TY - JOUR
AB - P1138Assessment of echocardiographic epicardial adipose tissue thickness: a new method S P Provenzano S P Provenzano 1University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy M G G Grimaldi M G G Grimaldi 2Casa di cura San Michele, Maddaloni, Italy G R Rengo G R Rengo 1University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy D L Leosco D L Leosco 1University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy N F Ferrara N F Ferrara 1University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy V Parisi V Parisi 1University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy 1University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy 2Casa di cura San Michele, Maddaloni, Italy R F Formisano R F Formisano 1University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy L P Petraglia L P Petraglia 1University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy A C Caruso A C Caruso 2Casa di cura San Michele, Maddaloni, Italy Introduction: Increased epicardial adipose tissue (EAT) thickness, is a marker of visceral adiposity and is associated to cardiac pathologies such as coronary artery disease (CAD) and aortic stenosis (AS). EAT thickness is commonly measured as the echo-free space between the right ventricular wall and the visceral layer of the pericardium in parasternal long axis view, using the aortic annulus as an anatomic landmark (EAT-1). Purpose. In the present study we propose the direct measurement of the adipose tissue thickness visualized, as an hyperechoic tissue, in the space between the ascending aorta and the right ventricle (EAT-2). Methods. We measured EAT-1 and EAT-2 in 375 pts with severe cardiac disease referred for cardiac surgery for isolated AS, severe CAD, and both severe AS and CAD (AS+CAD); and in 155 control subjects matched for age, sex and BMI. The two measurements were obtained at end-systole in 3 cardiac cycles, perpendicularly to the right ventricle wall (figure). Results. Both EAT-1 and EAT-2 measurements had an excellent reproducibility. In control subjects EAT-1 and EAT-2 were not statistically different. Both EAT 1 and EAT 2 were significantly increased in AS, CAD and AS+CAD pts vs controls (EAT1: p<0.001; EAT2: p<0.001). Of note, the two EAT measurements were statistically different among them in: AS pts (EAT1= 6.37±2.3; EAT2=13.3±3; p<0.0001), in CAD pts (EAT1=6.33±2.3; EAT2=12.2±3; p<0.0001) and in AS+CAD pts (EAT1=6.5±2.5; EAT2=13.4±3.02; p<0.0001). Conclusions: Our data demonstrate that EAT-2, as well as EAT-1, is a valuable method to measure EAT thickness and is increased in cardiac condition associated with augmented cardiac visceral fat. The two measure are similar in controls, but in pts where EAT is increased, EAT-2 is greater than EAT-1. The larger space between ascending aorta and right ventricle allows EAT expansion, thus we hypothesize that EAT2 could be a more sensible marker of cardiac visceral obesity. Open in new tabDownload slide Abstract P1138 Figure. Open in new tabDownload slide Abstract P1138 Figure. P1139Community screening using pocket transthoracic echocardiography: an exploratory study M J Vieira M J Vieira 1Hospital Santarém, Cardiology, Santarém, Portugal J Ribeiro J Ribeiro 2University Hospitals of Coimbra, Hospital Geral, Cardiology, Coimbra, Portugal P Dinis P Dinis 2University Hospitals of Coimbra, Hospital Geral, Cardiology, Coimbra, Portugal B Milagre B Milagre 3Health School of Multiperfil Clinic, Cardiology, Luanda, Angola L Goncalves L Goncalves 2University Hospitals of Coimbra, Hospital Geral, Cardiology, Coimbra, Portugal R Teixeira R Teixeira 2University Hospitals of Coimbra, Hospital Geral, Cardiology, Coimbra, Portugal 1Hospital Santarém, Cardiology, Santarém, Portugal 2University Hospitals of Coimbra, Hospital Geral, Cardiology, Coimbra, Portugal 3Health School of Multiperfil Clinic, Cardiology, Luanda, Angola Introduction: The identification of structural heart disease in asymptomatic individuals could enable early disease-modifying treatment. The miniaturization of echo machines that happened in recent years may help to spread the use of echocardiography in community screening programs. However, information on the impact of populational echocardiographic cardiovascular screening is scarce. Aim: To evaluate the feasibility and impact of community screening by pocket echocardiography (pTTE) in early detection of cardiac abnormalities. Methods: A prospective exploratory study was performed including 36 subjects of a community cardiovascular screening program. This program involved 97 health professionals and 362 citizens were screened through the "Heart Gymkhana", with 7 themed stations throughout the city (healthy lifestyles; healthy eating; alcohol consumption; stress management; smoking prevention; physical activity; and cardiovascular risk assessment). The echocardiographic exam was performed by a certified physician, using a pTTE device (Vscan Extend- GE Healthcare®). Clinical, demographic, laboratorial, electrocardiographic and echocardiographic parameters were described. Results: The population had a mean age of 43 ± 21 years and 56% were men. Regarding cardiovascular risk profile, 25% had hypertension, 6% diabetes mellitus, 28% dyslipidemia and 25% had an history of smoking habits. A positive medical history (dyspnea) was obtained in 3% of the subjects (Subj), and a positive physical examination (peripheral edema and abnormal cardiac auscultation) was present in 9%. The duration of each pETT exam was approximately 6 min for each Subj. Regarding echocardiographic parameters, left atrial dilatation was observed in 4 (11%) of the participants (3 mild and 1 moderate); mild left ventricular (LV) hypertrophy was observed in 4 (11%); LV segmental wall motion abnormalities were identified in 1 subject with a past history of myocardial infarction; mitral insufficiency was detected in 12 (33%) of the subjects (1 moderate and the remaining mild); aortic insufficiency was observed in 2 (6%) Subj (both moderate) and tricuspid insufficiency was present in 10 (28%) (mild). Three (9%) patients were referred to a medical evaluation (moderate valvular disease). Conclusion: This study demonstrates that pocket-sized echocardiography is a feasible technique at the cardiovascular community screening level. In this exploratory study, 9% of the patients were referred to a cardiology consult based on pTTE findings. This may suggest that pTTE may have an important role in future screening programs. The screened population in this study had a low cardiovascular risk (82% with a EuroSCORE class 1). To optimize screening programs, further studies are needed to identify the population profile that will benefit the most with the pTTE assessment. P1140Stress echocardiography with smartphone: real-time remote reading for regional wall motion C Scali C Scali 1Azienda Ospedaliero-Universitaria Pisana, Cardiology, Pisa, Italy C De Azevedo Bellagamba C De Azevedo Bellagamba 2Federal University of Rio Grande do Sul, Cardiology, Porto Alegre, Brazil Q Ciampi Q Ciampi 3Fatebenefratelli Hospital, Division of Cardiology, Benevento, Italy I Simova I Simova 4City Clinic, Cardiology, Sofia, Bulgaria J L De Castro E Silva Pretto J L De Castro E Silva Pretto 5Hospital Sao Vicente, Cardiology, Passo Fundo, Brazil A Djordjevic-Dikic A Djordjevic-Dikic 6Clinical center of Serbia, Cardiology, Belgrade, Serbia C Dodi C Dodi 7casa di cura figle di San Camillo, Cardiology, cremona, Italy L Cortigiani L Cortigiani 8San Luca Hospital, Cardiology, Lucca, Italy A Zagatina A Zagatina 9Medika Cardiocenter, Cardiology, Saint Petersburg, Russian Federation P Trambaiolo P Trambaiolo 10Sandro Pertini Hospital, Cardiology, Rome, Italy M A R Torres M A R Torres 2Federal University of Rio Grande do Sul, Cardiology, Porto Alegre, Brazil R Citro R Citro 11AOU S. Giovanni e Ruggi, Cardiology, Salerno, Italy P Colonna P Colonna 12Polyclinic Hospital of Bari, Cardiology, Bari, Italy M Paterni M Paterni 13Institute of Clinical Physiology, CNR, Cardiology, Pisa, Italy E Picano E Picano 13Institute of Clinical Physiology, CNR, Cardiology, Pisa, Italy 1Azienda Ospedaliero-Universitaria Pisana, Cardiology, Pisa, Italy 2Federal University of Rio Grande do Sul, Cardiology, Porto Alegre, Brazil 3Fatebenefratelli Hospital, Division of Cardiology, Benevento, Italy 4City Clinic, Cardiology, Sofia, Bulgaria 5Hospital Sao Vicente, Cardiology, Passo Fundo, Brazil 6Clinical center of Serbia, Cardiology, Belgrade, Serbia 7casa di cura figle di San Camillo, Cardiology, cremona, Italy 8San Luca Hospital, Cardiology, Lucca, Italy 9Medika Cardiocenter, Cardiology, Saint Petersburg, Russian Federation 10Sandro Pertini Hospital, Cardiology, Rome, Italy 11AOU S. Giovanni e Ruggi, Cardiology, Salerno, Italy 12Polyclinic Hospital of Bari, Cardiology, Bari, Italy 13Institute of Clinical Physiology, CNR, Cardiology, Pisa, Italy On behalf of: Stress Echo 2020 study group Background: The diffusion of smart-phones offers access to the best remote expertise in Stress Echo (SE). Purpose: To evaluate the reliability of SE based on smart-phone filming and reading. Methods: A set of 20 SE video-clips were read in random sequence with a multiple choice six-answer test by 10 readers from 5 different countries (Italy, Brazil, Serbia, Bulgaria, Russia) of the "SE2020" study network. The gold standard to assess accuracy was a core-lab expert reader in agreement with angiographic verification (0 = wrong, 1 = right). The same set of 20 SE studies were read, in random order and > 2 months apart, on desktop Workstation and via smartphones (WhatsApp application) by 10 remote readers. Image quality was graded from 1 = poor, to 3 = excellent. Kappa (k) statistics was used to assess intra- and inter-observer agreement. Results: The image quality was comparable in desktop workstation vs. smartphone (2.0± 0.5 vs 2.4± 0.7, p = NS): see figure (left panel). The average reading time per case was similar for desktop vs. smartphone (90± 39 vs. 82± 54 s, p = NS). The overall diagnostic accuracy of the 10 readers was similar for desktop workstation vs smartphone (84 vs. 91 %, p = NS): see figure, right panel. Intra-observer agreement (desktop vs. smartphone) was good (k = 0.81±0.14). Inter-observer agreement was good and similar via desktop or smartphone (k = 0.69 vs. k = 0.72, p= NS). Conclusions: The diagnostic accuracy and consistency of SE reading among certified readers was high and similar via desktop workstation or via smartphone. Smartphone-SE is feasible, simple, fast and effective in providing semi-real-time access to remote consulting for regional wall motion in SE reading. Since state-of-the-art regional wall motion analysis remains qualitative and subjective, this may increase the clinical robustness of SE and reshape the current way we practice SE. Open in new tabDownload slide Abstract P1140 Figure. Figure Open in new tabDownload slide Abstract P1140 Figure. Figure P1141Variability of left atrial volume in patients with ischemic heart disease M Backman M Backman 1South Hospital Stockholm, Stockholm, Sweden S Rosfors S Rosfors 2Karolinska Institute, Stockholm, Sweden 1South Hospital Stockholm, Stockholm, Sweden 2Karolinska Institute, Stockholm, Sweden Background/Introduction: Left atrial volume (LAV) is of prognostic value in ischemic heart disease and a marker for left ventricular filling pressures over time. To be able to know the real change in LAV between two examinations, measurement variability has to be determined. Methods: 57 consecutive patients (44 men) with verified ischemic heart disease, mean age 64 years (40-91 years), were examined by transthoracic echocardiography (TTE). Patients with atrial fibrillation or significant valve disease were excluded. After a standard TTE the patient was repositioned and a second examiner acquired new four- and two- chamber cine loops for measurement of LAV. The variability was expressed as coefficient of variation (CV) and standard error (s), both for two examiners measuring the same pictures (measurement error) and for loops acquired by two persons at the same occasion representing total variability including measurement error. Thus, total variability can be used to estimate when a change between two examinations is likely to represent a true alteration (± 2s). Results: Mean LAV was 74 ml (CI 68-80 ml), indexed for BSA 38 ml/m2 (CI 35-41ml/m2). LAV correlated significantly with E/e´ (r = 0.29, p<0.001) and low ejection fraction (r = 0.46, p<0.01). For variability results, see table. Conclusions: Left atrial volume measured by echocardiography has acceptable variability in clinical praxis where about half of the variability is explained by measurement error. In patients with ischemic heart disease, a difference of 10 ml/m2 between two examinations indicates a true change in volume, possible due to a change in left ventricular filling pressure and/or a change in systolic function. Variability of left atrial volume . Measurement error . . Total variability . . CV% s CV% s LAV (ml) 5.7 4.3 12.1 9.3 LAV/BSA (ml) 5.7 2.2 11.6 4.6 . Measurement error . . Total variability . . CV% s CV% s LAV (ml) 5.7 4.3 12.1 9.3 LAV/BSA (ml) 5.7 2.2 11.6 4.6 Variability of left atrial volume . Measurement error . . Total variability . . CV% s CV% s LAV (ml) 5.7 4.3 12.1 9.3 LAV/BSA (ml) 5.7 2.2 11.6 4.6 . Measurement error . . Total variability . . CV% s CV% s LAV (ml) 5.7 4.3 12.1 9.3 LAV/BSA (ml) 5.7 2.2 11.6 4.6 P1142Left atrial function beyond its size predicts atrial fibrillation recurrence after trans-catheter ablation: a systematic review and meta-analysis I Bytyci I Bytyci 1University Clinical Centre of Kosova, Clinic of Cardiology, Pristina, Kosovo Republic of G Bajraktari G Bajraktari 1University Clinical Centre of Kosova, Clinic of Cardiology, Pristina, Kosovo Republic of B Bytyci B Bytyci 2University Clinical Centre of Kosovo, Clinic of Rheumathology, Prishtina, Kosovo Republic of M Y Henein M Y Henein 3Umea University, Department of Public Health and Clinical Medicine, Umea, Sweden 1University Clinical Centre of Kosova, Clinic of Cardiology, Pristina, Kosovo Republic of 2University Clinical Centre of Kosovo, Clinic of Rheumathology, Prishtina, Kosovo Republic of 3Umea University, Department of Public Health and Clinical Medicine, Umea, Sweden Background and Aim: Left atrial (LA) size is commonly associated with atrial fibrillation (AF) with its known complications. Recently, studies have shown the role of LA function in predicting recurrence after trans-catheter ablation, which has become a conventional treatment for AF. The aim of this meta-analysis was to assess the role of LA function beyond its size in predicting AF recurrence in patients undergoing trans-catheter ablation. Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to February 2017 in order to select clinical trials and observational studies which assessed the predictive role of LA function [(LA strain, left atrial total emptying fraction (LA total EF) and the time interval from the onset of the P-wave on ECG to the beginning of the A′-wave in tissue Doppler Imaging (PA-TDI interval)] in AF recurrence after catheter-ablation. Twenty articles with a total of 2071 patients were finally included, 680 of them were AF recurrence. Results: The pooled analysis showed that after a follow-up period of 17 ± 10 months, patients with AF recurrence had reduced LA function: reduced LA strain; WMD -7.39% ([95% CI -9.70 to -5.00], P < 0.000) as well as LA total EF; WMD -3.72% ([95% CI -5.83 to -1.61], P < 0.0001) and prolonged PA-TDI interval; WMD 14.74% ([95% CI 12.50 to 16.98], P < 0.0001). Conclusions: Reduced left atrial function, total emptying fraction and prolonged PA-TDI interval predict atrial fibrillation recurrence after catheter ablation. These results highlight the role of LA function assessment before catheter ablation in daily practice, to predict best clinical outcome. P11433D printing facilitates left atrial appendage device closure E Friend E Friend Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America G S Pressman G S Pressman Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America E Obasare E Obasare Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America S K Mainigi S K Mainigi Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America D L Morris D L Morris Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America Background: Left atrial appendage (LAA) device closure in patients with atrial fibrillation is equivalent to long-term anticoagulation with warfarin for stroke reduction. Accurate measurement of the LAA orifice is important for closure device sizing. Purpose: The goal of our study was to determine whether patient specific 3-dimensional (3D) printing of the LAA during pre-procedure planning would increase precision in device sizing and placement. Methods: Twenty-four patients underwent LAA device closure (71±11 years, 42% female, 50% white, risk scores: CHA2DS2-VASC 4.5±1.7 and HAS-BLED 3.7±1.4). All patients underwent complete pre-procedural 2-dimensional (2D) transesophageal echocardiography (TEE). Fourteen patients had cardiac computed tomography (CCT) of the LAA for 3D printing to produce a latex model for pre-procedural closure planning. Figure shows stages of left atrial appendage closure with Watchman device facilitated by patient specific 3D print model as follows: left atrial appendage closure device (LAA-CD) sizing was performed using multi-plane 2D transesophageal echocardiogram, interrogated from multiple angles in order to determine the minimum and maximum orifice diameter and depth (A-C). Multi-slice computed tomography images of the patient’s heart and LAA [circle zoomed in] were acquired and exported in Cartesian format (D-F). They were then loaded into an open source segmentation software. The heart and LAA were automatically segmented, in early atrial diastole (E-F). The surface meshes of the segmented structures were converted to stereolithography (STL) files and 3D printed to help produce physical latex models (Figures G-H). Multi-modality imaging was used intra-procedurally for all 24 patients including fluoroscopy, TEE, 3D TEE, and intra-cardiac echocardiography (I-L). Results: The 3D printed model correlated perfectly with the final device used in all cases (R²=1; p<0.001), while the TEE LAA maximal diameter LAA predicted size showed good correlation (R²=0.34; CI 0.23 to 0.98; p=0.03). When using a 3D print model compared to pre-procedural TEE planning alone there were decreases per case in total procedure time: 69±19 minutes versus 105±50 minutes (p=0.03), trans-septal to catheter removal time: 50±19 minutes versus 74±34 minutes (p=0.04), anesthesia time: 134±31 minutes versus 188±61 minutes (p=0.01), fluoroscopy time: 11±45 minutes versus 29±31 minutes (p=0.04), number of deployments: 1.3±0.5 versus 1.9±1.2 (p=0.12), and number of devices: used 1.3±0.5 versus 1.8±0.9 (p=0.11). Conclusion: Patient specific 3D print models of the LAA improve precision in closure device sizing and placement. Open in new tabDownload slide Abstract P1143 Figure. 3D Print Left Atrial Appendage Closure Open in new tabDownload slide Abstract P1143 Figure. 3D Print Left Atrial Appendage Closure P1238Assessment of biventricular function in human immunodeficiency virus infection in adolescents and young adults by three-dimensional speckle tracking echocardiography L Capotosto L Capotosto Sapienza University, Rome, Italy C Ajassa C Ajassa Sapienza University, Rome, Italy G D'ettorre G D'ettorre Sapienza University, Rome, Italy N Cavallari N Cavallari Sapienza University, Rome, Italy M R Ciardi M R Ciardi Sapienza University, Rome, Italy V Vullo V Vullo Sapienza University, Rome, Italy A Vitarelli A Vitarelli Sapienza University, Rome, Italy Sapienza University, Rome, Italy Background: The pathogenesis of left ventricular (LV) dysfunction in HIV patients includes cardiac direct effects of HIV, the presence of autoantibodies, myocardial inflammatory response to viruses, other infections related to the immune status of patients and side effects associated with antiretroviral drugs or other drugs used for the management of HIV. The purpose of our study was to evaluate biventricular parameters of wall deformation with three-dimensional speckle tracking echocardiography (3DSTE) in HIV-infected patients on antiretroviral therapy in order to detect a possible subclinical myocardial dysfunction. Methods: Sixteen patients aged 12 to 31years with human immunodeficiency virus infection and 16 normal controls of the same age and sex were studied with 3DSTE. All patients were stable in terms of HIV infection, with no history of heart disease or other chronic systemic disease except HIV infection. Patients were on HAART with good immunological control. Standard echocardiographic measures of LV-RV function were assessed. Tricuspid annular systolic plane excursion (TAPSE) was measured by M-mode of the lateral tricuspid valve annulus. LV global longitudinal, circumferential and radial strains were calculated. Global area strain (GAS) was calculated by 3DSTE as percentage variation in surface area defined by the longitudinal and circumferential strain vectors. Right ventricular (RV) 3D global and free-wall longitudinal strain were obtained. Data analysis was performed offline. Results: LV global longitudinal strain and GAS were lower in HIV patients compared to normal controls (-15.9% vs -19.1%, p=0.013, and -33.9% vs -38.7%, p=0.004, respectively). There were no significant differences in ejection fractions between the groups. There was a trend toward reduced TAPSE in HIV patients compared to controls (20.2±2.3mm vs 23.4±2.6mm, p=0.08). RV free-wall longitudinal strain was significantly reduced in HIV patients when compared with the control group (-19.8% vs -23.7%, p=0.025). No patient had pulmonary systolic pressure higher than 35mmHg. There was no correlation between echocardiographic parameters and selected biomarkers and inflammatory markers. Conclusions: Three-dimensional speckle tracking echocardiography may help to identify HIV patients at high cardiovascular risk allowing early detection of biventricular dysfunction in the absence of pulmonary hypertension. P1239Two-dimensional longitudinal strain accuracy for cardiotoxicity prediction in breast cancer patients during anthracycline and trastuzumab treatment E De Almeida Gripp E De Almeida Gripp State University of Rio de Janeiro (UFRJ), Cardiology, Rio de Janeiro, Brazil G E De Oliveira G E De Oliveira State University of Rio de Janeiro (UFRJ), Cardiology, Rio de Janeiro, Brazil L A Feijo L A Feijo State University of Rio de Janeiro (UFRJ), Cardiology, Rio de Janeiro, Brazil S S Xavier S S Xavier State University of Rio de Janeiro (UFRJ), Cardiology, Rio de Janeiro, Brazil M I Garcia M I Garcia State University of Rio de Janeiro (UFRJ), Cardiology, Rio de Janeiro, Brazil A S De Souza A S De Souza State University of Rio de Janeiro (UFRJ), Cardiology, Rio de Janeiro, Brazil State University of Rio de Janeiro (UFRJ), Cardiology, Rio de Janeiro, Brazil Background: Cardiotoxicity morbidity and mortality associated to antineoplastic therapy for breast cancer could decrease through early use of cardioprotective drugs but ventricle ejection fraction (LVEF) has limited sensitivity. Two-dimensional global longitudinal strain (GLS) arises for early detection of myocardial contractile function changes. Aims: To define GLS accuracy to identify cardiotoxicity early. Methods: Prospective observational study of consecutive breast cancer outpatients, who have undergone anthracycline and/or trastuzumab use was performed. They were quarterly evaluated, blindly to therapy, with complete follow-up of 6 to 12 months. Cox regression was used to evaluate clinical, therapeutic and echocardiography association with cardiotoxicity. We set up a ROC curve to identify the 3rd month cut off point of GLS, which could predict the 6th month reduction of LVEF. Results: Five cases of cardiotoxicity were identified (10%), among 49 women, with the mean age of 49.7±12.2 years. GLS was independently associated to the event (p=0.004; HR=2.77; 95%CI: 1.39–5.54), with cut off point for this diagnosis an absolute value of -16.6% (AUC=0.95; 95%CI: 0.87–1.0) or a percentage reduction of 14% (AUC=0.97; 95%CI: 0.9-1.0). Conclusion: Reduction of 14% of GLS or absolute value of -16.6% identified patients who might develop cardiotoxicity associated with anthracycline or trastuzumab use. Open in new tabDownload slide Abstract P1239 Figure. LVEF versus GLS for cardiotoxicity Open in new tabDownload slide Abstract P1239 Figure. LVEF versus GLS for cardiotoxicity P1240Subendocardial speckle tracking overestimates myocardial shortening and may falsely indicate preserved systolic function in hypertrophic cardiomyopathy patients E W Remme E W Remme Oslo University Hospital, Institute for Surgical Research, Oslo, Norway T M Stokke T M Stokke Oslo University Hospital, Institute for Surgical Research, Oslo, Norway K H Haugaa K H Haugaa Oslo University Hospital, Institute for Surgical Research, Oslo, Norway O A Smiseth O A Smiseth Oslo University Hospital, Institute for Surgical Research, Oslo, Norway T Edvardsen T Edvardsen Oslo University Hospital, Institute for Surgical Research, Oslo, Norway Oslo University Hospital, Institute for Surgical Research, Oslo, Norway Funding Acknowledgements: This work was supported by the Center for Cardiological Innovation, funded by the Research Council of Norway (RCN grant number 203489/o30) Background: It is well known that circumferential and longitudinal shortening increases from epicardium to endocardium. If the speckle tracking region of interest (ROI) is covering only the subendocardial region instead of the entire wall thickness, it may lead to higher strain values and thus potentially misinterpretations of systolic function. This may be of particular importance in patients with ventricular hypertrophy. Purpose: 1) Evaluate differences in strain magnitude for subendocardial placement of ROI vs. covering the entire wall thickness in hypertrophic cardiomyopathy (HCM) patients, and 2) quantification of the transmural strain gradient using a mathematical model of the left ventricle (LV). Methods: In 20 HCM patients, global circumferential (GCS) and longitudinal (GLS) strains were assessed by speckle tracking echocardiography. The ROI was first placed in the inner third of the wall and then repositioned to cover the entire wall thickness. We derived the theoretical transmural gradient in strain magnitude using a mathematical model of a thick-walled, truncated ellipsoid based on the average geometry of the 20 HCM patients. Results: Subendocardial ROI placement resulted in apparently better circumferential and longitudinal shortening compared to a ROI covering the entire wall thickness (Fig. 1). Seven of the patients had GCS worse than -18% indicating reduced systolic function by an entire wall ROI. Importantly, a subendocardial placement of the ROI in 5 of these 7 patients resulted in a GCS better than -18%, which would have been incorrectly interpreted as normal function (Fig. 2). The mathematical model showed that the transmural strain gradient depended on wall thickness, cavity size and degree of shortening. The model demonstrated a 21 and 4 percentage points increase in circumferential and longitudinal shortening, respectively, from epicardium to endocardium, which underline the importance of correct ROI positioning. Conclusion: Subendocardial assessment of strain may in some patients lead to misinterpretation of systolic LV function as normal, while transmural assessment would have revealed depressed LV function. The large transmural gradient in strains implies that standardized protocols are required for correct and reproducible strain measurements. Open in new tabDownload slide Abstract P1240 Figure. Open in new tabDownload slide Abstract P1240 Figure. P1241Improvements in regional myocardial function on 2D STE with optimized chelation in patients with thalassemia major D Chowdhury D Chowdhury 1Cardiology Care for Children, Lancaster, United States of America N Alvi N Alvi 2Aga Khan University, Karachi, Pakistan S Cesar S Cesar 3Hospital Sant Joan de Déu, Barcelona, Spain B Bijnens B Bijnens 4University Pompeu Fabra, Barcelona, Spain R Tomredle R Tomredle 1Cardiology Care for Children, Lancaster, United States of America B Hasan B Hasan 2Aga Khan University, Karachi, Pakistan 1Cardiology Care for Children, Lancaster, United States of America 2Aga Khan University, Karachi, Pakistan 3Hospital Sant Joan de Déu, Barcelona, Spain 4University Pompeu Fabra, Barcelona, Spain Intro: Thalassemia Major (TM) is characterized by recurrent blood transfusions. This leads to significant myocardial siderosis and complications including arrhythmias and heart failure. These can be reversible provided timely assessment of the iron status and adequate chelation management is initiated. Myocardial iron deposition is non-homogenous with subtle regional longitudinal systolic strain (LSsys) changes seen on 2D Speckle Tracking Echocardiography (2D STE) prior to LVEF deterioration. We explored the effect of improved chelation and subsequent cardiac T2* MRI (CMR) values on regional myocardial function assessed by 2D STE in setting of normal LVEF. Methods: Data was derived from TM patients recruited for the AMIT study (efficacy of amlodipine with chelation in reducing myocardial iron). All patients underwent repeat echocardiographic imaging at baseline, 6 and 12 months. Standard echocardiography was performed and LSsys was extracted from basal, mid, and apical segments of the LV medial and lateral wall by 2D STE technique. A linear regression model was run to determine the effect of improved T2* in the setting of improved chelation on regional LSsys strain parameters. Results: Nineteen TM patients (11 males) with median age 16 (8-21) years, and median height and weight were 145.5 (119-168) cm and 39 (24-68) kg were recruited. All participants were transfused every two to three weeks and maintained a median pre-transfusional hemoglobin of 9.3 (8.3-10.8) mg/dL. T2* based chelation regimen was initiated at baseline and compliance to this regimen was gauged at regular clinical visits. 25 data points were available from interval 2D STE imaging and were pooled together for analysis. Medial basal LSsys (-17.3% ± 2.2) and lateral basal LSsys (-16.7% ± 4.4) strains were significantly lower than mean apical LSsys strains (-24.9% ± 4.0) (p <0.01). With optimized improved chelation, we determined up to a 6.3% improvement was seen in LSsys basal septal and 6.7% improvement in LSsys apical septal for each 1 ms improvement in T2* (p values < 0.05). Conclusion: In conclusion, in patients with TM conventional and novel echocardiogarphic parameters like 2D STE can help identify regional myocardial dysfunction prior to development of overt cardiac dysfunction, reduce frequency of CMR imaging and aide with optimization of chelation. Echocardiographic imaging can thus improve management at lower cost for these patients. Open in new tabDownload slide Abstract P1241 Figure. Open in new tabDownload slide Abstract P1241 Figure. P1242Role of myocardial constructive work in the identification of responders to CRT E Galli E Galli 1University Hospital of Rennes, Cardiology, Rennes, France C Leclercq C Leclercq 1University Hospital of Rennes, Cardiology, Rennes, France A Hubert A Hubert 1University Hospital of Rennes, Cardiology, Rennes, France O Smiseth O Smiseth 2University of Oslo, Oslo, Norway E Samset E Samset 2University of Oslo, Oslo, Norway A Hernandez A Hernandez 3University of Rennes, Laboratoire Traitement du Signal et de l'Image, INSERM U-1099, Rennes, France E Donal E Donal 1University Hospital of Rennes, Cardiology, Rennes, France 1University Hospital of Rennes, Cardiology, Rennes, France 2University of Oslo, Oslo, Norway 3University of Rennes, Laboratoire Traitement du Signal et de l'Image, INSERM U-1099, Rennes, France Background: Cardiac resynchronization therapy (CRT) plays a pivotal role in the management of patients with heart failure (HF) and wide QRS complex. However, the treatment is plagued by numerous non-responders. Aim of the study is to evaluate the role myocardial work estimated by pressure-strain loops (PSLs) in the prediction of CRT response. Methods and results: 97 patients with symptomatic HF undergoing CRT implantation according to current recommendations were retrospectively included in the study. 2D and speckle tracking echocardiography were performed before CRT and at the 6-month follow-up (FU). Global and regional myocardial constructive work (CW) and wasted work (WW) were estimated by PSL analysis. A >15% reduction in left ventricular (LV) end-systolic volume at FU defined CRT-positive response. At FU, 63 (65%) patients were CRT-responders. At multivariate analysis, CWtot >1057 mmHg% (OR 14.69, p=0.005) and septal flash (OR 8.05, p=0.004) were the only significant predictors of CRT-PR (See Table). CWtot was associated with the entity of CRT-induced myocardial remodeling in both ischaemic (r=-0.55, p<0.0001) and non-ischaemic patients (r=-0.65, p<0.0001). Conclusions: Patients with higher CWtot exhibit a favourable response to CRT. These data encourage further studies for the assessment of the myocardial substrate related to the functional response to CRT. . Univariate analysis . . Multivariate analysis . . OR (95% CI) p-value OR (95% CI) p-value LV-EDV, per ml 0.99 (0.98-1.00) 0.04 1.02 (0.98-1.07) 0.34 LV-ESV, per ml 0.99 (0.98-1.00) 0.10 0.98 (0.95-1.02) 0.98 Ischaemic aetiology 0.27 (0.11-0.65) 0.004 0.44 (0.12-1.60) 0.22 QRS width, per ms 1.02 (0.99-1.05) 0.09 1.02 (0.98-1.06) 0.36 LBBB 2.20 (0.77-6.26) 0.14 Septal flash, n (%) 7.29 (2.82-18.83) 0.0001 5.7 (1.60-20.52) 0.007 LV septo-lateral delay, per ms 1.00 (0.99-1.01) 0.88 Total CW, per mmHg% 1.003 (1.001-1.004) 0.001 1.003 (1.001-1.005) 0.036 Septal CW, per mmHg% 1.001 (1-1.002) 0.19 Lateral CW, per mmHg% 1.002 (1.001-1.003) 0.001 0.99 (0.99-1.00) 0.54 Total WW, per mmHg% 0.99 (0.99-1.00) 0.004 0.99 (0.99-1.01) 0.72 Septal WW, mmHg% 1.005 (1.002-1.007) <0.0001 1.00 (0.99-1.01) 0.24 Lateral WW, per mmHg% 1.004 (1.001-1.007) 0.02 1.00 (0.99-1.01) 0.38 . Univariate analysis . . Multivariate analysis . . OR (95% CI) p-value OR (95% CI) p-value LV-EDV, per ml 0.99 (0.98-1.00) 0.04 1.02 (0.98-1.07) 0.34 LV-ESV, per ml 0.99 (0.98-1.00) 0.10 0.98 (0.95-1.02) 0.98 Ischaemic aetiology 0.27 (0.11-0.65) 0.004 0.44 (0.12-1.60) 0.22 QRS width, per ms 1.02 (0.99-1.05) 0.09 1.02 (0.98-1.06) 0.36 LBBB 2.20 (0.77-6.26) 0.14 Septal flash, n (%) 7.29 (2.82-18.83) 0.0001 5.7 (1.60-20.52) 0.007 LV septo-lateral delay, per ms 1.00 (0.99-1.01) 0.88 Total CW, per mmHg% 1.003 (1.001-1.004) 0.001 1.003 (1.001-1.005) 0.036 Septal CW, per mmHg% 1.001 (1-1.002) 0.19 Lateral CW, per mmHg% 1.002 (1.001-1.003) 0.001 0.99 (0.99-1.00) 0.54 Total WW, per mmHg% 0.99 (0.99-1.00) 0.004 0.99 (0.99-1.01) 0.72 Septal WW, mmHg% 1.005 (1.002-1.007) <0.0001 1.00 (0.99-1.01) 0.24 Lateral WW, per mmHg% 1.004 (1.001-1.007) 0.02 1.00 (0.99-1.01) 0.38 . Univariate analysis . . Multivariate analysis . . OR (95% CI) p-value OR (95% CI) p-value LV-EDV, per ml 0.99 (0.98-1.00) 0.04 1.02 (0.98-1.07) 0.34 LV-ESV, per ml 0.99 (0.98-1.00) 0.10 0.98 (0.95-1.02) 0.98 Ischaemic aetiology 0.27 (0.11-0.65) 0.004 0.44 (0.12-1.60) 0.22 QRS width, per ms 1.02 (0.99-1.05) 0.09 1.02 (0.98-1.06) 0.36 LBBB 2.20 (0.77-6.26) 0.14 Septal flash, n (%) 7.29 (2.82-18.83) 0.0001 5.7 (1.60-20.52) 0.007 LV septo-lateral delay, per ms 1.00 (0.99-1.01) 0.88 Total CW, per mmHg% 1.003 (1.001-1.004) 0.001 1.003 (1.001-1.005) 0.036 Septal CW, per mmHg% 1.001 (1-1.002) 0.19 Lateral CW, per mmHg% 1.002 (1.001-1.003) 0.001 0.99 (0.99-1.00) 0.54 Total WW, per mmHg% 0.99 (0.99-1.00) 0.004 0.99 (0.99-1.01) 0.72 Septal WW, mmHg% 1.005 (1.002-1.007) <0.0001 1.00 (0.99-1.01) 0.24 Lateral WW, per mmHg% 1.004 (1.001-1.007) 0.02 1.00 (0.99-1.01) 0.38 . Univariate analysis . . Multivariate analysis . . OR (95% CI) p-value OR (95% CI) p-value LV-EDV, per ml 0.99 (0.98-1.00) 0.04 1.02 (0.98-1.07) 0.34 LV-ESV, per ml 0.99 (0.98-1.00) 0.10 0.98 (0.95-1.02) 0.98 Ischaemic aetiology 0.27 (0.11-0.65) 0.004 0.44 (0.12-1.60) 0.22 QRS width, per ms 1.02 (0.99-1.05) 0.09 1.02 (0.98-1.06) 0.36 LBBB 2.20 (0.77-6.26) 0.14 Septal flash, n (%) 7.29 (2.82-18.83) 0.0001 5.7 (1.60-20.52) 0.007 LV septo-lateral delay, per ms 1.00 (0.99-1.01) 0.88 Total CW, per mmHg% 1.003 (1.001-1.004) 0.001 1.003 (1.001-1.005) 0.036 Septal CW, per mmHg% 1.001 (1-1.002) 0.19 Lateral CW, per mmHg% 1.002 (1.001-1.003) 0.001 0.99 (0.99-1.00) 0.54 Total WW, per mmHg% 0.99 (0.99-1.00) 0.004 0.99 (0.99-1.01) 0.72 Septal WW, mmHg% 1.005 (1.002-1.007) <0.0001 1.00 (0.99-1.01) 0.24 Lateral WW, per mmHg% 1.004 (1.001-1.007) 0.02 1.00 (0.99-1.01) 0.38 P1243Relevance of strain imaging in clinical evolution after an acute myocardial infarction A Nunes A Nunes Sao Joao Hospital, Cardiology Service, Porto, Portugal S Torres S Torres Sao Joao Hospital, Cardiology Service, Porto, Portugal P M Araujo P M Araujo Sao Joao Hospital, Cardiology Service, Porto, Portugal C Sousa C Sousa Sao Joao Hospital, Cardiology Service, Porto, Portugal P B Almeida P B Almeida Sao Joao Hospital, Cardiology Service, Porto, Portugal V Ribeiro V Ribeiro Sao Joao Hospital, Cardiology Service, Porto, Portugal R Almeida R Almeida Sao Joao Hospital, Cardiology Service, Porto, Portugal J Rodrigues J Rodrigues Sao Joao Hospital, Cardiology Service, Porto, Portugal S Costa S Costa Sao Joao Hospital, Cardiology Service, Porto, Portugal G Ferreira G Ferreira Sao Joao Hospital, Cardiology Service, Porto, Portugal S Maia S Maia Sao Joao Hospital, Cardiology Service, Porto, Portugal M B Campelo M B Campelo Sao Joao Hospital, Cardiology Service, Porto, Portugal F Macedo F Macedo Sao Joao Hospital, Cardiology Service, Porto, Portugal M J Maciel M J Maciel Sao Joao Hospital, Cardiology Service, Porto, Portugal Sao Joao Hospital, Cardiology Service, Porto, Portugal Introduction: Acute myocardial infarction (AMI) remains a major cause of morbi-mortality worldwide and the evolution with cardiac complications or higher Killip class is associated with worse outcomes. Strain imaging by speckle tracking echocardiography (STE) has been shown to provide substantial information on regional and global ventricular function and may be a helpful tool in risk assessment of patients (pts) with AMI. Purpose: We aimed to assess the relationship between myocardial strain imaging parameters and complicated evolution during hospitalization for AMI. Methods: We retrospectively evaluated pts who were admitted to our center due to AMI during a six-month period, with significant coronary artery disease and who had strain evaluation through two-dimensional (2D) STE. Global longitudinal and circumferential strain of the left ventricle (LV) were assessed by 2D STE with layer-specific myocardial deformation quantitative analysis. Clinical, laboratorial and coronary anatomy data were also evaluated. Results: A total of 70 pts, of whom 77.1% (n=54) were male, with a mean age of 65.3±11.8 years, were included. The diagnosis was STEMI in 55.7% (n=39) and NSTEMI in 44.3 % (n=31). Mean LV ejection fraction (LVEF) was 46.1±14.2%. All pts were submitted to coronariography: 8.6% had left main significant disease, 42.9% had one-vessel disease, 30% had two-vessel disease and 18.6% had three-vessel disease. Thirty six pts (51.4%) had a more complex in-hospital evolution, either due to a cardiac complication (n=23) or due to a Killip class >1 (n=25). These pts had significantly lower endocardial (-13.05 vs -15.41; p=0.024), epicardial (-10.40 vs -12.39; p=0.021) and mid-layer (-11.66 vs -13.75; p=0.026) longitudinal strain, lower endocardial (-14.11 vs -21.68; p<0.001), epicardial (-8.54 vs -12.60; p=0.010) and mid-layer (-10.83 vs -16.11; p=0.001) circumferential strain, lower LVEF (43 vs 50%; p=0.025) and higher BNP values (744 vs 186 pg/ml; p=0.001). Considering only the pts with a LVEF >50% (n=27; 38,6%), those who had a complex in-hospital evolution still had significantly lower endocardial, epicardial and mid-layer circumferential strain (-15.22 vs -22.70, p=0.023; -8.87 vs -14.57, p=0.026; -11.21 vs -18,16, p=0.013) comparing to pts without any complication and with a Killip class of I. There were no significant differences regarding longitudinal strain or BNP values. Conclusion: In this study, pts with a complex in-hospital evolution after an AMI had more impaired layer-specific longitudinal and circumferential strain, and even when LV function was preserved, circumferential strain was still a significant discriminator. Therefore, myocardial deformation may have additional value in the risk stratification of patients with AMI, besides classic echocardiographic and laboratorial parameters. P1244Aortic arch mechanics and left ventricular diastolic function M J Vieira M J Vieira 2Hospital of Santarem, Cardiology, Santarem, Portugal L Puga L Puga 1University Hospitals of Coimbra, Cardiology Department, Coimbra, Portugal R Teixeira R Teixeira 1University Hospitals of Coimbra, Cardiology Department, Coimbra, Portugal J M Ribeiro J M Ribeiro 1University Hospitals of Coimbra, Cardiology Department, Coimbra, Portugal L Reis L Reis 1University Hospitals of Coimbra, Cardiology Department, Coimbra, Portugal P Dinis P Dinis 1University Hospitals of Coimbra, Cardiology Department, Coimbra, Portugal M Madeira M Madeira 1University Hospitals of Coimbra, Cardiology Department, Coimbra, Portugal A Siserman A Siserman 1University Hospitals of Coimbra, Cardiology Department, Coimbra, Portugal L Goncalves L Goncalves 1University Hospitals of Coimbra, Cardiology Department, Coimbra, Portugal 1University Hospitals of Coimbra, Cardiology Department, Coimbra, Portugal 2Hospital of Santarem, Cardiology, Santarem, Portugal Background: Vascular mechanics assessed with two-dimensional speckle tracking echocardiography (2D-STE) have been considered a new imaging surrogate of vascular stiffening. Our group has recently showed the feasibility and reproducibility of the vascular mechanics assessment at the aortic arch level. Purpose: To study the association between global circumferential aortic arch strain and the left ventricular early relaxation velocity (LV e’). Methods: We included 107 subjects (61 healthy subjects and 46 hypertensive patients) who underwent a complete echocardiographic exam, including a short axis view of the aortic arch. The speckle-tracking methodology was used to calculate aortic arch mechanics offline. The analysis was performed for circumferential aortic strain and for the early circumferential aortic strain rate, and we used an average result of the six equidistant segments of the arterial wall. The classic aortic stiffness index (b1) was calculated as: ln(Ps / Pd)/(As – Ad)/Ad (22), where Ps and Pd are systolic and diastolic arterial pressures, and As and Ad are M-mode guided systolic and diastolic aortic arch diameters. We subsequently created a multivariate linear regression model for the LV e’. Results: The sample consisted of 61 healthy subjects with mean age was 33±9 years, (59% women) and 46 hypertensive patients with mean age 45±12 years (54% women). Circumferential aortic arch strain (r=0.61, P<0.01) and circumferential aortic arch strain rate (r=0.52, P<0.01) were significantly correlated with LV e’. In a stepwise multivariate linear regression model, adjusted for age and systolic blood pressure, we found that circumferential aortic strain (b 0.27; P<0.01), remained independently associated with LV e’. This was in contrast to the classic b1 index. Conclusions: We conclude that aortic arch circumferential strain was independently associated with left LV e’. Vascular mechanics assesses with 2D-STE may reflect structural changes of the vascular wall which can influence the LV myocardial diastolic function. P1245Automatic measurements of left ventricular longitudinal function for inexperienced users J F Grue J F Grue 1Norwegian University of Science and Technology, NTNU, Department of Circulation and Medical Imaging, Trondheim, Norway S Storve S Storve 1Norwegian University of Science and Technology, NTNU, Department of Circulation and Medical Imaging, Trondheim, Norway O C Mjoelstad O C Mjoelstad 2St. Olav's Hospital, Trondheim University Hospital, Clinic of Cardiology, Trondheim, Norway T Eriksen-Volnes T Eriksen-Volnes 2St. Olav's Hospital, Trondheim University Hospital, Clinic of Cardiology, Trondheim, Norway S O Samstad S O Samstad 2St. Olav's Hospital, Trondheim University Hospital, Clinic of Cardiology, Trondheim, Norway H Torp H Torp 1Norwegian University of Science and Technology, NTNU, Department of Circulation and Medical Imaging, Trondheim, Norway H Dalen H Dalen 1Norwegian University of Science and Technology, NTNU, Department of Circulation and Medical Imaging, Trondheim, Norway B O Haugen B O Haugen 1Norwegian University of Science and Technology, NTNU, Department of Circulation and Medical Imaging, Trondheim, Norway 1Norwegian University of Science and Technology, NTNU, Department of Circulation and Medical Imaging, Trondheim, Norway 2St. Olav's Hospital, Trondheim University Hospital, Clinic of Cardiology, Trondheim, Norway Funding Acknowledgements: The Research Council of Norway. Smartscan (project code 219282). Introduction: Automatic measurements of indices reflecting left ventricular (LV) function could be advantageous for inexperienced users of pocket-sized ultrasound devices when evaluating patients with suspected or known LV dysfunction. We have developed an automatic algorithm that measures the mitral annular plane systolic excursion (MAPSE) from color tissue Doppler (CTD) recordings. Purpose: To compare automatic MAPSE measurements from recordings by medical students with minimal training with reference measurements by clinicians, and to evaluate the potential of using the automatic measurements to detect LV dysfunction. Materials and methods: Stationary ultrasound scanners were used. Medical students (n=39) were given a 15 minute instruction on how to acquire an apical four-chamber view. Patients (n=75) underwent a conventional echocardiographic examination by clinicians, who evaluated LV function according to guidelines. LV dysfunction was defined as ejection fraction <50% or signs of elevated filling pressure. The clinicians measured MAPSE using M-mode. Each patient was subsequently examined by a student, and their CTD recordings were stored. The image quality was graded from 1 to 6, where a score ≥3 was defined as adequate, and these recordings were included in the further analysis (off-line). The performance of the automatic MAPSE measurements (applied to the students recordings) to detect LV dysfunction was evaluated by receiver-operating characteristics (ROC) analysis. Results: The median number of patients examined by the students was 2 (1st–3rd quartile: 1–2). Adequate quality was seen in 66 (88%) of the students’ recordings, of which 20 (27%) patients had LV dysfunction. The automatic algorithm correctly identified and tracked the mitral annulus in 48 (73%) of the adequate recordings. 32 (82%) of the students acquired at least 1 adequate recording where the algorithm tracked the mitral annulus. The mean difference±standard deviation between automatic and reference measurements of MAPSE was -0.4±3.2 mm. The area under the ROC curve (AUC) was 0.861. Automatic MAPSE ≤11 mm provided 80% sensitivity, 78% specificity, 62% positive predictive value and 90% negative predictive value for detection of LV dysfunction. Conclusion: With minimal training, 82% of the medical students were able to acquire an adequate four-chamber view with successful automatic MAPSE measurement. The discriminating ability between normal and LV dysfunction was good, despite moderate agreement with the reference measurements of MAPSE. Along with more training in image acquisition, the algorithm can be helpful for inexperienced ultrasound operators when assessing patients. P1246Global longitudinal strain patterns in healthy individuals in general population M Stylidis M Stylidis 1UiT The Arctic University of Norway, Department of Community Medicine, Tromso, Norway D Leon D Leon 2School of Hygiene and Tropical Disease, London, United Kingdom A Rossner A Rossner 3University Hospital of North Norway, Department of Cardiology, Tromso, Norway H Schirmer H Schirmer 4UiT The Arctic University of Norway, Department of Clinical Medicine, Tromso, Norway 1UiT The Arctic University of Norway, Department of Community Medicine, Tromso, Norway 2School of Hygiene and Tropical Disease, London, United Kingdom 3University Hospital of North Norway, Department of Cardiology, Tromso, Norway 4UiT The Arctic University of Norway, Department of Clinical Medicine, Tromso, Norway Funding Acknowledgements: Ph.D. grant from UiT The Arctic University of Norway Background: Speckle-tracking derived global longitudinal myocardial strain (GLS) is a high reproducible novel method for assessing myocardial function. Analysis of GLS patterns in healthy individuals can provide relevant prognostic information. However, the previous studies on the prevalence and structure of sex-specific GLS were conducted mostly in small clinical samples and need validation in larger population-based studies. Purpose: To assess the sex-specific GLS levels of healthy individuals and determine if the proportion of abnormal GLS change by age among healthy from a general population. Methods: GLS was measured by the speckle-tracking technique. We evaluated GLS in 802 individuals from a population-based cohort study (2015-2016). After exclusion of individuals with comorbidities, GLS of healthy 40-79 years old persons was analysed. We used mean GLS of -17.4±2.96% as a cutoff value for abnormal strain calculation. Results: We found the decline in the proportion of healthy participants from 72% in 40-49 years old group to 11% in 80+ years old group. Out of total 358 men and 444 women, 118 (33%) and 187 (42.1%) were defined as healthy. We found that the mean GLS in healthy men and women was -16.1±2.77% and -18.2±2.79% respectively (p diff >0.05) with no change by age. The combined upper limit of normal (mean+SD*1.96) was -11.6%. Proportion of abnormal GLS by age groups (years) in the total population were 4.8% (40-49), 3.2% (50-59), 8.5% (60-69), 11.2% (70-79) and 10.2% (80+) (p for trend = 0.012). Intraclass correlation coefficient for GLS was 0.94 (0.81-0.98, p<0.001) confirming excellent intra-reader reproducibility level. Conclusions: We did not find significant differences between GLS levels of healthy men and women from a random sample of the general population. An increasing proportion with abnormal GLS was revealed with increasing age in total sample but not in a healthy subsample. P1247Cardiac shear wave velocity in hypertrophic cardiomyopathy patients M Strachinaru M Strachinaru 1Erasmus Medical Center, Cardiology, Rotterdam, Netherlands M Michels M Michels 1Erasmus Medical Center, Cardiology, Rotterdam, Netherlands A Van Den Bosch A Van Den Bosch 1Erasmus Medical Center, Cardiology, Rotterdam, Netherlands J G Bosch J G Bosch 2Erasmus Medical Center, Biomedical Engineering, Rotterdam, Netherlands N De Jong N De Jong 2Erasmus Medical Center, Biomedical Engineering, Rotterdam, Netherlands H J Vos H J Vos 2Erasmus Medical Center, Biomedical Engineering, Rotterdam, Netherlands M L Geleijnse M L Geleijnse 1Erasmus Medical Center, Cardiology, Rotterdam, Netherlands 1Erasmus Medical Center, Cardiology, Rotterdam, Netherlands 2Erasmus Medical Center, Biomedical Engineering, Rotterdam, Netherlands Background: Shear waves in the heart walls are initiated by closure of the valves and can be measured with high frame rate ultrasound. Their propagation velocity can be used to estimate the stiffness and viscosity of the myocardium. This can be important in specific pathologies, e.g. in hypertrophic cardiomyopathy(HCM), where the myocardium is thickened and rigid. Purpose: We compare shear waves velocities of HCM patients and normal individuals. Methods: Twenty HCM patients and twenty healthy volunteers matched for age and sex were prospectively recruited and underwent a high frame rate colour tissue Doppler study, synchronized to the simultaneous recording of the electrocardiogram and phonocardiogram. We used a clinical scanner (Philips IE33; Philips, Best, The Netherlands), equipped with a S5-1 probe, achieving over 500Hz in TDI by tuning the normal system settings. The shear wave front propagating in the basal third of the interventricular septum after the closure of the aortic valve (Ao V) was mapped along a virtual M-mode line traced mid-wall, by using Philips Qlab 8 post processing software, and its propagation velocity was computed from the wave front slope. The velocity of the shear wave induced by the closure of the AoV (synchronous to the onset of the 2nd heart sound) was averaged over 3 heartbeats for every subject. Results: The figure shows one heart cycle of a HCM patient on the left panel, with the mean tissue velocity along a virtual M-mode line in the mid panel, synchronous to the ECG signal (green line) and phonocardiogram (yellow line) in the lower panel. The onset of the second heart sound (S2) is marked with a vertical white line. The mean shear wave velocity in the patient group was 6.25±1.10, range 4.33 to 9.33m/s (Table and Figure right panel). In our healthy volunteer group the mean velocity of the shear wave induced by AoV closure was 3.56±0.43m/s, range 3.00 to 4.66m/s. Conclusion: The velocity range of the shear waves generated by the closure of the aortic valve is significantly higher in HCM patients, as compared to normal individuals. This confirms that a stiffer myocardium would be characterized by a higher velocity of the naturally occurring shear waves. Category . HCM N=20 . Normal N=20 . P . Age 45±12 41±13 0.32 Male gender 60% 60% 1 BMI 27±4 24±4 0.001 Frame rate 516±16Hz 516±13Hz 1 Aortic shear wave velocity 6.25±1.1m/s 3.56±0.43m/s <0.0001 Category . HCM N=20 . Normal N=20 . P . Age 45±12 41±13 0.32 Male gender 60% 60% 1 BMI 27±4 24±4 0.001 Frame rate 516±16Hz 516±13Hz 1 Aortic shear wave velocity 6.25±1.1m/s 3.56±0.43m/s <0.0001 Category . HCM N=20 . Normal N=20 . P . Age 45±12 41±13 0.32 Male gender 60% 60% 1 BMI 27±4 24±4 0.001 Frame rate 516±16Hz 516±13Hz 1 Aortic shear wave velocity 6.25±1.1m/s 3.56±0.43m/s <0.0001 Category . HCM N=20 . Normal N=20 . P . Age 45±12 41±13 0.32 Male gender 60% 60% 1 BMI 27±4 24±4 0.001 Frame rate 516±16Hz 516±13Hz 1 Aortic shear wave velocity 6.25±1.1m/s 3.56±0.43m/s <0.0001 Open in new tabDownload slide Abstract P1247 Figure. Open in new tabDownload slide Abstract P1247 Figure. P1144Volumetric and strain analysis of the right atrium in hypereosinophilic syndrome - a three-dimensional speckle-tracking echocardiographic study E Posfai E Posfai 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary S Modok S Modok 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 N Ambrus N Ambrus 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary Z Borbenyi Z Borbenyi 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary T Forster T Forster 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary A Nemes A Nemes 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary I Marton I Marton 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 Introduction: Hypereosinophilic syndrome (HES) is a myeloproliferative disorder characterized by persistent eosinophil blood count >1.5 x 10(9) cells/L for at least 6 months, independent of known secondary causes of eosinophilia. Cardiac dysfunction is considered to be one of the major cause of morbidity and mortality is HES. The early stage of cardiac involvement begins with eosinophilic infiltration, followed by an intermediate thrombotic and a late fibrotic stage. The present study was designed to assess three-dimensional speckle-tracking echocardiography (3DSTE)-derived right atrial (RA) volumetric and functional properties in HES, and to compare to that of matched controls. Methods: A total of 11 HES patients in early necrotic phase and 22 age- and gender-matched healthy controls were enrolled into the study. 3DSTE was used for calculation of RA volumes, volume-based functional properties and strain parameters. Results: Significantly increased maximum (68.7 ± 33.1 ml vs. 40.3 ± 12.1 ml, p=0.001), minimum (48.3 ± 31.0 ml vs. 28.3 ± 9.4 ml, p=0.009) RA volumes and RA volume before atrial contraction (58.6 ± 27.3 ml vs. 34.5 ± 11.8 ml, p=0.001) were found in HES patients as compared to controls. Total (20.4 ± 11.0 ml vs. 11.9 ± 5.8 ml, p=0.007) and passive (10.1 ± 8.4 ml vs. 5.8 ± 3.8 ml, p=0.05) RA stroke volumes proved to be significantly increased in HES patients. RA emptying fractions respecting cardiac cycle did not differ between the groups. None of global and mean segmental peak strains and strains at atrial contraction differed significantly between the HES patients and matched controls. Conclusions: Increased cyclic RA volumes and mild alterations in RA functional properties could be demonstrated in HES patients in early asymptomatic necrotic stage. P1248Transient right ventricular dysfunction detected by speckle tracking echocardiography in patients with transapical TAVR M A S Fahim M A S Fahim Mayo Clinic, Cardiovascular Department, Rochester, United States of America C Pislaru C Pislaru Mayo Clinic, Cardiovascular Department, Rochester, United States of America V T Nkomo V T Nkomo Mayo Clinic, Cardiovascular Department, Rochester, United States of America P A Pellikka P A Pellikka Mayo Clinic, Cardiovascular Department, Rochester, United States of America G C Kane G C Kane Mayo Clinic, Cardiovascular Department, Rochester, United States of America M F Eleid M F Eleid Mayo Clinic, Cardiovascular Department, Rochester, United States of America K L Greason K L Greason Mayo Clinic, Cardiovascular Department, Rochester, United States of America S V Pislaru S V Pislaru Mayo Clinic, Cardiovascular Department, Rochester, United States of America Mayo Clinic, Cardiovascular Department, Rochester, United States of America Background: Right ventricle (RV) systolic dysfunction has been documented to occur after surgical aortic valve replacement and attributed to either opening of pericardial space or the result of heart lung machine. Whether this effect is also seen with TransApical Transcatheter Aortic Valve Replacement (TA-TAVR) is still controversial. Aim: To investigate RV systolic function before and after TA-TAVR. Methods: 65 consecutive patients undergoing TA-TAVR were included in the analysis. Patients with atrial fibrillation were excluded. Digitally stored echocardiograms performed preprocedure, 1 month and 1 year follow-up were used for RV free-wall longitudinal strain (RVLS) and longitudinal strain rate (RVLSR) analysis, using speckle tracking. Quantitative echocardiographic parameters of RV systolic function (lateral tricuspid annular systolic velocity, s’; tricuspid annular plane systolic excursion, TAPSE) as well as semi-quantitative assessment of RV size were obtained from the echocardiographic report. Results: A total of 65 patients were included in this retrospective analysis; 43% male, age 82 ± 8 years. At baseline, Rv systolic dysfunction using TAPSE < 16mm was reported in 36%, RV S’ <10 cm/s in 41% and RVLS >-25% in 66% of patients (see table). After TA-TAVR, there was no significant change in standard echocardiographic parameters and reported RV function. However, both RVLS and RVLSR demonstrated a significant decrease in function at 1 month follow-up vs baseline (p=0.0009* and 0.012 respectively, see table), and subsequently recovered at 1 year. Conclusion: Conventional echocardiographic measures of RV function are not sensitive enough to detect early postprocedure decrease in RV systolic function. RVLS is a more sensitive index, and should be considered in the routine assessment of RV function post TAVR. Whether transient RV dysfunction as assessed by strain imaging contributes to excess morbidity in TA TAVR remains to be investigated. . Preprocedure . 1 Month follow up . 1 Year follow up . Indexed cardiac output, L/m2 3.1 ± 0.6 3.6 ± 0.7 3.7 ± 0.9 S’, m/s 0.11 ± 0.07 0.1 ± 0.02 0.09 ± 0.02 * TAPSE, mm 16.7 ± 4.4 16.1 ± 3.0 16.5 ± 4.4 RVLS, % -21.9 ± 6.9 -18.6 ± 6.1 * -19.9 ± 6.7 PASP, mmHg 38.4 ± 11.3 39.1 ± 10.7 38.7 ± 10.9 RVLSR, s -1 -1.3 ± 0.5 -1.1 ± 0.4 * -1.1 ± 0.4 RVLS > -25%, (%) 66.2 83.6 81.4 Increased RV size, n (%) 10 (15.4) 13 (21.3) 7 (15.9) . Preprocedure . 1 Month follow up . 1 Year follow up . Indexed cardiac output, L/m2 3.1 ± 0.6 3.6 ± 0.7 3.7 ± 0.9 S’, m/s 0.11 ± 0.07 0.1 ± 0.02 0.09 ± 0.02 * TAPSE, mm 16.7 ± 4.4 16.1 ± 3.0 16.5 ± 4.4 RVLS, % -21.9 ± 6.9 -18.6 ± 6.1 * -19.9 ± 6.7 PASP, mmHg 38.4 ± 11.3 39.1 ± 10.7 38.7 ± 10.9 RVLSR, s -1 -1.3 ± 0.5 -1.1 ± 0.4 * -1.1 ± 0.4 RVLS > -25%, (%) 66.2 83.6 81.4 Increased RV size, n (%) 10 (15.4) 13 (21.3) 7 (15.9) . Preprocedure . 1 Month follow up . 1 Year follow up . Indexed cardiac output, L/m2 3.1 ± 0.6 3.6 ± 0.7 3.7 ± 0.9 S’, m/s 0.11 ± 0.07 0.1 ± 0.02 0.09 ± 0.02 * TAPSE, mm 16.7 ± 4.4 16.1 ± 3.0 16.5 ± 4.4 RVLS, % -21.9 ± 6.9 -18.6 ± 6.1 * -19.9 ± 6.7 PASP, mmHg 38.4 ± 11.3 39.1 ± 10.7 38.7 ± 10.9 RVLSR, s -1 -1.3 ± 0.5 -1.1 ± 0.4 * -1.1 ± 0.4 RVLS > -25%, (%) 66.2 83.6 81.4 Increased RV size, n (%) 10 (15.4) 13 (21.3) 7 (15.9) . Preprocedure . 1 Month follow up . 1 Year follow up . Indexed cardiac output, L/m2 3.1 ± 0.6 3.6 ± 0.7 3.7 ± 0.9 S’, m/s 0.11 ± 0.07 0.1 ± 0.02 0.09 ± 0.02 * TAPSE, mm 16.7 ± 4.4 16.1 ± 3.0 16.5 ± 4.4 RVLS, % -21.9 ± 6.9 -18.6 ± 6.1 * -19.9 ± 6.7 PASP, mmHg 38.4 ± 11.3 39.1 ± 10.7 38.7 ± 10.9 RVLSR, s -1 -1.3 ± 0.5 -1.1 ± 0.4 * -1.1 ± 0.4 RVLS > -25%, (%) 66.2 83.6 81.4 Increased RV size, n (%) 10 (15.4) 13 (21.3) 7 (15.9) P12492D-Speckle Tracking of common carotid artery as a novel marker of atherosclerosis in coronary artery disease G Palmiero G Palmiero AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy F Pisacane F Pisacane AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy A Carbone A Carbone AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy S Severino S Severino AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy P Caso P Caso AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy F Arenga F Arenga AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy L Scotto Di Vetta L Scotto Di Vetta AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy Background: The arterial stiffness is a well known pathophysiological and prognostic factor of coronary artery disease (CAD) and correlates with cardiovascular (CV) risk factors. The circumferential two-dimensional Speckle Tracking analysis of the carotid artery has been recently applied for non-invasive measurement of vascular stiffness. Aims: Aim of this study is to explore the possible interplay that the neuroendocrine alterations, typical of the early phase of the CAD, and the exposure to classical CV risk factors may have on the arterial stiffness measured by strain analysis. Methods: 40 patients with CAD and CV risk factors (hypertension, dyslipidaemia, diabetes mellitus) were dichotomized based on acute (ACS group) or chronic (CAD group) ischemic heart disease. The strain analysis was performed on right common carotid artery short axis and the circumferential strain obtained by automated software. Intima-media thickness and pulse pressure were measured as described in guidelines. Results: The carotid strain values were significantly more impaired in CAD than in ACS group (see Table 1), while no significant differences were found in terms of IMT. At the multivariate analysis, the severity of CAD (number of epicardial vessels involved) correlated more with the carotid strain values than with the IMT and the lowest strain values were noticed in three-vessels coronary disease. Conclusions: In our study the vascular stiffness, measured by circumferential strain analysis, was more affected by longstanding exposure to CV risk factors than by neuroendocrine activation of the early phase of ACS. Indeed, age, pulse pressure, diabetes mellitus and multi-vessels CAD were independent predictors of vascular stiffness evaluated by strain imaging. Thus, this technique seems to be an early and reliable surrogate marker of vascular stiffness in CAD. Variable . ACS group (n=20) . CAD group (n=20) . P . Age (yrs) 65,9±10,5 61,2±7,9 ns BMI (Kg/m2) 26,5±2,7 27,8±3,8 ns Pulse pressure (mmHg) 51,5±15,4 49,2±10,9 ns Circumferential peak strain (%) 3,3±2,2 2,9±2,6 <0.01 CPS/PP 0,07±0,06 0,05±0,06 <0.05 Early strain rate (1/sec) 0,22±0,17 0,19±0,18 <0.05 Late strain rate (1/sec) 0,008±0,006 0,010±0,007 ns IMT (mm) 1,16±0,27 1,04±0,20 ns Variable . ACS group (n=20) . CAD group (n=20) . P . Age (yrs) 65,9±10,5 61,2±7,9 ns BMI (Kg/m2) 26,5±2,7 27,8±3,8 ns Pulse pressure (mmHg) 51,5±15,4 49,2±10,9 ns Circumferential peak strain (%) 3,3±2,2 2,9±2,6 <0.01 CPS/PP 0,07±0,06 0,05±0,06 <0.05 Early strain rate (1/sec) 0,22±0,17 0,19±0,18 <0.05 Late strain rate (1/sec) 0,008±0,006 0,010±0,007 ns IMT (mm) 1,16±0,27 1,04±0,20 ns Baseline characteristics of the study population with dichotomization according to the presence (ACS group) or absence of Acute Coronary Syndrome (CAD group), Variable . ACS group (n=20) . CAD group (n=20) . P . Age (yrs) 65,9±10,5 61,2±7,9 ns BMI (Kg/m2) 26,5±2,7 27,8±3,8 ns Pulse pressure (mmHg) 51,5±15,4 49,2±10,9 ns Circumferential peak strain (%) 3,3±2,2 2,9±2,6 <0.01 CPS/PP 0,07±0,06 0,05±0,06 <0.05 Early strain rate (1/sec) 0,22±0,17 0,19±0,18 <0.05 Late strain rate (1/sec) 0,008±0,006 0,010±0,007 ns IMT (mm) 1,16±0,27 1,04±0,20 ns Variable . ACS group (n=20) . CAD group (n=20) . P . Age (yrs) 65,9±10,5 61,2±7,9 ns BMI (Kg/m2) 26,5±2,7 27,8±3,8 ns Pulse pressure (mmHg) 51,5±15,4 49,2±10,9 ns Circumferential peak strain (%) 3,3±2,2 2,9±2,6 <0.01 CPS/PP 0,07±0,06 0,05±0,06 <0.05 Early strain rate (1/sec) 0,22±0,17 0,19±0,18 <0.05 Late strain rate (1/sec) 0,008±0,006 0,010±0,007 ns IMT (mm) 1,16±0,27 1,04±0,20 ns Baseline characteristics of the study population with dichotomization according to the presence (ACS group) or absence of Acute Coronary Syndrome (CAD group), P1250Influence of single dose of energy drink on left ventricular and left atrial strain in young healthy adults A Olszanecka A Olszanecka Jagiellonian University Medical College, Ist Department of Cardiology, Interventional Electrocardiology and Hypertension, Krakow, Poland M Stopa M Stopa Jagiellonian University Medical College, Ist Department of Cardiology, Interventional Electrocardiology and Hypertension, Krakow, Poland M Lobacz M Lobacz Jagiellonian University Medical College, Ist Department of Cardiology, Interventional Electrocardiology and Hypertension, Krakow, Poland K Rutowska K Rutowska Jagiellonian University Medical College, Ist Department of Cardiology, Interventional Electrocardiology and Hypertension, Krakow, Poland M Niemczyk M Niemczyk Jagiellonian University Medical College, Ist Department of Cardiology, Interventional Electrocardiology and Hypertension, Krakow, Poland A Radko A Radko Jagiellonian University Medical College, Ist Department of Cardiology, Interventional Electrocardiology and Hypertension, Krakow, Poland D Czarnecka D Czarnecka Jagiellonian University Medical College, Ist Department of Cardiology, Interventional Electrocardiology and Hypertension, Krakow, Poland Jagiellonian University Medical College, Ist Department of Cardiology, Interventional Electrocardiology and Hypertension, Krakow, Poland Introduction: An energy drink (ED) is a type of beverage containing stimulant drugs, caffeine, taurine, which is marketed as providing mental and physical stimulation. The popularity of product is increasing especially among teenagers and young adults. So far, little evidence exists regarding acute effects of the ED on cardiac function. Aim: Analysis of the influence of acute effect of single dose of energy drink on hemodynamic parameters and myocardial function assessed by speckle tracking echocardiography in healthy volunteers. Methodology: A randomized double-blind placebo controlled cross-over study was conducted on 18 healthy volunteers (7 female, 11 male, mean age 23,67±1,19). Subjects received: 500 ml of energy drink containing standard values of caffeine and taurine or 500ml of placebo. Participants drank beverages in random order during two different meetings. Drinks did not differ in taste, smell and color. In all participants before and after consumption of a drink, in the same sequence and time intervals following procedures were performed: blood pressure (BP) measurement, ECG recording, pulse wave velocity analysis and echocardiography with speckle tracking analysis of left ventricular global longitudinal strain (GLS) as well as left atrial conduit (εCD) and contractile (εCT) strain. Results: ED consumption was related with significant increase of SBP in 75 min of observation compared to placebo (ΔSBP for ED 5,7 mmHg vs -0,3 mmHg for P, p=0,03). Tendency for increase of PWV in ED group was observed (ΔPWV for ED 0,6 m/s vs 0,2 m/s for P, p=0,10). The ECG parameters ( HR, PQ, QRS and QTc intervals, axis of P wave, QRS complex, T wave) did not reveal statistical differences between groups. There were no differences in echocardiographically determined cardiac output and LVEF. ED consumption did not change LV GLS (pre ED -20,2±2,0 % vs post ED -20,6±2,4%) and did not influence LA strain (pre ED εCT 14,8±3,2% vs post ED εCT -14,0±2,5%; εCD 24,8±4,6% vs 25,6±4,2%, respectively). Conclusions: single dose ED consumption increases SBP. This effect is probably mediated by vascular wall properties and not by cardiac performance. Further studies on the influence of chronic ED consumption on central and peripheral hemodynamic parameters are needed. P1251Evaluation of left ventricular motion pattern in patients with type B Wolff-Parkinson-White syndrome J Yao J Yao Jiangsu Provincial People's Hospital, Cardiography department, Nanjing, China People's Republic of D Xu D Xu Jiangsu Provincial People's Hospital, Cardiography department, Nanjing, China People's Republic of C Chen C Chen Jiangsu Provincial People's Hospital, Cardiography department, Nanjing, China People's Republic of Y J Zhang Y J Zhang Jiangsu Provincial People's Hospital, Cardiography department, Nanjing, China People's Republic of H Tang H Tang Jiangsu Provincial People's Hospital, Cardiography department, Nanjing, China People's Republic of Jiangsu Provincial People's Hospital, Cardiography department, Nanjing, China People's Republic of Funding Acknowledgements: Nature Science Foundation of China (No. 81571691,81000618) Background: Paradoxical or hypokinetic interventricular septal motion has been described in patients with B type Wolff-Parkinson-White (B-WPW). The motion pattern alternation regarding to left ventricular (LV) torsion in patients with B-WPW remain uncertain. Purpose: The purpose of this study was to investigate the LV torsion parameters of patients with B-WPW. Methods:Thirty-eight patients with B-WPW were studied. And 40 volunteers were selected as control. 2-D speckle tracking imaging was used to acquire left ventricular torsion parameters, including peak value and time to peak value of LV twist, LV apex rotation, and LV base rotation. Apical-basal rotation delay (RDA-B) was calculated. Biplane Simpson method was used to measure LVEDV, LVESV and LVEF. All above parameters were measured in patients with B-WPW pre- (B-WPW-B) and post-(B-WPW-A) radiofrequency catheter ablation (RFCA), as well as in control group. Results:Compared with the control group, peak value of LV apex rotation (RotA), LV base rotation (RotB) and LV twist (TwistLV) were lower (P<0.05), the time to RotB (TTPB) was shorter (P=0.002), RDA-B was longer(P=0.004), LVEDV and LVESV was increased (P<0.05), and QRS width was wider (P=0.000) in B-WPW-B group. Compared with B-WPW-B group, RotA, RotB, and RotLV in B-WPW-A group were increased (P<0.05), and TTPB was longer(P = 0.021). In contrast, which was accompanied by a reduction in RDA-B (P = 0.004). LVEDV and LVESV were decreased (P<0.05). The QRS width was shorter (P=0.000). But there were no differences in other left ventricular torsion parameters and LVEF between two groups (P>0.05). Compared with the control group, RotB and TwistLV were still lower in B-WPW-A group(P<0.05. LV twist(r=-0.731, p=0.000)and LVEF (r=-0.388, p=0.016) were negatively correlated with RDA-B. Conclusions:The left ventricular motion pattern of patients with B-WPW alters, including the changes of peak value and time to peak value in LV apex rotation, LV base rotation and LV twist, as well as LV myocardium dyssynchrony. The motion pattern of LV in patients with B-WPW was improved in acute stage after RFCA but not yet recover totally. Open in new tabDownload slide Abstract P1251 Figure. Open in new tabDownload slide Abstract P1251 Figure. P1252Redefining diastolic dysfunction: the impact of the new guidelines J Ponte Monteiro J Ponte Monteiro Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal A P Faria A P Faria Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal S Gomes S Gomes Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal A Celia A Celia Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal A Pereira A Pereira Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal D Pereira D Pereira Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal I Mendonca I Mendonca Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal Introduction: In 2016 the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI), proposed a new set of parameters to simplify the diagnosis of diastolic dysfunction (DD) and increase the utility of the guidelines in clinical practice. Purpose: Study the reclassification of DD in patients (pts) with Hypertension using the 2016 comparing to the 2009 algorithm. Methods: A randomized group of 290 pts diagnosed with Arterial Hypertension according to the latest European Society of Cardiology guidelines was submitted to Transthoracic Echocardiogram (TTE). Pts with moderate or severe valvulopathy, pts with atrial fibrillation and those with poor echocardiographic window were excluded. Pts with left ventricular ejection fraction (LVEF) <50% were excluded. Blood pressure prior to the execution of TTE was measured. All echocardiograms were recorded using the ®GE Healthcare Vivid E9 echocardiograph. Images were analyzed and extracted using ®EchoPAC software, and the statistical analysis done in ®IBM SPSS Statistics version 23. The study was blind to other pre-existing comorbidities and medication. Results:Population description:The study group consisted of 282 pts, 50% female (n=141), median age of 59 years (33 – 98), median Body Mass Index of 28,82 kg/m2 (16,61 – 43,25), 46,5% overweight (n=131), 39,7% obese (n=112). Median systolic blood pressure upon TTE of 138 mmHg (106 – 191), 54,2% with controlled systolic blood pressure, 35% grade 1 systolic hypertension, 8,2% grade 2 systolic hypertension and 2,1% grade 3 systolic hypertension. Median diastolic blood pressure of 81 mmHg (51 – 115), 76,3% with controlled diastolic blood pressure, 18,4% grade 1 diastolic hypertension, 2,8% grade 2 diastolic hypertension and 1,1% grade 3 diastolic hypertension. Overall, 50,4% of patients had both systolic and diastolic controlled blood pressure upon TTE. Regarding left ventricle (LV) geometry, we observed 25,5% normal LV (n=72), 32,3% concentric remodeling (n=91), 31,2% concentric hypertrophy (n=88) and 11,0% eccentric hypertrophy (n=31). Using the 2009 ASE guidelines, 13,1% of patients exhibited DD criteria (n=37). Only 10,8% (vs 27,8%, p=0,039) of those patients exhibited normal LV. Using the 2016 ASE guidelines, only 4 pts (1,4%) had criteria for DD, 58 pts (20,7%) add inconclusive result, and 218 pts had normal LV. No patient with DD using the 2016 guidelines exhibited a normal LV. Conclusion: Applying the newest DD guidelines resulted in a higher threshold for the diagnosis of DD. A higher rate of LV concentric hypertrophy and remodeling suggest that the geometry change preceded the DD. P1253Left atrial deformation assessed by 3D speckle tracking echocardiography:an early marker of subclinical disease G Esposito G Esposito 1Umberto I Polyclinic of Rome, Rome, Italy P Piras P Piras 1Umberto I Polyclinic of Rome, Rome, Italy A Evangelista A Evangelista 2Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy F Giordano F Giordano 1Umberto I Polyclinic of Rome, Rome, Italy A Delli Veneri A Delli Veneri 1Umberto I Polyclinic of Rome, Rome, Italy V Nuzzi V Nuzzi 1Umberto I Polyclinic of Rome, Rome, Italy G Pannarale G Pannarale 1Umberto I Polyclinic of Rome, Rome, Italy P E Puddu P E Puddu 1Umberto I Polyclinic of Rome, Rome, Italy C Torromeo C Torromeo 1Umberto I Polyclinic of Rome, Rome, Italy 1Umberto I Polyclinic of Rome, Rome, Italy 2Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy Background: Atrial fibrillation (AF) and systemic hypertension (HT) progressively induce left atrial (LA) structural remodeling which evolves into impaired LA function. The clinical implication could be an increased risk of tromboembolic events and heart failure. Currently, the correlation between LA structure and LA function is not adequately or fully investigated at an early stage. Purpose: We evaluated atrial deformation as an indicator of electromechanical remodeling in patients with AF and HT, either isolated or combined and with or without left ventricle hypertrophy (LVH). Also, we investigated whether this parameter could be a preclinical marker of LA impairment. Methods: Study population was composed by 130 patients in sinus rhythm without any grade of diastolic dysfunction. We enrolled 82 healthy subjects, 18 patients with HT, 10 patients with HT and LVH, and 20 patients with a previous AF (paroxysmal or persistent) represented by 9 patients with only AF, 11 patients with AF, HT and LVH. We performed 2D and 3D speckle tracking echocardiography (3D-STE): the latter evaluated the peak and the time to peak of LA longitudinal, circumferential and radial strain in diastolic atrial phase. 3D left atrial end diastolic volume (LAEDV 3D) and 3D left atrial end systolic volume (LAESV 3D) were measured and indexed. To define the relationship between early structural remodeling and impaired function, we correlated LA strain with 2D and 3D LA volume. Results: Global circumferential (GCS), longitudinal (GLS) and radial strain (GRS) were significantly reduced in both HT and AF patients with a gradual trend from control to AF_LVH (GCS, GLS and GRS: p-value < 0.001); also these groups showed significantly increased values of standard deviation time to peak longitudinal and circumferential strain (CsdT: p-value <0.019; LsdT: p-value <0.0014). 2D and 3D LA volume were progressively increased from controls to PAF_LVH (LAVi: p-value <0,001; LAESVi 3D and LAEDVi 3D: p-value <0.001), and had an inverse correlation with GLS and GCS values (GLS vs LAESVi 3D ρ= -0.359; GCS vs LAVi ρ= -0.453, GCS vs LAESVi 3D ρ= -0.703, GCS vs LAEDVi 3D ρ= -0.434), while they had positive correlation with GRS (GRS vs LAVi ρ= -0.411, GRS vs LAESVi 3D ρ= -0.420). However, LA volume showed a positive correlation with LV dimension and LV mass, to underline the link between atrial and ventricular remodeling (LAVi vs LVESVi ρ= -0.536, LAVi vs LVMASSi ρ= -0.488; LAESVi 3D vsLVESVi ρ= -0.561; LAEDVi 3D vs LVESVi ρ= -0.521). Conclusions: 3D-STE showed a progressive uneven atrial relaxation in AF and HT patients compared with controls. LA deformation detects structural and functional impairment in patients with early LA and LV remodeling. The correlation between LA volume and 3D strain may express the potential of this imaging technique and should be further investigated to be later included amongst clinical risk factors that might contribute to long-term complications. Open in new tabDownload slide Abstract P1253 Figure. Impaired 3D longitudinal strain Open in new tabDownload slide Abstract P1253 Figure. Impaired 3D longitudinal strain P1254Relative contribution of 3D radial and longitudinal endocardial contraction to right ventricle function M C Palumbo M C Palumbo 1Milan Polytechnic, Dipartimento di elettronica, informazione e bioingegneria, Milan, Italy F Bandera F Bandera 2IRCCS, Policlinico San Donato, University Cardiology Department, University of Milano School of Medicine, San Donato Milanese, Italy E Alfonzetti E Alfonzetti 2IRCCS, Policlinico San Donato, University Cardiology Department, University of Milano School of Medicine, San Donato Milanese, Italy E G Caiani E G Caiani 1Milan Polytechnic, Dipartimento di elettronica, informazione e bioingegneria, Milan, Italy M Guazzi M Guazzi 2IRCCS, Policlinico San Donato, University Cardiology Department, University of Milano School of Medicine, San Donato Milanese, Italy 1Milan Polytechnic, Dipartimento di elettronica, informazione e bioingegneria, Milan, Italy 2IRCCS, Policlinico San Donato, University Cardiology Department, University of Milano School of Medicine, San Donato Milanese, Italy Background: The interplay between right ventricle (RV) and arterial system, named as ventricular-arterial coupling (VAC), affects ventricular performance. However, how the fiber arrangements influences the mechanics of the RV and what the relative contribution with overall RV function is debated. Purpose: To assess the relative contribution of radial and longitudinal endocardial contraction to RV ejection fraction (RVEF) and VAC. Methods: 35 subjects (10 normals, 10 Pulmonary Hypertension, 3 Dilative cardiomyopathy, 12 with valve disease) underwent RV 3D echocardiography. Volume and functional parameters, as RVEF and stroke volume (SV), were derived through an offline post processing with a commercial software. The VAC was calculated as SV over end systolic volume (SV/ESV) relying on some assumptions. The 3D model of the RV was further analyzed through a developed custom software that allow quantifying the contribution of the change in volume distinguishing the longitudinal and radial contraction(figure a). RVEF due to a longitudinal shortening and RVEF due to a radial contraction were derived. A ratio between them was calculated to quantify the dominance between the two contributions. The ratio was normalized (Rnorm) to EF in order to dissect the relationship between longitudinal and radial contraction not depending on the global EF. Results: RVEF and the VAC, are mathematically linked but revealed a non linear relationship (figure b) indicating a better sensibility of VAC to discriminate pathological or normal value of EF. The radial EF showed a higher correlation with both EF (figure d) and VAC (figure e) with respect to the longitudinal EF (compared to EF: R2=0.96, R2=0.77, compared to VAC: R2=0.95, R2=0.76, respectively for radial and longitudinal EF) but they behaved differently. In relation with VAC a quadratic relationship was shown comparing radial EF, while a linear relation best correlate with longitudinal EF. The normalized ratio exhibited a good correlation with VAC using a power function (R2=0.69) (figure c). For a compromised VAC (<1.5) the contribution of longitudinal and radial contraction (figure e) tended to be similar, while for higher value, the radial contraction emerged with a prominent role. This can be appreciated with the power relation between the VAC and the normalized ratio (figure c) in which a reduced coupling revealed higher value of R norm probably due to a decrease in the radial contribution, while for optimal coupling the R_norm showed a quite constant behavior with a value around 1. Conclusions: This analysis suggests that the different fibers arrangement along two principal directions played a different role and the quantification of the relative contribution could be of great significance for therapeutic interventions. Open in new tabDownload slide Abstract P1254 Figure. Open in new tabDownload slide Abstract P1254 Figure. P1255High predictive values of 3D speckle tracking speed deformation to detect impaired left atrial function and paroxysmal atrial fibrillation G Esposito G Esposito 1Umberto I Polyclinic of Rome, Rome, Italy P Piras P Piras 1Umberto I Polyclinic of Rome, Rome, Italy A Evangelista A Evangelista 2Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy V Nuzzi V Nuzzi 1Umberto I Polyclinic of Rome, Rome, Italy P Nardinocchi P Nardinocchi 3Sapienza University of Rome, Rome, Italy G Pannarale G Pannarale 1Umberto I Polyclinic of Rome, Rome, Italy C Torromeo C Torromeo 1Umberto I Polyclinic of Rome, Rome, Italy P E Puddu P E Puddu 1Umberto I Polyclinic of Rome, Rome, Italy 1Umberto I Polyclinic of Rome, Rome, Italy 2Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy 3Sapienza University of Rome, Rome, Italy Background: Paroxysmal atrial fibrillation (PAF) is often asymptomatic and long-term electrocardiographic (ECG) monitoring is the reference method to assess silent FA for prompt detection of related complications. Left atrial (LA) function is closely associated with increased deposition of fibrous tissue and this is pathophysiologically related to atrial electro-mechanical and anatomical changes before the onset of AF. However, routine use of long-term ECG monitoring is not possible for economic reasons, so its identification remains difficult prior to symptoms onset. Purpose: This study evaluated LA function by 3D speed deformation, as a marker of impaired atrial relaxation, in hypertension (HT) and AF patients either isolated or combined and with or without left ventricle hypertrophy (LVH); also we assessed the performance of this method to identifying subjects, in sinus rhytm, who had history of PAF, compared with 2D LA volume (LAVi). Methods: We enrolled 82 healthy subject, 18 patients with HT, 10 patients with HT and LVH, 9 patients with only PAF (paroxysmal or persistent) and 11 patients with PAF, HT and LVH. To evaluate appropriately the atrial function, we introduced the concept of homologous times based on electromechanical time points that were defined on the tracings. A single cardiac cycle had 16 homologous times: 2 mechanical, LV end-systole and mitral valve opening, and 2 electrical, R wave peak and P wave peak whereas the other 12 times were obtained by sampling 4 equally spaced times between successive strictly homologous times. This approach enables to compare different individuals by eliminating interindividual beating discrepancies at a different heart rates. Speed deformation represents the ratio between the amount of strain and the time needed to occur, in a specific phase of the atrial cycle, identified by the respective homologous time. Longitudinal speed deformation (LSd), circumferential speed deformation (CSd) strain and volume speed change (VSc) were measured during the atrial pre-active phase (10th homologous time). Receiver operating characteristic curves (ROC) were constructed for each parameter and compared with LAVi for PAF detection. Results: LSd and CSd were significantly impaired compared to control group (CSd and LSd: p-value <0.001); Using CSd and LSd as unique independent variables, MANOVA was performed and both parameters were statistically significant to distinguish control from PAF (Control vs the other cathegories: p-value= 0.001). ROC’s curve was calculated to assess the performance of 3D strain to differentiate healthy subjects from PAF groups and it was compared with LAVi. Conclusions: Our study show anatomical and mechanical LA remodeling in patients with AF and HT,despite the absence of a detectable atrial diastolic dysfunction. 3D speed deformation and the approach by homologous times provide the highest predictive values to identify PAF patients. Large studies with 3D-STE are now necessary. Open in new tabDownload slide Abstract P1255 Figure. 3D Speed Deformation Results Open in new tabDownload slide Abstract P1255 Figure. 3D Speed Deformation Results P1256right ventricular 3d echocardiography and computational imaging: improving analysis accuracy M C Palumbo M C Palumbo 1Milan Polytechnic, Dipartimento di elettronica, informazione e bioingegneria, Milan, Italy F Bandera F Bandera 2IRCCS, Policlinico San Donato, University Cardiology Department, University of Milano School of Medicine, San Donato Milanese, Italy E Alfonzetti E Alfonzetti 2IRCCS, Policlinico San Donato, University Cardiology Department, University of Milano School of Medicine, San Donato Milanese, Italy E G Caiani E G Caiani 1Milan Polytechnic, Dipartimento di elettronica, informazione e bioingegneria, Milan, Italy M Guazzi M Guazzi 2IRCCS, Policlinico San Donato, University Cardiology Department, University of Milano School of Medicine, San Donato Milanese, Italy 1Milan Polytechnic, Dipartimento di elettronica, informazione e bioingegneria, Milan, Italy 2IRCCS, Policlinico San Donato, University Cardiology Department, University of Milano School of Medicine, San Donato Milanese, Italy Background: Currently, quantitative measures of right ventricle (RV) function and morphology are the volume and the derived ejection fraction from 3D echocardiography. However, the reconstructed 3D model of the RV stimulates further elaborations for a better understanding of the right heart disease. Purpose: To compare the 3D echocardiography derived RV ejection Fraction (EF) with the area strain or area change ratio (ACR), a parameter that reflects deformation of the endocardial surface from end-diastole (ED) to end-systole (ED) integrating the deformation in all the directions: longitudinal, radial and circumferential. Methods: 35 subjects (10 normals, 10 Pulmonary Hypertension, 3 Dilative cardiomyopathy, 12 with other valve disease) underwent RV 3D echocardiography. Volume and functional parameters, as RVEF and stroke volume, were derived through an offline post processing with a commercial software. A custom software was developed in order to quantify the area of the endocardial surface (figure a) at ED and ES of the 3D model. This algorithm was applied to all the 35 subjects. Results: A non-linear correlation between RVEF and ACR was found, a quadratic function best fitted the scatter plot with a coefficient of determination R2=0.97 (figure b). Functional parameter as tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP) showed a good correlation through a quadratic function with both ACR and RVEF (TAPSE vs ACR: R2=0.60, sPAP vs ACR: R2=0.52, TAPSE vs EF: R2=0.54, sPAP vs ACR: R2= 0.56). The correlation related to ACR maintained a more quadratic pattern in all the relations (figure c). Discussion: The non-linear relationship between EF and ACR suggests that for higher values of RVEF (>45), ACR could be more sensitive in determining the systolic function and could better classify patients belonging to a middle range RVEF. Moreover, a better correlation with TAPSE and a preserved quadratic shape was observed. Open in new tabDownload slide Abstract P1256 Figure. Open in new tabDownload slide Abstract P1256 Figure. P1257Diagnostic performance of coronary CT angiography performed by the novel whole-heart coverage high definition CT scanner in patients with very high heart rate D Andreini D Andreini 1University of Milan, Foundation Monzino (IRCCS), Center Cardiology, Dpt of Cardiology, Milan, Italy S Mushtaq S Mushtaq 2Cardiology Center Monzino IRCCS, Milan, Italy E Conte E Conte 2Cardiology Center Monzino IRCCS, Milan, Italy M Guglielmo M Guglielmo 2Cardiology Center Monzino IRCCS, Milan, Italy A Baggiano A Baggiano 2Cardiology Center Monzino IRCCS, Milan, Italy S Zanchi S Zanchi 2Cardiology Center Monzino IRCCS, Milan, Italy V Ditali V Ditali 2Cardiology Center Monzino IRCCS, Milan, Italy E Menotti E Menotti 2Cardiology Center Monzino IRCCS, Milan, Italy A Santos A Santos 2Cardiology Center Monzino IRCCS, Milan, Italy E Mancini E Mancini 2Cardiology Center Monzino IRCCS, Milan, Italy M Verdecchia M Verdecchia 2Cardiology Center Monzino IRCCS, Milan, Italy A L Bartorelli A L Bartorelli 1University of Milan, Foundation Monzino (IRCCS), Center Cardiology, Dpt of Cardiology, Milan, Italy C Fiorentini C Fiorentini 1University of Milan, Foundation Monzino (IRCCS), Center Cardiology, Dpt of Cardiology, Milan, Italy G Pontone G Pontone 2Cardiology Center Monzino IRCCS, Milan, Italy M Pepi M Pepi 2Cardiology Center Monzino IRCCS, Milan, Italy 1University of Milan, Foundation Monzino (IRCCS), Center Cardiology, Dpt of Cardiology, Milan, Italy 2Cardiology Center Monzino IRCCS, Milan, Italy Objectives: To evaluate image quality, radiation exposure and diagnostic accuracy of coronary CT angiography (CCTA) performed with a newest generation of cardiac-CT scanner in patients with heart rate (HR) >80 bpm and to compare this evaluation with that obtained in patients with HR suitable for conventional CCTA (<65 bpm). Background: Despite the progressive improvement of temporal resolution in the recent scanner generation, the evaluation of coronary arteries in patients with high heart rate is still a challenging application of cardiac-CT. Moreover, CCTA performed in this conditions is associated with particularly high radiation exposure. Materials and Methods: 202 patients (111 males, mean age 66±8 years old) undergoing CCTA for suspected CAD by using a novel whole organ volumetric CT scanner (16cm z-axis coverage with 256 detector rows and 512 slices, gantry rotation time 0.28 sec), were enrolled in the study. Prospective ECG-triggering was used in all patients. In 100 patients (Group 1), the HR during the scan was ≥80 bpm; in the remaining 102 patients (Group 2), the HR during the scan was ≤65 bpm. In all patients, image quality score and coronary interpretability were evaluated and effective dose (ED) was recorded. Of the 202 patients prospectively enrolled, we evaluated the CCTA diagnostic accuracy vs. invasive coronary angiography (ICA) in the 86 patients (40 patients in group 1, 46 patients in group 2) who were referred for a clinically indicated ICA in the 6 months following CCTA. Results: The mean HR during the scan was 93±24 bpm in Group 1 and 57±7 bpm in Group 2. The mean image quality was very high in both Groups (Likert=3.35 in Group 1 vs. 3.39 in Group 2). The overall coronary interpretability was 97.3% (1542/1584 segments) in Group 1 and 98% (1569/1600 segments) in Group 2, without statistically significant differences; The mean ED was low in the two Groups, with lower values in Group 2 (2.9±1.6 mSv in Group 1 and 1.1±0.5 mSv in Group 2). Sensitivity and specificity of CCTA for detection of >50% stenosis vs. ICA were 95.2% and 98.9% in a segment-based analysis and 100% and 81.8% in a patient-based analysis, respectively. Conclusions: The novel whole organ high definition CT scanner allows to evaluate coronary arteries in patients with very high HR with excellent image quality and coronary interpretability and low radiation exposure. P1145LA strain does not predict atrial fibrillation recurrence after electrical cardioversion: a systematic review and meta-analysis F Jashari F Jashari 3University of Prishtina, Clinic of Neurology, Prishtina, Kosovo Republic of H Jashari H Jashari 4Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden M Y Henein M Y Henein 4Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden 1University Clinical Center of Kosova, Clinic of Cardiology, Prishtina, Kosovo Republic of 2Faculty of Medicine, University of Prishtina, Clinic of Cardiology, Prishtina, Kosovo Republic of 3University of Prishtina, Clinic of Neurology, Prishtina, Kosovo Republic of 4Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden P Ibrahimi P Ibrahimi 1University Clinical Center of Kosova, Clinic of Cardiology, Prishtina, Kosovo Republic of G Bajraktari G Bajraktari 2Faculty of Medicine, University of Prishtina, Clinic of Cardiology, Prishtina, Kosovo Republic of I Bytyci I Bytyci 1University Clinical Center of Kosova, Clinic of Cardiology, Prishtina, Kosovo Republic of Background and Aim: Despite the improved outcome of patients with atrial fibrillation (AF) who undergo electrical cardioversion (ECV), the recurrence of the AF remain very high. Echocardiographic left atrial (LA) strain has been associated with AF. However, the predictive role of LA strain and other parameters in these patients is still unclear. The aim of this meta-analysis was to assess the potential association between LA strain and AF recurrence after ECV. Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to January 2017 in order to identify clinical trials and observational studies, which assessed the predictive role of LA strain in AF recurrence after ECV. The search identified 367 patients from 4 studies, with persistent AF (PeAF). Results: The pooled analysis showed that after a mean follow-up period of 6.1 months, baseline LA strain in patients with AF recurrence was similar to those without AF recurrence [11.98 (11.4-12.5) vs. 11.7 (11.2-12.2)], with a weighted mean difference (WMD) -0.174% ([95% CI 0.43 to -0.78], P =0.557). Conclusions: LA strain is not a discriminating marker of atrial function that could predict recurrence of AF after ECV. Open in new tabDownload slide Abstract P1145 Figure. Open in new tabDownload slide Abstract P1145 Figure. P1258Phase analysis, a novel SPECT technique for left ventricular dyssynchrony: Are degrees and milliseconds interchangeable? R Xavier R Xavier 1Harefield Hospital, Cardiology, London, United Kingdom A J Barron A J Barron 1Harefield Hospital, Cardiology, London, United Kingdom E Reyes E Reyes 2Royal Brompton Hospital, Cardiology, London, United Kingdom M Al-Housni M Al-Housni 1Harefield Hospital, Cardiology, London, United Kingdom S R Underwood S R Underwood 2Royal Brompton Hospital, Cardiology, London, United Kingdom 1Harefield Hospital, Cardiology, London, United Kingdom 2Royal Brompton Hospital, Cardiology, London, United Kingdom Introduction: Phase analysis of gated single photon emission computer tomography (SPECT) myocardial perfusion scintigraphy (MPS) provides a measure of left ventricular dyssynchrony and may have applications for identifying patients suitable for cardiac resynchronisation therapy (CRT). Published normal values typically have measured bandwidth and standard deviation in terms of degrees (with a single cardiac cycle lasting 360°). However cardiologists are familiar with ECGs, which measure dyssynchrony in terms of time. Purpose: To assess the relationship between phase measured in time and degrees, in order to determine whether they are interchangeable. Methods: Patients underwent SPECT myocardial perfusion imaging between January 2016 and April 2017 using Technetium-99m tetrofosmin. Patients with normal stress only images were identified. Data were analysed using QGS software (Cedars Sinai). On phase analysis of the ECG-gated post-stress tomograms, bandwidth and standard deviation were calculated by the software. Measurable patient factors (heart rate, age, gender, stress modality and ejection fraction) were analysed for their relation to phase variables using a multivariate model. P<0.05 was deemed to be statistically significant. Results: 399 patients (270 female) had normal scans. 13 were excluded for conduction abnormalities (LBBB 5, RBBB 2, paced 6). Median bandwidth was 42ms with 95% confidence intervals 21-82ms, or 24° with 95% confidence intervals 12-36°. Median standard deviation was 10ms with 95% confidence intervals 5-25ms, or 4.8° with 95% confidence intervals 2.6-11.7°. Bandwidth measured by time and degrees were strongly correlated with each other (correlation coefficient 0.87, P<0.001). On a multivariate model to predict bandwidth in ms from bandwidth in degrees, including the patient variables age, gender, ejection fraction and modality of stress did not significantly alter the strength of the model. With an R2 value of 0.93 the addition of heart rate (P<0.001) to the model explained most of the residual difference in variation between the two bandwidth measures. The results for standard deviation were similar. Discussion: In this large study of patients with normal myocardial perfusion and QRS duration, we show that bandwidth as measured by degrees of the cardiac cycle, the traditional way of displaying bandwidth, is not directly interchangeable with time in milliseconds, the more intuitive way of demonstrating it to cardiologists interested in patient selection for resynchronisation therapy. However most of the variation between the two bandwidth measures is explainable by heart rate. We would therefore propose that when using phase analysis heart rate during the gated acquisition should be quoted alongside the other results. Open in new tabDownload slide Abstract P1258 Figure. How phase analysis is displayed Open in new tabDownload slide Abstract P1258 Figure. How phase analysis is displayed P1146Automated 3D quantification of cardiac volumes and function with anatomical intelligence in adolescents X X Luo X X Luo 1ShenZhen Hospital of Southern Medical University, Department of Ultrasonography, Shenzhen, China People's Republic of F Fang F Fang 2The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Division of Cardiology, Prince of Wales Hospital, Hong Kong, Hong Kong SAR People's Republic of China M C Yam M C Yam 3The Chinese University of Hong Kong, Department of Paediatrics, Prince of Wales Hospital, Hong Kong, Hong Kong SAR People's Republic of China H K So H K So 3The Chinese University of Hong Kong, Department of Paediatrics, Prince of Wales Hospital, Hong Kong, Hong Kong SAR People's Republic of China C Liu C Liu 2The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Division of Cardiology, Prince of Wales Hospital, Hong Kong, Hong Kong SAR People's Republic of China B P Yan B P Yan 2The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Division of Cardiology, Prince of Wales Hospital, Hong Kong, Hong Kong SAR People's Republic of China P W Lee P W Lee 2The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Division of Cardiology, Prince of Wales Hospital, Hong Kong, Hong Kong SAR People's Republic of China Y S Zhu Y S Zhu 1ShenZhen Hospital of Southern Medical University, Department of Ultrasonography, Shenzhen, China People's Republic of 1ShenZhen Hospital of Southern Medical University, Department of Ultrasonography, Shenzhen, China People's Republic of 2The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Division of Cardiology, Prince of Wales Hospital, Hong Kong, Hong Kong SAR People's Republic of China 3The Chinese University of Hong Kong, Department of Paediatrics, Prince of Wales Hospital, Hong Kong, Hong Kong SAR People's Republic of China Funding Acknowledgements: This project was supported by the Health and Medical Research Fund (Ref no: 12131351), Food and Health Bureau, Hong Kong SAR Government. Background: The accuracy and reproducibility of HeartModel (Figure 1) for automated determination of three-dimensional echocardiography (3DE)-derived left atrial (LA) and left ventricular (LV) volumes and LV ejection fraction (LVEF) in adult patients has been reported earlier. However, this automated adaptive analytics algorithm relies on anatomic datasets derived from a "training" population, which may not encompass adequate echo images from adolescents. Objectives: The goal of this study was to explore the accuracy of HeartModel in adolescents compared with expert manual 3D echocardiography. Methods: A total of 53 adolescent subjects with or without heart disease (17 ± 3 years, 58% male) underwent 3DE imaging with an EPIQ system (Philips, Andover, MA). 3D cardiac volumes and LVEF obtained with the automated HeartModel program were compared with the manual 3DE measurements by an experienced echocardiographer. Inter-method comparisons included linear regression and Bland-Altman analyses. Time consumption and reproducibility of HeartModel were also compared with the manual 3DE method. Results: There was strong correlation between HeartModel and expert manual 3DE program for estimation of LV end-diastolic volume, LV end-systolic volume, LVEF and LA volume in all studied subjects (r = 0.875 to 0.965, all p < 0.001). Furthermore, automated LV and LA volumes were slightly overestimated when compared to expert manual measurements, while LVEF showed no significant differences in comparison with the manual method. Importantly, the intra- and inter-observer variability of automated 3DE model was relatively low (<1%), surpassing the manual approach (3.5% - 17.4%) (Table 1), yet requiring significantly less analyzing time (20 ± 7 vs. 177 ± 30s, p < 0.001). Of note, the automated technique had excellent test-retest reproducibility. Conclusion: Simultaneous quantification of LA and LV volumes and LVEF with the automated HeartModel program is rapid, accurate and reproducible in adolescent cohort, it therefore has potential to bring 3DE into busy pediatric practice. Table 1. Reproducibility . Intraobserver variability of HeartModel . Interobserver variability of HeartModel . Test-Retest of HeartModel . Intraobserver variability of Manual 3DE . Interobserver variability of Manual 3DE . LV end-diastolic volume 0.15 ± 0.57% 0.16 ± 0.86% 3.4 ± 3.7% 4.9 ± 3.6% 10.5 ± 6.9% LV end-systolic volume 0.72 ± 2.92% 0.48 ± 2.61% 5.1 ± 5.1% 8.3 ± 5.9% 13.1 ± 11.4% LV ejection fraction 0.69 ± 2.82% 0.20 ± 1.09% 2.5 ± 2.1% 3.5 ± 3.2% 10.8 ± 9.3% LA volume 0.07 ± 0.40% 0 ± 0% 5.9 ± 6.3% 4.8 ± 5.0% 17.4 ± 20.1% . Intraobserver variability of HeartModel . Interobserver variability of HeartModel . Test-Retest of HeartModel . Intraobserver variability of Manual 3DE . Interobserver variability of Manual 3DE . LV end-diastolic volume 0.15 ± 0.57% 0.16 ± 0.86% 3.4 ± 3.7% 4.9 ± 3.6% 10.5 ± 6.9% LV end-systolic volume 0.72 ± 2.92% 0.48 ± 2.61% 5.1 ± 5.1% 8.3 ± 5.9% 13.1 ± 11.4% LV ejection fraction 0.69 ± 2.82% 0.20 ± 1.09% 2.5 ± 2.1% 3.5 ± 3.2% 10.8 ± 9.3% LA volume 0.07 ± 0.40% 0 ± 0% 5.9 ± 6.3% 4.8 ± 5.0% 17.4 ± 20.1% Table 1. Reproducibility . Intraobserver variability of HeartModel . Interobserver variability of HeartModel . Test-Retest of HeartModel . Intraobserver variability of Manual 3DE . Interobserver variability of Manual 3DE . LV end-diastolic volume 0.15 ± 0.57% 0.16 ± 0.86% 3.4 ± 3.7% 4.9 ± 3.6% 10.5 ± 6.9% LV end-systolic volume 0.72 ± 2.92% 0.48 ± 2.61% 5.1 ± 5.1% 8.3 ± 5.9% 13.1 ± 11.4% LV ejection fraction 0.69 ± 2.82% 0.20 ± 1.09% 2.5 ± 2.1% 3.5 ± 3.2% 10.8 ± 9.3% LA volume 0.07 ± 0.40% 0 ± 0% 5.9 ± 6.3% 4.8 ± 5.0% 17.4 ± 20.1% . Intraobserver variability of HeartModel . Interobserver variability of HeartModel . Test-Retest of HeartModel . Intraobserver variability of Manual 3DE . Interobserver variability of Manual 3DE . LV end-diastolic volume 0.15 ± 0.57% 0.16 ± 0.86% 3.4 ± 3.7% 4.9 ± 3.6% 10.5 ± 6.9% LV end-systolic volume 0.72 ± 2.92% 0.48 ± 2.61% 5.1 ± 5.1% 8.3 ± 5.9% 13.1 ± 11.4% LV ejection fraction 0.69 ± 2.82% 0.20 ± 1.09% 2.5 ± 2.1% 3.5 ± 3.2% 10.8 ± 9.3% LA volume 0.07 ± 0.40% 0 ± 0% 5.9 ± 6.3% 4.8 ± 5.0% 17.4 ± 20.1% Open in new tabDownload slide Abstract P1146 Figure.. HeartModel program Open in new tabDownload slide Abstract P1146 Figure.. HeartModel program P11474D-flow CMR-derived thoracic aortic geometry in bicuspid aortic valve aortopathy N Villalva N Villalva 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain F Valente F Valente 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain L Galian L Galian 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain M Huguet M Huguet 2Sant Jordi Cardiovascular Centre, Clinica CETIR El Pilar, cardiac imaging, Barcelona, Spain L Gutierrez L Gutierrez 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain T Gonzalez T Gonzalez 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain R Fernandez R Fernandez 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain A Sao-Aviles A Sao-Aviles 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain D Garcia-Dorado D Garcia-Dorado 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain A Guala A Guala 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain L Dux-Santoy L Dux-Santoy 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain J F Rodriguez-Palomares J F Rodriguez-Palomares 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain G Teixido-Tura G Teixido-Tura 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain G Maldonato G Maldonato 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain A Evangelista A Evangelista 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain 2Sant Jordi Cardiovascular Centre, Clinica CETIR El Pilar, cardiac imaging, Barcelona, Spain Funding Acknowledgements: This project has been funded by La Marató de TV3 (nr. 20151330), Retos-Colaboración (RTC-2016-5152-1) and FP7/People n° 267128. Introduction: Ascending aorta (AAo) dilation (aortopathy) has been documented in 60-80% of patients with bicuspid aortic valve (BAV). However, an integral 3D study of all aortic geometric changes in a BAV population are still lacking. Purpose: We aimed to evaluate 3D changes in aortic geometry in BAV patients by 4D-flow CMR. Methods: Seventy-six patients with BAV and 23 age- and body size- matched healthy volunteers (HV) were studied. Non-contrast 4D-flow derived anatomical 3D images were used to characterize thoracic aortic geometry through a semi-automatic segmentation. Five sections divided the aorta into 4 segments: proximal and distal AAo, aortic arch, and proximal descending aorta (DAo). Different parameters were measured for each segment: aortic volume, centerline length, tortuosity, aortic valve inclination angle, arch height and width, and sagittal depth (Figure). The location of the maximum curvature in the AAo was identified. The AAo was considered dilated if the z-score was > 2. Results: Compared to HV, BAV patients presented increased aortic volume, length, tortuosity, aortic valve inclination angle, aortic arch height, width and sagittal depth (p-value<0.05 for all measurements). Volume, length and tortuosity were affected in all four sub-regions. Irrespective of AAo dilation, the centerline at STJ was directed more anteriorly and was more horizontal in BAV. However, dilated BAV patients compared to non-dilated only differed in AAo and arch volumes, tortuosity, arch width and sagittal depth (p <0.05). Of note, neither length nor STJ direction were increased in dilated patients. The location of the maximum centerline curvature was located more proximally in BAV patients, and even more in the dilated subgroup (p <0.05). Conclusions: BAV patients present a pattern of 3D geometrical aortic changes that distributes to the entire thoracic aorta and that are more pronounced in dilated patients. Further studies are needed to characterize the clinical implications of this 3D-geometrical description. Open in new tabDownload slide Abstract P1147 Figure. Open in new tabDownload slide Abstract P1147 Figure. P1148Ascending aorta longitudinal and circumferential strain in bicuspid aortic valve and their relation to aortic dilation L Galian L Galian 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain M Huguet M Huguet 2Sant Jordi Cardiovascular Centre, Clinica CETIR El Pilar, cardiac imaging, Barcelona, Spain L Gutierrez L Gutierrez 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain T Gonzalez T Gonzalez 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain R Fernandez R Fernandez 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain A Sao-Aviles A Sao-Aviles 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain D Garcia-Dorado D Garcia-Dorado 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain A Evangelista A Evangelista 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain 2Sant Jordi Cardiovascular Centre, Clinica CETIR El Pilar, cardiac imaging, Barcelona, Spain A Guala A Guala 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain L Dux-Santoy L Dux-Santoy 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain J F Rodriguez-Palomares J F Rodriguez-Palomares 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain G Teixido-Tura G Teixido-Tura 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain G Maldonato G Maldonato 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain N Villalva N Villalva 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain F Valente F Valente 1University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain Funding Acknowledgements: This project has been funded by La Marató de TV3 (nr. 20151330), Retos-Colaboración (RTC-2016-5152-1) and FP7/People n° 267128. Introduction: Different studies have associated aortic dilation with local biomechanical alterations in bicuspid aortic valve (BAV) patients. For that reason, the analysis of aortic deformation beyond stress parameters could be of value to understand aortic geometrical changes and dilation (aortopathy) in this population. Purpose: We aimed to quantify longitudinal and circumferential AAo strain in BAV patients and to determine their relation with local aortopathy. Methods: Seventy BAV patients with no severe valvular disease and 21 matched healthy volunteers were recruited. Sagittal, coronal and aortic valve 2D CINE MRI images were collected. Aortic valve plane movement was tracked in the three directions through an image registration code. Valve plane movement were then projected in the direction of the aorta at the sinotubolar junction to obtain the AAo longitudinal elongation, which divided by AAo length gave the mean AAo longitudinal strain. Circumferential strain was computed from circumference elongation measured through AAo double-oblique 2D CINE MRI images. A z-score > 2 value defined AAo dilation. Results: AAo was dilated in 52 and non-dilated in 18 patients. AAo circumferential strain (p<0,001) and AAo longitudinal strain (p=0.03) were reduced in BAVs with respect to controls irrespectively of AAo dilation. However, neither longitudinal nor circumferential strain were different between dilated and non-dilated BAV. No differences were found comparing BAV fusion pattern. Of note, inverse relations were found between AAo circumferential (R=0.44) and longitudinal (R=0.54) strain and age in the BAV population. Conclusions: Ascending aortic longitudinal and circumferential strain are influenced by age and impaired in BAV patients irrespectively of AAo dilation. These parameters could potentially be a marker of aortic stiffness at early stages of the disease and may permit a future understanding of the aorto-ventricular interaction. . . BAV . CONTROLS ALL DILATION NON DILATED DILATED 21 70 18 52 AAO circunferencial strain 14.7±3 7.6±4.6* 7.9±3.1* 7.4±4.7* AAo longitudinal strain 8.2±2.7 6.1±2.6* 6.4±2.3* 6.1±2.7* . . BAV . CONTROLS ALL DILATION NON DILATED DILATED 21 70 18 52 AAO circunferencial strain 14.7±3 7.6±4.6* 7.9±3.1* 7.4±4.7* AAo longitudinal strain 8.2±2.7 6.1±2.6* 6.4±2.3* 6.1±2.7* ascending (AAo) circumferential and longitudinal strain in healthy controls and BAV patients. *statistically-significant difference with respect to controls . . BAV . CONTROLS ALL DILATION NON DILATED DILATED 21 70 18 52 AAO circunferencial strain 14.7±3 7.6±4.6* 7.9±3.1* 7.4±4.7* AAo longitudinal strain 8.2±2.7 6.1±2.6* 6.4±2.3* 6.1±2.7* . . BAV . CONTROLS ALL DILATION NON DILATED DILATED 21 70 18 52 AAO circunferencial strain 14.7±3 7.6±4.6* 7.9±3.1* 7.4±4.7* AAo longitudinal strain 8.2±2.7 6.1±2.6* 6.4±2.3* 6.1±2.7* ascending (AAo) circumferential and longitudinal strain in healthy controls and BAV patients. *statistically-significant difference with respect to controls Open in new tabDownload slide Abstract P1148 Figure. Figure Open in new tabDownload slide Abstract P1148 Figure. Figure P1149Influencing factors on inferior vena cava diameter and its respiratory variation measured with ultrasound in cardiac disease patients T Kawata T Kawata University of Tokyo Hospital, Department of Cardiology, Tokyo, Japan M Daimon M Daimon University of Tokyo Hospital, Department of Cardiology, Tokyo, Japan K Kimura K Kimura University of Tokyo Hospital, Department of Cardiology, Tokyo, Japan T Nakao T Nakao University of Tokyo Hospital, Department of Cardiology, Tokyo, Japan N Sawada N Sawada University of Tokyo Hospital, Department of Cardiology, Tokyo, Japan S L Lee S L Lee University of Tokyo Hospital, Department of Cardiology, Tokyo, Japan I Komuro I Komuro University of Tokyo Hospital, Department of Cardiology, Tokyo, Japan University of Tokyo Hospital, Department of Cardiology, Tokyo, Japan M Hirokawa M Hirokawa University of Tokyo Hospital, Department of Cardiology, Tokyo, Japan M Watanabe M Watanabe University of Tokyo Hospital, Department of Cardiology, Tokyo, Japan Y Yatomi Y Yatomi University of Tokyo Hospital, Department of Cardiology, Tokyo, Japan Background: Right atrial pressure (RAP) is not only a simple hemodynamic parameter, but also known as a determinant of clinical outcomes in patients with various cardiac diseases. Ultrasound measurement of inferior vena cava (IVC) diameter and its respiratory variation has been widely used to estimate RAP in daily practice. Although IVC distends as RAP rises, the relation between IVC diameters, respiratory variation of IVC and another clinical variables has not been fully elucidated. Purpose: The aim of the present study was to assess the relation between IVC diameter and its collapsibility index (IVCCI), invasive data and clinical variables in patients with cardiac diseases. Methods: We enrolled consecutive 71 patients (49 ± 17 years, 23 male) with cardiac disease who were scheduled for right-heart catheterization. We obtained IVC maximum diameter and IVCCI according to the current guidelines during catheterization. We also collected clinical variables such as age, gender, body size, laboratory and echocardiographic data from medical records, and analyzed relation between IVC parameter and right-heart catheterization data and clinical variables. Results: Indications for invasive measurements were pulmonary hypertension (65%), congenital heart disease (22%), cardiomyopathy (10%) and ischemic heart disease (3%). IVC maximum diameter and IVCCI were 15 ± 4mm and 51 ± 15%, respectively. In univariate analysis, IVC maximum diameter was inversely correlated with age, positively correlated with body surface area, mean RAP and mean pulmonary capillary wedge pressure. IVC dilatation also associated with existence of significant tricuspid regurgitation. In stepwise multivariate analysis, IVC diameter was independently associated with mean RAP (β = 0.54, p < 0.0001), significant tricuspid regurgitation (β = 0.31, p = 0.001) and body surface area (β = 0.26, p = 0.0045). IVCCI was inversely correlated with mean RAP, mean pulmonary artery pressure, mean pulmonary capillary wedge pressure and serum total bilirubin, positively correlated with tricuspid annular plane systolic excursion in univariate analysis. Small IVCCI also associated with existence of atrial fibrillation. However, in stepwise multivariate analysis, IVCCI was independently associated with only mean RAP (β = -0.501, p < 0.0001). Conclusion: IVC distends mainly by elevated RAP. However, IVC also distends by existence of significant tricuspid regurgitation and large body surface area independently of RAP. On the other hand, IVCCI was prescribed only in RAP. Therefore, we should take care about estimation of RAP by IVC diameter when patients have significant tricuspid regurgitation or large body surface area. P1150Does aging affect on left ventricular intraventricular pressure gradient ?: noninvasive assessment by vector flow mapping A Tanaka A Tanaka Wakayama Medical University, Wakayama, Japan T Akasaka T Akasaka Wakayama Medical University, Wakayama, Japan Wakayama Medical University, Wakayama, Japan T Hozumi T Hozumi Wakayama Medical University, Wakayama, Japan T Nishi T Nishi Wakayama Medical University, Wakayama, Japan Y Nozawa Y Nozawa Wakayama Medical University, Wakayama, Japan K Takemoto K Takemoto Wakayama Medical University, Wakayama, Japan S Ota S Ota Wakayama Medical University, Wakayama, Japan M Kashiwagi M Kashiwagi Wakayama Medical University, Wakayama, Japan K Shimamura K Shimamura Wakayama Medical University, Wakayama, Japan T Kameyama T Kameyama Wakayama Medical University, Wakayama, Japan A Kuroi A Kuroi Wakayama Medical University, Wakayama, Japan Y Matsuo Y Matsuo Wakayama Medical University, Wakayama, Japan H Kitabata H Kitabata Wakayama Medical University, Wakayama, Japan Y Ino Y Ino Wakayama Medical University, Wakayama, Japan T Kubo T Kubo Wakayama Medical University, Wakayama, Japan Background: It has been reported that there are intraventricular pressure gradients (IVPG) between left ventricular (LV) base and apex during diastole and IVPG between LV apex and outflow tract during systole using invasive catheter method and noninvasive color M-mode echocardiography. However, whether aging affects on LV-IVPG has not been well known. Recent introduction of vector flow mapping (VFM) using combination of both color and tissue Doppler echocardiography provides noninvasive assessment of LV-IVPG. Purpose: T he purpose of this study was to examine whether aging affects on LV-IVPG in subjects without structural heart disease using VFM. Methods: The study population consists of 32 subjects without structural heart disease, and was divided into two groups according to age; group-Y (age<30 years, 18 subjects: 23 ± 1 years) and group-O (age>60 years, 14 subjects: 74 ± 6 years). Color Doppler images of LV long-axis view were recorded by color Doppler echocardiography (Prosound F 75 and α10, Hitachi). Using VFM analysis software (DAS-RS1, Hitachi), peak IVPG between mitral annulus and apex during early diastole (ED-IVPG) and late diastole (LD-IVPG) as shown in Fig.A, and peak IVPG between apex and LV outflow tract during systolic ejection period (S-IVPG) as shown in Fig.B were evaluated in both groups. Each IVPG was compared between group-Y and group-O. When there are significant differences between two groups, we evaluated correlation between each IVPG and various index for echocardiographic systolic and diastolic function. Results: In all the study subjects, ED-IVPG, LD-IVPG, and S-IVPG were successfully measured using VFM analysis. 1) ED-IVPG in group-O was significantly smaller compared with group-Y (1.05 ± 0.23 vs 2.34 ± 1.11 mmHg, p<0.01). ED-IVPG correlated well with E velocity (r=0.69), e’ velocity (r=0.69), and E/e’ (r=-0.51). 2) There was no significant difference in LD-IVPG between group-O and group-Y (1.09 ± 0.49 vs 0.90 ± 0.30 mmHg);. 3) S-IVPG: No significant difference was demonstrated in S-IVPG between group-O and group-Y (1.83 ± 0.89 vs 1.33 ± 0.49 mmHg). Conclusions: Noninvasive VFM analysis showed that aging affects on early diastolic IVPG related to decreased myocardial relaxation. Age in the study subjects should be considered in analysis of IVPG by VFM. Open in new tabDownload slide Abstract P1150 Figure. Open in new tabDownload slide Abstract P1150 Figure. P1151Is the assessment of pulmonary arterial hypertension by echocardiography reliable in patients with severe tricuspid regurgitation? C Arellano Serrano C Arellano Serrano University Hospital Puerta de Hierro Majadahonda, Cardiology, Madrid, Spain E Garcia-Izquierdo Jaen E Garcia-Izquierdo Jaen University Hospital Puerta de Hierro Majadahonda, Cardiology, Madrid, Spain V Monivas Palomero V Monivas Palomero University Hospital Puerta de Hierro Majadahonda, Cardiology, Madrid, Spain S Vilches Soria S Vilches Soria University Hospital Puerta de Hierro Majadahonda, Cardiology, Madrid, Spain J F Oteo Dominguez J F Oteo Dominguez University Hospital Puerta de Hierro Majadahonda, Cardiology, Madrid, Spain J Segovia Cubero J Segovia Cubero University Hospital Puerta de Hierro Majadahonda, Cardiology, Madrid, Spain M A Cavero Gibanel M A Cavero Gibanel University Hospital Puerta de Hierro Majadahonda, Cardiology, Madrid, Spain S Mingo Santos S Mingo Santos University Hospital Puerta de Hierro Majadahonda, Cardiology, Madrid, Spain University Hospital Puerta de Hierro Majadahonda, Cardiology, Madrid, Spain Introduction: The latest pulmonary arterial hypertension(PAH) guidelines (ESC 2015) confer to transthoracic echocardiography (TTE) a key role for evaluation and follow-up, although right heart catheterization(RHC) remains the gold standard to confirm the diagnosis. One of the limitations of TTE for PAH assessment is the presence of severe Tricuspid Regurgitation(TR), because the TR doppler signal is amputated by equalization of right ventricular(RV) and right atrial(RA) pressures and Bernoulli's sympathetic equation may underestimate the pressure gradient. Our objective is to correlate the estimation of PAH by different echocardiographic methods compared to the estimation by RHC in patients with severe TR. Methods: We consecutively enrolled all patients who have had an RHC in our center for suspicion of PAH between January and April 2017. An TTE was performed on the same day as the RHC. We analyzed patients with severe TR (contraction vein 7 mm, regurgitant orifice ≥40mm2), we obtained conventional parameters of RV function: TAPSE, S wave, speckle tracking longitudinal strain (6 segment model). Pulmonary arterial pressures(PAP) were estimated from the RT curve, estimated RA pressure and pulmonary velocity acceleration time (PVAT) as described in detail in the table. These measurements were compared with the data obtained in the RHC. Results: A total of 8 patients with severe IT were included. In all, PAH was confirmed (mean PAP≥25 mmHg in RHC). The mean age was 60.25±14.68 years, 50% were males. The RV parameters were: TAPSE17.25±4.74mm, Wave S9.29±1.92cm/s, fractional area change(FAC) 35.43±13.93% and RV Global Strain 12.4±3.86%. The correlations between the different measures of pulmonary pressure by TTE and the measurements by RHC were excellent as shown in the attached table. Conclusions: In our series, we demonstrated the reliability of transthoracic echocardiography to safely measure PTH in the presence of severe RT. This is a simple and non-invasive technique with a high correlation with right cardiac catheterization. RESULTS METHOD . TTE . RHC . CORRELATION . Systolic PAP = 4v2+ RA pressure 66.99 ± 24.90 mmHg 72.13 ± 24.12 mmHg 0.957 (p<0.001) Mean PAP = mean gradient TR + RA pressure 43.12 ± 15.37 mmHg 44.25 ± 14.01 mmHg 0,890 (p=0.003) Mean PAP = 0.61* Systolic PAP+2mmHg 42.86 ± 15.19 mmHg 44.25 ± 14.01 mmHg 0.952 (p<0.001) Mean PAP = 90- (0.62*PVAT) 48.15 ± 5.92 mmHg 44.25 ± 14.01 mmHg 0,905 (p=0,002) METHOD . TTE . RHC . CORRELATION . Systolic PAP = 4v2+ RA pressure 66.99 ± 24.90 mmHg 72.13 ± 24.12 mmHg 0.957 (p<0.001) Mean PAP = mean gradient TR + RA pressure 43.12 ± 15.37 mmHg 44.25 ± 14.01 mmHg 0,890 (p=0.003) Mean PAP = 0.61* Systolic PAP+2mmHg 42.86 ± 15.19 mmHg 44.25 ± 14.01 mmHg 0.952 (p<0.001) Mean PAP = 90- (0.62*PVAT) 48.15 ± 5.92 mmHg 44.25 ± 14.01 mmHg 0,905 (p=0,002) TTE: transthoracic echocardiography, RHC: right heart catheterization, PAP: pulmonary arterial pressures, TR: tricuspid regurgitation, PVAT: pulmonary velocity acceleration time. RA: right atrial RESULTS METHOD . TTE . RHC . CORRELATION . Systolic PAP = 4v2+ RA pressure 66.99 ± 24.90 mmHg 72.13 ± 24.12 mmHg 0.957 (p<0.001) Mean PAP = mean gradient TR + RA pressure 43.12 ± 15.37 mmHg 44.25 ± 14.01 mmHg 0,890 (p=0.003) Mean PAP = 0.61* Systolic PAP+2mmHg 42.86 ± 15.19 mmHg 44.25 ± 14.01 mmHg 0.952 (p<0.001) Mean PAP = 90- (0.62*PVAT) 48.15 ± 5.92 mmHg 44.25 ± 14.01 mmHg 0,905 (p=0,002) METHOD . TTE . RHC . CORRELATION . Systolic PAP = 4v2+ RA pressure 66.99 ± 24.90 mmHg 72.13 ± 24.12 mmHg 0.957 (p<0.001) Mean PAP = mean gradient TR + RA pressure 43.12 ± 15.37 mmHg 44.25 ± 14.01 mmHg 0,890 (p=0.003) Mean PAP = 0.61* Systolic PAP+2mmHg 42.86 ± 15.19 mmHg 44.25 ± 14.01 mmHg 0.952 (p<0.001) Mean PAP = 90- (0.62*PVAT) 48.15 ± 5.92 mmHg 44.25 ± 14.01 mmHg 0,905 (p=0,002) TTE: transthoracic echocardiography, RHC: right heart catheterization, PAP: pulmonary arterial pressures, TR: tricuspid regurgitation, PVAT: pulmonary velocity acceleration time. RA: right atrial P1152Competitive and systematic rugby training increases left ventricular mass and wall thickness within normal ranges and augments risk of left ventricular hypertrophy G Diaz Babio G Diaz Babio Cardiovascular Institute of San Isidro-Sanatorio Las Lomas, Buenos Aires, Argentina G Vera Janavel G Vera Janavel Cardiovascular Institute of San Isidro-Sanatorio Las Lomas, Buenos Aires, Argentina C Carrero C Carrero Cardiovascular Institute of San Isidro-Sanatorio Las Lomas, Buenos Aires, Argentina G Masson Juarez G Masson Juarez Cardiovascular Institute of San Isidro-Sanatorio Las Lomas, Buenos Aires, Argentina M Mezzadra M Mezzadra Cardiovascular Institute of San Isidro-Sanatorio Las Lomas, Buenos Aires, Argentina I Constantin I Constantin Cardiovascular Institute of San Isidro-Sanatorio Las Lomas, Buenos Aires, Argentina R Perez Etchepare R Perez Etchepare Cardiovascular Institute of San Isidro-Sanatorio Las Lomas, Buenos Aires, Argentina P Stutzbach P Stutzbach Cardiovascular Institute of San Isidro-Sanatorio Las Lomas, Buenos Aires, Argentina Cardiovascular Institute of San Isidro-Sanatorio Las Lomas, Buenos Aires, Argentina Background: Highly trained athletes develop different cardiovascular adaptations. Among them, increased left ventricular (LV) wall thickness and mass are one of the most relevant findings due to the differential diagnosis between athlete’s heart, LV hypertrophy (LVH) and hypertrophic cardiomyopathy. Thus, we studied the heart of male international-elite rugby players (RP) and untrained, control patients (CP) to test whether competitive and systematic rugby training (CSRT) develops LVH. Methods: Between 2015 and 2016, a total of 613 healthy male patients ranging from 14 to 49 y/o, with (RP, n=313) or without (CP, n=300) history of CSRT were prospectively included to be assessed clinically and with 2-D transthoracic echocardiography (TTE). Two independent and experienced physicians measured left atrial volume (LAV) and LV parameters: total mass (LVM), end-diastolic (LVDd) and end-systolic (LVSd) diameters, percent LV fractional shortening (LVFS), inter-ventricular septal (IVSd) and posterior (LVPWd) wall thickness, mitral E-wave velocity (m/s) and E/A wave ratio. Additionally, body surface area (BSA) was calculated to obtain LVM index (LVMi) and LAV index (LAVi). For LVH diagnosis, normal cut values were set at 12 mm for IVSd and 115 g/m2 for LVMi. Group data was compared with unequal variance T-test for independent samples and associations were tested with Chi-square test for independence with Yates’ correction. Results are reported as mean±SEM, or as percent proportions and odds ratio (OR, with 95% confidence intervals). Significance was set at p<0.05. Results: RP were younger (RP: 19.9±0.06, CP: 25.5±1.3 y-o, p<0.001) and had larger BSA (RP: 2±0.03, CP: 1.9±0.03 m², p<0.001). LV diastolic function and filling pressures were normal in both groups. CP had slightly lower E/A ratio (RP: 2.2±0.06, CP: 1.8±0.07, p<0.001) but similar E-wave velocity (RP: 0.9±0.02, CP: 0.9±0.02, p=NS). RP had similar LVDd (RP: 50.5±0.52, CP: 49.8±0.51 mm, p=NS) and greater LVSd (RP: 30.6±0.35, CP: 29.7±0.51, p<0.01); thus, they yield lower (although normal) LVFS (RP: 39.3±0.5, CP: 40.5±0.8%, p<0.05). RP had greater wall thickness, at both IVSd (RP: 10.3±0.12, CP: 9.1±0.15 mm, p<0.001) and LVPWd (RP: 9.2±0.11, CP: 8.5±0.13 mm, p<0.001) levels, and higher LVM (RP:182±5, CP: 154±4.3 g, p<0.001) and LVMi (RP: 90.3±1.7, CP: 80.9±1.8 g/m², p<0.001). Moreover, 7% of RP versus 2.6% of CP showed increased IVSd [OR=2.8 (1.2-6.3); p<0.02]. Similarly, 7% of RP versus 1.7% of CP showed incremented LVMi [OR=4.5 (1.7-11.9); p<0.003]. No athlete had IVSd greater than or equal to 14 mm. Conclusions: CSRT was associated with increased LV wall thickness and incremented LV mass within normal ranges. Although RP showed higher risk of LVH outcome, no evidence of hypertrophic cardiomyopathy was found in our population P1153Discrimination of different ballooning patterns in Takotsubo syndrome using cardiovascular magnetic resonance myocardial feature tracking T Stiermaier T Stiermaier 2University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany U Raaz U Raaz 1University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany J T Kowallick J T Kowallick 3University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany J Lotz J Lotz 3University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany G Hasenfuss G Hasenfuss 1University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany H Thiele H Thiele 2University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany I Eitel I Eitel 2University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany A Schuster A Schuster 1University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany 1University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany 2University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany 3University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany T Lange T Lange 1University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany Background: Patients with Takotsubo syndrome (TTS) exhibit distinctive left ventricular (LV) wall motion abnormalities resulting in characteristic contraction patterns with apical, midventricular or basal ballooning. The aim of the present study was to quantify regional LV deformation during the acute phase of TTS using cardiovascular magnetic resonance myocardial feature-tracking (CMR-FT), a technique that allows for a less operator dependent assessment of myocardial dysfunction compared to visual analysis (1). Methods: A total of 125 patients with confirmed TTS underwent CMR imaging in median 2 days (IQR 2-3 days) after initial presentation including balanced steady state–free precession sequences in multiple short-axes as well as in 2- and 4-chamber long-axis views. Circumferential and longitudinal strain was assessed using dedicated software (TomTec Imaging Systems, Munich, Germany) and compared between TTS patients with different ballooning patterns. Results: The study population was predominately female (92%) with a median age of 72 years (IQR 61-78 years). The majority of patients exhibited typical apical ballooning (66%) while midventricular (32%) and basal ballooning (2%) were less frequent. Apical ballooning was associated with a significantly lower peak global average LV circumferential strain (median -17%, IQR -14% to -21%) compared to midventricular (median -21%; IQR -19% to -26%) or basal ballooning (median -20%; IQR -19% to -21%; p<0.01). A segmental analysis of the peak global average basal/midventricular/apical circumferential strain resulted in median values of -29/-14/-6% among patients with apical ballooning, -28/-15/-21% in patients with midventricular ballooning and -16/-13/-31% in patients with a basal ballooning pattern, respectively. Likewise, the peak global average longitudinal strain values were lower in case of apical ballooning (p<0.01) and segmental analysis reliably identified different ballooning patterns. Conclusions: CMR-FT enables the quantification of regional LV deformation and therefore discrimination of different ballooning patterns in patients with TTS. Typical apical TTS is associated with more pronounced alterations of myocardial strain compared to atypical forms of TTS. P1154Atrioventricular dyssynchrony assessment by echocardiography in predicting clinical response to cardiac resynchronization therapy D Roque D Roque Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal H Ferreira H Ferreira Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal J Ferreira J Ferreira Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal F Madeira F Madeira Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal J Morais J Morais Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal A Freitas A Freitas Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal C Morais C Morais Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal M Borges Santos M Borges Santos Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal D Candeias Faria D Candeias Faria Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal J Bicho Augusto J Bicho Augusto Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal Background: Cardiac resynchronization therapy (CRT) is an established treatment in the management of patients with advanced heart failure (HF) and left bundle branch block (LBBB), improving pump performance and stopping/reversing the process of ventricular remodeling. However, approximately 30% of patients treated with CRT do not experience significant improvement. In recent evidence, echocardiographic assessment of ventricular dyssynchrony failed to improve patient selection for CRT, however, little attention has been given to atrioventricular dyssynchrony (AV-DYS). Purpose: We aim to determine the predictive value of AV-DYS and clinical response after device implantation. Methods: In a retrospective unicenter study, 54 subjects with standard indications for CRT underwent echocardiogram before device implantation. AV-DYS was calculated determining left ventricular filling time over the cardiac cycle (measured by pulsed wave Doppler at the mitral valve leaflet) and expressed as a percentage of the RR interval. Clinical evaluation was performed 3 to 6 months after device implantation. Clinical response was defined as improvement in New York Heart Association (NYHA) class. Results: A total of 54 patients were included with a mean age of 63.4 ± 10.6 years (85.2% males). At multivariable analysis, controlled for known predictors of clinical response (gender, QRS length and ischemic/non-ischemic aetiology), AV-DYS was the sole independent predictor of clinical response after CRT implantation (OR 1.23, CI 95% 1.01-1.49, p=0.037). Using ROC curve analysis (Figure 1), AV-DYS showed the best diagnostic accuracy (AUC 0.900, 95% CI 0.761–1.000, p=0.008). Optimal cut-off (Youden index) of AV-DYS for clinical response was calculated at ≤39%, with a sensitivity of 94% (CI 95% 71-100%) and a specificity of 80% (28-100%). Conclusions: AV-DYS evaluation can help to identify and exclude patients who would not benefit from CRT and improve the overall rate of CRT success. Open in new tabDownload slide Abstract P1154 Figure. ROC curve of AV-DYS Open in new tabDownload slide Abstract P1154 Figure. ROC curve of AV-DYS P1155Evaluation of left ventricular function with pulsed tissue doppler six months after percutaneous recanalization of chronic total occlusion G Stankovic G Stankovic Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia S Aleksandric S Aleksandric Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia M Dikic M Dikic Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia M Tesic M Tesic Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia M Dobric M Dobric Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia S Stojkovic S Stojkovic Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia O Petrovic O Petrovic Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia S Juricic S Juricic Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia I Jovanovic I Jovanovic Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia D Trifunovic-Zamaklar D Trifunovic-Zamaklar Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia I Paunovic I Paunovic Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia I Rakocevic I Rakocevic Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia M Boricic-Kostic M Boricic-Kostic Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia M Tomic-Dragovic M Tomic-Dragovic Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia M Petrovic M Petrovic Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia Background: Percutaneous coronary intervention of chronic total coronary occlusion (PCI of CTO) is proved to reduce symptoms of angina and long term survival. Purpose: This study aimed to assess systolic and diastolic left ventricular function with pulsed tissue Doppler imaging (PW-TDI). Myocardial performance index (MPI) is simple method for evaluation of overall cardiac function and is independent of heart rate and blood pressure. Methods: Convectional echocardiographic exam with PW-TDI was performed before and after 6 months of procedure. PW TDI was used to assess velocity curves of septal and lateral mitral annulus. A total of 19 patients (58±10 years, 90% male) were analyzed. Six patients had reduced ejection fraction (EF) ≤40%. Sample volumes were placed at four different sites in the mitral annulus, corresponding to the septum, lateral, anterior and inferior sites in order to record average of velocity time intervals - isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT) and ejection time (ET) and early diastolic annular velocity (e'). MPI was calculated as (IVCT+IVRT)/ET. The ratio of peak velocity of early mitral filling (E) to average early diastolic mitral annular velocity (e') was used for assessment of left ventricular diastolic function. Results: Six months after PCI of CTO patients showed no change in EF (51±11% vs 49±11% p =0.309). MPI was significantly decreased (0.49±0.08 vs. 0.44±0.07 p<0.01), E/e' was reduced, but not significantly (12.9±7 vs. 10.4±5 p=0.059), but when we analysed only patients with EF≤40% improvement of diastolic function (reduction od E/e') reached statistical significance (20.15±8 vs. 12.6±9 p<0.05). Conclusion: PCI of CTO improves global cardiac function, particularly diastolic function in patients with reduced ejection fraction. P1156The impact of age on left ventricular filling and ejection times in normal individuals F Vancheri F Vancheri 1Ospedale S.Elia, Internal Medicine, Caltanissetta, Italy M Y Henein M Y Henein 2Umea University, Public Health and Clinical Medicine, Cardiology, Heart Centre, Umea, Sweden 1Ospedale S.Elia, Internal Medicine, Caltanissetta, Italy 2Umea University, Public Health and Clinical Medicine, Cardiology, Heart Centre, Umea, Sweden Background and Aim: Left ventricular (LV) filling and ejection times are critical determinants of the stroke volume. Aging is known to affect diastolic but not systolic function. However, its impact on the duration of filling and ejection times, and on their relationship with heart rate (HR), has not been fully studied. We aimed to investigate the relationship between age and the absolute LV filling and ejection times as well as their duration relative to RR interval. Methods: Asymptomatic individuals, without signs or symptoms of coronary artery disease or heart failure, who underwent echocardiographic examination as a part of a cross-sectional survey for the prevalence of coronary risk factors in the general population, randomly selected from the population list in Caltanissetta, Sicily, Italy, were included in the study. The echocardiographic examination included the trans-mitral and aortic spectral Doppler flow velocities. LV filling time (FT) was measured from the onset of the E-wave to the end of the A-wave and ejection time (ET) from the onset to the end of the pulsed wave aortic velocity. The relative duration (with respect to RR interval) of filling and ejection was calculated by dividing each measurement by the RR interval, giving the FT/RR ratio and the ET/RR ratio, respectively. The isovolumic relaxation time (IVRT) was measured from the end of aortic velocity to the onset of mitral flow velocity. Total isovolumic time (t-IVT) was calculated as 60 – (total filling time + total ejection time), expressed as sec/min. Results: The study included 344 individuals (159 men, 185 women), mean age 56.1 (11.8) range 35-79 years. The mean value for RR interval was 901 ms (131), FT 479 ms (112) and ET 320 ms (28). The mean values for FT/RR ratio and ET/RR ratio were 52.5% (6.0) and 35.1% (4.2), respectively. There was no relationship between age and FT and ET. FT/RR ratio was inversely related to age (r= -0.10, p=0.05) but not ET/RR ratio. Age was associated with significant prolongation of IVRT and t-IVT (r=0.33, p=0.0001 and r=0.58, p=0.0001, respectively). Conclusions: Normally, relative LV filling time, but not ejection time, reduces with age. This could be explained by the prolongation of IVRT, which itself reflects the extent of cavity dyssynchrony. P1157Micro-RNA-21 (biomarker) and global longitudinal strain (functional marker) in detection of myocardial fibrotic burden in severe aortic valve stenosis: a pilot study I Fabiani I Fabiani 1University of Pisa, Department of Translational Research and new technologies in Medicine and Surgery, Pisa, Italy C Scatena C Scatena 1University of Pisa, Department of Translational Research and new technologies in Medicine and Surgery, Pisa, Italy C M Mazzanti C M Mazzanti 2Fondazione pisana per la scienza, Pisa, Italy L Conte L Conte 3University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area, Pisa, Italy N R Pugliese N R Pugliese 3University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area, Pisa, Italy E Calogero E Calogero 3University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area, Pisa, Italy S Franceschi S Franceschi 2Fondazione pisana per la scienza, Pisa, Italy M Menicagli M Menicagli 2Fondazione pisana per la scienza, Pisa, Italy U Bortolotti U Bortolotti 4University of Pisa, Pisa, Italy A G Naccarato A G Naccarato 4University of Pisa, Pisa, Italy S La Carrubba S La Carrubba 5Ospedali Riuniti Villa Sofia, Palermo, Italy V Di Bello V Di Bello 3University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area, Pisa, Italy 1University of Pisa, Department of Translational Research and new technologies in Medicine and Surgery, Pisa, Italy 2Fondazione pisana per la scienza, Pisa, Italy 3University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area, Pisa, Italy 4University of Pisa, Pisa, Italy 5Ospedali Riuniti Villa Sofia, Palermo, Italy Background: Myocardial fibrosis (MF) is a deleterious consequence of aortic valve stenosis (AVS). Global longitudinal strain (GLS) is a novel left ventricular (LV) functional parameter potentially useful to non-invasively estimate MF. MicroRNAs (miRNAs) are non-coding small ribonucleic acids (RNA) modulating genes function, mainly through RNA degradation. miRNA-21 is a biomarker associated with MF in pressure overload. Purpose: The aim of the present study was to find an integrated algorithm for detection of MF using a combined approach with both bio- and functional markers. Methods: Thirty-six patients (74.3 ± 7 y.o.; 64 % Female) with severe AVS and preserved LV ejection fraction (EF), candidate to surgical aortic valve replacement (sAVR) were enrolled. Clinical, bio-humoral evaluation (including plasmatic miRNA-21 collected using specific tubes, PAXgene, for stabilization of peripheral RNA) and a complete echocardiographic study, including GLS and septal strain, were performed before sAVR. Twenty-nine of those patients underwent sAVR and, in 24 of them, an inter-ventricular septum biopsy was performed. Tissues were fixed in formalin and embedded in paraffin. Sections were stained with Hematoxylin and Eosin for histological evaluation and with histochemical Masson trichrome for collagen fibers. The different components were calculated and expressed as micrometers. To evaluate tissue miRNA components, sections 2-μm thick were cut using a microtome blade for each slide. Regression analysis was performed to test association between dependent variable and various predictors included in the model. Results: Despite a preserved EF (67 ± 10 %), patients presented altered myocardial deformation parameters (GLS−14,08 ± 3.6 %; septal longitudinal strain, SSL −9.62 ± 2.6 %; septal longitudinal strain rate, SL-Sr −0.56 ± 0.16 1/s; Septal Longitudinal early-diastolic strain rate, SL-SrE 0.61 ± 0.31 1/s). The extent of MF showed an inverse association with both GLS and septal longitudinal deformation indices (GLS: R2 = 0.29; p = 0.02; SSL: R2 = 0.34; p = 0.01; SL-Sr: R2 = 0.38; p < 0.001; SL-SrE: R2 = 0.34; p = 0.001). miRNA-21 was mainly expressed in fibrous tissue (p < 0.0001). A significant association between MF and plasmatic miRNA-21, alone and weighted for measures of structural (LVMi R2 = 0.50; p = 0.0004) and functional (SSL R2 = 0.34; p = 0.005) remodeling, was found. Conclusions: In AVS, MF is associated with alterations of regional and global strain. Plasmatic miRNA-21 is directly related to MF and associated with LV structural and functional impairment. Open in new tabDownload slide Abstract P1157 Figure. miRNA expression in tissue samples Open in new tabDownload slide Abstract P1157 Figure. miRNA expression in tissue samples P1158Impact of obesity and surgical weight reduction on cardiac remodeling S Mostafa S Mostafa Benha Faculty of Medicine, cardiovascular medicine, Benha, Egypt Benha Faculty of Medicine, cardiovascular medicine, Benha, Egypt Introduction: the impact of weight changes on cardiac structure independent of obesity-related comorbidities has not been extensively studied. Aim: to study impact of obesity and surgical weight reduction on cardiac remodeling Patients and methods: the study included 52 patients with morbid obesity (BMI≥40 g/m²) and free of previous or overt cardiac risk factors and diseases, all patients underwent bariatric surgery (laparoscopic gastric band or ligation); Conventional echocardiography (2D, MM, Doppler), tissue Doppler velocity, strain and speckle tracking echocardiography for left and right ventricles were performed for all patients before and 6m after surgery. Results: the study included 52 patients with mean age of 40.2±8.6 years and a body mass index (BMI) of 42.3±3.4 g/m², 65% were female and 35% were male. 6 months postopeatively ; LV parameters showed statistically significant improvement as there was reduction in LV volume associated with increase in the ejection fraction; LVESV improved from 66.57±22 to 37.2±12 p< 0.001, LVEDV improved from169.4±43.2 to 120.36±19.6 ml with p< 0.001 and EF% 59±8 to 67±7 ml with p< 0.001, significant reduction in LVMI from143± 11to 95.5±7gm/m² p< 0.001 but LA volume index didn’t show significant change p=0.75. Significant improvement in the RVSA from 16.3±4.1 to 10.1±2.7 cm² p< 0.001 but insignificant improvement in RVDA from 30.2±1.5 to 26.7±2 cm² p=0.05, FAC from 49.5±2.1 to 52±1.2% p=0.7, TAPSI from 20.3±2.8 to 22.6±3.5 mm p=0.56 and PASP from 32.2±5.2 to 29.2±2.1mmHg with p=0.81. Early tissue Doppler diastolic velocity (Em) of the LV improved from 7.1±2.1 to12±3.5 p<0.001 and that of RV from 6.2±2.8 to 9.2±1.4, p=0.05 and tissue Doppler strain of the LV and RV improved from - 16.1± 2.5 to -22.8± 3.1, p< 0.001, -11.2± 2.6 to -17.3±3.4, p< 0.001 respectively. LVLPSS improved from -17.2±2.1 to -22.7±3.9 p< 0.001 and RVLPSS improved from -12.8±1.5 to -18.1±2.7 p< 0.001. Conclusion: obesity adversely affects cardiac structure independent of obesity-related comorbidities and weight reduction significantly improve the systolic and diastolic function of both ventricles. P1159Mechanical dispersion by strain echocardiography: a sensitive marker of left ventricular remodeling in stable coronary artery disease J Gravning J Gravning 4Oslo University Hospital, Department of Cardiology, Oslo, Norway 1Akershus University Hospital, Department of Cardiology, Akershus, Norway 2Oslo University Hospital, Department of Medical Biochemistry, Oslo, Norway 3Oslo University Hospital, Department of Paediatric and Adolescent Medicine, Oslo, Norway 4Oslo University Hospital, Department of Cardiology, Oslo, Norway T Edvardsen T Edvardsen 4Oslo University Hospital, Department of Cardiology, Oslo, Norway K Haugaa K Haugaa 4Oslo University Hospital, Department of Cardiology, Oslo, Norway B Benz B Benz 4Oslo University Hospital, Department of Cardiology, Oslo, Norway C Eek C Eek 4Oslo University Hospital, Department of Cardiology, Oslo, Norway M K Smedsrud M K Smedsrud 3Oslo University Hospital, Department of Paediatric and Adolescent Medicine, Oslo, Norway H Rosjo H Rosjo 1Akershus University Hospital, Department of Cardiology, Akershus, Norway L Morkrid L Morkrid 2Oslo University Hospital, Department of Medical Biochemistry, Oslo, Norway E N Aagaard E N Aagaard 1Akershus University Hospital, Department of Cardiology, Akershus, Norway B A Havneraas Kvisvik B A Havneraas Kvisvik 1Akershus University Hospital, Department of Cardiology, Akershus, Norway Background: Both cardiac biomarkers and traditional echocardiographic measurements are important in the early identification of subclinical left ventricular (LV) remodeling. However, it is largely unknown whether LV mechanical dispersion is relevant in this context. Purpose: We wanted to elucidate the role of LV mechanical dispersion in the identification of subclinical LV remodeling, as assessed by sensitive cardiac biomarkers, in patients with stable coronary artery disease (CAD). Methods: We included 145 patients with stable CAD, one year after successful coronary revascularization. LV systolic function was assessed by echocardiography through measurement of ejection fraction (EF), global longitudinal strain (GLS) and contraction duration (16 LV segments). Mechanical dispersion was defined as the standard deviation (SD) of contraction duration. Serum levels of high-sensitivity cardiac troponin I (hs-cTnI, Abbott) and amino-terminal pro B-type natriuretic peptide (NT-proBNP, Roche) were quantified and used as established markers of LV remodeling. Correlation coefficients were estimated by Spearman rank correlation. Results: Baseline median (IQR) LV mechanical dispersion was 45 (37-53) ms. Significant associations were found between LV mechanical dispersion and both heartrate (B, -0.20; 95 % CI, -0.41-0.00; P = 0.049) and hs-cTnI (B, 5.42; 95 % CI, 2.86-7.98 P < 0.001), in multivariate regression analysis. LV mechanical dispersion was correlated with both hs-cTnI and NT-proBNP (Table 1), while GLS only correlated with hs-cTnI. There were no significant associations between the measured biomarkers and EF. Conclusion: LV mechanical dispersion may give additional information of LV remodeling to traditional echocardiographic measurements in patients with stable CAD. Table 1 . Hs-TnI . NT-proBNP . R p value R p value LV EF 0.028 0.743 0.025 0.765 LV GLS 0.218 0.008 0.099 0.237 LV mechanical dispersion 0.409 <0.001 0.367 <0.001 . Hs-TnI . NT-proBNP . R p value R p value LV EF 0.028 0.743 0.025 0.765 LV GLS 0.218 0.008 0.099 0.237 LV mechanical dispersion 0.409 <0.001 0.367 <0.001 Association between echocardiographic measurements and cardiac biomarkers Table 1 . Hs-TnI . NT-proBNP . R p value R p value LV EF 0.028 0.743 0.025 0.765 LV GLS 0.218 0.008 0.099 0.237 LV mechanical dispersion 0.409 <0.001 0.367 <0.001 . Hs-TnI . NT-proBNP . R p value R p value LV EF 0.028 0.743 0.025 0.765 LV GLS 0.218 0.008 0.099 0.237 LV mechanical dispersion 0.409 <0.001 0.367 <0.001 Association between echocardiographic measurements and cardiac biomarkers P1160Fully automated 3D chamber quantification in chemotherapy surveillance C Fernandez-Golfin C Fernandez-Golfin 2University Hospital Ramon y Cajal de Madrid, Madrid, Spain 1Azienda Ospedaliero-Universitaria Pisana, Dipartimento di Patologia Medica, Chirurgica, Molecolare e dell’Area Critica, Pisa, Italy 2University Hospital Ramon y Cajal de Madrid, Madrid, Spain J L Zamorano J L Zamorano 2University Hospital Ramon y Cajal de Madrid, Madrid, Spain V Di Bello V Di Bello 1Azienda Ospedaliero-Universitaria Pisana, Dipartimento di Patologia Medica, Chirurgica, Molecolare e dell’Area Critica, Pisa, Italy I Fabiani I Fabiani 1Azienda Ospedaliero-Universitaria Pisana, Dipartimento di Patologia Medica, Chirurgica, Molecolare e dell’Area Critica, Pisa, Italy A Garcia Martin A Garcia Martin 2University Hospital Ramon y Cajal de Madrid, Madrid, Spain A Gonzalez-Gomez A Gonzalez-Gomez 2University Hospital Ramon y Cajal de Madrid, Madrid, Spain N Martinez-Janez N Martinez-Janez 2University Hospital Ramon y Cajal de Madrid, Madrid, Spain A Carbonell A Carbonell 2University Hospital Ramon y Cajal de Madrid, Madrid, Spain R Hinojar R Hinojar 2University Hospital Ramon y Cajal de Madrid, Madrid, Spain V Barletta V Barletta 1Azienda Ospedaliero-Universitaria Pisana, Dipartimento di Patologia Medica, Chirurgica, Molecolare e dell’Area Critica, Pisa, Italy Exposure to potentially cardiotoxic chemotherapeutic agents is a strong indication for the periodic evaluation of left ventricular (LV) function, both during and after cancer therapy. Although, current clinical guidelines recommend the use of 3D echocardiography (3DE) to monitor LV ejection fraction (LVEF), this method is time consuming and requires special expertise. Therefore, in daily clinical practice 2D echocardiography is still the preferred technique despite its suboptimal accuracy and reproducibility. Recently, a fully automated algorithm that quantifies left chambers volumes and ejection fraction using 3D datasets has been released. Here we sought to investigate whether the automated 3DE could be an accurate tool to measure LV volumes and EF, even among not highly trained sonographers. Methods: Our study comprises 30 consecutive patients referred to our EchoLab by the treating oncologist for clinical indicated echocardiographic examination. All patients underwent a full transthoracic (TT) echocardiography with 2D and 3D image acquisition (EPIQ, X5-1, Philips Healthcare), performed by the same cardiologist. Three independent investigators, with different experience levels, analyzed images using the automated Heart Model (HM, Philips Healthcare) and the conventional 3D (3DQ Advance, Philips Healthcare) software. In 2D images EF was calculated using the biplane method of disks. Results: Mean age was 62 years (range 33 – 83), 83% were female. 18 patients (60%) had a fair o bad echocardiographic window and analysis using HM required endocardial border correction. Inter-technique comparison showed good agreement between automated and manual 3DE measurements when performed by a high experienced investigator (r=0,84; p<0.001); correlation was less strong when measurements were performed by a cardiologist with medium expertise (r=0.65; p<0.001) or by a beginner (r=0.33; p <0.001). Consistently, intra-class inter-observer correlation showed a higher consistency for 2D measurement (ICC = 0.83, 95% confidence interval) than conventional 3DE (ICC = 0.47, 95% CI). Inter-observer correlation was extremely high for fully automatic analysis (ICC = 0.99; 95% CI) and it remained acceptable when border correction was performed (ICC = 0.77, 95% CI). Conclusions: Cancer patients treated with potentially cardiotoxic therapy are at high risk of developing systolic dysfunction and should therefore be kept under close cardiological surveillance. LVEF should be determined periodically with a method that guarantees accuracy and reproducibility. 3DE is recommended as the most robust technique, however it requires excellent acoustic window and expertise, precluding its use in clinical practice. This full automatic method overcomes these limitations and allows accurate and reproducible LVEF assessment independent of previous training on 3DE or even suboptimal acoustic window. This technology allows application of 3D technology in clinical practice P1161Value of three dimensional strain imaging on assessing subclinical left ventricular systolic dysfunction in chronic aortic regurgitation M X Xie M X Xie 1Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Department of Ultrasound, Wuhan, China People's Republic of H Li H Li 1Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Department of Ultrasound, Wuhan, China People's Republic of Y Song Y Song 1Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Department of Ultrasound, Wuhan, China People's Republic of S L Mi S L Mi 1Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Department of Ultrasound, Wuhan, China People's Republic of L Yuan L Yuan 1Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Department of Ultrasound, Wuhan, China People's Republic of X Y Jin X Y Jin 2Oxford Echo Core Lab, NDCLS, Radcliffe Dept of Medicine,University of Oxford,John Radcliffe Hospial, Oxford, United Kingdom 1Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Department of Ultrasound, Wuhan, China People's Republic of 2Oxford Echo Core Lab, NDCLS, Radcliffe Dept of Medicine,University of Oxford,John Radcliffe Hospial, Oxford, United Kingdom Funding Acknowledgements: National Natural Science Foundation of China (Grant No. 81401429) Background: In current guideline LVEF <55% is the key factor in the timing of AVR for AR. However incomplete recovery of LV function after AVR suggests EF>55% is insensitive to detect early stage myocardial disease. 3D speckle tracking imaging provides comprehensive myocardial deformation and can potentially detect early stage myocardial disease. Purpose: This study aimed to investigate the value of 3D STI in early detecting myocardial disease in AR patients. Methods: Conventional LV volume and function indexes, global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain(GRS), torsion, basal rotation (RoB), apical rotation (RoA) as well as all segmental strains by 3D STI were analyzed in 66 chronical severe AR patients and 30 normal controls. Of 66 patients, 31 AR with preserved LV function (AR+P-EF group, LVEF≥55%, age 50.4±14.2 yrs, male 18), and 36 AR with LV dysfunction (AR+R-EF group, LVEF<55%, aged 48.0±14.1 yrs, male 23). The 30 controls was aged at 49.8±14.3 yrs, 16 males. Results:(1) Compared with controls, GLS, GRS and torsion were reduced both in AR+P-EF & AR+R-EF group (GLS: -19.93±1.82, -17.87±2.43,-12.56±2.62; GRS: 43.63±3.28, 39.80±4.51, 27.13±5.90, Torsion: 2.31±0.60, 1.65±0.41, 1.17±0.46 in normal, AR+P-EF & AR+R-EF group, respectively, p<0.01). (2) GCS were preserved in AR+P-EF group, but reduced in AR+R-EF group (GCS: -32.47±3.53, -30.87±3.58, -20.74±4.8 in normal, AR+P-EF and AR+R-EF group, respectively, p<0.01). (3) Compared with AR+P-EF group, GLS, GRS, GCS and torsion were significantly decreased in AR+R-EF group. (4) Compared with normal group, strains in middle and apical segments, RoA were all decreased both in AR+P-EF & AR+R-EF groups (CS-mid: -37.03±5.51, -33.67±4.09, -23.28±6.27; CS-apex: -39.07±5.32, -35.08±4.64, -23.17±7.78; LS-mid: -18.44±3.34, -15.21±3.50, -11.02±3.15; LS-apex: -21.73±5.27, -19.18±7.85, -11.28±3.39; RS-mid: 46.02±5.82, 40.22±4.34, 28.16±7.18; RS-apex: 50.73±6.74, 45.20±9.24, 28.66±8.20; RoA: 10.42±2.92, 8.47±3.07, 7.22±2.74 in normal, AR+P-EF and AR+R-EF group, respectively, p<0.01). However, strains in basal segments and RoB were all preserved in AR+P-EF group, and reduced in AR+R-EF group (CS-basal: -29.80±5.30, -29.55±3.74, -20.47±4.71; LS-basal: -17.96±3.27, -17.69±3.89, -13.74±3.42; RS-basal: 38.48±5.00, 38.54±5.07, 27.94±5.58; RoB: -7.28±2.30, -6.45±3.16, -4.66±2.55 in normal, AR+P-EF and AR+R-EF group, respectively, p<0.01). (5) Compared with AR+P-EF group, all the segmental strains and RoB decreased in AR+REF group. Conclusion: In patient with chronical severe AR and EF>55%, 3D STI has already demonstrated consistent reduction in LV GLS, GRS and torsion, and suggests early stage of myocardial disease. The increased LV stroke volume is achieved by maintaining GCS, basal ventricle strains and rotation. When the above mechanisms attenuate, LVEF falls below 55%. We thus advocate further clinical trial by using 3D STI to improve AVR timing for AR. P1162Assessment of the left ventricular systolic function in cardiac syndrome X using speckle tracking echocardiography I Craciunescu I Craciunescu "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, Cardiology, Bucharest, Romania G Badea G Badea "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, Cardiology, Bucharest, Romania G Ursu G Ursu "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, Cardiology, Bucharest, Romania S Vasile S Vasile "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, Cardiology, Bucharest, Romania M Iancu M Iancu "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, Cardiology, Bucharest, Romania O Popa O Popa "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, Cardiology, Bucharest, Romania M Bolog M Bolog "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, Cardiology, Bucharest, Romania M Dumitrescu M Dumitrescu "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, Cardiology, Bucharest, Romania "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, Cardiology, Bucharest, Romania Cardiac syndrome X (CSX) is characterized by typical angina and abnormal exercise test results, with normal coronary arteries. Changes in subendocardial hypoperfusion were registrated after adenosine. The aim of this study was to evaluate left ventricular (LV) systolic strain by speckle tracking echocardiography (STE) for the early detection of myocardial dysfunction in patients with CSX and to investigate the contribution of separate myocardial layers. Methods: We compared 29 patients with CSX (19 females, mean age 54.3±12.1 years) with 29 healthy persons as a control group (19 females, mean age 49.8±10.8 years). Inclusion criteria for CSX were typical angina, a positive exercise ECG stress test, and angiographically documented normal coronary arteries. All subjects underwent two-dimensional STE to assess resting LV function. Layer-specific global longitudinal strain (GLS) and strain rate (SR) were assessed from the endocardium, midmyocardium, and epicardium. Results: LV echo ejection fraction (EF) was similar for both groups. Mean longitudinal strain (-16.8 ± 2.1% vs. -21.4 ± 1.7%; p<0.0001) was significantly lower in patients with CSX than in healthy control patients, while global circumferential strain values (-20.2±1.9% vs. -21.4±2.1%; p=NS) and global radial strain values did not differ significantly between the two groups. As compared to control group,left ventricular diastolic functions were impaired (E/A; 0.89 ± 0.21 vs 1.24 ± 0.31 p < 0.01), left ventricular end-diastolic pressures were increased (E/E'; 9.2 ± 1.73 vs 7.4 ± 1.56 p < 0.05), left atrial maximum volume and left atrial pre-A volume were increased in patients with CSX. Lower LS and CS were found in endocardial layer comparing with epicardial layer. Significant decrease in endocardial GLS (14.3 ± 2.6% vs 19.6 ± 2.1; p <0.01) and SR (0.76/sec±0.13 vs 0.93/sec±0.2; p:0.2) was registered in CSX group compared with control group, while midmyocardium and epicardium layers did not differ significantly between groups. Conclusion: Significant impairment of LV longitudinal myocardial systolic function was detected with STE in patients with CSX and also subendocardial impairment of contractile function, confirming the existence of reduced myocardial perfusion despite normal coronary angiography. P1163Right ventricular myomechanical index (RV-MI) for prediction of survival in a cohort of patients with precapillary pulmonary hypertension S Greiner S Greiner University Hospital of Heidelberg, Internal Medicine III, Heidelberg, Germany F Goppelt F Goppelt University Hospital of Heidelberg, Internal Medicine III, Heidelberg, Germany M Aurich M Aurich University Hospital of Heidelberg, Internal Medicine III, Heidelberg, Germany H A Katus H A Katus University Hospital of Heidelberg, Internal Medicine III, Heidelberg, Germany D Mereles D Mereles University Hospital of Heidelberg, Internal Medicine III, Heidelberg, Germany University Hospital of Heidelberg, Internal Medicine III, Heidelberg, Germany Funding Acknowledgements: No COI to declare Aim: To evaluate a new index for quantification of RV function regarding the complexity RV mechanics, and its applicability in daily clinical routine. Methods: Sixty-five consecutive patients with precapillary pulmonary hypertension (PH classes I, III, IV and V) under treatment underwent clinical assessment, serological testing and comprehensive transthoracic echocardiography with detailed focus on RV function and hemodynamics, and were followed prospectively for outcome over up to four years. NewRV study, clinicaltrials.gov: NCT01230294 Results: Sixteen patients died within the follow-up period. Mean follow-up time was 834 days. Right ventricular myomechanical index (RV-MI) was measureable in all examinations. RV-MI was analyzed and compared to established parameters in regard to its diagnostic accuracy and predictive value (table1). RV-MI and NT-proBNP were independently predictive (hazard ratio (HR) 2.9, 95% confidence interval (CI) 1.4-6.2, p=0.006; HR 2.6, 95% CI 1.5-4.6, p=0.001). Conclusion: In a cohort of patients with precapillary PH, the right ventricular myomechanical index (RV-MI) predicts survival of patients better than other available, non-invasive RV parameters by pre- and afterload adjusted quantification of RV function. Open in new tabDownload slide Abstract P1163 Figure. Table 1 Open in new tabDownload slide Abstract P1163 Figure. Table 1 P1164The role of right ventricular 2D strain in assessment of RV function among the patients with myocardial infarction (STEMI) F Opahle F Opahle Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany O Galuszka O Galuszka Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany D Steffens D Steffens 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: Adverse prognosis has been observed in patients with acute transmural myocardial infarction, in case of right ventricular involvement. New imaging techniques, such as two-dimensional strain measured by speckle-tracking echocardiography, have been developed to better characterize global and regional myocardial function. However, the prognostic relevance of these new parameters remains unclear. Therefore, the aim of this study is to assess the value of right ventricular global longitudinal strain and strain-rate in patients with acute transmural myocardial infarction (MI) who underwent percutaneous coronary intervention (PCI). Methods: Post-acquisition echocardiography analysis of 89 patients presented in our emergency admission with acute transmural myocardial infarction between January and September 2015 was evaluated after percutaneous coronary intervention. Right ventricular (RV) and atrial dimensions and function, including global longitudinal strain and strain-rate were measured using EchoPAC software version 113 by GE Healthcare. After a mean follow-up period of >12 months, patients were interviewed to evaluate their outcome. Results: Of the 89 patients, 62 (69,68%) were male, with the most frequent regions of myocardial infarction being anterior (47,73%) and inferior (42,05%) wall myocardial infarction. All patients received percutaneous coronary intervention. On average, echocardiography was conducted 3,7 days after PCI. Right ventricular strain was assessable in 37 patients and correlated well with TAPSE (r = 0,386, p < 0,05). The left ventricular ejection fraction was abnormal in 72,73% of all patients. Right ventricular strain was higher in patients with impaired left ventricular ejection fraction (-17,96 ± 5,82%) compared to the patients with ejection fraction higher than 60% (-21,57 ± 5,80%) with homogeneity of variance in both groups (F = 0,019). TAPSE was similar in both groups (22,00 ± 4,80 vs. 24,09 ± 2,86mm, p < 0,05). Interestingly, 96,9% of the patients with impaired RV strain (>-19%, n = 29) had normal TAPSE. The mean systolic pulmonary artery pressure was higher in patients with impaired RV strain (32,00 ± 11,25 mmHg) compared to others (25,01 ± 8,72mmHg, F = 0,114), although the correlation was not significant. There was no significant difference in right ventricular global longitudinal strain between patients with anterior and inferior wall MI (-18,82 ± 5,69 vs. -18,91 ± 4,39%) but the mean left ventricular global longitudinal strain varied significantly between those two groups (-10,62 ± 3,70 vs. -14,73 ± 4,75%, p < 0,05). Conclusion: Our findings show more impaired RV function with larger myocardial infarction indicated by lower EF. This study also shows a positive correlation between RV strain and TAPSE. RV strain appears to have higher sensitivity compared to TAPSE for the assessment of the right ventricular function. No difference between the localization of MI was found regarding to RV function. P1165Low tricuspid annular plane systolic excursion (TAPSE) predicts increased mortality in patients with percutaneous right ventricular impella support P Krishnamoorthy P Krishnamoorthy Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America B Abdulhadi B Abdulhadi Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America A Dias A Dias Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America J Rangaswami J Rangaswami Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America M Anderson M Anderson Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America D L Morris D L Morris Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America G Pressman G Pressman Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America Funding Acknowledgements: No funding or grant was involved. Background: Right ventricular failure is associated with increased morbidity and mortality in patients with left ventricular dysfunction. However, the right ventricle has been considered as a mere bystander and very limited information exists regarding echocardiographic measurement of right ventricular systolic function. Purpose: We aimed to describe various right ventricular echocardiographic parameters in patients undergoing percutaneous right ventricular (RP) impella support and compare them in patients who died vs patients who did not. Methods: We analyzed data from consecutive patients referred in our Medical Center from 2012 to 2017 undergoing RP impella device placement post myocardial infarction, post cardiac surgery and post left ventricular assist device placement. Baseline demographics, echocardiographic parameters and in-hospital mortality data were collected. P value was calculated by Kruskal-Wallis and unadjusted logistic regression analysis was performed to determine echocardiographic predictor of in hospital mortality. Results: A total of 36 patients were identified with a mean age of 63±13 years and 60% males. In hospital mortality was 16%. Among all echocardiographic parameters, TAPSE was significantly lower in patients who died vs who did not (0.9±0.2 vs 1.3±0.3; p=0.01) (Table 1). TAPSE was less than 1.3 cm in all patients who died. Higher TAPSE was associated with lower mortality in unadjusted logistic regression analysis [OR 0.01 (0.0001-0.61); P=0.03]. Conclusions: Poor right ventricular systolic function predicted by low TAPSE was associated with high mortality in patients undergoing right ventricular percutaneous impella support. Echo Parameters of RP Impella Patients Parameters . TotalN=36 . In Hospital DeathN=6 . No In Hospital DeathN=30 . P value* . N . . N . . N . . TAPSE (cm) 33 1.2±0.3 6 0.9±0.2 27 1.3±0.3 0.01 IVC Size (cm) 34 2.1±0.6 6 2.1±0.6 28 2.1±0.7 0.76 RVOT VTI (cm) 19 9.3±2 3 9.1±2.7 16 9.4±2 0.91 Acceleration Time across PV (msec) 27 83±15 5 79±11 22 84±16 0.47 TR jet maximum velocity (m/sec) 32 3.0±0.6 6 2.9±0.3 26 3.1±0.7 0.82 RV Basal Dimension (cm) 31 4.8±0.8 6 4.4±0.4 25 5±0.8 0.07 RV Mid Cavity Dimension (cm) 31 3.1±0.8 6 2.9±0.4 25 3.2±0.9 0.88 RV Proximal Linear Dimension (cm) 32 3.9±0.7 6 3.5±0.3 26 3.9±0.7 0.14 RVOT Distal Dimension (cm) 30 2.5±0.4 6 2.5±0.5 24 2.5±0.4 0.75 Parameters . TotalN=36 . In Hospital DeathN=6 . No In Hospital DeathN=30 . P value* . N . . N . . N . . TAPSE (cm) 33 1.2±0.3 6 0.9±0.2 27 1.3±0.3 0.01 IVC Size (cm) 34 2.1±0.6 6 2.1±0.6 28 2.1±0.7 0.76 RVOT VTI (cm) 19 9.3±2 3 9.1±2.7 16 9.4±2 0.91 Acceleration Time across PV (msec) 27 83±15 5 79±11 22 84±16 0.47 TR jet maximum velocity (m/sec) 32 3.0±0.6 6 2.9±0.3 26 3.1±0.7 0.82 RV Basal Dimension (cm) 31 4.8±0.8 6 4.4±0.4 25 5±0.8 0.07 RV Mid Cavity Dimension (cm) 31 3.1±0.8 6 2.9±0.4 25 3.2±0.9 0.88 RV Proximal Linear Dimension (cm) 32 3.9±0.7 6 3.5±0.3 26 3.9±0.7 0.14 RVOT Distal Dimension (cm) 30 2.5±0.4 6 2.5±0.5 24 2.5±0.4 0.75 * Kruskal-Wallis test was used to calculate P value Echo Parameters of RP Impella Patients Parameters . TotalN=36 . In Hospital DeathN=6 . No In Hospital DeathN=30 . P value* . N . . N . . N . . TAPSE (cm) 33 1.2±0.3 6 0.9±0.2 27 1.3±0.3 0.01 IVC Size (cm) 34 2.1±0.6 6 2.1±0.6 28 2.1±0.7 0.76 RVOT VTI (cm) 19 9.3±2 3 9.1±2.7 16 9.4±2 0.91 Acceleration Time across PV (msec) 27 83±15 5 79±11 22 84±16 0.47 TR jet maximum velocity (m/sec) 32 3.0±0.6 6 2.9±0.3 26 3.1±0.7 0.82 RV Basal Dimension (cm) 31 4.8±0.8 6 4.4±0.4 25 5±0.8 0.07 RV Mid Cavity Dimension (cm) 31 3.1±0.8 6 2.9±0.4 25 3.2±0.9 0.88 RV Proximal Linear Dimension (cm) 32 3.9±0.7 6 3.5±0.3 26 3.9±0.7 0.14 RVOT Distal Dimension (cm) 30 2.5±0.4 6 2.5±0.5 24 2.5±0.4 0.75 Parameters . TotalN=36 . In Hospital DeathN=6 . No In Hospital DeathN=30 . P value* . N . . N . . N . . TAPSE (cm) 33 1.2±0.3 6 0.9±0.2 27 1.3±0.3 0.01 IVC Size (cm) 34 2.1±0.6 6 2.1±0.6 28 2.1±0.7 0.76 RVOT VTI (cm) 19 9.3±2 3 9.1±2.7 16 9.4±2 0.91 Acceleration Time across PV (msec) 27 83±15 5 79±11 22 84±16 0.47 TR jet maximum velocity (m/sec) 32 3.0±0.6 6 2.9±0.3 26 3.1±0.7 0.82 RV Basal Dimension (cm) 31 4.8±0.8 6 4.4±0.4 25 5±0.8 0.07 RV Mid Cavity Dimension (cm) 31 3.1±0.8 6 2.9±0.4 25 3.2±0.9 0.88 RV Proximal Linear Dimension (cm) 32 3.9±0.7 6 3.5±0.3 26 3.9±0.7 0.14 RVOT Distal Dimension (cm) 30 2.5±0.4 6 2.5±0.5 24 2.5±0.4 0.75 * Kruskal-Wallis test was used to calculate P value P1166Echocardiographic assessment of ventricular function in the early time period after heart transplantation A Ingvarsson A Ingvarsson 1Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden A Werther Evaldsson A Werther Evaldsson 1Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden G Radegran G Radegran 1Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden J Waktare J Waktare 2Liverpool Heart and Chest Hospital, Liverpool, United Kingdom G Smith G Smith 1Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden M Stagmo M Stagmo 1Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden A Roijer A Roijer 1Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden C Meurling C Meurling 1Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden 1Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden 2Liverpool Heart and Chest Hospital, Liverpool, United Kingdom On behalf of: Lund echocardiographic research network Background: Noninvasive evaluation of allograft function early after heart transplantation (HTx) is challenging. Echocardiography is commonly used to detect changes in ventricular function but data concerning normal adaptation is lacking. Purpose: This study was designed to describe alterations in biventricular function, and define steady state for different parameters between 1 week and 6 months after HTx. Methods: Thirty-eight HTx patients (31 males, mean age 47±7 years) were prospectively included. Patients were examined 1, 4, 12 and 24 weeks following transplantation using iE33 (Philips) ultrasound scanner and data were analyzed using Xcelera (Philips). Strain data were calculated using Q-lab 10.1 version 1.0 (Philips). Statistical analysis was performed using SPSS (IBM, SPSS Statistics 22.0, Chicago, IL). Values were compared using paired t-test and expressed as mean±SD, 95% CI. Results: Regarding left ventricular (LV) parameters at 1 and 4 weeks we found an increase in global longitudinal strain (-12.9% vs. -14.7%, p>0.05), global circumferential strain (-19.3±7.3% vs. -22.7±6.3%, p<0.05) and stroke volume (57±15 ml vs. 64±15 ml, p<0.05), whereas ejection fraction was unaltered. After 4 weeks no further improvement was seen. Standard right ventricular (RV) parameters were increased between 1 and 4 weeks; TAPSE was 11±3mm vs. 13±2mm (p<0.05) and S´ was 7.1±1.5cm/s vs. 9.5±6.5cm/s (p<0.05). A gradual improvement up to 24 weeks was detected. Global RV strain and RV free wall strain were -13.6±4.4% and -14.2±4.1% respectively at 1 week compared to -16.8±4.4% (p<0.01) and -17.1±5.2% (p<0.05) respectively at 4 weeks. Thereafter no further improvement was seen. Conclusion: We found a significant improvement in biventricular function at 4 weeks post HTx. Our data suggests that clinically stable HTx recipients have reached steady state regarding LV function already after 4 weeks, whereas conventional measures of RV function continue to improve up to 24 weeks following transplantation. P1167Direct comparison of SPECT, CACS, CCTA, combined SPECT+CACS and hybrid SPECT/CCTA for long-term prediction of major cardiac events O F Clerc O F Clerc University Hospital Zurich, Zurich, Switzerland T A Fuchs T A Fuchs University Hospital Zurich, Zurich, Switzerland S Dougoud S Dougoud University Hospital Zurich, Zurich, Switzerland A P Pazhenkottil A P Pazhenkottil University Hospital Zurich, Zurich, Switzerland O Gaemperli O Gaemperli University Hospital Zurich, Zurich, Switzerland P A Kaufmann P A Kaufmann University Hospital Zurich, Zurich, Switzerland R R Buechel R R Buechel University Hospital Zurich, Zurich, Switzerland University Hospital Zurich, Zurich, Switzerland Funding Acknowledgements: This study received no funding. Background: Single-photon emission computed tomography (SPECT), coronary artery calcium score (CACS), coronary CT angiography (CCTA), combined SPECT+CACS and hybrid SPECT/CCTA can reliably predict future cardiac events. However, the relative prognostic value of these methods on the long term is unknown. Purpose: To perform a head-to-head comparison of these methods regarding prediction of major cardiac events in the same patients during a long-term follow-up. Methods: From 3 cardiac imaging cohorts, we included patients having undergone all imaging methods (SPECT, CACS, CCTA, SPECT+CACS and SPECT/CCTA). Exclusion criteria were previous coronary revascularisation or poor image quality. Findings were defined as following: SPECT as normal, scar or ischaemia; CACS with the Agatston method; CCTA with lesion severity and obstructive vessel disease; segment severity score with CCTA (CCTA-SSS); combined SPECT+CACS as normal, intermediate (normal perfusion and CACS 1-999), scar, or high-risk (ischaemia or CACS ≥1000); and hybrid SPECT/CCTA as normal, non-significant (non-obstructive lesions and normal perfusion), unmatched (perfusion defect or obstructive stenosis), or matched (obstructive stenosis with corresponding ischaemia). The modified Framingham risk score was also calculated. Major adverse cardiac events (MACE) were cardiac death, non-fatal myocardial infarction or elective revascularisation. Elective revascularisations within 6 weeks after imaging were excluded to avoid confounding between diagnosis and prognosis. We performed multivariate Cox regressions adjusted for cardiovascular risk factors and receiver operating characteristic (ROC) analysis with area under the curve (AUC) for MACE prediction. Results: Of 702 patients from 3 cohorts, 56 (8%) were lost to follow-up and 86 (12%) met exclusion criteria. Of the 560 remaining patients, 380 had undergone all imaging methods and were included. Mean age was 61.5 ±10.7 years, with 233 men (61%). During a mean follow-up of 6.3 ±0.9 years, MACE occurred in 61 patients (16%). In multivariate Cox regression, all imaging methods were independent MACE predictors (P ≤0.005 for SPECT and SPECT+CACS; P ≤0.001 for CACS, CCTA and SPECT/CCTA). ROC analysis showed the following AUC: SPECT 0.61 (0.56-0.66), Framingham 0.62 (0.57-0.67), combined SPECT+CACS 0.74 (0.69-0.78), hybrid SPECT/CCTA 0.75 (0.71-0.80), CCTA 0.78 (0.73-0.82), CACS 0.79 (0.75-0.83), CCTA-SSS 0.80 (0.76-0.84). Significant differences were found for SPECT versus all other imaging methods (all P ≤0.0001); for Framingham versus imaging methods, except SPECT (all P ≤0.002); and for combined SPECT+CACS versus CACS, CCTA or CCTA-SSS (all P ≤0.02). Conclusions: In direct comparison, CACS, CCTA, CCTA-SSS, combined SPECT+CACS and hybrid SPECT/CCTA showed higher long-term prognostic performance than SPECT and Framingham risk score. The advantage of CT-based methods may be the assessment of non-obstructive and obstructive lesion burden. Open in new tabDownload slide Abstract P1167 Figure. Receiver operating characteristic curves Open in new tabDownload slide Abstract P1167 Figure. Receiver operating characteristic curves P1168Comparative assessment of rest and stress transthoracic doppler signs for successful evaluation of stenotic left main coronary artery and left anterior descending coronary artery A Boshchenko A Boshchenko 1Cardiology Research Institute, Tomsk, Russian Federation A Vrublevsky A Vrublevsky 1Cardiology Research Institute, Tomsk, Russian Federation A Vassenkin A Vassenkin 2Tomsk Polytechnic University, Tomsk, Russian Federation 1Cardiology Research Institute, Tomsk, Russian Federation 2Tomsk Polytechnic University, Tomsk, Russian Federation Qualitative or semi-quantitative evaluation of stenotic left main coronary artery (LMCA) and left anterior descending artery (LAD) at rest by contrast transthoracic echocardiography (TTE) has been reported. Transthoracic coronary flow reserve (CFR) with adenosine and dipyridamole <2.0 for the detection of LAD stenosis >50% and >70% has been validated. Aim: to detect comparatively the potential of different qualitative, semi-quantitative, quantitative and functional transthoracic Doppler signs for successful evaluation of stenotic LMCA and LAD. Methods: 281 patients (53±10 years) with chest pain, sinus rhythm and scheduled quantitative coronary angiography (CAG) were evaluated by non-contrast TTE (Vivid 7, Vivid 9, GE Healthcare) at rest (Group 1, n=173) or during stress with dipyridamole (up to 0.84 mg/kg per 6 minutes; Group 2, n=108) in the comparative randomized study. The LMCA, proximal (p), mid (m) and distal (d) parts of the LAD were examined for Group 1. The Doppler signs of coronary stenosis >50% were determined as the following: (1) local Doppler aliasing with the Nyquist limit set at 60 cm/s; (2) ratio of «stenotic/prestenotic Vpd» >2.0; (3) stenosis >50% according to flow continuous equation: stenosis, % = 100 × (1 - prestenotic VTId / stenotic VTId), where VTId - diastolic time velocity integral. Coronary flow reserve (CFR) was assessed in Group 2 as the ratio of stress to rest Vpd at the dLAD. The level of CFR <2.0 (4) was decided as reduced and marked stenosis of LMCA or LAD >50%. CAG was performed within 1 week after TTE. Stenosis >50% of diameter reduction was considered as significant. Results: Good Doppler recording of coronary flow velocity pattern in Group 1 was acceptable for LMCA in 75% of cases, pLAD in 84%, mLAD in 84%, dLAD in 93%. Successful assessment of CFR at dLAD was possible in 94% of cases in Group 2. Sensitivity (Sens), specificity (Sp) and diagnostic accuracy (Ac) of different Doppler stenotic signs for LMCA+LDA are presented in Table 1. Thus, semi-quantitative and quantitative evaluation of ratio of stenotic to prestenotic coronary flow velocities at rest is more difficult assessed but more sensitive sign for detecting stenosis of the LMCA and LAD >50%, than qualitative assessment (aliasing), and more specific and accurate sign than CFR <2.0. Table 1. Doppler signs, number . Assessed sign, % . Sens, % . Sp, % . Ac, % . (1) 84## 53 94# 88 (2) 78## 75* 97## 94## (3) 78## 80* 98## 95## (4) 94 76* 86 84 Doppler signs, number . Assessed sign, % . Sens, % . Sp, % . Ac, % . (1) 84## 53 94# 88 (2) 78## 75* 97## 94## (3) 78## 80* 98## 95## (4) 94 76* 86 84 Note: * - p<0.01 vs sign (1), # - p<0.05, ## - p<0.001 vs sign (4). Table 1. Doppler signs, number . Assessed sign, % . Sens, % . Sp, % . Ac, % . (1) 84## 53 94# 88 (2) 78## 75* 97## 94## (3) 78## 80* 98## 95## (4) 94 76* 86 84 Doppler signs, number . Assessed sign, % . Sens, % . Sp, % . Ac, % . (1) 84## 53 94# 88 (2) 78## 75* 97## 94## (3) 78## 80* 98## 95## (4) 94 76* 86 84 Note: * - p<0.01 vs sign (1), # - p<0.05, ## - p<0.001 vs sign (4). P1169Echocardiography and cardiac MRI assessment of cardiac regeneration induced by microRNA in small and large animal models of acute myocardial infarction S Zacchigna S Zacchigna 1International Centre for Genetic Engineering and Biotechnology (ICGEB), Cardiovascular Biology Laboratory, Trieste, Italy P Lesizza P Lesizza 2University of Trieste, Department of Medical, Surgical and Health Sciences, Trieste, Italy M Dal Ferro M Dal Ferro 2University of Trieste, Department of Medical, Surgical and Health Sciences, Trieste, Italy G Prosdocimo G Prosdocimo 3International Centre for Genetic Engineering and Biotechnology (ICGEB), Molecular Medicine Laboratory, Trieste, Italy B Pinamonti B Pinamonti 2University of Trieste, Department of Medical, Surgical and Health Sciences, Trieste, Italy G Sinagra G Sinagra 2University of Trieste, Department of Medical, Surgical and Health Sciences, Trieste, Italy M Giacca M Giacca 3International Centre for Genetic Engineering and Biotechnology (ICGEB), Molecular Medicine Laboratory, Trieste, Italy 1International Centre for Genetic Engineering and Biotechnology (ICGEB), Cardiovascular Biology Laboratory, Trieste, Italy 2University of Trieste, Department of Medical, Surgical and Health Sciences, Trieste, Italy 3International Centre for Genetic Engineering and Biotechnology (ICGEB), Molecular Medicine Laboratory, Trieste, Italy Rationale: We have recently shown that two human microRNAs (miRNAs), hsa-miR-199a-3p and hsa-miR-590-3p stimulate cardiomyocyte proliferation and promote cardiac regeneration after myocardial infarction (MI) in mice. Objective: To assess the therapeutic activity of the pro-regenerative miRNAs, we delivered them as either AAV vectors or synthetic RNA and evaluated cardiac function and MI size by traditional US imaging and strain analysis. As a first step toward the clinical translation, we also delivered the same miRNAs in a pig model of ischemia-reperfusion and again measured cardiac function and MI size by cardiac steady-state free precession (SSFP) MRI, followed by late-gadolinium enhancement (LGE) quantification. Methods and Results: We have compared the efficacy of AAV vectors and different lipid formulations in delivering hsa-miR-199a-3p and hsa-miR-590-3p both in vitro and in vivo and optimized the transfection protocol to achieve persistence of the two miRNA mimics for more than 12 days after a single intracardiac injection. We then used the optimized protocol to deliver both miRNA mimics immediately after MI in mice and evaluated cardiac function and the extension of non-contracting myocardium by US imaging and strain analysis. In vivo functional data were confirmed by histology and immunofluorescence. Next, we validated the therapeutic potential of miR-199a, which is highly conserved among the species, in a pig model of ischemia-reperfusion, by direct myocardial injection of AAV6 vectors carrying the miR-199a precursor gene. One month after MI, the tissue was harvested and miR-199a-3p/5p expression levels evaluated by qRT-PCR to assess the expression of the transgene. Cardiac function and MI extension were evaluated at day 2 and 28 by US imaging and Gadolinium-enhanced cardiac magnetic resonance, which displayed a significant reduction of the infarct size and an increased ejection fraction in the animals treated with AAV6 miR-199a (n=8). Strain analysis of SSFP sequences confirmed an improvement in segmental radial strain both in infarcted segments and in remote zones and particularly at the sites of highest transgene expression. Histological analysis confirmed that cardiomyocyte proliferation, rather than hypertrophy, was responsible for the smaller scar observed in AAV6-miR-199a injected animals. Conclusions: The administration of a single shot of pro-regenerative synthetic miRNA stimulates myocardial repair and improves cardiac function in a model of myocardial infarction in the adult mouse, as assessed by US imaging and confirmed by histology. Moreover, AAV6-miR-199a injection in a pig model of ischemia-reperfusion significantly improves heart function, reducing the extension of MI scar, as assessed by cardiac MRI and confirmed by histology. P1170Effect of sonothrombolysis on recanalization rates and mechanics. Results of a single center, randomized trial in patients with acute ST elevation myocardial infarction M O Dias Aguiar M O Dias Aguiar 1Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil B G Tavares B G Tavares 1Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil J Tsutsui J Tsutsui 1Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil J C Nicolau J C Nicolau 1Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil E P Viana E P Viana 1Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil M T Oliveira M T Oliveira 1Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil A Soeiro A Soeiro 1Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil E E Ribeiro E E Ribeiro 1Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil C B B V Cruz C B B V Cruz 1Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil P Lemos P Lemos 1Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil R Kalil Filho R Kalil Filho 1Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil F Xie F Xie 2University of Nebraska Medical Center, Nebraska, United States of America T R Porter T R Porter 2University of Nebraska Medical Center, Nebraska, United States of America W Mathias Jr W Mathias Jr 1Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil 1Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil 2University of Nebraska Medical Center, Nebraska, United States of America Funding Acknowledgements: Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Introduction: In patients with acute ST segment elevation myocardial infarction (STEMI), preliminary clinical trials have demonstrated that high mechanical index (MI) impulses from a diagnostic ultrasound transducer during a commercially available ultrasound contrast microbubble infusion have been shown to improve microvascular flow within the risk area, when administered before and immediately after emergent percutaneous coronary intervention (PCI), a form of therapy known as sonothrombolysis. However, the effects on the left ventricle (LV) still remain to be observed. Purpose: To evaluate angiographic recanalization rates before PCI and the evolution of LV mechanics in patients presenting with their first acute STEMI, randomized to sonothrombolysis. Methods: A total of 52 patients were randomized either to multiple intermittent high MI ultrasound impulses (1.2), when microbubbles were visualized within the risk area, intended for imaging of the LV and therapy (Therapy group) or only 3 projections of low MI imaging alone plus microbubbles (Control group), in order to document myocardial perfusion and LV function. The therapy group received sonothrombolysis just prior to PCI as well as for additional minutes following PCI to complete a total of 50 minutes of treatment. Door to dilation times were monitored in order to avoid delay in PCI in both groups. Angiographic recanalization rates, ejection fraction (EF), peak troponin and MB-CK levels were acquired at baseline, just prior to PCI and during the follow-up. Global longitudinal strain (GLS) was acquired immediately after PCI and at one-month follow-up. All the parameters were compared between groups. Results: Baseline LV ejection fraction were similar in both groups, however there was a higher rate of angiographic recanalization just prior to PCI in therapy group than control (54.8% vs 9.5 %, p < 0.001) and at follow-up, there was a lower peak troponin level (42.95ng/ml vs 49.04ng/ml, p = 0.041) and lower peak MB-CK (167ng/ml vs 230ng/ml, p = 0.042) in therapy group than control. LV ejection fraction was similar prior to PCI (44.4+10.2% vs 41.7+8.0%; p=0.160), improved in the therapy group as compared to control group after PCI (49.7+10.6% vs 41.6+9.0%; p=0,002) and after one month (52.2+10.1% vs 43.8+11.5%; p=0,015), respectively. GLS value after PCI was already better in the therapy group (- 14.8% vs - 12.8%; p = 0.018) and continued to improve at one-month follow-up (-16.4% vs - 12.9%; p < 0.001). Conclusion: In this first human randomized trial, patients treated by sonothrombolysis exhibited lower peak cardiac enzyme values and higher recanalization rates, EF and GLS. Global longitudinal strain has the potential to predict LV function improvement in early on, in acute STEMI. P1171Improvement in mitral regurgitation is associated with left ventricular reverse remodeling but was not a predictor of favorable 1-year clinical outcome in patients with acute myocardial infarction H K Jeong H K Jeong Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of H Park H Park Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of M C Kim M C Kim Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of H J Yoon H J Yoon Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of K H Kim K H Kim Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of Y J Hong Y J Hong Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of J H Kim J H Kim Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of Y Ahn Y Ahn Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of M H Jeong M H Jeong Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of J G Cho J G Cho Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of J C Park J C Park Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of S S Oh S S Oh Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of J Y Cho J Y Cho Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of J Won J Won Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of D Y Hyun D Y Hyun Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of Background: Mitral regurgitation (MR) frequently occur in the setting of acute myocardial infarction (AMI). It is reported that concomitant MR in AMI predicts poor clinical outcome. However, impact of change in MR severity has been poorly studied. We aimed to investigate the effect of improvement MR on clinical outcomes in patients with AMI. Methods: A total of 12,432 patients with AMI were enrolled in a nation-wide AMI registry between Nov 2011 and June 2015. Among them, eligible 2,237 patients (61.6 ± 11.9 years, 1697 males) who underwent follow-up 2D-echocardiography at 1 year were divided into two groups; improved MR group (n=385, 63.8 ± 11.4 years, 277 males) vs. non-improved MR group (n=1,852, 61.1 ± 11.9 years, 1420 males). Primary end point was composite major adverse cardiac events (MACE) at 1 year follow-up. Results: MR was improved in 382 out of 2,237 patients (17.2%). Left ventricular ejection fraction (LVEF) was lower (47.5 ± 12.3 vs. 51.7 ± 11.0, p <0.0001) and LV end-diastolic diameter (LVEDD) [50.9 ± 6.4 vs. 49.4 ± 6.4, p <0.0001] and LV end-systolic diameter (LVESD) [36.9 ± 7.7 vs. 34.7 ± 7.1, p <0.0001] were all greater in the improved MR group. Initial MR grade was worse in the improved MR group than in the non-improved MR group (1.5 ± 0.7 vs. 0.2 ± 0.5, p <0.0001). However, increase in LVEF (ΔLVEF; 5.5 ± 10.5 vs. 3.9 ± 9.4 p=0.007) and decrease in LVEDD (ΔLVEDD; 1.1 ± 7.9 vs. -1.02 ± 7.5, p<0.0001) and LVESD (ΔLVESD; 1.7 ± 7.9 vs. -0.0 ± 7.3, p <0.0001) were all better in the improved MR group. Nonetheless, MACE was not different between the two groups (7.8% vs. 5.6%, p=0.098). Rather, significant MR (>= Gr 2) at 1-year follow-up showed worse clinical outcome compared with no significant MR (MACE; 11.8% vs. 5.6%, p=0.004) Conclusion: Improved MR in patients with AMI was associated with LV reverse remodeling, but 1-year MACE was associated with significant MR at follow-up echocardiography. P1172Correlation between haptoglobin phenotypes and myocardial reperfusion injury in consecutive ST-elevation myocardial infarction as detected by cardiac magnetic resonance C Banfi C Banfi 1Centro Cardiologico Monzino, IRCCS, Milan, Italy E Gianazza E Gianazza 1Centro Cardiologico Monzino, IRCCS, Milan, Italy A I Guaricci A I Guaricci 2Polyclinic Hospital of Bari, Bari, Italy A Pasquini A Pasquini 3Sapienza University of Rome, Rome, Italy C Berzovini C Berzovini 4Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy A Baggiano A Baggiano 1Centro Cardiologico Monzino, IRCCS, Milan, Italy F Fazzari F Fazzari 5University Hospital Paolo Giaccone, Palermo, Italy D Andreini D Andreini 1Centro Cardiologico Monzino, IRCCS, Milan, Italy S Mushtaq S Mushtaq 1Centro Cardiologico Monzino, IRCCS, Milan, Italy M Guglielmo M Guglielmo 1Centro Cardiologico Monzino, IRCCS, Milan, Italy N Cosentino N Cosentino 1Centro Cardiologico Monzino, IRCCS, Milan, Italy G Marenzi G Marenzi 1Centro Cardiologico Monzino, IRCCS, Milan, Italy E Tremoli E Tremoli 1Centro Cardiologico Monzino, IRCCS, Milan, Italy M Pepi M Pepi 1Centro Cardiologico Monzino, IRCCS, Milan, Italy G Pontone G Pontone 6University of Milan, Foundation Monzino (IRCCS), Center Cardiology, Dpt of Cardiology, Milan, Italy 1Centro Cardiologico Monzino, IRCCS, Milan, Italy 2Polyclinic Hospital of Bari, Bari, Italy 3Sapienza University of Rome, Rome, Italy 4Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy 5University Hospital Paolo Giaccone, Palermo, Italy 6University of Milan, Foundation Monzino (IRCCS), Center Cardiology, Dpt of Cardiology, Milan, Italy Background: Primary percutaneous coronary intervention (pPCI) has significantly reduced cardiovascular mortality of ST-segment elevation myocardial infarction (STEMI) patients. However, even rapid and complete restoration of culprit vessel flow may not guarantee adequate perfusion with consequential myocardial reperfusion injury. Recent studies on animal models showed that different variants of haptoglobin could play a role in the myocardial reperfusion injury. Cardiac magnetic resonance (CMR) has emerged as the gold standard technique for the measurement of the myocardial salvage index (MSI) and microvascular obstruction (MVO) over the traditional risk stratification. Purpose: Aim of this study is to evaluate the correlation between variants of haptoglobin and myocardial reperfusion injury as detected by CMR in consecutive STEMI patients who underwent successful pPCI. Methods: Consecutive STEMI patients reperfused by primary PCI were enrolled in this study. For each patient, the characterization of different phenotypes of haptoglobin was evaluated. Moreover, a CMR was performed by 1 week after STEMI evaluating the following parameters: left ventricle ejection fraction (LVEF), MSI and prevalence and amount of MVO. The primary endpoint of study was to evaluate the correlation between different phenotypes of haptoglobin and myocardial reperfusion injury as detected by CMR. Results: One-hundred twenty four consecutive STEMI were enrolled in this study (mean age: 62±11 years; male:102). The three different phenotypes Hp 1-1, Hp 1-2, Hp 2-2 were observed in 10 (8%), 55 (44%) and 59 (48%) patients, respectively. CMR showed a LVEF and MSI of 49±10% and 0.38±0.9, respectively. The MVO was observed in 33 patients (27%) with a mean value of 2±4% of left ventricle myocardial mass. The patients with phenotype Hp 1-1 or Hp 1-2 showed no differences in terms of LVEF (50.7±10% vs. 48±11%, p:0.18) and MSI (0.43±0.31 vs. 0.49±0.35, p:0.3) but higher prevalence (37% vs. 17%, p<0.01) and amount (2.7 ±0.4% vs. 1.3±0.4% of left ventricle mass, p<0.05) of MVO as compared to phenotype Hp 2-2. After correction for baseline characteristics the presence of phenotype Hp 2-2 was an independent predictor of MVO [HR:1.28 (1.08-2.4),p:0.20] Conclusions: Different variants of haptoglobin may play a crucial role in cardiac repair responses by reducing oxidative stress, maintaining microvascular integrity and proper scar formation. Further studies should be performed to evaluate if different therapeutic strategies should be developed based on phenotypes of haptoglobin of patients. P1173Epicardial adipose tissue remodeling drives left ventricular remodeling after ST segment elevation myocardial infarction M A Abitabile M A Abitabile 2Santa Maria di Loreto Mare Hospital, Naples, Italy D B Bruzzese D B Bruzzese 3Federico II University of Naples, Naples, Italy N F Ferrara N F Ferrara 1University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy B T Tuccillo B T Tuccillo 2Santa Maria di Loreto Mare Hospital, Naples, Italy D L Leosco D L Leosco 1University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy V Parisi V Parisi 4Univ. of Naples Federico II, Dpt Clinical Med., Cardiov. & Immunolog. Science, Cardiac Rehab. Unit, Naples, Italy 1University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy 2Santa Maria di Loreto Mare Hospital, Naples, Italy 3Federico II University of Naples, Naples, Italy 4Univ. of Naples Federico II, Dpt Clinical Med., Cardiov. & Immunolog. Science, Cardiac Rehab. Unit, Naples, Italy L P Petraglia L P Petraglia 1University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy R F Formisano R F Formisano 1University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy M A Accadia M A Accadia 2Santa Maria di Loreto Mare Hospital, Naples, Italy Introduction: Epicardial adipose tissue (EAT) thickness is associated to presence and severity of coronary artery disease (CAD). EAT, acting in a paracrine manner, can also affect myocardial remodelingbeing related to left ventricular (LV) mass and myocardial fibrosis. Purpose: We investigated the relationship between EAT thickness and cardiac remodeling after ST segment elevation myocardial infarction (STEMI) treated by primary angioplasty. Methods: We consecutively enrolled 100 patients with STEMI undergone primary coronary angioplasty. At the admission and at 3 months after STEMI patients underwent complete clinical and echocardiographic examination with EAT thickness measurement. We also measure EAT thickness in 30 control subjects. Results. At 3 months we obtained the follow-up (fu) of 93 patients. The mean basal EAT thickness value (10,4±3,6 mm) was significantly higher than in controls subjects (5,2±2,6) (p<0.001). Of interest after STEMI we assisted to an EAT remodelling. Relative change of EAT was significantly correlated to LV-end diastolic volume (LVEDV) (p=0.003); LV-end systolic volume (LVESV) (p= 0.023) and ejection fraction (EF) (p= 0.032). We divided patients into 3 groups: 1.increased EAT at fu; 2.Unchanged EAT at fu; 3.diminished EAT at fu. Interestingly, the three groups were different in LVEDV (1= 103.17±27.9, 2= 83.39 ± 15.5, 3= 95.7±33.2; p=0.016) and in LVESV (1= 48.9±21, 2= 36.12 ± 10.3, 3= 47.4±24.3; p=0.030). A significant increase in EAT thickness after STEMI was associated to higher risk of MACE at a 20 months follow-up, although did not reach significance (O.R 2.8 vs O.R. 2.33). Conclusions: After STEMI, EAT remodelling is associated to LV remodelling, expressed by LV volumes and ejection fraction. Longer follow-up is required to establish the prognostic impact of EAT in a such high risk population. P1174New classification of geometric patterns in severe aortic stenosis: could it be clinically useful? C Di Nora C Di Nora 1University Hospital Riuniti, Trieste, Italy E Cervesato E Cervesato 2Santa Maria degli Angeli Hospital, Cardiologia, Pordenone, Italy I Cosei I Cosei 3Institute of Cardiovascular Diseases Prof. C.C. Iliescu, Bucharest, Romania A Ravasel A Ravasel 3Institute of Cardiovascular Diseases Prof. C.C. Iliescu, Bucharest, Romania B A Popescu B A Popescu 3Institute of Cardiovascular Diseases Prof. C.C. Iliescu, Bucharest, Romania C Zito C Zito 4University of Messina, Cardiologia, Messina, Italy S Carerj S Carerj 4University of Messina, Cardiologia, Messina, Italy F Antonini-Canterin F Antonini-Canterin 5Ospedale Riabilitativo, Cardiologia Riabilitativa, Motta di Livenza, Italy 1University Hospital Riuniti, Trieste, Italy 2Santa Maria degli Angeli Hospital, Cardiologia, Pordenone, Italy 3Institute of Cardiovascular Diseases Prof. C.C. Iliescu, Bucharest, Romania 4University of Messina, Cardiologia, Messina, Italy 5Ospedale Riabilitativo, Cardiologia Riabilitativa, Motta di Livenza, Italy Background: Recently, a new more detailed classification of left ventricular (LV) geometric patterns has been proposed to overcome the limitation of the 4 classical categories, which were based upon LV mass index (LVMi) and relative wall thickness (RWT), in describing LV geometry. There is little information about the role of this new classification, which takes into account also the LV volume index (LVVi), in patients (pts) with severe aortic stenosis (AS). Purpose: The aim of the study was to describe the prevalence of the newly proposed remodeling patterns in pts with severe AS and their clinical relevance in terms of association with symptoms. Methods: A series of 376 consecutive pts with severe AS was evaluated by transthoracic echocardiography. There were 201 (54%) men, mean age 74 ± 9 years; 271 (72%) were hypertensive pts. Mean LV ejection fraction was 55 ± 10%, peak aortic jet velocity 4.4 ± 0.7 m/s, and mean aortic gradient 46 ± 15 mm Hg. According to LVVi (cut-off value 75 ml/m2), LVMi (cut-off value 115 g/m2 in men and 95 g/m2 in women) and RWT (cut-off values 0.32-0.42), pts were classified into 7 geometric patterns (physiologic hypertrophy pattern, which overlaps with dilated hypertrophy, was excluded in the context of severe AS). There were 224 (60%) symptomatic pts (angina or syncope or NYHA class III-IV). Results: The prevalence of remodeling patterns was: 196 pts (52%) had concentric hypertrophy, 89 pts (24%) had mixed hypertrophy, 40 pts (11%) had dilated hypertrophy, 9 pts (2%) had concentric remodeling, 8 pts (2%) had eccentric hypertrophy and 5 pts (1%) had a normal pattern. 29 pts (8%) could not be classified according to this new classification. Asymptomatic pts had in 55% of cases concentric hypertrophy, 16% mixed hypertrophy and 29% had other types of remodeling. In the symptomatic group 50% had concentric hypertrophy, 29% mixed hypertrophy and 21% other types of remodeling (p=0.016). Only 5 pts had a normal LV geometry (4 of them being asymptomatic). Conclusions: Using the new classification of LV remodeling patterns, pts with severe AS had most often concentric hypertrophy and mixed hypertrophy, while a minority of pts had other types of LV geometry. Our data suggests that symptomatic patients had more mixed hypertrophy than asymptomatic patients. The new classification of geometric patterns of LV remodeling could be useful to stratify the prognosis of patients with severe AS. P1175Reclassification of low gradient severe aortic stenosis by direct planimetry of LVOT area at 3D-TTE P Caso P Caso 2 AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy 1Second University of Naples, Department of Internal Medicine, Naples, Italy 2 AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy L Ascione L Ascione 2 AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy R Ascione R Ascione 2 AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy A Ferro A Ferro 2 AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy C Sordelli C Sordelli 2 AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy S Severino S Severino 2 AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy G Palmiero G Palmiero 1Second University of Naples, Department of Internal Medicine, Naples, Italy M Cavallaro M Cavallaro 2 AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy G Carlomagno G Carlomagno 2 AO dei Colli-Monaldi Hospital, Department of Cardiology, Naples, Italy Background: Aortic Valve Stenosis (AVS) severity is defined by aortic valve area (AVA) < 1cm2 in association with mean pressure gradient (MPG) ≥ 40 mmHg. Discrepancy between a severely reduced AVA and MPG is frequently encountered in clinical practice among patients with normal LVEF. In these patients the AVS is classified as a Low Flow-Low Gradient paradoxical (paradoxical LF-LG) or a Normal Flow-Low Gradient (NF-LG) form, according to measured indexed stroke volume (LF defined as indexed SV < 35 mL/m2). This discrepancy may be due to the assumption of a circular shape of LVOT, which actually has an elliptic shape, as shown by CT and 3D-TEE. Aims: Aim of this study is to test the effect of the direct measure of LVOT area, obtained by 3D-TTE, on AVS classification. Methods: 64 patients with a new diagnosis of aortic valve stenosis and LVEF > 50% were enrolled and both TTE and TEE were performed in all of them. At TTE: the AVA was calculated by traditional continuity (AVA-trad) equation, with LVOT area, calculated from its diameter, measured on parasternal long axis view. At TEE: a 3D dataset, including aortic valvular complex and LVOT, was obtained and a direct planimetry of LVOT was performed offline. Then the last was used in continuity equation to estimate the AVA (AVA-3D). Results: 14 of 64 patients (22% of total) were excluded because of inadequate image quality. Analysis was performed on the remaining 50 patients (mean age 76,5 ± 8,42 yrs, 58% male) and 41 patients had AVA trad<1 cm². Mean LVOT-3D was higher than mean LVOT-trad (3,916 ± 0,530 cm² vs 2,983 + 0,669 cm², p< 0,001). As expected, mean AVA-3D was greater than AVA-trad (1,029 ± 0,333 cm² vs 0,783 ± 0,260 cm² p<0,001). Both AVA-trad and AVA-3D had a significant correlation with MPG (r=0,684 and r=0,739 respectively, p<0,001 for both). Among the 41 patients with severe AS by AVA-trad, according to AVA-3D: 19/20 patients with NF-HG/LF-HG remained in the same category, 5/8 patients with LF-LG and 12/13 with NF-LG were reclassified as non severe AS. Conclusions: The 3D-TTE derived functional AVA allowed to reclassify AS severity in 81% (17/21) of patients with discrepant AVA-trad and MPG (LF-LG or NF-LG). P1176Left ventricular geometry and function in patients with anemia and aortic stenosis R Siliste R Siliste Coltea Clinical Hospital, Bucharest, Romania R Mihalcea R Mihalcea Coltea Clinical Hospital, Bucharest, Romania E Rizea E Rizea Coltea Clinical Hospital, Bucharest, Romania C Homentcovschi C Homentcovschi Coltea Clinical Hospital, Bucharest, Romania R Ianula R Ianula Coltea Clinical Hospital, Bucharest, Romania A Gurghean A Gurghean Coltea Clinical Hospital, Bucharest, Romania I Savulescu I Savulescu Coltea Clinical Hospital, Bucharest, Romania D Spataru D Spataru Coltea Clinical Hospital, Bucharest, Romania Coltea Clinical Hospital, Bucharest, Romania Background and aims: Anemia is a common finding in patients with aortic stenosis and its presence was independently associated with increased all-cause mortality. The objective of the study is to investigate if there is any correlation of anemia (defined as hemoglobin concentration of <12 g/dl in women and 13 g/dl in men) with the severity of the disease, as well as LV function and geometry changes in patients with aortic stenosis (AS). Material and methods: 85 patients with aortic stenosis admitted in Cardiology Unit during the last 4 years were included; mean age of the entire cohort was 76.85±8.71 years, 40% with severe aortic stenosis and 60% with mild/moderate aortic stenosis, 55% female. Patients with malignancy, end-stage renal disease, acute coronary syndrome, previous MI or other severe valvular disease, as well as patients with a specific etiology of anemia (assessed by superior and inferior digestive endoscopy and additional hematological tests) were excluded. Results: The mean hemoglobin (Hb) level was 12.18 ± 2.47 g/dL, and the prevalence of anemia in the overall group was 42%. The prevalence of anemia was higher in women (66%), in older patients (mean age of pts. with anemia was 80±5.3 years vs. 72±7 years in pts. without anemia) and in patients with higher Charlson comorbidity index. Hemoglobin level was correlated neither with severity of AS, nor with the LV mass (r=0,002, p=0.023), RWT (r=0,125, p=0.001) or LV diameter (r=0,027, p=0,023). A low Hb level was correlated to lower ejection fraction (r=0,67, p=0.05) and higher diastolic filling pressure (E/e’>12 in 45% patients with anemia vs. 30% patients without anemia, p=0.001). Conclusion: Anemia have a high prevalence in patients with AS, but its presence is not correlated to the severity of disease (according to the valvular area estimation) or the presence of severe hypertrophy, but seems to be related to LV dysfunction and higher LV filling pressures. P1177Detection of severe mitral stenosis in the presence of heavy annular calcification R Ranjan R Ranjan Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America E J Friend E J Friend Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America V Figueredo V Figueredo Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America G S Pressman G S Pressman Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America Background: Mitral stenosis (MS) due to mitral annular calcification (MAC) is little studied though increasingly encountered as the population ages. Purpose: We sought to determine echocardiographic variables that could distinguish those with severe MS among a group with severe MAC. Methods: Electronic records of echocardiograms (inpatient and outpatient) performed between 06/07 – 06/16 were searched for the term "calcific mitral stenosis". Studies showing features of rheumatic disease were excluded as were those with a mitral valve area (MVA) >2.5 cm2. This left a study set of 57 subjects. Results: Mean age was 74.4 ± 12.3 years; 56 (66%) were female; 38 (45%) were White, 40 (47%) were Black. 36 patients (62%) had severe mitral stenosis defined as MVA <1.5 cm2 (by continuity equation). Mean MV gradient for the group ranged from 2 – 22 mm Hg with an average of 8 ± 3.6. Pressure half-time (PHT) was 130 ± 39.1 ms (range 59 – 244). MV Doppler was E-wave dominant (E-wave velocity > A-wave velocity) in 30 (30%). MVA by planimetry showed a fair correlation with MVA by continuity (r2 = 0.81). MVA by PHT showed a poor correlation with both, planimetry (r2 = 0.27) and continuity equation (r2 = 0.19). Using nominal logistic regression, E-wave dominance, mean MV gradient, and PHT were identified as significant independent predictors of severe MS. Area under the ROC curve for this model = 0.88. For E-wave dominant patients a combination of PHT >120 and mean MV gradient > 9 yielded an 91% likelihood of severe MS. For A-wave dominant patients, a combination of PHT >150 and mean MV gradient > 10 yielded an 88% likelihood of severe MS. Conclusions: MS due to MAC is a unique clinical entity. PHT and planimetry cannot accurately discriminate severe MS in patients with this disorder. In fact, PHT is deceptively low in these patients. However, a combination of mean MV gradient and PHT (with different cutoffs for E-wave dominant vs A-wave dominant Doppler signals) can be used to identify the large majority of patients with severe MS (>90%). Open in new tabDownload slide Abstract P1177 Figure. Open in new tabDownload slide Abstract P1177 Figure. P1178Prognostic value of left ventricular strain imaging and Brain natriuretic peptide after percutaneous mitral balloon commissurotomy A Zaroui A Zaroui 1La Rabta Teaching Hospital, Tunis, Tunisia R Mechmeche R Mechmeche 2 tunis medicine faculty, tunis, Tunisia 1La Rabta Teaching Hospital, Tunis, Tunisia 2 tunis medicine faculty, tunis, Tunisia Aims: This study aimed (1) to evaluate the impact of preprocedural two-dimensional speckle-tracking echocardiography (2D-STE) on long-term outcome after successful percutaneous mitral balloon commissurotomy (PMC) in patients with mitral stenosis (MS) and the prognostic value on BNP for restenosis Methods: AND RESULTS: 122 consecutive MS patients with preserved left ventricular ejection fraction (LVEF ≥50%) and who underwent successfully PMC were studied. Successful immediate result was defined as post-procedural mitral valve area ≥1.5 cm2and ≤2/4 mitral regurgitation by catheterization. During a follow-up of 5.5 ± 2.3.0 years, there were 14 hospitalization for heart failure (11%) and 22 late mitralvalve reintervention for restenosis (18%) and 21 patients experienced atrial fibrillation(17%) . Univariate predictors of heart faillure were global longitudinal strain (GLS), age, right ventricular function, left atrial volume, BNP, and pre- and post-procedural pulmonary artery pressures (PAP). In the multivariate Cox model, GLS and PAP were the strongest predictor of HF [hazard ratio (HR) (95% CI), 1.56 (1.03-4.2); P= 0.01 and 1.26 (1.1-12.4); P= 0.02 ]. For atrial fibrillation and restenosis, LA volume, GLS and post-procedural left atrial pressure (LAP) were univariate predictors factors. multivariable analysis, demonstrated that GLS and LA volume remained in the final model with interesting predictive value [GLS HR (95% CI), 1.27 (0.87-11.72); P= 0.056, 2.66 (1.24- 12.44); P= 0.01 ]. There was no correlation between BNP value and restenosis. Conclusion: GLS and PAP are interesting predictor of long-term outcome after successful PMC and provides incremental prognostic value over traditional parameters. BNP and LA volume provide more informations regarding supra ventricular arythmia on the follow up . P1179Prognostic value of left atrial strain in patients with rheumatic mitral stenosis A Lourenco A Lourenco Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal F A Castro F A Castro Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal O Azevedo O Azevedo Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal M Lourenco M Lourenco Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal L Calvo L Calvo Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal M Oliveira M Oliveira Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal M Fernandes M Fernandes Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal S Leite S Leite Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal I Oliveira I Oliveira Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal Introduction: Rheumatic mitral stenosis (RMS) carries a high risk of cardiovascular (CV) events. The prognostic value of atrial strain parameters is not established in patients with RMS. Aim: To assess left atrial (LA) function using strain analysis by speckle tracking in patients with RMS. To evaluate the usefulness of LA strain for the prediction of adverse CV events in patients with RMS. Methods: We included 44 patients with mild to severe RMS, in sinus rhythm. All subjects underwent transthoracic echocardiogram, including evaluation of PALS (Peak atrial longitudinal strain), PACS (Peak atrial contraction strain) and LA contraction strain index (CSI - ratio (PACS/PALS) x100) by speckle tracking. PALS was measured at the end of the reservoir phase and PACS was measured just before the start of the active atrial contractile phase. The averages of PALS and PACS were obtained from the 12 LA segments at apical 4 and 2-chamber views. Demographic data, clinical and electrocardiographic findings were collected to identify predictors of prognosis. We defined a combined endpoint of CV events, composed by atrial fibrillation, percutaneous valvuloplasty, mitral valve replacement and pulmonar hypertension. Results: Patients were predominantly females (86,4%), with mean age of 59±12 years and a low PALS (17.5 ± 7.3) and PACS (9.5±4.9). Hospitalization occurred in 25% of cases. Mitral valve replacement was performed in 11,4% of cases. Pulmonary hypertension developed in 27,3% of patients and atrial fibrillation in 20,5%. The combined endpoint of CV events occurred in 31.8% of cases. Multivariate regression analysis identified PACS as an independent predictor of the combined endpoint of CV events (p=0,013), but also of hospitalization (p=0,039), pulmonary hypertension (p=0,022) and atrial fibrillation (p=0.024). The cut-off values of PACS that were found to predict CV events, hospitalization, pulmonary hypertension and atrial fibrillation were, respectively, 7,8 (p=0,013 AUC 0.68),7,5. (p=0,039 AUC 0.70), 7,8 (p=0,022 AUC 0.73) and 6,4 (p=0,024 0.75). Conclusion: In this study, PACS was an important independent predictor of CV events in patients with RMS. P1180Novel echocardiographic tool to predict mitral stenosis severity in degenerative mitral stenosis Z Khan Z Khan Ochsner Clinic Foundation, Cardiology, New Orleans, United States of America R Reihl R Reihl Ochsner Clinic Foundation, Cardiology, New Orleans, United States of America A Oktay A Oktay Ochsner Clinic Foundation, Cardiology, New Orleans, United States of America V Chainani V Chainani Ochsner Clinic Foundation, Cardiology, New Orleans, United States of America M E Cash M E Cash Ochsner Clinic Foundation, Cardiology, New Orleans, United States of America D Morin D Morin Ochsner Clinic Foundation, Cardiology, New Orleans, United States of America Y E Gilliland Y E Gilliland Ochsner Clinic Foundation, Cardiology, New Orleans, United States of America S Qamruddin S Qamruddin Ochsner Clinic Foundation, Cardiology, New Orleans, United States of America Ochsner Clinic Foundation, Cardiology, New Orleans, United States of America Background: Degenerative Mitral stenosis (DMS) is a poorly understood entity. Purpose: To understand the relationship between Mitral valve area (MVA) and mean Trans-mitral gradient (TMG) and to evaluate a novel dimensionless index: left ventricular outflow tract (LVOT)/ MV velocity-time-integral (VTI) ratio, to evaluate stenosis severity in DMS. Methods: Adult patients with DMS and a mean TMG of ≥4 mmHg were included. Pts. with tachycardia, more then mild mitral and aortic regurgitation, and more then mild aortic stenosis were excluded. MVA by continuity equation (CEQ) was calculated. Results: 47 patients (77±12 yrs., 23% males) were studied. There was a weak correlation between MVA by CEQ and mean TMG (r2=0.32, p-0.03). However, the LVOT/MV VTI ratio was very strongly correlated with MVA by CEQ (r2=0.9, p=0.0001).ROC curve (Figure) showed an LVOT/MV VTI ratio cut-off value of 0.48 can predict severe stenosis (MVA ≤1.5 cm2) with 90% sensitivity and 90% specificity (AUROC=0.96). Conclusion: Mean TMG does not correlate strongly with MVA and may not be a reliable predictor of severity of stenosis in DMS. Contrarily, dimensionless index of the mitral valve, the ratio of LVOT to MV VTI, is a strong predictor of MVA in DMS. Echocardiographic Variables . DMS (n=47) . LVEF(%) 59 ± 11 Mean TMG (mmHg) 7±2 Peak TMC (mmHG) 16±5 Heart rate (bmp) 72±13 E Velocity (cm/s) 1.7±0.4 Dec Time (msec) 400±138 LVOT Diameter (cm) 1.9±0.1 LVOT VTI (cm) 24±6 MV VTI (cm) 58±20 MVA CEQ (cm2) 1.3±0.4 LVOT/MV VTI ratio 0.44±0.13 Echocardiographic Variables . DMS (n=47) . LVEF(%) 59 ± 11 Mean TMG (mmHg) 7±2 Peak TMC (mmHG) 16±5 Heart rate (bmp) 72±13 E Velocity (cm/s) 1.7±0.4 Dec Time (msec) 400±138 LVOT Diameter (cm) 1.9±0.1 LVOT VTI (cm) 24±6 MV VTI (cm) 58±20 MVA CEQ (cm2) 1.3±0.4 LVOT/MV VTI ratio 0.44±0.13 Table. Baseline Echocardiographic Characteristics DMS, degenerative mitral stenosis; LVEF, left ventricular ejection fraction; TMG, transmitral gradient; Dec, Deceleration; LVOT, left ventricular outflow tract; VTI, velocity time integral; MV Mitral valve; MVA, mitral valve area; CEQ, continuity equation. Echocardiographic Variables . DMS (n=47) . LVEF(%) 59 ± 11 Mean TMG (mmHg) 7±2 Peak TMC (mmHG) 16±5 Heart rate (bmp) 72±13 E Velocity (cm/s) 1.7±0.4 Dec Time (msec) 400±138 LVOT Diameter (cm) 1.9±0.1 LVOT VTI (cm) 24±6 MV VTI (cm) 58±20 MVA CEQ (cm2) 1.3±0.4 LVOT/MV VTI ratio 0.44±0.13 Echocardiographic Variables . DMS (n=47) . LVEF(%) 59 ± 11 Mean TMG (mmHg) 7±2 Peak TMC (mmHG) 16±5 Heart rate (bmp) 72±13 E Velocity (cm/s) 1.7±0.4 Dec Time (msec) 400±138 LVOT Diameter (cm) 1.9±0.1 LVOT VTI (cm) 24±6 MV VTI (cm) 58±20 MVA CEQ (cm2) 1.3±0.4 LVOT/MV VTI ratio 0.44±0.13 Table. Baseline Echocardiographic Characteristics DMS, degenerative mitral stenosis; LVEF, left ventricular ejection fraction; TMG, transmitral gradient; Dec, Deceleration; LVOT, left ventricular outflow tract; VTI, velocity time integral; MV Mitral valve; MVA, mitral valve area; CEQ, continuity equation. Open in new tabDownload slide Abstract P1180 Figure. Receiver operating Characteristic Curve Open in new tabDownload slide Abstract P1180 Figure. Receiver operating Characteristic Curve P1181Role of exercise echocardiography in rheumatic mitral stenosis D R A Elremisy D R A Elremisy Cairo University, Cardiovascular, Cairo, Egypt M H Samaan M H Samaan Cairo University, Cardiovascular, Cairo, Egypt G Y Elsayed G Y Elsayed Cairo University, Cardiovascular, Cairo, Egypt W M Elnaggar W M Elnaggar Cairo University, Cardiovascular, Cairo, Egypt E Baleigh E Baleigh Cairo University, Cardiovascular, Cairo, Egypt Cairo University, Cardiovascular, Cairo, Egypt Background: Rheumatic mitral valve stenosis continues to be a challenge in Egypt. Most of our patients are symptomatic females even with a mild-moderate degree of mitral valve stenosis. The trend in our country is more towards managing these patients conservatively with medical treatment till they develop a more severe degree of stenosis. Purpose: is to determine the role of exercise echocardiography in determining dynamic changes in mitral stenosis and to identify high risk patients who may benefit from early intervention particularly in disproportionately symptomatic patients with mild-moderate mitral stenosis (MS). Methodology: thirty five patients, mean age of (41.6 y ±12.7) with pure rheumatic non-tight MS, 17 (48.6%) had atrial fibrillation (A.F). All patients with pure MS were studied by Doppler echocardiography, both during rest and immediately post a symptom-limited exercise test. Mean trans-mitral gradient (MPG) and the estimated pulmonary artery systolic pressure (PASP) were documented. Results: The mean resting MPG was (8.59 mmHg ±3.4 SD) and the mean resting PASP was (41.54 mmHg ±9.12 SD). The mean value of post exercise MPG was (14.34 mmHg ±4.15 SD) which was significantly correlated to mitral valve area (MVA) (p value 0.002) and was significantly correlated to the Wilkins score (p value 0.032). The mean value of post exercise PASP was (58.34 mmHg ±11.79 SD) which was less significantly correlated to MVA (p value 0.051) and was significantly correlated to the mean age (p value 0.006). Patients with AF, whatever MVA was, had significant correlation with post exercise high PASP ( p value 0.012) with mean post exercise PASP( 63.53 mmHg) and a significant correlation with high MPG( p value 0.001) with mean post exercise MPG (16.52 mmHg).It is worth mentioning that eight patients with MVA between 1.5- 1.7 cm2 developed during exercise an increase in the MPG < 10 mmHg in 87.5% (7 patients) and an increase in PASP ≥ 60 mmHg in 75.0% (6 patients). According to these results a change in the treatment strategy was considered in those patients with a MVA between 1.5-1.7 cm2. Conclusion: This study showed that exercise echo can have an important role in the clinical decision-making of challenging patients with MV disease. In older patients particularly in presence of AF, early intervention may be considered. Exercise echocardiography had an additional value to the treatment strategy in at least 75% of the patients with a MVA less than 1.7 cm2/BSA. P1182Comparison of mitral valve area calculated by pressure half time, planimetry and continuity equation in patients with calcific mitral stenosis R Ranjan R Ranjan Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America E J Friend E J Friend Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America R Sinha R Sinha Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America V Figueredo V Figueredo Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America G S Pressman G S Pressman Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America Albert Einstein Medical Center, Cardiology, Philadelphia, United States of America Background: Assessment of mitral valve area (MVA) is a critical component in determining the severity of mitral stenosis (MS). Methods used routinely to assess the MVA during echocardiography are pressure half time (PHT), planimetry and continuity equation. Although, validated in MS of rheumatic origin the validity and accuracy of these methods in evaluation of degenerative MS due to annular calcification is not known. Purpose: The aim of our study was to compare MVA estimated by PHT, planimetry and continuity equation in patients with degenerative MS caused by mitral annular calcification (MAC). Methods: We retrospectively reviewed echocardiograms of 84 patients with moderate-severe MAC and calculated MVA using PHT, planimetry and continuity equation. We also calculated atrioventricular compliance (Cn), measured mitral inflow (E and A wave) velocities and peak and mean pressure gradients across the MV. Note was also made of left ventricular (LV) size, systolic and diastolic function, left atrial size, pulmonary artery pressure, other valvular lesions and over all cardiac calcium score. Results: Of the 84 subjects (males= 55, females=29; mean age 74 ± 12 years) 49 (59 %) had severe MS (MVA <1.5 cm2) by continuity equation. The average PHT was 121.2 ± 38.7 msec (range 52 - 245), peak transvalvular velocity was 1.9 ± 1.3 m/sec (range 0.6 - 3.4) and peak and mean transvalvular pressure gradients were 16.2 ± 8.2 and 6.7 ± 4.2 mm Hg, respectively. Forty-two patients had aortic stenosis (mild in 16, moderate in 10 and severe in 16) and six had prosthetic aortic valve. There was a strong correlation between the MV calculated by planimetry and continuity equation (r² = 0.81). However, the correlation between the MVA calculated by PHT and planimetry (r² = 0.27) and PHT and continuity equation was poor (r² = 0.19). The MVA calculated using PHT was larger than the other two methods in 78% of patients. Conclusion(s): Our study indicates that PHT is unreliable and inaccurate in assessment of MVA in calcific MS. In fact, PHT is erroneously low and overestimates the valve area in most of these patients (78%). We advocate the use of planimetry in conjunction with continuity equation for assessment of MVA in patients with calcific MS. Open in new tabDownload slide Abstract P1182 Figure. Comparison of mitral valve area Open in new tabDownload slide Abstract P1182 Figure. Comparison of mitral valve area P1183Value of atrial strain as a an estimate of rheumatic mitral stenosis severity F A Castro F A Castro Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal M Lourenco M Lourenco Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal O Azevedo O Azevedo Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal B Faria B Faria Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal I Oliveira I Oliveira Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal A Lourenco A Lourenco Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal Introduction: Rheumatic mitral stenosis (RMS) causes left atrial (LA) geometrical changes, due to an increased pressure and volume, and, consequently, deterioration of its systolic function. LA strain analysis by speckle tracking emerges as a gold standard for evaluation of atrial myocardial deformation, particularly PALS (peak atrial longitudinal strain), PACS (peak atrial contraction strain) and LA CSI (contraction strain index). In patients with rheumatic mitral stenosis, PALS and PACS are significantly reduced. Aim: Assess LA function, using PALS, PACS and CSI, in patients with RMS and its relationship with the severity of the RMS. Methods: We included 44 patients with mild to severe RMS, in sinus rhythm. All subjects underwent transthoracic echocardiogram, including evaluation of maximum and medium gradients, anatomical valve area and pressure half time (PHT) and continuity equation. PALS (Peak atrial longitudinal strain), PACS (Peak atrial contraction strain) and LA contraction strain index (CSI - ratio (PACS/PALS) x100) were obtained by speckle tracking. PALS was measured at the end of the reservoir phase and PACS was measured just before the start of the active atrial contractile phase. The average of PALS and PACS were obtained from the 12 LA segments at apical 4 and 2-chamber views. Results: Patients were predominantly female (86,4%), with mean age of 59±12 and a low PALS (17.5 ± 7.3) and PACS (9.5±4.9). Maximum and medium gradients were 13.2±7 mmHg and 5.8 ± 4.3 mmHg, respectively. Functional mitral valve area, by PHT was 1.6 ± 0.4 cm2 and by continuity equation was 1.5 ± 0.4 cm2. Mean anatomic mitral valve area was 1.6 ± 0.5 cm2. Medium and maximum gradients and anatomic mitral valve area were correlated with LA CSI (p=0,017 r=0,36; p=0,019 r=0,035; p=0,032 r=0,44, respectively), but not with PALS and PACS (P>0,05). Functional valve area by PHT was correlated with PALS (p=0,03 r=0,44) and by continuity equation was correlated with PALS and PACS (p=0,00 r=0,60; p=0.026 r=0,38, respectively). Conclusion: Atrial strain parametres correlate with the severity of RMS. P1184The role of echocardiography in identifying patients with tricuspid regurgitation suitable for percutaneous intervention: experience at a tertiary teaching hospital Z H Teoh Z H Teoh King's College Hospital, Department of Cardiology, London, United Kingdom J Roy J Roy King's College Hospital, Department of Cardiology, London, United Kingdom J Byrne J Byrne King's College Hospital, Department of Cardiology, London, United Kingdom M Monaghan M Monaghan King's College Hospital, Department of Cardiology, London, United Kingdom King's College Hospital, Department of Cardiology, London, United Kingdom Introduction: Moderate to severe tricuspid regurgitation is associated with increased mortality and morbidity. Unsurprisingly, there has been a growing interest in the treatment of tricuspid regurgitation. This coincides with the emergence of several percutaneous interventions aimed at treating tricuspid regurgitation. However, they have often only been trialed in a small number of patients. Purpose: Using standard transthoracic echocardiography(TTE), we identified and opportunistically screened for patients with moderate-to-severe tricuspid regurgitation who would be suitable for percutaneous intervention eg Trialign or edge-to-edge clipping. Methods: Patients who had transthoracic echocardiography(TTE) performed in our College Hospital between 1st January 2016 to 31st December 2016 were screened for moderate-to-severe tricuspid regurgitation. The severity of tricuspid regurgitation was graded using quantitative criteria and assessed independently by accredited echocardiographers. Patients with previous tricuspid valve repair or replacement were excluded. Results: In total, over a 1-year period, 330 patients with moderate-to-severe tricuspid regurgitation were identified. The median age was 77. 196(59%) patients were female. 21(6%) had previous mitral valve surgery, 31(9%) had previous aortic valve surgery and 6(2%) had both previous aortic and mitral valve surgery. Within this cohort, 210*(74%) had right ventricular systolic pressures <=60mmHg. 215**(80%) had TAPSE >=13mm. In regard to left-sided heart function, 252***(77%) having left ventricular ejection fraction >35%. 9(3%) patients had significant mitral and aortic valvular pathology, whilst 88(27%) patients had significant isolated mitral valve pathology and 18(6%) patients had significant isolated aortic valve pathology***. Based on these echocardiographic findings, 85(26%) patients would potentially be eligible for a percutaneous tricuspid valve annuloplasty procedure (eg Trialign or edge-to-edge clipping), which has been shown in previous studies to be feasible and improve left ventricular systolic function and quality of life. Conclusion: Using the transthoracic echocardiography(TTE) service in a Tertiary Teaching Hospital as a screening tool, we identified a large number (330) of patients in one year with moderate-to-severe tricuspid regurgitation, of whom one quarter would be eligible for percutaneous tricuspid valve intervention. A similar approach could be easily replicated at other tertiary hospitals and potentially transform the management of patients with tricuspid regurgitation in the future. * RVSP was not available in 47 patients **TAPSE not measured in 61 patients ***EF unclear in 4 patients ***MV and/or AV not commented on in 6 patients P1185The role of protein z and protein z-dependent protease inhibitor polymorphisms in the development of prosthetic heart valve thrombosis S Karakoyun S Karakoyun 1Kars Kafkas University, Cardiology, Kars, Turkey M O Gursoy M O Gursoy 2Gaziemir State Hospital, Cardiology, Izmir, Turkey M Kalcik M Kalcik 3Hitit University Çorum Training and Research Hospital, Cardiology, Çorum, Turkey M Yesin M Yesin 4Kars Harakani State Hospital, Cardiology, Kars, Turkey S Gunduz S Gunduz 5Kosuyolu Kartal Heart Training and Reserch Hospital, Cardiology, istanbul, Turkey Z Bayram Z Bayram 5Kosuyolu Kartal Heart Training and Reserch Hospital, Cardiology, istanbul, Turkey B Cakal B Cakal 6Medipol University Faculty of Medicine, Cardiology, Istanbul, Turkey S Cersit S Cersit 5Kosuyolu Kartal Heart Training and Reserch Hospital, Cardiology, istanbul, Turkey E Bayam E Bayam 5Kosuyolu Kartal Heart Training and Reserch Hospital, Cardiology, istanbul, Turkey A Guner A Guner 5Kosuyolu Kartal Heart Training and Reserch Hospital, Cardiology, istanbul, Turkey S Kalkan S Kalkan 5Kosuyolu Kartal Heart Training and Reserch Hospital, Cardiology, istanbul, Turkey M Ozkan M Ozkan 7Ardahan University, Division of Health Sciences, Ardahan, Turkey 1Kars Kafkas University, Cardiology, Kars, Turkey 2Gaziemir State Hospital, Cardiology, Izmir, Turkey 3Hitit University Çorum Training and Research Hospital, Cardiology, Çorum, Turkey 4Kars Harakani State Hospital, Cardiology, Kars, Turkey 5Kosuyolu Kartal Heart Training and Reserch Hospital, Cardiology, istanbul, Turkey 6Medipol University Faculty of Medicine, Cardiology, Istanbul, Turkey 7Ardahan University, Division of Health Sciences, Ardahan, Turkey Background: Protein Z (PZ) is a vitamin K dependent factor, which is synthesized mainly by the liver. It acts as an activator of a serpin, the protein Z dependent inhibitor (ZPI), which inhibits factor Xa. The potential role of alterations in protein Z and/or ZPI levels in the pathogenesis of thrombotic and/or haemorrhagic diseases has been previously investigated in several studies which demonstrated conflicting findings. In this study; we aimed to evaluate the role of PZ/ZPI polymorphism in the development of prosthetic valve thrombosis (PVT). Methods: Our study was a prospective, observational and cross-sectional study which included 50 consecutive patients with PVT (non-obstructive thrombosis (NOT) in 35 ; obstructive thrombosis (OT) in 15 patients) and 50 consecutive healthy subjects with normally functioning prosthesis. We extracted gDNA from approximately 5 × 106 leukocytes with the QIAamp DNA Mini Kit (QIAGEN) according to the manufacturer's recommendations. For mutational analysis, minisequencing method was performed. The results of the analyses were compared between PVT and control group and also between OT and NOT subgroups. Results: The frequency of A allele (mutant type) of PZ-G79A was equal in all patients with PVT and control subjects. Regarding PZ-A13G polymorphism the frequency of mutant G allele was 22 % in PVT group and 19 % in control subjects. The Serpina-R67X polymorphism was observed in 8% of PVT group and 6% of the controls. Normal variant CC was present in 47(94 %) control subjects, whereas heterozygotic mutation (CT) was detected in 4 (8%) patients with PVT. The ZPI-r67x mutation was significantly higher in patients with OT than those with NOT (p=0.041). Conclusion: This is the first study that has evaluated the potential impact of PZ (PZ-A13G, PZ-G79A) and ZPI (R-67X, W303X) polymorphisms in the development of PVT. Based on the findings of this small observational case-control study, PZ/ZPI polymorphisms do not seem to play any role in the development of PVT necessitating further extensive studies. P1188Multimodality imaging for treatment optimization in prosthetic mitral valve dysfunction S Ghulam Ali S Ghulam Ali Centro Cardiologico Monzino IRCCS, Milan, Italy G Tamborini G Tamborini Centro Cardiologico Monzino IRCCS, Milan, Italy V Mantegazza V Mantegazza Centro Cardiologico Monzino IRCCS, Milan, Italy L Salvi L Salvi Centro Cardiologico Monzino IRCCS, Milan, Italy M Agrifoglio M Agrifoglio Centro Cardiologico Monzino IRCCS, Milan, Italy F Alamanni F Alamanni Centro Cardiologico Monzino IRCCS, Milan, Italy P Montorsi P Montorsi Centro Cardiologico Monzino IRCCS, Milan, Italy M Pepi M Pepi Centro Cardiologico Monzino IRCCS, Milan, Italy Centro Cardiologico Monzino IRCCS, Milan, Italy M Muratori M Muratori Centro Cardiologico Monzino IRCCS, Milan, Italy M Mapelli M Mapelli Centro Cardiologico Monzino IRCCS, Milan, Italy L Fusini L Fusini Centro Cardiologico Monzino IRCCS, Milan, Italy G Teruzzi G Teruzzi Centro Cardiologico Monzino IRCCS, Milan, Italy P Gripari P Gripari Centro Cardiologico Monzino IRCCS, Milan, Italy Background: Prosthetic Mitral Valve Dysfunction (PMVD), i.e. Prosthetic Mitral Valve Thrombosis/Pannus (PMVT/P) or Paravalvular Mitral Prosthetic Leak (PMPL), is a significant cause of morbidity and mortality that can complicate mitral valve replacement with mechanical single (SL) or bileaflets (BL) prosthesis. The differential diagnosis between PMPL or PMVT, based on clinical presentation may be challenging, but it is needed in order to select the optimal treatment. Furthermore, in case of PMVT, there is no consensus about what is preferable between thrombolysis therapy (TT) and surgical therapy (ST). Therefore a multimodality imaging approach, integrating transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) and fluoroscopy (F), is mandatory to define a correct therapeutic pathway. Purpose: The aim of this study was to determine TTE, TEE and F parameters allowing to define the proper therapy for PMVD treatment. Methods: One hundred forty-four consecutive patients (63±11years, 112 female; 30 SL, 114 BL) with suspected PMVD (NYHA > 2, embolic events or infective-like disease) were enrolled in the study. In all patients TTE, F and TEE were performed within 2 days after the admission to the hospital. PMPL diagnostic criteria were: (1) normal leaflet/s motion at F, (2) Peak Mitral Velocity > 1.9 m/sec, Mean gradient > 5 mmHg, PHT < 130 msec and VTIPrMV/VTILVO > 2.2 at TTE, (3) echo-free space close to the sewing ring, location and severity of mitral regurgitation at TEE. PMVT diagnostic criteria were: (1) leaflet/s restriction at F, (2) Peak Mitral Velocity > 2 m/sec, Mean gradient > 6 mmHg, PHT > 130 msec and VTIPrMV/VTILVO > 2.5 at TTE, (3) identification of prosthetic mass at TEE. In PMVT patients, TT was carried out when prosthetic mass size was < 0.8 cm2 and soft-echo density at TEE excluded pannus. ST was carried out in all other cases. Results: F, TTE and TEE demonstrated PMVD in 74 patients (34 PMPL and 40 PMVT). In PMPL group, 23 patients (68%) underwent ST with a mortality rate of 13%, while 11 patients were followed-up. PMPL was confirmed by the surgical inspection in all cases. In PMVT group, 16 patients (40%) underwent ST with a mortality rate of 6%. In all cases PMVT was confirmed by the surgeon. The remaining 18 patients (45%) underwent TT without major complications. A full success was achieved in 10 patients with disc/s motion and Doppler parameters normalization at F and TTE. In 5 patients, TT had partial success and in 3 was ineffective These 8 cases underwent ST with 25% mortality (2 out of 8 patients). Conclusions: A comprehensive multimodality approach, based on TTE, TEE, F is accurate in defining the mechanisms of PMVD and optimizes treatment. P1189Temporal trends and results of patients undergoing tricuspid valve replacement T Mendonca T Mendonca 1Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal A Valentim Goncalves A Valentim Goncalves 1Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal L M Branco L M Branco 1Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal A T Timoteo A T Timoteo 1Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal L Sousa L Sousa 1Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal J Abreu J Abreu 1Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal A Galrinho A Galrinho 1Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal I Rodrigues I Rodrigues 1Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal L C Miranda L C Miranda 2Hospital de Santa Marta, Department of Cardiothoracic surgery, Lisbon, Portugal N Banazol N Banazol 2Hospital de Santa Marta, Department of Cardiothoracic surgery, Lisbon, Portugal P Coelho P Coelho 2Hospital de Santa Marta, Department of Cardiothoracic surgery, Lisbon, Portugal J Fragata J Fragata 2Hospital de Santa Marta, Department of Cardiothoracic surgery, Lisbon, Portugal R C Ferreira R C Ferreira 1Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal 1Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal 2Hospital de Santa Marta, Department of Cardiothoracic surgery, Lisbon, Portugal Background: Tricuspid valve replacement is an infrequent procedure, indicated in patients with failed valve repair or with major valve destruction. Over time there have been changes in the patients who undergo tricuspid valve replacement. Whether the long-term results have improved is unknown. Purpose: To evaluate the characteristics of patients who required surgical tricuspid valve replacement and the results of the procedure in 2 different periods, 1986-1995 (P1) and 2003-2015 (P2), in a single center. Methods: Retrospective analysis of preoperative variables (gender, previous surgery, aetiology), surgical data (isolated or combined procedures) and re-operation rate, 30-day mortality, survival at 5 and 8 years. Preoperative and follow up data were obtained from hospital records, and follow up mortality from national database. Results: The study population consisted of 76 patients who underwent tricuspid valve replacement (42 in P1 and 34 in P2). All patients had biological prosthesis implanted. Mean follow-up was 54 ± 31 months in P1 and included 39 patients (93%). In P2 mean follow up was 59 ± 53 months and included 33 patients (97%). There was a higher incidence of combined procedures in P1 (85% versus 44.1%; p<0.01) and a trend towards younger age, higher female prevalence and rheumatic aetiology. There were no differences regarding the rate of previous cardiac surgery, rate of re operation during follow-up or 30-day mortality. However, mortality was higher during follow-up in P2 (23.1% versus 56%; p 0.009). 5 and 8-year survival was 78% and 63.6% in P1, 54.2% and 46.7% in P2, respectively. Conclusion: In the present time, tricuspid valve replacement is less frequent in patients with rheumatic valve disease than previously, which may explain the higher incidence of combined surgery and higher female prevalence in the first period. There were no differences in 30-day mortality between two different time periods, however long term survival remained poor, with a higher mortality in the most recent period with somehow different etiology and a trend to older population. P1190Transcatheter aortic valve implantation acutely improves left ventricular mechanical efficiency in an elderly population with degenerative calcific aortic valve stenosis G Binda G Binda Hospital Maggiore Della Carita, Cardiology, Novara, Italy A Panizza A Panizza Hospital Maggiore Della Carita, Cardiology, Novara, Italy I Bellacosa I Bellacosa Hospital Maggiore Della Carita, Cardiology, Novara, Italy E Micalizzi E Micalizzi Hospital Maggiore Della Carita, Cardiology, Novara, Italy C Monaco C Monaco Hospital Maggiore Della Carita, Cardiology, Novara, Italy M Commodo M Commodo Hospital Maggiore Della Carita, Cardiology, Novara, Italy A Bongo A Bongo Hospital Maggiore Della Carita, Cardiology, Novara, Italy G De Luca G De Luca Hospital Maggiore Della Carita, Cardiology, Novara, Italy P N Marino P N Marino Hospital Maggiore Della Carita, Cardiology, Novara, Italy Hospital Maggiore Della Carita, Cardiology, Novara, Italy Purpose: Metabolic energetic profile has been reported to improve after traditional aortic valve replacement through amelioration of left ventricular (LV) mechanical efficiency. The aim of the present study was to evaluate if transcatheter aortic valve implantation (TAVI) acutely affects mechanical efficiency immediately after TAVI. Metjods: A total of 40 patients (mean age, 79,4 ± 5,4 years) with symptomatic severe aortic stenosis underwent TAVI. A TEE was performed immediately before/after TAVI to measure pressure gradients, stroke volume and functional aortic valve area. Active and passive LV properties were quantified according to single-beat elastance algorithms which allow noninvasive estimation of the LV end-systolic pressure (ESP) and end-diastolic pressure (EDP) as obtained from E/é according to equation: EDP= 1.91 + (1.24 E/é). LV mechanical efficiency could then be computed in algorithms as external mechanical work/potential energy area ratio. Finally, valvuloarterial impedance (Zva) was determined as (aortic systolic pressure+mean gradient)/stroke volume index and LV meridional wall stress (∑) computed as 1.35*ESP*LVDs/4*STH*(1+(STH/LVDs)) where LVDs and STH are LV internal dimension and wall thickness, respectively, at end-systole. Results: Aortic valve area increased significantly (p<.001) after TAVI, concomitantly with a decrease in peak transvalvular gradient (p<.001) and no change in ventricular fractional shortening (%) (Table 1.). Mechanical efficiency significantly improved (p<.05) after TAVI. Periprocedural inotropes (8 patients) positively affected systolic elastance (Ees) changes after TAVI (interaction p=0.035). Conclusions: LV mechanical efficiency improves immediately after TAVI as what happens with AVA and transvalvular gradients. Such an effect seems to be mediated, at least in part, by concomitant pharmacological inotropic support. Table 1. . pre-TAVI . post-TAVI . p . Aortic area (cm2/m2) 0.43[0.32-0.47] 0.96[0.78-1.39] <0.001 Transvalvular gradient (mmHg) 49.0[32.6-63.3] 5.9[4.0-10.1] <0.001 Ventricular fractional shortening (%) 34[24-43] 35[27-42] 0.282 Efficiency (%) 46+7 59+23 <0.05 ∑ (g/cm2) 71.9[38.2-95.4] 50.0[28.2-80.2] <0.001 Ees (mmHg/ml) 2.47+2.36 3.42+3.67 0.07 Vo (ml) -28.1[-18.7- -6.06] -16.9[-11.5- -2.08] 0.239 Zva (mmHg/ml/cm) 3.99[3.14-5.31] 3.61[3.15-4.98] 0.372 . pre-TAVI . post-TAVI . p . Aortic area (cm2/m2) 0.43[0.32-0.47] 0.96[0.78-1.39] <0.001 Transvalvular gradient (mmHg) 49.0[32.6-63.3] 5.9[4.0-10.1] <0.001 Ventricular fractional shortening (%) 34[24-43] 35[27-42] 0.282 Efficiency (%) 46+7 59+23 <0.05 ∑ (g/cm2) 71.9[38.2-95.4] 50.0[28.2-80.2] <0.001 Ees (mmHg/ml) 2.47+2.36 3.42+3.67 0.07 Vo (ml) -28.1[-18.7- -6.06] -16.9[-11.5- -2.08] 0.239 Zva (mmHg/ml/cm) 3.99[3.14-5.31] 3.61[3.15-4.98] 0.372 ∑=meridional wall stress; Ees=systolic elastance; Zva=valvuloarterial impedance; Vo= LV volumes. Table 1. . pre-TAVI . post-TAVI . p . Aortic area (cm2/m2) 0.43[0.32-0.47] 0.96[0.78-1.39] <0.001 Transvalvular gradient (mmHg) 49.0[32.6-63.3] 5.9[4.0-10.1] <0.001 Ventricular fractional shortening (%) 34[24-43] 35[27-42] 0.282 Efficiency (%) 46+7 59+23 <0.05 ∑ (g/cm2) 71.9[38.2-95.4] 50.0[28.2-80.2] <0.001 Ees (mmHg/ml) 2.47+2.36 3.42+3.67 0.07 Vo (ml) -28.1[-18.7- -6.06] -16.9[-11.5- -2.08] 0.239 Zva (mmHg/ml/cm) 3.99[3.14-5.31] 3.61[3.15-4.98] 0.372 . pre-TAVI . post-TAVI . p . Aortic area (cm2/m2) 0.43[0.32-0.47] 0.96[0.78-1.39] <0.001 Transvalvular gradient (mmHg) 49.0[32.6-63.3] 5.9[4.0-10.1] <0.001 Ventricular fractional shortening (%) 34[24-43] 35[27-42] 0.282 Efficiency (%) 46+7 59+23 <0.05 ∑ (g/cm2) 71.9[38.2-95.4] 50.0[28.2-80.2] <0.001 Ees (mmHg/ml) 2.47+2.36 3.42+3.67 0.07 Vo (ml) -28.1[-18.7- -6.06] -16.9[-11.5- -2.08] 0.239 Zva (mmHg/ml/cm) 3.99[3.14-5.31] 3.61[3.15-4.98] 0.372 ∑=meridional wall stress; Ees=systolic elastance; Zva=valvuloarterial impedance; Vo= LV volumes. P1191Five-year echocardiographic follow-up after transcatheter aortic valve implantation: left ventricular mass and ejection fraction; aortic valve area and mean gradient M H Wong M H Wong Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China M C S Chiang M C S Chiang Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China M W Chu M W Chu Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China Y H Fong Y H Fong Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China Y W Cheng Y W Cheng Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China C F Tsang C F Tsang Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China C K Kwok C K Kwok Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China N H Luk N H Luk Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China K C Chan K C Chan Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China L K Chan L K Chan Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China C Y Wong C Y Wong Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China C L Fu C L Fu Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China K Y Lee K Y Lee Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China K T Chan K T Chan Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China S F Chui S F Chui Queen Elizabeth Hospital, Department of Medicine, Hong Kong, Hong Kong SAR People's Republic of China Background: Transcatheter aortic valve implantation (TAVI) has evolved in recent years to become an alternative approach to surgical aortic valve replacement for severe aortic stenosis (AS). This study reports single-centre experiences of echocardiographic evaluation of TAVI patients. Purpose: The objective of this study is to investigate the degree of regression in left ventricular (LV) mass; improvement in LV ejection fraction, aortic valve area and mean transaortic gradient after TAVI. Methods: A total of 69 patients with severe aortic stenosis who underwent TAVI from year 2010 to 2016 were included. Echocardiographic parameters including LV mass and LV ejection fraction; aortic valve area and mean transaortic gradient of patients at baseline and after TAVI at six-month, one-year, three-year and five-year follow-up were analysed. The LV mass was calculated using the Devereux formula. Results: The LV mass decreased from 237 ± 73 g at baseline to 189 ± 51 g at six-month (P < .001), 178 ± 44 g at one-year (P < .001), 180 ± 61 g at three-year (P = .007) and 165 ± 30 g at five-year (P = .019). There was improvement in LV ejection fraction after TAVI in subgroup of patients who had impaired LV ejection fraction before TAVI from 42 ± 10% at baseline to 51 ± 10% at six-month (P < .001), 54 ± 9% at one-year (P < .001), 55 ± 11% at three-year (P = .151) and 62 ± 3% at five-year (P = .093). There was no significant difference in LV ejection fraction after TAVI in subgroup of patients who had normal LV ejection fraction before TAVI. The aortic valve area increased from 0.68 ± 0.18 cm² at baseline to 1.91 ± 0.35 cm² at six-month (P < .001), 1.86 ± 0.38 cm² at one-year (P < .001), 1.94 ± 0.43 cm² at three-year (P < .001) and 1.96 ± 0.31 cm² at five-year (P < .001). The mean transaortic gradient decreased from 51 ± 15 mm Hg at baseline to 9 ± 3 mm Hg at six-month (P < .001), 9 ± 4 mm Hg at one-year (P < .001), 8 ± 3 mm Hg at three-year (P < .001) and 8 ± 3 mm Hg at five-year (P < .001). Conclusion: There was significant regression in LV mass at six-month follow-up and up to one-year follow-up after TAVI. There was significant improvement in LV ejection fraction in impaired pre-interventional LV ejection fraction subgroup at six-month follow-up and up to one-year follow-up. The results of significantly improved aortic valve area and mean transaortic gradient were sustained up to five-year after TAVI. The results of our study are in accordance with previous reports by other centres. Our study demonstrated favorable LV geometry and hemodynamic outcomes after successful TAVI. P1192Temporal changes in left ventricular mass, compliance and filling early after TAVI in severe aortic stenosis with marked cardiac hypertrophy T G Von Lueder T G Von Lueder 1Oslo University Hospital, Department of Cardiology, Oslo, Norway P Hoffmann P Hoffmann 2Oslo University Hospital, Department of Cardiology, Division of Cardiovascular and Pulmonary Disease, Oslo, Norway, Oslo, Norway R Bjornerheim R Bjornerheim 1Oslo University Hospital, Department of Cardiology, Oslo, Norway M Wennemo M Wennemo 3Oslo University Hospital, Department of Cardiothoracic Anesthesia, Oslo, Norway P Majak P Majak 4Oslo University Hospital, Department of Cardiothoracic Surgery, Oslo, Norway A Opdahl A Opdahl 2Oslo University Hospital, Department of Cardiology, Division of Cardiovascular and Pulmonary Disease, Oslo, Norway, Oslo, Norway A Al-Ani A Al-Ani 2Oslo University Hospital, Department of Cardiology, Division of Cardiovascular and Pulmonary Disease, Oslo, Norway, Oslo, Norway 1Oslo University Hospital, Department of Cardiology, Oslo, Norway 2Oslo University Hospital, Department of Cardiology, Division of Cardiovascular and Pulmonary Disease, Oslo, Norway, Oslo, Norway 3Oslo University Hospital, Department of Cardiothoracic Anesthesia, Oslo, Norway 4Oslo University Hospital, Department of Cardiothoracic Surgery, Oslo, Norway Background: Myocardial hypertrophy in aortic stenosis (AS) is associated with impaired left ventricular (LV) relaxation, compliance and filling. Transcatheter aortic valve implantation (TAVI) unloads the LV but whether it alters these maladaptive changes is unknown. Purpose: We hypothesized that cardiac unloading afforded by TAVI would confer changes in LV structure, stiffness, filling pattern and relaxation. Methods: We compared LV dimensions, LV tissue and filling velocities, and diastolic wall strain (DWS), an index of LV stiffness by echocardiography in 22 subjects (80±2 years, BMI 25±1 kg/m2) in sinus rhythm before, at day 2 after and at 3 months after TAVI using a self-expanding system. Results: Patients displayed marked concentric LV hypertrophy, low DWS consistent with high LV stiffness and severe diastolic functional abnormalities. E/e´, an index of LV filling pressures decreased and DWS increased after 3 months; while no other significant temporal changes in LV structural and filling indices were observed after TAVI. LV mass index (R=0.54), E velocity and DWS (R=-0.67; both P<0.05) a baseline correlated with mean transvalvular pressure gradient at 3 months. Conclusions: Our data suggest that in subjects with AS and a high degree of LV hypertrophy cardiac unloading by TAVI reduces LV filling pressures and stiffness at 3 months but does not alter other measures of LV structure, filling and relaxation. Preexisting LV hypertrophy and stiffness may be important determinants of LV diastolic function after TAVI. Demographics and echocardiography Parameter . Baseline . Day 2 TAVI . 3 months post TAVI . Mean aortic gradient (mmHg) 58±2 7±1*** 8±1*** Septum thickness (mm) 13.2±0.4 13.4±0.7 12.6±0.6 LV diastolic diameter (mm) 45±1 46±2 45±2 LV mass index (g/m2) 122±7 139±13 117±10 Diastolic wall strain 0.14±0.02 0.18±0.01* 0.22±0.02* E (m/s) 0.96±0.07 1.10±0.09 0.97±0.07 E/A 1.3±0.2 1.6±0.5 1.3±0.2 E deceleration time (ms) 221±15 202±19 229±20 e′ (cm/s) 4.1±0.3 4.1±0.4 3.9±0.2 E/e′ 20.0±2.3 20.8±3.0* 18.7±2.3* Isovolumic relaxation time (ms) 79±4 90±10 88±6 Tei index 0.50±0.03 0.59±0.05 0.56±0.03 Parameter . Baseline . Day 2 TAVI . 3 months post TAVI . Mean aortic gradient (mmHg) 58±2 7±1*** 8±1*** Septum thickness (mm) 13.2±0.4 13.4±0.7 12.6±0.6 LV diastolic diameter (mm) 45±1 46±2 45±2 LV mass index (g/m2) 122±7 139±13 117±10 Diastolic wall strain 0.14±0.02 0.18±0.01* 0.22±0.02* E (m/s) 0.96±0.07 1.10±0.09 0.97±0.07 E/A 1.3±0.2 1.6±0.5 1.3±0.2 E deceleration time (ms) 221±15 202±19 229±20 e′ (cm/s) 4.1±0.3 4.1±0.4 3.9±0.2 E/e′ 20.0±2.3 20.8±3.0* 18.7±2.3* Isovolumic relaxation time (ms) 79±4 90±10 88±6 Tei index 0.50±0.03 0.59±0.05 0.56±0.03 *P<0.05, ***P<0.0001 vs Baseline; ANOVA Demographics and echocardiography Parameter . Baseline . Day 2 TAVI . 3 months post TAVI . Mean aortic gradient (mmHg) 58±2 7±1*** 8±1*** Septum thickness (mm) 13.2±0.4 13.4±0.7 12.6±0.6 LV diastolic diameter (mm) 45±1 46±2 45±2 LV mass index (g/m2) 122±7 139±13 117±10 Diastolic wall strain 0.14±0.02 0.18±0.01* 0.22±0.02* E (m/s) 0.96±0.07 1.10±0.09 0.97±0.07 E/A 1.3±0.2 1.6±0.5 1.3±0.2 E deceleration time (ms) 221±15 202±19 229±20 e′ (cm/s) 4.1±0.3 4.1±0.4 3.9±0.2 E/e′ 20.0±2.3 20.8±3.0* 18.7±2.3* Isovolumic relaxation time (ms) 79±4 90±10 88±6 Tei index 0.50±0.03 0.59±0.05 0.56±0.03 Parameter . Baseline . Day 2 TAVI . 3 months post TAVI . Mean aortic gradient (mmHg) 58±2 7±1*** 8±1*** Septum thickness (mm) 13.2±0.4 13.4±0.7 12.6±0.6 LV diastolic diameter (mm) 45±1 46±2 45±2 LV mass index (g/m2) 122±7 139±13 117±10 Diastolic wall strain 0.14±0.02 0.18±0.01* 0.22±0.02* E (m/s) 0.96±0.07 1.10±0.09 0.97±0.07 E/A 1.3±0.2 1.6±0.5 1.3±0.2 E deceleration time (ms) 221±15 202±19 229±20 e′ (cm/s) 4.1±0.3 4.1±0.4 3.9±0.2 E/e′ 20.0±2.3 20.8±3.0* 18.7±2.3* Isovolumic relaxation time (ms) 79±4 90±10 88±6 Tei index 0.50±0.03 0.59±0.05 0.56±0.03 *P<0.05, ***P<0.0001 vs Baseline; ANOVA P1194Prognostic value of collagen biomarkers on left atrial remodeling and arrhythmia on hypertrophic cardiomyopathy A Zaroui A Zaroui 1La Rabta Teaching Hospital, Tunis, Tunisia M Boukhris M Boukhris 2 tunis medicine faculty, tunis, Tunisia M Asmi M Asmi 1La Rabta Teaching Hospital, Tunis, Tunisia R Mechmeche R Mechmeche 2 tunis medicine faculty, tunis, Tunisia 1La Rabta Teaching Hospital, Tunis, Tunisia 2 tunis medicine faculty, tunis, Tunisia Hypertrophic cardiomyopathy (HCM) is a disease characterized by cell disorganization with a matrix remodeling leading to fibrosis. Aim: to investigate biological markers which are the amino terminal pro peptide of type III collagen (PIIINP), a synthetic indicator which may reflect the rate of myocardial fibrosis, a metalloproteinase ( MMP3 )involved in the regulation of collagen and its specific tissue inhibitor TIPM2.we included 107 patients and 175 controls who beneficied of a clinical study. the serum level of the PIIINP, MMP3 and TIMP2 activities were determined in the peripheral vein by ELISA technique. We studied the association of serum levels of these markers with clinical, echocardiographic and prognostic parameters. Results:the mean age was 49 years, 60 were male, 75% were symptomatic (palpitations in 38% of cases, chest pain in 28% of cases, syncope in 25% of cases) the rate of PIIINP was significantly higher in patients compared with controls (361.92± 41.6 pg/ ml vs 242.80±46.7ng / ml; p = 0.036). same for the MMP3 and TIMP2 levels (12.16±4,33 pg/ ml vs 10.4±3.78 pg/ ml and 63.4 ±23.5pg/ ml vs 57.50±21.43 pg/ ml, respectively, p = 0.03). We note that the MMP3 / TIMP2 ratio is correlated to left ventricular (LV) mass and the left atrium volume (r=0.560, p=0.002, and r=0.633, p=0.001 respectively), the PIIINP is correlates to the maximum thickness of the LV (r=0.466, p=0.002), to the LV global longitudinal Strain (GLS) (r= -0.578, r=0.001, after a median follow up of 62 ±12 months, 26 Patients presented sustained atrial fibrillation symptomatic or detected by ECG monitoring. they were older and had a significantly higher rate of PIIINP (432.5±34.6 pg/ ml vs 320.44±32.8 pg/ ml, p=0.002 ) and more impaired LV global longitudinal Strain( -14.7 ±2.6 % vs 16.7 ±3.2%, p=0.0034) . Conclusion: HMC is characterized by atrial remodeling and fibrosis with a high risk of atrial arythmia and morbidity, related to the collagen accumulation that is reflected by MMP3 / TIMP2 ratio serum and the PIIINP concentration. These parameters may represent new risk factors for the atrial arhythmia . P1196Increased age, biventricular involvement and advanced atrial disfunction are independently related to symptomatic status in patients with hypertrophic cardiomyopathy M Rosca M Rosca "Carol Davila" University of Medicine and Pharmacy, Euroecolab, Bucharest, Romania C C Beladan C C 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 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 B A Popescu B A Popescu "Carol Davila" University of Medicine and Pharmacy, Euroecolab, Bucharest, Romania "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 Background: Characterized by high genetic, phenotypic and prognostic heterogeneity, HCM remains a challenging disease. Heart failure, syncope, angina and arrhythmias are the main clinical signs of HCM progression, with unpredictable occurrence. Although the physiopathological bases of HCM have extensively been studied, the information regarding the myocardial structural changes that make the difference between symptomatic and asymptomatic patients are scarce. Purpose: To assess the impact of left and right ventricular (LV, RV) and left atrial (LA) remodelling on the clinical status in pts with HCM. Methods: We have prospectively enrolled 127 pts (52±16 years, 58 men) with HCM. A comprehensive echocardiogram was performed in all, including the measurement of maximum LV and RV free wall thickness (WT). LV filling pressures were assessed using the E/meanl e’ ratio. Global longitudinal LV strain (ɛ), RVɛ, LAɛ and strain rate (SR) during early (ESr) and late diastoly (ASr) have been assessed by speckle tracking echocardiography. Systolic pulmonary artery pressure (sPAP) has been estimated. The functional status was defined according to the New York Heart Association (NYHA) classification. The presence of angina, syncope, paroxysmal atrial fibrillation (AF) or ventricular tachycardia (VT), were also recorded. Results: Ninety four pts had heart failure symptoms (NYHA class ≥ 2), 30 pts had angina, 17 pts had syncope, 36 pts had AF and 26 pts had VT. Fourteen pts were free of any symptoms. Asymptomatic pts were younger (40±15 vs 54±16 years, p=0.005), more often male (78% vs 41%, p=0.009), less often with LV obstruction (21% vs 57%, p=0.01) or RV hypertrophy (14% vs 51%, p=0.009) than symptomatic pts. Despite similar LV hypertrophy (LVWT: 21.1±5,2 vs 20.5±6.1 mm, p=0.72) and LV longitudinal dysfunction (LVɛ: -13.6±3.3 vs -14.7±2.7, p=0.24), symptomatic pts had higher values for E/e’(19.0±8.2 vs 11.6±3.9, p=0.003), LAVi (62±25 vs 44±13 ml/m2, p=0.001), RVWT (6.3±1.8 vs 5.0±0.7 mm, p=0.007) and sPAP (35±11 vs 29±5 mmHg, p=0.04) and lower values for LA function parameters (15.9±6.3 vs 21.7±7.2 %, p=0.002 for LAɛ; -0.6±0.3 vs -1.0±0.3 s-1, p<0.001 for Esr, -0.9±0.4 vs -1.4±0.5 s-1, p<0.001 for Asr) and RVɛ (p=0.04). Age (OR=1.06, p=0.01), RV hypertrophy (OR=8.45, p=0.02) and LA dysfunction (OR=8.74, p=0.008) were independently related to symptomatic status in this group of pts. Conclusions: Younger male HCM patients, without LV obstruction and RV hypertrophy were more likely to be asymptomatic. Advanced age, LA dysfunction and presence of RV hypertrophy were independently related to presence of typical symptoms of HCM in our population. P11973D left atrium ejection fraction predicts atrial fibrillation in hypertrophic cardiomyopathy G Pestana G Pestana 1Sao Joao Hospital, Cardiology, Porto, Portugal C Sousa C Sousa 1Sao Joao Hospital, Cardiology, Porto, Portugal A Goncalves A Goncalves 2Faculty of Medicine University of Porto, Medicine Department, Porto, Portugal I Rangel I Rangel 3Hospital Garcia de Orta, Cardiology, Almada, Portugal M Tavares-Silva M Tavares-Silva 1Sao Joao Hospital, Cardiology, Porto, Portugal R Pinto R Pinto 1Sao Joao Hospital, Cardiology, Porto, Portugal E Martins E Martins 1Sao Joao Hospital, Cardiology, Porto, Portugal J Silva-Cardoso J Silva-Cardoso 1Sao Joao Hospital, Cardiology, Porto, Portugal F Macedo F Macedo 1Sao Joao Hospital, Cardiology, Porto, Portugal M J Maciel M J Maciel 1Sao Joao Hospital, Cardiology, Porto, Portugal 1Sao Joao Hospital, Cardiology, Porto, Portugal 2Faculty of Medicine University of Porto, Medicine Department, Porto, Portugal 3Hospital Garcia de Orta, Cardiology, Almada, Portugal Background: / Purpose: Atrial fibrillation (AF) is more frequent in hypertrophic cardiomyopathy (HCM) patients (pts) than in the general population and the former seem to be particularly susceptible to its complications, namely cardioembolism. We sought to compare the association of standard echocardiographic parameters and novel 3D techniques with new onset atrial fibrillation. Methods: A cohort of HCM pts was gathered for comprehensive evaluation at our centre in 2011. As part of this study detailed transthoracic echocardiography was performed with ACUSON SC2000TM (Siemens Medical Solutions USA Inc.), including 3D acquisitions for calculation of left atrial (LA) volumes and, henceforth, 3D LA ejection fraction (LAEF). We reviewed these patients' clinical files 5 years after the initial evaluation and assessed the relationship between the echocardiographic parameters with a new diagnosis of AF. Results: After excluding pts with a previous diagnosis of AF a cohort of 41 pts was obtained, 26 of which male (63.4%) and with a mean age of 46 years. At a mean follow-up of 4.6±1 years, a total of 5 pts (12.2%) had a new diagnosis of AF. All of these pts were male and they were significantly older compared to the remainders (66 vs 43 years, p=0.04). While a trend towards bigger atria in new onset AF pts compared to the remainder was observed, there was no statistically significant association with indexed LA linear dimension (28 vs 26mm/m², p=0.24), 2D volume (46 vs 36mL/m², p=0.17) or 3D volume (55 vs 40mL/m², p=0.09). Lower 3D LAEF, however, was significantly associated with de novo AF diagnosis (mean 3D LAEF 24 vs 43%; odds ratio of 1.13, 95% CI 1.02 – 1.25, p=0.021). ROC curve analysis also revealed significant power of 3D LAEF for identifying pts with de novo AF (AUC=0.882, p=0.006), with a 35% cut-off value showing 100% sensitivity and 76% specificity. When considering follow-up time, 3D LAEF was still the only parameter with a statistically significant association with survival free of AF; furthermore, multivariate analysis showed this association was independent from LA linear dimension, 2D or 3D volumes (p=0.026) as well as from age (p=0.023). Conclusions: Our results point to a promising value of LAEF as evaluated on 3D transthoracic echocardiography as a potential predictor of new onset AF in HCM. 3D LAEF is a reproducible and somewhat effortless measure, thus, once confirmed in larger cohorts, 3D LAEF might become an important tool in the management of HCM pts. Open in new tabDownload slide Abstract P1197 Figure. ROC curve for 3D LAEF and de novo AF Open in new tabDownload slide Abstract P1197 Figure. ROC curve for 3D LAEF and de novo AF P1198Cardiac involvement, morbidity and mortality in hereditary transthyretin-related amyloidosis associated with glu89gln mutation M Gospodinova M Gospodinova 1Medical Institute of Ministry of Interior, Clinic of Cardiology, Sofia, Bulgaria S Sarafov S Sarafov 2University Alexandrovska Hospital, Clinic of Neurology, Medical University, Sofia, Bulgaria T Chamova T Chamova 2University Alexandrovska Hospital, Clinic of Neurology, Medical University, Sofia, Bulgaria J Cherneva J Cherneva 1Medical Institute of Ministry of Interior, Clinic of Cardiology, Sofia, Bulgaria A Kirov A Kirov 3Department of Chemistry and Biochemistry, Medical University – Sofia, Medicodiagnostic Lab. Genika, Sofia, Bulgaria T Todorov T Todorov 3Department of Chemistry and Biochemistry, Medical University – Sofia, Medicodiagnostic Lab. Genika, Sofia, Bulgaria A Todorova A Todorova 3Department of Chemistry and Biochemistry, Medical University – Sofia, Medicodiagnostic Lab. Genika, Sofia, Bulgaria A Trenovski A Trenovski 4Faculty of Medicine, Sofia University "St. Kliment Ohridski", Sofia, Bulgaria M Atanassova M Atanassova 4Faculty of Medicine, Sofia University "St. Kliment Ohridski", Sofia, Bulgaria I Tournev I Tournev 5University Alexandrovska Hospital, Clinic of Neurology, Medical University, New Bulgarian University, Department of Cognitive Science and Psychology, Sofia, Bulgaria S Denchev S Denchev 1Medical Institute of Ministry of Interior, Clinic of Cardiology, Sofia, Bulgaria 1Medical Institute of Ministry of Interior, Clinic of Cardiology, Sofia, Bulgaria 2University Alexandrovska Hospital, Clinic of Neurology, Medical University, Sofia, Bulgaria 3Department of Chemistry and Biochemistry, Medical University – Sofia, Medicodiagnostic Lab. Genika, Sofia, Bulgaria 4Faculty of Medicine, Sofia University "St. Kliment Ohridski", Sofia, Bulgaria 5University Alexandrovska Hospital, Clinic of Neurology, Medical University, New Bulgarian University, Department of Cognitive Science and Psychology, Sofia, Bulgaria Hereditary transthyretin-related amyloidosis (ATTR) is a progressive multi-system disorder with significant neurological (peripheral and autonomic) and/or cardiac involvement, depending on the mutation. It may cause significant impairment in quality of life and death in several years from the onset of symptoms. Purpose: To evaluate cardiac involvement, morbidity and mortality in patients with ATTR associated with Glu89Gln mutation. Patients and methods: 63 patients, (29 males) at mean age 58±7 years with genetically verified Glu89Gln mutation were included in the study. A clinical examination, 12-lead ECG, and 2D, Pulse and Tissue Doppler, and Speckle Tracking Echocardiography were performed. The patients were followed for 31 months on average, in a range from 1 to 72 months. Results: Cardiomyopathy and peripheral polyneuropathy were present at diagnosis in all evaluated patients. A significant increase in wall thickness of both left and right ventricles (septum – 17,9±3,4 mm; posterior wall – 17,2±2,8 mm; RV free wall – 8,2±2,0 mm) was found with restrictive left ventricular (LV) filling pattern in 25 (39,7%) patients and a reduced LV ejection fraction in 12 (19%) patients. Reduced mitral annulаr systolic velocities (s´septum-5,4±1,9 cm/s, s lat.-5,8±1,9 cm/s) and global longitudinal strain (GLS -12,5±4,7%) indicated an impaired LV longitudinal systolic function. The systolic myocardial velocities of the tricuspid annulus and TAPSE values were reduced respectively 6,9±2,1cm/s and 12,8±3 mm in 22 of the patients (34,9%), all with advanced LV involvement. Pathological ECG was present in 51 (81%) patients with low voltage in 22 (34,9%), pathological Q wave in 34 (53,1%), first degree A-V block in 15 (23,8%), left anterior fascicular block in 24 (38,1,3%), left bundle branch block in 6 (9,5%), right bundle branch block in 6 (9,5%), atrial fibrillation in 6 (9,5%), and pace-maker rhythm in 4 (6,3%) patients. The most common and debilitating extra-cardiac complaints were: progressive walking disability in 32 (51%) patients, diarrhea and/or constipation in 35 (56%), unintentional weight loss in 41 (65%), syncope in 12 (19%). 15 deaths (24%) occurred during follow up (10 patients with advanced heart failure and severe LV dysfunction, 2 patients from ischemic stroke, 3 patients died suddenly). 1 (1,6%) patient suffered from non-fatal ischemic stroke, 19 (30,2%) had symptoms of worsening heart failure, 3 (4,8%) patients were with new onset atrial fibrillation (AF) and one patient with A-V block III degree. Conclusion: A significant cardiac involvement was found in the evaluated patients with ATTR associated with Glu89Gln mutation. Heart failure and rhythm and conduction disturbances were the main causes of death. The quality of life was profoundly impaired by both cardiac and extra-cardiac (neurologic and gastrointestinal) symptoms. P1199Echocardiographic features of early cardiac amyloidosis S F Ozer S F Ozer University College London, National Amyloidosis Centre, London, United Kingdom A Martinez De Azcona Naharro A Martinez De Azcona Naharro University College London, National Amyloidosis Centre, London, United Kingdom D Hutt D Hutt University College London, National Amyloidosis Centre, London, United Kingdom J Gilbertson J Gilbertson University College London, National Amyloidosis Centre, London, United Kingdom A Wechalekar A Wechalekar University College London, National Amyloidosis Centre, London, United Kingdom H Lachmann H Lachmann University College London, National Amyloidosis Centre, London, United Kingdom C Whelan C Whelan University College London, National Amyloidosis Centre, London, United Kingdom M Fontana M Fontana University College London, National Amyloidosis Centre, London, United Kingdom P Hawkins P Hawkins University College London, National Amyloidosis Centre, London, United Kingdom J Gillmore J Gillmore University College London, National Amyloidosis Centre, London, United Kingdom B Pawarova B Pawarova University College London, National Amyloidosis Centre, London, United Kingdom E Gonzalez-Lopez E Gonzalez-Lopez University College London, National Amyloidosis Centre, London, United Kingdom S F Grigore S F Grigore University College London, National Amyloidosis Centre, London, United Kingdom C C Quarta C C Quarta University College London, National Amyloidosis Centre, London, United Kingdom University College London, National Amyloidosis Centre, London, United Kingdom Introduction: Cardiac amyloidosis (CA) has been traditionally associated with typical features on echocardiogram (TTE). Increased interventricular septal (IVS) thickness has been classically considered a diagnostic criterion for cardiac involvement in amyloidosis. Additionally, concentric left ventricular wall thickening is considered one of the hallmarks of CA. Nowadays, new imaging techniques like 99mTc-DPD scintigraphy, have shown a high sensitivity to detect transthyretin (TTR) amyloidosis, even at early stages. Moreover, biopsy-based studies have identified CA patients with normal left ventricle (LV) wall thickness. Our aim was to describe the morphological features and remodelling patterns of CA by echocardiogram among those patients who do not fulfil the classical criteria of LV thickening. Methods: We included patients diagnosed with CA based on a positive endomyocardial biopsy (EMB) and/or a Perugini grade ≥ 2 by DPD scintigraphy and a maximal wall thickness of 13 mm on basal TTE. Clinical and echocardiographic parameters were retrospectively analysed. Results: Over a period of 6 years, 105 consecutive patients underwent a DPD scintigraphy and/or EMB at our centre. Among them, 14 (13.3%) had <13 mm of maximal wall thickness (57.1% males; mean age at diagnosis: 63.4±16). The majority (10, 71.4%) were diagnosed with hereditary TTR amyloidosis and 50% were known to be hypertensive. Only a third (5 patients, 35.1%) presented with a low voltage pattern on ECG. On echo, mean LV maximal wall thickness was 11.4±0.8 mm. The vast majority of patients presented with a concentric remodelling (CR) pattern (11 patients, 78.6%) and just one fulfilled the diagnostic criteria for concentric hypertrophy (7.1%). Indexed LV mass was within the normal limits and statistically lower among patients with CR (89.3±12 vs 106.3±5 g/m2; p < 0.005). Despite a normal LV ejection fraction (60.5±10.7%), MAPSE (12.7±3.6 mm) and myocardial contraction fraction (50±11%), patients tended to show a low normal or mildly reduce lateral TDI S, stroke volume (SV) and global longitudinal strain: 8±2 cm/s, 58.8±21.4 mL/beat and -18.4±5%, respectively. Segmental strain pattern was suggestive of infiltrative disease in up to 79% of cases. Only 2 (15.4%) patients presented with significant diastolic dysfunction (DD), although 77% had some degree of mild-moderate DD. Right ventricle wall thickness (RVWT) was mildly increase (6.5±0.9 mm) with normal systolic function: TAPSE 20.3±6 mm and TDI S 12±2 cm/s. Conclusions: Increasing the diagnostic accuracy of CA by TTE is highly desirable, especially at early phases when new therapies could potentially be more effective. Although CA can be diagnosed with normal or mildly increase LV wall thickness, being CR the most common pattern among those CA patients, in order to avoid misdiagnosis, other echocardiographic features such as RVWT, lateral TDI S, SV and segmental strain pattern should be combined to increase the diagnostic suspicion of CA. P1200Progression of cardiac dysfunction in patients with hereditary transthyretin-related amyloidosis associated with glu89gln mutation T Todorov T Todorov 3Department of Chemistry and Biochemistry, Medical University – Sofia, Medicodiagnostic Lab. Genika, Sofia, Bulgaria A Todorova A Todorova 3Department of Chemistry and Biochemistry, Medical University – Sofia, Medicodiagnostic Lab. Genika, Sofia, Bulgaria A Trenovski A Trenovski 4Faculty of Medicine, Sofia University "St. Kliment Ohridski", Sofia, Bulgaria M Atanassova M Atanassova 4Faculty of Medicine, Sofia University "St. Kliment Ohridski", Sofia, Bulgaria I Tournev I Tournev 5University Alexandrovska Hospital, Clinic of Neurology, Medical University, New Bulgarian University, Department of Cognitive Science and Psychology, Sofia, Bulgaria S Denchev S Denchev 1Medical Institute of Ministry of Interior, Clinic of Cardiology, Sofia, Bulgaria 1Medical Institute of Ministry of Interior, Clinic of Cardiology, Sofia, Bulgaria 2University Alexandrovska Hospital, Clinic of Neurology, Medical University, Sofia, Bulgaria 3Department of Chemistry and Biochemistry, Medical University – Sofia, Medicodiagnostic Lab. Genika, Sofia, Bulgaria 4Faculty of Medicine, Sofia University "St. Kliment Ohridski", Sofia, Bulgaria 5University Alexandrovska Hospital, Clinic of Neurology, Medical University, New Bulgarian University, Department of Cognitive Science and Psychology, Sofia, Bulgaria M Gospodinova M Gospodinova 1Medical Institute of Ministry of Interior, Clinic of Cardiology, Sofia, Bulgaria S Sarafov S Sarafov 2University Alexandrovska Hospital, Clinic of Neurology, Medical University, Sofia, Bulgaria T Chamova T Chamova 2University Alexandrovska Hospital, Clinic of Neurology, Medical University, Sofia, Bulgaria J Cherneva J Cherneva 1Medical Institute of Ministry of Interior, Clinic of Cardiology, Sofia, Bulgaria A Kirov A Kirov 3Department of Chemistry and Biochemistry, Medical University – Sofia, Medicodiagnostic Lab. Genika, Sofia, Bulgaria Restrictive cardiomyopathy is a common finding in hereditary transthyretin-related amyloidosis associated with Glu89Gln mutation. Purpose: To evaluate the progress of cardiac involvement. Patients and methods: 26 patients (12 males) at mean age 57±6 years with Glu89Gln mutation were evaluated by 2 D, Pulse and Tissue Doppler, and Speckle Tracking Echocardiography. The patients were followed for 21 (12-24) months. All patients were on treatment with Tafamidis. Results: The evaluated parameters and results are shown in Table 1. A statistically significant change was found in left ventricular (LV) posterior wall thickness and diastolic function (A wave, e’, a’, left atrium). Of borderline significance were the changes in E wave and deceleration time. No significant changes were found in LV systolic function (ejection fraction, Global Longitudinal Strain-GLS) and in right ventricular (RV) free wall thickness and RV longitudinal systolic function. Conclusion: Worsening of the LV diastolic function without significant reduction in systolic function, including the GLS was found in patients with Glu89Gln mutation. Echocardiographic measurements Parameter . Initial evaluation . Follow up . P value . LV septum thickness (mm) 17,4 17,5 0,31 LV posterior wall thickness (mm) 16,4 17,1 0,02 Ejection fraction (%) 62 60 0,31 Transmitral E wave (cm/s) 81,1 89,1 0,07 Transmitral A wave (cm/s) 72,7 66,5 0,05 Deceleration time (ms) 212 188 0,06 s septal (cm/s) 6,2 5,8 0,19 e' septal (cm/s) 4,7 4,3 0,03 a'septal (cm/s) 6,4 6 0,40 s lateral (cm/s) 6,7 6 0,02 e' lateral (cm/s) 6,2 5,4 0,01 a' lateral (cm/s) 6,9 5,8 0,03 RV free wall thickness (mm) 7,6 7,9 0,20 TAPSE (mm) 17,9 18,1 0,36 s tricuspid annulus (cm/s) 12,5 11,9 0,10 LA (mm) 38 42 0,0005 GLS (%) -14,4 -14,0 0,15 Parameter . Initial evaluation . Follow up . P value . LV septum thickness (mm) 17,4 17,5 0,31 LV posterior wall thickness (mm) 16,4 17,1 0,02 Ejection fraction (%) 62 60 0,31 Transmitral E wave (cm/s) 81,1 89,1 0,07 Transmitral A wave (cm/s) 72,7 66,5 0,05 Deceleration time (ms) 212 188 0,06 s septal (cm/s) 6,2 5,8 0,19 e' septal (cm/s) 4,7 4,3 0,03 a'septal (cm/s) 6,4 6 0,40 s lateral (cm/s) 6,7 6 0,02 e' lateral (cm/s) 6,2 5,4 0,01 a' lateral (cm/s) 6,9 5,8 0,03 RV free wall thickness (mm) 7,6 7,9 0,20 TAPSE (mm) 17,9 18,1 0,36 s tricuspid annulus (cm/s) 12,5 11,9 0,10 LA (mm) 38 42 0,0005 GLS (%) -14,4 -14,0 0,15 LV - left ventricle RV - right ventricle TAPSE - tricuspid annular plane systolic excursion GLS - Global Longitudinal Strain Echocardiographic measurements Parameter . Initial evaluation . Follow up . P value . LV septum thickness (mm) 17,4 17,5 0,31 LV posterior wall thickness (mm) 16,4 17,1 0,02 Ejection fraction (%) 62 60 0,31 Transmitral E wave (cm/s) 81,1 89,1 0,07 Transmitral A wave (cm/s) 72,7 66,5 0,05 Deceleration time (ms) 212 188 0,06 s septal (cm/s) 6,2 5,8 0,19 e' septal (cm/s) 4,7 4,3 0,03 a'septal (cm/s) 6,4 6 0,40 s lateral (cm/s) 6,7 6 0,02 e' lateral (cm/s) 6,2 5,4 0,01 a' lateral (cm/s) 6,9 5,8 0,03 RV free wall thickness (mm) 7,6 7,9 0,20 TAPSE (mm) 17,9 18,1 0,36 s tricuspid annulus (cm/s) 12,5 11,9 0,10 LA (mm) 38 42 0,0005 GLS (%) -14,4 -14,0 0,15 Parameter . Initial evaluation . Follow up . P value . LV septum thickness (mm) 17,4 17,5 0,31 LV posterior wall thickness (mm) 16,4 17,1 0,02 Ejection fraction (%) 62 60 0,31 Transmitral E wave (cm/s) 81,1 89,1 0,07 Transmitral A wave (cm/s) 72,7 66,5 0,05 Deceleration time (ms) 212 188 0,06 s septal (cm/s) 6,2 5,8 0,19 e' septal (cm/s) 4,7 4,3 0,03 a'septal (cm/s) 6,4 6 0,40 s lateral (cm/s) 6,7 6 0,02 e' lateral (cm/s) 6,2 5,4 0,01 a' lateral (cm/s) 6,9 5,8 0,03 RV free wall thickness (mm) 7,6 7,9 0,20 TAPSE (mm) 17,9 18,1 0,36 s tricuspid annulus (cm/s) 12,5 11,9 0,10 LA (mm) 38 42 0,0005 GLS (%) -14,4 -14,0 0,15 LV - left ventricle RV - right ventricle TAPSE - tricuspid annular plane systolic excursion GLS - Global Longitudinal Strain P1201Usefulness of the combined deformation parameter in cardiac amyloidosis E Romero Dorta E Romero Dorta 1Hospital Dr. Peset, Servicio de Cardiología, Valencia, Spain V Mora Llabata V Mora Llabata 1Hospital Dr. Peset, Servicio de Cardiología, Valencia, Spain I Roldan Torres I Roldan Torres 1Hospital Dr. Peset, Servicio de Cardiología, Valencia, Spain J Bertolin Boronat J Bertolin Boronat 1Hospital Dr. Peset, Servicio de Cardiología, Valencia, Spain C Perez-Olivares Delgado C Perez-Olivares Delgado 1Hospital Dr. Peset, Servicio de Cardiología, Valencia, Spain J Perez-Gozalbo J Perez-Gozalbo 1Hospital Dr. Peset, Servicio de Cardiología, Valencia, Spain P Aguar Carrascosa P Aguar Carrascosa 1Hospital Dr. Peset, Servicio de Cardiología, Valencia, Spain V Faga V Faga 1Hospital Dr. Peset, Servicio de Cardiología, Valencia, Spain M M Perez-Gil M M Perez-Gil 1Hospital Dr. Peset, Servicio de Cardiología, Valencia, Spain J A Lowenstein J A Lowenstein 2Investigaciones Medicas de Buenos Aires, Servicio de Cardiodiagnóstico, Buenos Aires, Argentina 1Hospital Dr. Peset, Servicio de Cardiología, Valencia, Spain 2Investigaciones Medicas de Buenos Aires, Servicio de Cardiodiagnóstico, Buenos Aires, Argentina Background: Left ventricular (LV) systolic function is usually inferred from ejection fraction (EF). Nonetheless, before the EF diminishes, other myocardial function components may be impaired. Objective: To verify the usefulness of the new "Combined Deformation Parameter" in the diagnosis of amyloidosis and in the understanding of its pathophysiology. Methods: Comparative study with speckle-tracking echocardiography (STEc) of 7 patients (p) with cardiac amyloidosis and preserved EF, and of 14 healthy volunteers. We calculated the "Combined Deformation Parameter" for the most complete estimation of myocardial function, incorporating values of rotational mechanics (twist) and dynamic longitudinal shortening (longitudinal strain (LS)). This includes the Deformation Product (twist x LS (°x%)) and the Deformation Index (twist/LS (°/%)), the latter being considered a dynamic torsion parameter. Longitudinal strain was obtained from apical 4, 3, and 2-chamber views. The parameters of ventricular rotation, circumferential strain (CS) and radial strain (RS) resulted from the basal, medial and apical transverse views of the LV. The Twist was calculated as the addition of the basal and apical rotation (degrees). The Deformation Product (normal or diminished) reports jointly of longitudinal and rotational myocardial function, while the Deformation Index informs both the possible affected component(s) and the influence of each of them. Results: No differences in age were observed (68,4 ± 10,6 vs 64,5 ± 2,6 years; p = 0,41) or in EF (64,8 ± 8,7 vs 68,1 ± 6,9%; p = 0.39) between p with amyloidosis and controls. Patients with amyloidosis showed a lower LS (-10,0 ± 4,4 vs -20,6 ± 2,3%; p <0,001), CS (-14,0 ± 2,3 vs -22,4 ± 4,9%; p<0,001) and RS (19,6 ± 8,3 vs 31,1 ± 10,5%; p <0,05). The "Combined Deformation Parameter" in the cardiac amyloidosis shows a smaller Deformation Product, with an increase in the Deformation Index regarding the control group. See table. Conclusions: Despite the preserved EF in patients with cardiac amyloidosis, the Combined Deformation Parameter reflects myocardial dysfunction, and it could be useful in its monitoring. The higher Deformation index in p with amyloidosis explains that the EF is maintained at the expense of increased ventricular torsion. Table . EF (%) . LS (%) . Twist (º) . Twist x LS (º x %) . Twist/LS (º/%) . Control group 68,1 ± 6,9 -20,6 ± 2,3 21,5 ± 6,4 -443,0 ± 139,4 -1,0 ± 0,3 Amyloidosis 64,8 ± 8,7 -10,0 ± 4,4 22,2 ± 10,7 -233,3 ± 169,3 -2,3 ± 1,2 p 0,39 < 0,01 0,86 < 0,01 < 0,01 . EF (%) . LS (%) . Twist (º) . Twist x LS (º x %) . Twist/LS (º/%) . Control group 68,1 ± 6,9 -20,6 ± 2,3 21,5 ± 6,4 -443,0 ± 139,4 -1,0 ± 0,3 Amyloidosis 64,8 ± 8,7 -10,0 ± 4,4 22,2 ± 10,7 -233,3 ± 169,3 -2,3 ± 1,2 p 0,39 < 0,01 0,86 < 0,01 < 0,01 Table . EF (%) . LS (%) . Twist (º) . Twist x LS (º x %) . Twist/LS (º/%) . Control group 68,1 ± 6,9 -20,6 ± 2,3 21,5 ± 6,4 -443,0 ± 139,4 -1,0 ± 0,3 Amyloidosis 64,8 ± 8,7 -10,0 ± 4,4 22,2 ± 10,7 -233,3 ± 169,3 -2,3 ± 1,2 p 0,39 < 0,01 0,86 < 0,01 < 0,01 . EF (%) . LS (%) . Twist (º) . Twist x LS (º x %) . Twist/LS (º/%) . Control group 68,1 ± 6,9 -20,6 ± 2,3 21,5 ± 6,4 -443,0 ± 139,4 -1,0 ± 0,3 Amyloidosis 64,8 ± 8,7 -10,0 ± 4,4 22,2 ± 10,7 -233,3 ± 169,3 -2,3 ± 1,2 p 0,39 < 0,01 0,86 < 0,01 < 0,01 P1202Absolute measures of right ventricle, but not indexed values, are markers of ventricular arrhythmia in female arrhythmogenic cardiomyopathy patients C Rootwelt C Rootwelt Oslo University Hospital, Department of Cardiology, Rikshospitalet, and Center for Cardiological Innovation, Oslo, Norway O H Lie O H Lie Oslo University Hospital, Department of Cardiology, Rikshospitalet, and Center for Cardiological Innovation, Oslo, Norway L A Dejgaard L A Dejgaard Oslo University Hospital, Department of Cardiology, Rikshospitalet, and Center for Cardiological Innovation, Oslo, Norway T Edvardsen T Edvardsen Oslo University Hospital, Department of Cardiology, Rikshospitalet, and Center for Cardiological Innovation, Oslo, Norway K H Haugaa K H Haugaa Oslo University Hospital, Department of Cardiology, Rikshospitalet, and Center for Cardiological Innovation, Oslo, Norway Oslo University Hospital, Department of Cardiology, Rikshospitalet, and Center for Cardiological Innovation, Oslo, Norway Funding Acknowledgements: Center for Cardiological Innovation funded by the Norwegian Research Counsil Background: Arrhythmogenic cardiomyopathy (AC) is an inheritable heart disease associated with high risk of life-threatening ventricular arrhythmias. Disease penetrance in AC is higher in men, and most studies on markers for ventricular arrhythmia include predominantly male subjects. Task Force Criteria of 2010 suggests indexing diameters by body surface area, but the applicability to female patients is not studied. Purpose: To explore echocardiographic Task Force Criteria of 2010 parameters and their relation to ventricular arrhythmias in female AC patients. Methods: We examined female AC patients by echocardiography. Right ventricular (RV) fractional area change (RV FAC) was measured, along with RV basal diameter (RVD) and RV outflow tract diameter (RVOT) which were reported as absolute and indexed values. We also assessed left ventricular ejection fraction (LVEF). Ventricular arrhythmia was defined as sustained ventricular tachycardia or fibrillation, aborted cardiac arrest or appropriate therapy from an implantable cardioverter-defibrillator. Results: We included 79 female AC patients (42% probands, age 42±16 years), of which 26 (33%) had experienced ventricular arrhythmia (Table). RV FAC was worse in women with than without ventricular arrhythmia. RVOT and RVD were markers of ventricular arrhythmia only as absolute values. LVEF did not differ between the groups. Conclusions: RV FAC and absolute RV dimensions were markers of ventricular arrhythmia, while indexed dimensions were not. Evaluation of female AC patients should not rely on indexed values established in predominantly male studies. Further studies on imaging markers in female AC patients are warranted. . No VA n= 53 . VA n=26 . p-value . RVD (mm) 36±5 45±9 <0.001 RVDi (mm/m2) 19±4 21±3 0.28 RVOT (mm) 31±5 36±9 0.01 RVOTi (mm/m2) 17±4 17±4 0.71 RV FAC (%) 46±7 35±9 <0.001 LV EF (%) 58±5 58±7 0.83 . No VA n= 53 . VA n=26 . p-value . RVD (mm) 36±5 45±9 <0.001 RVDi (mm/m2) 19±4 21±3 0.28 RVOT (mm) 31±5 36±9 0.01 RVOTi (mm/m2) 17±4 17±4 0.71 RV FAC (%) 46±7 35±9 <0.001 LV EF (%) 58±5 58±7 0.83 Values are mean ± SD, compared by Students t-test. LVEF = left ventricular ejection fraction, RV FAC = right ventricular fractional area change, RVDi = indexed right ventricular diameter, RVOTi = indexed right ventricular outflow tract diameter, VA = ventricular arrhythmia. . No VA n= 53 . VA n=26 . p-value . RVD (mm) 36±5 45±9 <0.001 RVDi (mm/m2) 19±4 21±3 0.28 RVOT (mm) 31±5 36±9 0.01 RVOTi (mm/m2) 17±4 17±4 0.71 RV FAC (%) 46±7 35±9 <0.001 LV EF (%) 58±5 58±7 0.83 . No VA n= 53 . VA n=26 . p-value . RVD (mm) 36±5 45±9 <0.001 RVDi (mm/m2) 19±4 21±3 0.28 RVOT (mm) 31±5 36±9 0.01 RVOTi (mm/m2) 17±4 17±4 0.71 RV FAC (%) 46±7 35±9 <0.001 LV EF (%) 58±5 58±7 0.83 Values are mean ± SD, compared by Students t-test. LVEF = left ventricular ejection fraction, RV FAC = right ventricular fractional area change, RVDi = indexed right ventricular diameter, RVOTi = indexed right ventricular outflow tract diameter, VA = ventricular arrhythmia. P1203Focal reduction in left ventricular I-123 metaiodobenzylguanidine uptake reflects the impairment in systolic function in patients with Anderson-Fabry disease L Spinelli L Spinelli 1Department of Advanced Biomedical Sciences, Federico II University, Naples,, Naples, Italy T Pellegrino T Pellegrino 1Department of Advanced Biomedical Sciences, Federico II University, Naples,, Naples, Italy M Imbriaco M Imbriaco 1Department of Advanced Biomedical Sciences, Federico II University, Naples,, Naples, Italy A Pisani A Pisani 2Department of Nephrology,University Federico II, Naples, Italy G Giugliano G Giugliano 1Department of Advanced Biomedical Sciences, Federico II University, Naples,, Naples, Italy A Cuocolo A Cuocolo 1Department of Advanced Biomedical Sciences, Federico II University, Naples,, Naples, Italy B Trimarco B Trimarco 1Department of Advanced Biomedical Sciences, Federico II University, Naples,, Naples, Italy 1Department of Advanced Biomedical Sciences, Federico II University, Naples,, Naples, Italy 2Department of Nephrology,University Federico II, Naples, Italy Purpose: We investigated the relationship between abnormalities of cardiac sympathetic innervation and left ventricular (LV) function in patients with Anderson-Fabry disease (AFD). Methods: We performed I-123 metaiodobenzylguanidine (MIBG) cardiac imaging and speckle tracking echocardiography in 23 patients (11 men, mean age 43±13 years) with genetically proved AFD and preserved LV ejection fraction and in 10 age and gender-matched control subjects. From single-photon emission computed tomography (SPECT) MIBG images heart to mediastinum (H/M) ratio and regional defect score were calculated. Using the standardized 17-segment model, segmental tracer uptake was visually estimated according to 0 to 4 score (0=normal, 1= mildly reduced, 2= moderately reduced, 3= severely reduced, a= absent). The total defect score (TDS) was calculated as the sum of the segmental scores. Global and segmental longitudinal systolic strain was obtained by speckle tacking echocardiography. Results: At MIBG SPECT, TDS was 0 in 10 patients (group 1) and ranged from 1 to 36 in the remaining 13 patients (group 2). Late H/M ratio below two-fold standard deviation of control subjects (≤1.75) was observed in 8 patients of group 2 and in none of group 1. Patients of group 2 had significantly higher LV mass index (161± 54 g/m2 vs 118±35 g/m2, p<0.05), relative wall thickness (0.50±0.08 vs 0.41±06, p<0.01), left atrial volume (48.3± 10 ml vs 35.5±12 ml, p<0.01) and systolic pulmonary artery pressure (34±7 mmHg vs 28±5 mmHg, p<0.01). On the contrary, systolic longitudinal strain was significantly lower in patients of group 2 compared to those of group 1 (-14±4.5% vs -19±3%, p<0.01). In the whole patient population, a significant correlation between TDS and global longitudinal strain (r=0.61, p<0.002) and left atrial volume (r=-0.56, p<0.004) was found. At multivariable linear regression analysis, global longitudinal strain was the only independent predictor of TDS ≥1 (β=4.83, p<0.05). Conclusions: The results of the present study indicate that reduced cardiac MIBG uptake parallels impairment in LV longitudinal function in AFD patients. Noteworthy, focal derangement of cardiac sympathetic activity may be present even in patients with preserved H/M ratio P1204Echocardiographic predictors of outcome in PAH pts stable on dual combination therapy: the role of GLS A La Leggia A La Leggia Royal Brompton Hospital, London, United Kingdom C Flick C Flick Royal Brompton Hospital, London, United Kingdom C Kavouras C Kavouras Royal Brompton Hospital, London, United Kingdom K Dimopoulos K Dimopoulos Royal Brompton Hospital, London, United Kingdom A Kempny A Kempny Royal Brompton Hospital, London, United Kingdom L C Price L C Price Royal Brompton Hospital, London, United Kingdom C Mccabe C Mccabe Royal Brompton Hospital, London, United Kingdom S W Wort S W Wort Royal Brompton Hospital, London, United Kingdom W Li W Li Royal Brompton Hospital, London, United Kingdom Royal Brompton Hospital, London, United Kingdom Introduction: PAH is a progressive disease with adverse outcome. PAH therapies have changed the natural history of this disease, improved symptoms, and the outcome of patients with this condition. However, mortality remains high even in patients who are presumed to be stable on PAH therapy. PAH patients at increased risk of adverse events should, thus, be identified and offered more aggressive treatment. However, there is little information on how to risk stratify patients who are already on PAH therapies and presumed to be stable. Methods: A sample of patients on combination PAH therapy were identified on our National database and the first echocardiogram after 90 days of stability on combination therapy was identified and analysed. Stability was defined as freedom from death, hospitalisation, or evidence of deterioration (increasing symptoms or congestive heart failure). Cox survival analysis was used to assess the relation between echocardiographic parameters and the following endpoints: a) death or transplantation, b) hospitalisation. RV GLS was assessed in the 4-chamber view averaging 6 segments. Results: A total of 142 patients were included. Age at the time of echo was 54.0+/-17.1years. The majority belonged to group 1 [PAH, 100(70.4%)], followed by group 4 [CTEPH, 28(19.7%)], with a minority of patients from groups 3 [5(3.5%)] and 5 [9(6.3%)]. The majority patients in group 1 had idiopathic PAH [41(41%)], followed by congenital heart disease [22(22%)] and connective tissue disease [scleroderma 20(20%), non-scleroderma 15(15%)]. The majority of patients were on a PDE-5 inhibitor (PDE5) and endothelin receptor antagonist (ERA) combination [120(84.5%)], 20(14.1%) were on a combination including a prostanoid and only 8(5.6%) were on triple combination (ERA, PDE5 and prostanoid). Over a median follow-up of 2.5years, 23 patients died. Mortality for this populations was 5.75% per person-year 95%CI:3.84-8.63. The following echo parameters were associated with the risk of death:TAPSE <15mm (0.88, 95%CI:0.77-0.99, p=0.04), mid-RV size (1.67, 95%CI:1.09-2.57, p=0.02) and RV length (1.04, 95%CI:1-1.09, p=0.047), RA size (1.06, 95%CI:1.01-1.1, p=0.02) and RV GLS <-20% (0.9, 95%CI:0.82-0.99, p=0.03). On multivariable analysis, RVmid (1.62, 95%CI:1.04-2.52, p=0.03) and RVGLS (0.91, 95%CI:0.82-0.99, p=0.04) both stayed in the model. Conclusions: Patients with PAH are still at significant risk of adverse outcome, even after combination therapy and apparently stable. Echocardiographic parameters of RV dimensions and function, including GLS, can help identify patients at greater risk of deterioration and should be used to guide further escalation of therapy. Open in new tabDownload slide Abstract P1204 Figure. Open in new tabDownload slide Abstract P1204 Figure. P1205Rapid cardiovascular imaging with pocket-size devices improves the initial assessment of suspected pulmonary embolism D Filipiak D Filipiak Medical University of Lodz, Lodz, Poland J D Kasprzak J D Kasprzak Medical University of Lodz, Lodz, Poland P Lipiec P Lipiec Medical University of Lodz, Lodz, Poland Medical University of Lodz, Lodz, Poland Background: Oftentimes the onset of pulmonary embolism is overlooked due to the non-specific character of its symptoms. With the use of the Pocket-size imaging devices (PSID) imaging diagnostics can be effortlessly implemented into the prompt physical examination. Purpose: The aim of this study was to verify the hypothesis if the supplementation of the initial bedside assessment with four-point compression venous ultrasonography (CUS) and right ventricular size assessment with the use of PSID equipped with linear probe could positively influence the accuracy of clinical risk assessment scores. Methods: 100 pts (47 men, mean age 68±13 years) with suspected PE underwent clinical assessment in the ER environment on the basis of Wells and revised Geneve score and physical examination supplemented with CUS and RV measurements in long axis parasternal and 4-chamber apical (basal and mid diameter) view. Subsequently the points "clinical signs of DVT" in Wells rule and "pain on lower limb deep venous palpation and unilateral oedema" in revised Geneva score was changed into ‘positive CUS result’ and was attributed 3 and 7 pts respectively. When the RV enlargement was detected, 1 point was added. Results: The mean time of CUS and RV size assessment was 5,3 minute and was universally accepted by the patients as a part of clinical examination. PE was confirmed in 24 pts. 15 pts had the deep venous thrombosis (5 proximal, 10 distal) detected in CUS. In 59 pts RV enlargement was recorded in at least 1 measurement. According to the three-category Wells rule the clinical risk of PE was estimated as low in 74 pts among which 10 were eventually diagnosed with PE, as intermediate in 24 pts (12 confirmed PE), as high in 2pts (PE confirmed). In compliance with revised Geneva score 54 pts had low clinical risk of PE (in 9 PE was confirmed), 44 pts-intermediate (13 cases of PE); 2 patients-high (PE confirmed). Wells score diagnostic accuracy within our study population could be described with the positive predictive value (PPV) -59%, negative predictive value (NPV)-89%, specificity 86% and sensitivity 67%, AUC 0,776 (95% CI 0,681-0,853, p<0,0001). Similar values calculated for the revised Geneva score were as follows: PPV-35%, NPV-82%, specificity 50% and sensitivity 71%, AUC 0,664 (95% CI 0,563-0,756, p= 0,0104). Supplementing the revised Geneva score with additional criteria of positive CUS test and RV enlargement resulted in significant improvement of diagnostic accuracy of this score- difference between areas 0,199 ( 95% Cl 0,0893-0,308, p=0,0004). Similar modification of Wells score increased AUC by 0,133 (95%CI 0,0443-0,223, p= 0,0034). Conclusion: Rapid imaging protocols with PSID allow improved initial evaluation of patients with suspected pulmonary embolism despite their limited quantitative functionality. P1206A new index for the identification of early forms of pulmonary precapillary hypertension C Magnino C Magnino 1University Hospital "S. Giovanni Battista", Departement of Medical Sciences, Turin, Italy P Omede' P Omede' 2Città della Salute e della Scienza, Division of Cardiology, Turin, Italy E Avenatti E Avenatti 1University Hospital "S. Giovanni Battista", Departement of Medical Sciences, Turin, Italy F Gaita F Gaita 2Città della Salute e della Scienza, Division of Cardiology, Turin, Italy F Veglio F Veglio 1University Hospital "S. Giovanni Battista", Departement of Medical Sciences, Turin, Italy A Milan A Milan 1University Hospital "S. Giovanni Battista", Departement of Medical Sciences, Turin, Italy 1University Hospital "S. Giovanni Battista", Departement of Medical Sciences, Turin, Italy 2Città della Salute e della Scienza, Division of Cardiology, Turin, Italy Background: Echocardiography relies mostly on the peak velocity of tricuspid regurgitation (TRv) to identify subjects with suspected pulmonary hypertension (PH). However, its ability to indentify PH in early stages is unknown. Purpose: To test the ability of TRv to identify early degree of PH and find other potential indexes to enhance the screening capability of echocardiography Methods: 200 subjects addressed to right heart catheterization for various reasons underwent a complete transthoracic echocardiography within 60 minutes. Various echocardiographic variables, including TRv, were tested for their ability to identify patients with PH in the subset of subjects with mean pulmonary arterial pressure (mPAP) between 20 and 30 mmHg. The same variables were tested to identify pre-capillary (pre-PH) forms. Results: 190 subjects were included in the analysis. 58 subjects had mPAP values between 20 and 30 mmHg, 32 of them (55%) had PH. The basic antropometric, echocardiographic and hemodynamic characteristics are shown in the Table. TRv was significantly different between the two groups (2.47±0.36 vs 2.75±0.44 ms/s, p=0.02), but showed poor performance in identifying PH (best cutoff 2.6 m/s, 0.66 sensitivity, 0.58 specificity, AUC 0.68 [0.54-0.82]). Only the right ventricular fractional area change demonstrated a better performance (AUC 0.801 [0.671-0.930]), but it was less feasible. We then compared subjects with versus without pre-PH. The right ventricular TDI systolic excursion velocity (S’) was significantly higher in the pre-PH group (13.7±2.4 vs 11.0±3.3 cm/s, p=0.03), whereas the pulmonary artery acceleration time (AcT) was significantly lower (0.089±0.018 vs 0.115±0.036 s, p=0.05). The index obtained by the ratio between S’ and AcT showed good discrimination ability (AUC 0.834 [0.712-0.956], see figure). Values under 110 cm/s2 and above 170 cm/s2 had 0.90 specificity to respectively rule-out and rule-in pre-PH. We tested these values in the 62 patients with TRv between 2.4 and 2.8 m/s (the area in which TRv showed the lowest reliability). S’/AcT was feasible in 53 patients (85.5%). 30 patients were identified with low probability of prePH, correctly in 28 cases (93.3%). 5 patients were identified with high probability of prePH, correctly in 3 cases (60.0%). Conclusions: TRv is not able to identify patients with PH when mPAP values are relatively low. The cutoffs commonly used could potentially miss a significant amount of diagnosis in the early stages of the disease, and should be used with caution especially in high risk population. The S’/AcT ratio is a novel index that can help to discriminate patients with or without pre-PH in presence of borderline TRv value, enhancing the screening performances of echocardiography. Open in new tabDownload slide Abstract P1206 Figure. Open in new tabDownload slide Abstract P1206 Figure. P1207Assessment of pulmonary artery elastic properties in patients with Eisenmenger syndrome - a comparison to other types of pulmonary hypertension R Enache R Enache 1Carol Davila University of Medicine and Pharmacy, Euroecolab, Prof. Dr. C.C. Iliescu Institute, Bucharest, Romania E Popa E Popa 1Carol Davila University of Medicine and Pharmacy, Euroecolab, Prof. Dr. C.C. Iliescu Institute, Bucharest, Romania R Badea R Badea 2Institute of Cardiovascular Diseases "Prof. Dr. CC Iliescu", Bucharest, Romania A Calin A Calin 1Carol Davila University of Medicine and Pharmacy, Euroecolab, Prof. Dr. C.C. Iliescu Institute, Bucharest, Romania C C Beladan C C Beladan 1Carol Davila University of Medicine and Pharmacy, Euroecolab, Prof. Dr. C.C. Iliescu Institute, Bucharest, Romania M Rosca M Rosca 1Carol Davila University of Medicine and Pharmacy, Euroecolab, Prof. Dr. C.C. Iliescu Institute, Bucharest, Romania P Platon P Platon 2Institute of Cardiovascular Diseases "Prof. Dr. CC Iliescu", Bucharest, Romania I M Coman I M Coman 1Carol Davila University of Medicine and Pharmacy, Euroecolab, Prof. Dr. C.C. Iliescu Institute, Bucharest, Romania B A Popescu B A Popescu 1Carol Davila University of Medicine and Pharmacy, Euroecolab, Prof. Dr. C.C. Iliescu Institute, Bucharest, Romania C Ginghina C Ginghina 1Carol Davila University of Medicine and Pharmacy, Euroecolab, Prof. Dr. C.C. Iliescu Institute, Bucharest, Romania 1Carol Davila University of Medicine and Pharmacy, Euroecolab, Prof. Dr. C.C. Iliescu Institute, Bucharest, Romania 2Institute of Cardiovascular Diseases "Prof. Dr. CC Iliescu", Bucharest, Romania Patients with Eisenmenger’s syndrome (ES) have a better survival than other patients with pulmonary arterial hypertension (PAH), probably due to the preservation of right ventricular (RV) function. In patients with PAH RV remodeling and function depend not only on pulmonary artery pressure (PAP) but also on the intrinsic proprieties of pulmonary artery wall. Data regarding pulmonary artery stiffness (PAS) assessed by echocardiography in patients with ES are scarce. Purpose: To assess RV function and PAS parameters by 2D transthoracic echocardiography in patients with ES compared to other patients with pulmonary hypertension (PH) receiving specific vasodilator therapy. Methods: Forty-seven patients with PAH were enrolled: 14 patients with ES and 33 non-ES patients, including patients with other types of PAH (13 with idiopathic PAH, 3 with operated congenital heart disease, 6 with connective tissue disease and 5 with other forms of PAH) or chronic thromboembolic PH (6 patients) treated with either bosentan, sildenafil, or both. Clinical parameters, B-type natriuretic peptide (BNP), RV function parameters and PAS parameters were assessed: pulmonary capacitance (PC), pulmonary capacitance indexed to body surface area (PC/BSA), elastic modulus (EP), beta-index. PH patients were followed-up for 23 months (2-49). Results: Pulmonary vascular resistance (PVR) assessed by right heart catheterization was similar in both groups (11±10 vs 10±6 Wood units, p=0.78). ES patients had lower BNP levels (lnBNP 3.79±1.61 vs 5.23±1.30, p=0.007) and better RV function than non-ES patients: RV-free wall S wave (12.3±2.2 vs 10.5±1.8 cm/s, p=0.004), RV fractional area change (38±6 vs 32±10%, p=0.025), RV-free wall global longitudinal strain (-15.3±4.7 vs -13.4±4.8%, p=0.023). In ES patients PAS parameters were less impaired than in non-ES patients (PC 1.89±0.94 vs 1.11±0.61 ml/mmHg, p=0.003; PC/BSA 1.17±0.53 vs 0.65±0.37 ml/mmHg m2, p=0.001; EP 447.6±219.4 vs 630.8±379.5 mmHg, p=0.046; beta index 6.60±3.04 vs 11.43±6.47, p=0.001) and these parameters did not significantly change during follow-up (PC 1.89±0.94 vs 1.61±0.68 ml/mmHg, p=0.16; PC/BSA, 1.17±0.53 vs 0.98±0.34 ml/mmHg m2 p=0.15; EP 447.6±219.4 vs 475.9±200.8 mmHg, p=0.51, beta index 6.60±3.04 vs 6.87±2.51, p=0.64). In non-ES patients some PAS parameters were further impaired during follow-up (PC 1.11±0.61 vs 1.11±0.63 ml/mmHg, p=0.96; PC/BSA 0.65±0.37 vs 0.66±0.40 ml/mmHg m2, p=0.93; EP 630.8±379.5 vs 1123.4±852.7 mmHg, p=0.004; beta index, 11.43±6.47 vs 19.22±15.74, p =0.011). Conclusions: Patients with ES have not only better RV function but also less impaired PA stiffness parameters compared to patients with other types of PH and similar PVR. Moreover, a further impairment in PA stiffness during follow-up is observed in other types of PH and not in ES patients. The impact of these finding on clinical outcomes in ES patients remains to be further studied. P1208Discriminating between pre-capillary and post-capillary pulmonary hypertension - is there a role for echocardiography? A E Vijiiac A E Vijiiac Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania S Iancovici S Iancovici Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania A Scarlatescu A Scarlatescu Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania A Deaconu A Deaconu 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 Background: Transthoracic echocardiography is a safe, cost effective, widely available tool for the evaluation of patients with pulmonary hypertension (PH). However, in the differential diagnosis of the various forms of PH, no echocardiographic algorithm has been validated so far. Purpose: We sought to assess if simple echocardiographic parameters, which are easy to obtain and interpret, can differentiate between pre-capillary and post-capillary PH. Methods: We have included 50 patients in our study, dividing them into 2 groups: the pre-capillary group consisted of 23 patients with pulmonary arterial hypertension, who were referred to our clinic for right heart catheterization. The post-capillary group consisted of 27 patients from our daily clinical practice with PH assessed by echocardiography and significant left heart disease (either severe left ventricular systolic dysfunction, or severe mitral regurgitation, or severe aortic stenosis). Standard echocardiographic measurements were performed for all patients and we used T test to compare various parameters between the two groups. We used receiver operating characteristic (ROC) analysis to find the optimal cut-off value for maximum sensitivity (Sn) and specificity (Sp) and to calculate the area under the curve (AUC) as a measure of discriminatory power. Results: Several echocardiographic parameters differed significantly between the two groups. The pre-capillary group had lower pulmonary valve acceleration time (59.52 ± 18.54 vs. 71.72 ± 12.77, p=0.015) and larger right ventricular (RV) diameter (50.30 ± 8.73 vs. 41.33 ± 7.12, p<0.0001). The left atrial volume, measured using the biplane area-length method, was lower in the pre-capillary group (43.22 ± 16.39 vs. 112.26 ± 45.64, p<0.0001), with the cutoff of 58 having an excellent discriminatory power (AUC=0.930) between the two groups (Sn=88%, Sp=83%). The thickness of RV free wall measured from the subcostal view was higher in the pre-capillary group (8 ± 1.91 vs. 5.86 ± 1.28, p<0.0001), with the cutoff of 6.5 providing good discrimination (AUC=0.847, Sn=78%, Sp=78%). The transmitral E-wave/ septal mitral annular Doppler Tissue Imaging e′-wave ratio was lower in the pre-capillary group (8.49 ± 3.09 vs. 20.85 ± 8.85, p<0.0001), while the cutoff of 11.6 provided excellent discriminatory power (AUC=0.935, Sn=87%, Sp=80%). The ratio between right atrial volume and left atrial volume was higher in the pre-capillary group (3.28 ± 3.70 vs. 0.70 ± 0.20, p=0.003), and the cutoff of 0.81 had an excellent discriminatory power (AUC=0.984, Sn=100%, Sp=71%). Conclusion: Transthoracic echocardiography with conventional measurements appears to be a useful tool for guiding the differential diagnosis of PH. Further investigation is necessary in order to establish the potential of simple echocardiographic parameters to reduce the need for cardiac catheterization. Open in new tabDownload slide Abstract P1208 Figure. ROC analysis Open in new tabDownload slide Abstract P1208 Figure. ROC analysis P1209Does plasma ghrelin level predict severity of pulmonary arterial hypertension S Unlu S Unlu Gazi University, Cardiology Department, Ankara, Turkey B Sezenoz B Sezenoz Gazi University, Cardiology Department, Ankara, Turkey G Tacoy G Tacoy Gazi University, Cardiology Department, Ankara, Turkey S Turkoglu S Turkoglu Gazi University, Cardiology Department, Ankara, Turkey R Yalcin R Yalcin Gazi University, Cardiology Department, Ankara, Turkey A Cengel A Cengel Gazi University, Cardiology Department, Ankara, Turkey Gazi University, Cardiology Department, Ankara, Turkey Background: Pulmonary arterial hypertension (PAH), regardless of etiology, causes right ventricular (RV) remodeling and dysfunction as the disease progresses which result in clinical deterioration and mortality. Thus RV function and the natriuretic peptide levels are among the strongest predictors of prognosis in PAH patients. Ghrelin is a peptide mostly secreted from gaster, which has various effects in cardiovascular system, such as vasodilatation. Ghrelin is proposed to be a new biomarker of prognosis and a target for treatment of PAH. Purpose: PAH patients are shown to have increased ghrelin level in plasma, however ghrelin level could depend on different clinical factors. Moreover, ghrelin levels of patients from different etiologies other than IPAH are not elucidated yet. We aimed to figure out ghrelin levels in PAH patients and its correlation with RV function and brain natriuretic peptide (BNP) levels. . Methods: 18 PAH patients (37±15 yo,17 female) with different etiologies and a matched control group with 20 volunteers were included. Plasma ghrelin levels were studied. RV dimensions, fractional area change (FAC), segmental (LS) and global longitudinal strain (GLS) as well as left ventricular ejection fraction (LV EF) and LV LS and GLS were measured. Correlation coefficient test was used to analyze the association between ghrelin, BNP and echocardiographic methods. Results: The serum ghrelin levels did not significantly differ between groups. (1067 ± 489 pg/ml vs 860 ± 240 pg/ml; P =0.232) (Fig A). PH patients had similar LV EF, RV FAC and TAPSE (58±10%vs.62±9%, 31.2±10%vs.40.4±9%, 16.5±3,7mm vs 19±3,1mm, all P = NS, respectively), however; PAH group had lower RV GLS (-16.1± 4.8% vs.-25.9±4.5%, P < 0.001) RV free-wall LS (-15.7± 6.9% vs.-20.0± 5.0%, P < 0.001) and LV GLS (-16.3± 7.2% vs.-25.0± 5.0%, P < 0.001). Plasma ghrelin level showed no statistically significant correlation with serum BNP levels, RV GLS, RV LS and LV GLS (R2 values are represented in Fig B and Fig C, all p=NS). Contrarily, serum BNP levels showed significant correlations with RV GLS, RV LS and LV GLS (R2 values are represented in Fig D, all p<0.001). Conclusion: Ghrelin would play a role in PAH pathogenesis but up to date data is insufficient to verify exact relationship between ghrelin and PAH. Even though IPAH patients have higher ghrelin levels compare to other populations, our study is unable to validate ghrelin as a new prognostic marker. Ghrelin levels cannot be used to predict clinical outcome of PAH since it does represent the actual clinical situation of patient. Open in new tabDownload slide Abstract P1209 Figure. Open in new tabDownload slide Abstract P1209 Figure. P1210Evaluation of cardiac remodeling in patients with chronic thromboembolic pulmonary hypertension A Bogdanova A Bogdanova 1Pirogov City Clinical Hospital 1, Moscow, Russian Federation V Shemenkova V Shemenkova 1Pirogov City Clinical Hospital 1, Moscow, Russian Federation N Shostak N Shostak 2Russian National Research Medical University, The Department of faculty therapy named after acad. A.I. Nesterov, Moscow, Russian Federation A Klimenko A Klimenko 2Russian National Research Medical University, The Department of faculty therapy named after acad. A.I. Nesterov, Moscow, Russian Federation D Kotova D Kotova 1Pirogov City Clinical Hospital 1, Moscow, Russian Federation 1Pirogov City Clinical Hospital 1, Moscow, Russian Federation 2Russian National Research Medical University, The Department of faculty therapy named after acad. A.I. Nesterov, Moscow, Russian Federation Introduction: chronic thromboembolic pulmonary hypertension (CTEPH) is a significant complication of venous thromboembolism. The persistent CTEPHleads to right-ventricle pressure overload. As a result, there is often significant functional and morphological alteration of both the right and the left ventricle. Transthoracic echocardiography (EchoCG), which allows for the estimation of pulmonary arterial pressures, not only plays an important role in the diagnosis of pulmonary hypertension (PH) but also provides insights in the pathophysiology of CTEPH. Objective: to assess the structural and functional state of the right and left heart in patients with CTEPH, depending on the functional class (FC) of pulmonary hypertension. Materials and methods: 21 patients (12 women and 9 men) were included in the study with a confirmed diagnosis of CTEPH. The average age of the patients was 60,1 ± 3,7 years. EchoCG was performed on an expert class Vivid E7 using standard accesses and regimens. Parameters such as systolic pulmonary artery pressure (SPAP), TAPSE, left ventricular ejection fraction (LV EF), sizes of right and left chambers of the heart were evaluated. All patients underwent a 6-minute walk test to determine the FC of the PH. By this parameter, patients were divided into 2 subgroups: subgroup 1 - 9 people with I and II FC; subgroup 2 - 12 people with III and IV FC. Statistical comparisons were performed by using Statistica 7.0 Results: patients with III and IV FC of PH had significantly more right heart enlargement with lower values of LV systolic function than patients with I and II FC. Diastolic dysfunction of the right ventricle (RV) was detected in all patients with CTEPH regardless of FC, while diastolic LV dysfunction was disrupted only in 14 (66,7%) patients. When assessing the left heart, patients with III-IV FC had significantly lower end-systolic and end-diastolic volume in comparison with patients I and II FC. Conclusions: Patients with CTEPH noted to have right heart remodeling processes in the form of dilatation of the right atrium (RA) and RV, hypertrophy of the RV, the severity of which is correlated with the degree and FC of PH. In all patients with CTEPH, regardless of PH FC, there was diastolic dysfunction of the RV. Predictors of unfavorable prognosis (frequent hospitalizations due to decompensation of heart failure, fatal outcome) in our patients were such values of echocardiographic parameters as TAPSE <1,7 cm and RA area> 22 cm2, which is comparable with international data of other authors. Also remodeling and left heart processes were revealed in the form of a decrease in LV systolic function as a function of PH FC. Thus, the echocardiographic parameters of the right and left parts of the heart make it possible to evaluate the cardiac remodeling processes in patients with CTEPH, to compare them with clinical data, including FC and to prognostic unfavorable indicators of CTEPH flow. P1211Chronic obstructive pulmonary, but not parenchymal, disease significantly impacts left ventricular structure and function F Hasson F Hasson Luton and Dunstablr Hospital, Cardiology, London, United Kingdom M Y Henein M Y Henein Luton and Dunstablr Hospital, Cardiology, London, United Kingdom Luton and Dunstablr Hospital, Cardiology, London, United Kingdom Background and aim: Deterioration of breathlessness in patients with lung disease is commonly due to the original pathology, but in a subset of patients it may be contributed to by cardiac dysfunction, with or without secondary pulmonary hypertension. We aimed in this study to assess any relationship between lung function and left ventricular (LV) function in three varieties of lung disease. Methods: We studied 71 patients with lung disease: 22 with chronic obstructive pulmonary disease (COPD) (mean age 65.1 ± 13.1 years, 10 males); 22 with Interstitial lung disease (ILD) (mean age 56.4±13.6 years, 8 males) and 27 with cystic fibrosis (CF), (mean age 28.3±12.4 years, 14 males). All patients underwent lung function tests and transthoracic echocardiography, from which LV systolic (ESD) and diastolic (EDD) dimensions were measured and the ejection fraction was calculated. Results: The COPD patients were the oldest group (p=0.036) and the CF were the youngest. In the COPD patients, age correlated with forced expiratory volume in one second (FEV1) (r=0.42, p=0.047), FEV1% (r=0.56, p=0.006), total lung capacity (TLC) (r=0.54, p=0.03) and measurements of the transfer factor (KCOc) (r=0.47, p=0.035), but no similar relationship was found in either the ILD or CF groups. Also, only in the COPD group, the LV ejection fraction correlated inversely with forced vital capacity (FVC) (r= -0.54, p= 0.014), and TLC (r= -0.65, p=0.010) as did LVEDD with the percent residual volume (RV%) (r= -0.58, p=0.034). The only relationship found between LV and lung function in ILD and CF patients was between LVEDD and TLC (r=0.49, p=0.029 and r=0.47, p=0.044, respectively). Conclusion: Age has a significant impact on lung function only in patients with chronic obstructive airway disease. In these patients, LV function and volume are inversely associated with lung function. In contrast, LV size is directly associated with total lung capacity in those with parenchymal disease. These findings need to be reconfirmed in a larger group of patients. P1212Ejection fraction underestimates left ventricular dysfunction in patients with acute pulmonary embolism K Sveric K Sveric Dresden University of Technology, Heart Center, Department of Cardiology and Intensive Care, Dresden, Germany U Richter U Richter Dresden University of Technology, Heart Center, Department of Cardiology and Intensive Care, Dresden, Germany M Forkmann M Forkmann Dresden University of Technology, Heart Center, Department of Cardiology and Intensive Care, Dresden, Germany R H Strasser R H Strasser Dresden University of Technology, Heart Center, Department of Cardiology and Intensive Care, Dresden, Germany C Wunderlich C Wunderlich Dresden University of Technology, Heart Center, Department of Cardiology and Intensive Care, Dresden, Germany K Ibrahim K Ibrahim Dresden University of Technology, Heart Center, Department of Cardiology and Intensive Care, Dresden, Germany Dresden University of Technology, Heart Center, Department of Cardiology and Intensive Care, Dresden, Germany Background: Patients with acute submassive pulmonary embolism (PE) exhibit a severe impairment of right ventricular (RV) function with higher risk for rapid left ventricular (LV) deterioration. By now, the biventricular interplay remains not fully elucidated in PE. Therefore, the aim of the study was to compare LV ejection fraction (EF) and stroke volume (SV) with three-dimensional (3D) transthoracic echocardiography (TTE) to assess and determine the degree of LV dysfunction in PE patients. Methods: TTE was performed in 20 patients (67±7 years, 30% female) with PE at the first hour of hospital admission. Nineteen age and sex matched healthy volunteers served as controls. RV sphericity-index (RVSI) served as a marker of adverse RV dilatation, and right ventricular systolic pressure (RVSP) was assessed to indicate pressure overload. RV function was determined with RV EF by 3D-TTE and tricuspid annular plane systolic excursion (TAPSE) by two-dimensional TTE. LV function and geometry was determined by 3D-TTE with EF, stroke volume (SV), and exentricity index (LEI). Results: PE patients exhibited a sever decrease of RV EF and TAPSE with signs of pressure overload compared to controls (25±5 vs 55±5 %, 14±6 vs 27±8 mm, 62±12 vs 25±5 mmHg, for all p< 0.001). Both, LV EF and LV SV were significantly decreased in comparison with controls (46±10 vs 56±4 %, 30±10 vs 45±5 ml/m2, for all p< 0.001). However, LV SV was stronger correlated with a RV dysfunction (r = 0.71) than LV EF (r= 0.21). In PE patients with a more severe deterioration of RV function (TAPSE <14 mm and RV EF < 30%) LV SV was more impaired (25±7 vs 42±6, p< 0.001) than LVEF (46±4 vs 53+6, p= 0.04). In multiple regression analysis LV SV remained the best predictor of RV dysfunction in PE patients (beta estimate: 0.74, overall model r2= 0.50, p< 0.05) with LEI as covariate. Conclusion: Our study demonstrated clearly, that left ventricular ejection fraction underestimates lLV dysfunction in patients with acute submassive pulmonary embolism. Best indicator of a cardiac deterioration were right ventricular ejection fraction and left ventricular stroke volume. One may assume that far more patients are under higher risk of clinical worsening than assumed. However, the underlying mechanism of biventricular interaction in acute pulmonary embolism needs to be elucidated in further studies. P1213Causes of pulmonary hypertension in children N S Eleftherakis N S Eleftherakis Aghia Sophia Children's Hospital, Cardiology, Athens, Greece N Andreou N Andreou Aghia Sophia Children's Hospital, Cardiology, Athens, Greece A Giannakopoulou A Giannakopoulou Aghia Sophia Children's Hospital, Cardiology, Athens, Greece S Loukopoulou S Loukopoulou Aghia Sophia Children's Hospital, Cardiology, Athens, Greece M Papafylactou M Papafylactou Aghia Sophia Children's Hospital, Cardiology, Athens, Greece E Karanasios E Karanasios Aghia Sophia Children's Hospital, Cardiology, Athens, Greece Aghia Sophia Children's Hospital, Cardiology, Athens, Greece A Anagnostopoulou A Anagnostopoulou Aghia Sophia Children's Hospital, Cardiology, Athens, Greece Introduction: (or Basis or Objectives): Pulmonary hypertension is defined as increased pressure in the pulmonary artery exceeding 25 mmHg. The aetiology of Pulmonary Hypertension in Children is quite different to the one in adults. The initial classification system for the aetiology of pediatric pulmonary hypertension in children appeared in 1998 and it was based on pathologic causes. Subsequently the classification system was revised in 2013, from the Pediatric Task Force of the 5th World Symposium on Pulmonary arterial hypertension. Purpose: The purpose of the study is to delineate the causes of increased pulmonary pressures measured invasively and classify them according to the Pediatric Task Force of the 5th World Symposium on Pulmonary arterial hypertension. Methods: A large retrospective study was undertaken at the cardiac catheterization laboratory of a large paediatric hospital during the years 2011-2015. The children who had invasive measurement of pulmonary hypertension were identified and their aetiologies revised and classified. The cardiac causes were identified and analysed. Results: 120 children were identified with pulmonary artery pressure >25 mmHg. The average value was 45 mmHg with a standard deviation 19.48 mmHg. The majority of the catheterizations were diagnostic 87/120, 7 of which started as interventional and the rest 33/120 were interventional. Τhe majority 114/120 of the pulmonary hypertension had a cardiac cause associated with congenital heart disease. The most common underlying cause was VSD 18/114(15.7%), followed by PDA 14/114(12.2%) and ASD 12/114 (10.5%).Other common congenital heart diseases were Coarctation of aorta/interrupted aortic arch (11/114), TAPVD/PAPVD (11/114), AVSD (6/114), Aortic stenosis (6/114), Pulmonary stenosis (10/114), Tetralogy of Fallot (7/114)and TGA (6/114) Conclusions: The majority of the causes of pulmonary hypertension in children is associated with congenital heart disease, of which the most common are VSD, PDA and ASD. P1214Non-invasive leg muscle blood flow assessment with power doppler ultrasound during whole body exercise H M Heres H M Heres 1Eindhoven University of Technology, Biomedical Engineering, Eindhoven, Netherlands T Schoots T Schoots 2Maxima Medical Center, Cardiology, Eindhoven, Netherlands M C M Rutten M C M Rutten 1Eindhoven University of Technology, Biomedical Engineering, Eindhoven, Netherlands F N Van De Vosse F N Van De Vosse 1Eindhoven University of Technology, Biomedical Engineering, Eindhoven, Netherlands R G P Lopata R G P Lopata 1Eindhoven University of Technology, Biomedical Engineering, Eindhoven, Netherlands 1Eindhoven University of Technology, Biomedical Engineering, Eindhoven, Netherlands 2Maxima Medical Center, Cardiology, Eindhoven, Netherlands Funding Acknowledgements: FP-7 EU Framework Program Background and purpose: Assessment of limitations in the perfusion dynamics might provide insight in the complexity of exercise intolerance in e.g. heart failure patients [1]. Power Doppler Ultrasound (PDUS) has been recognized as a sensitive tool for the detection of moving blood volume, a perfusion related parameter [2]. However, until now, PDUS has never been used for the assessment of perfusion in muscle during whole body exercise. In this volunteer study, we investigate the validity and reliability of perfusion measurements in the vastus lateralis muscle, with PDUS, during controlled exercise protocols. Materials and methods: Power Doppler measurements were performed with a MyLab US system (ESAOTE). A 7.5 MHz linear array probe was fixated on the vastus lateralis muscle with a custom made probe holder. From the ultrasound frames, the number of PDUS pixels was divided by the total area of interest to get the ratio of perfused area (RPA), as a measure of perfusion. Validity was tested during leg extension exercise (N=18), by determining the correlation between RPA and the increase of blood flow in the supplying lateral circumflex femoral artery, measured with Pulsed Wave Doppler (PWD) ultrasound. To test reliability of measurements on perfusion kinetics, the RPA was measured in 30 volunteers during cycling exercises; submaximal (6 min. at 80% of the anaerobic threshold, which is comparable to daily exercise) and maximal (12 minutes at increasing load until max), repeated on two different days. Exercise was interrupted by resting periods of 10s to allow PDUS measurements without motion artefacts. Absolute and relative reliability of RPA kinetic parameters during exercise (onset, slope, maximum value) and recovery (overshoot, time constant) were investigated. Results and conclusion: The fixation of the probe allowed for continuous PDUS measurements during both leg extension and cycling exercise. RPA dynamics correlated well with blood flow in PWD (r = 0.8). During cycling, an increase of RPA followed by a signal recovery, was measured in all volunteers. RPA onset during submaximal exercise shows good reliability (ICC = 0.8) Other kinetic parameters during exercise and recovery showed moderate reliability with ICC ranging from 0.3-0.6. The validity and reliability of the measured muscle blood flow onset in submaximal exercise holds a promise for non-invasive clinical assessment of exercise intolerance with PDUS. [1] M. J. Sullivan and M. H. Hawthorne, "Exercise intolerance in patients with chronic heart failure," Prog. Cardiovasc. Dis., vol. 38, no. 1, pp. 1–22, Jul. 1995. [2] J. M. Rubin, R. S. Adler, J. B. Fowlkes, S. Spratt, J. E. Pallister, J. F. Chen, and P. L. Carson, "Fractional moving blood volume: estimation with power Doppler US.," Radiology, vol. 197, no. 1, pp. 183–90, Oct. 1995. Open in new tabDownload slide Abstract P1214 Figure. Open in new tabDownload slide Abstract P1214 Figure. P1215Adiponectin correlates with anthropometric, not cardiac, measurements in dialysis patients A Poniku A Poniku 1University Clinical Centre of Kosova (UCC), Service of Cardiology, Pristina, Kosovo Republic of G Bajraktari G Bajraktari 1University Clinical Centre of Kosova (UCC), Service of Cardiology, Pristina, Kosovo Republic of P Ibrahimi P Ibrahimi 1University Clinical Centre of Kosova (UCC), Service of Cardiology, Pristina, Kosovo Republic of M Y Henein M Y Henein 2Heart Centre and Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden S Elezi S Elezi 1University Clinical Centre of Kosova (UCC), Service of Cardiology, Pristina, Kosovo Republic of 1University Clinical Centre of Kosova (UCC), Service of Cardiology, Pristina, Kosovo Republic of 2Heart Centre and Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden Background and Aim: Adiponectin is a serum protein produced and secreted by adipose tissue which exerts anti-inflammatory, anti-diabetic and anti-atherosclerotic properties, and hence is today considered as cardio-protective marker. Since the role of adiponectin in dialysis patients remains unclear, we aimed to investigate its relationship with left ventricular structure and function in such patients. Methods: This study included 89 (age 56±13 years, 43% male) patients treated with regular dialysis for > 6 months, and 55 control subjects with normal renal function. A complete 2 dimensional, M-mode and Tissue-Doppler echocardiographic study, and biochemical blood analyses, adiponectin and anthropometric parameters were obtained at the same day. Results: Patients had lower BMI and lower BSA (p<0.001 for both), lower waist/hips ratio (p=0.005), higher LV mass index (LVMI, p<0.001), larger LV end-systolic diameter (LVESD, p=0.029) and LV end-systolic volume (p=0.003), lower LV ejection fraction (p=0.006), longer isovolumic relaxation time (p<0.001), lower mean LV strain (p=0.002), larger LA volume (p=0.022) and decreased LA emptying fraction (p=0.026), compared to controls. In the patients, adiponectin correlated with waist circumference (r=-0.427, p<0.001), BMI (r=-0.403, p<0.001) and BSA (r=-0.480, p<0.001), and to a lesser extent with LVMI (r=0.296, p=0.005), waist/hips ratio (r=-0.222, p=0.037) and total cholesterol (r=-0.292, p=0.013). But in controls, it correlated only with age (r=0.304, p=0.024), hemoglobin (r=0.371, p=0.005), HDL cholesterol (r=0.315, p=0.019), LV EDD (r=0.278, p=0.040) and LVMI (r=0.277, p=0.043). Conclusion: It seems that in dialysis patients, adiponectin modest correlation with anthropometric measurements suggests an ongoing catabolic process not related to heart function. P1216Association between albuminuria and left ventricular diastolic function in chronic kidney disease outpatients with preserved systolic function K Takada K Takada 1Fujita Health University, School of Health Sciences, Toyoake, Japan A Yamada A Yamada 2Fujita Health University School of Medicine, Toyoake, Japan Y Kawada Y Kawada 2Fujita Health University School of Medicine, Toyoake, Japan M Miyagi M Miyagi 2Fujita Health University School of Medicine, Toyoake, Japan N Hoshino N Hoshino 2Fujita Health University School of Medicine, Toyoake, Japan K Sugimoto K Sugimoto 3Fujita Health University Hospital, Toyoake, Japan Y Ozaki Y Ozaki 2Fujita Health University School of Medicine, Toyoake, Japan 1Fujita Health University, School of Health Sciences, Toyoake, Japan 2Fujita Health University School of Medicine, Toyoake, Japan 3Fujita Health University Hospital, Toyoake, Japan Chronic kidney disease (CKD) has been more and more recognised for its association with cardiovascular events. Overt albuminuria is one of the characteristic manifestations of CKD. However, the relationship between degree of albuminuria and left ventricular (LV) function remains to be clarified. The aim of this study was to examine how albuminuria was associated with LV diastolic function in outpatients with preserved systolic function. We studied 776 consecutive outpatients with CKD in our institution between 2007 and 2010. CKD was defined as one of the following conditions: proteinuria > 0.15 g/gCr and/or albuminuria > 30 mg/gCr, and/or glomerular filtration rate < 60 ml/1.73m2. The inclusion criteria were as follows: LV ejection fraction (LVEF) > 50% by echocardiography and quantitative estimation of urinary albumin within 6 months of the echo examination. LVEF was measured using modified Simpson’s method. Study subjects were excluded from this study if they had at least one of the following: atrial fibrillation, significant valvular heart disease, hemodialysis and poor echo image quality. Conventional echo parameters were measured and compared with urinary albumin levels. Two hundred and ninety-four patients (mean age 71.5 years, 175 men) were eligible for this study. They were classified into 3 groups based on the albuminuria levels: Group A (albuminuria < 30 mg/gCr, 43 patients), Group B (30-299 mg/gCr, 90 patients) and Group C (> 300 mg/gCr, 161 patients). There were no differences in LVEF among the groups, however, LV mass index (LVMI), left atrial volume index (LAVI) and E/e’ increased as albuminuria level rose (LVMI: 96 vs 99 vs 114 g/m2, p < 0.01; LAVI: 28.9 vs 35.5 vs 35.2 ml/m2, p = 0.04; E/e’: 9.0 vs 10.7 vs 11.2, p = 0.04, Group A vs B vs C, retrospectively). Although there was no difference in the prevalence of hypertension among the groups, the proportion of diabetic patients increased significantly as the urinary albumin went up (48.8 vs 51.1 vs 66.4%, Group A vs B vs C, p = 0.01) As urinary albumin level increased, LV diastolic function tended to be more deteriorated in spite of preserved LV systolic function. Diabetes mellitus may have been one of the contributors to it. Particularly assessment of LV diastolic function would be beneficial to the CKD patients because it would allow for earlier intervention to prevent latent cardiac events. P1217Evaluation of classic and novel echocardiographic indices of left ventricular function in patients with kidney transplantation L Lakkas L Lakkas 1University Hospital of Ioannina, 2nd Cardiology Department, Ioannina, Greece K K Naka K K Naka 1University Hospital of Ioannina, 2nd Cardiology Department, Ioannina, Greece A Bechlioulis A Bechlioulis 1University Hospital of Ioannina, 2nd Cardiology Department, Ioannina, Greece A Duni A Duni 2University Hospital of Ioannina, Nephrology Department and Renal Transplant Unit, Ioannina, Greece I Gkirdis I Gkirdis 3University of Ioannina, Michaelidion Cardiac Centre, Ioannina, Greece C Pappas C Pappas 2University Hospital of Ioannina, Nephrology Department and Renal Transplant Unit, Ioannina, Greece E Ntounousi E Ntounousi 2University Hospital of Ioannina, Nephrology Department and Renal Transplant Unit, Ioannina, Greece L K Michalis L K Michalis 1University Hospital of Ioannina, 2nd Cardiology Department, Ioannina, Greece 1University Hospital of Ioannina, 2nd Cardiology Department, Ioannina, Greece 2University Hospital of Ioannina, Nephrology Department and Renal Transplant Unit, Ioannina, Greece 3University of Ioannina, Michaelidion Cardiac Centre, Ioannina, Greece Introduction: Cardiovascular disease is the leading cause of death in kidney transplant recipients (KTRs). Myocardial dysfunction is a risk factor for cardiovascular complications in KTRs. Echocardiographic study, including conventional indices and novel deformation related indices, is considered a suitable diagnostic utility for the evaluation of subclinical left ventricular (LV) dysfunction and may discriminate patients at high cardiovascular risk. Purpose: To evaluate possible changes in classic and novel echocardiographic parameters in a KTR population over 3 years of follow up. Methods: Thirty-sevenKTRs (mean eGFR-MDRD 51±16ml/min/1.73m2, mean age 50 years old, 42% men, median time from KT 59 months), in steady state from the outpatient clinic, were included in this prospective study. Exclusion criterion was known cardiovascular disease. Patients were followed up (FU) for 3 years. Renal function markers (eGFR-MDRD and 24h urine protein-UPR, mg/24h) and LV systolic and diastolic function indices (by conventional tissue Doppler and 2D strain echocardiography) were assessed at baseline and at the end of FU period. Results: In echocardiographic studies a significant increase in LV mass index (LVMI, mean increase 15.9 gr/m2, p=0.009) and a significant decrease in LV ejection fraction (LVEF, mean decrease -5.3%, p=0.001) were observed over time. Regarding novel echocardiographic indices, a decrease in E’, E/A ratio and apical twist angle and an increase in E/E’ ratio and apical untwist angle (p<0.05 for all) were shown at FU. eGFR-MDRD did not change significantly, whereas UPR increased (p=0.03) during FU. Neither changes of LVMI and LVEF nor changes in renal function markers were correlated with changes of the novel indices at FU. Conclusion: In a population of KTRs, a worsening in several classic and novel echocardiographic indices of LV function was observed in a short term FU indicating probably a subclinical deterioration of cardiac function and an increased cardiovascular risk. Interestingly this deterioration was evident independently of changes in renal function. Further studies are needed to establish the diagnostic and prognostic role of these novel echocardiographic parameters in clinical practice. P1218The impact of cardiac rehabilitation on cardiopulmonary exercise testing variables in patients with ischemic heart disease S Arslan S Arslan 2Hitit University Çorum Training and Research Hospital, Chest Disease, çorum, Turkey T Dogan T Dogan 1Hitit University Çorum Training and Research Hospital, Cardiology, Çorum, Turkey O Karaarslan O Karaarslan 1Hitit University Çorum Training and Research Hospital, Cardiology, Çorum, Turkey O Celik O Celik 1Hitit University Çorum Training and Research Hospital, Cardiology, Çorum, Turkey L Bekar L Bekar 1Hitit University Çorum Training and Research Hospital, Cardiology, Çorum, Turkey Z Golbasi Z Golbasi 1Hitit University Çorum Training and Research Hospital, Cardiology, Çorum, Turkey 1Hitit University Çorum Training and Research Hospital, Cardiology, Çorum, Turkey 2Hitit University Çorum Training and Research Hospital, Chest Disease, çorum, Turkey I Ekinozu I Ekinozu 1Hitit University Çorum Training and Research Hospital, Cardiology, Çorum, Turkey M Yetim M Yetim 1Hitit University Çorum Training and Research Hospital, Cardiology, Çorum, Turkey Y Karavelioglu Y Karavelioglu 1Hitit University Çorum Training and Research Hospital, Cardiology, Çorum, Turkey M Kalcik M Kalcik 1Hitit University Çorum Training and Research Hospital, Cardiology, Çorum, Turkey Purpose: Cardiac rehabilitation (CR) is a secondary prevention method for the treatment of cardiovascular diseases and associated with a reduction in both cardiac morbidity and mortality. CR improves functional capacity and perceived quality of life whilst also supporting early return to work and the development of self-management skills. Cardiopulmonary exercise testing (CPET) measures a broader range of variables related to cardiorespiratory function with the goal of exploring metabolic, cardiovascular, and pulmonary responses to exercise. CPET has become an important clinical tool to evaluate functional capacity and to predict outcomes in patients with cardiovascular diseases. The objective of this study was to analyze the effects of CR on CPET variables in patients with ischemic heart disease. Method: This study enrolled 78 patients (mean age: 57.5±10.1; male:60) who participated in CR program after the diagnosis of ishemic heart disease between 2016 and 2017. CR programme was performed to the participants with an integrated multidisciplinary team consisting of cardiologist, experienced nurse and physiotherapist in the CR center of our hospital. All patients were evaluated by CPET and spirometry before and after the CR program. All data entered into a dataset and "before & after" comparison was made between dependent variables. Result: Comparison of spirometry results revealed no significant difference before and after CR. However, there were significant differences in terms of CPET parameters between the groups before and after CR. The duration of CPET and maximum load were significantly increased after CR [15.8 (13-17) vs 18 (14.3-20), p<0.001 and 114 (88.5-132.3) vs. 139.5 (105.8-160), p=0.001 respectively]. There was also a significant increase in VE (expired volume) and VT (tidal volume) at maximum exercise [73.2±15.2 vs 83.1±17.8 p<0.001 and 1.98 (1.57-2.19) vs. 2.08 (1.83-2.54), p<0.001 respectively]. Peak VO2, peak VO2/KG significantly increased after CR (11.9±2.8 vs 14.3±3.1, p<0.001 and 19.3±4.5 vs 22±4.9, p<0.001). There was 11.4% increase in mean peakVO2 after CR. There was no significant difference in VE/VO2 and VE/VCO2 before and after CR [39.8±6.2 vs 40.8±6.8, p=0.202 and 36.5±4.1 vs. 37.1±5.9, p=0.411 respectively] at maximum effort. There was also a significant increase in VO2 and VO2/KG in the recovery phase after CR [0.99 (0.86-1.1) vs 1.09 (0.96-1.33), p<0.001 and 12 (10.5-13.5) vs. 14 (11.5-15.5), p=0.001 respectively]. Whereas no significant difference was found between peak respiratory exchange ratios before and after CR [1.12 (1.07-1.14) vs 1.1 (1.02-1.13), p=0.502]. There was a significant decrease in heart rate, systolic and diastolic blood pressures at rest and during exercise after CR. Conclusion: This study revealed that CR improves CPET parameters in patients with ischemic heart disease. CPET may be a useful tool to evaluate functional capacity changes in patients with cardiovascular diseases after CR. P1219Two-dimensional strain and strain rate imaging of the left atrium as markers for detection of atrial tachyarrhythmias in patients after percutaneous closure of inter-atrial communications C Kavouras C Kavouras 1Hippokration General Hospital, Athens, Greece M Vavouranakis M Vavouranakis 2A.Cardiologic Clinic University of Athens, Hippokration General Hospital, Athens, Greece I Vlasseros I Vlasseros 1Hippokration General Hospital, Athens, Greece K Lampropoulos K Lampropoulos 3Evangelismos General Hospital of Athens, Athens, Greece D Tousoulis D Tousoulis 3Evangelismos General Hospital of Athens, Athens, Greece 1Hippokration General Hospital, Athens, Greece 2A.Cardiologic Clinic University of Athens, Hippokration General Hospital, Athens, Greece 3Evangelismos General Hospital of Athens, Athens, Greece Introduction: Transcatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO) is performed with increasing frequency. The long-term effects of implantation of atrial septal closure devices (ASCD) have been associated with concerns regarding potential adverse effects on atrial function over time. Appearance of atrial tachyarrhythmias (ATs) may occur without any known cause after the implantation. Purpose: Left atrial (LA) strain (S) and strain rate (SR) are a sensitive measure of LA mechanics. However, their relationship with rhythm outcomes after percutaneous closure of inter atrial communications are not well established. We evaluate changes in regional left atrial myocardial function using strain and strain rate imaging before the procedure and 6 months after ASCD implantation. We made comparison in patients with and without ATs after the percutaneous closure of the defect. Methods: Transcatheter closure of interatrial communications with Amplatzer devices was carried out on 70 patients (pts), 35 with ASD and 35 with PFO, 28 pts (40%) were men, aged 49 ± 4 years. None of the pts that were included in the study had history of AT prior to the implantation. Patients had scheduled clinical visits every 3 months, 48-hour Holter monitoring at 3 and 6 months after the closure. Echocardiographic data were taken before the procedure and 6 months after the procedure. The analysis for atrial function was performed on the anterior, lateral and inferior wall of the LA from apical four-chamber view. Peak longitudinal strain (S) and Strain rate (SR) during LA reservoir, passive emptying (conduit) and atrial contraction phases were measured. Results: All pts underwent successful closure of the defect. New ATs after implantation of Amplatzer devices were observed in 15 patients (21%). There were 9 patients with paroxysmal atrial fibrillation, 4 patients with atrial flutter and 2 patients with supraventricular tachycardia which occurred between the first month and 6 months after implantation. In patients were ATs occurred a decrease on the anterior left atrial wall SR during contractile phase was noticed after 6 months (from 2.12±0.22 to 1.66±0.26, p<0.002) and a decrease at the lateral atrial wall during contractile phase (4.2 ± 1.2 to 3.1 ± 1.4 P <0.001), while no change was noticed at inferior atrial wall. These changes were not observed in patients were no atrial arrhythmias occurred during these 6 months. Peak strain at LA reservoir, conduit and contraction phases were similar before and after the procedure. Conclusion: Transcatheter closure of ASD and PFO using Amplatzer devices is associated with a risk of new atrial tachyarrhythmias. Patients with decreased atrial SR after implantation of ASCD appear to have a greater likelihood of episodes of ATs. Possible mechanisms may be focal irritation caused by the device and long term follow up is required. P1220Comparison between non invasive and invasive estimation of pulmonary vascular resistance (abbas and dahiya method) in adult atrial septal defect patients L Krisdinarti L Krisdinarti Gadjah Mada University, Department of Cardiology and Vascular Medicine, Yogyakarta, Indonesia D W Anggrahini D W Anggrahini Gadjah Mada University, Department of Cardiology and Vascular Medicine, Yogyakarta, Indonesia A B Hartopo A B Hartopo Gadjah Mada University, Department of Cardiology and Vascular Medicine, Yogyakarta, Indonesia Gadjah Mada University, Department of Cardiology and Vascular Medicine, Yogyakarta, Indonesia Background: Measurement of Pulmonary Vascular Resistance (PVR) is very important to determine the operability of Atrial Septal Defect (ASD) patient. Right Heart Catheterization (RHC) is still a valid tool to measure PVR but it is invasive and can not be done frequently. Measurement of PVR by echocardiography using Dahiya and Abbas method has not been validated to determine PVR in adult ASD patients. Objectives: To seek whether Dahiya and Abbas method have some correlations with invasive measurement to determine PVR in adult ASD patients and to compare which one of the two method has better correlation with invasive measurement. Method: Echocardiography and Right Heart Catheterization were performed simultaneously in Adult ASD patients. PVR echocardiography using Dahiya method with equation PVR = (RVSP - E/e’)/RVOTVTI and Abbas method with equation: 10 x TRVmax/TVIrvot +0,16 and this two method were correlated with PVR invasive by catheterization. Results: Sixty one adult ASD patients with mean age 35,7 ± 11,9 years old were included in this study with mean PVR invasive was 10.18 ± 11,57 WU and mean PVR echocardiography with Dahiya method 5,43 ± 5,7 WU and Abbas method 3,28 ± 5.70 respectively. Coefficient correlation between PVR by invasive Dahiya method and Abbas method were 0,851 and 0,787 with p <0,001 respectively. Furthermore, based on Blandaltmann analysis, we conclude that Abbas and Dahiya method have equality mean differences 6,90477 and 4,75628 with p<0,001 respectively. Conclusion: PVR echocardiography with Dahiya method have better correlation with PVR invasive compare to Abbas method in adult ASD patients. P1221The relation between ventricular systolic function and long term issues in an adult contemporary cohort of patients with single ventricle physiology R Barracano R Barracano 1Royal Brompton Hospital, London, United Kingdom G Scognamiglio G Scognamiglio 2Second University of Naples, Naples, Italy A Mattera Iacono A Mattera Iacono 2Second University of Naples, Naples, Italy M Palma M Palma 2Second University of Naples, Naples, Italy D Colonna D Colonna 2Second University of Naples, Naples, Italy G Di Nardo G Di Nardo 2Second University of Naples, Naples, Italy E Romeo E Romeo 2Second University of Naples, Naples, Italy M D'alto M D'alto 2Second University of Naples, Naples, Italy M G Russo M G Russo 2Second University of Naples, Naples, Italy B Sarubbi B Sarubbi 2Second University of Naples, Naples, Italy 1Royal Brompton Hospital, London, United Kingdom 2Second University of Naples, Naples, Italy Background: Nowadays, it is well known that ventricular function of patients with a single ventricle physiology is less than this of their healthy peers. Moreover, there is considerable concern over long-term deterioration of clinical state and ventricular performance in older univentricular heart patients. The aim of the present study was to analyse the systolic function of the single ventricle at rest and its relation with long-term outcome of a contemporary cohort of such patients followed at a tertiary Centre. Materials and methods: From our GUCH database we identified thirty-five patients (16 male, mean 35.4 ± 10.5 years) with functional single ventricle. Twenty-nine patients (82.8%) underwent Fontan palliation, one patient (3%) had a Glenn palliation and one patient (3%) underwent a systemic to pulmonary shunt. Four patients (11.4%) were in natural history, all exhibiting anatomy of double inlet left ventricle. Five patients (14.3%) were exhibiting a dominant right ventricle, while thirty patients (85.7%) had a dominant left ventricle. In all patients we evaluated ventricular systolic function, functional status and long-term complications on follow-up. Results: The systolic function of the single ventricle at rest was preserved in the majority of our cohort (mean EF 52.8 ± 7.5%). A mildly impaired systolic function was observed in all patients with dominant right ventricle (mean EF 52 ± 11%). Mean six-minute walking distance was 361±79 meters. A lower functional status was observed in all patients ≥ 30 years old, mainly in those in natural history and in those with atrio-pulmonary connection. A mildly impaired systolic function was also observed in all patients with a lower functional status (mean EF 53 ± 7.6%). Over a median follow-up of 10 years (IQR 4,6-13,2), a total of 114 hospital admissions were recorded in 23 patients. A mildly-moderate impaired systolic function (defined as mean EF ≤ 55%), observed in twenty-six cases (74.2%), seemed to be no strongly associated with the number of hospital admissions for each patient. Analogously, the systolic function of the single ventricle seemed to have no impact on determining the appearance of arrhythmias, protein-losing enteropathy and thromboembolic events. On the other hand, a strong relation among impaired systolic function, acute decompensated heart failure and infective endocarditis was observed in our cohort. Conclusions: Ventricular function is relatively well preserved in modern-day single ventricle patients. Nonetheless, systolic ventricular dysfunction has been reported in a considerable amount of adult patients with univentricular heart. The impact of systolic ventricular function on functional status of patients with univentricular physiology has been clearly confirmed, whereas the relation between systolic dysfunction and main complications seems to be still unclear. Further studies and more advanced echocardiographic technique are required to determine this. P1222Aortic stiffness as early detectable manifestation of aortic wall changes in patients with Turner syndrome or bicuspid aortic valve M K Malik M K Malik 1Erasmus Medical Center, Cardiology, Rotterdam, Netherlands A L Duijnhouwer A L Duijnhouwer 2Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands J S Mcghie J S Mcghie 1Erasmus Medical Center, Cardiology, Rotterdam, Netherlands A E Van Den Bosch A E Van Den Bosch 1Erasmus Medical Center, Cardiology, Rotterdam, Netherlands H M Siebelink H M Siebelink 3Leiden University Medical Center, Cardiology, Leiden, Netherlands R P Budde R P Budde 4Erasmus Medical Center, Radiology and Nuclear Medicine, Rotterdam, Netherlands J W Roos-Hesselink J W Roos-Hesselink 1Erasmus Medical Center, Cardiology, Rotterdam, Netherlands 1Erasmus Medical Center, Cardiology, Rotterdam, Netherlands 2Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands 3Leiden University Medical Center, Cardiology, Leiden, Netherlands 4Erasmus Medical Center, Radiology and Nuclear Medicine, Rotterdam, Netherlands L R Bons L R Bons 1Erasmus Medical Center, Cardiology, Rotterdam, Netherlands A T Van Den Hoven A T Van Den Hoven
TI - Poster session 4
JF - European Heart Journal - Cardiovascular Imaging
DO - 10.1093/ehjci/jex297
DA - 2017-12-01
UR - https://www.deepdyve.com/lp/oxford-university-press/poster-session-4-hxCwLZrGtT
SP - iii268
VL - 18
IS - suppl_3
DP - DeepDyve
ER -