TY - JOUR
AU - Bossone,, E.
AB - Purpose : The association between aortic root diameters and aortic regurgitation in hypertension (HT) is disputed with lack of understanding of the underline mehanisms lT. We investigate the relationship between aortic root diameters and aortic regurgitation in newly diagnosed and never treated hypertensive patients and in a group healthy subjects. Method: Participants were 175 hypertensives (42 F and 133 M) and 305 normotensives (134 F, 168 M) age matched (mean age 52.4±13 vs 52.6 ±15.2 years). Antropometric, office blood pressure (BP) measurements, a comprehensive echocardiography and local carotid stiffness study were performed. Aortic measures for annulus, sinuses of Valsalva, sinotubular junction and ascending aorta were taken in late diastole according to the leading edge method. The sinotubular junction/annulus ratio was calculated. Results: Hypertensive patients had significantly higher body surface area (BSA), systolic (SBP) and diastolic pressure (DBP), mean arterial pressure (MAP) and pulse?pressure (PP) (p<0.0001) than normotensives. Annulus and sinotubular junction diameters, indexed by BSA and after adjustment for gender, MAP, heart rate?(HR), were significantly higher in normotensives than hypertensives. Considering subjects with aortic regurgitation (trivial or mild) we found a higher prevalence in?hypertensives (25.7 % vs 10.2%, p<0.0001). Moreover in hypertensives we found no difference in aortic diameters between patients with or without aortic regurgitation?but ascending aorta /BSA (p=0.002) whereas in healthy subjects aortic regurgitation was associated with larger aortic root diameters included sinotubular junction/annulus ratio (table 1). In the logistic regression analysis, aortic regurgitation was associated with age, gender, BP parameters, one point carotid stiffness parameters. Conclusions: Hypertensive patients had smaller indexed aortic root dimensions than normal subjects but they had heigher prevalence of trivial-mild aortic regurgitation in contrast to normotensives who had aortic regurgitation combined with larger aortic diameters. P1008Ultrasonic assessment of backscatter signal intensity of the right ventricle in patients with arterial hypertension as a method of measuring alterations of myocardium S. Ivanov S. Ivanov I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation V. Matveev V. Matveev I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation L. Kuznetsova L. Kuznetsova I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation I. Dmitrieva I. Dmitrieva I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation Objective: comparative evaluation of backscatter signal intensity of the right ventricle (RV) in patients with arterial hypertension (AH) and healthy individuals using standard echocardiography. Methods: the study included a total of 62 cases. The control group consisted of 34 healthy participants. The study group included 28 patients with AH (systolic blood pressure (SBP) – 147±18 mm Hg, diastolic blood pressure (DBP) – 92±10 mm Hg). Inclusion criteria for the patients in the study group were the diagnosis of essential arterial hypertension stage I and the lack of medical treatment. There was no statistically significant difference in age or sex between the groups. The echocardiographic examination was performed with the expert class ultrasound system. Right ventricle function analysis was performed using VVI (Vector Velocity Imaging) application. The evaluation of myocardial backscatter signal intensity was done through analysis of histograms of the RV myocardium compared to reference histograms of pericardium using the ImageJ histogram analysis tool (v1.50g). The mean signal intensity values were recorded for the basal and middle segments of the RV and the interventricular septum (Spt) – MnRV and MnSpt. The interventricular septum was regarded as the RV medial wall. The mean signal intensity values for pericardium MnP were recorded in the same manner. These final values were processed to yield myocardial-to-pericardial intensity ratios (MnRV/MnP and MnSpt/MnP) which were compared among patients with AH and controls. The results are expressed as the arithmetic means±standard deviations (S±σ). The values for p>0,05 were considered statistically significant. Results: MnRV, MnSpt, MnRV/MnP and MnSpt/MnP showed a statistically significant difference during the histographic analysis of backscatter signal intensity in patients with arterial hypertension (p>0,05). MnRV and MnSpt from the control group were equal to 109,55±16,80 and 125,02±18,53, and in patients with AH – 114,11±19,03 and 132,84±23,30, respectively. MnRV/MnP and MnSpt/MnP in healthy subjects had values of 0,47±0,07 and 0,53±0,08, in hypertensive patients – 0,49±0,08 and 0,57±0,10, respectively. Conclusions: the findings demonstrate that the backscatter signal intensity of the right ventricle is significantly higher in patients with hypertension than it is in healthy individuals. The aforementioned method of myocardial structure measurement can be employed as an objective method for quantification of backscatter signal intensity of myocardium and it's alteration (sclerosis) rate for patients with different kinds of cardiovascular pathology (including arterial hypertension) with the help of echocardiography. P1009Speckle strain echocardiography for the evaluation of left ventricular dyssynchrony in patients with severe lung diseases and pulmonary hypertension M. Szulik M. Szulik 1Silesian Center for Heart Diseases, Medical University of Silesia; Department of Cardiology , Zabrze, Poland J. Nowak J. Nowak 1Silesian Center for Heart Diseases, Medical University of Silesia; Department of Cardiology , Zabrze, Poland W. Skowron W. Skowron 1Silesian Center for Heart Diseases, Medical University of Silesia; Department of Cardiology , Zabrze, Poland J. Klys J. Klys 1Silesian Center for Heart Diseases, Medical University of Silesia; Department of Cardiology , Zabrze, Poland M. Koziel M. Koziel 1Silesian Center for Heart Diseases, Medical University of Silesia; Department of Cardiology , Zabrze, Poland W. Streb W. Streb 1Silesian Center for Heart Diseases, Medical University of Silesia; Department of Cardiology , Zabrze, Poland P. Rozentryt P. Rozentryt 1Silesian Center for Heart Diseases, Medical University of Silesia; Department of Cardiology , Zabrze, Poland S. Zeglen S. Zeglen 2Silesian Center for Heart Diseases of the Medical University of Silesia, Zabrze, Poland Z. Kalarus Z. Kalarus 1Silesian Center for Heart Diseases, Medical University of Silesia; Department of Cardiology , Zabrze, Poland T. Kukulski T. Kukulski 1Silesian Center for Heart Diseases, Medical University of Silesia; Department of Cardiology , Zabrze, Poland 1Silesian Center for Heart Diseases, Medical University of Silesia; Department of Cardiology , Zabrze, Poland 2Silesian Center for Heart Diseases of the Medical University of Silesia, Zabrze, Poland Background: Pulmonary hypertension (PH) may lead not only to the right ventricular (RV) but also to the left ventricular (LV) dysfunction. Strain Measurements by speckle echocardiography (SE) ) is a useful tool for early detection of both ventricular impairment and mechanical intraventricular dyssynchrony. The purpose of this study was to evaluate the usefulness of SE to detect RV and also LV mechanical dyssynchrony in patients with severe lung diseases and PH, referred to lung transplantation (LT) Material and methods: The study population comprised 30 patients (age 41, LVEF 54%, strain LV -14% ,strain RV -14 %, FAC – 33%, TAPSE – 19 mm, sPAP 59 ± 24mmHg, QRS < 130 ms) with severe lung diseases qualified to LT: 23 (87 %) patients with interstitial pulmonary fibrosis (IPF), and 7(23 %) patients with chronic obstructive pulmonary disease (COPD). In all patients conventional echocardiography, SE and right heart catheterization (RHC) were performed. Based on the RHC results, only the patients with mean pulmonary artery pressure (mPAP) ≥25 mmHg and capillary wedge pressure (PCWP) ≤ 15 mmHg were enrolled into the study. The control group consisted of 29 healthy subjects. The RV intramural dyssynchrony was defined as a SD of the time to peak longitudinal strain measured in 3 RV segments (RV-SD) and similarly LV intraventricular dyssynchrony (LV-SD) was calculated for 6 LV segments in the apical 4-ch view. Onset of QRS was set as reference time point. Results: In the control group the mean RV-SD was 17.9 ± 13 ms, and mean LV-SD was 26.0 ± 11 ms. In PH group RV-SD and LV-SD were 34.3 ± 29 (NS vs. control) and 47.2 ± 20 ms (p=0.01 vs control), respectively. LV-SD occurred to correlate well with: transpulmonary gradient (r=.6; p=.007), invasive SPAP (r=71;p=.001), PVR (r=.5; p=.04), NT-proBNP (r=.58; p=.006), LV sphericity index (r=.45;p=.03), RV wall thickness (r=.56; p=.02), RV early inflow velocity (r=.46; p=.016). RV-SD correlated significantly only with RV E wave velocity (r=.41; p=.032). Conclusions: In patients with PH due to severe lung disease the ventricular interdependence plays a key role in mechanical myocardial response to the increased RV afterload. The degree of intraventricular LV dyssynchrony but not RV wall dyssynchrony may represent an early sign of mechanical maladaptation of the pressure overloaded right ventricle. P1010Impaired left ventricular ejection fraction in a cohort of systemic sclerosis patients: clinical and echocardiographic characteristics S. Llerena Butron S. Llerena Butron 1Royal Free Hospital, Cardiology, London, United Kingdom CP. Denton CP. Denton 2University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom JG. Coghlan JG. Coghlan 1Royal Free Hospital, Cardiology, London, United Kingdom BE. Schreiber BE. Schreiber 3Royal Free Hospital, Rheumatology, London, United Kingdom 1Royal Free Hospital, Cardiology, London, United Kingdom 2University College London, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom 3Royal Free Hospital, Rheumatology, London, United Kingdom Introduction: Systemic sclerosis (SSc) is a rare autoimmune disease that usually affects skin and visceral organs. Cardiac involvement in SSc has a poor prognosis, with high rates of mortality in symptomatic patients. LV systolic dysfunction is also rare in this subset of patients. Our purpose was to quantify and describe the characteristics of patients with LVEF ≤ 40% in a cohort of SSc patients. Methods: We performed a retrospective review of the computerised hospital medical records for all echocardiograms requested by the Scleroderma service between December 2012 and November 2014 in a large tertiary centre. Echocardiograms with reported LVEF ≤ 40% were reviewed and detailed case notes review was conducted. Survival was checked on the national health database. Results: 1169 echocardiograms were conducted in 854 patients, of whom 94% (n=803) had SSc. An LVEF ≤ 40% was found in 11 patients (1.4%). 7 patients were female (63.6%) and 4 were male (36.4%), in a ratio of 1.75:1. Median age was 54.45 ± 11.9 years old, (range 27-73 years). Diffuse cutaneous SSc was diagnosed in 54.5% of the patients (n=6), limited cutaneous SSc in 27.3% (n=3), and overlap syndromes in 18.2% (n=2). 4 patients (36.4%) had history of ischaemic heart disease (IHD) and/or coronary artery disease (CAD). 5 patients (45.5%) were in NYHA class III and 6 patients (54.5%) in class II. ICDs were implanted in 54.5% (6 patients), and CRT in 45.5% (5 patients). The mean LVEF was 26.1% ±13.18%, with a mean LVEDD of 50.62 mm ± 4 mm and mean interventricular septum width of 9.6 mm ± 1.2 mm. The mean TAPSE was 16 mm ± 6.24 mm, mean basal RV diameter was 40.2 mm ± 5.76 mm, and a mean RA area of 20.33 cm² ± 7.8 cm. The mean TR velocity was 2.38 m/s ± 0.39 m/s, and a mean PSAP of 33.26 mmHg ± 12.2 mmHg. The mean NT ProBNP was 243.45 pmol/L ± 327.85 pmol/L. 2 patients (18.2%) had pericardial effusion of no more than moderate degree. Patients were followed for 7-74 months. There were 4 deaths between 7 and 43 months. 2 year-survival from diagnosis was 90%, and 4 year-survival from diagnosis was 43%. Variables were analysed with respect to survival at 4 years: those who died had lower LVEF (12.5 ± 5% vs 33.86 ± 9.14%, p=0.002), more frequent pericardial effusion (100% vs 0%, p=0.039) and a greater proportion had the diffuse SSc (66.7% vs 33.3%, p=0.022). There was a tendency for lower TAPSE and global RV function, but the differences in these and the others variables were not statistically significant. There were no statistically significant differences associated with presence of IHD/CAD. Conclusions: in a cohort of SSc patients, cardiac involvement is rare, affecting about 1.4%, with a predominance of diffuse skin disease. A third of the patients had a history of IHD, and almost half of the patients had an ICD with CRT. On echocardiography the LV did not appear dilated. Predictors of poor outcome included LVEF ≤ 18%, presence of pericardial effusion and diffuse skin disease. P1011Prognostic role of subclinical left ventricular systolic dysfunction evaluated using strain imaging by speckle-tracking echocardiography G. Cioffi G. Cioffi 1Villa Bianca Hospital, Department of Cardiology, Trento, Italy O. Viapiana O. Viapiana 2University Hospital, Department of Medicine, Verona, Italy F. Ognibeni F. Ognibeni 2University Hospital, Department of Medicine, Verona, Italy A. Dalbeni A. Dalbeni 2University Hospital, Department of Medicine, Verona, Italy A. Giollo A. Giollo 2University Hospital, Department of Medicine, Verona, Italy D. Gatti D. Gatti 2University Hospital, Department of Medicine, Verona, Italy L. Idolazzi L. Idolazzi 2University Hospital, Department of Medicine, Verona, Italy A. Cherubini A. Cherubini 3Centro Cardiovascolare A.S.S. 1, Trieste, Trieste, Italy C. Mazzone C. Mazzone 3Centro Cardiovascolare A.S.S. 1, Trieste, Trieste, Italy G. Faganello G. Faganello 3Centro Cardiovascolare A.S.S. 1, Trieste, Trieste, Italy A. Di Lenarda A. Di Lenarda 3Centro Cardiovascolare A.S.S. 1, Trieste, Trieste, Italy M. Rossini M. Rossini 2University Hospital, Department of Medicine, Verona, Italy 1Villa Bianca Hospital, Department of Cardiology, Trento, Italy 2University Hospital, Department of Medicine, Verona, Italy 3Centro Cardiovascolare A.S.S. 1, Trieste, Trieste, Italy Introduction. Speckle tracking echocardiography (STE) allows early detection of subclinical left ventricular systolic dysfunction (LVSD) in patients with rheumatoid arthritis (RA). Purpose. In this prospective study, we assessed the prevalence and the prognostic role of subclinical LVSD detected by STE in RA patients. Methods. Global longitudinal (GLS) and circumferential (GCS) 2D strain were measured in 209 RA patients without overt cardiac disease. LVSD was defined as low GLS ( > -16.0%) and/or low GCS (> -17.8%). Primary end-point was all-causes hospitalization; co-primary end-point was hospitalization for cardiovascular causes. Results. Study population had a mean age of 58±11 years, 67% female, 52% hypertensive, 14±10 months of RA duration. Low GLS was detected in 51 patients (24%), low GCS in 42 patients (20%), combined low GLS & GCS in 18 patients (9%). During a median follow-up of 16 [10–21] months, a primary end-point occurred in 50 patients (24%), 25 patients were hospitalized for a cardiovascular event. Multiple Cox regression analyses revealed that combined low GLS & GCS was independently associated with the end-point defined as all-causes hospitalization together with higher aortic stiffness. Examined individually, neither low GCS nor low GLS showed an independent association with this typology of clinical outcome. Conversely, both low GCS and low GLS (examined individually or as combined low GLS & GCS) emerged as strong independent prognosticators of cardiovascular events. Conclusions. Subclinical LVSD defined as low GLS and/or low GCS is common in RA patients without overt cardiac disease and provides additional prognostic information in these subjects. Open in new tabDownload slide Abstract P1011 Figure. Open in new tabDownload slide Abstract P1011 Figure. P1012Inferior vena cava diameter is a strong and practical marker of physical activity and fitness HACM Bruin De- Bon HACM Bruin De- Bon Academic medical center, Amsterdam, Netherlands HT. Jorstad HT. Jorstad Academic medical center, Amsterdam, Netherlands SM. Boekholdt SM. Boekholdt Academic medical center, Amsterdam, Netherlands NM. Panhuyzen-Goedkoop NM. Panhuyzen-Goedkoop Academic medical center, Amsterdam, Netherlands BJ. Bouma BJ. Bouma Academic medical center, Amsterdam, Netherlands RJG Peters RJG Peters Academic medical center, Amsterdam, Netherlands Academic medical center, Amsterdam, Netherlands Introduction: Quantification of physical fitness and physical activity in clinical practice depends largely on self-report. Simple measurement tool are lacking, although insufficient physical activity is among the most important risk factors for atherosclerosis Purpose: We investigated the association between the diameter of the inferior vena cava (dIVC) indexed for body surface area (BSA) and physical fitness and physical activity in apparently healthy individuals. Methods: We studied 116 individuals (mean age 48, 24% women) undergoing general health screening. We collected maximum exercise capacity on treadmill tests (in METS), self-reported weekly hours of exercise, anthropometrics and echocardiograms. Transthoracic echocardiography was used to determine dIVC in the subcostal view 1–2 cm caudal to the junction with the right atrium. We used Pearson’s correlation and ANOVA to quantify the linear relationship between dIVC/BSA and METS and hours of physical activity. Results: The mean dIVC/BSA was 10.3 mm (SD 2.2 mm); mean METS achieved were 10.5 (SD 2.0). There was a strong linear association between dIVC/BSA and METS (R=0.52, p<0.0001). In women, this correlation was more pronounced (R=0.80, p<0.0001) than in men (R=0.46, p<0.0001). dIVC/ BSA was strongly associated with the number of weekly hours of exercise [(<1h, (8.1 mm SD 1.5mm) 1-3h ( 10.3mm SD 2.5mm), >3h (11.6mm SD 1.7mm)) (p<0.0001)]. Furthermore, dIVC/BSA was associated with systolic blood pressure (R= - 0.46, p<0.0001), resting heart rate (R= - 0.35, p<0.0001) and diastolic function as measured by E/e’ (R= - 0.31, p<0.001). Conclusion: IVC diameters are strongly associated with physical fitness and the amount of physical activity in apparently healthy individuals. This is a novel, inexpensive, objective and non-invasive parameter, which can be readily incorporated into cardiovascular risk assessments. Open in new tabDownload slide Abstract P1012 Figure. Open in new tabDownload slide Abstract P1012 Figure. P1013When the heart works for two: morphologic and functional adaptation during pregnancy P. Meras Colunga P. Meras Colunga 1University Hospital La Paz, Department of Cardiology, Madrid, Spain S. Prado Diaz S. Prado Diaz 2University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain N. Montoro Lopez N. Montoro Lopez 1University Hospital La Paz, Department of Cardiology, Madrid, Spain O. Gonzalez Fernandez O. Gonzalez Fernandez 1University Hospital La Paz, Department of Cardiology, Madrid, Spain V. Rial Baston V. Rial Baston 1University Hospital La Paz, Department of Cardiology, Madrid, Spain SC. Valbuena Lopez SC. Valbuena Lopez 1University Hospital La Paz, Department of Cardiology, Madrid, Spain E. Refoyo Salicio E. Refoyo Salicio 1University Hospital La Paz, Department of Cardiology, Madrid, Spain M. Moreno Yanguela M. Moreno Yanguela 1University Hospital La Paz, Department of Cardiology, Madrid, Spain M. De?La?Calle M. De?La?Calle 3University Hospital La Paz, Gynecology, Madrid, Spain JL. Bartha Rasero JL. Bartha Rasero 3University Hospital La Paz, Gynecology, Madrid, Spain R. Dalmau Gonzalez-Gallarza R. Dalmau Gonzalez-Gallarza 1University Hospital La Paz, Department of Cardiology, Madrid, Spain JL. Lopez Sendon JL. Lopez Sendon 1University Hospital La Paz, Department of Cardiology, Madrid, Spain G. Guzman Martinez G. Guzman Martinez 1University Hospital La Paz, Department of Cardiology, Madrid, Spain 1University Hospital La Paz, Department of Cardiology, Madrid, Spain 2University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain 3University Hospital La Paz, Gynecology, Madrid, Spain Introduction: During pregnancy some maternal heart changes are needed to adapt to the new transitory overload. Methods: A prospective unicentric study was designed in order to evaluate systolic and diastolic left ventricle, as well as, right ventricle function and hemodynamic changes developed along gestation, evaluated with transthoracic echocardiogram performed in second (2T) and third trimester (3T). Results: 44 singleton healthy pregnancy women were included. Median age was 34 years old (range 27-42). 81.8% were spontaneous gestations. Blood pressure and cardiac frequency did not show differences between 2T and 3T (102/64 vs 105/61 mmHg, p=NS; 80.6 vs 81.4 bpm; p=NS)). Cardiac output neither showed statistic significantly differences (4.5 vs 4.3; p=NS) Systolic function estimated by Simpsom method slightly decreased during pregnancy (3D 65.2 vs 60. 8, 2D 62% vs 59,4%; p<0,05), as well as myocardial deformation measured as global longitudinal strain (table 1). Also, non significantly rise of ventricle volume and index mass were observed in 3T. Diastolic function suffered variations; E wave and ratio E/A felt in 3T, but not pathologic inflow patterns were achieved. No significant differences were detected in ratio E/e´ however there was a tend to left atrium size increase in 3T. Significant drop in TAPSE and right ventricle shortening fraction in 3T, probably related to volume overload, was noted. Conclusions: Maternal heart suffers structural and functional changes during pregnancy. These changes affect systolic and diastolic function both right and left ventricle, and could be non-invasive quantified by transthoracic echocardiogram. Appropriate evaluation of physiology pregnancy is needed to define limits in complicated gestations 2T 3T p LVEF (Simpson) 62 59.4 0.02 Left Ventricle Global Longitudinal Strain (%) 21.2 19.5 <0.01 Telediastolic Left Ventricule Diametre 81.9 84.6 0.53 E wave (cm/s) 85.9 76.2 <0.01 E/A 1.5 1.3 <0.01 E/e' 5.8 6.2 0.36 TAPSE (cm) 26 23 <0.01 Right Ventricle Shortening Fraction (%) 52.8 49.6 <0.01 Left Ventricle Mass (index) 71.4 76.6 0.06 Left Atrium Area (cm2) 15.5 16.4 0.09 2T 3T p LVEF (Simpson) 62 59.4 0.02 Left Ventricle Global Longitudinal Strain (%) 21.2 19.5 <0.01 Telediastolic Left Ventricule Diametre 81.9 84.6 0.53 E wave (cm/s) 85.9 76.2 <0.01 E/A 1.5 1.3 <0.01 E/e' 5.8 6.2 0.36 TAPSE (cm) 26 23 <0.01 Right Ventricle Shortening Fraction (%) 52.8 49.6 <0.01 Left Ventricle Mass (index) 71.4 76.6 0.06 Left Atrium Area (cm2) 15.5 16.4 0.09 2T 3T p LVEF (Simpson) 62 59.4 0.02 Left Ventricle Global Longitudinal Strain (%) 21.2 19.5 <0.01 Telediastolic Left Ventricule Diametre 81.9 84.6 0.53 E wave (cm/s) 85.9 76.2 <0.01 E/A 1.5 1.3 <0.01 E/e' 5.8 6.2 0.36 TAPSE (cm) 26 23 <0.01 Right Ventricle Shortening Fraction (%) 52.8 49.6 <0.01 Left Ventricle Mass (index) 71.4 76.6 0.06 Left Atrium Area (cm2) 15.5 16.4 0.09 2T 3T p LVEF (Simpson) 62 59.4 0.02 Left Ventricle Global Longitudinal Strain (%) 21.2 19.5 <0.01 Telediastolic Left Ventricule Diametre 81.9 84.6 0.53 E wave (cm/s) 85.9 76.2 <0.01 E/A 1.5 1.3 <0.01 E/e' 5.8 6.2 0.36 TAPSE (cm) 26 23 <0.01 Right Ventricle Shortening Fraction (%) 52.8 49.6 <0.01 Left Ventricle Mass (index) 71.4 76.6 0.06 Left Atrium Area (cm2) 15.5 16.4 0.09 P1014Extensive use of lung ultrasound in pediatric cardiac surgery: preliminary experience M. Cantinotti M. Cantinotti 1Gabriele Monasterio Foundation, Massa, Italy L. Ait-Ali L. Ait-Ali 2National Research Council, Pisa, Italy EF. Franchi EF. Franchi 1Gabriele Monasterio Foundation, Massa, Italy M. Scalese M. Scalese 2National Research Council, Pisa, Italy L. Gargani L. Gargani 2National Research Council, Pisa, Italy 1Gabriele Monasterio Foundation, Massa, Italy 2National Research Council, Pisa, Italy Background: Lung ultrasound (LUS) is gaining consensus for the diagnosis of pulmonary disease in acute setting. Pulmonary complications are very common in pediatric cardiac surgery. Despite this of LUS remain limited. Our aim was to test the feasibility, and prognostic accuracy of LUS in pediatric cardiac surgery. Methods: 138 LUS examinations have been performed in 79 children at different post-operative times (12-24 hours, at 5-7 days and before discharge). For each hemi-thorax 3 major areas (anterior/lateral/posterior) have been evaluated separately. Results: B-lines were present in all post-operative patients. The percentage of B lines did not vary from 12-24 hours versus 5-7 days (right lung 53%±26 vs 56%±30; left lung 53%±27 vs 58%±28) while reduced significantly at discharge (right lung 22%±22, p<0.001; left lung 33%±31, p<0.001). Pleural effusion (from mild to severe) were diagnosed in 59.0% at 12-24 hours, in 48.7% at 5-7 days, and were still present in 22.2% before discharge. Atelectasis (from trivial to severe) were present in 76.6% at 12-24 hours; in 82.5% at 5-7 days, and persisted in 38.9% before discharge. In 77 cases LUS allowed reclassification of X-Ray findings (figure 1), including 47 new diagnosis (I.e diagnosis of effusion/atelectasis when negative X-Ray reports) and 30 differential analysis (I.e effusions reclassified as atelectasis/interstitial syndrome or viceversa). The posterior approach was much more accurate than anterior/lateral in the diagnosis of effusion/atelectasis (Kappa coefficient ranging from 0.08 to 0.26). Conclusions: LUS may allow reclassification/differential diagnosis of X-Ray findings after pediatric cardiac surgery. The posterior approach should be preferred for the diagnosis of effusion/atelectasis. Open in new tabDownload slide Abstract P1014 Figure. Open in new tabDownload slide Abstract P1014 Figure. P1015Asymptomatic delayed right ventricular perforation by cardiac implantable electronic devices lead, echocardiographic features B. Zaborska B. Zaborska Postgraduate Medical School, Grochowski Hospital, Dept of Cardiology, Warsaw, Poland E. Makowska E. Makowska Postgraduate Medical School, Grochowski Hospital, Dept of Cardiology, Warsaw, Poland E. Pilichowska-Paszkiet E. Pilichowska-Paszkiet Postgraduate Medical School, Grochowski Hospital, Dept of Cardiology, Warsaw, Poland M. Sikora-Frac M. Sikora-Frac Postgraduate Medical School, Grochowski Hospital, Dept of Cardiology, Warsaw, Poland A. Czepiel A. Czepiel Postgraduate Medical School, Grochowski Hospital, Dept of Cardiology, Warsaw, Poland M. Swiatkowski M. Swiatkowski Postgraduate Medical School, Grochowski Hospital, Dept of Cardiology, Warsaw, Poland P. Kulakowski P. Kulakowski Postgraduate Medical School, Grochowski Hospital, Dept of Cardiology, Warsaw, Poland Postgraduate Medical School, Grochowski Hospital, Dept of Cardiology, Warsaw, Poland Background: Lead-related cardiac perforation is a rare (0.1-1%) complication of cardiac implantable electronic devices (CIED). Delayed perforation (> 1 month) is even rarer but does occur and could cause dangerous complications. Diagnosis of perforation – acute, subacute and delayed - is based on device parameters check-up and cardiac imaging. Chest pain and pericardial fluid are the most common findings in acute and subacute cases. Purpose: was to find echocardiographic features of right ventricular (RV) delayed perforation Methods: We analysed data of patients with CIED referred to echocardiography lab due to pacing failure (increasing of RV capture threshold, especially in unipolar configuration, with sensing and lead impedance values remaining within normal range) between June 2014 and May 2016. Results: Seven patients (5 females, 2 males, aged 65-87 years) of delayed RV perforation were identified in our centre, where approximately 4.000 follow-up outpatient visits and 300 implantations per year are performed. CIED (6 pacemakers and 1 ICD) were implanted 1-96 months earlier. All patients were asymptomatic: six were referred to transthoracic echocardiography (TTE) due to pacing problems detected during routine device check-up. In one case perforation was found incidentally. In all patients TTE in standard views revealed lack of pericardial fluid and normal appearance of right chambers and CDIE leads. However TTE nonstandard views focused on apical region of RV free wall showed: localized 2-9 mm fibrotic layer with small amount of fluid 2-8 mm in the pericardium, normal thickness of RV free wall and lead movement in opposite direction than ventricular wall during systole, with tip of lead penetrating through RV wall – spear-like movement. All patients were treated with elective transvenous lead removal and repositioning or new lead implantation. Conclusions: In some patients delayed lead related RV perforation may occur without pericardial fluid and no symptoms ("dry perforation"). Echocardiography reveals characteristic spear-like lead movement against myocardium. This potentially dangerous complication can be overlooked by standard TTE. The key to successful diagnosis and management is high index of suspicion and active attitude during echocardiographic examination with dedicated nonstandard views. P1016Novel echocardiographic prognostic markers for cardiac tamponade in patients with large malignant pericardial effusions. A paradigm shift from flow to tissue imaging G. Chalikias G. Chalikias Democritus University of Thrace, Medical School, Department of Cardiology, Alexandroupolis, Greece A. Samaras A. Samaras Democritus University of Thrace, Medical School, Department of Cardiology, Alexandroupolis, Greece P. Kikas P. Kikas Democritus University of Thrace, Medical School, Department of Cardiology, Alexandroupolis, Greece A. Thomaidis A. Thomaidis Democritus University of Thrace, Medical School, Department of Cardiology, Alexandroupolis, Greece I. Drosos I. Drosos Democritus University of Thrace, Medical School, Department of Cardiology, Alexandroupolis, Greece D. Tziakas D. Tziakas Democritus University of Thrace, Medical School, Department of Cardiology, Alexandroupolis, Greece Democritus University of Thrace, Medical School, Department of Cardiology, Alexandroupolis, Greece Background: Although numerous echocardiographic signs have been proposed so far for diagnosing imminent cardiac tamponade, their prognostic value remains uncertain. Purpose: With the present prospective study we sought to investigate the prognostic value of novel echocardiographic tissue imaging markers in predicting tamponade among patients with large malignant pericardial effusion compared to routinely used echocardiographic signs. Methods: 96 consecutive patients with large malignant pericardial effusion, not in clinical cardiac tamponade, underwent a comprehensive standard echocardiographic examination and were prospectively assessed for a follow up of 1 month. Clinically evident cardiac tamponade was considered as the study end-point. The prognostic performance of novel tissue imaging echocardiographic markers (tricuspid valve annular plane systolic excursion (TAPSE), peak systolic annular velocity at the lateral margin of the tricuspid valve annulus (STV) and exaggerated respirophasic fluctuations in tricuspid annular velocities (ΔΕ’TV > |40%| or ΔA’TV > |40%|) were assessed and compared to routinely used imaging signs. Results: During follow up 37 patients (39%) developed clinically evident cardiac tamponade. TAPSE [Area under the curve (AUC) 0.958] and STV (AUC 0.948) had excellent predictive accuracy for tamponade. Multivariate analysis showed that TAPSE [Hazard ratio (HR) 3.03; 95%CI 1.60-5.73, P=0.001) and STV (HR 1.17; 95% CI 1.05-1.29, P=0.005) remained independent significant predictors of cardiac tamponade. Reclassification analysis using integrated discrimination improvement and decision curve analysis using net benefit curves showed additive prognostic value and adjunct clinical benefit of these markers when added to a recently published triage pericardiocentesis score. Conclusion: Novel echocardiographic tissue imaging markers such as TAPSE and STV are characterized by an excellent prognostic ability for development of cardiac tamponade and better prognostic value compared to routine echocardiographic signs in patients with large malignant pericardial effusion. Incorporating these markers to a recent triage pericardiocentesis score resulted in additional prognostic value and increased clinical benefit. P1017Doppler echocardiographic parameters as a marker of cardiac tamponade JW. Son JW. Son 1Yeungnam University Hospital, Division of cardiology, Department of internal medicine, Daegu, Korea Republic of HJ. Kim HJ. Kim 1Yeungnam University Hospital, Division of cardiology, Department of internal medicine, Daegu, Korea Republic of BJ. Kim BJ. Kim 1Yeungnam University Hospital, Division of cardiology, Department of internal medicine, Daegu, Korea Republic of KW. Choi KW. Choi 1Yeungnam University Hospital, Division of cardiology, Department of internal medicine, Daegu, Korea Republic of JH. Nam JH. Nam 1Yeungnam University Hospital, Division of cardiology, Department of internal medicine, Daegu, Korea Republic of JH. Lee JH. Lee 1Yeungnam University Hospital, Division of cardiology, Department of internal medicine, Daegu, Korea Republic of CH. Lee CH. Lee 1Yeungnam University Hospital, Division of cardiology, Department of internal medicine, Daegu, Korea Republic of W. Kim W. Kim 1Yeungnam University Hospital, Division of cardiology, Department of internal medicine, Daegu, Korea Republic of JS. Park JS. Park 1Yeungnam University Hospital, Division of cardiology, Department of internal medicine, Daegu, Korea Republic of DG. Shin DG. Shin 1Yeungnam University Hospital, Division of cardiology, Department of internal medicine, Daegu, Korea Republic of YJ. Kim YJ. Kim 1Yeungnam University Hospital, Division of cardiology, Department of internal medicine, Daegu, Korea Republic of JH. Choi JH. Choi 2Busan Medical Center, Division of cardiology, Department of internal medicine, Busan, Korea Republic of 1Yeungnam University Hospital, Division of cardiology, Department of internal medicine, Daegu, Korea Republic of 2Busan Medical Center, Division of cardiology, Department of internal medicine, Busan, Korea Republic of Background: Cardiac Tamponade is life threatening medical condition that needs prompt diagnosis and pericardiocentesis. Transthoracic echocardiography (TTE) is method of choice for diagnosing the cardiac tamponade, however, comprehensive and complex 2D and Doppler echocardiographic evaluation including respiratory variation of mitral inflow velocity, diastolic hepatic vein flow reversal and inferior vena caval plethora are necessary. The aim of this study was to evaluate the usefulness of more simple Doppler echocardiographic parameters related with left ventricular filling pressure and cardiac output as a marker for cardiac tamponade. Methods: Fifty four patients with pericardial effusion of more than moderate amount who underwent TTE were enrolled in this study. Patients with cardiac tamponade who underwent therapeutic pericardiocentesis were designated to group A (n=21) and others were designated to group B (n=33). Doppler echocardiographic parameters including mitral inflow pattern, E and A velocity, E/A ratio, mitral and LV outflow tract time velocity integral (LVOT TVI) and medial mitral annular E’ velocity were measured and the difference of each parameters were compared between two groups. Results: All the patients in group A showed relaxation abnormality mitral inflow pattern, however, in group B only 37% of patients showed relaxation abnormality pattern (p<0.001). Mitral E velocity (pre 0.57±0.14 vs. 0.87±0.21 m/sec, p=0.010) and E/A ratio (0.9±0.3 vs. 1.3±0.4, p=0.03) were significantly lower in group A and LVOT TVI (14.8±3.9 vs. 18.1±3.7 cm, p=0.02) was also significantly lower in group A. Conclusion: Simple Doppler echocardiographic parameters including Mitral E velocity, E/A ratio and LVOT TVI were significantly lower in cardiac tamponade patients and can be useful markers for detecting the cardiac tamponade. P1018Sigmoid septum as a marker of elongation of thoracic aorta caused by progression of atherosclerosis Y. Wada Y. Wada 1Yamaguchi University Graduate School of Medicine, Department of Medicine and Clinical Science, Ube, Japan A. Fujii A. Fujii 2Yamaguchi University Hospital, Ultrasound Examination Center, Ube, Japan T. Ariyoshi T. Ariyoshi 2Yamaguchi University Hospital, Ultrasound Examination Center, Ube, Japan S. Okuda S. Okuda 1Yamaguchi University Graduate School of Medicine, Department of Medicine and Clinical Science, Ube, Japan A. Omuro A. Omuro 1Yamaguchi University Graduate School of Medicine, Department of Medicine and Clinical Science, Ube, Japan M. Hisaoka M. Hisaoka 1Yamaguchi University Graduate School of Medicine, Department of Medicine and Clinical Science, Ube, Japan T. Nao T. Nao 1Yamaguchi University Graduate School of Medicine, Department of Medicine and Clinical Science, Ube, Japan T. Yamasaki T. Yamasaki 2Yamaguchi University Hospital, Ultrasound Examination Center, Ube, Japan N. Tanaka N. Tanaka 3Yamaguchi University Graduate School of Medicine, Department of Clinical Laboratory Sciences, Ube, Japan M. Yano M. Yano 1Yamaguchi University Graduate School of Medicine, Department of Medicine and Clinical Science, Ube, Japan 1Yamaguchi University Graduate School of Medicine, Department of Medicine and Clinical Science, Ube, Japan 2Yamaguchi University Hospital, Ultrasound Examination Center, Ube, Japan 3Yamaguchi University Graduate School of Medicine, Department of Clinical Laboratory Sciences, Ube, Japan Background: Sigmoid shape of a septum is frequently observed in elderly patients and is associated with a sharper angulation of the ascending aorta on the axis of the left ventricle, but is usually recognized as a minor innocent finding. Some previous studies have described that the cause of sigmoid septum may be a change in the spatial relationship between ascending aorta and left ventricle due to elongation of arteriosclerotic aorta with advanced aging. However, there is no evidence to support such a hypothesis. Methods: We performed routine 2D and 3D transthoracic echocardiography (TTE) in 43 patients with atherosclerotic AS who underwent Multi Detector-row Computed Tomography (MDCT) on the same day as TTE. Using the cutting images obtained by 3DTTE, we measured the minimum and maximum diameters of aortic annulus and the septoaortic angle (SAA), which was measured as the open angle between the axis of the base of the interventricular septum and the ascending aorta. Moreover, the thoracic aortic length (TAL), which was defined as the distance from the sinotubular junction to the diaphragm, was also measured by MDCT (Figure). Results: TAL indexed by height (TAL/Ht) and diastolic blood pressure (DBP) had significant correlations with SAA (TAL/Ht : r= -0.463; p<0.001, DBP: r= 0.349; p<0.01). In stepwise multivariate regression analysis, TAL/Ht was independent determinant of SAA (stdβ= -0.401; p<0.01). Conclusion: Our findings suggest that elongation of the thoracic aorta impacts on the sharp SAA. We revealed that patients with sigmoid septum are likely to have a systemic arteriosclerosis and its complications. Open in new tabDownload slide Abstract P1018 Figure. Open in new tabDownload slide Abstract P1018 Figure. P1019Carotid artery atherosclerosis and stiffness: comparison of different metabolic measures C. Di Nora C. Di Nora 1University Hospital Riuniti, Cardiovascular Department, Trieste, Italy S. Poli S. Poli 1University Hospital Riuniti, Cardiovascular Department, Trieste, Italy O. Vriz O. Vriz 2San Daniele del Friuli Hospital, ASS4, Cardiology Department, San Daniele del Friuli, Italy L. Sparacino L. Sparacino 3Santa Maria degli Angeli Hospital, Cardiology Department, Pordenone, Italy C. Zito C. Zito 4U.O. Polyclinic G. Martino, Cardiology Department, Messina, Italy S. Carerj S. Carerj 4U.O. Polyclinic G. Martino, Cardiology Department, Messina, Italy D. Pavan D. Pavan 3Santa Maria degli Angeli Hospital, Cardiology Department, Pordenone, Italy F. Antonini-Canterin F. Antonini-Canterin 3Santa Maria degli Angeli Hospital, Cardiology Department, Pordenone, Italy 1University Hospital Riuniti, Cardiovascular Department, Trieste, Italy 2San Daniele del Friuli Hospital, ASS4, Cardiology Department, San Daniele del Friuli, Italy 3Santa Maria degli Angeli Hospital, Cardiology Department, Pordenone, Italy 4U.O. Polyclinic G. Martino, Cardiology Department, Messina, Italy Background. Recently a new index of metabolic impairment has been introduced: the triglycerides/HDL ratio (TG/HDL). This index indicates an atherogenic lipid profile and an increased risk for the development of common atherosclerosis. Purpose. To evaluate in a population of non diabetic patients the role of TG/HDL ratio compared to non-HDL cholesterol and insulin resistance in predicting early carotid atherosclerosis and stiffness. Methods. The study population consisted of 377 non-diabetic asymptomatic patients (mean age 54 ± 14 years; 242 females, BMI 34.6 ± 8 Kg/m2) referred to our Department for clinical evaluation and primary prevention. All patients underwent a high definition carotid ultrasound examination implemented by an echo-tracking system. In all cases, we evaluated beta-index vascular stiffness, intimal media thickness (IMT) values and the presence of carotid vascular plaque defined as IMT > 1.5 mm. Complete lipid profile was obtained as well as insulin resistance by means of HOMA index. Non-HDL cholesterol was used instead of LDL estimation by Friedewald formula because the high prevalence of hypertriglyceridemia. Results. Mean IMT was 0.87 ± 0.17 mm, mean beta index was 7.3 ± 2.8. One hundred forty one pts (37%) showed a carotid plaque at the ultrasound evaluation. In a model considering systolic blood pressure, glicemia, HOMA index, triglycerides, TG/HDL ratio and non-HDL cholesterol, only non-HDL cholesterol emerged as predictive variable for elevated IMT, elevated beta stiffness and presence of carotid plaque (p?<.001). Conclusion. In a population of non diabetic patients in primary prevention, non-HDL cholesterol is superior in predicting carotid atherosclerosis and stiffness than triglycerides/HDL ratio and HOMA index. P1020Feasibility of triple imaging vasodilator stress echo in patients with suspected coronary artery disease Q. Ciampi Q. Ciampi 1Fatebenefratelli Hospital, Division of Cardiology, Benevento, Italy M. Paterni M. Paterni 2Institute of Clinical Physiology of CNR, Pisa, Italy B. Villari B. Villari 1Fatebenefratelli Hospital, Division of Cardiology, Benevento, Italy E. Picano E. Picano 1Fatebenefratelli Hospital, Division of Cardiology, Benevento, Italy 1Fatebenefratelli Hospital, Division of Cardiology, Benevento, Italy 2Institute of Clinical Physiology of CNR, Pisa, Italy Background. Regional wall motion abnormalities (RWMA) are the diagnostic cornerstone of stress echo (SE), but the positivity rate has been declining over the last decades. Additional information is obtained with simultaneous assessment of coronary flow velocity reserve (CFVR) on left anterior descending artery and global left ventricular contractility reserve (LVCR) from systolic pressure/end-systolic volume relationship. Aim: to assess the feasibility of triple imaging (RWMA + LVCR + CFVR) during dipyridamole SE. Methods. We enrolled 40 consecutive patients (30 men; 62±11 years, mean value of ejection fraction: 62±7%), referred to testing for suspected coronary artery disease. All underwent dipyridamole (0.84 mg/kg in 6') SE. LVCR was defined as the ratio between peak and rest elastance index (cuff systolic blood pressure/ left ventricular end-systolic volume from biplane Simpson method, normal values: > 1.0). CFVR was defined as the ratio between maximal vasodilation and rest peak diastolic flow velocity in left anterior descending coronary artery (normal values > 2.0). Results. In 40 consecutive patients, interpretable images were obtained in 40/40 patients (100%) for RWMA, 40/40 (100 %) for LVCR and 40/40 (100%) for CFVR. The positivity rate was 1/40 (2%) for RWMA, 4/40 (10%) for LVCR, 6/40 (15%) for CFVR and 9/40 (22.5 %) with any of the three criteria combined (figure). The average additional imaging time at peak stress after completion of RWMA imaging was 45 seconds for CFVR, no extra-time was required for LVCR. The average analysis time (off-line) was 30 seconds for RWMA, 55 seconds for LVCR, and 15 seconds for CFVR. Conclusions. Triple imaging vasodilator SE was highly feasible and non-time consuming. Abnormal values are more frequently found with CFVR and LVCR than with RWMA. Triple imaging might become the new diagnostic standard in SE, and larger scale validation is now ongoing in the Italian Stress echo 2020 multicenter study. On behalf of: Stress-echo 2020 study group. Open in new tabDownload slide Abstract P1020 Figure. Open in new tabDownload slide Abstract P1020 Figure. P1022The use of combined echo and cardio-pulmonary stress for discriminating cardiac problems from de-conditioning in patients with dyspnea YT. Topilsky YT. Topilsky Sourasky Medical Center, Cardiology, Tel Aviv, Israel ZR. Rozenbaum ZR. Rozenbaum Sourasky Medical Center, Cardiology, Tel Aviv, Israel KS. Khoury KS. Khoury Sourasky Medical Center, Cardiology, Tel Aviv, Israel GK. Keren GK. Keren Sourasky Medical Center, Cardiology, Tel Aviv, Israel Sourasky Medical Center, Cardiology, Tel Aviv, Israel Background: Discriminating circulatory problems with reduced stroke volume from de-conditioning in which the muscles cannot consume O2 normally by gas exchange parameters is difficult. Methods: We performed combined stress echo and cardio-pulmonary (CPET) tests in 115 consecutive patients to evaluate multiple hemodynamic parameters and oxygen content difference (A-VO2 Difference) in four predefined activity levels to assess which of the gas measures may help in the discrimination. Results: Reduced anaerobic threshold (AT), low unchanging peak O2 pulse, periodic breathing, shallow DVO2/D work rate (WR) ratio, and high VE/VCO2 slope were all associated with abnormal stroke volume response (p<0.05 for all). The best discriminator was VE/VCO2/peak O2/kg (≥2.7; AUC 0.79: p<0.0001). Combined stress echo and CPET analysis showed that high VE/VCO2/peak O2 reflects an impaired cardiac condition, whose main determinants are reduced stroke volume, elevated left atrial pressure, and impaired right ventricular-pulmonary vascular function. The optimal gas exchange model included DVO2/D work rate<8.6, VE/VCO2/peak O2≥2.7, and periodic breathing (AUC of 0.84, p<0.0001). Addition of rest stroke volume to VE/VCO2/peak O2 performed even better (AUC 0.87, p<0.0001). Conclusion: The best single gas exchange parameter to discriminate between circulatory problems to de-conditioning is VE/VCO2/peak O2. Combining it to DVO2/D work rate and periodic breathing or to rest echo parameters improves the discriminative ability. Nonetheless, gas exchange parameters lack sensitivity, thus in borderline cases addition of stress echo is recommended. P1023Long-term prognosis of a stress echocardiography in patients after successful primary percutaneous intervention and incomplete revascularization of non-culprit lesions MT. Petrovic MT. Petrovic Clinic for Cardiology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia V. Giga V. Giga Clinic for Cardiology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia J. Stepanovic J. Stepanovic Clinic for Cardiology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia N. Boskovic N. Boskovic Clinic for Cardiology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia D. Trifunovic D. Trifunovic Clinic for Cardiology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia S. Aleksandric S. Aleksandric Clinic for Cardiology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia I. Nedeljkovic I. Nedeljkovic Clinic for Cardiology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia M. Tesic M. Tesic Clinic for Cardiology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia M. Dobric M. Dobric Clinic for Cardiology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia I. Rakocevic I. Rakocevic Clinic for Cardiology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia B. Beleslin B. Beleslin Clinic for Cardiology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia A. Djordjevic-Dikic A. Djordjevic-Dikic Clinic for Cardiology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia Clinic for Cardiology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia Background: The role of stress echocardiography in a risk stratification of patients after primary percutaneous coronary intervention (pPCI) has been incompletely documented. Aim of our study was to assess prognostic value of stress echocardiography after successful pPCI for acute myocardial infarction (AMI). Also, we sought to evaluate prognostic value of heart rate recovery (HRR) and Duke treadmill score in stable coronary artery disease. Methods: Our study comprised of 119 patients successfully treated with pPCI. All patients performed stress echocardiography according Bruce protocol in order to assess residual ischemia in coronary artery other than treated vessel. Stress echocardiography was considered positive for ischemia in the case of new or worsening of preexisting wall motion abnormalities. Duke treadmill score, wall motion score index (WMSI) at rest as well as HRR in the first minute after exercise was calculated in all patients. Lesion severity of on culprit coronary arteries was assessed by quantitative coronary angiography. All the patients were followed for the occurrence of hard cardiac events: cardiac death, myocardial infarction and coronary artery bypass graft (CABG) intervention. Results: Out of 119 patients 14 patients had positive stress echo test and they were scheduled for elective PCI, remaining 105 patients were included in the study (68 male, 37 female). The average age was 58±9 years. During the follow up period (mean 40±14 months) hard cardiac events occurred in 8 patients with negative stress echocardiography (2 deaths, 3 myocardial infarcts, 3 CABG). There was statistically significant difference between patients with and without hard cardiac events regarding WMSI at rest (p= 0.03), but there was no difference in diameter stenosis (p>0.05), HRR and Duke score (p= 0.38). Nevertheless patients with lower Duke score (5.7 vs. 6.8) showed trend to more hard cardiac events. Area under receiver operating characteristic curve for WMSI was 0.803 with cut off value of 1.22 (Sn 83%, Sp 64%). Conclusions: Negative stress echo test after successfully pPCI in patients with incomplete revascularization had good negative prognostic value for the occurrence of the hard cardiac events. The WMSI at rest was proven well in further risk stratification of our patients while HRR as well as Duke treadmill score have failed. P1024Diastolic exercise stress echo can unmask diastolic dysfunction in type 2 diabetes, a five-year follow-up study C. Bjork Ingul C. Bjork Ingul Norwegian University of Science and Technology, Faculty of Medicine, The K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Trondheim, Norway AS. Timilsina AS. Timilsina Norwegian University of Science and Technology, Faculty of Medicine, The K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Trondheim, Norway SM. Hollekim-Strand SM. Hollekim-Strand Norwegian University of Science and Technology, Faculty of Medicine, The K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Trondheim, Norway Norwegian University of Science and Technology, Faculty of Medicine, The K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Trondheim, Norway Background: Type 2 diabetes (T2D) is associated with diastolic dysfunction (DD), which could lead to heart failure and early identification is thus important. Resting echo can underestimate the severity of disease. Purpose: To study whether diastolic exercise echo can identify masked DD in patients with T2D and the effect of 5 years aging. Methods: We studied 51 patients with T2D (mean age 59.8±6.4 years, male 32) and reduced (DF-red; n=29) or normal (DF-norm; n=22) diastolic function (DF) measured as peak early diastolic tissue Doppler velocity (e’) during resting echo. Echo was performed during exercise on a cycle ergometer (upright) with mitral Doppler flow and color tissue Doppler recordings at 25W, 50W, 75 W (3 minutes at each workload) at baseline and 5 year follow-up. Results: The mean difference in e’ during rest on bicycle between groups was 1.6 cm/s (p<0.001) at baseline and 0.9 cm/s (p<0.05) at 5 year follow-up. At baseline, DF-norm had significantly higher e’ at all exercise workloads compared to DF-red (Table). The DF-norm group had not changed resting e’, but had significantly lower e’ at all exercise workloads after 5 years (Table). Baseline difference between the DF-red and DF-norm group were sustained, but there was no significant difference in e’ during diastolic exercise test after 5 years. Mitral Doppler flow was not sensitive enough to detect the differences between groups. Conclusion: Diastolic exercise stress echo can unmask diastolic dysfunction in type 2 diabetes with normal diastolic function at rest. P1025Diabetes mellitus is the major limitation for diagnosis of coronary artery disease assessed by semisupine ergometer stress echocardiography HR. Tsai HR. Tsai 1Madou Sin-Lau Hospital, Division of Cardiology, Department of Internal Medicine, Tainan, Taiwan ROC YW. Liu YW. Liu 2National Cheng Kung University, College of Medicine, National Cheng Kung University Hospital, Division of Cardiology, Department of Internal Medicine, Tainan, Taiwan ROC WC. Tsai WC. Tsai 2National Cheng Kung University, College of Medicine, National Cheng Kung University Hospital, Division of Cardiology, Department of Internal Medicine, Tainan, Taiwan ROC 1Madou Sin-Lau Hospital, Division of Cardiology, Department of Internal Medicine, Tainan, Taiwan ROC 2National Cheng Kung University, College of Medicine, National Cheng Kung University Hospital, Division of Cardiology, Department of Internal Medicine, Tainan, Taiwan ROC Background: Stress echocardiography(SE) has developed to be one of the leading diagnostic modalities for evaluation of coronary artery disease(CAD). Exercise or pharmacological SE was applied according to patient characteristics and feasibilities among institutions. Purpose: We used semisupine bicycle ergometer SE in stable symptomatic patients who had non-diagnostic treadmill exercise electrocardiography. The purpose of this study was to identify the independent clinical factors of indeterminate ergometer SE. Methods: We conducted a retrospective chart review of semisupine ergometer SE studies for evaluation of de novo CAD. Results: A total of 257 ergometer SE studies for de novo CAD were included from 400 consecutive SE performed between May 2013 and September 2015. Indeterminate SE was defined by no inducible wall motion abnormality at peak stress imaging with a peak heart rate(HR) below 85% of the maximal predicted HR for age. There were 21 positive, 161 negative, and 75 indeterminate studies. A total of 14 patients were later documented CAD by coronary angiography from 8 positive ergometer SE and 6 indeterminate ones. The sensitivity and specificity of ergometer SE was 100% and 92.5%, respectively. The significant independent factors for indeterminate ergometer SE included diabetes mellitus (OR 3.133; 95% CI 1.501-6.538; P= 0.002), beta-blocker regimen (OR 2.324; 95% CI 1.225-4.411; P= 0.010), and baseline HR (OR 0.956; 95% CI 0.929-0.983; P=0.002). Preexisting chronic lung disease and joint disease of lower extremities were the major negative findings which do not contribute to indeterminate ergometer SE. Conclusion: In conclusion, diabetes mellitus is the most important factor of indeterminate ergometer SE for evaluation of de novo CAD. We recommend stressor modalities other than bicycle ergometer for better informative CAD diagnostic value in diabetic patients. P1026Longitudinal changes of atherosclerotic features in the aorta on transcatheter aortic valve implantation using transesophageal echocardiography M. Bando M. Bando 1Saiseikai Kumamoto Hospital, Department of Critical Care and Cardiology, Kumamoto, Japan K. Nishigami K. Nishigami 1Saiseikai Kumamoto Hospital, Department of Critical Care and Cardiology, Kumamoto, Japan Y. Horibata Y. Horibata 2Saiseikai Kumamoto Hospital, Division of Cardiology, Kumamoto, Japan K. Nakao K. Nakao 2Saiseikai Kumamoto Hospital, Division of Cardiology, Kumamoto, Japan T. Sakamoto T. Sakamoto 2Saiseikai Kumamoto Hospital, Division of Cardiology, Kumamoto, Japan 1Saiseikai Kumamoto Hospital, Department of Critical Care and Cardiology, Kumamoto, Japan 2Saiseikai Kumamoto Hospital, Division of Cardiology, Kumamoto, Japan Background: Transcathether aortic valve implantation (TAVI) has been an optimal option for patients with severe aortic valve stenosis (AS) in high risk. Recent reports showed that stroke occurred more frequently in TAVI than in surgical aortic valve replacement (SAVR). Aortic plaque could cause stroke, however, longitudinal change of aortic plaque during TAVI has been not fully assessed. The purpose of this study was to assess the longitudinal change of aortic plaques during TAVI, and investigate the relationship of the presence of plaque change and both the patient characteristics and the clinical outcome. Methods: We enrolled 92 consecutive patients who underwent TAVI during a specified period from Dec. 2013 to Dec. 2015 at Saiseikai Kumamoto Hospital. All patients were received 2-dimensional transeshophageal echocardiography (2D-TEE) during TAVI, and evaluated the morphological plaque changes pre and post procedure. We divided into 3 parts of short axis images, 0 to 4 o'clock, 4 to 8 o'clock and 8 to 12 o'clock in intermediate aortic arch, distal arch and descending aorta using 2 dimensional transesophageal echocardiography. The changes of 828 parts before and after TAVI were compared. The classification of plaque was ?: normal or max intra-media thickness (IMT) <2mm, ?: 2mm≦max IMT <4mm, ?:max IMT≧4mm, ?: mobile plaque. The primary outcome was stroke and mortality within 30 days. Results: 13 plaques (2%) in 10 patients (11%) were mobile before TAVI. In all patients, 80 patients underwent TAVI by trans-femoral approach (19 patients with plaque change (24%)) and 12 patients underwent by trans-apical approach (3 patients with plaque change (25%)). There were 37 plaques (4%) with plaque change in 22 patients, and the plaque changed the most frequently in the greater curvature side (greater curvature side; 62% vs other sides; 38%). Strokes within 30 days occurred significantly more frequently in patients with plaque change (15% vs 2.9%; p=0.04) (Figure 1). Patients with plaque change had more prevalence of CAD, but not significant (59% vs 36%; p=0053). Conclusion: The region with plaque change was the most frequent in the greater curvature side. Patients with plaque change had worse outcome within 30 days after TAVI. Open in new tabDownload slide Abstract P1026 Figure. Open in new tabDownload slide Abstract P1026 Figure. P1027Severe aortic stenosis: comparison between effective and anatomical aortic?valvular area by two and three dimension transesophageal ecocardiography G. Perea G. Perea Sanatorium de la Trinidad Palermo, Buenos Aires, Argentina M. Lombardero M. Lombardero Sanatorium de la Trinidad Palermo, Buenos Aires, Argentina R. Henquin R. Henquin Sanatorium de la Trinidad Palermo, Buenos Aires, Argentina MC. Corneli MC. Corneli Sanatorium de la Trinidad Palermo, Buenos Aires, Argentina Sanatorium de la Trinidad Palermo, Buenos Aires, Argentina Introduction: The reference method for measuring aortic valve effective area (AVAE) is 2D transthoracic echocardiography (2DETT), but depends on two points of potential errors: flow and area of the outflow tract of left ventricle (LVOT). Anatomical aortic valve area (AVAA) can be measured by 2D transesophageal echocardiography planimetry (2DTEE), but there is no clear reference plane. 3D transesophageal echocardiography (3DTEE) has tools that can avoid or minimize these errors. Objectives: compare the measurement of AVAE by ETT2D vs AVAE with hybrid 2D / 3D method vs AVAA by 2D TEE and 3D TEE direct planimetry multislice in patients with aortic stenosis (AS). Method: 36 patients with severe AS with 2D ETT followed by 2D/3D TEE were evaluated prospectively. AVAA 2D TEE was performed by direct planimetry in mesosystole (short axis). AVAA 3D TEE was performed through multislice tool QLAB program (Philips). The AVAE for Hybrid 2D / 3D method combine the measurement of LVOT by 3D TEE in mesosystole by the VTI LVOT divided by the spectral wave VAO by 2D ETT. Results: AVAE by 2D ETT was 0.66 (± 0.21) cm², the average gradient 38.7 (± 12.8) mmHg and FE 55% (± 12.2). The diameter and LVOT area by 2D ETT was: 2.01 (± 0.28) cm and 3.23 ± 0.87 cm² respectively. LVOT area by 3D TEE was 3.91 ± 0.94 cm² (Lin Index 0.08). The agreement between the AVAE for Hybrid 2D / 3D vs AVAA 3D TEE by direct planimetry multislice: Lin index 0.76, 95% CI Bland & Altman -0.23-0.28; and between AVAA by direct planimetry multislice and AVAA ETE2D: Lin index 0.59, 95% CI Bland & Altman -0.23-0.42. Conclusions: calculating the AVAE the difference in measuring the area of 3D vs 2D LVOT could over-estimate the severity of aortic stenosis. The poor correlation between anatomical methods (2D vs 3D) is explained by the absence of two-dimensional cutting reference planes. The two methods based on 3D Transesophageal Echo had good agreement with each other, and could be a valid alternative in the assessment of aortic stenosis in cases of lack of resolution or incongruity area / 2D gradient echo. Comparison between measurements of VAo Mean and SD IC 95%Bland & Altman Lin Index AVAE 2D ETT 0.66 ±0.21 AVAE Hybrid 3D TEE 0.81±0.21 * -0.41-0.12 0.64 AVAA 2D TEE 0.88 ± 0.23 ** -0.65-0.21 0.34 AVAA 3D TEEMultiplane 0.79 ±0.16 *** -0.45-0.20 0.50 Mean and SD IC 95%Bland & Altman Lin Index AVAE 2D ETT 0.66 ±0.21 AVAE Hybrid 3D TEE 0.81±0.21 * -0.41-0.12 0.64 AVAA 2D TEE 0.88 ± 0.23 ** -0.65-0.21 0.34 AVAA 3D TEEMultiplane 0.79 ±0.16 *** -0.45-0.20 0.50 Reference Table: * p <0.001 vs AVAE ETT2D, ** p <0.001 vs AVAE ETT2D, *** p <0.001 vs AVA ETT2D Comparison between measurements of VAo Mean and SD IC 95%Bland & Altman Lin Index AVAE 2D ETT 0.66 ±0.21 AVAE Hybrid 3D TEE 0.81±0.21 * -0.41-0.12 0.64 AVAA 2D TEE 0.88 ± 0.23 ** -0.65-0.21 0.34 AVAA 3D TEEMultiplane 0.79 ±0.16 *** -0.45-0.20 0.50 Mean and SD IC 95%Bland & Altman Lin Index AVAE 2D ETT 0.66 ±0.21 AVAE Hybrid 3D TEE 0.81±0.21 * -0.41-0.12 0.64 AVAA 2D TEE 0.88 ± 0.23 ** -0.65-0.21 0.34 AVAA 3D TEEMultiplane 0.79 ±0.16 *** -0.45-0.20 0.50 Reference Table: * p <0.001 vs AVAE ETT2D, ** p <0.001 vs AVAE ETT2D, *** p <0.001 vs AVA ETT2D P1028Region growing method provides better left ventricular volume and cardaic output measuring H-L Cheng H-L Cheng National Taiwan University Hospital, Anesthesia, Taipei, Taiwan ROC National Taiwan University Hospital, Anesthesia, Taipei, Taiwan ROC Background: In 3D TEE left ventricular volume and cardiac output measurement, commercialized software package such as Philips QLAB, provides a convenient way to perform our daily practice. However, its image processing method such as Snack algorithm sometimes makes more round shape than real thus could possibly cause less precise measurement. In this study, we propose to use another algorithm - region growing. Methods: We reviewed all patients underwent cardiac surgery and 3D TEE in consecutive 6 months, patients with valvular heart disease, intra-cardiac tumor, congenital heart disease were excluded. The 3D TEE images must be acquired before skin incision with good quality. Images were processed by Philips QLAB 7.1 3DQA and MeVisLab 2.5 (region growing algorithm) respectively. The cardiac output measurements were compared with those by pulmonary artery catheter (PAC). Results: There are 10 patients included finally, all of them underwent coronary artery bypass surgery. The cardiac output of Philips group has a correlation coefficient 0.244 with PAC data, while MeVisLab (region growing algorithm) group has a correlation coefficient 0.579. Conclusion: In this small pilot study, region growing could provide better cardiac output measurement with correlation to PAC data than QLAB. Larger study with careful design and good parameter settings may be required to clarify this issue. Open in new tabDownload slide Abstract P1028 Figure. Open in new tabDownload slide Abstract P1028 Figure. P10293 dimensional echocardiographic evaluation of mitral valve geometry in patients with secondary and primary mitral regurgitation R. Schueler R. Schueler 1University of Bonn, Medical Clinic II - Cardiology, Bonn, Germany C. Oeztuerk C. Oeztuerk 1University of Bonn, Medical Clinic II - Cardiology, Bonn, Germany M. Weber M. Weber 1University of Bonn, Medical Clinic II - Cardiology, Bonn, Germany A. Welz A. Welz 2University Hospital Bonn, Cardiac Surgery, Bonn, Germany N. Werner N. Werner 1University of Bonn, Medical Clinic II - Cardiology, Bonn, Germany G. Nickenig G. Nickenig 1University of Bonn, Medical Clinic II - Cardiology, Bonn, Germany C. Hammerstingl C. Hammerstingl 1University of Bonn, Medical Clinic II - Cardiology, Bonn, Germany 1University of Bonn, Medical Clinic II - Cardiology, Bonn, Germany 2University Hospital Bonn, Cardiac Surgery, Bonn, Germany Background: The impact of interventional edge-to-edge-repair with the MitraClip system on mitral valve (MV) annular diameters is thought to be different in patients with primary and secondary mitral regurgitation (s/pMR) due to progressive annular dilatation in sMR on the one and smaller annuli with elongated, prolapsing mitral leaflets in pMR on the other hand. The Alfieri stich combined edge-to-edge repair to accomplish MR reduction in sMR as well as in pMR patients. However, data on MV geometry in sMR or pMR are somewhat inconclusive and the influence of MitraClip implantation on MV annular dimensions is controversially discussed. We sought to evaluate MV annular geometry defining parameters in sMR and pMR patients using 3D echocardiography. Methods and Results: We prospectively examined 165 patients (77% sMR, 33% pMR, 62.4% male, age 80.5±8.2years) at high surgical risk (EuroScore 20.5±17.1%) undergoing interventional MV edge-to-edge repair with the MitraClip device. All patients underwent 3D transesophageal echocardiography prior to the intervention with offline reconstruction of MV geometry using dedicated analysis software. MV annular anatomy was determined during a full heart cycle for dynamic analysis. Patients with sMR presented with larger LV volumes (EDV: 160.0±63.7ml, 121.6±43.9ml, p=0.01; ESV: 102.5±52.1ml, 54.2±31.5ml, p<0.001), larger LV diameters (59.3±11.9mm, 54.4±9.2mm, p=0.03) and lower LV ejection fraction (38.9±14.7%, 54.2±31.5%, p<0.001). Interestingly, we found no differences in both groups with regard to MV lateral-medial diameter (sMR vs. pMR: 4.1±0.7cm, 4.3±0.9cm; p=0.8), anterior-posterior diameter (3.9±0.5cm, 4.1±0.8cm; p=0.8),) 3D annulus area (13.4±3.8cm2, 15.4±5.6 cm2; p=0.07), mitral leaflet areas (9.5±3.4cm2, 9.5±3.8 cm2; p=0.98) and MV annular sphericity index (0.95±0.1, 0.97±0.1; p=0.33). Significant differences were detected in 3D annular geometry, indicating on less pronounced saddle shape of the MV annulus in sMR patients, accompanied by a significant increased tenting height (p<0.05) and increased PML- (p=0.03) and AML- (p=0.02) to-MV-plane angle. Conclusion: In contrast to current pathophysiological understanding of sMR, 3D reconstruction of MV annular geometry showed no relevant differences in MV annular diameters when compared to patients with pMR. Differences in annular geometry were subtler and seemed mediated by increased MV leaflet tethering via LV geometrical changes. P1030The impact of adjustable region of interest on ventricular strain measurements and arrhythmic risk assessment in patients with hypertrophic cardiomyopathy M. Rosca M. Rosca "Carol Davila" University of Medicine and Pharmacy, Euroecolab, Bucharest, Romania L. Mandes L. Mandes "Carol Davila" University of Medicine and Pharmacy, Euroecolab, Bucharest, Romania A. Calin A. Calin "Carol Davila" University of Medicine and Pharmacy, Euroecolab, Bucharest, Romania CC. Beladan CC. Beladan "Carol Davila" University of Medicine and Pharmacy, Euroecolab, Bucharest, Romania R. Enache R. Enache "Carol Davila" University of Medicine and Pharmacy, Euroecolab, Bucharest, Romania A. Mateescu A. Mateescu "Carol Davila" University of Medicine and Pharmacy, Euroecolab, Bucharest, Romania C. Calin C. Calin "Carol Davila" University of Medicine and Pharmacy, Euroecolab, Bucharest, Romania R. Jurcut R. Jurcut "Carol Davila" University of Medicine and Pharmacy, Euroecolab, Bucharest, Romania C. Ginghina C. Ginghina "Carol Davila" University of Medicine and Pharmacy, Euroecolab, Bucharest, Romania BA. Popescu BA. Popescu "Carol Davila" University of Medicine and Pharmacy, Euroecolab, Bucharest, Romania "Carol Davila" University of Medicine and Pharmacy, Euroecolab, Bucharest, Romania Background: In hypertrophic cardiomyopathy (HCM), ventricular hypertrophy is often asymmetrical, with non-contiguous patterns of increased wall thickness. The underlying structural changes are also heterogeneously distributed and lead to functional inhomogeneity. The assessment of myocardial deformation by speckle tracking echocardiography (STE), able to identify subtle abnormalities in myocardial function, is highly dependent on accurately tracing the selected region of interest (ROI). In pts with HCM, the use of a classical, fixed-width ROI can lead to skewed data depending on what part of the ventricular wall has been sampled. Purpose: To compare global longitudinal strain (ɛ) values for both left (ɛLV) and right (ɛRV) ventricles as determined using fixed-width (f) or fully adjustable (a) ROI, and to assess the relationship between ɛ, the presence of ventricular arrhythmias, and the risk of sudden cardiac death (SCD) score. Methods: A comprehensive echocardiogram was performed in 62 consecutive pts with HCM (51±18 years, 27 men), including the measurement of maximal LV and RV wall thickness (WT). Longitudinal ventricular deformation was measured by STE (EchoPAC version 201) (using both fixed and adjustable ROI) as a mean of strain values in 17 segments for the LV and 6 segments for the RV, respectively. The presence of malignant ventricular arrhythmias (VA) during 24-hour ambulatory ECG monitoring was determined. HCM Risk-SCD Score was calculated based on the ESC 2014 guidelines on HCM. Results: Twenty one pts had obstructive HCM, 36 pts had non-obstructive HCM, and 5 pts had apical HCM. Mean values of ɛ were: -14±3 for ɛLVf, -13±3 % for ɛLVa, -20±5 % for ɛRVf and -18±4 for ɛRVa. The percentage in change of ɛRVf when an adjustable ROI was used (range between 0 and 43%, median 10%) correlated with LVWT (r=0.50, p<0.001). The percentage in change of ɛLVf when an adjustable ROI was used (range between 0 and 20%, median 5%) did not correlate with LVWT, type of HCM, nor with the distribution of hypertrophy. Fifteen pts had VA. Patients with VA had higher values of LVWT (p=0.02), RVWT (p=0.01) and lower values of ɛLVf (p=0.003), ɛLVa (p=0.002) and ɛRVa (p=0.02) than pts without VA. Receiver operating characteristic curve analysis showed that both ɛLVf and ɛLVa have a good discriminative value in distinguishing pts with from those without VA (AUC = 0.72, 0.74 respectively, p<0.009 for both). In multivariable analysis ɛLVa was independently correlated with the presence of VA (OR=1.4, 95% CI 1.10 to 1.78, p=0.006). ɛRVa was the only strain-derived parameter which correlated with Risk-SCD Score (r=0.32, p=0.01). Conclusions: Half of the HCM patients had a change of ≥5% in ɛLV, and of ≥10% in ɛRV when the adjustable ROI was used. Reduced LV and RV strain measured by STE using adjustable ROI seem to have a closer relation to the presence of VA or to a high Risk-SCD Score than conventionally measured strain parameters. P1031Left ventricular strain at presentation predicts long-term outcome in ALCAPA patients G. Di Salvo G. Di Salvo 1Italian Society of Cardiovascular Echography (SIEC), Milan, Italy N. Muhanna N. Muhanna 2King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia G. Siblini G. Siblini 2King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia Z. Bulbul Z. Bulbul 3American University of Beirut AUB, Pediatric Cardiology, Beirut, Lebanon Z. Issa Z. Issa 2King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia A. Abu Hazeem A. Abu Hazeem 2King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia B. Fadel B. Fadel 2King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia V. Pergola V. Pergola 2King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia Z. Halees Z. Halees 2King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia M. Fayyadh M. Fayyadh 2King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia 1Italian Society of Cardiovascular Echography (SIEC), Milan, Italy 2King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia 3American University of Beirut AUB, Pediatric Cardiology, Beirut, Lebanon Background: Outcome after surgical repair of ALCAPA remains incompletely defined. The predictive power of preoperative variables in terms of mortality and LV?functional recovery is still controversial. However, all previous studies assessed?preoperative cardiac function by standard echo. Thus, our aim is to evaluate the prognostic value of speckle tracking echocardiography (STE) in ALCAPA patients. Methods: Thirty-eight consecutive ALCAPA patients who underwent surgical repair were pre-operatively investigated by standard echo and STE measuring LV global longitudinal strain (GLS), global circumferential strain (GCS), and LV torsion at baseline echo. Patients were followed for a mean follow-up period of 6.1years (range 0.1 to 24 years). Results: Before surgical repair ALCAPA patients showed dilated LV (Z-score +8.6±3.8) and reduced LVEF (32.7±15.3). Follow- up: There were 4 (10.5%) deaths and four (10.5%) patients showed a reduced LVEF<50% (average 39.5±7.2%). Those 8 patients were comparable to the remaining ALCAPA patients for age at repair, weight, BSA and standard echo parameters at repair. Preoperative GLS (median -2.8 [IQR -4.9 -0.7]vs. median -6.2 [IQR -9.8 -3.3], p=0.032) and GCS (median -4.16 [IQR -5.7 -2.5] vs. median -8.0 [IQR -13.7 -4.2]p=0.041) were significantly lower in patients with poor outcome. At multivariate analysis (including age at repair, weight, LV diameters, GLS and GCS), the only independent predictor was GCS (p=0.0252). Conclusions: We suggest including LV GCS in the pre-operative evaluation of ALCAPA patients in order to identify the group of ALCAPA patients at higher risk and to ensure strict cardiac surveillance during the recovery period, which may last several years. Open in new tabDownload slide Abstract P1031 Figure. Open in new tabDownload slide Abstract P1031 Figure. P1032Global atrial-ventricular strain as a new index of subclinical left heart dysfunction in hypertensive and diabetic patients M. Cameli M. Cameli University of Siena, Department of Cardiovascular Diseases, Siena, Italy GE. Mandoli GE. Mandoli University of Siena, Department of Cardiovascular Diseases, Siena, Italy FM. Righini FM. Righini University of Siena, Department of Cardiovascular Diseases, Siena, Italy C. Albizzi C. Albizzi University of Siena, Department of Cardiovascular Diseases, Siena, Italy E. Capitani E. Capitani University of Siena, Department of Cardiovascular Diseases, Siena, Italy C. Pastore C. Pastore University of Siena, Department of Cardiovascular Diseases, Siena, Italy F. D'ascenzi F. D'ascenzi University of Siena, Department of Cardiovascular Diseases, Siena, Italy M. Focardi M. Focardi University of Siena, Department of Cardiovascular Diseases, Siena, Italy S. Mondillo S. Mondillo University of Siena, Department of Cardiovascular Diseases, Siena, Italy University of Siena, Department of Cardiovascular Diseases, Siena, Italy Background: Arterial hypertension and diabetes mellitus determine untimely impair in left atrium (LA) and ventricle (LV) even with normal volumes and size. In this phase, ejection fraction (EF) is still preserved and the patient is usually asymptomatic but chambers remodeling could become irreversible without correct therapies. Purpose: The aim of this study was to evaluate global LA strain, LV longitudinal strain and a new parameter, global atrial-ventricular (GAV) strain, using Speckle-Tracking Echocardiography (STE), in patients with hypertension or diabetes and normal LA volume, LV size and EF, in order to detect early dysfunction. Methods: We enrolled 242 patients affected by arterial hypertension or diabetes with?LA volume indexed < 34 ml/m2, LV end diastolic diameter < 54 mm (male) or < 48 mm (female) and LV EF ≥55% (85 hypertensives, 78 diabetics and 79 both hypertensive and diabetic subjects) and 60 age-matched healthy controls. All subjects?underwent standard and advanced (STE) echocardiography. By an off-line analysis, we evaluate: peak atrial longitudinal strain (PALS), LV longitudinal strain (LS) and GAV strain during late diastole in the same cardiac cycle. GAV strain was?calculated as the sum of absolute values of PALS and LV LS in four- and two-chambers view. Results: PALS resulted lower in patients with hypertension (31.8±10.3%) and with diabetes (26.2±6.3%) than in controls (39.4±7.8%) and further reduced in patients with both diabetes and hypertension (20.4±11.2%) (overall P < .0001). Also GAV strain showed a significant statistical difference between the different groups with the same trend (57.5±6.4% in controls, 49.2±7.3% in hypertensives, 42.8±9.1% in diabetics and 36.7±10.6% in hypertensives and diabetics, p<.0001). LV LS resulted significantly reduced only in diabetics and hypertensive-diabetics (-18.1 ± 3.7; -17.4 ± 3.2 (ns); -16.6 ± 4 (p=0.05); -16.3 ± 3.6 (p=0.01), respectively). Conclusion(s): PALS confirmed to be the most sensitive index of early impaired function. In fact, in both hypertensive and diabetic patients, atrial function is mainly involved in premature dysfunction, before size alterations and LV deterioration. Nevertheless, the assessment of GAV, a parameter that considers simultaneously LA and LV myocardial deformation, should represent a promising tool in the early detection of global contractile abnormalities in patients, also in a subsequent phase of systolic dysfunction. Open in new tabDownload slide Abstract P1032 Figure. Open in new tabDownload slide Abstract P1032 Figure. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: Journals.permissions@oup.com.
TI - P1007Aortic root diameters and aortic regurgitation in hypertensive patients and normal subjects
JO - European Heart Journal - Cardiovascular Imaging
DO - 10.1093/ehjci/jew260.002
DA - 2016-12-01
UR - https://www.deepdyve.com/lp/oxford-university-press/p1007aortic-root-diameters-and-aortic-regurgitation-in-hypertensive-IVYupTfZ2U
SP - ii201
VL - 17
IS - suppl_2
DP - DeepDyve
ER -