.11 ± 6.49 <0.001 End-diastolic left ventricular volume (mL) 108.24 ± 38.8 99.54 ± 34.3 <0.001 End-systolic left ventricular volume (mL) 57.3 ± 35.82 43.86 ± 24.41 <0.001 Left ventricular ejection fraction (%) 49.86 ± 13.14 57.65 ± 8.04 <0.001 Left atrial volume (mL) 74.67 ± 19.69 70.97 ± 18.55 0.10  Aortic valve Maximum systolic gradient (mmHg) 79.52 ± 21.84 22.19 ± 9.76 <0.001 Mean systolic gradient (mmHg) 46.95 ± 12.62 11.23 ± 5.87 <0.001 Aortic valve area / Effective orifice area (cm2) 0.65 ± 0.12 2.48 ± 1.37 <0.001 Maximal tricuspid regurgitation (cm/seg) 2.72 ± 0.47 2.58 ± 0.40 0.45  View Large Baseline Follow-up P  Left Ventricle Septal thickness (mm) 14.24 ±1.26 13.41 ± 1.19 <0.001  End-systolic left ventricular diameter (mm) 48.68 ± 6.79 47.11 ± 6.49 <0.001 End-diastolic left ventricular volume (mL) 108.24 ± 38.8 99.54 ± 34.3 <0.001 End-systolic left ventricular volume (mL) 57.3 ± 35.82 43.86 ± 24.41 <0.001 Left ventricular ejection fraction (%) 49.86 ± 13.14 57.65 ± 8.04 <0.001 Left atrial volume (mL) 74.67 ± 19.69 70.97 ± 18.55 0.10  Aortic valve Maximum systolic gradient (mmHg) 79.52 ± 21.84 22.19 ± 9.76 <0.001 Mean systolic gradient (mmHg) 46.95 ± 12.62 11.23 ± 5.87 <0.001 Aortic valve area / Effective orifice area (cm2) 0.65 ± 0.12 2.48 ± 1.37 <0.001 Maximal tricuspid regurgitation (cm/seg) 2.72 ± 0.47 2.58 ± 0.40 0.45  Baseline Follow-up P  Left Ventricle Septal thickness (mm) 14.24 ±1.26 13.41 ± 1.19 <0.001  End-systolic left ventricular diameter (mm) 48.68 ± 6.79 47.11 ± 6.49 <0.001 End-diastolic left ventricular volume (mL) 108.24 ± 38.8 99.54 ± 34.3 <0.001 End-systolic left ventricular volume (mL) 57.3 ± 35.82 43.86 ± 24.41 <0.001 Left ventricular ejection fraction (%) 49.86 ± 13.14 57.65 ± 8.04 <0.001 Left atrial volume (mL) 74.67 ± 19.69 70.97 ± 18.55 0.10  Aortic valve Maximum systolic gradient (mmHg) 79.52 ± 21.84 22.19 ± 9.76 <0.001 Mean systolic gradient (mmHg) 46.95 ± 12.62 11.23 ± 5.87 <0.001 Aortic valve area / Effective orifice area (cm2) 0.65 ± 0.12 2.48 ± 1.37 <0.001 Maximal tricuspid regurgitation (cm/seg) 2.72 ± 0.47 2.58 ± 0.40 0.45  View Large View largeDownload slide Abstract P1467 Figure. View largeDownload slide Abstract P1467 Figure. P1468 The impact of diastolic impairment on exercise capacity following ST-Elevation Myocardial Infarction (STEMI) H Klimis H Klimis Westmead Hospital, Cardiology, Sydney, Australia A Ferkh A Ferkh Westmead Hospital, Cardiology, Sydney, Australia M Altman M Altman Westmead Hospital, Cardiology, Sydney, Australia P Brown P Brown Westmead Hospital, Cardiology, Sydney, Australia R Zecchin R Zecchin Westmead Hospital, Cardiology, Sydney, Australia L Thomas L Thomas Westmead Hospital, Cardiology, Sydney, Australia Westmead Hospital, Cardiology, Sydney, Australia Background: Diastolic function evaluation following ST-Elevation Myocardial Infarction (STEMI) is frequently omitted, although it has been associated with a worse prognosis. Purpose: We sought to determine the impact of diastolic dysfunction on exercise capacity following STEMI. Methods: Consecutive STEMI patients were retrospectively evaluated over 17 months. Individual diastolic parameters (average peak E, e’ velocity, and E/e’) were measured on transthoracic echocardiogram (TTE) performed at index presentation with STEMI. Diastolic grade was determined by 2 independent cardiologists (2016 ASE/EACVI guidelines). Exercise capacity was determined using METS (metabolic equivalents) achieved during symptom limited stress test performed 7-10 weeks after STEMI. Normal exercise capacity was defined as METS≥10. Hospital readmission details were obtained from data linked to electronic medical records. Results: 89 STEMI patients (89% male, mean age 59yrs) were included. 38/89 (43%) had normal diastolic function, 31/89 (35%) grade 1, and 20/89 (22%) grade 2 diastolic impairment. 60% had normal left ventricular ejection fraction (LVEF≥52%) and 31% mildly impaired systolic function (LVEF 41-51%). A higher grade of diastolic dysfunction was associated with lower METS (p < 0.001). METS correlated inversely with age (rs=-0.45, p < 0.001), average E/e’ (rs=-0.39, p < 0.001), and maximum left atrial volume index (LAVI) (rs=-0.22, p < 0.05). There was a trend towards correlation with LVEF (rs = 0.21, p = 0.06) and minimum LAVI (rs=-0.20, p = 0.07). Only diastolic parameters including average E/e’ and e’ velocity were significant predictors of reduce exercise capacity (i.e. METS < 10; p <0.01 for both), while LVEF was not a significant predictor (p = 0.08). There were 7/89 hospital readmissions with heart failure including 1 death secondary to heart failure (mean follow-up 520 days). In this group, 6/7 had diastolic dysfunction. Conclusions: Diastolic dysfunction was more prevalent following STEMI than impaired LVEF. Diastolic function rather than systolic function, was a determinant of exercise capacity in this group. P1469 Subclinical left ventricular systolic dysfunction in patients with morbid obesity referred to bariatric surgery in Western Norway - the FatWest study D Cramariuc D Cramariuc Department of Heart Disease, Haukeland University Hospital, Bergen, Norway S Nadirpour S Nadirpour Haugesund Hospital, Department of Heart Disease, Haugesund, Norway J Hjertaas J Hjertaas University of Bergen, Department of Clinical Science, Bergen, Norway K Matre K Matre University of Bergen, Department of Clinical Science, Bergen, Norway BG Nedrebo BG Nedrebo Haugesund Hospital, The Internal Medicine Clinic, Haugesund, Norway B Rogge B Rogge Department of Heart Disease, Haukeland University Hospital, Bergen, Norway E Gerdts E Gerdts University of Bergen, Department of Clinical Science, Bergen, Norway Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Haugesund Hospital, Department of Heart Disease, Haugesund, Norway University of Bergen, Department of Clinical Science, Bergen, Norway Haugesund Hospital, The Internal Medicine Clinic, Haugesund, Norway Background: Obesity increases the risk of heart failure being responsible for 10-15% of clinical heart failure. However, obese subjects often maintain normal ejection fraction (EF). Purpose: We sought to evaluate changes in left ventricular (LV) systolic function and geometry in morbidly obese patients without known heart disease. Methods: Clinic and echocardiographic data were recorded at baseline in 110 obese subjects (mean 42 ± 11years, 74% women, mean BMI 41.9 ± 4.8kg/m2, 33% hypertension, 15% diabetes) recruited in the FatWest (Bariatric Surgery on the West Coast of Norway) study, a prospective study on the 5years impact of bariatric surgery on weight loss and quality of life (primary) as well as on cardiopulmonary function and hormonal changes (secondary endpoints). Patients were grouped according to median weight (118.5kg). LV function was assessed by EF by Simpson´s biplane method, stress-corrected midwall function (scMWS) and endocardial global longitudinal strain (GLS) by 2D vector velocity imaging using a 16-segment model. Results: The heavyweight group (≥118.5kg) included a higher proportion of men and patients with hypertension (p < 0.05), had larger left atrial systolic volumes, more LV concentric remodelling, and larger right ventricular end-diastolic diameter and wall thickness. EF did not differ between groups, while scMWS (89.5% vs. 94.8%) and GLS (-14.32% vs. -16.94%) were lower in heavyweight subjects (both p <0.05, Figure). In multivariate regression analyses, heavy weight was associated with lower scMWS (Beta -0.22, p =0.04) and lower GLS (Beta 0.22, p = 0.03) independent of gender, hypertension, heart rate, left atrial volume, stroke volume, mitral peak early inflow/annular velocity ratio, LV mass, concentric geometry, and presence of mitral or aortic regurgitation. Conclusion: Among subjects with morbid obesity and free of clinical heart disease, LV systolic function assessed by midwall function and GLS becomes impaired with increasing weight, despite normal ejection fraction and independent of clinical and echocardiographic confounders. View largeDownload slide Abstract P1469 Figure View largeDownload slide Abstract P1469 Figure P1470 Long-term survival in heart failure patients with mid-range ejection fraction in comparison to reduced and preserved ejection fraction EE Yakubovskaya EE Yakubovskaya I.M. Sechenov First Moscow State Medical University, University Clinical Hospital 1 , Moscow, Russian Federation MG Poltavskaya MG Poltavskaya I.M. Sechenov First Moscow State Medical University, University Clinical Hospital 1 , Moscow, Russian Federation IYU Giverts IYU Giverts I.M. Sechenov First Moscow State Medical University, University Clinical Hospital 1 , Moscow, Russian Federation VP Sedov VP Sedov I.M. Sechenov First Moscow State Medical University, University Clinical Hospital 1 , Moscow, Russian Federation MD Kuklina MD Kuklina I.M. Sechenov First Moscow State Medical University, University Clinical Hospital 1 , Moscow, Russian Federation AL Syrkin AL Syrkin I.M. Sechenov First Moscow State Medical University, University Clinical Hospital 1 , Moscow, Russian Federation I.M. Sechenov First Moscow State Medical University, University Clinical Hospital 1 , Moscow, Russian Federation Objectives: heart failure (HF) with left ventricular ejection fraction (LVEF) in a range of 40-49% has been defined by 2016 European guidelines as HF with mid-range EF (HFmrEF). The data concerning prognosis in this specific type of patients is scarce. The aim of the study was to compare survival in HFmrEF patients to heart failure patients with reduced (HFrEF) and preserved (HFpEF) ejection fraction. Methods: we retrospectively analyzed 112 patients with HF, NYHA classes II-III (76 male, mean age 58.3 ± 14,2 years) previously included in the prospective observational study. All patients were on optimal medical treatment. 57 patients had HFrEF (50,9%), 31 – HfmrEF (27,7%) and 24 – HFpEF (21,4%). At baseline the patients underwent comprehensive investigation including standard clinical examination, echocardiography, 6-minute walk test (6-mwt), Duke Activity Status Index (DASI) and cardiopulmonary exercise testing. Average follow-up amounted 54,0 ± 29,6 months. Cardiovascular death and composite end-point (cardiovascular death and hospitalization for HF) were considered as primary analysis variables. Results: At baseline patients with HFrEF and HFpEF demonstrated worse 6-mwt and DASI, worse quality of life according to Minnesota questionnaire, higher E/e" and BNP value. HFpEF patients were older with higher percent of women compared to other groups. Cardiovascular death was registered in 25 patients with HFrEF (43,9%), 4 patients with HFmrEF (12,9%) and 10 patients with HFpEF (41,6%). Causes of death were comparable in all groups. Kaplan-Meyer analysis showed better survival in HFmrEF compared to HFrEF and HFpEF (Log rang = 10,3; p = 0,006). Composite end-point was observed in 11 patients with HFpEF (45,8%), 14 patients with HFmrEF (41,2%) and 32 patients with HFrEF (56,1%0. Kaplan-Mayer curves for composite end-point were comparable in all 3 groups with no statistical difference. Conclusions: Subgroup of patients with HFmrEF may demonstrate better survival in comparison toHFrEF and HFpEF patients. This may be related to heterogeneity of HF population and small amount of statistical sample. Further investigations are necessary to confirm this data. P1471 A teaching intervention increases the accuracy of echocardiographic visual left ventricular ejection fraction assessment S Anilkumar S Anilkumar Hamad Medical Corporation Heart Hospital, Doha, Qatar B Albizreh B Albizreh Hamad Medical Corporation Heart Hospital, Doha, Qatar S Adhiraja S Adhiraja Hamad Medical Corporation Heart Hospital, Doha, Qatar N Elkum N Elkum Qatar Cardiovascular Research Center, Sidra Medical and Research Center, Doha, Qatar A Salustri A Salustri Hamad Medical Corporation Heart Hospital, Doha, Qatar Hamad Medical Corporation Heart Hospital, Doha, Qatar Qatar Cardiovascular Research Center, Sidra Medical and Research Center, Doha, Qatar Background. The international societies of echocardiography recommend the assessment of the left ventricular ejection fraction (LVEF) by quantitative methods, however still visual assessment is widely applied in daily practice with intrinsic low accuracy. Purpose. This study sought to determine whether a formal teaching intervention could improve the accuracy in visual assessment of LVEF among a group of physicians. Methods. Twenty-six participants (physicians and cardiology fellows) with varying experience in echocardiography ranging from 3 months to 12 years were provided a single-point LVEF estimate for 20 echocardiograms with a spectrum of LVEF ranging from 10% to 70% selected from the ESCeL platform of the European Association of Cardiovascular Imaging (EACVI) (with the EACVI measurements considered as reference). After this baseline assessment, the individual results were discussed with the participants during a one-to-one session with the Head of the Echocardiography Laboratory. In addition, all the participants were divided into groups and received three sessions of training on the same platform chaired by one cardiologist with >15 years of experience in echocardiography. Each session included 30 cases with interactive discussions and tips and tricks for proper visual assessment of LVEF. After 2 months from the initial assessment, 20 new echocardiograms were presented to the same 26 participants for visual assessment of LVEF using the same methodology described for the baseline assessment. For each participant, the visual LVEF for each case was compared with the reference LVEF values. A difference of > ±10% between the visual and the reference LVEF was considered a misclassification. Additional analysis was done with differences of > ±5% to define misclassification. Fisher’s exact test was used to determine differences in misclassification rates pre- and postintervention. Results. The teaching intervention resulted in a decrease in the absolute difference between reference and visual assessment of LVEF (from 7.9 ± 9.6 to 1.2 ± 7.8; p < 0.0001). The misclassification rate for the preintervention reads was 65%, while for the postintervention it decreased to 51% (p < 0.0001). Using a difference in LVEF of > ±5% to define misclassification, the rates were 81% before the intervention and 74% afterward (p < 0.01). When categorized by level of experience, there was no difference in the degree of improvement in accuracy pre- versus postintervention. Conclusions. In readers of LVEF with varying levels of experiences, a tutor based teaching intervention improved the accuracy of echocardiographic visual LVEF evaluation. This intervention provides quality measures and improves reliability of reporting. P1472 Left atrial structural and functional remodeling following balloon mitral valvuloplasty A Samaan A Samaan Cairo University, Cardiovascular department, Cairo, Egypt K Said K Said Cairo University, Cardiovascular department, Cairo, Egypt W El Aroussy W El Aroussy Cairo University, Cardiovascular department, Cairo, Egypt M Hassan M Hassan Cairo University, Cardiovascular department, Cairo, Egypt A Hassan A Hassan Cairo University, Cardiovascular department, Cairo, Egypt M Fawzy M Fawzy Aswan Heart Centre, Aswan, Egypt M Yacoub M Yacoub Aswan Heart Centre, Aswan, Egypt Cairo University, Cardiovascular department, Cairo, Egypt Aswan Heart Centre, Aswan, Egypt Purpose: To investigate changes of left atrial (LA) volume and functions in patients with isolated rheumatic mitral stenosis (MS) following successful balloon mitral valvuloplasty (BMV). Methods: Using biplane method, trans-thoracic echocardiography was used to measure maximal (V max), minimal (V min) and pre-A (V pre-A) LA volumes in 30 patients with MS. All measurements were indexed to body surface area, and were repeated 6 months and one year following BMV. LA volumetric functions were then estimated (figure and table). Results: MS patients had a median mitral valve area (MVA) of 0.9 cm² and a mean pressure gradient of 12.5 mmHg. Following BMV, there were a significant increase in MVA (1.9 cm² , p < 0.001) and a significant drop in mean pressure gradients (5 mmHg, p < 0.001) A significant regression of V max index was noticed at 6 months (51 vs. 60 ml/m², p = 0.001) with a further decrease at one year (48 vs. 51 ml/m² , p = 0.03). LA active emptying fraction showed a significant improvement at 6 months (20% vs. 18%, p = 0.016) with a further improvement at one year (31% vs. 20%, p = 0.001). Other LA functions showed a similar pattern of improvement (table and figure) . Conclusion: BMV is associated with a significant regression of LA volume that is accompanied by a significant improvement in LA volumetric functions. Parameter Baseline 6 months follow -up P (1)  One year follow-up P (2)  LA volume ( ml) 106.5 (80-237) 85 (75-117) 0.003 80 (69-116) 0.001 LA Vmax indexed (LAVI), ml/m2 60 (45-118) 51 (32-95) 0.001 48 (35-92) 0.001 LA Vmin indexed (ml/m2) 41 (27-79) 37 (21-73) 0.005 30 (15-70) <0.001 LA VpreA indexed (ml/m2) 50 (28-110) 43 (30-87) 0.003 40 (25-81) 0.001 LA total emptying volume ( ml) 20 (4-39) 20 (8.5-37) 0.39 22 (10-35) 0.79 LA total emptying fraction (%) 30 (7-50) 42 (19-62) 0.001 47 (23-67) 0.007 LA passive emptying volume, ml 14 (3.6-27) 13 (2.5-24) 0.25 9 (4-20) 0.78 LA passive emptying fraction (%) 14 (3-29) 26 (7-52) 0.033 29 (10-42) 0.029 LA active emptying volume ( ml) 9 (2-31) 7 (2.5-16) 0.58 13 (3-22) 0.034 LA active emptying fraction (%) 18 (4-37) 20 (11-44) 0.016 31 (8-51) 0.001 Parameter Baseline 6 months follow -up P (1)  One year follow-up P (2)  LA volume ( ml) 106.5 (80-237) 85 (75-117) 0.003 80 (69-116) 0.001 LA Vmax indexed (LAVI), ml/m2 60 (45-118) 51 (32-95) 0.001 48 (35-92) 0.001 LA Vmin indexed (ml/m2) 41 (27-79) 37 (21-73) 0.005 30 (15-70) <0.001 LA VpreA indexed (ml/m2) 50 (28-110) 43 (30-87) 0.003 40 (25-81) 0.001 LA total emptying volume ( ml) 20 (4-39) 20 (8.5-37) 0.39 22 (10-35) 0.79 LA total emptying fraction (%) 30 (7-50) 42 (19-62) 0.001 47 (23-67) 0.007 LA passive emptying volume, ml 14 (3.6-27) 13 (2.5-24) 0.25 9 (4-20) 0.78 LA passive emptying fraction (%) 14 (3-29) 26 (7-52) 0.033 29 (10-42) 0.029 LA active emptying volume ( ml) 9 (2-31) 7 (2.5-16) 0.58 13 (3-22) 0.034 LA active emptying fraction (%) 18 (4-37) 20 (11-44) 0.016 31 (8-51) 0.001 Changes in left atrium (LA) volumes and function following BMV as assessed by 2D echocardiography. LA volumetric functions were estimated where LA total emptying fraction was calculated as (V max –V min)/ V max, LA passive emptying fraction as (V max –V pre A)/ V max and LA active emptying fraction as (V pre A – V min) / V pre A. Values are expressed as median and range. P value (1): Baseline vs. 6 months follow up , P value(2): baseline vs. one year follow up View Large Parameter Baseline 6 months follow -up P (1)  One year follow-up P (2)  LA volume ( ml) 106.5 (80-237) 85 (75-117) 0.003 80 (69-116) 0.001 LA Vmax indexed (LAVI), ml/m2 60 (45-118) 51 (32-95) 0.001 48 (35-92) 0.001 LA Vmin indexed (ml/m2) 41 (27-79) 37 (21-73) 0.005 30 (15-70) <0.001 LA VpreA indexed (ml/m2) 50 (28-110) 43 (30-87) 0.003 40 (25-81) 0.001 LA total emptying volume ( ml) 20 (4-39) 20 (8.5-37) 0.39 22 (10-35) 0.79 LA total emptying fraction (%) 30 (7-50) 42 (19-62) 0.001 47 (23-67) 0.007 LA passive emptying volume, ml 14 (3.6-27) 13 (2.5-24) 0.25 9 (4-20) 0.78 LA passive emptying fraction (%) 14 (3-29) 26 (7-52) 0.033 29 (10-42) 0.029 LA active emptying volume ( ml) 9 (2-31) 7 (2.5-16) 0.58 13 (3-22) 0.034 LA active emptying fraction (%) 18 (4-37) 20 (11-44) 0.016 31 (8-51) 0.001 Parameter Baseline 6 months follow -up P (1)  One year follow-up P (2)  LA volume ( ml) 106.5 (80-237) 85 (75-117) 0.003 80 (69-116) 0.001 LA Vmax indexed (LAVI), ml/m2 60 (45-118) 51 (32-95) 0.001 48 (35-92) 0.001 LA Vmin indexed (ml/m2) 41 (27-79) 37 (21-73) 0.005 30 (15-70) <0.001 LA VpreA indexed (ml/m2) 50 (28-110) 43 (30-87) 0.003 40 (25-81) 0.001 LA total emptying volume ( ml) 20 (4-39) 20 (8.5-37) 0.39 22 (10-35) 0.79 LA total emptying fraction (%) 30 (7-50) 42 (19-62) 0.001 47 (23-67) 0.007 LA passive emptying volume, ml 14 (3.6-27) 13 (2.5-24) 0.25 9 (4-20) 0.78 LA passive emptying fraction (%) 14 (3-29) 26 (7-52) 0.033 29 (10-42) 0.029 LA active emptying volume ( ml) 9 (2-31) 7 (2.5-16) 0.58 13 (3-22) 0.034 LA active emptying fraction (%) 18 (4-37) 20 (11-44) 0.016 31 (8-51) 0.001 Changes in left atrium (LA) volumes and function following BMV as assessed by 2D echocardiography. LA volumetric functions were estimated where LA total emptying fraction was calculated as (V max –V min)/ V max, LA passive emptying fraction as (V max –V pre A)/ V max and LA active emptying fraction as (V pre A – V min) / V pre A. Values are expressed as median and range. P value (1): Baseline vs. 6 months follow up , P value(2): baseline vs. one year follow up View Large View largeDownload slide Abstract P1472 Figure. Measurement of left atrial volumes View largeDownload slide Abstract P1472 Figure. Measurement of left atrial volumes P1473 Prognostic usefulness of changes in left ventricular global longitudinal strain after transcatheter aortic valve implantation in severe aortic stenosis patients with preserved ejection fraction E Sakaguchi E Sakaguchi Fujita Health University School of Medicine, Cardiology, Toyoake, Japan A Yamada A Yamada Fujita Health University School of Medicine, Cardiology, Toyoake, Japan T Muramatsu T Muramatsu Fujita Health University School of Medicine, Cardiology, Toyoake, Japan Y Kawada Y Kawada Fujita Health University School of Medicine, Cardiology, Toyoake, Japan N Hoshino N Hoshino Fujita Health University School of Medicine, Cardiology, Toyoake, Japan M Hoshino M Hoshino Fujita Health University School of Medicine, Cardiology, Toyoake, Japan K Takada K Takada Fujita Health University School of Medicine, Cardiology, Toyoake, Japan K Sugimoto K Sugimoto Fujita Health University School of Medicine, Cardiology, Toyoake, Japan Y Ozaki Y Ozaki Fujita Health University School of Medicine, Cardiology, Toyoake, Japan Fujita Health University School of Medicine, Cardiology, Toyoake, Japan Introduction: Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) are shown to be prognostic factors in patients with severe aortic stenosis (AS) after transcatheter aortic valve implantation (TAVI). However, clinical usefulness of the changes in these parameters in TAVI patients with preserved LVEF remains to be clarified. Methods: We examined 59 consecutive severe AS patients with preserved LVEF (≧ 50%) (age 82 ± 5 year; 36% male) who underwent successful TAVI between March 2015 and April 2018. We performed echocardiography and measurement of plasma NT-ProBNP levels on the same day prior to TAVI as well as after TAVI. The changes in LVEF, GLS and NT-ProBNP were calculated by subtracting the first data from the second. The study end points were cardiac events. Results: Patients were followed for a median of 387 ± 258 days. Mean transaortic valve pressure gradient improved from 50 ± 17 mmHg to 12 ± 5 mmHg after TAVI (p < 0.0001). Cardiac events occurred in 7 patients (12%) during the follow-up (2 death cases, 3 congestive heart failure cases, 1 arrhythmia case, 1 acute coronary syndrome case). In multivariate analysis, the change in GLS (ΔGLS: p = 0.04) was the best prognostic factor of the cardiac events, whereas baseline and follow-up LVEF and NT-ProBNP, changes in LVEF and NT-ProBNP could not predict cardiac events. The optimal cut-off value of ΔGLS for cardiac events by receiver operating characteristic curves analysis was -1.0% (sensitivity 72%, specificity 85%, AUC 0.88). Kaplan-Meier analysis showed that patients with ΔGLS less than -1.0% (i.e. improved GLS after TAVI) experienced significantly less cardiac events during the follow-up period (p = 0.0016, log-rank). Conclusions: These results suggest that change in GLS would be a useful prognostic indicator after successful TAVI in patients with preserved LVEF. P1474 Echocardiographic comparison of early hemodynamic performance between two corevalve percutaneous prosthesis models: a single center experience A Luque Moreno A Luque Moreno University Hospital Reina Sofia, Cardiology, Cordoba, Spain M Ruiz Ortiz M Ruiz Ortiz University Hospital Reina Sofia, Cardiology, Cordoba, Spain D Mesa Rubio D Mesa Rubio University Hospital Reina Sofia, Cardiology, Cordoba, Spain M Delgado Ortega M Delgado Ortega University Hospital Reina Sofia, Cardiology, Cordoba, Spain N Paredes Hurtado N Paredes Hurtado University Hospital Reina Sofia, Cardiology, Cordoba, Spain MJ Oneto Fernandez MJ Oneto Fernandez University Hospital Reina Sofia, Cardiology, Cordoba, Spain E Martin Dorado E Martin Dorado University Hospital Reina Sofia, Cardiology, Cordoba, Spain L Carnero Montoro L Carnero Montoro University Hospital Reina Sofia, Cardiology, Cordoba, Spain J Sanchez Fernandez J Sanchez Fernandez University Hospital Reina Sofia, Cardiology, Cordoba, Spain C Ferreiro Quero C Ferreiro Quero University Hospital Reina Sofia, Cardiology, Cordoba, Spain M Romero Moreno M Romero Moreno University Hospital Reina Sofia, Cardiology, Cordoba, Spain S Ojeda Pineda S Ojeda Pineda University Hospital Reina Sofia, Cardiology, Cordoba, Spain J Suarez De Lezo Herreros De Tejada J Suarez De Lezo Herreros De Tejada University Hospital Reina Sofia, Cardiology, Cordoba, Spain F Hidalgo Lesmes F Hidalgo Lesmes University Hospital Reina Sofia, Cardiology, Cordoba, Spain M Pan Alvarez-Ossorio M Pan Alvarez-Ossorio University Hospital Reina Sofia, Cardiology, Cordoba, Spain University Hospital Reina Sofia, Cardiology, Cordoba, Spain Background: Since the introduction of Transcatheter Aortic Valve Implantation (TAVI), new devices have been designed, including the Evolut R valve, which has shown a reduction of paravalvular regurgitation in some series. The aim of this study is to compare the immediate echocardiographic results between Evolut R and CoreValve prostheses. Methods: From April 2008 to December 2016, 292 patients underwent TAVI in our center. 201 patients were treated with CoreValve prosthesis and 41 with Evolut R prosthesis. Only patients treated with a 26 mm or 29 mm bioprosthesis were included. We excluded the first 20 cases of CoreValve (learning curve), patients who died during admission, TAVI in severe aortic regurgitation (AR) without stenosis and those who had a previous biological prosthesis. We finally included 201 patients: 177 were treated with CoreValve and 34 with Evolut R. All patients underwent doppler echocardiographic examination at baseline and 72 hours after the implantation. We evaluated transvalvular pressure gradients, prosthesis-patient mismatch (PPM) and paravalvular AR. Results: Significant differences were observed between patients treated with Evolut R versus CoreValve regarding to: age (80 ± 6 years vs 79 ± 5, respectively), hypertension (100% vs 71%), smoking (9% vs 0%), dyspnea (62% vs 95%), angina (71% vs 55%) or recent myocardial infarction (6% vs 0%), p < 0,05 for all comparisons. No differences were observed regarding: sex (41% males vs 45%), risk scores or prosthesis size (62% were treated with a 26 mm Evolut R prosthesis vs 64% with a 26 mm CoreValve), p = ns for all comparisons. There were no differences in echocardiographic parameters in both groups at discharge: máximum gradient (15,1 ± 6,4mmHg vs 14,7 ± 6,2mmHg, p = 0,73), mean gradient (7,8 ± 3,7mmHg vs 7,8 ± 3,8mmHg, p = 0,98) or PPM (23,3% vs 24,4%, p = 0,90). A lower rate of moderate/severe or severe AR was observed in the Evolut R group, although the difference was not statistically significant (3,1% vs 10,3%, p = 0,32). The results were similar when analyzed separately both sizes of prosthesis. Conclusions: In our cohort, early echocardiographic outcomes were comparable between Evolut R and CoreValve prosthesis regarding transvalvular gradients or PPM. A lower rate of significant AR was observed after the implantation of new Evolut R prosthesis, although the difference was not statistically significant. P1475 Relation of asymmetric aortic valve to eccentric aortic regurgitation in patients with tricuspid aortic valve T-H Park T-H Park Dong-A University, Busan, Korea Republic of K Park K Park Dong-A University, Busan, Korea Republic of YR Cho YR Cho Dong-A University, Busan, Korea Republic of JS Park JS Park Dong-A University, Busan, Korea Republic of MH Kim MH Kim Dong-A University, Busan, Korea Republic of YD Kim YD Kim Dong-A University, Busan, Korea Republic of JI Park JI Park Dong-A University, Busan, Korea Republic of Dong-A University, Busan, Korea Republic of Background: Bicuspid aortic valve is known as a major cause of eccentric aortic regurgitation (AR) due to its asymmetric structure. However, it is unclear whether asymmetry itself plays a role in developing eccentric AR in patients with tricuspid aortic valve (TAV). Thus, the aim of this study was to determine whether an asymmetric aortic valve structure may predispose to eccentric AR in TAV patients. Methods: Of the 164,410 patients that underwent echocardiography between January 2006 and January 2018 at Dong-A University hospital, 306 (mean age 69.9 ± 12.6 years; 62% were men) with eccentric AR were identified. After excluding patients with bicuspid AV (n = 115) and prolapsed AV (n = 87), we were enrolled 104 patients who had eccentric AR with TAV. Comprehensive echocardiographic AV cusp measurements (cusp height, cusp area, and asymmetry index) in these patients were compared to those of 104 age- and gender- matched control patients with central AR. Asymmetric AV was defined if the cusp area asymmetry index was≥5%. Results: In the eccentric group, 65 patients (62.5%) had asymmetric AV, whereas in central AR group, 43 patients (41.3%). The mean cusp height and average asymmetry index of cusp height were significantly larger in eccentric AR group than those in central AR group (1.8 ± 0.3 cm vs. 1.6 ± 0.2 cm, and 5.1 ± 3.5% vs. 3.7 ± 2.2%, p < 0.001, respectively). Furthermore, the mean cusp area and average asymmetric index of cusp area were also significantly larger in the eccentric AR group than those in the central AR group (2.6 ± 0.8 cm² vs. 2.2 ± 0.5 cm², and 7.0 ± 4.4% vs. 4.6 ± 2.5%, p < 0.001, respectively). However, cusp area and asymmetric index of cusp were not significantly correlated with the severity of AR. Conclusion: AV asymmetry indices of eccentric AR patients were significantly larger than those of patients with central AR. The present data suggest that the presence of asymmetric AV might be an important factor to develop eccentric AR in TAV patients. P1476 Is the surgical left atrial reduction alone better than maze procedure in restoring atrial contractility after rheumatic mitral valve surgery? DK Firmansyah DK Firmansyah Harapan Kita Hospital, Cardiology and Vascular Medicine, Jakarta, Indonesia AM Soesanto AM Soesanto Harapan Kita Hospital, Cardiology and Vascular Medicine, Jakarta, Indonesia DA Hanafy DA Hanafy Harapan Kita Hospital, Cardiology and Vascular Medicine, Jakarta, Indonesia Harapan Kita Hospital, Cardiology and Vascular Medicine, Jakarta, Indonesia Background: As a benchmark for surgical management of atrial fibrillation (AF), the surgical ablation with Maze procedure have less satisfactory result in restoring atrial contractility in rheumatic mitral valve disease. The surgical reduction of left atrium has an acceptable success rate in conversion of sinus rhythm, yet, the efficacy in restoring atrial contractility is unknown. If the surgical reduction of left atrium is effective in restoring atrial contractility, it will become the more economic and simpler strategy to manage AF as well as reducing the risk of thromboembolism. Objectives: To analyze the success rate of left atrial reduction surgery on restoration of left atrial contractility in rheumatic mitral valve disease and to compare the success rate with surgical ablation. Methods: Patient clinical profile, ECG, and echocardiography data from July 2014 to November 2017 were analyzed retrospectively. Data were collected within 1 month, and 6 months post-surgery. The effective atrial contraction was defined as the presence of A wave during late diastole with peak velocity ≥ 10 cm/s in Pulse Wave (PW) doppler of mitral inflow or the atrial filling fraction ≥ 20%. Results: At the early observation [median 7 days (3-30)], there were total 90 samples that eligible for analysis. The samples were classified into 2 groups, each consist of 45 samples. The success rate of surgical reduction of left atrium in restoring atrial contractility was 8.9% while in surgical ablation group was 26.7% (p = 0.027). In those whose atrial contractility returned, all demonstrated effective contraction. The atrial filling fraction of the subject with returned atrial contractility was not significantly different between the two groups (21.5 ± 6.8 in surgical ablation group and 24.6 ± 8.3 in surgical reduction group, p = 0.469). The early post-operative left atrial volume index (LAVi) was the only variable that independently associated with higher success rate of early atrial contractility restoration in both group after adjustment for potential confounding variables in multivariate analysis [PR = 0.97, 95% CI 0.95-0.99 (p = 0.007)]. The cut off value of post-operative LAVi that associated with restoration of contractility was ≤ 76 ml/m2 (AUC 0.76, sensitivity 81%, specificity 70%). Conclusions: The surgical reduction of left atrium alone had lower success rate compared to surgical ablation with Maze procedure in restoring atrial contractility after rheumatic mitral valve surgery. The early post operative LAVI ≤ 76 ml/m2 was the only variable that associated with the higher rate of success in restoration of early atrial contractility. P1477 TAVI reverses the longitudinal cardiac function and cardiac phase: evaluation of atrioventricular annulus T Ota T Ota Shonan Kamakura General Hospital, Anesthesiology, Kamakura, Japan Y Murakami Y Murakami Shonan Kamakura General Hospital, Cardiac Ultrasound Laboratory, Kamakura, Japan Y Kozuka Y Kozuka Shonan Kamakura General Hospital, Cardiac Ultrasound Laboratory, Kamakura, Japan C Ohshiro C Ohshiro Shonan Kamakura General Hospital, Cardiac Ultrasound Laboratory, Kamakura, Japan T Yamabe T Yamabe Shonan Kamakura General Hospital , Cardiovascular Surgery, Kamakura, Japan K Noguchi K Noguchi Shonan Kamakura General Hospital , Cardiovascular Surgery, Kamakura, Japan K Shishido K Shishido Shonan Kamakura General Hospital, Cardiology, Kamakura, Japan F Yamanaka F Yamanaka Shonan Kamakura General Hospital, Cardiology, Kamakura, Japan S Saito S Saito Shonan Kamakura General Hospital, Cardiology, Kamakura, Japan Shonan Kamakura General Hospital, Anesthesiology, Kamakura, Japan Shonan Kamakura General Hospital, Cardiac Ultrasound Laboratory, Kamakura, Japan Shonan Kamakura General Hospital , Cardiovascular Surgery, Kamakura, Japan Shonan Kamakura General Hospital, Cardiology, Kamakura, Japan Background:In severe aortic valve stenosis (AS), the left ventricle is exposed to a huge afterload by the stenosed valve, which leads to the delay in the peak of ejection time (ET) and also affects the isovolumetric systolic time (IVST) and the isovolumetric relaxation time (IVRT). Evidences have shown that cardiac function improves as a result of TAVI releasing the left ventricular afterload, however, the change in the cardiac phase has not yet been clarified. Although the standard method to evaluate cardiac function is the left ventricular ejection fraction, it is known that cardiac function evaluation more reflects longitudinal cardiac function in patients with advanced left ventricular hypertrophy, such as AS. In this study, we used the tricuspid annular plane systolic excursion (TAPSE), mitral annular plane systolic excursion (MAPSE) and tissue Doppler mitral annulus velocity waveforms to investigate in aim to evaluate the longitudinal change of cardiac function and cardiac phase. Purpose:To evaluate the longitudinal effect of TAVI on the cardiac function and cardiac phase in patients with severe AS by examining the atrioventricular annulus Method:For patients undergoing TAVI at our hospital from January to December 2016, the echo data before and after TAVI were retrospectively analyzed. TAPSE, MAPSE, lateral mitral annular systolic velocity (s") were used as evaluation of cardiac contraction, and ET and IVST / IVRT were used as evaluation of cardiac time phase. The exclusion criteria were Grade 2 or severer of atrioventricular valve regurgitation, and moderate degrees or severer of paravalvular regurgitation. Wilcoxon signed-rank test with statistical threshold of P < 0.05 was used in statistical analysis. Results:Among the 52 cases of TAVI recruited within the study period, 31 cases were excluded and 21 cases were analyzed. When compared before the operation and after 12 months, cardiac contraction improved remarkably in MAPSE [10.5 ± 3.7 vs. 12.9 ± 3.9; p < 0.05, r=.56], and s’ [4.9 ± 1.2 vs. 6.0 ± 1.0; p < 0.05, r=.64], but not in TAPSE [16.7 ± 4.4 vs. 17.1 ± 4.8; p = N.S. r=.13]. On the other hand, cardiac phase improved in IVST/IVRT [1.00 ± 0.58 vs. 0.86 ± 0.44; p = 0.09, r=.40], but not differ in ET [0.24 ± 0.07 vs. 0.24 ± 0.06; p = N.S. r=.02]. Conclusion:At 12 months after TAVI, we found that the left ventricular function improved significantly, while the right ventricular function did not change. In cardiac phase, ET did not change but IVST / IVRT tended to decrease. Thus, TAVI supports the longitudinal reverse of left ventricular function and cardiac phase in patients with severe AS. P1478 Estimation of inter-commissural length and area and shape of valsalva cusp in patient with aortic regurgitation by three-dimensional trans esophageal echocardiography D Murai D Murai Sapporo City General Hospital, Department of Cardiovascular Medicine, Sapporo, Japan H Komatsu H Komatsu NTT East Japan Sapporo Hospital, Department of Cardiovascular Medicine, Sapporo, Japan D Tatsuta D Tatsuta Sapporo City General Hospital, Department of Cardiovascular Medicine, Sapporo, Japan T Sato T Sato Sapporo City General Hospital, Department of Cardiovascular Medicine, Sapporo, Japan R Suzuki R Suzuki Sapporo City General Hospital, Department of Cardiovascular Medicine, Sapporo, Japan M Toba M Toba Sapporo City General Hospital, Department of Cardiovascular Medicine, Sapporo, Japan K Asakawa K Asakawa Sapporo City General Hospital, Department of Cardiovascular Medicine, Sapporo, Japan Y Dannoura Y Dannoura Sapporo City General Hospital, Department of Cardiovascular Medicine, Sapporo, Japan T Makino T Makino Sapporo City General Hospital, Department of Cardiovascular Medicine, Sapporo, Japan T Kouya T Kouya Sapporo City General Hospital, Department of Cardiovascular Medicine, Sapporo, Japan Sapporo City General Hospital, Department of Cardiovascular Medicine, Sapporo, Japan NTT East Japan Sapporo Hospital, Department of Cardiovascular Medicine, Sapporo, Japan Background: Relationship between inter-commissural length or area of aortic valve and severity in aortic valve regurgitation (AR) have not been clear. How the morphological changes of aortic valve cusp affect to AR have not been uncertain. Methods: Three dimensional (3D) trans-esophageal echocardiography was performed in 60 patients at our institution from April 2016 to October 2017: patients with normal function in aortic valve without AR (FN) (n = 32), mild AR (n = 15), and moderate or severe AR without organic change in valve cusp (mod-seve AR) (n = 13). The 3D images of AVC acquired using EPIQ7c and X7-2t 3D TEE probe were analyzed. The cross-sectional entire circumferential length of Valsalva sinus (entire VCL) was measured. VCL, Inter-commissural length (CL) and geometric height (GH) of non-coronary, left-coronary and right-coronary cusp (NCC, LCC, RCC, respectively) were also measured. The commissural triangle area surrounded with three inter-commissural lines (CTA) was calculated. The ratio of VCL to GH (VCL/GH) was also calculated due to estimate cusp morphological change. These indices and clinical characteristics were statistically compared among three groups by one-way ANOVA. Results: The entire VCL of the patients in mode-seve AR was larger than other groups, and that in mild AR tended to be larger than FN (FN: mild AR: mode-seve AR ; 105.1 ± 14.5 vs 109.3 ± 13.6 vs 135.1 ± 19.6 mm, p < 0.01 by ANOVA). CTA in mod-seve AR was also larger (240.2 ± 63.7 vs 247.5 ± 31.6 vs 402.3 ± 130.9 mm2, p < 0.01). CL of RCC in mode-seve AR was also significantly larger than others (24.5 ± 3.2 vs 24.4 ± 2.2 vs 31.3 ± 5.5 mm, p < 0.01). VCL/GH was tended to be larger in mod-seve AR group. Similar findings were shown in LCC and NCC. Conclusion: Severity of AR was related to the enlargement of valsalva sinus and Inter-commissural length and area. P1479 Is the raphe a predisposing factor for valvulopathy and/or aortopathy in bicuspid aortic valve patients? M Bellino M Bellino University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy R Citro R Citro University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy C Baldi C Baldi University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy G Provenza G Provenza University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy L Soriente L Soriente University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy C Prota C Prota University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy R Benvenga R Benvenga University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy F Cogliani F Cogliani University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy A Longobardi A Longobardi University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy P Masiello P Masiello University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy R Leone R Leone University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy A Gigantino A Gigantino University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy S Iesu S Iesu University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy G Galasso G Galasso University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy F Piscione F Piscione University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy Background: Aim of the study wasto evaluate the association between the presence of raphe in BAV (bicuspid aortic valve) patients and valve dysfunction and/or aortopathy. Methods: Prevalence of aortic valve dysfunction and aortopathy has been investigated in BAV patients with and without raphe. Aortic valve dysfunction (regurgitation or stenosis) was categorized in mild, moderate and severe. Aortopathy was defined as: annulus ≥ 14 mm/m2; root ≥ 20 mm/m2; sino-tubular junction (STJ) ≥ 16 mm/m2; ascending aorta (AA) ≥ 17 mm/m2; it was classified in: type A, dilation of the ascending aorta; type B, dilation of the aortic root and the ascending aorta; and type C, isolated dilation of the aortic root. Results: Study population consisted of 105 BAV patients; 73 (69%) with raphe and 32 (31 %) without raphe. Patients with, compared with those without raphe, had higher prevalence of severe aortic stenosis and larger aortic sinus (Table 1). In patients with raphe, overall and Type B aortopathy have been significantly detected (Table 1). At univariate analysis the presence of raphe [0.23 (0.05 - 1.03) P = 0.05] and severe aortic stenosis [2.43 (0.28 - 20.90) P= 0.41] were associated with aortopathy. If only patients with raphe have been considered, there were no significant differences in prevalence of aortopathy according to the presence or absence of aortic stenosis [34 (100) vs 36 (92.30%) P = 0.09]. Conclusions: BAV patients with raphe have increased risk for aortopathy especially for Type B regardless the presence of valve dysfunction. Table 1 With Raphe (73) Without raphe (32) p-value Age, mean (SD), y 52.56 (18.06) 40.57 (21.28) 0.00 Male sex 52 (71.23) 24 (75) 0.69 Aortic Sinus indexed (mm/m2) 20.36 (3.21) 18.81 (4.49) 0.04 Ascending Aorta indexed (mm/m2) 23.25 (4.88) 21.69 (3.86) 0.11 Severe Aortic Stenosis 21 (30.88) 3 (10.34) 0.03 Severe Aortic Regurgitation 6 (9.83) 2 (7.69) 0.75 Aortopathy 70 (95.89) 27 (84.37) 0.04 Aortopathy Type A 31 (42.46) 15 (46.87) 0.67 Aortopathy Type B 38 (52.05) 10 (31.25) 0.04 Aortopathy Type C 1 (1.36) 2 (6.25) 0.16 With Raphe (73) Without raphe (32) p-value Age, mean (SD), y 52.56 (18.06) 40.57 (21.28) 0.00 Male sex 52 (71.23) 24 (75) 0.69 Aortic Sinus indexed (mm/m2) 20.36 (3.21) 18.81 (4.49) 0.04 Ascending Aorta indexed (mm/m2) 23.25 (4.88) 21.69 (3.86) 0.11 Severe Aortic Stenosis 21 (30.88) 3 (10.34) 0.03 Severe Aortic Regurgitation 6 (9.83) 2 (7.69) 0.75 Aortopathy 70 (95.89) 27 (84.37) 0.04 Aortopathy Type A 31 (42.46) 15 (46.87) 0.67 Aortopathy Type B 38 (52.05) 10 (31.25) 0.04 Aortopathy Type C 1 (1.36) 2 (6.25) 0.16 View Large Table 1 With Raphe (73) Without raphe (32) p-value Age, mean (SD), y 52.56 (18.06) 40.57 (21.28) 0.00 Male sex 52 (71.23) 24 (75) 0.69 Aortic Sinus indexed (mm/m2) 20.36 (3.21) 18.81 (4.49) 0.04 Ascending Aorta indexed (mm/m2) 23.25 (4.88) 21.69 (3.86) 0.11 Severe Aortic Stenosis 21 (30.88) 3 (10.34) 0.03 Severe Aortic Regurgitation 6 (9.83) 2 (7.69) 0.75 Aortopathy 70 (95.89) 27 (84.37) 0.04 Aortopathy Type A 31 (42.46) 15 (46.87) 0.67 Aortopathy Type B 38 (52.05) 10 (31.25) 0.04 Aortopathy Type C 1 (1.36) 2 (6.25) 0.16 With Raphe (73) Without raphe (32) p-value Age, mean (SD), y 52.56 (18.06) 40.57 (21.28) 0.00 Male sex 52 (71.23) 24 (75) 0.69 Aortic Sinus indexed (mm/m2) 20.36 (3.21) 18.81 (4.49) 0.04 Ascending Aorta indexed (mm/m2) 23.25 (4.88) 21.69 (3.86) 0.11 Severe Aortic Stenosis 21 (30.88) 3 (10.34) 0.03 Severe Aortic Regurgitation 6 (9.83) 2 (7.69) 0.75 Aortopathy 70 (95.89) 27 (84.37) 0.04 Aortopathy Type A 31 (42.46) 15 (46.87) 0.67 Aortopathy Type B 38 (52.05) 10 (31.25) 0.04 Aortopathy Type C 1 (1.36) 2 (6.25) 0.16 View Large P1480 New cases of aortic insufficiency after coronary angiography DS Lira DS Lira UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil DR Tiezzi DR Tiezzi UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil TMS Terra TMS Terra UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil C Machado C Machado UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil S Zurba S Zurba UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil G De Rossi G De Rossi UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil W Nadruz Jr W Nadruz Jr UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil J R M Souza J R M Souza UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil Introduction: Coronary angiography is a common examination in the scenario of suspected coronary artery disease. Handling the catheter is very close to the heart valves. The examination may lead to some degree of valve injury and onset of reflux. We investigated the appearance of aortic insufficiency in patients undergoing coronary angiography. Methods: We analyzed the echocardiography database with 12 544 records and 1248 patientes, fulfilled the criterion of serial echocardiograms in the maximum interval of 24 months and minimum of 6 months. 746 patientes without angiography and 502 cases of patients undergoing coronary angiography who underwent echocardiography at least 12 months before and no later than 12 months after coronary angiography. 27 new diagnoses of aortic regurgitation were added to patients with normal echocardiography before coronary angiography. Compared to only 6 cases of new diagnoses in non-coronary angiography patients who underwent two echocardiograms in the twenty-four months interval.(p < 0,001) Conclusion: The manipulation of the coronary catheter near the aortic semilunar valves may be associated with trauma and subsequent mild dysfunction. This initial finding may guide future studies and measures to reduce the risk of valvular lesions in the procedure P1481 Detailed point-of-care echocardiographic screening for left-sided valve heart disease using a hand-held scanner: Results from an elderly cohort recruited in primary practice C Williams C Williams West Wales General Hospital, Carmarthen, United Kingdom A Mateescu A Mateescu University of Medicine and Pharmacy Carol Davila, Cardiology, Bucharest, Romania E Rees E Rees Swansea University, Swansea, United Kingdom K Truman K Truman Regional Cardiac Centre Morriston Hospital, Swansea, United Kingdom C Elliott C Elliott Regional Cardiac Centre Morriston Hospital, Swansea, United Kingdom B Bahlay B Bahlay Regional Cardiac Centre Morriston Hospital, Swansea, United Kingdom A Wallis A Wallis Regional Cardiac Centre Morriston Hospital, Swansea, United Kingdom A Ionescu A Ionescu Regional Cardiac Centre Morriston Hospital, Swansea, United Kingdom West Wales General Hospital, Carmarthen, United Kingdom University of Medicine and Pharmacy Carol Davila, Cardiology, Bucharest, Romania Swansea University, Swansea, United Kingdom Regional Cardiac Centre Morriston Hospital, Swansea, United Kingdom Funding Acknowledgements: Unrestricted grant from Edwards Lifesciences Background. Valvular heart disease (VHD) is increasing in prevalence as the population ages, but data about the epidemiology of VHD in the elderly is relatively scarce. Hand-held ultrasound devices (HUD) allow point of care ultrasound scanning (POCUS) for VHD and other pathologies, but their use in an elderly population has not been reported so far in primary practice. Aims. To identify the prevalence of left-sided VHD using HUD in a cohort of non-cardiac patients over 70 years of age attending a large primary care centre, to estimate costs of V-scanning in a primary care setting and the cost of additional hospital scans generated by POCUS findings. Methods. We included 100 consecutive subjects aged >70y attending a primary care medical centre without a VHD diagnosis, documented their cardiac risk factors and performed POCUS by an accredited sonographer with a contemporary HUD (Vscan). We referred patients in whom V-scanning identified valve pathology for TTE in the local cardiac centre, to confirm or refute POCUS findings. We documented costs of buying the Vscan, paying for POCUS, additional hospital TTEs and for transport. Results. Mean age (SD) was 79.08 (3.74) years, range 72-92 years; 61F. By Vscan, we found 5 patients with > moderate aortic stenosis (AS), 8 with > moderate mitral regurgitation (MR)and none with > mild aortic regurgitation. In the AS and MR groups each, 1 patient had valve intervention following from the initial diagnosis by Vscan, 2 and 1 respectively are under follow-up in the valve clinic, while 2 and 4 respectively refused TTE or follow-up. Two patients in the moderate MR group by Vscan had mild and mild/moderate MR respectively by TTE and were discharged. Total cost for scanning 100 patients was £12,780 (EU 14,734; $18,201 - i.e. £128/patient – EU 148; $182) if we consider only the physiologist fees for the extra formal TTEs in hospital, or £12,300 + £2,600 = £14,900 (EU17,186; $ 21,221 – i.e. £149/patient; EU 172, $212) if we include the total charge levied by the hospital for the extra TTEs.Conclusions. Screening with a hand-held scanner (Vscan) we identified 5/100 elderlysubjects who needed valve replacement or follow-up in valve clinic, at a cost of . P1482 Dilated left atrium and significant tricuspid regurgitation as predictors of postoperative atrial fibrillation after isolated surgical aortic valve replacement AC Iliescu AC Iliescu Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu" , Iasi, Romania M Floria M Floria University of Medicine and Pharmacy "Gr. T. Popa", Sf Spiridon University Hospital , Iasi, Romania DL Salaru DL Salaru University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania I Achitei I Achitei Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu" , Iasi, Romania M Grecu M Grecu Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu" , Iasi, Romania GR Tinica GR Tinica University of Medicine and Pharmacy "Gr. T. Popa", Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu", Iasi, Romania Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu" , Iasi, Romania University of Medicine and Pharmacy "Gr. T. Popa", Sf Spiridon University Hospital , Iasi, Romania University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania University of Medicine and Pharmacy "Gr. T. Popa", Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu", Iasi, Romania Objective: Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery, with increased risk of stroke and higher mortality. Our aim was to identify the predictors of POAF in patients undergoing isolated surgical aortic valve replacement. Methods: In this single center study, we evaluated 1191 patients requiring isolated surgical aortic valve replacement (SAVR) between January 2000 and June 2014. The patients were followed during the early postoperative period, until their discharge. Results: Atrial fibrillation (AF) occurred in 342 patients (28.71%). Six variables associated with higher arrhythmic risk (advanced age, body mass index, tricuspid regurgitation, prolonged ventilation, longer staying in the intensive care units and dilated left atrium (≥35 ml/m2)) were selected to form a multivariate prediction model that predicts POAF in 64.7% cases. This prediction model had a moderate discriminative power (AUC = 0.65). We also developed a CHAID model showing multilevel interactions among risk factors for POAF, age being the variable with the greatest discriminative power, patients older than 68 years being at higher risk. In patients with low-risk, the subgroup with dilated left atrium (volume ≥40 ml) has more chances to develop POAF. For intermediate risk group, the history of AF is the next in decision tree. In the high-risk group, the tricuspid regurgitation at least moderate was the next predictive variable. Conclusion: The multivariate logistic model has an acceptable predictive value. Dilated left atrium and significant tricuspid regurgitation are predictors of postoperative atrial fibrillation after isolated surgical aortic valve replacement. P1483 Pulmonary hypertension in severe aortic stenosis: is valvular intervention too late? M Saraiva M Saraiva Hospital of Santarem, Cardiology, Santarem, Portugal MJ Vieira MJ Vieira Hospital of Santarem, Cardiology, Santarem, Portugal N Craveiro N Craveiro Hospital of Santarem, Cardiology, Santarem, Portugal K Domingues K Domingues Hospital of Santarem, Cardiology, Santarem, Portugal L Marta L Marta Hospital of Santarem, Cardiology, Santarem, Portugal ML Pitta ML Pitta Hospital of Santarem, Cardiology, Santarem, Portugal M Leal M Leal Hospital of Santarem, Cardiology, Santarem, Portugal Hospital of Santarem, Cardiology, Santarem, Portugal Introduction: Severe aortic stenosis (SAS) encloses an adverse prognosis when a conservative approach is chosen. Main indications for valve intervention (VI) (either percutaneous or surgical) include the presence of symptoms or a reduction in left ventricular ejection fraction (LVEF). However, even after VI, some patients (pts) are left with the burden of heart failure (HF), without major improvement of prognosis: probably, these pts are left with a relevant extent of "cardiac damage". Pts with pulmonary hypertension (PH) usually have a worse prognosis, putting the benefits of VI into question in this population. Purpose: evaluate the prognosis of pts with SAS and PH and the potential benefits of VI. Methods: retrospective study of a population with severe aortic stenosis, divided in 2 groups: group A - under conservative treatment (either due to patient refusal of VI, Heart Team refusal for VI or asymptomatic and normal LVEF); group B - underwent VI. Primary endpoint was: hospital admission for cardiovascular causes or death during 12 months follow-up (group A) or during 12 months follow-up after VI (group B). Statistical analysis of clinical and echocardiographic data was made. Results: we included 72 patients, mean age 79.09 ± 6.35 years, 58.3% were female. The majority had history of hypertension (80.6%), and less than half had type 2 diabetes mellitus and coronary artery disease (43.1% and 26.4% respectively). Most of them (81.7%) were symptomatic, most frequently presenting with HF (76.4%). Less than a quarter (23.6%) had LVEF < 50%; 34.7% had evidence of PH and 23.6% of right ventricular dysfunction. About half of the pts (52.8%) underwent VI, mainly surgical valve replacement (76.31%). Pts undergoing VI were younger (group A 79.57 ± 7.32 vs group B 78.25 ± 5.06 years, p = 0.006) and had higher creatinine clearance (group A 46.86 ± 17.69 vs group B 57 ± 30.33 mL/min, p = 0.018). About one third of the pts reached the endpoint (26.4%), mostly pts with systemic hypertension (p = 0.007), PH (p = 0.044) and pts from group A (p = 0.001). Considering only the pts with PH, patients from group A were more likely to reach the endpoint, with a statistically significant difference (OR = 8.18 [95% CI 1.28-52.42], p = 0.001). Conclusion: VI is essential to improve the adverse prognosis of pts with SAS. Despite their worse prognosis, pts with PH still benefit from VI, with a relevant improvement in survival and quality of life. P1484 Prognostic role of secondary mitral regurgitation in patients with aortic valve stenosis under medical management G Benfari G Benfari University Hospital, Section of Cardiology, Department of Medicine , Verona, Italy C Maffeis C Maffeis University Hospital, Section of Cardiology, Department of Medicine , Verona, Italy G Vinco G Vinco University Hospital, Section of Cardiology, Department of Medicine , Verona, Italy F Onorati F Onorati University Hospital, Division of Cardiovascular Surgery, Verona, Italy RM Inciardi RM Inciardi University Hospital, Section of Cardiology, Department of Medicine , Verona, Italy S Nistri S Nistri CMSR Veneto Medica, Altavilla Vicentina, Italy FL Ribichini FL Ribichini University Hospital, Section of Cardiology, Department of Medicine , Verona, Italy A Rossi A Rossi University Hospital, Section of Cardiology, Department of Medicine , Verona, Italy University Hospital, Section of Cardiology, Department of Medicine , Verona, Italy University Hospital, Division of Cardiovascular Surgery, Verona, Italy CMSR Veneto Medica, Altavilla Vicentina, Italy Background: Secondary Mitral Regurgitation (sMR) (i.e., without typical lesions of the mitral valve apparatus commonly observed in organic MR) is frequently associated with significant aortic valve stenosis (AS). However, its clinical relevance is generally overlooked since the amount of regurgitation is usually modest. We hypothesize that sMR is associated with heart failure development during the medical follow up of patients with significant AS. Methods: The study population included patients with AS referred to the echocardiographic laboratory of Verona. Exclusion criteria were: left ventricular ejection fraction <50%; organic mitral valve disease or mitral valve prosthesis. Cardiovascular (CV) events included hospitalization for heart failure and CV death; aortic valve surgery/transcatheter valve intervention (TAVI) was considered a censoring event. Results: Patients included were 68 (age 77 ± 8 years, 59% female). AS was moderate in 19 (28%) patients and severe in 49 (72%) patients (mean gradient 38 ± 12 mmHg, aortic valve area [AVA] 0.92 ± 0.32 cm2). Overall, 42 patients (62%) had concomitant sMR (ERO 9.8 ± 6.8 mm2). Patients with sMR were significantly older (80 ± 6 vs 74 ± 10, p = 0.004), were predominantly female (71 vs 39%, p = 0.01), had lower forward stroke volume (72 ± 19 vs 81 ± 17 mL, p = 0.04), higher E/e’ (13 ± 5 vs 10 ± 4, p = 0.01), larger left atrial volume (51 ± 19 vs 36 ± 11mL/m2, p = 0.002) and smaller AVA (0.85 ± 0.36 vs 1.04 ± 0.20 cm2, p = 0.02). Five cases of heart failure and 6 cases of death were identified during a mean follow up time of 1.22 ± 1.28 years (Figure 1 ); 43 (63%) patients underwent aortic valve surgery or TAVI. Among the CV events, 91% (10/11) occurred in sMR patients (mean ERO 13.2 ± 8.6 mm2). The HR for CV events for ERO 0.05 cm2 increase was 1.45 (95%CI 1.08-1.91), p = 0.02. ERO prognostic role was maintained after adjusting for AVA, (HR for 0.05 cm2 increase:1.47 [95%CI 1.07-1.98], p = 0.02) and presented a clear trend after adjustment for age (HR for 0.05 cm2 [95%CI 0.96-2.17], p = 0.07). Conclusion: In this pilot study, the presence of sMR associated to moderate-severe AS predicts CV events during the medical follow up. MR quantitative assessment through ERO may identify the patients who need to be followed up closely. View largeDownload slide Abstract P1484 Figure 1. CV events during follow up View largeDownload slide Abstract P1484 Figure 1. CV events during follow up P1485 A research of influential factors upon phase changes of aortic valve annulus cross sectional area and ring morphology within cardiac cycle H Komatsu H Komatsu Sapporo City General Hospital, Cardiovascular medicine, Sapporo, Japan D Murai D Murai Sapporo City General Hospital, Cardiovascular medicine, Sapporo, Japan D Tatsuta D Tatsuta Sapporo City General Hospital, Cardiovascular medicine, Sapporo, Japan T Sato T Sato Sapporo City General Hospital, Cardiovascular medicine, Sapporo, Japan R Suzuki R Suzuki Sapporo City General Hospital, Cardiovascular medicine, Sapporo, Japan M Toba M Toba Sapporo City General Hospital, Cardiovascular medicine, Sapporo, Japan K Asakawa K Asakawa Sapporo City General Hospital, Cardiovascular medicine, Sapporo, Japan Y Dannnoura Y Dannnoura Sapporo City General Hospital, Cardiovascular medicine, Sapporo, Japan T Makino T Makino Sapporo City General Hospital, Cardiovascular medicine, Sapporo, Japan T Kouya T Kouya Sapporo City General Hospital, Cardiovascular medicine, Sapporo, Japan Sapporo City General Hospital, Cardiovascular medicine, Sapporo, Japan Background: The aorta-ventricular junction (AVJ) annulus has elliptical shape and Its sectional area (AVJA) is proportional to the physique and varies with the cardiac cycle. However, it is still not clear whether the AVJA and elliptical form of AVJ and their cycle fluctuation are affected by the hemodynamics of the aortic valve and mitral valve. Methods: Among consecutive cases who underwent three dimensional (3D) trans-esophageal echocardiography at our institution from April 2016 to October 2017 and acquired 3D images of native aortic valve using EPIQ7c and X7-2t probe, a total of 58 cases divided into three groups as patients with normal aortic valve function (FN) without moderate or higher mitral regurgitation (MR) (FN&MR(-) group, n = 31), FN and moderate or higher MR cases (FN&MR(+) group, n = 16) and moderate or higher aortic regurgitation (AR) without moderate or higher MR cases (AR group, n = 11). Using 3D analysis software, the AVJ annulus connecting the bottom of each leaflet is identified and measured AVJA and short and long diameters in 4 cardiac phase (end diastole (ED), middle systole (MS), end systole (ES) and mid diastole (MD)). AVJA corrected by body surface area (AVJAI) and oblateness ratio of AVJ (AVJobl) were calculated [AVJobl = 1- (short diameter / long diameter)]. Clinical characteristics, AVJAI and AVJobl of 3 groups were statistically compared using Fisher"s exact test ,one-way analysis of variance (ANOVA) and repeated measure ANOVA. Results: Except for left ventricular end diastolic diameter, there were no significant differences between 3 groups in the clinical background. AVJAI of AR group was significantly greater than FN&MR(-) and FN&MR(+) group in either 4 cardiac phase (e.g. AVJAI in MS: FN&MR(-) vs FN&MR(+) vs AR 264 ± 50 vs 263 ± 39 vs 337 ± 58 mm2/m2, p < 0.001 by ANOVA). In repeated measure ANOVA, AVJAI showed a significant difference between 3 groups, but no difference was observed in the 4 cardiac phase (intergroup p < 0.001, time phase p = 0.051). On the other hand, AVJobl observed a common temporal change which was smallest in MS and largest in MD in repeated measure ANOVA, and showed a statistically significant difference between 3 groups and 4 cardiac phase (intergroup p < 0.01, time phase p <0.0001). In one-way ANOVA, the AVJobl of FN&MR(+) was larger than that of AR in ES and those of others in MD (AVJobl FN&MR(-) vs FN&MR(+) vs AR ES: 0.23 ± 0.09 vs 0.28 ± 0.08 vs 0.18 ± 0.09 p <0.05, MD: 0.25 ± 0.09 vs 0.31 ± 0.05 vs 0.22 ± 0.06 p < 0.01). Conclusion: AVJA is significantly larger in the AR case than in case with normal aortic valve function. Regardless of valve function, the elliptical form of AVJ has a common cardiac cycle change. The elliptical form of the AVJ annulus at the end systole and mid-diastole is influenced by MR independently of the cross-sectional area. Morphology and its phase change of the aortic annulus may be influenced by mitral valve function together with physique and aortic valve function. View largeDownload slide Abstract P1485 Figure. View largeDownload slide Abstract P1485 Figure. P1486 Influence of successful reduction of mitral regurgitation on left ventricular function after interventional edge-to-edge repair of functional mitral regurgitation MDW Von Roeder MDW Von Roeder University of Leipzig, Heart Center, Department of Internal Medicine and Cardiology, Leipzig, Germany S Blazek S Blazek University of Leipzig, Heart Center, Department of Internal Medicine and Cardiology, Leipzig, Germany KP Rommel KP Rommel University of Leipzig, Heart Center, Department of Internal Medicine and Cardiology, Leipzig, Germany C Besler C Besler University of Leipzig, Heart Center, Department of Internal Medicine and Cardiology, Leipzig, Germany K Fengler K Fengler University of Leipzig, Heart Center, Department of Internal Medicine and Cardiology, Leipzig, Germany J Seeburger J Seeburger University of Leipzig, Heart Center, Department of Cardiac Surgery, Leipzig, Germany T Noack T Noack University of Leipzig, Heart Center, Department of Cardiac Surgery, Leipzig, Germany H Thiele H Thiele University of Leipzig, Heart Center, Department of Internal Medicine and Cardiology, Leipzig, Germany P Lurz P Lurz University of Leipzig, Heart Center, Department of Internal Medicine and Cardiology, Leipzig, Germany University of Leipzig, Heart Center, Department of Internal Medicine and Cardiology, Leipzig, Germany University of Leipzig, Heart Center, Department of Cardiac Surgery, Leipzig, Germany Background: The evidence regarding the influence of interventional edge-to-edge repair (Mitraclip®-Implantation, MC) of functional mitral regurgitation (MR) on left ventricular (LV) function is conflicting and some studies show an improvement of LV function while others do not, but previous studies did not report results according to MR reduction. The degree of MR reduction could be of influence by alleviating chronic volume overload. Aim of the current study was to investigate acute and chronic changes of LV structure and function according to MR reduction following MC. Methods: We performed 2-D echocardiography, Doppler echocardiography and 2-D LV strain analysis in 25 patients with severe functional MR before and after (mean 3.6 ± 2.3 days) MC and at follow up (FU, mean 172 ± 70 days). Patients were grouped as having strong MR reduction (MR-, MR ≤1, n = 14) on FU or as having less MR reduction (MR+, MR > 1, n = 11). Repeated measures ANOVA was used to reveal changes between pre- and postinterventional parameters and parameters on FU. Results: Baseline characteristics were well balanced between both groups (mean age 74 ± 8 years, 40% female, 52% ischemic cardiomyopathy, 72% atrial fibrillation) as well as echocardiographic parameters (mean LV-EF 38 ± 3%, LV end diastolic volume (EDV) 116 ± 39 ml/m², global longitudinal strain (GLS) -9.1 ± 4.9%, left atrial end-systolic volume index (LAESVI) 65 ± 21 ml/m²). Two clips were implanted in 43% of MR- patients and 18% of MR+ patients (p = 0.23). No changes in LVEDV were observed in MR+ patients (pre 106 ± 33, post 107 ± 28, FU 111 ± 24ml/m², p = 0.77) while MR- patients showed a lower LVEDV on FU (pre 123 ± 43, post 119 ± 46, FU 111 ± 46ml/m², p = 0.01 pre vs FU). LVEF and GLS dropped postinterventional in MR-, but recovered to previous level on FU (LVEF pre 40 ± 15, post 31 ± 12, FU 38 ± 13%, p = 0.001 pre vs post and post vs FU; GLS pre -9.1 ± 5.6, post -7.3 ± 5.1, FU -10.0 ± 5.4, p = 0.001 pre vs post and post vs FU). In MR+ patients LVEF remained unchanged postinterventional but showed a significant drop on FU as compared to preinterventional (pre 37 ± 11, post 36 ± 10, FU 32 ± 7%, p = 0.02 pre vs FU) and GLS dropped immediately postinterventional with further deterioration on FU (pre -9.1 ± 4.1, post -8.1 ± 3.7, FU -7.9 ± 2.7, p = 0.04 pre vs FU). No correlation between the number of implanted clips and changes in GLS or LVEF could be found (p = n.s.). Conclusion: In patients with functional MR and moderately to severely depressed LV function treated with percutaneous mitral valve repair, MR reduction to grade ≤1 leads to acute dropping in LV function -most likely due to preload reduction- with recuperation on follow up while patients without significant MR reduction experience further decline in LV function on follow up. View largeDownload slide Abstract P1486 Figure. LV longitudinal strain according to MR View largeDownload slide Abstract P1486 Figure. LV longitudinal strain according to MR P1488 LV stroke volume measurement using 2D and 3D contrast echocardiography: comparison with Doppler measurements M Choy M Choy Mazankowski Alberta Heart Institute, Edmonton, Canada A Durand A Durand Mazankowski Alberta Heart Institute, Edmonton, Canada V Sarban V Sarban Mazankowski Alberta Heart Institute, Edmonton, Canada H Kalashyan H Kalashyan Mazankowski Alberta Heart Institute, Edmonton, Canada E Mirhadi E Mirhadi Mazankowski Alberta Heart Institute, Edmonton, Canada J Choy J Choy Mazankowski Alberta Heart Institute, Edmonton, Canada H Becher H Becher Mazankowski Alberta Heart Institute, Edmonton, Canada Mazankowski Alberta Heart Institute, Edmonton, Canada Funding Acknowledgements: Heart & Stroke Foundation of Alberta, Northwest Territories and Nunavut Background: Contrast echocardiography (CE) has been shown to improve the reproducibility and accuracy of left ventricular (LV) volume and ejection fraction (EF) measurements compared to non-contrast echocardiography. The difference between end diastolic and end systolic volume is stroke volume (SV) which is a relevant parameter for assessment of valvular disease. In most echocardiographic laboratories SV is assessed by pulsed wave Doppler (PW) echocardiography and 2D echocardiography measuring the diameter of the LV outflow tract (LVOT). There have been no studies comparing the SV measurements using Doppler echocardiography with SV assessed by CE. When SV measured with CE and SV measured by Doppler are not different in patients without mitral and/or aortic valvular disease, there will be an opportunity for more accurate measurements of regurgitant fraction in patients with mitral regurgitation. Objectives: To compare indexed SV measured with 2D CE, 3D CE and an automated 3D non-contrast method with indexed SV measured by PW Doppler echocardiography. Methods: 51 patients referred for CE for the monitoring of cardiotoxic effects of chemotherapy were included. Inclusion criteria were adequate contrast 2D and 3D recordings. All echocardiograms and contrast injections were performed mainly by three experienced sonographers. Non-contrast 3D echocardiography was performed using a fully automated method. Perflutren injectable suspension (0.5 mL) was diluted into a 10 mL solution with saline. Bolus injections of the diluted solution (0.5 mL) were administered using a low mechanical index (MI ≈ 0.10 – 0.18) contrast specific imaging modality in order to provide optimal LV delineation. In all patients a minimum of two 2 beat loops of the apical four, two and three chamber views were acquired in all patients as well as 3D datasets. PW Doppler measurements of the flow in the LVOT and measurements of the LVOT diameter were performed according American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) guidelines. Results: There were no statistically significant differences between indexed SV measured by PW Doppler 44 ± 10 mL/m2 (mean, SD) and 2D CE (Simpson’s biplane method) 41 ± 8 mL/m2, F= 1.12, p = 0.48; 3D CE 29 ± 6 mL/m2; F = 0.75, p = 0.12 and automated non-contrast 3D echocardiography 37 ± 10 mL/m2 , F= 2.36, p = 0.74. The smallest variance (F) was between PW Doppler and 2D CE. The best agreement was found between the SV measured by 2D CE and Doppler echocardiography (Figure 1). Conclusions: 2D CE provides comparable measurements of the LV SV in the majority of patients. The underestimation of the SV by 3D CE using bolus injections of contrast is probably due to technical limitations such as apical destruction of contrast and basal attenuation. View largeDownload slide Abstract P1488 Figure 1 View largeDownload slide Abstract P1488 Figure 1 P1489 Intraventricular flow patterns after percutaneous mitral valve repair with MitraClip implantation in patients with functional MR D Filomena D Filomena Umberto I Polyclinic of Rome, Rome, Italy S Cimino S Cimino Umberto I Polyclinic of Rome, Rome, Italy V Maestrini V Maestrini Umberto I Polyclinic of Rome, Rome, Italy D Cantisani D Cantisani Umberto I Polyclinic of Rome, Rome, Italy V Petronilli V Petronilli Umberto I Polyclinic of Rome, Rome, Italy M Sannino M Sannino Umberto I Polyclinic of Rome, Rome, Italy G La Vecchia G La Vecchia Umberto I Polyclinic of Rome, Rome, Italy M Mancone M Mancone Umberto I Polyclinic of Rome, Rome, Italy G Sardella G Sardella Umberto I Polyclinic of Rome, Rome, Italy C Iacoboni C Iacoboni Umberto I Polyclinic of Rome, Rome, Italy L Agati L Agati Umberto I Polyclinic of Rome, Rome, Italy Umberto I Polyclinic of Rome, Rome, Italy Background: Percutaneous Mitral Valve (MV) repair using MitraClip implantation has become a useful tool for patients with moderate-to-severe and severe mitral regurgitation (MR) and high surgical risk. It is already known that vortex reversal flow occurring after MV replacement with mechanical prosthesis is related with an increase in energy dissipation (ED) and with left ventricular remodelling (LVR). After MV repair (both surgical and percutaneous), vortex reversal flow is not detected and the usefulness of flow assessment in predicting LVR is debated. Purpose: Aim of the present study was to study intraventricular fluid-dynamics in patients with significant functional MR undergoing Mitraclip implantation and to find if there are differences in cardiac vortices considering different etiologies. Methods: From May 2015 to December 2017, 23 consecutive patients with severe functional MR undergoing MitraClip implantation were enrolled. All pts underwent contrast echocardiography before and after the procedure (2 ± 1 days) for Echo-PIV analysis and vortex quantification. The following parameters were evaluated by 2D/3D transthoracic echocardiography (TTE): etiology of MR (ischemic and non- ischemic), MV anatomic characteristics, tricuspid regurgitation (TR), pulmonary artery systolic pressure (PASP), LV volumes and function. The following parameters were evaluated by Echo-PIV analysis: vortex area, intensity and geometry, ED, and flow force momentum angle (φ°). Acute procedural success (APS) was defined as successful clip implantation with residual MR grade ≤2+. All patients underwent TTE after 6-month for LV dimension and function assessment. Reverse LVR (rLVR) was defined as a reduction >10% in end systolic volume (ESV) at follow-up. Results: The study population was divided in two groups according to MR etiology (ischemic 60%, non- ischemic 40%). No differences in baseline TTE and flow analysis were found. Both APS and rLVR rate at follow-up were similar in the two groups. By comparing vortex data before and after the procedure, in all patients, vortex area and intensity decreased after the procedure (0.33 ± 0.13 vs 0.31 ± 0.11; p = 0.003 and -0.46 ± 0.16 vs-0.29 ± 0.27; p = 0.013) while significant increment in both ED (0.5 ± 0.2 vs 0.9 ± 0.5; p = 0.016) and φ° (35 ± 7 vs 41 ± 8; p = 0.027) was detected. Sub-group analysis showed that ischemic patients were more likely to have a significant vortex area reduction, (0.39 ± 0.04 vs 0.31 ± 0.11; p = 0.018) and significant φ° increase (43 ± 7 vs 47 ± 4; p = 0.027). No significant changes in those parameters were observed in non-ischemic group, in which a trend towards a reduction in LV end diastolic volume (EDV), assessed at FU, was detected. Conclusion: The results of this study showed significant changes in intraventricular flow patterns following MitraClip implantation in patients with functional MR, with different characteristics between etiologies. View largeDownload slide Abstract P1489 Figure. Ischemic functional MR: flow forces View largeDownload slide Abstract P1489 Figure. Ischemic functional MR: flow forces P1490 Bolus technique for ultrasound enhancing agents without saline flush M Choy M Choy Mazankowski Alberta Heart Institute, Edmonton, Canada E Mirhadi E Mirhadi Mazankowski Alberta Heart Institute, Edmonton, Canada J Choy J Choy Mazankowski Alberta Heart Institute, Edmonton, Canada H Becher H Becher Mazankowski Alberta Heart Institute, Edmonton, Canada Mazankowski Alberta Heart Institute, Edmonton, Canada Funding Acknowledgements: Heart & Stroke Foundation of Alberta, Northwest Territories and Nunavut Background: The recommended method of administration of contrast agents is via infusion or bolus administration followed by a saline flush. The injection of a saline flush after every bolus injection of the contrast agent appears to be unnecessary when the contrast agent has been diluted. When only bolus injections of diluted contrast agents are performed, a ‘closed’ injection system can be used which simplifies the administration of contrast agents and allows a sonographer to more easily perform the injection and scan at the same time. The objective is to present the experience of a high volume centre with respect to this approach. Methods: Consecutive patients referred for contrast echocardiography for the monitoring of cardiotoxic effects of chemotherapy were included. The left ventricle ejection fraction was measured using the Simpson’s biplane method. All echocardiograms and contrast injections were performed by one experienced sonographer. A closed system was used (Figure 1) consisting of: (1) 24 or 22 gauge intravenous catheter (2) 18 cm small bore extension set (approximately 0.24 mL) with a microclave, clamp and rotating luer (3) 10 mL syringe of 5% solution of perflutren injectable suspension (0.5 mL perflutren injectable suspension in 9.5 mL saline). This represents a closed system which allows multiple 0.5 mL or less bolus injections of diluted perflutren injectable suspension. On completion of echocardiogram, the system is removed from the patient without flushing. This technique is mainly used for outpatients but can also be used for inpatients. In the case of inpatients, the intravenous (IV) line is only flushed when all echocardiographic recordings are completed to remove contrast from the IV line prior to the patient returning to the unit. Results: Between 2016 and 2018, 698 patients received contrast during their echocardiograms. Volumes of 5% solution of perflutren injectable suspension used were as follows: 2 mL used in 237 patients (34%), 4 mL used in 321 (46%), 6 mL used in 105 (15 %), 8 mL used in 21 (3%) and 10 mL used in 14 (2%). With the exception of one patient, all echocardiograms were completed with one 10 mL syringe of 5% solution of perflutren injectable suspension. All echocardiograms were deemed diagnostic for quantitative assessment by the sonographer. No additional injections were requested by the reading cardiologist. Only one patient experienced minor back pain. Contrast administration was stopped immediately and the pain resolved within 10 minutes without treatment. Conclusion: The closed system for bolus administration of contrast agents without a saline flush has been shown to be effective in a high volume echocardiographic centre. It facilitates sonographer administered contrast agents without compromising quality. View largeDownload slide Abstract P1490 Figure 1 View largeDownload slide Abstract P1490 Figure 1 P1491 Contrast echocardiography and global longitudinal strain as markers of coronary and myocardial reserve in patients with coronary artery disease D Mrikaev D Mrikaev Bakoulev Center for Cardiovascular Surgery RAMS, Noninvasive Arrhythmology, Moscow, Russian Federation EZ Golukhova EZ Golukhova Bakoulev Center for Cardiovascular Surgery RAMS, Noninvasive Arrhythmology, Moscow, Russian Federation TV Mashina TV Mashina Bakoulev Center for Cardiovascular Surgery RAMS, Noninvasive Arrhythmology, Moscow, Russian Federation VS Dzhanketova VS Dzhanketova Bakoulev Center for Cardiovascular Surgery RAMS, Noninvasive Arrhythmology, Moscow, Russian Federation Bakoulev Center for Cardiovascular Surgery RAMS, Noninvasive Arrhythmology, Moscow, Russian Federation Background: Assessment of left ventricle (LV) systolic function in patients with coronary artery disease (CAD) has a great importance in the choice of treatment strategy. Modern ultrasound technology – 2-Dimensional Speckle Tracking (2-D ST) with the calculation of Global Longitudinal Strain (GLS) and contrast-enhanced echocardiography (Echo) are highly informative tools in assessing the myocardial and coronary reserve in these patients. Purpose: Evaluation of LV systolic function using GLS and myocardial perfusion by the contrast-enhanced Echo. Methods. The study included 27 patients with ischemic cardiomyopathy (ICMP) (mean age was 63 ± 6 years) and a control group of 23 healthy subjects (mean age was 58 ± 7 years). Exclusion criteria: patients with organic valvular heart disease and after open heart surgery. According to coronarography all patients had multivessel lesions. Patients underwent a standard two-dimensional echocardiographic study with determination of the LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV) and LV ejection fraction (LVEF), also calculation of GLS in 2-D ST mode, contrast- enhanced Echo using contrast Sonovue (Bracco). The volumes and LVEF were assessed in the Low Mechanical Index mode. Perfusion was evaluated by a semi-quantitative method: absent contrast opacification - 0 points (absence of perfusion), heterogeneous contrast opacification - 1 point (hypoperfusion), homogenous contrast opacification - 2 points (normal perfusion). The scores for each segment are summed and then divided by the number of segments to yield a contrast perfusion index. Results. In the group of patients with ICMP mean LVEDV was 219 ml ± 108.4 ml (p = 0.02), LVESV - 122 ml ± 87.4 ml (p = 0.03), mean LVEF was 43.2% ± 11.5% (p = 0.02). In the control group LVEDV was 119 ml ± 25.4 ml (p = 0.04), LVESV – 42 ml ± 14.3 ml (p = 0.02), mean LVEF was 61.2% ± 8.5% (p = 0.03). The mean GLS in the ICMP group was -10.55%±4.7% (p = 0.04), in the control group -19.7%±7.4% (p = 0.02). The mean time of the mechanical dispersion (Time SD) in the ICMP group was 76.44 ms ± 33 ms (p = 0.04), in the control group - 33 ms ± 15 ms (p = 0.02). All subjects of the control group had normal perfusion (2 points). In the group with ICMP absence of perfusion was noted in 6 patients, hypoperfusion in 14 patients and normal perfusion in 7 patients. In those group we revealed a high correlation of the GLS and LVEDV (r = 0.78, p = 0.01), GLS and LV ESV (r = 0.78, p = 0.01), GLS and LVEF (r = -0.88, p = 0.03), GLS and Time SD (r = 0.53, p = 0.04). There was a high reliable correlation of GLS with myocardial perfusion (r = -0.8, p = 0.03). Conclusion. Choosing the tactics of treatment in patients with ICMP, the combined use of GLS and contrast Echo in myocardial perfusion mode for determining myocardial and coronary reserves may be useful. P1492 The effect of smoking on right atrial volume and phasic functions in healthy subjects B Ozben Sadic B Ozben Sadic Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey O Can Bostan O Can Bostan Marmara University, Pulmonary and Critical Care, Istanbul, Turkey T Bayram T Bayram Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey M Sunbul M Sunbul Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey A Cincin A Cincin Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey K Tigen K Tigen Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey N Sayar N Sayar Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey B Kanar B Kanar Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey H Ozdil H Ozdil Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey E Eryuksel E Eryuksel Marmara University, Pulmonary and Critical Care, Istanbul, Turkey Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey Marmara University, Pulmonary and Critical Care, Istanbul, Turkey Funding Acknowledgements: None Background and purpose: Smoking is a risk factor for cardiovascular diseases. The aim of this study was to evaluate the right atrial volume and phasic functions in apparently healthy smokers. Methods: Forty healthy smokers and 20 healthy nonsmokers were consecutively included in the study. None of the subjects had additional cardiovascular risk factor other than smoking. The right atrial and ventricular functions were assessed by speckle tracking echocardiography. Results: The echocardiographic parameters of the smokers and nonsmokers are listed in Table 1. The smokers had significantly larger right atrial volumes. The right atrial reservoir and conduit strain were lower in healthy smokers compared to those of nonsmokers although the difference was not significant. Right ventricular global longitudinal strain was significantly lower in smokers. Conclusion: Smoking impairs right atrial and ventricular functions even in apparently healthy young people with no other additional cardiovascular risk factors. Speckle tracking echocardiography is useful in detecting subclinical right atrial and ventricular dysfunction in healthy smokers. Table 1 Smokers (n= 40) Nonsmokers (n= 20) p Age (years) 34.4 ± 7.8 26.5 ± 3.4 <0.001 Male sex (n-%) 28 (70%) 9 (45%) 0.060 RAVmax (mL) 42.4 ± 17.0 28.7 ± 9.2 0.001 RAVmin (mL) 17.0 ± 9.1 10.8 ± 3.8 0.002 RAVpre-A (mL) 26.4 ± 12.2 17.2 ± 5.4 0.001 RA total stroke volume (mL) 25.4 ± 11.2 17.9 ± 7.1 0.010 RA total emptying fraction (%) 60.3 ± 12.6 61.2 ± 10.6 0.857 RA passive stroke volume (mL) 16.0 ± 8.1 11.5 ± 5.4 0.033 RA passive emptying fraction (%) 38.2 ± 11.9 38.9 ± 10.5 0.707 RA active stroke volume (mL) 9.4 ± 4.6 6.4 ± 2.6 0.007 RA active emptying fraction (%) 36.7 ± 12.5 37.1 ± 9.8 0.695 RA expansion index 183.1 ± 114.8 178.4 ± 85.5 0.857 RA reservoir function (%) 35.7 ± 10.2 40.8 ± 13.1 0.207 RA conduit function (%) 16.0 ± 6.1 19.4 ± 7.6 0.106 Right ventricular global longitudinal strain (%) - 18.5 ± 2.2 - 21.3 ± 1.5 <0.001 Smokers (n= 40) Nonsmokers (n= 20) p Age (years) 34.4 ± 7.8 26.5 ± 3.4 <0.001 Male sex (n-%) 28 (70%) 9 (45%) 0.060 RAVmax (mL) 42.4 ± 17.0 28.7 ± 9.2 0.001 RAVmin (mL) 17.0 ± 9.1 10.8 ± 3.8 0.002 RAVpre-A (mL) 26.4 ± 12.2 17.2 ± 5.4 0.001 RA total stroke volume (mL) 25.4 ± 11.2 17.9 ± 7.1 0.010 RA total emptying fraction (%) 60.3 ± 12.6 61.2 ± 10.6 0.857 RA passive stroke volume (mL) 16.0 ± 8.1 11.5 ± 5.4 0.033 RA passive emptying fraction (%) 38.2 ± 11.9 38.9 ± 10.5 0.707 RA active stroke volume (mL) 9.4 ± 4.6 6.4 ± 2.6 0.007 RA active emptying fraction (%) 36.7 ± 12.5 37.1 ± 9.8 0.695 RA expansion index 183.1 ± 114.8 178.4 ± 85.5 0.857 RA reservoir function (%) 35.7 ± 10.2 40.8 ± 13.1 0.207 RA conduit function (%) 16.0 ± 6.1 19.4 ± 7.6 0.106 Right ventricular global longitudinal strain (%) - 18.5 ± 2.2 - 21.3 ± 1.5 <0.001 View Large Table 1 Smokers (n= 40) Nonsmokers (n= 20) p Age (years) 34.4 ± 7.8 26.5 ± 3.4 <0.001 Male sex (n-%) 28 (70%) 9 (45%) 0.060 RAVmax (mL) 42.4 ± 17.0 28.7 ± 9.2 0.001 RAVmin (mL) 17.0 ± 9.1 10.8 ± 3.8 0.002 RAVpre-A (mL) 26.4 ± 12.2 17.2 ± 5.4 0.001 RA total stroke volume (mL) 25.4 ± 11.2 17.9 ± 7.1 0.010 RA total emptying fraction (%) 60.3 ± 12.6 61.2 ± 10.6 0.857 RA passive stroke volume (mL) 16.0 ± 8.1 11.5 ± 5.4 0.033 RA passive emptying fraction (%) 38.2 ± 11.9 38.9 ± 10.5 0.707 RA active stroke volume (mL) 9.4 ± 4.6 6.4 ± 2.6 0.007 RA active emptying fraction (%) 36.7 ± 12.5 37.1 ± 9.8 0.695 RA expansion index 183.1 ± 114.8 178.4 ± 85.5 0.857 RA reservoir function (%) 35.7 ± 10.2 40.8 ± 13.1 0.207 RA conduit function (%) 16.0 ± 6.1 19.4 ± 7.6 0.106 Right ventricular global longitudinal strain (%) - 18.5 ± 2.2 - 21.3 ± 1.5 <0.001 Smokers (n= 40) Nonsmokers (n= 20) p Age (years) 34.4 ± 7.8 26.5 ± 3.4 <0.001 Male sex (n-%) 28 (70%) 9 (45%) 0.060 RAVmax (mL) 42.4 ± 17.0 28.7 ± 9.2 0.001 RAVmin (mL) 17.0 ± 9.1 10.8 ± 3.8 0.002 RAVpre-A (mL) 26.4 ± 12.2 17.2 ± 5.4 0.001 RA total stroke volume (mL) 25.4 ± 11.2 17.9 ± 7.1 0.010 RA total emptying fraction (%) 60.3 ± 12.6 61.2 ± 10.6 0.857 RA passive stroke volume (mL) 16.0 ± 8.1 11.5 ± 5.4 0.033 RA passive emptying fraction (%) 38.2 ± 11.9 38.9 ± 10.5 0.707 RA active stroke volume (mL) 9.4 ± 4.6 6.4 ± 2.6 0.007 RA active emptying fraction (%) 36.7 ± 12.5 37.1 ± 9.8 0.695 RA expansion index 183.1 ± 114.8 178.4 ± 85.5 0.857 RA reservoir function (%) 35.7 ± 10.2 40.8 ± 13.1 0.207 RA conduit function (%) 16.0 ± 6.1 19.4 ± 7.6 0.106 Right ventricular global longitudinal strain (%) - 18.5 ± 2.2 - 21.3 ± 1.5 <0.001 View Large P1493 Right ventricular deformation analysis after cardiac transplantation: can we predict functional recovery? L Halmai L Halmai Milton Keynes Hospital NHS Trust, Department of Cardiology, Milton Keynes, United Kingdom S Kaul S Kaul Harefield Hospital, Adult Intensive Care Unit, London, United Kingdom O Dar O Dar Harefield Hospital, Department of Transplant Medicine and Circulatory Support, London, United Kingdom N Banner N Banner Harefield Hospital, Department of Transplant Medicine and Circulatory Support, London, United Kingdom S Rahman Haley S Rahman Haley Harefield Hospital, Department of Cardiology, London, United Kingdom Milton Keynes Hospital NHS Trust, Department of Cardiology, Milton Keynes, United Kingdom Harefield Hospital, Adult Intensive Care Unit, London, United Kingdom Harefield Hospital, Department of Transplant Medicine and Circulatory Support, London, United Kingdom Harefield Hospital, Department of Cardiology, London, United Kingdom Variable degree of right ventricular (RV) dysfunction can occur in up to 25-50% of cardiac transplant (OCTx) recipients and it can remain a key determinant of outcome as RV failure (RVF) accounts for 19% of early deaths in the post-transplant period. Therefore, accurate assessment of RV mechanical function after OCTx has a significant impact on postoperative management strategies. AIMS: We wanted to assess if Myocardial Deformation Imaging (MDI) by Speckle Tracking Analysis can provide incremental prognostic information and predict functional recovery of the RV function in those OCTx recipients, who develop early postoperative RVF. METHODS: 16 transplant recipients were enrolled from June 2016 to this pilot study (45.8 ± 18.6yrs, 9 males, 6 ischaemic), who developed RVF after OCTx. Standard Echo, 3D-Full Volume and MDI Analysis, right heart catheter (RHC) measurements made on 1st, 6th postoperative week and after 3 months of OCTx. Indexed EDV, ESV and RV-EF, Free-Wall Longitudinal and Circumferential Strain (FW-LS, -CS), Twist angle and Recoil Rate (Rec), Mechanical Functional Dispersion as SD of time-to-peak Strain was calculated after standard Echo analysis was completed. The Vasoactive Inotropic Score was calculated at 48 hrs. RESULTS: The postoperative RV function remained mild-to-moderately impaired despite normal RV-sizes. The RV-EF increased (50.1 ± 4.8 vs 45.8 ± 4.7%) from the 2nd postoperative assessment and the 3D-measurements at 3rd stage were used as reference for correlation analysis. The FW-LS increased (-12.1 ± 1.9 vs -10.8 ± 2.1%, p < 0.001), the CS increased (-26.4 ± 2.6 from -20.4 ± 3.9%), the Twist angles increased (5.6 ± 0.2 vs 3.4 ± 0.9º, p < 0.03), the Rec rate became faster at each stage (26.3 ± 2.5 vs 22.5 ± 2.4°/s), the degree of mechanical RV-dispersion reduced (75 ± 10.2, 67.4 ± 8.6 vs 81.1 ± 10.5ms, p < 0.001) continuously. The baseline RV-S`, FW-LS, CS, Rec indices correlated well with the final 3D-RV-EF, ESVi and FAC (r2 = 0.96, p < 0.001). The Twist angle correlated with the VIS score in <48-hours and with the RAP/PCWP data provided by the RHC measurements. Conclusions: We found the standard Echo measurements to have limited value to predict recovery of RV function in the acute phase of OCTx. The FW-LS, CS, Twist and Recoil mechanics, the Dispersion of RV-contraction however, showed early improvement after OCTx with good correlation with the level of inotropic support, the pulmonary pressures and the final RV-EF, while the standard echo-indices still have not changed. It appears the 3D-Full Volume and MDI methods are able to predict functional recovery of the RV systolic function after OCTx. These measurements may have an advantage over the standard Echo indices to provide data of prognostic value and may have implications in different forms of post-operative RV impairment and therefore may guide therapeutic strategies. P1495 Left ventricular regional longitudinal strain in patients with severe aortic stenosis; a speckle tracking echocardiography study P Kostakou P Kostakou Thriassio General Hospital, Cardiology Department, Athens, Greece V Kostopoulos V Kostopoulos Thriassio General Hospital, Cardiology Department, Athens, Greece E Tryfou E Tryfou Thriassio General Hospital, Cardiology Department, Athens, Greece V Giannaris V Giannaris Thriassio General Hospital, Cardiology Department, Athens, Greece CH Olympios CH Olympios Thriassio General Hospital, Cardiology Department, Athens, Greece N Kouris N Kouris Thriassio General Hospital, Cardiology Department, Athens, Greece Thriassio General Hospital, Cardiology Department, Athens, Greece Introduction: Two-dimensional speckle tracking echocardiography (2DSTE) can quantitatively measure myocardial mechanics (strain and strain rate) of premature left ventricular (LV) dysfunction in longitudinal (LVGLS), circumferential and radial directions even when conventional echocardiography does not reveal impairment of LV ejection fraction (LVEF). In severe aortic stenosis (sAS), the aortic valve replacement is important to be carried out before LV remodeling. It has been referred that global strain is reduced in sAS with normal LVEF. Purpose: This study aimed to investigate whether there is correlation between sAS and impairment of LVGLS in particular segments, using 2DSTE, in patients with sAS and normal LVEF. Methods: The study included 50 consecutive patients, 30 men and 20 women, of mean age 76.5 ± 9 years with sAS (AVA = 0.8 ± 0.15cm2 or AVAi = 0.45 ± 0.08cm2) and preserved LVEF (58 ± 5%). All patients underwent conventional 2D echocardiography and 2DSTE. LVGLS was measured in 2, 3- and 4-chamber (CH) views. Furthermore, the regional longitudinal systolic LV wall strain was evaluated at the area opposite of the aorta as the median strain value of the basic, middle and apical segments of the lateral and posterior walls and was compared to the average strain value of the interventricular septum (IVS) at the same views. Results: LVGLS was decreased and was not statistically different between 3- and 4-CH views (-12.5 ± 3.6 vs -11.4 ± 5.5%, p = 0.2). The average strain values of the lateral and posterior walls were statistically reduced compared to the average value of the IVS (lateral vs IVS: -7.8 ± 3.7 vs -10 ± 5.3%, p = 0.005, posterior vs IVS: -7.7 ± 4.2 vs -10.3 ± 3.8%, p < 0.0001). There was no significant difference between lateral and posterior walls (-7.8 ± 3.7 vs -7.7 ± 4.2%, p = 0.9). Conclusions: The strain of lateral and posterior LV walls, which lay just opposite to the aortic valve seem to be more reduced compared to other walls in patients with sAS and preserved LVEF possibly due to their anatomical position. This impairment seems to be the reason of the overall LVGLS reduction. Regional strain could be used as an extra tool for the estimation of the severity of AS as well as for prognostic information. P1496 Effects of lower body elastic compression garment on left ventricular rotational mechanics in lipedema - A three-dimensional speckle-tracking echocardiographic study A Nemes A Nemes 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary A Kormanyos A Kormanyos 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary P Domsik P Domsik 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary A Kalapos A Kalapos 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary L Kemeny L Kemeny University of Szeged, Department of Dermatology and Allergology, Szeged, Hungary T Forster T Forster 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary G Szolnoky G Szolnoky University of Szeged, Department of Dermatology and Allergology, Szeged, Hungary 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary University of Szeged, Department of Dermatology and Allergology, Szeged, Hungary Introduction. Lipedema is a symmetrical, bilateral and disproportional obesity. Its conservative treatment comprises the use of flat-knitted compression panty-hoses. Lipedema is associated increased aortic stiffness and left ventricular rotational alterations. The present study aimed to assess the effects of graduated compression stockings on left ventricular (LV) rotational mechanics measured by three-dimensional speckle-tracking echocardiography (3DSTE) in lipedema patients. Methods. The present study comprised twenty lipedema patients (mean age: 45.8 ± 11.0 years, all females) undergoing 3DSTE who were also compared to 51 age- and gender-matched healthy controls (mean age: 39.8 ± 14.1 years, all females). 3DSTE analysis was performed at rest, and subsequent to one hour application of compression class 2 made-to-measure flat-knitted panty-hose. Results. Six lipedema patients showed significant LV rotational abnormalities at rest including absence of LV twist and severely reduced basal and/or apical LV rotation. Among the remaining 14 lipedema patients, LV basal rotation proved to be similar in lipedema patients and in controls (-4.45 ± 1.65 degree vs -4.18 ± 2.14 degree, p =ns), LV apical rotation was significantly lower in lipedema patients as compared to controls at rest (6.68 ± 2.67 degree vs 9.69 ± 4.29 degree, p <0.05). One hour after the use of panty-hose LV basal rotation rotation showed significant reduction (-4.45 ± 1.65 degree vs. -2.79 ± 1.84 degree, p <0.05), while LV apical rotation showed significant increase (6.68 ± 2.67 degree vs. 9.08 ± 3.14 degree, p <0.05) with unchanged LV twist (11.14 ± 3.32 degree vs. 11.87 ± 3.42 degree). The use of panty-hose in patients with significant LV rotational abnormalities have different effects on LV rotational mechanics. Conclusion. The use of compression garments might have beneficial effects on LV rotational mechanics in selected lipedema patients however they sometimes have several resting LV rotational abnormalities which show different changing patterns following elastic compression. P1497 Left auricular strain: a new marker of left ventricular diastolic dysfunction C Mas Llado C Mas Llado University Hospital Son Espases, Palma de Mallorca, Spain MF Ramis Barcelo MF Ramis Barcelo University Hospital Son Espases, Palma de Mallorca, Spain A Rodriguez A Rodriguez University Hospital Son Espases, Palma de Mallorca, Spain P Pericas P Pericas University Hospital Son Espases, Palma de Mallorca, Spain J Maristany J Maristany University Hospital Son Espases, Palma de Mallorca, Spain M Noris M Noris University Hospital Son Espases, Palma de Mallorca, Spain R Gonzalez R Gonzalez University Hospital Son Espases, Palma de Mallorca, Spain L Pasamar L Pasamar University Hospital Son Espases, Palma de Mallorca, Spain V Peral V Peral University Hospital Son Espases, Palma de Mallorca, Spain JF Forteza JF Forteza University Hospital Son Espases, Palma de Mallorca, Spain University Hospital Son Espases, Palma de Mallorca, Spain Introduction: In previous studies, the peak left atrial (LA) strain has shown a good correlation with the grade of diastolic dysfunction (DD) according the 2009 American Society of Echocardiography guidelines classification criteria in patients with preserved left ventricular (LV) ejection fraction (EF) >50%. Purpose: The aim of this study is to corroborate the adequate correlation between the peak LA strain and the grade of DD according to the new 2016 American society of Echocardiography guidelines in patients with preserved (EF > 53%) and reduced LV EF Methods: We performed a retrospective study with patients who underwent a complete 2- dimension transthoracic echocardiography between January 2017 and March 2018. Inclusion criteria required normal sinus rhythm and no significant valvular heart disease (defined as more than mild regurgitation). Results: We included 148 patients, 62,2% male, mean age of 58 years (±14,7SD). A 64,9% of them had preserved ejection fraction and 35,1% had reduced ejection fraction. 41,2% without DD, 43,9% DD grade 1, and 13,5% DD grade 2 + 3. We found a statistically significant correlation between the values of peak LA strain and the grade of the DD (Table). These values of peak LA strain were similar to those observed in the previous studies. When we adjusted the results for EF and LA maximum volume the correlation remained statistically significant (p< 0.05, OR 0.952, IC 95% 0.923-0.982). Receiver-operating curve (ROC) demonstrated area under the curve value of 0.768 for differentiating between normal diastolic function and DD, reflecting good diagnostic performance (Figure) Conclusions: Our results suggest that the peak LA strain is a useful tool to determine the diastolic function in patients with preserved and reduced ejection fraction. Table 1 Diastolic dysfunction Peak LA strain 0 38.16% (±17.6 SD) * 1 25.85% (±12.9 SD) * 2 18.44% (±12.5 SD) * Diastolic dysfunction Peak LA strain 0 38.16% (±17.6 SD) * 1 25.85% (±12.9 SD) * 2 18.44% (±12.5 SD) * 0: Normal diastolic function; 1: DD grade 1; 2: DD grade 2 + 3. *p < 0.05 View Large Table 1 Diastolic dysfunction Peak LA strain 0 38.16% (±17.6 SD) * 1 25.85% (±12.9 SD) * 2 18.44% (±12.5 SD) * Diastolic dysfunction Peak LA strain 0 38.16% (±17.6 SD) * 1 25.85% (±12.9 SD) * 2 18.44% (±12.5 SD) * 0: Normal diastolic function; 1: DD grade 1; 2: DD grade 2 + 3. *p < 0.05 View Large View largeDownload slide Abstract P1497 Figure. ROC curve View largeDownload slide Abstract P1497 Figure. ROC curve P1498 The evaluation of right atrial and ventricular functions by speckle tracking echocardiography in patients with nonmassive acute pulmonary embolism B Ozben Sadic B Ozben Sadic Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey T Bayram T Bayram Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey O Can Bostan O Can Bostan Marmara University, Pulmonary and Critical Care, Istanbul, Turkey M Sunbul M Sunbul Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey N Sayar N Sayar Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey K Tigen K Tigen Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey E Gurel E Gurel Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey A Cincin A Cincin Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey H Ozdil H Ozdil Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey B Kanar B Kanar Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey E Eryuksel E Eryuksel Marmara University, Pulmonary and Critical Care, Istanbul, Turkey Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey Marmara University, Pulmonary and Critical Care, Istanbul, Turkey Funding Acknowledgements: None Background and purpose: Right ventricular functions are impaired due to acute right ventricular pressure overload in patients with massive and submassive acute pulmonary embolism. Right ventricular size and functions are presumed to be normal in patients with nonmassive pulmonary embolism. The aim of this study was to assess right atrial and ventricular functions in patients with nonmassive acute pulmonary embolism. Methods: Twenty-nine patients with acute nonmassive pulmonary embolism and 29 normal subjects were consecutively included. The right atrial, right and left ventricular functions were evaluated by both conventional and speckle-tracking echocardiography. Results: The echocardiographic parameters of the pulmonary embolism patients and controls are listed in Table 1. Although conventional parameters except tricuspid annular plane systolic excursion (TAPSE) were similar, the right ventricular global longitudinal strain was significantly lower compared to those of controls. The pulmonary embolism patients had also reduced right atrial reservoir and conduit strain, but the differences were not statistically significant. The left ventricular global longitudinal strain of the pulmonary embolism patients was significantly lower while the left ventricular ejection fraction was similar between patients and controls. Conclusion: Right and left ventricular functions are affected in patients with nonmassive pulmonary embolism. Speckle tracking echocardiography may be useful in determining the subclinical right and left ventricular dysfunction in those patients. Echocardiographic parameters Pulmonary Embolism (n= 29) Controls (n= 29) p Age (years) 58.7 ±14.7 37.1 ± 6.3 <0.001 Male sex (n-%) 20 (69.0%) 14 (48.3%) 0.110 Right atrial reservoir function (%) 31.7 ± 12.9 36.0 ± 10.3 0.156 Right atrial conduit function (%) 16.6 ± 9.1 16.8 ± 6.0 0.639 Right ventricle (mm) 34.4 ± 4.7 32.8 ± 5.1 0.242 Right ventricular fractional area change (%) 40.7 ± 9.0 44.1 ± 5.6 0.146 Tricuspid annular S velocity (cm/s) 12.9 ± 1.8 14.5 ± 1.4 0.919 TAPSE (mm) 20.1 ± 4.3 23.8 ± 2.8 0.003 Systolic pulmonary arterial pressure (mmHg) 30.0 ± 13.5 21.4 ± 7.4 0.005 Right ventricular global longitudinal strain (%) - 17.6 ± 3.0 - 19.0 ± 2.5 0.048 Left ventricular ejection fraction (%) 52.6 ± 6.0 54.3 ± 3.2 0.241 Left ventricular global longitudinal strain (%) -17.3 ± 2.1 -19.8 ±2.2 <0.001 Pulmonary Embolism (n= 29) Controls (n= 29) p Age (years) 58.7 ±14.7 37.1 ± 6.3 <0.001 Male sex (n-%) 20 (69.0%) 14 (48.3%) 0.110 Right atrial reservoir function (%) 31.7 ± 12.9 36.0 ± 10.3 0.156 Right atrial conduit function (%) 16.6 ± 9.1 16.8 ± 6.0 0.639 Right ventricle (mm) 34.4 ± 4.7 32.8 ± 5.1 0.242 Right ventricular fractional area change (%) 40.7 ± 9.0 44.1 ± 5.6 0.146 Tricuspid annular S velocity (cm/s) 12.9 ± 1.8 14.5 ± 1.4 0.919 TAPSE (mm) 20.1 ± 4.3 23.8 ± 2.8 0.003 Systolic pulmonary arterial pressure (mmHg) 30.0 ± 13.5 21.4 ± 7.4 0.005 Right ventricular global longitudinal strain (%) - 17.6 ± 3.0 - 19.0 ± 2.5 0.048 Left ventricular ejection fraction (%) 52.6 ± 6.0 54.3 ± 3.2 0.241 Left ventricular global longitudinal strain (%) -17.3 ± 2.1 -19.8 ±2.2 <0.001 TAPSE: Tricuspid annular plane systolic excursion View Large Echocardiographic parameters Pulmonary Embolism (n= 29) Controls (n= 29) p Age (years) 58.7 ±14.7 37.1 ± 6.3 <0.001 Male sex (n-%) 20 (69.0%) 14 (48.3%) 0.110 Right atrial reservoir function (%) 31.7 ± 12.9 36.0 ± 10.3 0.156 Right atrial conduit function (%) 16.6 ± 9.1 16.8 ± 6.0 0.639 Right ventricle (mm) 34.4 ± 4.7 32.8 ± 5.1 0.242 Right ventricular fractional area change (%) 40.7 ± 9.0 44.1 ± 5.6 0.146 Tricuspid annular S velocity (cm/s) 12.9 ± 1.8 14.5 ± 1.4 0.919 TAPSE (mm) 20.1 ± 4.3 23.8 ± 2.8 0.003 Systolic pulmonary arterial pressure (mmHg) 30.0 ± 13.5 21.4 ± 7.4 0.005 Right ventricular global longitudinal strain (%) - 17.6 ± 3.0 - 19.0 ± 2.5 0.048 Left ventricular ejection fraction (%) 52.6 ± 6.0 54.3 ± 3.2 0.241 Left ventricular global longitudinal strain (%) -17.3 ± 2.1 -19.8 ±2.2 <0.001 Pulmonary Embolism (n= 29) Controls (n= 29) p Age (years) 58.7 ±14.7 37.1 ± 6.3 <0.001 Male sex (n-%) 20 (69.0%) 14 (48.3%) 0.110 Right atrial reservoir function (%) 31.7 ± 12.9 36.0 ± 10.3 0.156 Right atrial conduit function (%) 16.6 ± 9.1 16.8 ± 6.0 0.639 Right ventricle (mm) 34.4 ± 4.7 32.8 ± 5.1 0.242 Right ventricular fractional area change (%) 40.7 ± 9.0 44.1 ± 5.6 0.146 Tricuspid annular S velocity (cm/s) 12.9 ± 1.8 14.5 ± 1.4 0.919 TAPSE (mm) 20.1 ± 4.3 23.8 ± 2.8 0.003 Systolic pulmonary arterial pressure (mmHg) 30.0 ± 13.5 21.4 ± 7.4 0.005 Right ventricular global longitudinal strain (%) - 17.6 ± 3.0 - 19.0 ± 2.5 0.048 Left ventricular ejection fraction (%) 52.6 ± 6.0 54.3 ± 3.2 0.241 Left ventricular global longitudinal strain (%) -17.3 ± 2.1 -19.8 ±2.2 <0.001 TAPSE: Tricuspid annular plane systolic excursion View Large P1499 Cardiac involvement in patients with cystic fibrosis: correlation between right ventricular systolic function and lungs function tests M Oliveira M Oliveira University of Lisbon, Department of Cardiology, University Hospital of Santa Maria, CHLN, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal C Amaro C Amaro University of Lisbon, Department of Cardiology, University Hospital of Santa Maria, CHLN, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal S Goncalves S Goncalves University of Lisbon, Department of Cardiology, University Hospital of Santa Maria, CHLN, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal R Vaz R Vaz University of Lisbon, Department of Cardiology, University Hospital of Santa Maria, CHLN, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal S Silva S Silva University of Lisbon, Department of Cardiology, University Hospital of Santa Maria, CHLN, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal L Santos L Santos University of Lisbon, Department of Cardiology, University Hospital of Santa Maria, CHLN, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal P Santos P Santos University of Lisbon, Department of Cardiology, University Hospital of Santa Maria, CHLN, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal A Mauricio A Mauricio University of Lisbon, Department of Cardiology, University Hospital of Santa Maria, CHLN, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal F Ribeiro F Ribeiro University of Lisbon, Department of Cardiology, University Hospital of Santa Maria, CHLN, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal J Agostinho J Agostinho University of Lisbon, Department of Cardiology, University Hospital of Santa Maria, CHLN, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal T Leal T Leal University of Lisbon, Department of Cardiology, University Hospital of Santa Maria, CHLN, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal A Almeida A Almeida University of Lisbon, Department of Cardiology, University Hospital of Santa Maria, CHLN, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal F Pinto F Pinto University of Lisbon, Department of Cardiology, University Hospital of Santa Maria, CHLN, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal University of Lisbon, Department of Cardiology, University Hospital of Santa Maria, CHLN, CAML, CCUL, Faculty of Medicine, Lisbon, Portugal (Introduction) Cystic fibrosis (CF) is the most common lethal genetic disease in Caucasians, occurring in 1/3400 among Caucasians. Patients with CF have a progressive right ventricular (RV) deterioration parallel to the severity of the disease, however, the type and onset of these changes is unclear. (Purpose) Correlate parameters of right ventricular longitudinal systolic function with parameters of lungs function tests (LFT) in patients with CF. (Methodology) A prospective, descriptive-correlational study in patients followed at the CF clinic of our hospital, who underwent a transthoracic echocardiogram (TTE) between September and December of 2017 and a LFT on the same day as the TTE. The systolic excursion of the tricuspid ring evaluated by M-mode (TAPSE), the tissue Doppler (S "ring) and the longitudinal deformation of the right ventricular free wall (absolute value of the right ventricle global peak strain, peak strain of the basal, middle and apical segments) were defined as variables of study of the systolic function of the RV. As for the lungs function, the following variables were used: maximum expiratory volume in the first second (FEV1), forced vital capacity (FVC) and Tiffeneau index (FEV1 / FVC). It was studied the correlation between the variables of the two different types of diagnostic techniques, taking into account age and gender. To test the hypothesis of correlation between variables, it was used the nonparametric Spearman correlation test with a significance level of 5%. (Results) Thirty-seven patients (13 men, 14 women, mean age 32 + -9 years) had no technical limitations for a correct evaluation of the echocardiographic parameters. Of the 27 patients analyzed, 89% had an obstructive pattern in LFT and 4% had a reduced of RV systolic function in the ETT. It was verified that in male gender there is a correlation with statistical significance between TAPSE (p = 0.591, r = 0.033), the global RV peak strain (p = 0.565, r = 0.044) and the middle segment peak strain of the RV (p = 0.607, r = 0.028) with FEV1. For female patients there were no correlations with statistical significance between the parameters of the two different diagnostic techniques. The age of the patient, regardless of gender, is also not correlated with these parameters. (Conclusions) In this sample, there appears to be a statistically significant correlation between the decrease in FEV1 and the decrease in values of some parameters of RV systolic function, in male patients with CF. Thus, cardiac ultrasonography plays an important role in the early identification of the right cardiac function deterioration in this pathology. P1500 Significance of 2d strain during dobutamine stressecho in hypertensive patients S Stojsic S Stojsic Institute of CVD Vojvodina, Sremska Kamenica, Serbia A Ilic A Ilic Institute of CVD Vojvodina, Sremska Kamenica, Serbia A Stojsic-Milosavljevic A Stojsic-Milosavljevic Institute of CVD Vojvodina, Sremska Kamenica, Serbia D Grkovic D Grkovic Institute of CVD Vojvodina, Sremska Kamenica, Serbia S Tadic S Tadic Institute of CVD Vojvodina, Sremska Kamenica, Serbia Institute of CVD Vojvodina, Sremska Kamenica, Serbia Introduction: Reveling of latent systolic dysfunction in hypertensive patients is still not defined. We wondered if measuring myocardial deformation during Dobutamine stressecho (DSE), can be important for evaluation of early systolic dysfunction in hypertensive patients, and can it implicate development of major adverse cardiovascular events. Purpose: To determine the significance and prognostic value of 2D strain evaluation of systolic function during DSE in patients with hypertension. Methods: Study included 120 patients which have had DSE, and no signs of ischemic disease. There were 70 patients with hypertension, and 50 controls. 5.25% of hypertensive patients had diabetes mellitus. 2D strain analysis was performed at rest and peak dose. Global longitudinal strain (GLS) was measured in 4CH, 2CH and 3CH view, also on epicardial, endocardial and mid myocardial level. All patients were observed for hospitalization due to adverse events such as myocardial infarction, cerebrovascular event and heart failure, during the two year period Results: All patients had normal average values of GLS at rest. GLS was significantly lower at all levels in hypertensive group comparing to the controls, measured at rest. (epicardial AVR 20.49 ± 2.4 vs 22.19 ± 3.68, p< 0.015, endocardial AVR 23.10 ± 2.87 vs 24.79 ± 4.09, p < 0.031, mid AVR 22.33 ± 4.29 vs 24.86 ± 4.24 p< 0.011). Subgroup of patients with hypertension and diabetes mellitus had significantly lower GLS on endocardial level at rest, comparing to hypertensive patients without diabetes mellitus. (20.84 ± 4.79 vs 23.76 ± 4.79, p < 0.039). There was no significant difference in values of GLS at the peak dose in hypertensive patients comparing to the controls.During 2 year period 2.22% of hypertensive patients were hospitalized. Those patients had significantly lower values of GLS at rest on mid (AVR 16.80 ± 5.02 vs 20.80 ± 3.82 p < 0.048), and endocardial level (AVR 18.83 ± 5.28 vs 23.54 ± 4.35 p < 0.040 ) and they also had significantly lower values of GLS at peak dose comparing to hypertensives that had no hospitalization, at all levels : mid (AVR 17.43 ± 4.86 vs 22.18 ± 3.15 p< 0.015 ), epicardial (AVR 15.30 ± 4.11 vs 19.31 ± 2.87 p < 0.023) and endocardial (AVR 20.00 ± 5.40 vs 25.69 ± 3.87 p < 0.016). Conclusion : 2D analysis of global longitudinal strain can be significant in evaluation of systolic function in hypertensive patients, but Dobutamine stressecho cannot be a tool for evaluating latent systolic dysfunction. 2D strain during DSE can be of value in risk stratification for developing major significant events in hypertensive patients. P1501 Assessment of global longitudinal strain and post-systolic shortening in assymptomatic hypertensive patients by speckle tracking S Zurba S Zurba UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil DR Tiezzi DR Tiezzi UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil TMS Terra TMS Terra UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil C Machado C Machado UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil DS Lira DS Lira UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil G De Rossi G De Rossi UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil W Nadruz Jr W Nadruz Jr UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil J R M Souza J R M Souza UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil UNICAMP - State University of Campinas, Department of Cardiology, Campinas, Brazil Introduction: The reduced global longitudinal strain (GLS) is an established incipient marker of ventricular dysfunction, including in arterial hypertension. Reduced myocardial strain along the longitudinal fibers, especially in subendocardial ones, could be compromised more precociously in hypertensive heart disease7. The post-systolic shortening (PSS) occurs after the aortic valve closure and previous studies have found a link between PSS and delayed passive recoil of myocardia subjected to increased afterload. . Diastolic function, GLS and PSI were studied in 119 individuals by echocardiography study. Among these subjects, 32 in the control group, 40 in the hypertensive group with normal diastolic function (HNDF), and 47 in the hypertensive group with altered diastolic function (HADF), all asymptomatic with preserved ejection fraction (EF). There is a positive correlation of values of PSI and GLS (control R = 0.441 s = 0.012; HNDF R = 0.317 s = 0.046; HADF R = 0.547 s < 0.001and total R = 0.574 s < 0.001). Conclusion: PSI was higher in the hypertensive compared to the control group, and more significant in hypertensive with altered diastolic function. There is a correlation between increased PSI and the reduction of longitudinal strain, mainly in the basal and middle segments, where the PSI showed higher values compared to the apical segments. View largeDownload slide Abstract P1501 Figure. Global PSI View largeDownload slide Abstract P1501 Figure. Global PSI P1502 The detection of coronary microvascular disease by means of two-dimensional speckle-tracking echocardiography OM Galuszka OM Galuszka Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany D Steffens D Steffens Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany J Friebel J Friebel Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany U Rauch-Krohnert U Rauch-Krohnert Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany U Landmesser U Landmesser Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany M Kasner M Kasner Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany Background: Coronary microvascular disease (MVD) is manifested by an angina-like chest pain with a positive response to exercise stress testing and normal coronary angiographic findings. The development of new imaging modalities, such as two-dimensional speckle tracking echocardiography (2D STE), provides a method for the non-invasive assessment of global and local LV function. Previous studies have indicated that 2D STE is more sensitive than conventional echocardiography parameters for detecting subclinical ventricular dysfunction in various clinical disorders. Aim The aim of this study was to evaluate the role of left ventricular (LV) systolic strain assessed bytwo-dimensional speckle-trackingechocardiography for the early detection ofmyocardial dysfunction in patients with stable angina and proven coronary microvascular disease. Methods We compared 45patients with angiographically documented normalcoronaryarterieswith coronary microvascular disease defined by reduced coronary flow velocity reserve (CFVR < 2, assessed by Doppler echocardiography)with 32healthy persons as a control group (CFVR > 2). Exclusion criteria for both groups were valvularheartdisease, cardiomyopathies, inflammatory diseases, myocarditis, vasculitis, arthropathies, Tietze"s syndrome, gastrointestinal diseases, aortic diseases, arrhythmias, liver diseases, and alcohol use. All subjects underwent conventional echocardiography including speckle-tracking analysis to assess resting LV function. STE measures were taken from all 16 wall segments. Student"s t-test and chi-square test were used to statistically analyze data. Results LVsystolic function assessed by means of LVejection fraction (LVEF)wassimilar for both groups(62.7 vs. 60.6 %).Patients with MVD had significantly impaired diastolic function compared with healthy individuals (E/E" 9.5± 2.7 vs. 7.7± 2.9, p < 0.05).Moreover, global longitudinal strain (GLS; -15.8 ± 2.8% vs. -17.6 ± 2.5%; p < 0.001) was significantly lower in patientswith MVDthan in healthy control patients.On the other hand,patients with arterial hypertension presenting with stable angina showed no significant impairment in microvascular (n = 16) LV function assessed by means of 2D STE (-17.2 ± 2.7% vs. -17.6 ± 2.4%; p = 0.82). Conclusions Despite normal LVEF significant impairment of LV longitudinal myocardial systolicfunction was detected with STE in patients withMVD. Therefore, atherosclerosis of smallcoronaryarteries andmicrovasculardysfunction affectsmyocardial longitudinal strain which may contribute topatient clinical outcome. P1503 Improvement of mitral annular displacement and its impact on patients with severe aortic stenosis after transcatheter aortic valve implantation: a philippine experience A Cordero A Cordero St. Luke"s Medical Center, Global City, Heart Institute, Taguig, Philippines AK Tiu AK Tiu St. Luke"s Medical Center, Global City, Heart Institute, Taguig, Philippines R Mambulao R Mambulao St. Luke"s Medical Center, Global City, Heart Institute, Taguig, Philippines M Loquias M Loquias St. Luke"s Medical Center, Global City, Heart Institute, Taguig, Philippines SA Locnen SA Locnen St. Luke"s Medical Center, Global City, Heart Institute, Taguig, Philippines O Valencia O Valencia St. Luke"s Medical Center, Global City, Heart Institute, Taguig, Philippines FE Posas FE Posas St. Luke"s Medical Center, Global City, Heart Institute, Taguig, Philippines St. Luke"s Medical Center, Global City, Heart Institute, Taguig, Philippines Background and Purpose of the Study Transcatheter aortic valve implantation (TAVI) has evolved into an alternative and effective therapeutic option in patients with severe symptomatic aortic stenosis (AS). Previous studies have demonstrated an improvement in left ventricular (LV) systolic function in severe aortic stenosis patients who underwent conventional surgical aortic valve replacement or TAVI. Speckle-tracking echocardiography-derived mitral annular (STE-MAD) displacement introduces a fast and accurate analysis of LV systolic function compared to conventional techniques, and has been utilized worldwide. However, there are insufficient studies in using STE-MAD in assessing LV systolic function in post-TAVI patients. Thus, the aim of present study was to investigate the effect of TAVI in LV systolic function using STE-MAD in patients with severe aortic stenosis. Methods: This was a retrospective case-series study on the effect of TAVI in the improvement of STE-MAD. Out of 105 severely symptomatic aortic stenosis patients who underwent TAVI, 33 patients fulfilled the inclusion criteria. Eligible patients had baseline transthoracic 2D echocardiography (TTE) and one TTE study ≤ 30-day post-TAVI. STE-MAD was then measured for all qualified patients. Results: There was an improvement in the STE-MAD measurements of post-TAVI patients. Measurements were inversely correlated with mortality and heart failure outcomes but not associated with improvement in LV ejection fraction in post-TAVI patients. Conclusions: STE-MAD may measure an improvement in systolic function which may still not be detected early by an increased in LV EF post-TAVI. This may be proven by improvement in clinical symptoms. P1504 Right ventricular strain and volumes comparison between mitral valve repair vs replacement operated for s mitral regurgitation, in patients with normal 3-dimensional ejection fraction J Grapsa J Grapsa Cleveland Clinic Foundation, Cardiology, Cleveland, United States of America C Ramalhao C Ramalhao Cleveland Clinic Abu Dhabi, Cardiology, Abu Dhabi, United Arab Emirates S Suhail S Suhail Cleveland Clinic Abu Dhabi, Cardiology, Abu Dhabi, United Arab Emirates S Adigopula S Adigopula Cleveland Clinic Abu Dhabi, Cardiology, Abu Dhabi, United Arab Emirates L Geraldes L Geraldes Cleveland Clinic Abu Dhabi, Cardiology, Abu Dhabi, United Arab Emirates T Mihaljevic T Mihaljevic Cleveland Clinic Foundation, Cardiology, Cleveland, United States of America R Suri R Suri Cleveland Clinic Foundation, Cardiology, Cleveland, United States of America EM Tuzcu EM Tuzcu Cleveland Clinic Foundation, Cardiology, Cleveland, United States of America Cleveland Clinic Foundation, Cardiology, Cleveland, United States of America Cleveland Clinic Abu Dhabi, Cardiology, Abu Dhabi, United Arab Emirates Purpose: Right ventricular (RV) function and the degree of tricuspid regurgitation are important prognostic indicators of postoperative outcome following mitral valve (MV) surgery for degenerative mitral regurgitation. In the present study we hypothesized that mitral valve repair may result to better RV remodelling and reduction of the degree of TR post-operatively. Methods: Thirty-five unselected patients with severe degenerative MV regurgitation were prospectively recruited. Two-dimensional (2DE) and 3-dimensional studies were performed prior to surgery and post-operatively. RV volumes, stroke volume, ejection fraction, RV free wall and global longitudinal strain were analysed. Regression analysis was used to demonstrate the effect of surgical mitral repair on the reverse RV remodelling. All strain values were indexed to RV end-diastolic volume as per Laplace equation. Results: RV systolic pressure (RVSP) was reduced from 42.5 ± 9.7 mmHg, to 28.9 ± 8.5 mmHg after surgery (p = 0.029). Compared to pre-operative volumes, there was a significant reduction in RV diastolic volume, stroke volume and increased RV ejection fraction 6-months after surgery (RVEDV: 108.5 ± 14.8 ml/m2 vs 75.8 ± 12.9 ml/m2, p < 0.001, RVSV: 70.2 ± 12.3 ml/m2 vs. 50.9 ± 14.2 ml/m2, p < 0.001 and RV free wall longitudinal strain improved (pre surgery: -0.184 ± (-0.045) double indexed to ml/m2 vs. (-0.329 ± (-0.08) double indexed to ml/m2). On the contrary there was no significant difference post operatively for RV global longitudinal strain. Over a 6-month follow up period, there were no deaths or readmission for heart failure. Twenty-six patients (74%) had mild TR prior to MV surgery which stayed intact in 21 patients (60%) while 5 patients had mild to moderate TR. Conclusions: Mitral valve repair leads to a positive RV remodelling and better overall RV function P1505 Changes in myocardial mechanics and tachycardia mediated cardiomyopathy S Trivedi S Trivedi Westmead Hospital, Department of Cardiology, Sydney, Australia L Thomas L Thomas Westmead Hospital, Department of Cardiology, Sydney, Australia S Kumar S Kumar Westmead Hospital, Department of Cardiology, Sydney, Australia Westmead Hospital, Department of Cardiology, Sydney, Australia Background: Idiopathic ventricular arrhythmias may evolve into tachycardia-induced cardiomyopathy. Speckle tracking strain echocardiography (STE) can detect subclinical changes in ventricular myocardial mechanical function before development of overt cardiomyopathy with decreased left ventricular (LV) ejection fraction (EF). Hypothesis: We hypothesised that patients without overt electrical and structural abnormalities and otherwise "idiopathic ventricular arrhythmias" may have subclinical changes in myocardial mechanics that may help explain predilection toward tachycardia-induced cardiomyopathy. Methods: STE was performed in 20 consecutive patients with idiopathic ventricular arrhythmias (no structural heart disease by cardiac magnetic resonance imaging; Group A) prior to undergoing catheter ablation/high-density voltage mapping and compared to 20 age/gender matched controls (Group B). Results: Baseline characteristics were similar for age (A vs. B: 40 ± 18y vs 42 ± 15y) and LVEF (54 ± 6% vs. 59 ± 8, p = 0.10). Right Ventricular (RV) global longitudinal strain (GLS) was similar between the two groups (A vs. B: -20.9 ± 4.8% vs. -23.6 ± 2.8%, p = 0.15) and all patients had normal RV voltage. LV GLS and LV circumferential strain were significantly impaired in Group A vs. B (-16.9 ± 3.3% vs. -19.2 ± 1.7%; p = 0.03 and -18.7 ± 2.9% vs. -22.3 ± 2.1%, p = 0.006 respectively). Conclusion: Alterations in myocardial mechanics, even remote from the site of arrhythmia, in patients without overt electrical and structural abnormalities may help explain why tachycardia-induced cardiomyopathy develops with otherwise "idiopathic" ventricular arrhythmias. Further study is needed to examine if these changes are reversible with ablation, and if alterations in STE can differentiate early forms of primary cardiomyopathy from reversible tachycardia-induced cardiomyopathy. P1506 Left atrium remodelling and BNP levels after mitraclip therapy R Ilhao Moreira R Ilhao Moreira Hospital de Santa Marta, Cardiology, Lisbon, Portugal L Moura Branco L Moura Branco Hospital de Santa Marta, Cardiology, Lisbon, Portugal L Morais L Morais Hospital de Santa Marta, Cardiology, Lisbon, Portugal F Ferreira F Ferreira Hospital de Santa Marta, Cardiology, Lisbon, Portugal T Mano T Mano Hospital de Santa Marta, Cardiology, Lisbon, Portugal A Goncalves A Goncalves Hospital de Santa Marta, Cardiology, Lisbon, Portugal T Mendonca T Mendonca Hospital de Santa Marta, Cardiology, Lisbon, Portugal I Rodrigues I Rodrigues Hospital de Santa Marta, Cardiology, Lisbon, Portugal P Modas Daniel P Modas Daniel Hospital de Santa Marta, Cardiology, Lisbon, Portugal S Aguiar Rosa S Aguiar Rosa Hospital de Santa Marta, Cardiology, Lisbon, Portugal P Rio P Rio Hospital de Santa Marta, Cardiology, Lisbon, Portugal J Abreu J Abreu Hospital de Santa Marta, Cardiology, Lisbon, Portugal A Galrinho A Galrinho Hospital de Santa Marta, Cardiology, Lisbon, Portugal D Cacela D Cacela Hospital de Santa Marta, Cardiology, Lisbon, Portugal R Cruz Ferreira R Cruz Ferreira Hospital de Santa Marta, Cardiology, Lisbon, Portugal Hospital de Santa Marta, Cardiology, Lisbon, Portugal Background: Mitraclip device has been suggested to effectively improve functional and clinical outcomes in high-risk patients with mitral regurgitation (MR). Plasma levels of brain natriuretic peptide (BNP) have been shown to reduce after Mitraclip therapy. However, the role of this compound as a non-invasive marker of left atrial (LA) dysfunction is yet to be established. Aims: The study aim was to correlate levels of BNP changes with LA function assessed by two-dimensional speckle tracking echocardiography after percutaneous mitral valve repair with Mitraclip system. Methods: A total of 27 consecutive patients with moderate-to-severe or severe MR were included. Patients underwent clinical, functional, laboratory and echocardiographic evaluation before and 6 months after the clip implantation. LA reservoir (SR-LAs), conduit (SR-LAe) and booster-pump (SR-LAa) functions were determined as the averaged global LA speckle tracking longitudinal strain rate from apical four-chamber views. Venous blood samples were withdrawn to monitor BNP levels during the same period. Results: Mean BNP level decreased after Mitraclip implantation (589 pg/mL before and 468 pg/mL six month after) and functional capacity assessed by the 6-minute walk test was improved (318 m to 344 m). At 6 month follow-up, mean left ventricular ejection fraction change was 0.8% and it was not correlated to BNP level changes (p 0.463). Conversely, two-dimensional speckle tracking analysis demonstrated that changes in SR-LAs at 6 month follow-up were significantly correlated with changes in BNP levels (p 0.003). Conclusion: In the studied population, changes in BNP levels correlated significantly with LA reservoir function improvement. BNP levels may be used as a non-invasive marker of left atrial remodelling after Mitraclip therapy. P1507 Utility of evaluation of Left atrial reservoir strain and time to peak longitudinal strain by 2d speckle tracking in patients with atrial fibrillation and high risk of cardiac embolism J Moreno J Moreno Hospital Country 2000, Imagen Cardiovascular, Guadalajara, Mexico P Torres P Torres Hospital Country 2000, Imagen Cardiovascular, Guadalajara, Mexico J Zuniga J Zuniga Hospital Angeles del Carmen, Cardiología , Guadalajara, Mexico Hospital Country 2000, Imagen Cardiovascular, Guadalajara, Mexico Hospital Angeles del Carmen, Cardiología , Guadalajara, Mexico Objective: The purpose of this study was to investigate the ability of 2d speckle tracking testing left atrial reservoir strain (LARS) and Left atrial time to peak longitudinal strain (LALS) to find patients with Left atrial appendage thrombus (LAAT) Methods: We performed a prospective study including 70 patients with atrial fibrillation, selected to perform transesophageal echo (TEE), to evaluate LAA Doppler systolic velocity, and LAA thrombi. LARS and LALS were measure in transthoracic echo in a 12 segments model in two apical views (4 and 2- chamber) and values were obtained by averaging all segments. Results: We found 21 (30%) patients with LAAT (group A), and 49 patients without LAAT (group B), of all our variables tested we found statistical significant differences only in LARS GROUP A VS B (P0.003), and LAA systolic velocity (P0.05). LALS presented high variability in both groups associated to atrial fibrillation; with not significant differences in patients with or without LAAT. Conclusion : We found that LARS tested via transthoracic echo could be a useful tool to help in discriminating patients with LAAT, and high risk of cardiac embolic event, but further investigations are needed. Table 1 GROUP A (21 pts.) GROUP B  (49 pts.) LA VOLUME (ML/M2) 44 +/-14 50 +/- 17 P not significant LARS (%) 11%+/-3.2 27%+/-9 P 0.003 LALS (MS) 185MS+/-66 198MS+/-85 P not significant LAA systolic Velocity (CM/S) 17 +/- 6 22 +/-8 P 0.05 LVEF (%) 48% +/-5 55%+/-9 P not significant GROUP A (21 pts.) GROUP B  (49 pts.) LA VOLUME (ML/M2) 44 +/-14 50 +/- 17 P not significant LARS (%) 11%+/-3.2 27%+/-9 P 0.003 LALS (MS) 185MS+/-66 198MS+/-85 P not significant LAA systolic Velocity (CM/S) 17 +/- 6 22 +/-8 P 0.05 LVEF (%) 48% +/-5 55%+/-9 P not significant View Large Table 1 GROUP A (21 pts.) GROUP B  (49 pts.) LA VOLUME (ML/M2) 44 +/-14 50 +/- 17 P not significant LARS (%) 11%+/-3.2 27%+/-9 P 0.003 LALS (MS) 185MS+/-66 198MS+/-85 P not significant LAA systolic Velocity (CM/S) 17 +/- 6 22 +/-8 P 0.05 LVEF (%) 48% +/-5 55%+/-9 P not significant GROUP A (21 pts.) GROUP B  (49 pts.) LA VOLUME (ML/M2) 44 +/-14 50 +/- 17 P not significant LARS (%) 11%+/-3.2 27%+/-9 P 0.003 LALS (MS) 185MS+/-66 198MS+/-85 P not significant LAA systolic Velocity (CM/S) 17 +/- 6 22 +/-8 P 0.05 LVEF (%) 48% +/-5 55%+/-9 P not significant View Large P1508 Myocardial and vascular function in HCV related liver cirrhotic patients treated with direct antiviral agent (DAA) G Novo G Novo University of Palermo, Department of Cardiology, Palermo, Italy C Nugara C Nugara University of Palermo, Department of Cardiology, Palermo, Italy FP Guarneri FP Guarneri University of Palermo, Department of Cardiology, Palermo, Italy FP Macaione FP Macaione University of Palermo, Department of Cardiology, Palermo, Italy T Guarino T Guarino University of Palermo, Department of Cardiology, Palermo, Italy S Novo S Novo University of Palermo, Department of Cardiology, Palermo, Italy A Licata A Licata Polyclinic P. Giaccone, Palermo, Italy University of Palermo, Department of Cardiology, Palermo, Italy Polyclinic P. Giaccone, Palermo, Italy Introduction: HCV related liver cirrhosis is a condition that can be associated with cardiovascular damage. 2D speckle tracking echocardiography (2D-STE) and the study of arterial stiffness allow early assessment of myocardial and vascular damage. Purpose: Aim of the present study was to evaluate myocardial and vascular function in patients with compensated HCV related liver cirrhosis and to identify early signs of cardiotoxicity induced by treatment with direct antiviral agents (DAA). Methods: we enrolled an homogenous group of 39 patients with well compensated HCV related liver cirrhosis and an healthy control group of 39 patients. In all patients we evaluated myocardial deformation index by 2D-STE (VVI, Siemens) and carotid arterial stiffness by QAS (Quality arterial stiffness, Esaote). Twenty-eight out of 39 cirrhotic patients underwent follow-up after DAA treatment. Results: In the group of cirrhotic patients higher values of left ventricular mass (111± 27 vs 100± 20, p = 0.04) and of E/’E ratio (8.2± 2.3 vs 7± 1.7, p = 0.01) were found. Furthermore, significant differences were found between cirrhotic patients and controls for global longitudinal strain (GLS) (-18.6 ± 3.1 vs. -21.5 ± 1.5, p <0.0001) and for carotid arterial stiffness evaluated in term of PWV (pulse wave velocity) both on the right (8.3± 2 vs 6.8 ± 1.3, p = 0.0162) and on the left side (9.1 ± 2.2 vs 7 ± 1.2, p = 0.0016). At follow-up we didn’t observe any significant differences than basal evaluation but it emerged that there is a trend toward improvement for both myocardial deformation index and arterial stiffness parameters. Conclusions: Patients with liver cirrhosis have subclinical myocardial and vascular damage detectable at rest by 2D-SDTE and arterial stiffness. Our results show that DAA are safe for heart and vessels function. P1510 Evaluation of left and right atrial dysfunction in patients with atrial fibrillation using a novel three-dimensional speckle tracking echocardiographic system K Sakata K Sakata Kyorin University School of Medicine, Tokyo, Japan J Ito J Ito Kyorin University School of Medicine, Tokyo, Japan A Isaka A Isaka Kyorin University School of Medicine, Tokyo, Japan H Mitsuda H Mitsuda Kyorin University School of Medicine, Tokyo, Japan T Minamishima T Minamishima Kyorin University School of Medicine, Tokyo, Japan M Furuya M Furuya Kyorin University School of Medicine, Tokyo, Japan K Matsushita K Matsushita Kyorin University School of Medicine, Tokyo, Japan T Satoh T Satoh Kyorin University School of Medicine, Tokyo, Japan K Soejima K Soejima Kyorin University School of Medicine, Tokyo, Japan H Yoshino H Yoshino Kyorin University School of Medicine, Tokyo, Japan Kyorin University School of Medicine, Tokyo, Japan Objective: Patients with atrial fibrillation (AF) are characterized by elevated rates of thromboembolic events, left ventricular dysfunction and heart failure. It is important to evaluate left atrial (LA) sizes and function. Three-dimensional echocardiography (3DE) can evaluate volume and function more accurately. Speckle tracking echocardiography (STE) used also to evaluate atrial chambers function in recent years. LA strain by STE was very promising tools for evaluation in patients with AF over age and volume. We investigated whether three-dimensional speckle tracking echocardiography (3D-STE) can evaluate LA and right atrium (RA) dysfunction in patients with AF. Methods: We performed 3D-STE in 40 healthy subjects and 45 patients with AF. We measured area change ratio (ACR) as a 3D strain in LA and RA. Three-dimensional max LA and RA volume were also measured from 3D images. Results: Three-dimensional maximum LA volume was significantly larger (83.1 ± 38.3 ml vs 44.5 ± 11.0 ml; P < 0.001), and LA-ACR was significantly lower (15.7 ± 11.0 % vs 66.5 ± 19.7%; P < 0.001) in patients with AF compared with normal subjects. Three-dimensional maximum RA volume was significantly larger (69.6 ± 37.8 ml vs 44.0 ± 9.6 ml; P = 0.004), and RA-ACR was significantly lower (19.0 ± 20.5 % vs 65.4 ± 24.4%; P < 0.001) in patients with AF compared with normal subjects. Conclusion: LA and RA dysfunction appeared in patients with AF. 3D-STE is a novel and useful tool for accurate and quantitative assessment of atrial function in patients with AF. P1513 Global longitudinal left ventricular strain as a predictor of left atrial ejection fraction J Ker J Ker University of Pretoria, Internal Medicine, Pretoria, South Africa University of Pretoria, Internal Medicine, Pretoria, South Africa Funding Acknowledgements: No funding was received for this study Introduction.: The structure and function of the left atrium is a relatively ignored aspect of cardiac assessment in patients with heart failure1 . Furthermore, left atrial dysfunction is an important adverse prognostic indicator in patient with heart failure, independent of other prognostic indicators 1, 2 . Global longitudinal strain of the left ventricle, as assessed by 2-dimensional speckle tracking echocardiography, has emerged as a predictor of long-term risk of cardiovascular morbidity and mortality in both low and high risk populations3, 4 . Purpose of this study. What is the correlation between GLS and LAEF? Methods.: 40 patients (31 males and 9 females) who presented at a general internal medicine practice were enrolled into the study. The first 40 patients who were seen in the period of the 15`th to the 19`th January 2018 were chosen to participate. They all had different diagnoses, were asymptomatic and did not have clinical signs of any cardiac dysfunction. Global left ventricular longitudinal strain was measured in each patient. Maximum (LAmax) and minimum (LAmin) left atrial volumes were measured. In this study the maximum and minimum left atrial volumes are the left atrial diastolic and systolic volumes respectively. Contour tracing of the left atrial border with a border detection algorithm was performed after the identification and marking of the dome of the atrium and mitral annulus in each case. See Figure 1. LAmax vol was measured at the end of ventricular systole (timed at the end of the T wave) and LAmin vol at the end of ventricular diastole (timed at the beginning of the P wave). The total left atrial emptying fraction (LAEF), encompassing the fraction entering the left ventricle passively and actively due to atrial contraction, was calculated in each case. LAEF = [LAmax volume – LAmin volume] / LAmax volume 6 . LAmax vol occurs at the end of ventricular systole, just before mitral valve opening 6 . LAmin vol occurs at the end of ventricular diastole, at mitral valve closure 6. The lower reference value of 45% for normal left atrial ejection fraction was chosen5 . Results.: These 40 patients had a variety of diagnoses (Table 1). None had clinical cardiac dysfunction. A Fisher exact test on a two-by two table revealed no statistical significance (0.5211). There are no correlation between GLS and LAEF in this cohort of patients. Conclusion.: There are no correlation between GLS and LAEF in patients free from clinical cardiac dysfunction. Among the various differences between the atria and ventricles, there are also ultrastructural differences which involve atrial and ventricular proteins6 . In the clinical scenario left atrial dysfunction may be present despite a normal or even an above normal GLS of the left ventricle. View largeDownload slide Abstract P1513 Figure 1 View largeDownload slide Abstract P1513 Figure 1 P1514 Subclinical involvement of the heart and its associated factors in patients with sarcoidosis with normal systolic function using 2D-speckle tracking F Bayat F Bayat Shahid Beheshti University of Medical Sciences, Cardiovascular Research Center, Tehran, Iran (Islamic Republic of) A Fahimi A Fahimi Shahid Beheshti University of Medical Sciences, Cardiovascular Research Center, Tehran, Iran (Islamic Republic of) M Khani M Khani Shahid Beheshti University of Medical Sciences, Cardiovascular Research Center, Tehran, Iran (Islamic Republic of) AS Karimi AS Karimi tehran azad university, emergency department of booali hospital, tehran, Iran (Islamic Republic of) Shahid Beheshti University of Medical Sciences, Cardiovascular Research Center, Tehran, Iran (Islamic Republic of) tehran azad university, emergency department of booali hospital, tehran, Iran (Islamic Republic of) Funding Acknowledgements: there is no financial support OnBehalf: Cardiovascular Research Center.Shahid Beheshti Univerity of Medical Sciences, ,Tehran,Iran Introduction: Heart disease has been reported In 50% of patients with sarcoidosis , that localized cardiac involvement is one of the most severe manifestations of sarcoidosis and may endanger the person"s life and death. In this regard, the use of two-dimensional speckle tracking strain has been reported to be valuable in detecting cardiac sarcoidosis .Early diagnosis of cardiac involvement in sarcoidosis and early treatment may prevent arrhythmias and heart failure. Purpose:The aim of this study was investigation of the subclinical cardiac involvement using 2D-speckle tracking and its associated factors in patients with normal systolic function by 2D TTE. Methods: In a cross-sectional descriptive-analytical study, 55 patients with sarcoidosis and 21 controls were evaluated by 2D-speckle tracking. The mean global circumferential and longitudinal strain(GLS) for the left ventricle was calculated as an average of 16 segments per patient. Results: The comparison of the mean 2D speckle tracking indices including , Average GCS, and also Average GLS showed a significant difference between the two groups. Also, the evaluation of each of the above indices with a specific cutoff point as well as a high sensitivity and acceptable specificity predicted the presence of sarcoidosis. The occurrence of changes in the above indices was independent of ventricular function by simpson in 2D echocardiography in these patients. Conclusion: The marked changes in the 2D speckle tracking parameters in patients with sarcoidosis can be of great value in the prediction of cardiac sarcoidosis or even its severity. The occurrence of the above-mentioned cardiac changes should be considered in patients with normal ventricular function. Early diagnosis of cardiac sarcoidosis can lead to early treatment, which can be a preventive factor for cardiovascular events such as sudden cardiac death. View largeDownload slide Abstract P1514 Figure. GLS of LV by 2D speckle tracking View largeDownload slide Abstract P1514 Figure. GLS of LV by 2D speckle tracking P1515 Quantification of stroke volume by three-dimensional echocardiography in patients with severe aortic stenosis. Any involvement regarding the classification according to the flow? C Santoro C Santoro University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain R Hinojar R Hinojar University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain A Marco Del Castillo A Marco Del Castillo University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain A Gonzalez-Gomez A Gonzalez-Gomez University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain A Garcia A Garcia University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain L Salido L Salido University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain E Ortega E Ortega University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain M Abellas M Abellas University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain JJ Jimenez-Nacher JJ Jimenez-Nacher University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain R Hernandez Antolin R Hernandez Antolin University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain JL Zamorano Gomez JL Zamorano Gomez University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain C Fernandez-Golfin C Fernandez-Golfin University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain Introduction. Stroke volume (SV) estimation is fundamental in patients with aortic stenosis (AS), not only to compute the aortic valve area (AVA) but also for its classification in normal or low flow. Three-dimensional echocardiography (3D) has shown its usefulness in this scenario for the most accurate calculation of AVA, however its clinical application has been poor, due to difficulties in acquisition and subsequent analysis. In recent years, technological improvement has facilitated the acquisition of images and automatic software has reduced the analysis and learning times needed. The aim of our study was to evaluate the usefulness of this new technology in the quantification of SV in patients with severe AS and the possible impact on the classification of the type of AS according to the gradient. Methods. From January 2016 to March 2017 consecutive patients with severe AS were prospectively included. All patients underwent a complete echocardiographic examination including the acquisition of a complete volume in 3D. The SV was calculated using the conventional Doppler method and from the 3D images by using a complete automated software. AS was considered low flow when SV was <35 ml / m2. Results Eighty-eight patients (mean age 83.4 ± 6.84, 61.8% women) were included. 3D analysis could be performed in 73.6% of patients. Significant differences were obtained in the estimated VL between the two techniques (68.4 ± 17.2 vs 66.2 ± 17.4, p <0.0001) with higher values obtained by 3D echocardiography. Although the percentage of patients identified as low-flow was similar (72% by Doppler measurement and 67.3% by 3D analysis), in 10 cases (11%) patients were misclassified as normal flow using the conventional Doppler method (p. = 0.05). Conclusions The automatic quantification of SV by 3D echocardiography in patients with severe AS is able to better characterize the type of AS according to the flow and to reclassify up to 10% of patients with normal flow at low flow. It can be therefore and especially useful to identify this type of patients, with different prognosis and therapeutic management. P1516 Direct quantification of aortic regurgitation by using a flow quantification software with 3-Dimensional color doppler echocardiography JM Song JM Song Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Republic of KS Lee KS Lee Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Republic of DH Yang DH Yang Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Republic of TY Ha TY Ha Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Republic of YJ Kim YJ Kim Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Republic of JW Kang JW Kang Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Republic of SA Lee SA Lee Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Republic of S Lee S Lee Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Republic of DH Kang DH Kang Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Republic of JK Song JK Song Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Republic of Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Republic of Background: Aortic regurgitation (AR) quantification is mostly dependent on color Doppler images of the AR jet. However, this is subject to the jet direction and the shape of the regurgitant orifice area. Although volumetric quantification can be used to estimate regurgitant volume or fraction, many sources of error may cause incorrect assessment. Purpose: This study aimed to validate the usefulness of nongated real-time 3-dimensional (3D) volume color flow Doppler (RT-VCFD) and eSie Flow in quantifying AR compared with phase-contrast cardiac magnetic resonance (CMR) imaging. Methods: RT-VCFD and CMR images were obtained in 36 patients with various degrees of AR. In RT-VCFD images, a disc-shaped region of interest designed to measure outflow was placed in the left ventricular outflow tract (flows directed away from the left ventricular apex). A second disc designed to measure incoming flow (toward the left ventricular apex) was positioned at the proximal aorta just above the aortic valve. This disc allows for the direct measurement of reverse flows (Fig. A). Using CMR images, forward and reversal aortic flow were quantified using through-plane phase-contrast velocity mapping, as previously described (Fig. B). The parameters of AR, including forward stroke volume, regurgitant volume, and regurgitant fraction, were measured using RT-VCFD and CMR imaging independently and blindly. Results: There were good correlations between RT-VCFD and CMR imaging in forward stroke volume (r = 0.725, p < 0.001), regurgitant volume (r = 0.713, p < 0.001), and regurgitant fraction (r = 0.573, p = 0.003). RT-VCFD tended to underestimate forward stroke volume and regurgitant volume, whereas it overestimated regurgitant fraction (Fig. C). Conclusion: Our pilot study demonstrated that RT-VCFD might be a feasible method of evaluating AR severity by directly measuring forward and reversal volumes. View largeDownload slide Abstract P1516 Figure. View largeDownload slide Abstract P1516 Figure. P1517 In patients with functional tricuspid regurgitation due to atrial fibrillation, right atrial three-dimensional volume is the most important determinant of tricuspid annulus dilation AC Guta AC Guta University of Medicine and Pharmacy Carol Davila, Bucharest, Romania RC Ochoa-Jimenez RC Ochoa-Jimenez Mount Sinai Medical Center, New York, United States of America P Aruta P Aruta University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy D Genovese D Genovese University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy K Nguyen K Nguyen University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy G Sammarco G Sammarco University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy V Guida V Guida University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy R Tenaglia R Tenaglia University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy C Palermo C Palermo University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy R Enache R Enache University of Medicine and Pharmacy Carol Davila, Bucharest, Romania D Bartos D Bartos University of Medicine and Pharmacy Carol Davila, Bucharest, Romania S Iliceto S Iliceto University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy L Badano L Badano University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy D Muraru D Muraru University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Mount Sinai Medical Center, New York, United States of America University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy Background. Functional tricuspid regurgitation (FTR) occurs as a consequence of right ventricular (RV) dilation and/or dysfunction. Recent data showed that atrial fibrillation (AF) itself may cause FTR through tricuspid annular (TA) dilatation. However, not all AF patients develop significant FTR, suggesting that the pathophysiologic determinants of TA enlargement in AF are still poorly understood. Methods. Fifty consecutive FTR patients (78 ± 8 years, 58% women) with persistent or chronic AF were prospectively enrolled and compared with 58 controls matched for gender and BSA (p > 0.3). Patients with poor acoustic window, organic valve diseases, pulmonary hypertension, congenital, ischemic heart disease, or devices were excluded. Right ventricular (RV) and atrial (RA) volumes by 3D echocardiography (3DE), as well as conventional measures of RV, RA and TA size were obtained. Tricuspid annulus (TA) area was quantified in end-diastole with previously validated prototype 3DE software. Results. There were 34% and 26% AF pts with moderate and severe FTR, respectively. As expected, pts had larger TA and right chamber dimensions in comparison with controls (Table). Nearly all pts (49/50), in comparison with controls, had dilated TA and RA, and only 29/50 and 9/50 pts had dilated or dysfunctional RV, respectively. Using current EACVI/ASE guidelines criteria, only 54%, 92% and 24% pts would have been classified with dilated TA, RA and RV, respectively. At multivariable analysis, the RA maximum volume was the most important determinant of TA area in AF pts, accounting alone for 55% of TA variance and the BSA for 10% of TA variance (F = 38.7, p < 0.0001). No significant correlations were found between TA area and age, gender or PAPS. Conclusions. RA dilation, and not RV dilation, seems to be the most important determinant of annular dilation and subsequent FTR development in AF patients. These findings may have important implications for rhythm control strategies to prevent RA remodeling and FTR worsening, as well as for patient selection for catheter-based therapy. Variable FTR pts with AF  (mean ± SD) Controls (mean ± SD) p value TA ED area (cm&sup2;/m&sup2;) 7.2 ± 0.2 4.8 ± 0.1 <0.0001 3D RAV max (ml/m&sup2;) 63 ± 3 29 ± 1 <0.0001 2D RAV max (ml/m&sup2;) 58 ± 3 27 ± 1 <0.0001 RVEDV (ml/m&sup2;) 70 ± 2 62 ± 2 0.0100 RV basal diameter (mm/m&sup2;) 24 ± 0.4 23 ± 0.4 0.0540 Variable FTR pts with AF  (mean ± SD) Controls (mean ± SD) p value TA ED area (cm&sup2;/m&sup2;) 7.2 ± 0.2 4.8 ± 0.1 <0.0001 3D RAV max (ml/m&sup2;) 63 ± 3 29 ± 1 <0.0001 2D RAV max (ml/m&sup2;) 58 ± 3 27 ± 1 <0.0001 RVEDV (ml/m&sup2;) 70 ± 2 62 ± 2 0.0100 RV basal diameter (mm/m&sup2;) 24 ± 0.4 23 ± 0.4 0.0540 ED: end-diastolic; RAV: right atrial volume; RVEDV: right ventricular end-diastolic volume. View Large Variable FTR pts with AF  (mean ± SD) Controls (mean ± SD) p value TA ED area (cm&sup2;/m&sup2;) 7.2 ± 0.2 4.8 ± 0.1 <0.0001 3D RAV max (ml/m&sup2;) 63 ± 3 29 ± 1 <0.0001 2D RAV max (ml/m&sup2;) 58 ± 3 27 ± 1 <0.0001 RVEDV (ml/m&sup2;) 70 ± 2 62 ± 2 0.0100 RV basal diameter (mm/m&sup2;) 24 ± 0.4 23 ± 0.4 0.0540 Variable FTR pts with AF  (mean ± SD) Controls (mean ± SD) p value TA ED area (cm&sup2;/m&sup2;) 7.2 ± 0.2 4.8 ± 0.1 <0.0001 3D RAV max (ml/m&sup2;) 63 ± 3 29 ± 1 <0.0001 2D RAV max (ml/m&sup2;) 58 ± 3 27 ± 1 <0.0001 RVEDV (ml/m&sup2;) 70 ± 2 62 ± 2 0.0100 RV basal diameter (mm/m&sup2;) 24 ± 0.4 23 ± 0.4 0.0540 ED: end-diastolic; RAV: right atrial volume; RVEDV: right ventricular end-diastolic volume. View Large P1518 Right ventricular remodelling in CHD-PAH patients using 3D speckle tracking P Moceri P Moceri University Hospital of Nice - Hospital Pasteur, Nice, France N Duchateau N Duchateau University Claude Bernard of Lyon, CREATIS, Lyon, France N Dursent N Dursent Hospital Haut Leveque, Bordeaux-Pessac, France X Iriart X Iriart Hospital Haut Leveque, Bordeaux-Pessac, France S Hascoet S Hascoet Surgical Centre Marie Lannelongue, Le Plessis Robinson, France D Baudouy D Baudouy University Hospital of Nice - Hospital Pasteur, Nice, France E Ferrari E Ferrari University Hospital of Nice - Hospital Pasteur, Nice, France M Sermesant M Sermesant INRIA, Asclepios Research Project, Sophia-Antipolis, France University Hospital of Nice - Hospital Pasteur, Nice, France University Claude Bernard of Lyon, CREATIS, Lyon, France Hospital Haut Leveque, Bordeaux-Pessac, France Surgical Centre Marie Lannelongue, Le Plessis Robinson, France INRIA, Asclepios Research Project, Sophia-Antipolis, France Funding Acknowledgements: AO2I 2013 du CHU de Nice, Grant from Actelion Pharmaceuticals Introduction: Survival in pulmonary arterial hypertension (PAH) relates to right ventricular (RV) function. Whereas prognosis differs widely between PAH associated with congenital heart disease (CHD) and other causes of PAH, only little is known about differences in right ventricular function. Purpose: We aimed at comparing right ventricular function assessed by 3D-speckle-tracking in patients with CHD-PAH, other PAH aetiologies and healthy controls; and assess the relationship between ventricular function and prognostic parameters. Methods: We performed a prospective multi-centric study between June 2015 and June 2017 recruiting 27 patients with CHD-PAH (3 had closed shunts, 24 had Eisenmenger syndrome; among these, 11 had a pre-tricuspid shunt whereas 13 had a post-tricuspid shunt), to compare with 27 patients with group 1 non-CHD related-PAH (group nPAH) and 27 controls matched on age and sex with the CHD-PAH group. Patients with complex CHD were excluded. All patients underwent 2D and 3D transthoracic echocardiography at baseline. 3D RV echocardiographic sequences were analysed by a commercial RV-specific software and output meshes were post-processed to extract and compare regional deformation data. Results: There was no significant age difference between the subgroups. In CHD-PAH patients, RV global area and longitudinal strain did not significantly differ as compared to nPAH (respectively p = 0.21 and p = 0.35) but RV global circumferential strain was significantly improved (p = 0.006). All strain components were impaired as compared to controls (p < 0.0001). In the whole patient population, over a mean follow-up of 27.6 ± 13.3 months, 10 patients (17.5%) died from PAH or were transplanted (including 2 patients with CHD-PAH). Global RV circumferential strain was significantly associated to death or transplant (p = 0.004, AUC 0.823; HR 1.41[1.09-1.81]). Conclusion: RV remodelling differs between adults with CHD-PAH and PAH from other aetiologies: 3D RV global circumferential strain is better in CHD-PAH patients and associated with survival free from transplant. View largeDownload slide Abstract P1518 Figure. Circumferential strain over RV meshes View largeDownload slide Abstract P1518 Figure. Circumferential strain over RV meshes P1519 Left Ventricular Longitudinal 3D strain: a surrogate of fibrosis in hypertrophic cardiomyopathy? MJ Nobre De Matos Pereira Vieira MJ Nobre De Matos Pereira Vieira Hospital Santarém, Cardiology, Santarém, Portugal M Carringhton M Carringhton Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal L Reis L Reis University Hospitals of Coimbra, Hospital Geral, Cardiology, Coimbra, Portugal R Teixeira R Teixeira University Hospitals of Coimbra, Hospital Geral, Cardiology, Coimbra, Portugal A Goncalves A Goncalves Faculty of Medicine University of Porto, Cardiovascular Research Center, Porto, Portugal L Goncalves L Goncalves University Hospitals of Coimbra, Hospital Geral, Cardiology, Coimbra, Portugal Hospital Santarém, Cardiology, Santarém, Portugal Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal University Hospitals of Coimbra, Hospital Geral, Cardiology, Coimbra, Portugal Faculty of Medicine University of Porto, Cardiovascular Research Center, Porto, Portugal Myocardial fibrosis is a known risk factor of adverse myocardial events in Hypertrophic Myocardiopathy (HCM). Late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) is the actual gold standard to cardiac fibrosis detection, but its availability isn´t always present. Purpose: We aim to study the role of 3D Speckle Tracking Echocardiography in detecting myocardial fibrosis assessed by LGE-CMR in patients with HCM. Methods: Observational, monocentric study, including 24 patients with HCM (12 men, mean age 58 ±17years). 3D Speckle Tracking Echocardiography was performed for phenotypic characterization and assessment of left ventricular function (LVEF), 3D volumes, 3D global longitudinal strain (GLS), 3D global circumferential strain (GCS) and 3D global radial strain (GRS). LGE-CMR was performed to assess left ventricular (LV) mass, LV function and the presence of LGE. Patients were divided in two groups: Group A with LGE-CMR consistent with myocardial fibrosis (46%; n = 11) and Group B (54%; n = 15) without LGE-CMR. Results: LGE-CMR consistent with myocardial fibrosis was observed in 46% (n = 11) of patients (Group A), with the remaining 15 patients (Group B) without signs of LGE. Regarding demographic characteristic, prevalence of cardiovascular risk factors, baseline echocardiography, 2D deformation parameters and LVEF assessed either by echocardiography or CMR no differences were observed between the groups (figure 1 – A). 3D Global longitudinal strain in group A patients was significantly lower than in group B patients (−14.3 ± 3.3% vs. −11.1 ± 2.9%, P = 0.036). Multivariate analysis showed that 3D GLS was an independent predictor of LGE (P= 0.042), with a good accuracy to detected fibrosis (ROC 0.73, 0.70 sensitivity and 0.80 specificity), when assuming a cut-off point of -12,7%. Other 3D derived parameters didn’t show any correlation with the presence of LGE (figure 1 – B, C). Conclusion: These results suggest that global 3D GLS might provide useful information about the presence of myocardial fibrosis in HCM patients, with eventual detection of patients with a higher risk of cardiovascular adverse events. View largeDownload slide Abstract P1519 Figure. View largeDownload slide Abstract P1519 Figure. P1520 Percutaneous closure of left atrial appendage: the role of real time 3d transesophageal echocardiograpy in 90 procedures L Lanzoni L Lanzoni "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy G Molon G Molon "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy G Canali G Canali "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy S Bonapace S Bonapace "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy A Chiampan A Chiampan "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy C Dugo C Dugo "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy A Cecchetto A Cecchetto "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy E Barbieri E Barbieri "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy Introduction: planning percutaneous closure of left atrial appendage (LAA) transesophageal echocardiography (TEE) is fundamental for anatomical screening, for choosing the right device, implantation guidance and follow up. RT3DTEE is utilized to guide these procedures in addition to multiplane two dimensional TEE. Methods: in our experience (90pts,mean age75,8 ± 5,2,CHA2DS2-VASc 4.07,HASBLED 3,7,Watchman 71,ACP/Amulet 19) 3DTEE before the procedure is fundamental for correct sizing of ostium, neck and depht. With the possibility to perform "en face" view and multiplanar reconstruction (fig.1) is possible to see LAA in three different dimensions in particolar in short axis for correct measurement of landing zone. With this reconstruction the neck zone of LAA appears with oval shape. During procedure 3DTEE guides the transseptal puncture: X plane imaging and simultaneous 3D (fig. 2 and 3) is able to demonstrate the tenting of fossa ovalis in the adequate site of puncture and afterwards the passage of the catheter in the left atrium. 3DTEE is useful to follow exactly the position of the catheter, i.e. an atraumatic pig tail (fig.4) reaching the LAA. Immediately after the deployment is important to assess the complete exclusion of LAA without any persistent communication with left atrium. If there a slight protusion of a shoulder of the device with an associated important posterior leak, the device could be withdrawed and repositioned in a more appropriate position (fig. 5).TEE follow –up is performed at standard intervals post device implantation to assess leak’s presence, dislodgement or thrombus formation on atrial side of the device (fig.6). Conclusions: in our experience RT3DTEE is a powerful, additional tool in every step of the procedure, that mat help in improving the safety profile e the good result of the procedures. View largeDownload slide Abstract P1520 Figure. Role of RT3dTEE for the procedure. View largeDownload slide Abstract P1520 Figure. Role of RT3dTEE for the procedure. P1521 Segmental analysis of the left ventricle by 3D-speckle tracking in cellular rejection after heart transplantation B Schulze B Schulze Heart and Diabetes Center NRW, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany B Fujita B Fujita Heart and Diabetes Center NRW, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany KT Puhlmann KT Puhlmann Heart and Diabetes Center NRW, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany U Schulz U Schulz Heart and Diabetes Center NRW, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany J Gummert J Gummert Heart and Diabetes Center NRW, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany L Paluszkiewicz L Paluszkiewicz Heart and Diabetes Center NRW, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany Heart and Diabetes Center NRW, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany Funding Acknowledgements: None Background: Two and three dimensional deformation parameters of LV have been reported to be significantly decreased in acute cellular rejection (ACR).Our objective was to evaluate all segments of the LV by 3D speckle tracking echocardiography (3D STE) in pts with biopsy-proven ACR. Methods: 60 heart transplant recipients with suitable 3D full volumes were prospectively examined by 3D STE shortly after endomyocardial biopsy (EMB) blinded to the results. Three groups were analysed: Group G0R = 20 pts. with ACR-grade 0R (no rejection), group G1R = 20 pts. with grade 1R (mild rejection) and group G2R = 20 pts with grade 2R (moderate rejection). No EMB was classified as grade 3 (severe rejection). A total of 48 segments were analyzed (16 each in the three groups longitudinal (GLS), circumferential (GCS) and radial (GRS)). Results: In 26 of 48 segments, we found a statistically significant correlation between strain reduction and the grade of rejection as assessed by Spearman’s correlation (10 segments in GLS and GRS, 6 segments in GCS). In GLS and GRS, these correlations were found in all mid-ventricular and apical segments, whereas no correlations were found in the 6 basal segments. Furthermore we found a significant reduction of GCS in the basal, mid and apical anterior-septal region. These findings were not influenced by paradoxical septum movement. Conclusions: 3D STE in ACR provided significant decrease of strain in all three dimensions of the LV with particular pronunciation of the mid-apical segments. Further analyses have to address this phenomenon and evaluate possible advantages over 2D STE. P1522 Left heart study based on left atrial and left ventricle three-dimensional speckle tracking deformation in hypertrophic cardiomyopathy and hypertrophic cardiomyopathy genotipe positive and fenotipe G Esposito G Esposito Umberto I Polyclinic of Rome, Rome, Italy P Piras P Piras UniversitÇÿ Rome Tre, Rome, Italy A Evangelista A Evangelista Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy L Teresi L Teresi Sapienza University of Rome, Rome, Italy PE Puddu PE Puddu Sapienza University of Rome, Rome, Italy C Torromeo C Torromeo Sapienza University of Rome, Rome, Italy Umberto I Polyclinic of Rome, Rome, Italy UniversitÇÿ Rome Tre, Rome, Italy Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy Sapienza University of Rome, Rome, Italy Background: Hypertrophic Cardiomyopathy (HCM) is one of the most prevalent heart diseases among those genetically determined. Whereas HCM impact on left ventricle (LV) is largely studied, investigations in HCM with genotipe positive and fenotipe negative (HCMG + P-) are less common, especially on left atrium (LA) . Purpose: This study evaluated the left heart (LH) function such as LA and LV deformation separately using 3DSTE in C, HCM and HCMG + P- patients. To assess pathophysiological consequences of HCM condition on LH , we investigated the impact of the genetic mutations on LH functioning in patients who have no clinical symptoms or structural abnormalities based on 2D echocardiography. Methods: We enrolled 82 C, 25 HCM and 11 HCMG + P- patients; 20 subjects in HCM group had an obstructive sub-aortic gradient (SUB_AO). 2D and 3DSTE echocardiography were performed sequentially, and for the latters we acquired LA and the corresponding LV, for each subject in the same clip. In the first part of the study we assessed LA and LV mechanical remodeling only in C and HCM, then in the second step we included also HCMG + P-. 3DSTE evaluated the peak and the time to peak of longitudinal (GLS,GLPDS) circumferential (GCS,GCPDS) and radial strain (GRS,GRPDS) during systolic phase for LV and in diastolic phase for LA. GRS was not acquired for LA because his thickness wall is too small. In order to define the correlation among structural remodeling and impaired function, we correlated 2D parameters with 3DSTE. Results: Concerning 2D parameters we found dilated LAVi, higher LVMASSi and increased E/e" ratio in HCM compared with C; when we included also HCMG + P-, we found the same results. 3DSTE variables showed impaired GLS and GCS in HCM for both LV and LA analysis and GRS only for LV; also GLPDS was increased in HCM subject. At pairwise analysis, GLS and GLPDS were in agreement to demonstrate normal deformation in HCMG + P- (similar with C) (see Figure 1). We also found a correlation among 3DSTE, LVMASSi, E/e" ratio and LAVi (GLS: vs LVMASSi ρ 0.381; vs LAVi ρ -0.446; vs E/e" ρ 0.312; GLPDS: vs LVMASSi ρ 0.338), whereas a positive association among 2D parameters and SUB_AO (SUB_AO: vs LVMASSi ρ 0.593; vs LAVi ρ 0.580; E/e": vs LVMASSi ρ 0.513; vs LAVi ρ 0.534). Increased LVMASSi might determine poor LV compliance with the development of diastolic dysfunction and finally increased LAVi; on the other hand, the presence of SUB_AO contributed to LH remodeling by determining higher LV pressures. These alterations might impact significantly on LH mechanical properties as detected by impaired 3DSTE parameters and may underline the relation between LH remodeling and reduced 3D strain. Conclusions: Main findings concern normal LH deformation in HCMG + P-despite the genetic mutations, and impaired deformation in HCM group compared to C; in particular, reduced strain were found both in LA and LV as a marker of worst mechanical remodeling with evidence of correlation with GLS and GCS. View largeDownload slide Abstract P1522 Figure. Result of statistical analysis View largeDownload slide Abstract P1522 Figure. Result of statistical analysis P1523 Biatrial remodelling in atrial fibrillation: evolution of three-dimensional volume according to rhythm outcome at 6-month follow-up L Soulat-Dufour L Soulat-Dufour Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France S Lang S Lang Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France S Ederhy S Ederhy Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France Y Ancedy Y Ancedy Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France A Beraud A Beraud Clinique Pasteur, Toulouse, France S Adavane-Scheuble S Adavane-Scheuble Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France M Chauvet-Droit M Chauvet-Droit Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France N Hammoudi N Hammoudi Sorbonne Université, APHP, Hôpital Pitié Salpêtrière, PARIS, France P Nhan P Nhan Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France M Charbonnier M Charbonnier Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France F Boccara F Boccara Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France A Cohen A Cohen Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France Clinique Pasteur, Toulouse, France Sorbonne Université, APHP, Hôpital Pitié Salpêtrière, PARIS, France Background. Atrial remodelling has been poorly investigated in atrial fibrillation (AF) and few studies have focused on bi-atrial remodelling in AF patients after cardioversion. Purpose. Our study aimed to evaluate left (LA) and right atrial (RA) remodelling in AF using evaluation of three dimensional (3D) atrial volumes according to rhythm outcome at mid-term follow-up. Material and methods. Two-dimensional (2D) and 3D transthoracic echocardiography (TTE) were performed in patients admitted for AF within 24 hours (M0) and 6 months (M6) after admission. RA and LA parameters were assessed: body surface area indexed maximum 3D volume (Max 3D RA Voli, Max 3D LA Voli) and indexed minimum 3D volume (Min 3D RA Voli, Min 3D LA Voli) ; atrial emptying fraction (3D RAEF, 3D LAEF), atrial expansion index (3D RAEI, 3D LAEI). Results. Forty-eight consecutive patients hospitalised for AF were prospectively included. The mean age was 62.7 ± 11.7 years, 36 (75%) patients were men, CHA2DS2-VASc risk score was ≥2 in 32 (66.7%) patients. At admission, LV ejection fraction (LVEF) was <40% in 8 (16.7%) patients. Three groups were then individualised: cardioversion success (SuccCV) in 25 (52.1%) patients (AF at M0 and sinus rhythm (SR) at M6); failure or contra indication to cardioversion (FailCV) in 13 (27.1%) patients (AF at M0 and AF at M6); spontaneous cardioversion prior to the first TTE (SponCV) in 10 (20.8%) patients (SR at M0 and SR at M6). Between M0 and M6 in group SuccCV, we found : 1/ a significant decrease in Max 3D RA Voli (respectively 33.31 ± 2.70ml/m² and 26.94 ± 2.00ml/m²; p= 0.0199), in Min 3D RA Voli (respectively 21.48 ± 2.03ml/m² and 14.59 ± 1.16ml/m²; p= 0.0008), in Max 3D LA Voli (respectively 45.19 ± 2.60ml/m² and 37.88 ± 2.50ml/m²;p =0.0010) and in Min 3D LA Voli (respectively 27.28 ± 2.29ml/m² and 20.26 ± 2.07ml/m²; p = 0.0021); 2/ a significant increase in 3D RAEF (respectively 34.3 ± 4. and 44.2 ± 4.3%; p = 0.0366), and 3D RAEI (respectively 65.2 ± 15.3 and 96.4 ± 15.4%; p = 0.0343), and no significant difference in 3D LAEF and 3D LAEI. There was no significant difference with regard to all these parameters in FailCV and SponCV groups. Conclusion. In patients admitted for AF, successfully cardioverted, we found a reversal of RA and LA remodelling at 6 months characterized by an improved 3D RAEF and RAEI and a decrease in atrial 3D volumes. This ongoing prospective study aims to correlate these findings with cardiovascular events at long-term follow-up. P1524 A real-time 3 dimensional transesophageal echocardiographic assessment and surgical treatment of discrete subaortic stenosis A Furugen A Furugen Sapporo Cardio Vascular Clinic, Cardiology, Sapporo, Japan HD Doi HD Doi Sapporo Cardio Vascular Clinic, Cardiovascular surgery, Sapporo, Japan Sapporo Cardio Vascular Clinic, Cardiology, Sapporo, Japan Sapporo Cardio Vascular Clinic, Cardiovascular surgery, Sapporo, Japan Introduction: Discrete Subaortic Stenosis (DSS) is a rare entity in adults with an unclear etiology and variable clinical presentations. We report two successful surgical cases of DSS in adults. Methods and Results: Two patients with the diagnosis of DSS in our hospital between September, 2014 and September, 2015. Both of them were females (30 and 46 yrs old), and had symptom with syncope and dyspnea. We assessed the geometry precise anatomical analysis of stenotic lesions of the left ventricular outflow tract (LVOT) in DSS using by the transthoracic (TTE) and the real-time 3-dimensional transesophageal echocardiogram (RT3D-TEE). Careful review of TTE and RT3D-TEE were indicative for the presence of possible subaortic membrane and showed LVOT obstruction. RT3D-TEE showed narrowed area and we measured by manual planimetry (0.94cm2 and 0.90cm2, respectively). Max pressure gradients in LVOT were 81mmHg and 49mmHg, respectively. Low-dose Dobutamine stress echocardiography showed pressure gradient increasing (153mmHg and 117mmHg, respectively) in LVOT. Both cases had mild aortic regurgitation. These patients underwent successful surgical resection of the subaortic membrane and concomitant selective myectomy without any complication. Postoperative LVOT gradient were controlled in 10mmHg or less and improved clinical symptoms. LVOT gradient were sustained good control at medium term. Conclusion: RT3D-TEE revealed DSS with LVOT obstruction. Surgical resection of the subaortic membrane and concomitant selective myectomy to achieve complete relief of the LVOT obstruction is a safe procedure and provide good result at medium term. View largeDownload slide Abstract P1524 Figure. 3D image View largeDownload slide Abstract P1524 Figure. 3D image P1525 Worsening pulmonary hypertension after chemotherapy was associated HJ Yoon HJ Yoon The Heart center of Chonnam National University Hospital, Gwangju, Korea Republic of HY Kim HY Kim The Heart center of Chonnam National University Hospital, Gwangju, Korea Republic of HJ Park HJ Park The Heart center of Chonnam National University Hospital, Gwangju, Korea Republic of JY Cho JY Cho The Heart center of Chonnam National University Hospital, Gwangju, Korea Republic of KH Kim KH Kim The Heart center of Chonnam National University Hospital, Gwangju, Korea Republic of JC Park JC Park The Heart center of Chonnam National University Hospital, Gwangju, Korea Republic of The Heart center of Chonnam National University Hospital, Gwangju, Korea Republic of Background and objectives: Multiple myeloma (MM) is known a hematological malignancy characterized by the neoplastic proliferation of plasma cells within bone marrow and extramedullary sites. The prognosis of MM is dependent on the stage of the disease mainly. Although cardiovascular pathology has been frequently associated with MM, pulmonary hypertension (PH), which is characterized by elevated pulmonary artery pressure (PAP) is not a commonly recognized complication. Therefore, the aim of the present study was to investigate the relation between PH and prognosis in the MM patient underwent chemotherapy. Methods: A total 107 patients treated after chemotherapy for multiple myeloma who performed echocardiography in baseline and follow up were divided into 4 groups according to development of PH; Normal-normal (n = 28, 54.0 ± 10.9 years), normal-PH (n = 17, 53.8 ± 10.8), PH-normal (n = 27, 56.1 ± 8.7) and PH-PH (n = 35, 57.9 ± 6.7). PH was defined as right ventricular systolic pressure of > 35mmHg via tricuspid regurgitation. Clinical, laboratory, and echocardiographic findings were compared between groups. Results: On follow up echocardiography after chemotherapy, PH was detected in 52 patients (48.5%). Newly developed PH was 17 cases (15.8%), and persistence or aggravated PH was 35 cases (37.5%). There was no significant difference in baseline characteristics such as age, sex, stage of disease, combined disease, and laboratory findings between groups. There was no significant difference in chemo-therapeutic regimen among groups except etoposide. In post chemotherapy echocardiography, diastolic parameters were significant deteriorated in PH groups. In Kaplan Meier analysis, mortality was higher in developing PH group and worsening PH group than in normal pressure group and normalized group respectively after chemotherapy (Fig). Conclusion: Worsening PH after chemotherapy was associated with mortality in MM. Therefore, careful monitoring and regular checkup of echocardiography should be performed in MM patients during therapy. View largeDownload slide Abstract P1525 Figure. View largeDownload slide Abstract P1525 Figure. P1526 Right atrial mechanics in pulmonary hypertension: the right prognostic marker? P Alves P Alves University Hospitals of Coimbra, Cardiology, Coimbra, Portugal V Marinho V Marinho University Hospitals of Coimbra, Cardiology, Coimbra, Portugal C Domingues C Domingues University Hospitals of Coimbra, Cardiology, Coimbra, Portugal R Baptista R Baptista University Hospitals of Coimbra, Cardiology, Coimbra, Portugal G Castro G Castro University Hospitals of Coimbra, Cardiology, Coimbra, Portugal L Goncalves L Goncalves University Hospitals of Coimbra, Cardiology, Coimbra, Portugal University Hospitals of Coimbra, Cardiology, Coimbra, Portugal Bakground: Right ventricular (RV) dysfunction is considered the major determinant of morbidity and mortality in pulmonary hypertension (PH). We assessed RV function and right atrium (RA) mechanics through 2-dimensional speckle-tracking echocardiography (2D-STE) in different groups of PH. Methods: All 91 PH incident cases followed in our center in the previous 5 years, group 1 (pulmonary arterial hypertension – PAH) (n = 63) and group 4 (chronic thromboembolic PH – CTEPH) (n = 28) were prospectively included. RV global longitudinal strain (RVLS) and RA mechanics were assessed through 2D-STE. Global atrial strain and atrial strain rate during systole (RA ɛsys and SRs), early diastole (RAɛe, SRe), and late diastole (RAɛa, SRa) were measured, corresponding to RA reservoir, conduit and contractile functions, respectively. Results: Mean age was 48 ± 19 years for PAH and 59.7 ± 16 years for CTEPH; 62% were women. Mean TAPSE and tricuspid regurgitation velocity (TRV) did not vary between groups. RVLS values were numerically better in CTEPH (-13 ± 4% vs -10 ± 9%, p = 0.170). RA mechanics was globally and statistically superior in CTEPH patients (table 1). BNP values (r2 = 0.53, p = 0.003) and RHC-derived cardiac index (CI) (r2 = 0.51, p = 0.039) at admission were correlated to RA ɛsys, but not to RVLS. In CTEPH patients, BNP values were only moderately correlated with RV diameter (r2 = 0.33, p = 0.005), TAPSE (r2 = 0.42, p = 0.003) and RA volume (r2 = 0.50, p < 0.001), but were strongly correlated with RVLS (r2 = 0.57, p= 0.018), RA ɛsys (r2 = 0.67, p = 0.027) and RAɛa (r2 = 0.59, p = 0.004). A similar pattern of correlation was seen for CI [TAPSE (r2= 0.3, p = 0.02), RVLS (r2 = 0.56, p = 0.041), RA ɛsys (r2 = 0.64, p = 0.036) and RAɛa (r2 = 0.58, p = 0.004)]. Pulmonary vascular resistance (PVR) was only associated to RAɛa (r2 = 0.56, p = 0.007) and mean pulmonary artery pressure (mPAP) to RAɛe (r2 = 0.72, p = 0.012). Conclusions: 2D-STE derived RVLS and RA mechanics demonstrated stronger correlations with established prognostic factors in CTEPH, as BNP or RHC-derived indexes, than currently used morphological parameters, as TAPSE or cavity dimensions. CTEPH PAH P value RA ɛsys 15.0 ± 4.2 12.4 ± 4.1 0.011 RA ɛe 7.5 ± 3.8 5.2 ± 3.6 0.009 RA ɛa 7.2 ± 2.9 6.1 ± 2.9 0.09 SRs 0.8 ± 0.4 0.6 ± 0.3 0.04 SRe -0.5 ± 0.4 -0.7 ± 0.9 0.55 SRa -1.3 ± 0.6 -0.8 ± 0.4 <0.001 CTEPH PAH P value RA ɛsys 15.0 ± 4.2 12.4 ± 4.1 0.011 RA ɛe 7.5 ± 3.8 5.2 ± 3.6 0.009 RA ɛa 7.2 ± 2.9 6.1 ± 2.9 0.09 SRs 0.8 ± 0.4 0.6 ± 0.3 0.04 SRe -0.5 ± 0.4 -0.7 ± 0.9 0.55 SRa -1.3 ± 0.6 -0.8 ± 0.4 <0.001 View Large CTEPH PAH P value RA ɛsys 15.0 ± 4.2 12.4 ± 4.1 0.011 RA ɛe 7.5 ± 3.8 5.2 ± 3.6 0.009 RA ɛa 7.2 ± 2.9 6.1 ± 2.9 0.09 SRs 0.8 ± 0.4 0.6 ± 0.3 0.04 SRe -0.5 ± 0.4 -0.7 ± 0.9 0.55 SRa -1.3 ± 0.6 -0.8 ± 0.4 <0.001 CTEPH PAH P value RA ɛsys 15.0 ± 4.2 12.4 ± 4.1 0.011 RA ɛe 7.5 ± 3.8 5.2 ± 3.6 0.009 RA ɛa 7.2 ± 2.9 6.1 ± 2.9 0.09 SRs 0.8 ± 0.4 0.6 ± 0.3 0.04 SRe -0.5 ± 0.4 -0.7 ± 0.9 0.55 SRa -1.3 ± 0.6 -0.8 ± 0.4 <0.001 View Large P1527 Changes in pulmonary artery pressure in haemodialysis patients after arteriovenous fistula flow reduction A Valerianova A Valerianova First Faculty of Medicine and General Teaching Hospital, 3rd Department of Internal Medicine, Prague, Czech Republic L Kovarova L Kovarova First Faculty of Medicine and General Teaching Hospital, 3rd Department of Internal Medicine, Prague, Czech Republic L Hruskova L Hruskova First Faculty of Medicine and General Teaching Hospital, Department of Nephrology, Prague, Czech Republic V Bednarova V Bednarova First Faculty of Medicine and General Teaching Hospital, Department of Nephrology, Prague, Czech Republic V Tuka V Tuka First Faculty of Medicine and General Teaching Hospital, 3rd Department of Internal Medicine, Prague, Czech Republic P Trachta P Trachta First Faculty of Medicine and General Teaching Hospital, 3rd Department of Internal Medicine, Prague, Czech Republic J Malik J Malik First Faculty of Medicine and General Teaching Hospital, 3rd Department of Internal Medicine, Prague, Czech Republic First Faculty of Medicine and General Teaching Hospital, 3rd Department of Internal Medicine, Prague, Czech Republic First Faculty of Medicine and General Teaching Hospital, Department of Nephrology, Prague, Czech Republic Funding Acknowledgements: Grant of the Agency of Health Research of the Czech Republic 17-31796A Background: Pulmonary hypertension affects about 50 % of patients with end-stage renal disease (ESRD) and is associated with 2-fold increase in mortality. Its aetiology is multifactorial – precapillary, postcapillary, and also hyperkinetic. The individual contribution of these mechanisms is not fully described. The hyperkinetic circulation is caused by volume overload, anaemia and by the presence of dialysis arteriovenous fistula (AVF). Some AVFs have very high flow volume (above 2.0 L/min) and are therefore indicated to surgical banding due to various causes. Purpose: To quantify the effect of high-flow AVF banding on pulmonary artery pressure. Material and methods: A cohort of ESRD patients with high-flow AVF indicated to surgical banding was examined by echocardiography before and 6 weeks after the procedure with the special interest in pulmonary artery pressure. AVF flow volume was measured also by ultrasound. Results: 16 patients were included into the study. All of them underwent an AVF banding, which led to a significant decrease of AVF blood flow volume (from 2788 ± 1273 mL/min to 1206 ± 531 mL/min, p˂0.0001) followed by significant decrease in cardiac index (from 4460 ± 1340 mL/min to 3449 ± 1053 mL/min/m2, p = 0.03). 13 (81%) patients had pulmonary hypertension prior to the procedure; in 8 (61%) of them the PASP normalized after AVF banding. In the whole group, the estimated pulmonary artery systolic pressure (PASP) decreased from 52 ± 14 mmHg to 36 ± 15 mmHg, p = 0.0002. Conclusions: Pulmonary hypertension is very frequent in high-flow AVFs. The surgical banding cured pulmonary hypertension in the majority. The contribution of AVF flow should be always suspected in ESRD patients with pulmonary hypertension. P1528 Abnormal endothelial glycocalyx is related to impaired arterial elasticity, contributing to severity of decompensation, diastolic dysfunction and the rehospitalisation in acute heart failure I Ikonomidis I Ikonomidis University of Athens, Athens, Greece D Vlastos D Vlastos National and Kapodistrian University of Athens, Medical School, 2nd Department of Cardiology, Attikon Hospital, Athens, Greece G Kostelli G Kostelli National and Kapodistrian University of Athens, Medical School, 2nd Department of Cardiology, Attikon Hospital, Athens, Greece G Bakosis G Bakosis National and Kapodistrian University of Athens, Medical School, 2nd Department of Cardiology, Attikon Hospital, Athens, Greece V Bistola V Bistola National and Kapodistrian University of Athens, Medical School, 2nd Department of Cardiology, Attikon Hospital, Athens, Greece J Parissis J Parissis National and Kapodistrian University of Athens, Medical School, 2nd Department of Cardiology, Attikon Hospital, Athens, Greece N Cholevas N Cholevas National and Kapodistrian University of Athens, Medical School, 2nd Department of Cardiology, Attikon Hospital, Athens, Greece S Vlachos S Vlachos National and Kapodistrian University of Athens, Medical School, 2nd Department of Cardiology, Attikon Hospital, Athens, Greece D Benas D Benas National and Kapodistrian University of Athens, Medical School, 2nd Department of Cardiology, Attikon Hospital, Athens, Greece M Varoudi M Varoudi National and Kapodistrian University of Athens, Medical School, 2nd Department of Cardiology, Attikon Hospital, Athens, Greece H Triantafyllidi H Triantafyllidi National and Kapodistrian University of Athens, Medical School, 2nd Department of Cardiology, Attikon Hospital, Athens, Greece J Lekakis J Lekakis National and Kapodistrian University of Athens, Medical School, 2nd Department of Cardiology, Attikon Hospital, Athens, Greece E Iliodromitis E Iliodromitis National and Kapodistrian University of Athens, Medical School, 2nd Department of Cardiology, Attikon Hospital, Athens, Greece University of Athens, Athens, Greece National and Kapodistrian University of Athens, Medical School, 2nd Department of Cardiology, Attikon Hospital, Athens, Greece Background: Arterial stiffening and endothelial dysfunction constitute key underlying mechanisms of ventricular-arterial decoupling and abnormal left ventricular loading in the context of acute heart failure. However, their diagnostic and prognostic significance have not been fully defined. Methods: We examined 50 patients hospitalised for acute decompensated heart failure and 30 healthy controls. Patients were examined on the day of admission in the hospital and on the day of their discharge. We measured: a) the carotid-femoral pulse wave velocity (PWV); b) the augmentation index (Aix); c) the perfusion boundary region (PBR-micrometers) of the sublingual arterial microvessels as a marker of endothelial glycocalyx thickness; and d) E’ and A’ of the mitral annulus by Tissue Doppler echocardiography. Results: Endothelial glycocalyx integrity was significantly impaired in the patients with decompensated AHF (PBR 5-25= 2.09 vs 1.92, PBR 5-9= 1.15 vs 1.09, PBR 10-19= 2.21 vs 2.03, PBR 20-25= 2.70 vs 2.42, p < 0.05 for all comparisons). Increased PBR was related with increased PWV at discharge (r = 0.53, p= 0.04). Additionally, PWV on admission was significantly positively associated with Forrester classification at discharge (r= 0.54, p= 0.01), while PWV at discharge was significantly positively associated with E’ as assessed by TDI (r = 0.799, p= 0.006). Lastly, there was a significant correlation of Aix, as well as of E’/A’ ratio at discharge with the risk of rehospitalisation (r=-0.507, p= 0.04, r=-0.57, p= 0.04 respectively). Conclusion: Abnormal endothelial glycocalyx is associated with impaired arterial elasticity in AHF. Arterial elasticity and endothelial function are impaired in patients with acute decompensated heart failure and may be related to the severity of decompensation, LV diastolic dysfunction, and the risk of rehospitalisation. P1530 A comparison of right ventricular function between before and after left ventricular assist device implantation: assessment by right ventricular pressure volume curve E Kanemaru E Kanemaru Yokohama City University Hospital, Anesthesiology, Yokohama, Japan K Yoshitani K Yoshitani National Cerebral and Cardiovascular Center, Department of Anesthesiology, Suita, Osaka, Japan S Kato S Kato National Cerebral and Cardiovascular Center, Department of Anesthesiology, Suita, Osaka, Japan Y Inatomi Y Inatomi National Cerebral and Cardiovascular Center, Department of Anesthesiology, Suita, Osaka, Japan Y Ohnishi Y Ohnishi National Cerebral and Cardiovascular Center, Department of Anesthesiology, Suita, Osaka, Japan Yokohama City University Hospital, Anesthesiology, Yokohama, Japan National Cerebral and Cardiovascular Center, Department of Anesthesiology, Suita, Osaka, Japan Background/Purpose Right ventricular failure (RVF) is significantly associated with morbidity and mortality after left ventricular assist device implantation (LVADI). However, it remains to be resolved whether LVADI itself would cause RVF. Analysis of RV pressure volume curve (PVC) would be the most reliable methodology to evaluate RV function, but there are few data evaluating RV function after LVADI by PVC. Recently, three-dimensional transesophageal echocardiography (3D-TEE) has enabled accurate assessment of RV volume and function intraoperatively. Therefore, we aimed to depict PVC by using 3D-TEE and pulmonary artery catheter and examine RV function after LVADI. Methods We enrolled 22 patients who underwent LVADI between September 2016 and January 2018. RV function was examined before and after LVADI intraoperatively. After basic RV images were recorded by 3D-TEE, RV volumes and ejection fraction were analyzed by offline. RV pressure was obtained by pulmonary artery catheter at the same heartbeat. PVC was depicted by the combination of the RV volume and pressure. Stroke work index (SWI) was calculated by integrating PVC. We compared RV function between before and after LVADI. Results Figure 1 shows the typical difference of PVC between before and after LVADI. The differences of echocardiographic and hemodynamic parameters between before and after LVADI are shown in Table 1. Although SWI was similar, the shape of PVC changed significantly (systolic RV pressure and RV end-systolic volume decreased significantly (P < 0.01)). Heart rate increased significantly (P < 0.01). Consequently, RV minute work index (SWI × HR) increased significantly (P < 0.01). Conclusion: RVF was not caused by LVADI. Although SWI was similar between before and after LVADI, RV minute work index increased significantly to increase its cardiac output and match LVAD flow. Table 1. pre post P value Cardiac index (l/min/m2) 2.0 ± 0.7 3.4 ± 0.6 <0.01 Heart rate (beats/min) 69.9 ± 13.3 99.3 ± 9.5 <0.01 RVEF (%) 26.3 ± 13.3 32.2 ± 13.1 <0.01 RV end-systolic volume (ml) 139.8 ± 91.6 120.8 ± 85.0 <0.01 RV end-diastolic volume (ml) 179.7 ± 94.2 166.7 ± 87.3 0.1 Systolic RVP (mmHg) 38.4 ± 9.1 31.9 ± 5.3 <0.01 Diastolic RVP (mmHg) 9.3 ± 4.2 7.6 ± 3.4 0.09 SWI (mmHg･ml/m2) 400.0 ± 169.8 442.5 ± 220.1 0.41 RVMWI (mmHg･ml/m2/min) 27625.8 ± 11871.6 43641.5 ± 21426.9 <0.01 pre post P value Cardiac index (l/min/m2) 2.0 ± 0.7 3.4 ± 0.6 <0.01 Heart rate (beats/min) 69.9 ± 13.3 99.3 ± 9.5 <0.01 RVEF (%) 26.3 ± 13.3 32.2 ± 13.1 <0.01 RV end-systolic volume (ml) 139.8 ± 91.6 120.8 ± 85.0 <0.01 RV end-diastolic volume (ml) 179.7 ± 94.2 166.7 ± 87.3 0.1 Systolic RVP (mmHg) 38.4 ± 9.1 31.9 ± 5.3 <0.01 Diastolic RVP (mmHg) 9.3 ± 4.2 7.6 ± 3.4 0.09 SWI (mmHg･ml/m2) 400.0 ± 169.8 442.5 ± 220.1 0.41 RVMWI (mmHg･ml/m2/min) 27625.8 ± 11871.6 43641.5 ± 21426.9 <0.01 RVMWI: right ventricular minute work index View Large Table 1. pre post P value Cardiac index (l/min/m2) 2.0 ± 0.7 3.4 ± 0.6 <0.01 Heart rate (beats/min) 69.9 ± 13.3 99.3 ± 9.5 <0.01 RVEF (%) 26.3 ± 13.3 32.2 ± 13.1 <0.01 RV end-systolic volume (ml) 139.8 ± 91.6 120.8 ± 85.0 <0.01 RV end-diastolic volume (ml) 179.7 ± 94.2 166.7 ± 87.3 0.1 Systolic RVP (mmHg) 38.4 ± 9.1 31.9 ± 5.3 <0.01 Diastolic RVP (mmHg) 9.3 ± 4.2 7.6 ± 3.4 0.09 SWI (mmHg･ml/m2) 400.0 ± 169.8 442.5 ± 220.1 0.41 RVMWI (mmHg･ml/m2/min) 27625.8 ± 11871.6 43641.5 ± 21426.9 <0.01 pre post P value Cardiac index (l/min/m2) 2.0 ± 0.7 3.4 ± 0.6 <0.01 Heart rate (beats/min) 69.9 ± 13.3 99.3 ± 9.5 <0.01 RVEF (%) 26.3 ± 13.3 32.2 ± 13.1 <0.01 RV end-systolic volume (ml) 139.8 ± 91.6 120.8 ± 85.0 <0.01 RV end-diastolic volume (ml) 179.7 ± 94.2 166.7 ± 87.3 0.1 Systolic RVP (mmHg) 38.4 ± 9.1 31.9 ± 5.3 <0.01 Diastolic RVP (mmHg) 9.3 ± 4.2 7.6 ± 3.4 0.09 SWI (mmHg･ml/m2) 400.0 ± 169.8 442.5 ± 220.1 0.41 RVMWI (mmHg･ml/m2/min) 27625.8 ± 11871.6 43641.5 ± 21426.9 <0.01 RVMWI: right ventricular minute work index View Large View largeDownload slide Abstract P1530 Figure. View largeDownload slide Abstract P1530 Figure. P1533 Ventriculo-arterial coupling in patients with acute pulmonary edema and preserved ejection fraction AE Vijiiac AE Vijiiac Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania C Neagu C Neagu Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania M Dorobantu M Dorobantu Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania Funding Acknowledgements: CREDO Project ID:49182, financed by the National Authority of Scientific Research and Innovation,co-financed by the European Regional Development Fund Ventricular-arterial coupling (VAC) is defined as the ratio between the arterial elastance and the end-systolic ventricular elastance and it reflects the efficiency of the energy transfer from the left ventricle to the aorta. Noninvasive assessment of VAC can be derived from a routine echocardiogram. Its prognostic role was studied in different clinical scenarios and the ventricular-vascular uncoupling was associated with poor clinical outcomes and suboptimal response to therapy. Information regarding the changes of VAC in patients with acute heart failure and preserved ejection fraction (EF) has been scarce so far. We sought to assess the VAC in a cohort of patients with acute pulmonary edema and preserved EF and compare it with a normal reference group. We included 50 consecutive patients with acute pulmonary edema and preserved EF in our study. Patients with severe aortic or mitral valve disease were not considered eligible. Neither of the patients had angina on admission, nor did they have previous history of ischemic heart disease. We performed thorough echocardiographic evaluation on admission for these patients and we assessed the VAC non-invasively, as the ratio between the arterial elastance and the ventricular elastance. The control group consisted of 50 subjects with no heart disease. We used T-test to compare parameters between the two groups. The mean age in the study group was 76 ± 12.14 years, while the mean age in the control group was 40 ± 13.38 years (p < 0.0001). Both groups had preserved EF: the mean EF was 55.2% ± 7.2% in the study group and 54.8% ± 5.1% in the control group (p = 0.72). The blood pressure (BP) on admission was higher in the acute pulmonary edema group: 180.9 ± 39.8 mm Hg, versus 122.2 ± 13.8 mm Hg in the control group for the systolic BP (p < 0.0001) and 94.1 ± 24.8 mm Hg, versus 73.8 ± 10.6 mm Hg in the control group for the diastolic BP (p < 0.0001). The arterial elastance was higher in the acute pulmonary edema group: 2.65 ± 1.19, versus 1.50 ± 0.35 in the normal group (p < 0.0001). The ventricular elastance was also higher in the acute pulmonary edema group: 3.98 ± 1.98, versus 1.93 ± 0.66 in the normal group (p < 0.0001). However, the non-invasive VAC was significantly lower in the acute pulmonary edema group: 0.6916 ± 0.168 versus 0.806 ± 0.139 in the normal group (p = 0.0003). VAC provides us with a better understanding of the ventricular and vascular mechanics and with a pathophysiological insight of acute pulmonary edema in patients with preserved EF. This parameter should be routinely analyzed in such patients, since it is derived from simple echocardiographic measurements. Impaired VAC may serve as a base for intensive cardiovascular prevention or even tailored therapy in patients with cardiovascular risk factors, while in patients with acute pulmonary edema and preserved EF, it might unravel potential therapeutic targets and thus guide the therapeutic strategy, should it be studied more extensively. P1534 Bicuspid aortic valve disease - is there any association with neoplasia? J Rigueira J Rigueira Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal A Nunes-Ferreira A Nunes-Ferreira Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal I Aguiar-Ricardo I Aguiar-Ricardo Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal I Santos-Goncalves I Santos-Goncalves Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal J Agostinho J Agostinho Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal R Santos R Santos Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal R Placido R Placido Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal C David C David Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal FJ Pinto FJ Pinto Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal AG Almeida AG Almeida Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal Introduction: The genetic background underlying bicuspid aortic valvulopathy (BAV) is still poorly understood. Associations between BAV and mutations in the NOTCH1 gene have been described, which is known to have a pro-oncogenic function in several tumors, especially genito-urinary tumors such as the breast and uterus. However, there is no evidence to support the association of neoplasia with BAV. Objective: To evaluate the prevalence of neoplasia in patients (pts) with BAV and to identify its impact on the prognosis. Methods: Retrospective single centre study of patients with BAV documented on echocardiogram in the last 8 years. Demographic, clinical and echocardiographic data were obtained. We searched for the patients with a history of neoplasia, the type of neoplasia and its relation with the valvular phenotype. Cox regression was used to establish a relationship with the prognosis and the prevalence of neoplasms with the global population was compared using the one sample T-test. Results: A population of 200 consecutive pts (mean age 50.7 ± 15.2 years, 74% men), was included. Most has valvular dysfunction (regurgitation in 46.8%, stenosis in 27.2% and mixed disease in 4.6 %) and 46.2% had ascending aorta dilation. 69.1% had type 1 BAV, 25.8% type 2 and 4.6% type 3. The prevalence of neoplasia in this population was 13.5%, mainly genito-urinary (46.1%) and gastro-intestinal tract (30,8%). The most frequent neoplasms were neoplasia of the uterus (21.7%), breast (17.4%), colorectal (17.4%) and kidney (8.7%). After excluding confounding factors such as the diagnosis of neoplasia before the performance of the first echocardiogram, the total prevalence of neoplasia was 9,5%. The prevalence of cancer in pts with BAV is significantly higher than the overall prevalence of neoplasia (9.5% vs. 0.05%, p <0.001). Also of relevance is the young mean age of pts with BAV, emphasizing the importance of cancer in this early age. We found a relationship between BAV type 1 and cancer, with BAV type 1 being identified in 74% of patients with neoplasia. By univariate Cox regression, there was a tendency for neoplasia to be a predictor for surgery (p = 0.09, HR 2.2, 95% CI 0.75-6.2), with no association with endocarditis or mortality. Conclusion: the prevalence of neoplasia was higher in our sample of patients with BAV compared to the general population, with an association with BAV type 1 and a predominance of genito-urinary and gastro-intestinal tract neoplasias. These findings suggest the need to study the genetic background of these pts in an attempt to clarify the association between neoplasia and BAV. P1535 Prognostic value of echocardiography in systemic sclerosis: the right heart and pulmonary circulation matter L Gargani L Gargani CNR, Institute of Clinical Physiology, Pisa, Italy C Bruni C Bruni Careggi University Hospital (AOUC), Florence, Italy A Moreo A Moreo Niguarda Ca" Granda Hospital, Cardiology, Milan, Italy B De Chiara B De Chiara Niguarda Ca" Granda Hospital, Cardiology, Milan, Italy L Belloli L Belloli Niguarda Ca" Granda Hospital, Rheumatology, Milan, Italy F Casadei F Casadei Niguarda Ca" Granda Hospital, Cardiology, Milan, Italy S Guiducci S Guiducci Careggi University Hospital (AOUC), Florence, Italy OM Epis OM Epis Niguarda Ca" Granda Hospital, Rheumatology, Milan, Italy E Bossone E Bossone Cardarelli Hospital, Naples, Italy M Matucci-Cerinic M Matucci-Cerinic Careggi University Hospital (AOUC), Florence, Italy CNR, Institute of Clinical Physiology, Pisa, Italy Careggi University Hospital (AOUC), Florence, Italy Niguarda Ca" Granda Hospital, Cardiology, Milan, Italy Niguarda Ca" Granda Hospital, Rheumatology, Milan, Italy Cardarelli Hospital, Naples, Italy Funding Acknowledgements: Italian Ministry of Health - RF-2011-02350341 Background: Cardiac involvement is frequent in patients with systemic sclerosis (SSc) and is associated with poor prognosis. Echocardiography is the routine imaging tool to detect cardiac involvement and pulmonary hemodynamics. Purpose: To evaluate the prognostic value of a comprehensive standard echocardiogram to predict cardiac events in SSc patients without known cardiac involvement. Methods: Three hundred and sixteen SSc patients (mean age 53 ± 15 years, 91.7% females) with a thorough clinical assessment underwent a comprehensive standard echocardiogram with Tissue Doppler Imaging (TDI), according to the European Association of Cardiovascular Imaging (EACVI) recommendations. Patients with known cardiac involvement and/or a diagnosis of pulmonary arterial hypertension (PAH) were excluded. Patients were followed-up and cardiac events were recorded as new onset of heart failure (HF), development of PAH, significant ventricular or supraventricular arrhythmias requiring therapy or implantable cardioverter defibrillator (ICD). Results: Mean follow-up was 30.3 ± 25.7 months. During the follow-up a total of 46 events occurred. Echocardiographic predictors of cardiac events by univariate analysis were E/e’ (e’ as mean of TDI lateral and septal values), right ventricular (RV) end-diastolic diameter, pulmonary artery systolic pressure (PASP), inferior vena cava (IVC) diameter, and presence of even trivial pericardial effusion. PASP, IVC and pericardial effusion were independent predictors at multivariate analysis (see Figure). Conclusions: A complete standard echocardiogram provides prognostic information in patients with SSc. In particular, data related to pulmonary hemodynamics are independent predictors of further cardiac events, even in patients without known PAH. View largeDownload slide Abstract P1535 Figure. View largeDownload slide Abstract P1535 Figure. P1536 Echocardiographic assessment of Takotsubo syndrome female rat model induced by isoprenaline S Borodzicz S Borodzicz Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland R Glowczynska R Glowczynska 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland K Czarzasta K Czarzasta Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland M Wojciechowska M Wojciechowska Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland A Kolodzinska A Kolodzinska 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland G Opolski G Opolski 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland A Cudnoch-Jedrzejewska A Cudnoch-Jedrzejewska Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland Funding Acknowledgements: The research is funded by "Diamond Grant" from the Polish Ministry of Science and Higher Education (project No. DI2015 003045). Background: Takotsubo syndrome (TS) is an acute and usually reversible left ventricular (LV) failure syndrome occurring mainly in postmenopausal women. TS is induced by emotional or physical stress, therefore the animal models of TS induced by intraperitoneal injection of non-selective beta receptor agonist, isoprenaline, has been established. Purpose: The aim of the study was to evaluate echocardiographic features of TS in female rat model and to compare echocardiographic features between fertile and ovariectomized rats. Methods: Sprague Dawley female rats, 9 weeks old, were ovariectomized or sham operated and after 3 weeks injected intraperitoneally with a single dose of 150 mg/kg isoprenaline (T group). The control rats were ovariectomized or sham operated and injected with 0.9% NaCl (C group). Assessment of echocardiographic features typical for TS (regional LV contraction abnormalities) was performed 6 hours (T6h), 12 hours (T12h), 24 hours (T24h), 72 hours (T72h) and 10 days (T10d) after ISO administration. Results: In T group we observed features of typical apical akinesia, as well as basal, mid-basal and mixed variant of TS (with both apical and basal akinesia) (Figure 1). Comparison between T ovariectomized and T sham-operated rats with control group revealed differences in regard to LV dimensions, stroke volume, velocities in pulmonary artery and aorta. Conclusions: The study revealed significant differences in echocardiographic features of TS in regard to the presence of sex hormones in female rat model of TS. View largeDownload slide Abstract P1536 Figure 1 View largeDownload slide Abstract P1536 Figure 1 P1537 Parameters of ventricular-arterial coupling are associated with NTproBNP and atrial geometry in patients with decompensated heart failure O Lukina O Lukina Peoples` Friendship University of Russia (RUDN University), moscow, Russian Federation A Soloveva A Soloveva Peoples` Friendship University of Russia (RUDN University), moscow, Russian Federation I Meray I Meray Peoples` Friendship University of Russia (RUDN University), moscow, Russian Federation S Villevalde S Villevalde Peoples` Friendship University of Russia (RUDN University), moscow, Russian Federation Z Kobalava Z Kobalava Peoples` Friendship University of Russia (RUDN University), moscow, Russian Federation Peoples` Friendship University of Russia (RUDN University), moscow, Russian Federation Objective: The interaction of the left ventricle (LV) with the arterial system, termed ventricular-arterial coupling (VAC), is a central determinant of cardiovascular performance and cardiac energetics. Congestive heart failure (HF) modify the structure and function of LV. The aim of the study was to assess VAC parameters in patients with decompensated HF. Methods: In 355 patients admitted with decompensated HF (198 male, 72 ± 11 years (M ± SD), arterial hypertension 94%, previous myocardial infarction (MI) 42%, HF with preserved ejection fraction (HFpEF) 36%, HF with reduced EF (HFrEF) 44%, HF with mid-range EF (HFmrEF) 20%, diabetes 40%, NTproBNP 3763 (1801;5486) pg/ml, serum creatinine 108 (92;134) µmol/l, eGFR 51 (41;64) ml/min/1.73 m2, hospital length of stay 10.0 (8.0;12.0) days, in hospital ACE inhibitors 79%, angiotensin receptor blockers 16%, beta-blockers 94%, aldosterone receptor antagonists 76%, iv loop diuretics 88%, iv nitrates 48%) parameters of VAC were assessed by 2-dimentional echocardiography. VAC is expressed as the ratio between arterial elastance (Ea) and end-systolic LV elastance (Ees), optimal range is considered as 0.5-1.2. Wilcoxon test was considered significant if p < 0.05. Results: In the general group, the values of Ea, Ees and VAC were 2.2 (1.7; 2.9) mmHg/ml/m2, 1.8 (1.0; 3.0) mmHg/ml/m2 and 1.32 (0.75; 2.21) respectively. 55% of patients had VAC > 1.2 (predominantly patients with HFrEF), 8% had index of VAC < 0.5 (all patients with HFpEF). Normal VAC had 78, 42 and 1% patients with HFpEF, HFmrEF and HFrEF. Groups with normal VAC and VAC < 0.5 did not differ by studied parameters. Patients with VAC > 1.2 compared with normal and low VAC were more likely men (69 vs 40%; p < 0,001), smokers (33 vs 18%; p < 0,001), had higher incidence of MI (55 vs 26%; p < 0,001), levels of heart rate (97 ± 25 vs 88 ± 20 beats; p < 0,01), NTproBNP (4458 (2855;5926) vs 2817 (1313;4588) pg/ml; p < 0,01), creatinine (115 (94;137) vs 103 (90;128) µmol/l; p < 0,01), PASP (54 (40;65) vs 43 (31;67) mmHg; p < 0,05), sizes of left atrial (LA) (48 (45;52) vs 45 (42;49) mm; p < 0,001) and right ventricular (RV) (33 (30;37) vs 30 (27;35) mm; p < 0,001) and had lower levels of SBP (133 ± 27 vs 148 ± 32 mmHg; p < 0,001), DBP (79 ± 13 vs 83 ± 14 mmHg; p < 0,001), HDL (0.9 (0.7;1.1) vs 1.0 (0.9;1.3) mmol/l; p < 0,001), EF (32 ± 9 vs 58 ± 9 %; p < 0,001). There was significant correlation between value of VAC and levels of NTproBNP (R = 0.35), hematocrit (R = 0.29), hemoglobin (R = 0.26), SPAP (R = 0.18), sizes of LA (R = 0.32) and RA (R = 0.32). Conclusion: Patients admitted with decompensated HF with VAC > 1.2 more often had reduced EF. This group of patients differed from patients with normal and reduced VAC by higher values of NTproBNP, LA, RV. P1538 Abnormal coronary flow during transthoracic echocardiography reveals high-risk patients amongst groups without signs of CAD A Zagatina A Zagatina Saint Petersburg State University Clinic of advanced medical technologies, Cardiology, Saint Petersburg, Russian Federation N Zhuravskaya N Zhuravskaya Saint Petersburg State University Clinic of advanced medical technologies, Cardiology, Saint Petersburg, Russian Federation O Guseva O Guseva Northwestern Medical University n.a. I.I. Mechnikov, St. Petersburg, Russian Federation E Kalinina E Kalinina Northwestern Medical University n.a. I.I. Mechnikov, St. Petersburg, Russian Federation D Shmatov D Shmatov Saint Petersburg State University Clinic of advanced medical technologies, Cardiosurgery, Saint Petersburg, Russian Federation Saint Petersburg State University Clinic of advanced medical technologies, Cardiology, Saint Petersburg, Russian Federation Northwestern Medical University n.a. I.I. Mechnikov, St. Petersburg, Russian Federation Saint Petersburg State University Clinic of advanced medical technologies, Cardiosurgery, Saint Petersburg, Russian Federation Background: Several recent studies have reported the opportunity for diagnosing significant narrowing of the coronary arteries without stress testing using local flow acceleration. However, there is a lack of information about the prognostic value of this data. The aim of the study was to define the prognostic value of local flow acceleration in the left main (LM) or left anterior descending (LAD) or circumflex (Cx) arteries measured by Doppler method during routine echocardiography amongst a subgroup with no signs of CAD. Methods: This is a part of coronary flow velocity prognostic value prospective study. All consecutive patients who were referred to echocardiography were screened for the study by additional scans of coronary arteries. The exclusion criteria was established CAD (history of myocardial infarction and/or angiography with significant stenoses and/or angina) or high pretest probability of CAD. One hundred and seventy-eight consecutive patients were prospectively included in the study (109 women, 56 ± 13 years old). All frames and clips were digitally recorded for offline analysis, which was performed by an independent expert specialist, blind to clinical or echocardiographic data. The follow-up period was 3 years. All-cause death, nonfatal myocardial infarction, and revascularization were defined as major adverse cardiac events (MACE). Results: Forty-three patients (Group 1) had sites of aliasing flow with a velocity of more than 65 cm/s, 135 patients (Group 2) had no such sites. All-cause deaths or MI occurred more frequently in Group 1 (11.6% vs. 1.5%; p < 0.003, between Groups 1 and 2, respectively). Patients in Group 1 had significantly higher death/MI/coronary bypass surgery (30.2% vs. 1.5%; p < 0.0000001 between Group 1 and 2, respectively). The rates of MACE were 50.0% vs. 1.5%; p < 0.0000001 in Groups 1 and 2. Conclusion: Coronary flow velocity assessment during routine echocardiography could help to recognize high-risk patients amongst the population without signs of CAD. P1539 A monocentric echocardiographic study on Ehlers-Danlos syndrome M Squillace M Squillace IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy G Malanchini G Malanchini IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy E Gherbesi E Gherbesi IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy FB Sozzi FB Sozzi IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy C Gobbi C Gobbi IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy M Schiavone M Schiavone IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy R Meazza R Meazza IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy M Strata M Strata IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy P Perolo P Perolo IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy LMC Diehl LMC Diehl IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy F Lombardi F Lombardi IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy Background: The Ehlers–Danlos syndromes (EDS) are a heterogeneous group of heritable connective tissue disorders, they affect about 1 over 5,000 people. Aortic root (AR) dilation is known as the main abnormality, but also mitral valve prolapse (MVP) has been described. Purpose: To describe the echocardiographic findings in a large cohort of EDS patients and to estimate the incidence of AR dilation and other cardiac abnormalities. Secondly, to evaluate potential echocardiographic predictors of AR dilatation in EDS. Methods: All consecutive patients with EDS referred for echocardiography at our centre between March 2015 and May 2018 were included in the study. Patients underwent comprehensive two-dimensional and Doppler echocardiography. Linear regression analysis was used to investigate potential relationships between variables. Statistical analysis was performed using Statview 5.0.1. Results: The study included 351 subjects (75,8% female) with a mean age of 39.6 years (DS ±12.2). Aortic dimension over body surface area (BSA) was, on average, in the normality range. Only 39 patients (11%) had a dilated aortic root. Two patients had mild-to-moderate aortic regurgitation, 16 only mild regurgitation, which was found to be the most frequent valvular abnormality. Left atrial enlargement was present in six patients. Seven patients (2%) had an echocardiographic diagnosis of MVP, but only two of them had a mitral regurgitation greater than mild. On average the patients had a good biventricular cardiac function (Table 1). No significative differences were found between patients with and without aortic root dilation nor with or without aortic regurgitation. In a multivariate analysis, including the above-mentioned measures as fixed values, LVEDD was found to be a good predictor of AR diameter (β coefficient : 0,419; p < 0,001). Conclusion: Patients with EDS seem to have a normal biventricular cardiac function. MVP and AR dilatation are relatively uncommon in this cohort. The correlation between LVEDD and AR dimension gives us a clue in performing routinely evaluation of patients affected by Ehlers–Danlos syndromes. Table 1 Variables Mean± SD Aortic root diameter/BSA (mm/sqm) 16.3 ± 2.3 End diastolic diameter/BSA (mm/sqm) 25.2 ± 3.1 End diastolic volume/BSA (ml/sqm) 45.6 ± 10.1 Ejection fraction (%) 63 ± 3.6 TAPSE (mm) 24.4 ± 4.6 Left ventricular mass index (g/sqm) 69.9 ± 20.1 Variables Mean± SD Aortic root diameter/BSA (mm/sqm) 16.3 ± 2.3 End diastolic diameter/BSA (mm/sqm) 25.2 ± 3.1 End diastolic volume/BSA (ml/sqm) 45.6 ± 10.1 Ejection fraction (%) 63 ± 3.6 TAPSE (mm) 24.4 ± 4.6 Left ventricular mass index (g/sqm) 69.9 ± 20.1 View Large Table 1 Variables Mean± SD Aortic root diameter/BSA (mm/sqm) 16.3 ± 2.3 End diastolic diameter/BSA (mm/sqm) 25.2 ± 3.1 End diastolic volume/BSA (ml/sqm) 45.6 ± 10.1 Ejection fraction (%) 63 ± 3.6 TAPSE (mm) 24.4 ± 4.6 Left ventricular mass index (g/sqm) 69.9 ± 20.1 Variables Mean± SD Aortic root diameter/BSA (mm/sqm) 16.3 ± 2.3 End diastolic diameter/BSA (mm/sqm) 25.2 ± 3.1 End diastolic volume/BSA (ml/sqm) 45.6 ± 10.1 Ejection fraction (%) 63 ± 3.6 TAPSE (mm) 24.4 ± 4.6 Left ventricular mass index (g/sqm) 69.9 ± 20.1 View Large P1540 3D cine kat-ARC single breath hold versus 2D cine bSSFP multi breath hold for function evaluation and biventricular volumes G Muscogiuri G Muscogiuri Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy A Baggiano A Baggiano Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy M Gatti M Gatti Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy S Pica S Pica IRCCS, Policlinico San Donato, San Donato Milanese, Italy M Guglielmo M Guglielmo Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy AI Guaricci AI Guaricci Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy D Andreini D Andreini Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy S Mushtaq S Mushtaq Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy E Conte E Conte Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy AD Annoni AD Annoni Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy A Formenti A Formenti Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy ME Mancini ME Mancini Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy M Pepi M Pepi Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy G Pontone G Pontone Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy IRCCS, Policlinico San Donato, San Donato Milanese, Italy Purpose Evaluation of diagnostic accuracy and reproducibility of 3D cine k adaptive Single breath hold for quantification of biventricular volumes, function and left myocardial mass. Materials and Methods: 74 patients underwent cardiac magnetic resonance for clinical indications.. In the whole population 3D cine kat-ARC and 2D cine bSSFP images were acquired on short axis view. Subsequently, the population was divided in three subgroups (dilated, hypetrophic, other phenotypes). Two experienced observers performed analysis of volumes, biventricular function and left ventricular mass using an off-line workstation. Statistical analysis was performed using Student"s t-test, linear regression and Bland-Altman plot, correlation coefficient η2 and the intraclass correlation coefficient (ICC). A cut-off value of p <0.05 was considered statistically significant. Results: Biventricular volumes, function and left ventricular mass evaluated with 3D cine kat-ARC sequences did not show any significant difference compared to 2D bSSFP sequences in the overall population (p> 0.05). Bland-Altman analysis showed good agreement between the two sequences as well as linear regression (r ≥ 0.82). Subgroup analysis showed a statistically significant difference (p = 0.04) for left ventricular ejection fraction (LVEF) in patients with a dilated phenotype; showing a minimum overestimation tendency for 3D cine kat ARC (2D cine bSSFP LVEF = 46.44 ± 15.83% vs 3D cine kat-ARC LVEF = 48.36 ± 16.50%). Conclusion: 3D cine kat-ARC 3D sequences allow an accurate evaluation of biventricular volumes and function in a single breath hold. P1541 Clinical differences between extended and pure apical HCM HY Kim HY Kim Chonnam National University Hospital, Department of Cardiovascular Medicine, Gwangju, Korea Republic of KKH Kim KKH Kim Chonnam National University Hospital, Department of Cardiovascular Medicine, Gwangju, Korea Republic of SC LEE Lee SC LEE Lee Samsung Medical Center, Division of Cardiology, Department of Internal medicine, Seoul, Korea Republic of Chonnam National University Hospital, Department of Cardiovascular Medicine, Gwangju, Korea Republic of Samsung Medical Center, Division of Cardiology, Department of Internal medicine, Seoul, Korea Republic of Backgrounds and objectives We sought to find out the difference between the extended type and the pure apical type of apical HCM. Patients and Methods: Ninety consecutive subjects who received CMR at our institute under the diagnosis of apical HCM by echocardiography were included in this study. When the hypertrophy was confined only to the 4 LV apical segments, the subject was included in the pure apical group (n = 41). The second group consisted of subjects whose apical hypertrophy was extended to at least one of the mid-ventricular 6 segments, hence extended apical group (n = 49). Results: There were no significant differences in age, gender, history of syncope, NYHA class, presence of atrial fibrillation, or family history of sudden cardiac death or HCM. There were no differences in non-sustained ventricular tachycardia on 24-hour ECG or abnormal hemodynamic response to exercise either. In the extended apical group, the frequency and volume of late Gadolinium enhancement, left ventricular mass index, and presence of dynamic left ventricular cavity obstruction was significantly higher compared to the pure apical group. Notably, there were 20 cases of apical pouching (40.8 %) which were found only in the extended apical group. Conclusions: The extended type of apical hypertrophy in apical HCM demonstrates a higher rate of potentially serious findings for the prognosis of the disease compared to the pure apical type. View Large View Large View largeDownload slide Abstract P1541 Figure. View largeDownload slide Abstract P1541 Figure. P1542 Fractal analysis in left ventricular noncompaction G Casas G Casas University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain JF Rodriguez-Palomares JF Rodriguez-Palomares University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain G Oristrell G Oristrell University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain M Borregan M Borregan Hospital Sant Joan de Deu, Genetics, Barcelona, Spain J Limeres J Limeres University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain L Gutierrez L Gutierrez University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain G Teixido G Teixido University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain L Galian L Galian University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain MT Gonzalez-Alujas MT Gonzalez-Alujas University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain R Fernadez-Galera R Fernadez-Galera University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain D Garcia-Dorado D Garcia-Dorado University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain A Evangelista A Evangelista University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain Hospital Sant Joan de Deu, Genetics, Barcelona, Spain Background: Fractal analysis is a mathematical method of quantifying complex geometric patterns such as left ventricular (LV) trabeculae. Since LV noncompaction (LVNC) diagnostic criteria are not well established, fractal dimension (FD) has been proposed as a new diagnostic method. FD differences between LVNC and controls have been shown in apical LV segments (not in basal segments). Objective: The aim of the study is to perform fractal analysis in a cohort of patients with imaging criteria for LVNC and to correlate it with other imaging parameters and clinical outcomes. Methods: Patients with both echocardiographic and cardiac MR criteria (Chin and Petersen, respectively) for LVNC and either positive genetic testing or family aggregation were considered for the study. Fractal analysis was performed in short axis slices and results were divided into basal or apical segments. Global LV maximal FD was used as the main marker for LV trabeculation. Other imaging parameters and clinical outcomes were also recorded. Results: 45 patients with LVNC were analysed: 30 (67%) with positive LVNC genotype and 15 (33%) with only family aggregation. 27 (60%) were men and age at diagnosis was 43.5 ± 17.1 years. LVEF on CMR was 47.6 ± 15.7%. Maximal apical FD was 1.368 ± 0.076, maximal basal FD was 1.340 ± 0.062 and global LV maximal FD was 1.385 ± 0.069. All parameters were consistently higher than reference values for Caucasian controls (1.235 ± 0.03, 1.164 ± 0.003 and 1.228 ± 0.002 respectively), confirming hypertrabeculation in LVNC. While only 17 (38%) of our patients reached LVNC cut-off for apical FD (1.392), high FD values were also observed in basal segments. Actually, 40% of global LV maximal values were obtained in basal slices and only 2 (4%) of our cases were below LVNC cut-off (1.213). This could suggest a more severe phenotype with hypertrabeculation starting already in basal segments in genetically confirmed LVNC patients or those with family aggregation. Global LV maximal FD was not different according to gender and had a weak negative correlation with age (R=-0.33, p = 0.03). It was not associated with hypertension or diabetes. Global LV maximal FD did not correlate with LVEF (R = 0.19, p = 0.22) or LVEDV (R=-0.08, p = 0.64) and was similar across all LVEF ranges (p = 0.145). Importantly, global LV maximal FD was still increased in patients with preserved LVEF (1.394 ± 0.066). FD was not associated with incidence of heart failure, ventricular tachycardia, systemic embolisms or supraventricular tachycardia (all p ns). Conclusion: In a cohort of patients with conventional imaging criteria for LVNC and either positive genotype or family aggregation, fractal analysis showed hypertrabeculation throughout all LV segments, suggesting a more severe phenotype expression with involvement of basal segments. Fractal dimension can be assessed as an imaging criterion of LVNC; however, it did not correlate with LV size or function and was not associated with clinical outcomes. P1543 Prognostic impact of right ventricle volumes measured by cardiac magnetic resonance in patients with significant tricuspid regurgitation S Hernandez Jimenez S Hernandez Jimenez University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain R Hinojar Baydes R Hinojar Baydes University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain A Gonzalez-Gomez A Gonzalez-Gomez University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain A Esteban-Peris A Esteban-Peris University Hospital Ramon y Cajal de Madrid, Radiology, Madrid, Spain MA Fernandez-Mendez MA Fernandez-Mendez University Hospital Ramon y Cajal de Madrid, Radiology, Madrid, Spain A Pascual Izco A Pascual Izco University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain A Marco Del Castillo A Marco Del Castillo University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain JM Monteagudo Ruiz JM Monteagudo Ruiz University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain M Plaza Martin M Plaza Martin University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain J Ramos Jimenez J Ramos Jimenez University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain M Valverde Gomez M Valverde Gomez University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain C Lozano Granero C Lozano Granero University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain JJ Jimenez Nacher JJ Jimenez Nacher University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain JL Zamorano Gomez JL Zamorano Gomez University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain C Fernandez-Golfin C Fernandez-Golfin University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain University Hospital Ramon y Cajal de Madrid, Radiology, Madrid, Spain Introduction: Right ventricle (RV) size and function have great prognostic impact in different cardiovascular conditions. Cardiac magnetic resonance (CMR) is the gold standard to measure these parameters. Howeever, in contrast to left valvular heart diseases, in tricuspid regurgitation (TR) there are no clear cut off points to support valve surgery. Methods: Patients with at least moderate TR undergoing a CMR study were consecutively included. RV and left ventricle (LV) end-diastolic (EDV) and end-systolic (ESV) volumes were obtained from cine sequences. A primary combined endpoint (PE) of all-cause mortality, heart failure (HF) and need of valvular surgery was defined. Univariant Cox regressions were made for these parameters. Results: 45 patients were included from 2012 to 2017. Baseline characteristics are shown in table 1. In a median follow-up of 16 (IQR 6 – 21.5) months, 12 events occurred (7 surgeries, 4 HF, and 1 death). RV parameters were predictive of higher risk of the defined PE (as shown in table 1). A RVEDV of 202 ml had the best accuracy to predict outcomes (sensibility 75%, specificity 91%). Conclusions: RV volumes and flows are related with higher risk of cardiovascular events in patients with significant TR. However, it is yet necessary the definition of concrete cut off points to help the clinicians to take decisions in these patients. Table 1 Age (median ± IQR) 73 ± 6 yo Women (n, %) 36, 80% Native tricuspid valve (n, %) 37, 82% RVEDV (median; IQR) 162; (89-113) ml RVESV (median; IQR) 69; (37 - 82.3) ml RVO(median; IQR) 6.7 (5.25 - 8.02) l/min Univariant Cox regressions RVEDV HR 1.015 CI 95% [1.008 - 1.022] p < 0.0001 RVESV HR 1.029 CI 95% [1.014- 1.044] p < 0.0001 RVSV HR 1.023 CI 95% [1.011- 1.036] p < 0.0001 RV output HR 1.393 CI 95% [1.133- 1.714] p = 0.002 LVSV HR 1.013 CI 95% [0.976 - 1.052] p = 0.498 RVEDV/LVEDV HR 3.379 CI 95% [1.814- 6.296] p < 0.0001 RVESV/LVESV HR 1.916 CI 95% [1.340 - 2.741] p < 0.0001 RVSV/LVSV HR 5.551 CI 95% [2.242- 13.744] p < 0.0001 Age (median ± IQR) 73 ± 6 yo Women (n, %) 36, 80% Native tricuspid valve (n, %) 37, 82% RVEDV (median; IQR) 162; (89-113) ml RVESV (median; IQR) 69; (37 - 82.3) ml RVO(median; IQR) 6.7 (5.25 - 8.02) l/min Univariant Cox regressions RVEDV HR 1.015 CI 95% [1.008 - 1.022] p < 0.0001 RVESV HR 1.029 CI 95% [1.014- 1.044] p < 0.0001 RVSV HR 1.023 CI 95% [1.011- 1.036] p < 0.0001 RV output HR 1.393 CI 95% [1.133- 1.714] p = 0.002 LVSV HR 1.013 CI 95% [0.976 - 1.052] p = 0.498 RVEDV/LVEDV HR 3.379 CI 95% [1.814- 6.296] p < 0.0001 RVESV/LVESV HR 1.916 CI 95% [1.340 - 2.741] p < 0.0001 RVSV/LVSV HR 5.551 CI 95% [2.242- 13.744] p < 0.0001 View Large Table 1 Age (median ± IQR) 73 ± 6 yo Women (n, %) 36, 80% Native tricuspid valve (n, %) 37, 82% RVEDV (median; IQR) 162; (89-113) ml RVESV (median; IQR) 69; (37 - 82.3) ml RVO(median; IQR) 6.7 (5.25 - 8.02) l/min Univariant Cox regressions RVEDV HR 1.015 CI 95% [1.008 - 1.022] p < 0.0001 RVESV HR 1.029 CI 95% [1.014- 1.044] p < 0.0001 RVSV HR 1.023 CI 95% [1.011- 1.036] p < 0.0001 RV output HR 1.393 CI 95% [1.133- 1.714] p = 0.002 LVSV HR 1.013 CI 95% [0.976 - 1.052] p = 0.498 RVEDV/LVEDV HR 3.379 CI 95% [1.814- 6.296] p < 0.0001 RVESV/LVESV HR 1.916 CI 95% [1.340 - 2.741] p < 0.0001 RVSV/LVSV HR 5.551 CI 95% [2.242- 13.744] p < 0.0001 Age (median ± IQR) 73 ± 6 yo Women (n, %) 36, 80% Native tricuspid valve (n, %) 37, 82% RVEDV (median; IQR) 162; (89-113) ml RVESV (median; IQR) 69; (37 - 82.3) ml RVO(median; IQR) 6.7 (5.25 - 8.02) l/min Univariant Cox regressions RVEDV HR 1.015 CI 95% [1.008 - 1.022] p < 0.0001 RVESV HR 1.029 CI 95% [1.014- 1.044] p < 0.0001 RVSV HR 1.023 CI 95% [1.011- 1.036] p < 0.0001 RV output HR 1.393 CI 95% [1.133- 1.714] p = 0.002 LVSV HR 1.013 CI 95% [0.976 - 1.052] p = 0.498 RVEDV/LVEDV HR 3.379 CI 95% [1.814- 6.296] p < 0.0001 RVESV/LVESV HR 1.916 CI 95% [1.340 - 2.741] p < 0.0001 RVSV/LVSV HR 5.551 CI 95% [2.242- 13.744] p < 0.0001 View Large P1544 Cardiovascular magnetic resonance imaging feature tracking: impact of training on observer performance and reproducibility SJ Backhaus SJ Backhaus Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany G Metschies G Metschies Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany M Billing M Billing Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany JT Kowallick JT Kowallick University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany R Gertz R Gertz Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany T Lapinskas T Lapinskas Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine / Cardiology, Berlin, Germany B Pieske B Pieske Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine / Cardiology, Berlin, Germany J Lotz J Lotz University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany B Bigalke B Bigalke Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany S Kutty S Kutty Children"s Hospital and Medical Center, Omaha, United States of America G Hasenfus G Hasenfus Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany P Beerbaum P Beerbaum University Hospital, Department of Pediatric Cardiology and Intensive Care, Hannover, Germany S Kelle S Kelle Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine / Cardiology, Berlin, Germany A Schuster A Schuster University of Sydney, Royal North Shore Hospital, Department of Cardiology, Sydney, Australia Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine / Cardiology, Berlin, Germany Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany Children"s Hospital and Medical Center, Omaha, United States of America University Hospital, Department of Pediatric Cardiology and Intensive Care, Hannover, Germany University of Sydney, Royal North Shore Hospital, Department of Cardiology, Sydney, Australia Funding Acknowledgements: German Center for Cardiovascular Research (DZHK) Background: Cardiovascular magnetic resonance feature tracking (CMR-FT) is increasingly used for myocardial deformation assessment including ventricular strain, showing prognostic value beyond established risk markers if used in experienced centres. Little is known about the impact of appropriate training on CMR-FT performance. Consequently, this study aimed to evaluate the impact of training on observer variance using different commercially available CMR-FT software. Methods: Intra- and inter-observer reproducibility was assessed prior to and after dedicated one-hour observer training. Employed FT software included 3 different commercially available platforms (TomTec, Medis, Circle). Left (LV) and right (RV) ventricular global longitudinal as well as LV circumferential and radial strains (GLS, GCS and GRS) were studied in 12 heart failure patients and 12 healthy volunteers. Results: Training improved intra- and inter-observer reproducibility. GCS and LV GLS showed the highest reproducibility before (ICC >0.86 and >0.81) and after training (ICC >0.91 and >0.92). RV GLS and GRS were more susceptible to tracking inaccuracies and reproducibility was lower. Inter-observer reproducibility was lower than intra-observer reproducibility prior to training with more pronounced improvements after training. Before training, LV strain reproducibility was lower in healthy volunteers as compared to patients with no differences after training. Whilst LV strain reproducibility was sufficient within individual software solutions inter-software comparisons revealed considerable software related variance. Conclusion: Observer experience is an important source of variance in CMR-FT derived strain assessment. Dedicated observer training significantly improves reproducibility with most profound benefits in states of high myocardial contractility and potential to facilitate widespread clinical implementation due to optimized robustness and diagnostic performance. P1545 Biventicular strain in myocarditis with feature-tracking cardiac magnetic resonance RA Guerreiro RA Guerreiro Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal J Carvalho J Carvalho Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal B Picarra B Picarra Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal AR Santos AR Santos Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal K Congo K Congo Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal J Pais J Pais Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal D Bras D Bras Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal M Carrington M Carrington Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal A Caeiro A Caeiro Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal J Aguiar J Aguiar Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal Introduction: Patients with myocarditis present very often a normal left ventricle ejection fraction (LVEF). Although LVEF is routinely used as surrogate for myocardial systolic function, having normal LVEF does not mean that these patients with myocarditis cannot have an impairment in myocardial systolic function when accessed by other methods. Purpose: Authors pretend to evaluate biventricular myocardial systolic deformation with feature-tracking cardiac magnetic resonance (FT-CMR) in patients with myocarditis with normal LVEF, testing the hypothesis that these patients may present lower values of strain due to inflammation and oedema. Methods: Prospective observational study including all consecutive patients between January 2013 and October 2016 with a clinical suspicion and a cardiac magnetic resonance (CMR) compatible with myocarditis. CMRs were performed in a 1.5 Tesla scanner for morphology, function and late gadolinium enhancement characterization. Patients with LVEF <50% were excluded. Myocardial left ventricle (LV) longitudinal, circumferential and radial strain and right ventricle (RV) longitudinal strain were calculated using the freely available software Segment and compared with reference values described in the literature. Results: 43 patients were included in this study. The mean age was 38.4 ± 16.2 years, 76.7% were men, with the following prevalence of cardiovascular risk factors: arterial hypertension, 36.6%, smoking 34.1%, hyperlipidaemia 22%, diabetes mellitus 2.4%. Regarding myocardial strain accessed in FT-CMR, the mean values were: LV longitudinal strain -12.78% ± 2.41 (reference value -19.1% ± 4.1), LV circumferential strain -20.45% ± 3.13 (reference value -18.4% ± 2.9), LV radial strain 16.23% ± 5.94 (reference value 39.8% ± 8.3), RV longitudinal strain -13.46% ± 2.65 (reference value -21.9% ± 3.24). Comparing each deformation parameter with the lower limit of the confidence interval with two standard deviations from the mean described in the literature, the authors found lower values of LV longitudinal strain in 20 (32.6%) patients, LV circumferential strain in 0 (0%) patients, LV radial strain in 36 (83.7%) patients and RV longitudinal strain in 33 (76.7%) patients. In 40 (93%) patients at least one strain parameter was lower than normal. Conclusion: In our sample, patients with myocarditis and normal LVEF present important changes in myocardial systolic deformation when accessed by FT-CMR. The myocardial deformation parameters most frequent impaired were LV radial strain and RV longitudinal strain. The majority (93%) of patients had impairment of at least one of the myocardial deformation parameters analysed. P1546 Effectiveness of extracorporeal shockwave myocardial revascularization therapy in stable angina patients using a cardiac magnetic resonance feature tracking technique A Rimkus A Rimkus Vilnius University, Faculty Of Medicine, Vilnius, Lithuania G Burneikaite G Burneikaite Vilnius University, Clinic of Cardiac and Vascular diseases, Center of Cardiology and Angiology, Vilnius, Lithuania S Glaveckaite S Glaveckaite Vilnius University, Clinic of Cardiac and Vascular diseases, Center of Cardiology and Angiology, Vilnius, Lithuania J Celutkiene J Celutkiene Vilnius University, Clinic of Cardiac and Vascular diseases, Center of Cardiology and Angiology, Vilnius, Lithuania D Palionis D Palionis Vilnius University, Department of Radiology, Nuclear Medicine and Medical Physics, Vilnius, Lithuania N Valeviciene N Valeviciene Vilnius University, Department of Radiology, Nuclear Medicine and Medical Physics, Vilnius, Lithuania A Laucevicius A Laucevicius Vilnius University, Clinic of Cardiac and Vascular diseases, Center of Cardiology and Angiology, Vilnius, Lithuania Vilnius University, Faculty Of Medicine, Vilnius, Lithuania Vilnius University, Clinic of Cardiac and Vascular diseases, Center of Cardiology and Angiology, Vilnius, Lithuania Vilnius University, Department of Radiology, Nuclear Medicine and Medical Physics, Vilnius, Lithuania Introduction: Ultrasound-guided cardiac shock-wave therapy (CSWT) is a promising non-invasive modality in patients with stable refractory angina (SRA). The effectiveness of CSWT in a randomized, sham-controlled, triple-blind study, analyzing changes in left ventricular (LV) myocardial deformation indices by transthoracic echocardiography (TTE) speckle tracking (ST) technique and a novel cardiovascular magnetic resonance (CMR) feature tracking (FT) technique (Figure 1), has not been examined. Aim: To determine the reproducibility of CMR-FT strain measurements between 2 experienced reviewers (n = 10), the correlation between CMR-FT and TTE-ST longitudinal strains (LS) in all patients before treatment (n = 37) and the efficacy of CSWT compared with placebo, based on changes in CMR-FT and TTE-ST strains. Methods: A randomized, sham-controlled, triple-blind study included 37 SRA patients who were randomized to CSWT (n = 21) and control (n = 16) groups. TTE-ST and CMR-FT were performed before and 6 months after 9 weeks of CSWT or placebo. CMR-FT was conducted using Circle cvi42 by 2 independent, experienced reviewers. The data was analyzed using SPSS 23. Results: There was a good reproducibility of CMR-FT 4-, 3-chamber LS and basal radial (RS), circumferential (CS) strain measurements between 2 reviewers (interclass correlation coefficients 0.93, 0.84, 0.75, 0.77, respectively). We found moderate correlations between global, 3-, 2-chamber CMR-FT and TTE-ST LS [r = 0.56 (p = 0.001), r = 0.41 (p = 0.032), r = 0.45 (p = 0.01), respectively] in all patients at baseline. At baseline, CMR-FT 4-chamber LS and midsegmental CS were lower in the control versus treatment group [-11.60 ± 4.97 vs -15.25 ± 3.88 (p = 0.017) and -14.59 ± 3.75 vs -17.39 ± 4.40 (p = 0.049), respectively]. 6 months after treatment, CMR-FT global, 4-, 3-, 2-chamber LS remained lower in the placebo compared with treatment group [-11.55 ± 5.59 vs -15.87 ± 4.51 (p = 0.014); -10.62 ± 5.04 vs -14.01 ± 4.69 (p = 0.042); -13.15 ± 6.19 vs -17.34 ± 5.73 (p = 0.040); -10.89 ± 8.52 vs -16.26 ± 5.49 (p = 0.026), respectively]. There were no significant differences in TTE-ST LS or LV EF and volumes before and after treatment in either group, as assessed by CMR. CMR-FT 2-chamber LS, global, midsegmental CS and LV EF changes were significant 6 months after treatment in all patients [2.14 (p = 0.037); 1.02 (p = 0.038); 1.17 (p = 0.034); 2.31 (p = 0.045), respectively]. We found no significant changes in CMR-FT LS, RS, CS; TTE-ST LS or LV EF and volumes, as evaluated by CMR, between the treatment and control groups 6 months after treatment compared with baseline. Conclusion: There was good reproducibility of CMR-FT strains between the 2 experienced, independent reviewers regarding LV 4-, 3-chamber LS and basal RS and CS measurements. The correlation between LV global, 3-, 2-chamber CMR-FT and TTE-ST LS was moderate. CSWT was not effective compared with placebo, based on CMR-FT LS, RS, CS; TTE-ST LS; LV EF and volumes, as assessed by CMR. View largeDownload slide Abstract P1546 Figure. View largeDownload slide Abstract P1546 Figure. P1547 Myocardial mechanics in asymptomatic patients with left bundle branch block and preserved ejection fraction studied by CMR feature tracking B Berlot B Berlot Bristol Heart Institute, Bristol, United Kingdom A Scatteia A Scatteia Villa dei Fiori Hospital, Division of Cardiology, Naples, Italy A Barittusio A Barittusio University of Padova, Department of cardiac, thoracic and vascular sciences, Padua, Italy A Palazzuoli A Palazzuoli University of Siena, Cardiovascular Diseases Unit, Dept. of Internal Medicine, Siena, Italy C Bucciarelli-Ducci C Bucciarelli-Ducci Bristol Heart Institute, Bristol, United Kingdom Bristol Heart Institute, Bristol, United Kingdom Villa dei Fiori Hospital, Division of Cardiology, Naples, Italy University of Padova, Department of cardiac, thoracic and vascular sciences, Padua, Italy University of Siena, Cardiovascular Diseases Unit, Dept. of Internal Medicine, Siena, Italy Background Left bundle branch block (LBBB) is associated with mechanical dyssynchrony and heart failure. Cardiac magnetic resonance (CMR) can provide structural and mechanical myocardial information. Aim In this study we sought to investigate the potential role of CMR in identifying mechanical features of LBBB in patients without structural heart disease and clinical signs of heart failure. Methods We enrolled 50 consecutive asymptomatic patients(48% male, 58 ± 15 years) from two centers who presented with true LBBB at CMR examination, left ventricular (LV) ejection fraction (EF) above 45% and without evidence of structural heart disease or presence of late gadolinium enhancement (LGE). All CMR scans were performed in a 1.5T scanner consisted of cine and LGE sequences. Global radial and circumferential strains, strain rates and times to peak systolic strain were assessed by dedicated feature tracking software. Results were compared to age- and gender-matched patients with normal CMR examination and normal QRS duration on ECG. Additionally, segmental LV wall deformation analysis in the LBBB group was performed. Results LV end-diastolic indexed volume was similar between patients and controls (85 ± 13 vs. 79 ± 10 ml/m2, p = 0.085) while the EF was significantly lower (65 ± 5 vs. 55 ± 7 %, p = 0.002) in patients group. All myocardial deformation parameters were significantly impaired compared to controls (Table 1). In multiple logistic regression including age, gender and EF, radial strain and peak radial systolic strain rate were the strongest independent predictors of LBBB. Segmental deformation analysis revealed markedly impaired septal strains and strain rates and longer time to peak systolic strain of the intraventricular septum compared to other walls (Figure 1). Conclusions In patients with LBBB and no underlying structural myocardial abnormalities CMR can be used to identify and evaluate mechanical dyssynchrony. Segmental analysis provides additional information on mechanism of mechanical impairment. Global myocardial deformation Control Group LBBB Group p N 50 50 Global Radial strain (%) 42 ± 7 35 ± 9 <0.001 Global Circumferential strain (%) -21 ± 2 -16 ± 4 <0.001 Time to peak radial strain (ms) 348 ± 40 408 ± 68 <0.001 Time to peak circumf. strain (ms) 351 ± 42 406 ± 70 <0.001 Global systolic radial strain rate (%/s) 311 ± 76 188 ± 53 <0.001 Global systolic circumf. strain rate (%/s) -150 ± 31 -98 ± 35 <0.001 Control Group LBBB Group p N 50 50 Global Radial strain (%) 42 ± 7 35 ± 9 <0.001 Global Circumferential strain (%) -21 ± 2 -16 ± 4 <0.001 Time to peak radial strain (ms) 348 ± 40 408 ± 68 <0.001 Time to peak circumf. strain (ms) 351 ± 42 406 ± 70 <0.001 Global systolic radial strain rate (%/s) 311 ± 76 188 ± 53 <0.001 Global systolic circumf. strain rate (%/s) -150 ± 31 -98 ± 35 <0.001 View Large Global myocardial deformation Control Group LBBB Group p N 50 50 Global Radial strain (%) 42 ± 7 35 ± 9 <0.001 Global Circumferential strain (%) -21 ± 2 -16 ± 4 <0.001 Time to peak radial strain (ms) 348 ± 40 408 ± 68 <0.001 Time to peak circumf. strain (ms) 351 ± 42 406 ± 70 <0.001 Global systolic radial strain rate (%/s) 311 ± 76 188 ± 53 <0.001 Global systolic circumf. strain rate (%/s) -150 ± 31 -98 ± 35 <0.001 Control Group LBBB Group p N 50 50 Global Radial strain (%) 42 ± 7 35 ± 9 <0.001 Global Circumferential strain (%) -21 ± 2 -16 ± 4 <0.001 Time to peak radial strain (ms) 348 ± 40 408 ± 68 <0.001 Time to peak circumf. strain (ms) 351 ± 42 406 ± 70 <0.001 Global systolic radial strain rate (%/s) 311 ± 76 188 ± 53 <0.001 Global systolic circumf. strain rate (%/s) -150 ± 31 -98 ± 35 <0.001 View Large View largeDownload slide Abstract P1547 Figure. Segmental myocardial deformation View largeDownload slide Abstract P1547 Figure. Segmental myocardial deformation P1548 The role of tissue-tracking cardiac magnetic resonance in early assessment of left ventricular dysfunction in patients with myocarditis and myocardial infarction S Doimo S Doimo Postgraduate School in Cardiovascular Sciences, Cardiovascular Department, Trieste, Italy F Ricci F Ricci G. d"Annunzio University, Department of Neuroscience, Imaging and Clinical Sciences, Chieti, Italy N Aung N Aung Queen Mary University of London, William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, London, United Kingdom J Cooper J Cooper Queen Mary University of London, William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, London, United Kingdom R Boubertakh R Boubertakh Queen Mary University of London, William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, London, United Kingdom MM Sanghvi MM Sanghvi Queen Mary University of London, William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, London, United Kingdom G Sinagra G Sinagra Postgraduate School in Cardiovascular Sciences, Cardiovascular Department, Trieste, Italy SE Petersen SE Petersen Queen Mary University of London, William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, London, United Kingdom Postgraduate School in Cardiovascular Sciences, Cardiovascular Department, Trieste, Italy G. d"Annunzio University, Department of Neuroscience, Imaging and Clinical Sciences, Chieti, Italy Queen Mary University of London, William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, London, United Kingdom Background. Tissue-tracking (TT) is a novel application in cardiovascular magnetic resonance (CMR) imaging for the assessment of myocardial deformation. Purpose. To explore the diagnostic performance of TT to detect global strain abnormalities in patients with preserved left ventricular ejection fraction (LVEF), no visual regional wall motion abnormalities and a diagnosis of myocardial infarction (MI) or myocarditis (MYO) by CMR. Methods. We retrospectively selected CMR studies of 50 MI, 50 MYO and 96 healthy controls from our local Bioresource. Inclusion criteria were LVEF > 50%, presence of late gadolinium enhancement (LGE) and absence of regional wall motion abnormalities. We analysed cardiac morphology, presence of LGE by a semi-quantitative method, 2D and 3D global peak radial, circumferential and longitudinal strain. The area under the receiving operating characteristic curve (AUROC) and Net Reclassification Index (NRI) were used to assess the ability of TT variables to improve discrimination between presence or absence of LGE in 3 logistic regression models. The first model considered age, sex, body surface area, diabetes, hypertension, dyslipidaemia and smoking, the second included the parameters of the first model plus left ventricular end- diastolic volume and LVEF, while in the third tissue tracking parameters were added also. For further validation, we estimated cut-off values and grey zone of the best predictor variables. Results. Compared to controls, 2D global peak longitudinal strain was significantly impaired in all cases (- 20.1 ± 3.1% vs -21.6 ± 2.7%, p= 0.0008) and in MYO group (-19.7 ± 2.9% vs -21.9 ± 2.4%, p= 0.0001), while 3D global peak radial strain was lower in MI group (34.3 ± 11.8% vs 40.3 ± 12.5%, p = 0.024). AUROC and NRI analyses showed that 2D global peak longitudinal strain was able to categorize MYO and 2D global peak radial strain, 3D global peak radial and circumferential strain discriminated MI (Figure 1). The best cut-off for 2D global peak longitudinal strain was -21.1, for 2D and 3D global peak radial strain were 39.1 and 37.7, respectively, while for 3D global peak circumferential strain was -16.4. The areas of grey zone were -23 to – 18.8, 28.6 to 53.5, 29.2 to 49.6 and -20.5 to -12.3 for 2D global peak longitudinal strain, 2D and 3D global peak radial strain and 3D global peak circumferential strain, respectively. Conclusions. Tissue tracking analysis by CMR revealed higher prevalence of global strain abnormalities in patients with MI/MYO and preserved ejection fraction compared with controls. Tissue tracking analysis could improve the diagnostic performance of CMR in early detection of patients at higher risk of developing left ventricular dysfunction. View largeDownload slide Abstract P1548 Figure. View largeDownload slide Abstract P1548 Figure. P1549 Intervendor comparison of cardiac MRI feature tracking global longitudinal strain in patients with aortic stenosis H Elzomor H Elzomor University of Pittsburgh, Pittsburgh, United States of America S Ahmed S Ahmed University of Pittsburgh, Pittsburgh, United States of America M Fukui M Fukui University of Pittsburgh, Pittsburgh, United States of America JL Cavalcante JL Cavalcante University of Pittsburgh, Pittsburgh, United States of America University of Pittsburgh, Pittsburgh, United States of America Background: Global longitudinal strain (GLS) detects subtle alterations of myocardial deformation which have clinical relevance in different myocardial diseases. Cardiac magnetic resonance based feature-tracking (CMR-FT) allows for strain analysis using regular cine images. However, there is limited data regarding intervendor comparison and none in AS patients. Purpose: To assess left-ventricular GLS using CMR-FT in patients with moderate to severe AS and to compare the intervendor agreement between two different post processing softwares. Methods: We conducted a retrospective cohort analysis of patients who have moderate to severe AS diagnosis by transthoracic echocardiography and underwent clinical CMR exam at the University of Pittsburgh Medical Center, between July 2011 and January 2017. We excluded patients if CMR cine images were unavailable or of inadequate quality due to cardiac arrhythmia or breathing artifact. Baseline characteristics and clinical data were collected from our chart review of electronic medical records. Steady-state free precession (cine) images of the left ventricle in 4-chamber, 2-chamber and 3-chamber were chosen for GLS analysis using 2D Cardiac Performance Analysis MR© Image-Arena Version 4.6 Build 4.6.3.9 (TomTec Imaging Systems GmbH) and CVI42©, Release 5.6.4 (Circle Cardiovascular Imaging Inc.). Inter-observer variability was assessed in randomly selected patients by two experienced operators. Pearson correlation coefficients were computed and agreement was assessed using linear regression and Bland-Altman analysis. Results: A total of 110 consecutive patients were included (mean age 69± 14 years, 48% female, aortic valve mean gradient was 34 ± 17 mmHg, mean indexed aortic valve area was 0.45 ± 0.16 cm2/m2.). The mean LVEF by CMR was 52 ± 17%. CMR-FT GLS was slightly higher by TomTec (-17.4 ± 6.1%) than CVI42 (-15.01 ± 5.7%, p < 0.001). Although there was very strong GLS correlation between both softwares (r = 0.90, p < 0.001, Figure 1A), the Bland-Altman analysis shows that the numbers are not interchangeable. (Figure 1B). Importantly, there was almost perfect agreement for both intra-observer and inter-observer variability for both softwares (Intraclass Correlation Coefficient ICC > 0.9 for both) suggesting good reproducibility. Conclusion: CMR-FT is feasible in patients with AS using different software vendors. Although there is very strong intervendor correlation, the values are not interchangeable. Importantly, there was very good inter & intra observer reproducibility for both softwares. CMR-FT can be used effectively in clinical practice for patients with AS, however current analysis suggests that same software should be used for clinical follow-up. View largeDownload slide Abstract P1549 Figure. Correlation between GLS(Tomtec Vs CVI42) View largeDownload slide Abstract P1549 Figure. Correlation between GLS(Tomtec Vs CVI42) P1550 Abnormal flow pattern in the proximal descending aorta in Marfan patients by 4D flow MRI: impact of aortic geometrical characteristics A Guala A Guala University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain L Dux-Santoy L Dux-Santoy University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain JF Rodriguez-Palomares JF Rodriguez-Palomares University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain A Ruiz-Munoz A Ruiz-Munoz University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain I Dentamaro I Dentamaro University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain N Villalva N Villalva University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain R Fernandez R Fernandez University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain F Valente F Valente University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain L Gutierrez L Gutierrez University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain L Galian L Galian University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain D Garcia-Dorado D Garcia-Dorado University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain A Evangelista A Evangelista University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain G Teixido-Tura G Teixido-Tura University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain Funding Acknowledgements: ISCIII PI14/0106, La Marató de TV3 (20151330), Retos-Colaboración 2016 (RTC-2016-5152-1), FP7/People grant agreement n° 267128 Introduction: Marfan syndrome (MFS) is a hereditary connective tissue disorder caused by mutation in the FBN1 gene. Typical cardiovascular manifestation of MFS is the dilation of the ascending aorta (AAo) or of the aortic root. Recent improvements in the management of the AAo caused a marked increase in MFS life expectancy. A longer life led to the growth of disease of the descending aorta (DAo). Recent studies in MFS revealed the presence of abnormal vortex in the proximal DAo, with consequent areas of low wall shear stress (WSS) in the inner wall, which were related to local dilation. However, no previous study has investigated the origin of these flow abnormalities. Purpose: We aimed to investigate the relationship between aortic 3D geometry features and abnormal flow characteristics in the thoracic aorta of MFS. Methods: Fifty-tree MFS patients were prospectively included from our Aortic unit. Inclusion criteria were: age > 18 years, absence of congenital heart diseases, aortic valve disease and MFS confirmed by genetic test. We further include 40 age-matched healthy volunteers (HV) for comparison. All participants underwent 4D flow-MRI, obtaining flow field and angiography without the use of a contrast agent. Geometric and flow parameters were determined at 20 planes located from the sinotubular junction to the proximal DAo. Geometric parameters (diameter, ellipticity and curvature) and flow characteristics (in-plane rotational flow IRF, systolic flow reversal ratio SFRR) were computed. Results: In the proximal AAo (p < 0.001) and in the proximal DAo (p = 0.028) aortic diameters were significantly-larger in MFS compared to volunteers, but no differences were revealed in the aortic arch. Aortic ellipticity and peak of aortic curvature were larger in MFS compared to controls. Rotational flow (IRF, related to helicity) was lower and systolic flow reversal ratio (SFRR, related to vortices) was higher in MFS patients in the vast majority of the thoracic aorta. Univariate correlation demonstrated a statistically-significant inverse relation between proximal DAo peak curvature (R=-0.35, p = 0.015) and arch IRF and between arch ellipticity (R=-0.34, p = 0.016) and arch IRF. Maximum diameter of the proximal DAo was positively correlated with local SFRR (R = 0.605, p < 0.001) and negatively correlated with local IRF (R=-0.3, p = 0.038). Conclusions: MFS patients presented abnormal aortic ellipticity and curvature, which were related to an impaired flow helicity and to an increase in vorticity in the DAo. Longitudinal studies are needed to investigate the eventual causative cascade between geometry, altered hemodynamics and clinical outcomes. P1551 Deep learning for automated scar segmentation in CMR-LGE images S Moccia S Moccia Politecnico di Milano, Biomed. Eng. Dpt., Milan, Italy R Banali R Banali Politecnico di Milano, Biomed. Eng. Dpt., Milan, Italy G Muscogiuri G Muscogiuri Cardiology Center Monzino IRCCS, Milan, Italy C Martini C Martini University Hospital of Parma, Dipartimento Diagnostico, Parma, Italy G Pontone G Pontone Cardiology Center Monzino IRCCS, Milan, Italy M Pepi M Pepi Cardiology Center Monzino IRCCS, Milan, Italy EG Caiani EG Caiani Politecnico di Milano, Biomed. Eng. Dpt., Milan, Italy Politecnico di Milano, Biomed. Eng. Dpt., Milan, Italy Cardiology Center Monzino IRCCS, Milan, Italy University Hospital of Parma, Dipartimento Diagnostico, Parma, Italy Funding Acknowledgements: The study is partially supported by the Italian Space Agency (recipient EC Caiani) Purpose. In clinical practice, left ventricular (LV) scar quantification from cardiac magnetic resonance (CMR) with Late Gadolinium Enhancement (LGE) relies on manual or semi-automated analysis of each acquired image, resulting in a cumbersome approach, also biased by observer’s level of experience. Recently, deep learning (DL) approaches, designed to be trained and fed with raw data without predetermining the features of interest, have been successfully proposed for image segmentation purposes. Our aim was to train and apply DL network to CMR-LGE for scar segmentation, comparing results to manual gold standard (GS). Methods. CMR-LGE images acquired from 28 patients (24 M, 4F) with ischemic-heart disease were analyzed. To determine GS reference, one expert clinician manually traced LV myocardium and scar contours, if present. A DL approach for scar segmentation based on ENet, a deep fully-convolutional neural network was applied by testing two configurations: C1) to directly achieve scar segmentation from the CMR-LGE images; C2) to perform scar segmentation in the myocardial region defined by the GS. Each of the two configurations was evaluated using leave-one-patient-out cross validation, and data augmentation was performed to increase by factor eight the number of images used for training. Comparison with GS was performed on a pixel basis by computing accuracy (Acc), sensitivity (Sens), specificity (Spec) of segmentation, as well as by overlapping scar areas (DICE index). Results. A total of 233 CMR-LGE images were analyzed, where GS resulted in scar tissue present in 207/233 (89%) images, with an area between 20 and 1259 pixels. As expected, C2 resulted the best-performing configuration, with median(25th-75th percentiles) Sens 88(75-93)%, Spec 98(96-99)% and Acc 97(95-98)%, and 75(57-78)% DICE. In Figure, two examples obtained with C2 resulting in low and high DICE are presented. Conversely, C1 resulted in 72(61-86)% Sens, 97(95-98)% Spec and 96(93-97)% Acc, and DICE 54(37-67)% Conclusions. Automatic segmentation of scars in CMR-LGE images by DL network showed promising results, despite the relatively low number of images available for training, in particular when the searching area was limited to the manually-defined myocardial region. View largeDownload slide Abstract P1551 Figure. White:TP, Pink: FN, Green: FP View largeDownload slide Abstract P1551 Figure. White:TP, Pink: FN, Green: FP P1552 Cardiac magnetic resonance imaging with late gadolinium enhancement in acute myocarditis: toward the differentiation of immune-mediated and viral etiologies S Brun S Brun Toulouse Rangueil University Hospital (CHU), 31, Toulouse, France F Sebai F Sebai Toulouse Rangueil University Hospital (CHU), 31, Toulouse, France A Petermann A Petermann Toulouse Rangueil University Hospital (CHU), 31, Toulouse, France D Ribes D Ribes Toulouse Rangueil University Hospital (CHU), 31, Toulouse, France G Prevot G Prevot Toulouse Rangueil University Hospital (CHU), 31, Toulouse, France E Cariou E Cariou Toulouse Rangueil University Hospital (CHU), 31, Toulouse, France Y Lavie-Badie Y Lavie-Badie Toulouse Rangueil University Hospital (CHU), 31, Toulouse, France H Rousseau H Rousseau Toulouse Rangueil University Hospital (CHU), 31, Toulouse, France M Galinier M Galinier Toulouse Rangueil University Hospital (CHU), 31, Toulouse, France D Carrie D Carrie Toulouse Rangueil University Hospital (CHU), 31, Toulouse, France G Pugnet G Pugnet Toulouse Rangueil University Hospital (CHU), 31, Toulouse, France O Lairez O Lairez Toulouse Rangueil University Hospital (CHU), 31, Toulouse, France Toulouse Rangueil University Hospital (CHU), 31, Toulouse, France Background: Diagnosing immune-mediated (IM) myocarditis is challenged by nonspecific clinical signs and symptoms and low accuracy of endomyocardial biopsy. Cardiac magnetic resonance imaging (CMR) provides both cardiac anatomy and subepicardial late gadolinium enhancement (LGE) in the setting of acute myocarditis, but the diagnostic value of LGE localization for differentiation of IM and viral etiologies remains unknow. Objectives: This study sought to determine the value of CMR to differentiate IM and viral etiologies in a cohort with acute myocarditis with regard to myocardial localization of LGE. Methods: One hundred patients with acute myocarditis underwent CMR including LGE parameters were retrospectively included. Viral etiology was retained with a negative auto-immune and auto-inflammatory assessment at diagnosis and at 6 months follow-up. Results: Etiology was IM and viral in 27 and 73 patients, respectively. Patients with IM myocarditis were older (53 ± 17 vs. 31 ± 12 years, P < 0.001) and more likely to be female (48 vs 14%, P = 0.001) than those with viral myocarditis. There was no difference between IM and viral myocarditis for left ventricular ejection fraction (51 ± 15 vs. 55 ± 7%, P = 0.149) and left ventricular end-diastolic volume index (83 ± 21 vs. 78 ± 12 ml/m2, P = 0.225). Regarding LGE, patients with viral myocarditis were more likely to have basal anteroseptal (23 vs. 4%, P = 0.024), mid anteroseptal (29 vs. 4%, P = 0.007), mid anterior (47 vs. 0%, P < 0.001) and basal anterolateral (71 vs 40%, P = 0.004) localization than those with IM myocarditis. Patients with IM myocarditis were more likely to have apical septal (20 vs. 3%, P = 0.011), apical inferior (44 vs. 14%, P = 0.003), apical lateral (44 vs. 8%, P < 0.001) and mid anterolateral (44 vs. 19%, P = 0.016) localization than those with viral myocarditis. Finally, basal anterior (ie. basal anteroseptal + basal anterior + basal anterolateral) LGE localization minus apical (ie. apical septal + apical inferior + apical lateral) LGE localization ≤ 0.5 differentiate IM from viral myocarditis with 77% sensitivity and 96% specificity (area under the receiving operating curve 0.86, P < 0.001). Conclusions: CMR provides arguments for differentiating IM from viral acute myocarditis by showing a preferential LGE localization of apical septal, apical inferior and apical lateral segments. P1553 Impact of left ventricular myocardial fibrosis on postoperative morbidity following mitral valve surgery in rheumatic mitral stenosis TMH Putra TMH Putra Harapan Kita Hospital, Nuclear Cardiology and Cardiovascular Imaging, Jakarta, Indonesia DR Desandri DR Desandri Harapan Kita Hospital, Nuclear Cardiology and Cardiovascular Imaging, Jakarta, Indonesia R Sukmawan R Sukmawan Harapan Kita Hospital, Nuclear Cardiology and Cardiovascular Imaging, Jakarta, Indonesia CA Atmadikoesoemah CA Atmadikoesoemah Harapan Kita Hospital, Nuclear Cardiology and Cardiovascular Imaging, Jakarta, Indonesia E Sahara E Sahara Harapan Kita Hospital, Nuclear Cardiology and Cardiovascular Imaging, Jakarta, Indonesia M Kasim M Kasim Harapan Kita Hospital, Nuclear Cardiology and Cardiovascular Imaging, Jakarta, Indonesia Harapan Kita Hospital, Nuclear Cardiology and Cardiovascular Imaging, Jakarta, Indonesia Background: Myocardial fibrosis is a common finding in rheumatic Mitral Stenosis (MS). It is caused by chronic inflammatory process. Its occurrence may lead to hemodynamic problems, especially after cardiac surgery. Myocardial fibrosis is considered as one of major factors for worse morbidity after cardiac surgery, notably in coronary heart disease and aortic valve abnormality cases. However, this is not yet known in rheumatic MS. Purpose: To investigate the relationship between the extent of left ventricular myocardial fibrosis with in-hospital morbidity after mitral valve surgery in patients with rheumatic MS. Methods: This study is a prospectively enrolled observational study of 47 consecutive rheumatic MS patients. All patients had preoperative evaluation with Cardiac Magnetic Resonance Imaging (CMR) including Late Gadolinium Enhancement (LGE) protocol for myocardial fibrosis assessment prior to mitral valve surgery. All patients were followed during hospitalization period. Postoperative morbidity were defined as stroke, renal failure, and prolonged mechanical ventilation. Results: This study involved 33 (70.2%) women and 14 (29.8%) men with a mean age of 46 ± 10 years. Preoperative myocardial fibrosis was identified in 43 (91.5%) patients. Estimated fibrosis volume ranged from 0% to 12,8% (median 2.8%). Morbidity after mitral valve surgery occurred in 11 (23.4%) patients. Significant mean difference of myocardial fibrosis was observed between patients with morbidity and patients without morbidity after mitral valve surgery (5,97 ± 4,16% & 3,12 ± 2,62%, p = 0,04). This significant association was allegedly influenced by different postoperative hemodynamic changes between the two groups. Based on multivariate analysis, other variables associated with postoperative morbidity after mitral valve surgery were female gender and mean Mitral Valve Gradient (MVG). Conclusion: The extent of left ventricular myocardial fibrosis is associated with in-hospital morbidity after mitral valve surgery in patients with rheumatic MS. Multivariate analysis of factors Variables P Value HR CI 95% Extent of myocardial fibrosis (%) 0.01 1.58 1.10 - 2.27 Mean MVG (mmHg) 0.02 0.66 0.47 - 0.94 Female gender (n) 0.04 0.09 0.01 - 0.85 Variables P Value HR CI 95% Extent of myocardial fibrosis (%) 0.01 1.58 1.10 - 2.27 Mean MVG (mmHg) 0.02 0.66 0.47 - 0.94 Female gender (n) 0.04 0.09 0.01 - 0.85 MVG Mitral Valve Gradient. View Large Multivariate analysis of factors Variables P Value HR CI 95% Extent of myocardial fibrosis (%) 0.01 1.58 1.10 - 2.27 Mean MVG (mmHg) 0.02 0.66 0.47 - 0.94 Female gender (n) 0.04 0.09 0.01 - 0.85 Variables P Value HR CI 95% Extent of myocardial fibrosis (%) 0.01 1.58 1.10 - 2.27 Mean MVG (mmHg) 0.02 0.66 0.47 - 0.94 Female gender (n) 0.04 0.09 0.01 - 0.85 MVG Mitral Valve Gradient. View Large View largeDownload slide Abstract P1553 Figure. LGE protocol from some patients View largeDownload slide Abstract P1553 Figure. LGE protocol from some patients P1554 Focal scar and diffuse myocardial fibrosis in patients with history of repaired tetralogy of Fallot X Iriart X Iriart university hospital of Bordeaux. Department of congenital heart disease, Bordeaux-Pessac, France H Cochet H Cochet University Hospital of Bordeaux - Hospital Haut Leveque, Departement of Cardiology, Bordeaux-Pessac, France A Allain-Nicolai A Allain-Nicolai bordeaux université hospital, department of cardiovascular imaging, pessac, France C Camaioni C Camaioni bordeaux université hospital, department of cardiovascular imaging, pessac, France S Sridi S Sridi bordeaux université hospital, department of cardiovascular imaging, pessac, France E Fournier E Fournier university hospital of Bordeaux. Department of congenital heart disease, Bordeaux-Pessac, France ML Dinet ML Dinet university hospital of Bordeaux. Department of congenital heart disease, Bordeaux-Pessac, France Z Jalal Z Jalal university hospital of Bordeaux. Department of congenital heart disease, Bordeaux-Pessac, France F Laurent F Laurent bordeaux université hospital, department of cardiovascular imaging, pessac, France ML Montaudon ML Montaudon bordeaux université hospital, department of cardiovascular imaging, pessac, France JB Thambo JB Thambo university hospital of Bordeaux. Department of congenital heart disease, Bordeaux-Pessac, France university hospital of Bordeaux. Department of congenital heart disease, Bordeaux-Pessac, France University Hospital of Bordeaux - Hospital Haut Leveque, Departement of Cardiology, Bordeaux-Pessac, France bordeaux université hospital, department of cardiovascular imaging, pessac, France Background: Left and right ventricular (LV and RV) remodeling in repaired tetralogy of Fallot (TOF) is poorly understood. Objectives: To identify correlates of focal scar and diffuse fibrosis in patients with history of TOF repair by using cardiac magnetic resonance (CMR). Methods: Patients with prior TOF repair underwent CMR including cine imaging to assess ventricular volumes and ejection fraction (EF), T1 mapping to assess LV and RV diffuse fibrosis, and high resolution late gadolinium-enhanced (LGE) imaging to quantify scar size. Structural imaging data were related to clinical characteristics and functional imaging markers. In 40 patients, cine and T1 mapping results were compared to age- and sex-matched controls. Results: 103 patients were enrolled (age 28 ± 15 years, 36% women), including 36 with prior PV replacement. Compared to controls, TOF patients showed lower LV and RVEF and higher RV volume, RV wall thickness, and native T1 and ECV values on both ventricles. Scar size related to LVEF and RVEF while LV and RV native T1 related to RV dilatation. On multivariable analysis, scar size and LV native T1 were independent correlates of ventricular arrhythmia. Patients with history of PV replacement showed larger scar on RV outflow tract but LV and RV native T1 were shorter. Conclusions: Focal scar and biventricular diffuse fibrosis are detected on CMR after TOF repair. Scar size relates to systolic dysfunction, and diffuse fibrosis to RV dilatation. Both may be implicated in ventricular arrhythmias. The finding of shorter T1 after PV replacement suggests that diffuse fibrosis may reverse with therapy. View largeDownload slide Abstract P1554 Figure. Exemples of scar distribution View largeDownload slide Abstract P1554 Figure. Exemples of scar distribution P1555 Fibrosis and sustained ventricular arrhythmia in idiopathic cardiomyopathy with severe left ventricular systolic dysfunction: role of CMR in selecting patients for defibrillator implantation A Travieso Gonzalez A Travieso Gonzalez Hospital Clinic San Carlos, Madrid, Spain T Luque T Luque Hospital Clinic San Carlos, Madrid, Spain F Islas F Islas Hospital Clinic San Carlos, Madrid, Spain J Palacios-Rubio J Palacios-Rubio Hospital Clinic San Carlos, Madrid, Spain M Luaces M Luaces Hospital Clinic San Carlos, Madrid, Spain J Arrazola J Arrazola Hospital Clinic San Carlos, Madrid, Spain C Olmos C Olmos Hospital Clinic San Carlos, Madrid, Spain Hospital Clinic San Carlos, Madrid, Spain Background and Purpose: prophylactic implantable cardioverter defibrillator (ICD) is recommended in patients with non-ischemic dilated cardiomyopathy (DCM) and left ventricular ejection fraction (LVEF) <35%. However, a recent trial has shown that this procedure did not reduce long-term mortality in this population. Our aim was to evaluate whether the burden of fibrosis measured by cardiac magnetic resonance (CMR) is a predictor of sustained ventricular arrhythmia in DCM with LVEF < 35%, which could help to improve patient selection for ICD. Methods: patients with idiopathic DCM and LVEF < 35% who received prophylactic ICD implantation between January 2009 and December 2017 were retrospectively reviewed, and those who underwent CMR prior to ICD were included in the study. Patients with previous history of ventricular tachyarrhythmia were excluded. All CMR studies were performed with a 1.5 Tesla scanner, and the presence and extent of late gadolinium enhancement (LGE) relative to LV mass (LGE%), as well as LV function, mass, and volumes were blindly measured. The association between LGE% and sustained ventricular tachyarrhythmia (prompting antitachycardia pacing or shock) was investigated. Results: Forty-one patients were included in the study, of which 58% were male. Median age was 62 (50-68) years. Thirty-three percent of patients had diabetes, 44% hypertension, 40% hypercholesterolemia, and 9% had family history of DCM. In 69% of patients, a CRT-D was implanted. Median follow-up was 3.66 years (1.53-5.74). Median LVEF was 25% (20-31%), Median LGE% was 14% (6-19%), and median LVEDVI was 154.6 ml/m² (133.2-169.36 ml/m²). Five out of 17 patients with LGE%≥14% (29.4%) had appropriate device therapies vs 1 out of 24 patients (4.2%) who had LGE%<14% (hazard ratio: 29.3 [1.63-527.11]; p = 0.022), after adjustment for LV volumes and LVEF. Only the extent of fibrosis measured by LGE%, but not the presence/absence of LGE was significantly associated with sustained ventricular arrhythmia. Conclusions: the burden of fibrosis, measured by LGE%, is independently associated with sustained ventricular arrhythmia, and it may help to identify patients who would benefit most from ICD prophylactic implantation. View largeDownload slide Abstract P1555 Figure. Graph 1: results. View largeDownload slide Abstract P1555 Figure. Graph 1: results. P1556 Comparison of signal intesity ratio and transmurality between a novel lge black-blood and standard lge bright-blood sequences in patients with ischemic heart disease G Muscogiuri G Muscogiuri Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy A Baggiano A Baggiano Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy M Gatti M Gatti Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy S Dell"aversana S Dell"aversana Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy M Guglielmo M Guglielmo Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy AI Guaricci AI Guaricci Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy D Andreini D Andreini Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy S Mushtaq S Mushtaq Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy E Conte E Conte Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy AD Annoni AD Annoni Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy A Formenti A Formenti Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy ME Mancini ME Mancini Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy M Pepi M Pepi Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy G Pontone G Pontone Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy Cardiology Center Monzino IRCCS, Department of Imaging, Milan, Italy Funding Acknowledgements: Na OnBehalf: Na Purpose: The aim of the study is to compare the different signal intensity ratios (SIR) between a novel dark-blood LGE (DBLGE) and standard bright-blood LGE (SBBLGE) sequences in patients with ischemic cardiomyopathy. Furthermore, the difference in terms of LGE transmurality was assessed. Materials and methods: 29 patients with clinical history of ischemic cardiomyopathy underwent to cardiac magnetic resonance. Both SBBLGE and DBLGE sequences were acquired 10-15 minutes after endovenous administration of gadolinium based contrast agent (0.15 mmol / kg). Subsequently images were transferred to an off-line workstation. SIR between blood pool-late gadolinium enhancement (LGE), remote myocardium-LGE and left ventricular myocardium-myocardial blood pool was calculated in all patients. Transmurality index for both sequences was evaluated with a 4 point scale (1 = 0-25%; 2 = 25-50%; 3: 50-75%; 4: 75-100%). Statistical analysis of SIR and transmurality was performed using Wilcoxon signed rank and Student’s t test. A value of p <0.05 was considered statistically significant. Results: A statistical significant difference was observed in terms of left ventricular blood-pool-LGE SIR between DBLGE and SBBLGE, with higher values of SIR observed in DBLGE sequences (p <0.01; DBLGE: 2 ± 2, SBBLGE: 0.2 ± 0.2). No statistically significant difference of SIR was observed in SIR between remote myocardium-LGE (p = 0.3) and left ventricular myocardium-myocardial blood pool (p = 0.09) for both sequences. Evaluation of transmurality was statistically significant different between the SBBLGE and DBLGE (p = 0.02). A tendency to underestimate the transmurality in the DBLGE sequences was observed (DBLGE: 3.1 ± 1.0, SBBLGE: 3.2 ± 1.0). Conclusions: The DBLGE sequences allow to accurately differentiate the infarcted area thanks to an excellent SIR between the left ventricular blood pool and the infarcted area. P1557 Prevalence and pattern of left ventricular late gadolinium enhancement on cardiac magnetic resonance in patients with arrhythmogenic right ventricular dysplasia L Bocquillon L Bocquillon Toulouse Rangueil University Hospital (CHU), Cardiac Imaging Center, Toulouse University Hospital, France, Toulouse, France A Nguyen A Nguyen Toulouse Rangueil University Hospital (CHU), Department of Radiology, Rangueil University Hospital, Toulouse, France, Toulouse, France A Petermann A Petermann Toulouse Rangueil University Hospital (CHU), Department of Radiology, Rangueil University Hospital, Toulouse, France, Toulouse, France A Rollin A Rollin Toulouse Rangueil University Hospital (CHU), Cardiac Imaging Center, Toulouse University Hospital, France, Toulouse, France M Galinier M Galinier Toulouse Rangueil University Hospital (CHU), Department of Cardiology, Rangueil University Hospital, Toulouse, France, Toulouse, France D Carrie D Carrie Toulouse Rangueil University Hospital (CHU), Department of Cardiology, Rangueil University Hospital, Toulouse, France, Toulouse, France H Rousseau H Rousseau Toulouse Rangueil University Hospital (CHU), Department of Radiology, Rangueil University Hospital, Toulouse, France, Toulouse, France P Maury P Maury Toulouse Rangueil University Hospital (CHU), Department of Cardiology, Rangueil University Hospital, Toulouse, France, Toulouse, France O Lairez O Lairez Toulouse Rangueil University Hospital (CHU), Cardiac Imaging Center, Toulouse University Hospital, France, Toulouse, France Toulouse Rangueil University Hospital (CHU), Cardiac Imaging Center, Toulouse University Hospital, France, Toulouse, France Toulouse Rangueil University Hospital (CHU), Department of Radiology, Rangueil University Hospital, Toulouse, France, Toulouse, France Toulouse Rangueil University Hospital (CHU), Department of Cardiology, Rangueil University Hospital, Toulouse, France, Toulouse, France Background. Role of inflammation/fat infiltration in the left ventricle (LV) involvement in arrhythmogenic right ventricular dysplasia (ARVD) remains unclear. The aim was to explore the prevalence, the pattern and the prognostic impact of LV late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) in ARVD. Methods. Forty-six patients with ARVD were enrolled. LGE was quantified using 17-segments model. The location of LGE through the myocardium was specified. Results. Among patients with LGE, the mean number of segments with contrast enhancement (CE) was 1.2 and most frequently in the lateral free wall. CE had a patchy distribution from the epicardial quartile of the wall in 13 (28%) patients. LGE had no impact on cardiac prognosis (HR 1.0; 95% confidence interval 0.2–4.1, P = 0.980). Conclusion. It is not possible to distingue myocarditis scar in CMR from fat infiltration, although localization and characterization of LGE recall myocarditis scar. LV LGE had no impact of prognosis in ARVD. Population demographics and MRI findings Whole population LGE- LGE+ P-value n = 46 n = 26 n = 20 Age, y 44 ± 14 46 ± 15 43 ± 13 0.520 Male, n (%) 31 (67) Circumstances of diagnosis, n (%) Palpitations 1 (2) 1 (4) 0 (0) 0.565 Syncope 17 (37) 11 (42) 6 (30) 0.293 Chest pain 5 (11) 17 (65) 3 (15) 0.373 Ventricular ectopic beats 7 (15) 6 (23) 1 (5) 0.098 Sustained ventricular tachycardia 21 (46) 10 (38) 11 (55) 0.207 Right ventricular enlargement 4 (9) 1 (4) 3 (15) 0.211 Family screening 5 (11) 2 (8) 3 (15) 0.373 Electrocardiogram (T wave inversion), n (%) V1 and V2 7 (16) 3 (12) 4 (20) 0.343 Beyond V2 19 (43) 8 (31) 11 (55) 0.079 MRI findings LV ejection fraction, % 55 ± 11 57 ± 9 52 ± 12 0.253 Indexed LV end-diastolic volume, mL 80 ± 20 79 ± 18 82 ± 22 0.758 RV ejection fraction, % 43 ± 15 45 ± 13 40 ± 16 0.123 Indexed RV end-diastolic volume, mL 118 ± 65 107 ± 51 133 ± 79 0.298 Whole population LGE- LGE+ P-value n = 46 n = 26 n = 20 Age, y 44 ± 14 46 ± 15 43 ± 13 0.520 Male, n (%) 31 (67) Circumstances of diagnosis, n (%) Palpitations 1 (2) 1 (4) 0 (0) 0.565 Syncope 17 (37) 11 (42) 6 (30) 0.293 Chest pain 5 (11) 17 (65) 3 (15) 0.373 Ventricular ectopic beats 7 (15) 6 (23) 1 (5) 0.098 Sustained ventricular tachycardia 21 (46) 10 (38) 11 (55) 0.207 Right ventricular enlargement 4 (9) 1 (4) 3 (15) 0.211 Family screening 5 (11) 2 (8) 3 (15) 0.373 Electrocardiogram (T wave inversion), n (%) V1 and V2 7 (16) 3 (12) 4 (20) 0.343 Beyond V2 19 (43) 8 (31) 11 (55) 0.079 MRI findings LV ejection fraction, % 55 ± 11 57 ± 9 52 ± 12 0.253 Indexed LV end-diastolic volume, mL 80 ± 20 79 ± 18 82 ± 22 0.758 RV ejection fraction, % 43 ± 15 45 ± 13 40 ± 16 0.123 Indexed RV end-diastolic volume, mL 118 ± 65 107 ± 51 133 ± 79 0.298 View Large Population demographics and MRI findings Whole population LGE- LGE+ P-value n = 46 n = 26 n = 20 Age, y 44 ± 14 46 ± 15 43 ± 13 0.520 Male, n (%) 31 (67) Circumstances of diagnosis, n (%) Palpitations 1 (2) 1 (4) 0 (0) 0.565 Syncope 17 (37) 11 (42) 6 (30) 0.293 Chest pain 5 (11) 17 (65) 3 (15) 0.373 Ventricular ectopic beats 7 (15) 6 (23) 1 (5) 0.098 Sustained ventricular tachycardia 21 (46) 10 (38) 11 (55) 0.207 Right ventricular enlargement 4 (9) 1 (4) 3 (15) 0.211 Family screening 5 (11) 2 (8) 3 (15) 0.373 Electrocardiogram (T wave inversion), n (%) V1 and V2 7 (16) 3 (12) 4 (20) 0.343 Beyond V2 19 (43) 8 (31) 11 (55) 0.079 MRI findings LV ejection fraction, % 55 ± 11 57 ± 9 52 ± 12 0.253 Indexed LV end-diastolic volume, mL 80 ± 20 79 ± 18 82 ± 22 0.758 RV ejection fraction, % 43 ± 15 45 ± 13 40 ± 16 0.123 Indexed RV end-diastolic volume, mL 118 ± 65 107 ± 51 133 ± 79 0.298 Whole population LGE- LGE+ P-value n = 46 n = 26 n = 20 Age, y 44 ± 14 46 ± 15 43 ± 13 0.520 Male, n (%) 31 (67) Circumstances of diagnosis, n (%) Palpitations 1 (2) 1 (4) 0 (0) 0.565 Syncope 17 (37) 11 (42) 6 (30) 0.293 Chest pain 5 (11) 17 (65) 3 (15) 0.373 Ventricular ectopic beats 7 (15) 6 (23) 1 (5) 0.098 Sustained ventricular tachycardia 21 (46) 10 (38) 11 (55) 0.207 Right ventricular enlargement 4 (9) 1 (4) 3 (15) 0.211 Family screening 5 (11) 2 (8) 3 (15) 0.373 Electrocardiogram (T wave inversion), n (%) V1 and V2 7 (16) 3 (12) 4 (20) 0.343 Beyond V2 19 (43) 8 (31) 11 (55) 0.079 MRI findings LV ejection fraction, % 55 ± 11 57 ± 9 52 ± 12 0.253 Indexed LV end-diastolic volume, mL 80 ± 20 79 ± 18 82 ± 22 0.758 RV ejection fraction, % 43 ± 15 45 ± 13 40 ± 16 0.123 Indexed RV end-diastolic volume, mL 118 ± 65 107 ± 51 133 ± 79 0.298 View Large View largeDownload slide Abstract P1557 Figure. Location of LV LGE in ARVD. View largeDownload slide Abstract P1557 Figure. Location of LV LGE in ARVD. P1558 Hungarian cardiac magnetic resonance registry of patients with malignant ventricular arrhythmias and normal coronary arteries H Vago H Vago Heart Center Semmelweis University, Budapest, Hungary L Szabo L Szabo Heart Center Semmelweis University, Budapest, Hungary CS Czimbalmos CS Czimbalmos Heart Center Semmelweis University, Budapest, Hungary ZS Dohy ZS Dohy Heart Center Semmelweis University, Budapest, Hungary I Csecs I Csecs Heart Center Semmelweis University, Budapest, Hungary A Toth A Toth Heart Center Semmelweis University, Budapest, Hungary V Juhasz V Juhasz Heart Center Semmelweis University, Budapest, Hungary FI Suhai FI Suhai Heart Center Semmelweis University, Budapest, Hungary T Simor T Simor Heart Institute, Faculty of Medicine, University of Pécs , Pecs, Hungary
TI - Poster Session - Poster session 5
JF - European Heart Journal – Cardiovascular Imaging
DO - 10.1093/ehjci/jey273
DA - 2019-01-01
UR - https://www.deepdyve.com/lp/oxford-university-press/poster-session-poster-session-5-AYBom8LCKL
SP - i1022
VL - 20
IS - Supplement_1
DP - DeepDyve
ER -