TY - JOUR
AB -   P1692 A novel high quality ultrafast ultrasound imaging method for mapping heart dynamics W N Lee W N Lee The University of Hong Kong, Electrical and Electronic Engineering, Hong Kong, Hong Kong SAR People"s Republic of China Y Zhang Y Zhang The University of Hong Kong, Electrical and Electronic Engineering, Hong Kong, Hong Kong SAR People"s Republic of China H Li H Li The University of Hong Kong, Electrical and Electronic Engineering, Hong Kong, Hong Kong SAR People"s Republic of China The University of Hong Kong, Electrical and Electronic Engineering, Hong Kong, Hong Kong SAR People"s Republic of China Funding Acknowledgements: NSFC/RGC (N_HKU713_15) and Midstream Research Programme for Universities under Innovation and Technology Commission (MRP/072/17X) Ultrafast ultrasound imaging (UUI) of the heart has emerged in recent years, enabling measurement of transient cardiac dynamics, such as myocardial motion and chamber vector flow. However, existing transthoracic UUI techniques are based on pulsed and unfocused ultrasound waves, and therefore they suffer from limited sonographic signal-to-noise ratio (SNR) and penetration due to fast attenuation of the insufficient delivery of ultrasound waves through the chest wall. In this study, we propose an unprecedented ultrafast ultrasound cascaded-wave synthetic aperture (CaSA) imaging method that can achieve superior SNR at ultrafast frame rates to map heart dynamics with high quality. Our ultrafast ultrasound CaSA imaging takes full advantage of both the aperture (i.e., probe width) and depth (i.e., wave propagation) domains of the ultrasound probe. On transmission, the probe is divided into M (M = 2^m, m = 0, 1, 2,…) sub-apertures in the width domain, and this is similar to the virtual-source-based synthetic aperture imaging (SA) and the Hadamard encoded SA (H-SA). Ours, however, is distinct in that the M sub-apertures transmit simultaneously and that each sub-aperture transmission is a train of divergent waves which contains N (N = 2^n, n = 0, 1, 2,…) cascaded waves with short time intervals and positive or negative polarity coefficients. We design a novel coding matrix of the polarity coefficients for each cascaded wave transmission. On reception, we design a corresponding decoding scheme for subsequent image formation to increase the SNR by 10·log10(NM) without compromising spatial resolution and frame rate. An In vivo human heart (male, 26 y.o.) was scanned in a transthoracic apical four-chamber view using a Vantage system (Verasonics, Kirkland, WA) with an ATL P4-2 probe (center frequency 2.5 MHz, acquisition rate 4000 fps, M = 4 and N = 32). Myocardial motion was estimated by our in-house speckle tracking method, and blood flow was mapped using standard power Doppler with spatiotemporal filtering. The proposed CaSA imaging (Figure A-3) significantly improved SNR (+20.46 dB higher than SA; + 14.83 dB higher than H-SA) with comparable spatial resolution and frame rate in the human heart. Higher quality images obtained by CaSA yielded more accurate mapping of myocardial motion (Figure B-3) and higher contrast Doppler flow imaging (Figure C-3) than benchmark methods (the top two rows in the figure). View largeDownload slide Abstract P1692 Figure. View largeDownload slide Abstract P1692 Figure. P1693 Incremental value of two-dimensional vector flow mapping for estimating left ventricular diastolic filling pressure PP Sengupta PP Sengupta West Virginia University Heart and Vascular Institute, Heart and Vascular Department, Morgantown, United States of America West Virginia University Heart and Vascular Institute, Heart and Vascular Department, Morgantown, United States of America M Ashraf M Ashraf West Virginia University Heart and Vascular Institute, Heart and Vascular Department, Morgantown, United States of America G Casaclang-Verzosa G Casaclang-Verzosa West Virginia University Heart and Vascular Institute, Heart and Vascular Department, Morgantown, United States of America JS Cho JS Cho West Virginia University Heart and Vascular Institute, Heart and Vascular Department, Morgantown, United States of America M Tokodi M Tokodi West Virginia University Heart and Vascular Institute, Heart and Vascular Department, Morgantown, United States of America K Patel K Patel West Virginia University Heart and Vascular Institute, Heart and Vascular Department, Morgantown, United States of America Background: The assessment of left ventricular (LV) filling pressure is essential to obtain diastolic dysfunction. The most commonly used noninvasive method to estimate LV filling pressure is obtaining the ratio of early mitral inflow velocity (E) and mitral annular early diastolic velocity (e’) using transthoracic echocardiography. However, these parameters are one-dimensional velocity representation of a rotating diastolic flow field which is characterized by vortex formation. We investigated the relationship of early diastolic transmitral blood flow in velocity field in two dimensions (2D) for estimating E/e’ ratio for assessment of LV diastolic filling pressure. Method: We prospectively characterized 2D flow in 30 patients undergoing 2D echocardiogram for assessment of LV diastolic function. Eighteen of these patients also underwent left heart catheterization with invasive assessment of LV end-diastolic pressure (LVEDP). Doppler derived E and e` was assessed in separate and within the same cardiac cycle. Two dimensional velocity profile was obtained along the transmitral plane at a time point when the transmitral flow was peaking in early diastole using vector flow mapping (VFM) (Figure A and B). Results: There was good correlation between E/e’ measured by pulsed wave Doppler and VFM techniques (r = 0.80, p < 0.001). Furthermore the two techniques also correlated with the invasively obtained LVEDP (E/e’ Doppler: r = 0.70, p = 0.001; E/e’ VFM: r = 0.76, p < 0.001). The linear model combining the Doppler and VFM derived E/e` resulted in good diagnostic value (AUC: 0.86, sensitivity: 89%, specificity: 79%, Figure C) for predicting LVEDP greater than 14 mmHg. Conclusion: Transmittal flow has asymmetric 2D velocity profile which may be incompletely characterized in one dimension using pulse wave Doppler. E/e’ ratio estimated from 2D flow fields improves the ability to estimate LV filling pressure noninvasively. View largeDownload slide Abstract P1693 Figure A,B and C View largeDownload slide Abstract P1693 Figure A,B and C P1694 Application of knowledge-based reconstruction to three dimensional echocardiography and comparison with semiautomatic border detection method for evaluating ventricular function S Kutty S Kutty University of Nebraska Medical Center, Omaha, United States of America University of Nebraska Medical Center, Omaha, United States of America Ventripoint Ltd., Toronto, Canada G Varghese G Varghese University of Nebraska Medical Center, Omaha, United States of America M Craft M Craft University of Nebraska Medical Center, Omaha, United States of America J Graba J Graba Ventripoint Ltd., Toronto, Canada L Li L Li University of Nebraska Medical Center, Omaha, United States of America Background: The Knowledge-Based Reconstruction (KBR) technology has conventionally used two-dimensional (2D) echocardiograms and positional data for processing into 3-dimensional representations and surface rendering of ventricles for functional assessment. For this, KBR utilizes anatomic cardiac landmarks and databases without requiring border tracing. Our purpose was (1) to investigate the feasibility of a new KBR system and algorithm in conjunction with three dimensional echocardiograms (3DE, VMS+, Ventripoint), and (2) compare the results of ventricular function assessment between VMS+ and semiautomatic 3DE contour detection methods: 4D-LV analysis 3.0 and 4D-RV function 2.0 (Image Arena, TomTec). Methods: 3DE was prospectively performed in 50 subjects including 25 patients with tetralogy of Fallot (TOF) and 25 age and body surface area (BSA) matched controls using the iE33 system (Philips). Full-volume acquisitions of the left and right ventricles (LV, RV) were made from focused apical views using ECG gating. After importing raw cartesian coordinate 3DE datasets, borders and specific anatomical structures of LV and RV were defined by placing points on standard VMS 2D scan planes. The anatomical landmarks included LV apex, LV endocardium, interventricular septum (IVS), mitral and aortic annulus (for LV); RV apex, RV free wall endocardium, basal RV bulge, IVS, tricuspid and pulmonic annulus and conal septum (for RV). Using VMS+ KBR, an initial abstract model of the 3D shape was generated, which was refined by blending and scaling to best fit, and 3D volume derived by processing through VMS-CMR libraries (Figure). The resultant 3D model was used to calculate end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) for LV and RV, and data compared to TomTec measurements. Results: For TOF group, subject age was 15.8 ± 10 yrs, BSA was 1.4 ± 0.5 m2, and for the normal group, age was 15.1 ± 9 yrs, and BSA 1.4 ± 0.5 m2. LV and RV volumes, function and analysis times by both methods are shown in Table. LV volumes showed excellent agreement between VMS+ and TomTec, while agreement was lower for RV volumes. Conclusion: This study demonstrates clinical feasibility of quantifying biventricular volumes and function using VMS+ on native 3DE datasets from normal and repaired TOF hearts. Analyses times with VMS+ were closer with semiautomatic border detection for the LV, however for the RV, VMS+ analysis times were longer. RV volumes obtained by VMS+ were greater than those by semiautomatic border detection, likely due to better outflow tract inclusion with VMS+. View largeDownload slide Abstract P1694 Figure View largeDownload slide Abstract P1694 Figure P1695 Signal intensity coefficient predicted the long term outcome in patient with aortic stenosis induced myocardial fibrosis S Cheng S Cheng Brigham and Women"s Hospital, Cardiovascular Division, Boston, United States of America Chi-Mei Medical Center, Cardiology, Tainan, Taiwan ROC Brigham and Women"s Hospital, Cardiovascular Division, Boston, United States of America R Liao R Liao Brigham and Women"s Hospital, Cardiovascular Division, Boston, United States of America CH Lin CH Lin Chi-Mei Medical Center, Cardiology, Tainan, Taiwan ROC P Hiremath P Hiremath Brigham and Women"s Hospital, Cardiovascular Division, Boston, United States of America C Wei-Ting C Wei-Ting Chi-Mei Medical Center, Cardiology, Tainan, Taiwan ROC Background: Despite the advanced techniques of aortic valve replacement nowadays, the aortic stenosis (AS) induced irreversible myocardial fibrosis remains contributing to the worse outcomes. Therefore, in addition to the early diagnosis of AS, the detection of myocardial fibrosis is crucial for physicians to determine when to perform the surgery. Cardiac magnetic resonance is regarded as the most reliable non-invasive examination to detect myocardial fibrosis. However, its time consuming, limited access and potential adverse effects of contrast reagents attenuate the clinical application. Methods: In our previous study, we have validated Signal Intensity Coefficient (SIC), in differentiating between normal myocardium and hypertensive heart disease in humans as well as the mice. Herein, we aim to investigating the application of SIC in the detecting of myocardial fibrosis in patients with aortic stenosis. From the parasternal long axis view, SIC was obtained at the specific region of interest, defined as the pericardium adjacent and parallel to the mid-to-basal section of the inferolateral segment of the myocardium. SICs were calculated prior to and post aortic valve replacement within three months. Results: Retrospectively, we collected the medical records and echocardiography imaging of 50 patients received aortic valve replacement for aortic stenosis since 2010 to 2015. Patients with myocardial infarction, left ventricular ejection fraction (LVEF) less than 50% or dysfunction of the replaced valve were excluded. Major cardiovascular outcomes included mortality and the hospitalization due to heart failure. Our result indicated a significant decline of SIC post aortic valve replacement. Also, the baseline and the changes of SIC were significantly associated with major outcomes. In the contrast, the changes of LVEF, left ventricular mass index and left ventricular volume failed to predict outcomes at the post-operative early stage. Conclusion: SIC can detect early changes in myocardial microstructure in patients with aortic stenosis and correlate to the clinical outcomes. View largeDownload slide Abstract P1695 Figure 1 View largeDownload slide Abstract P1695 Figure 1 P1697 Intervendor comparison of mitral valve analysis software B Lin B Lin Yale New Haven Hospital, Cardiology, New Haven, United States of America B Lin B Lin Yale New Haven Hospital, Cardiology, New Haven, United States of America J Mancina J Mancina Canon Medical Systems, Nasu, Japan J Mancina J Mancina Canon Medical Systems, Nasu, Japan S Fukuda S Fukuda Canon Medical Systems, Nasu, Japan S Fukuda S Fukuda Canon Medical Systems, Nasu, Japan T Imamura T Imamura Yale New Haven Hospital, Cardiology, New Haven, United States of America T Imamura T Imamura Yale New Haven Hospital, Cardiology, New Haven, United States of America W Gorrisen W Gorrisen Yale New Haven Hospital, Cardiology, New Haven, United States of America W Gorrisen W Gorrisen Yale New Haven Hospital, Cardiology, New Haven, United States of America L Sugeng L Sugeng Yale New Haven Hospital, Cardiology, New Haven, United States of America L Sugeng L Sugeng Yale New Haven Hospital, Cardiology, New Haven, United States of America Yale New Haven Hospital, Cardiology, New Haven, United States of America Canon Medical Systems, Nasu, Japan I Vaitkeviciute I Vaitkeviciute Yale New Haven Hospital, Cardiology, New Haven, United States of America I Vaitkeviciute I Vaitkeviciute Yale New Haven Hospital, Cardiology, New Haven, United States of America Q Zhu Q Zhu Yale New Haven Hospital, Cardiology, New Haven, United States of America Q Zhu Q Zhu Yale New Haven Hospital, Cardiology, New Haven, United States of America S Garwood S Garwood Yale New Haven Hospital, Cardiology, New Haven, United States of America S Garwood S Garwood Yale New Haven Hospital, Cardiology, New Haven, United States of America M Bratanoff M Bratanoff Yale New Haven Hospital, Cardiology, New Haven, United States of America Background: Accurate and reproducible mitral valve (MV) measurements are required for MV interventions and pre-surgical planning. MV analysis software is tedious and time-consuming. A new MV software with a automated algorithm has been developed to improve efficiency. The aim of our study is to validate a new MV software (4D MVA-Mitral Valve Analysis) by Canon Medical Systems. Methods: A total of 47 patients (66 y, 70% m) who underwent cardiac surgery were included in this study. All patients consented to have two transesophageal echocardiography (TEE) studies intra-operatively in the same setting. A 4D volume focused on the mitral valve was acquired on 2 ultrasound systems. The first TEE study was performed on the Aplio i900 ultrasound system with the i6SVX 4D TEE transducer (Canon Medical Systems Nasu) and then a second TEE using iE33 ultrasound system /EPIQ7c ultrasound system with the X-7T2 3D TEE transducer (Philips Healthcare) was performed. The 4D datasets were analyzed using both mitral valve software, MVN (Philips) and 4D MVA. The anterior-posterior and commissural diameter, annulus area and circumference and leaflet area were compared. Inter- and intra-observer variability were analyzed. Results: All patients underwent double-insertion of TEE probes without any complication. Amongst 5 parameters, there was no significant bias. The correlation for all measurements was excellent (r≥0.87). The average time for completing analysis was 428 sec with MVN (Philips) and 316 sec with 4D MVA (Canon) including final mitral parametric valve model display. This represents a potential of 26% time savings and workflow improvement for new users with a new 4D MVA software versus traditional methods. The intraclass correlation for 4D MVA showed an excellent correlation for the intra- and interobserver variability (r≥0.922) Conclusion: This is the first inter-vendor comparison of MV analysis software for new users that offers potential time savings, workflow improvement, and accuracy in the literature. This new 4D MVA software was found to be reliable, faster than predicate software by 26%, reproducible and comparable in adoption time versus other commercially available MV software. Table 1 MVN 4D MVA Bias AP Diameter (cm) 3.13 3.10 0.04 ± 0.26 CC Diameter (cm) 3.85 4.01 -0.16 ± 0.26 Circumference (cm) 11.97 12.07 -0.1 ± 0.68 Annulus Area (cm2) 10.23 10.72 0.49 ± 1.06 Leaflet Area (cm2) 11.83 11.97 -0.14 ± 1.34 MVN 4D MVA Bias AP Diameter (cm) 3.13 3.10 0.04 ± 0.26 CC Diameter (cm) 3.85 4.01 -0.16 ± 0.26 Circumference (cm) 11.97 12.07 -0.1 ± 0.68 Annulus Area (cm2) 10.23 10.72 0.49 ± 1.06 Leaflet Area (cm2) 11.83 11.97 -0.14 ± 1.34 View Large Table 1 MVN 4D MVA Bias AP Diameter (cm) 3.13 3.10 0.04 ± 0.26 CC Diameter (cm) 3.85 4.01 -0.16 ± 0.26 Circumference (cm) 11.97 12.07 -0.1 ± 0.68 Annulus Area (cm2) 10.23 10.72 0.49 ± 1.06 Leaflet Area (cm2) 11.83 11.97 -0.14 ± 1.34 MVN 4D MVA Bias AP Diameter (cm) 3.13 3.10 0.04 ± 0.26 CC Diameter (cm) 3.85 4.01 -0.16 ± 0.26 Circumference (cm) 11.97 12.07 -0.1 ± 0.68 Annulus Area (cm2) 10.23 10.72 0.49 ± 1.06 Leaflet Area (cm2) 11.83 11.97 -0.14 ± 1.34 View Large P1698 Quantitative analysis of intraventricular blood flow dynamics using a new technique, Doppler analyzer: circulation strength and energy dissipation in patients with non-ischemic cardiomyopathy EK Kim EK Kim Samsung Medical Center, Sungkyunkwan University, Seoul, Korea Republic of C Hahn C Hahn Korea University, Computational Fluid Dynamics & Acoustics Laboratory, Seoul, Korea Republic of Y Moon Y Moon Korea University, Computational Fluid Dynamics & Acoustics Laboratory, Seoul, Korea Republic of SW Park SW Park Samsung Medical Center, Sungkyunkwan University, Seoul, Korea Republic of SJ Park SJ Park Samsung Medical Center, Sungkyunkwan University, Seoul, Korea Republic of SA Chang SA Chang Samsung Medical Center, Sungkyunkwan University, Seoul, Korea Republic of SC Lee SC Lee Samsung Medical Center, Sungkyunkwan University, Seoul, Korea Republic of Samsung Medical Center, Sungkyunkwan University, Seoul, Korea Republic of Korea University, Computational Fluid Dynamics & Acoustics Laboratory, Seoul, Korea Republic of Funding Acknowledgements: None Background: Although studies on intraventricular blood flow dynamics have been conducted continuously, its clinical applications have been hampered by a limited vendor, complex software, long processing time and the absence of objective parameters. Recently, we suggested Doppler Analyzer which a novel method visualizing intracardiac blood flow patterns and enables quantification of flow dynamics with 2-dimensional (2D) and color Doppler data using conventional echocardiography. Purpose: Here, we tried to investigate the relation between the conventional parameters reflecting LV systolic function and new parameters reflecting intraventricular flow dynamics. Methods: We got the conventional color Doppler and 2D images at the apical 3 chamber view during three cardiac cycles. By tracing LV wall using commercially available software (EchoPAC System, General Electric), LV wall position and velocity data were acquired. Using the digitalized software named as ‘Doppler Analyzer’, we visualized overall velocity field within the LV cavity and calculated ‘Circulation Strength’ and ‘Energy Dissipation’ which means dynamic force of blood flow and attenuation of dynamic fluid energy, respectively. Calculation formulas were as follows; Circulation Strength = ∫((∂ Vy)⁄(∂ x)- (∂ Vx)⁄(∂ y))dA , Energy Dissipation =∫μ((∂ Vx)⁄(∂ y)+ (∂ Vy)⁄(∂ x))dA . Results: We analyzed 76 patients (44 male, 56.4 ± 15.0 years), 53 of whom had normal cardiac function (Group A) and 23 of whom had left ventricular dysfunction (Group B). Median duration of measurements was 3 (IQR, 2-5) minutes per person. Intra-observer and inter-observer agreement for quantitative parameters such as Circulation Strength and Energy Dissipation were about 95%. There were significant differences of LV ejection fraction (65.6 ± 5.1% vs. 32.6 ± 11.0%, p < 0.001) and LV global longitudinal strain (-19.6 ± 2.8 vs. -9.3 ± 4.0%, p < 0.001) between two groups. Compared to Group A, Group B had lower Circulation Strength during diastole {(9.1 ± 3.0)*10-3 vs. (4.9 ± 3.5)*10-3, p < 0.001} and systole phase {(3.6 ± 2.2)*10-3 vs. (2.9 ± 2.6)*10-3, p = 0.282}. Energy Dissipation rate was also lower in patients with LV dysfunction, but it was not statistically significant (0.9 ± 0.4 vs. 0.8 ± 0.6, p = 0.333). Among three parameters that reflect blood flow dynamics within the LV cavity, Circulation Strength during diastole was significantly correlated with LVEF (correlation coefficient, r = 0.548, p < 0.001) and strain value (r = 0.634, p < 0.001). Conclusion: Using color Doppler with 2D LV cavity data from the conventional echocardiography, we could quantify intraventricular flow dynamics and derive objective parameters, Circulation Strength and Energy Dissipation. Circulation Strength during the LV filling period was significantly correlated with LVEF and strain. To confirm the clinical implication of the above parameter, clinical validation study in various disease entities is currently being processed. View largeDownload slide Abstract P1698 Figure. View largeDownload slide Abstract P1698 Figure. P1699 Ejection fraction can be accurately detrmined using a cloud based platform on mobile devices A Salacata A Salacata Mid Michigan Medical Center, Alpena, United States of America J Kapalla J Kapalla Mid Michigan Medical Center, Alpena, United States of America S Panknin S Panknin Mid Michigan Medical Center, Alpena, United States of America Mid Michigan Medical Center, Alpena, United States of America Despite its shortcomings, left ventricular ejection fraction (EF) remains the most widely used measure of systolic function. Echocardiography remains the most widely used modality for measuring EF given its widespread availability, portability, reliability and low cost. Given the digital nature of echocardiographic data, echocardiograms can potentially be viewed and analyzed using mobile devices. We therefore performed this preliminary study to compare echocardiographic EF derived on a widely available mobile device. Method: We randomly selected 20 transthoracic echocardiograms (TTE) with regional wall motion abnormalities from which identifying information was removed. All studies were acquired using GE Vivid 7 system then converted from native to mp4 format with a compression ratio of 69:1 using a commercially available web/cloud based service for analysis, archiving and retrieval. They were then interpreted in random order by an echocardiographer with level 3 training on a standard computer display (STRD) with a minimum LCD display size and resolution of 20" x 24" and 1600 x 1200 pixels, and an iPad 2 (MBL) with a screen size and resolution of 5.82" x 7.76" and 1024 x 768 pixels. EF was determined using a previously derived method1 of that scored segmental wall motion in the 4 and 2 chamber views. Results: Of the 20 subjects (15 male, mean age 71.2 ± 3.74 years), 3 had suboptimal studies requiring contrast administration for LV opacification. There was no significant difference in the mean EF by STRD vs. MBL (47.9 ± 13.44, range 28.05-66, vs. 45.89 ± 14.25, 24.83-66, p = 0.53). There was good agreement between both methods by regression analysis (R = 0.55, p = 0.01), and as demonstrated using a Bland-Altman plot (average difference between methods = 2.0, 95% CI ± 14.07). Conclusion: TTE EF can be reliably evaluated on a mobile device with results comparable to EF obtained by STRD. This will potentially lead to faster and timelier availability of this important piece of information. Additional studies on a larger number of mobile platforms should also be carried out. View largeDownload slide Abstract P1699 Figure. View largeDownload slide Abstract P1699 Figure. P1702 The challenge of a new insight into evaluation of abnormal left ventricular wall motion Y Nakamura Y Nakamura Specified Clinic of Soyokaze CardioVascular Medicine and Diabetes Care, Cardiovasculra Medicine, Matsuyama, Japan Specified Clinic of Soyokaze CardioVascular Medicine and Diabetes Care, Cardiovasculra Medicine, Matsuyama, Japan Background: Cardiac resynchronization therapy (CRT) relieves those chronic heart failure patients with impaired systolic function. However, approximately 30% of patients with a wide QRS complex on the electrocardiogram remain non-responders when implanted with CRT devices. Unfortunately, prediction using echocardiography has failed to select responders to CRT although it is a modality visualizing left ventricular (LV) wall motion. Purpose: This study proposed that the locus of center of gravity (LCG) differed in normal and diseased hearts, with a view to subsequently evaluating whether this technology would be suitable for selection of CRT indicators. Methods: Twenty-seven dilated cardiomyopathy patients (DCM) (71 ± 11 years) and 45 old myocardial infarction with aneurysm patients (OMI) (72 ± 11 years) were enrolled in this study. In addition, 188 with normal wall motion (62 ± 16 years) were evaluated. In an off-line system, the border of the endocardium was defined for each coordinate via the 2D speckle tracking technique using an ‘e-tool viewer’ (Hitachi Co). The LCG of each image was then calculated. Thereafter, the LCG of the 3-dimensional LV was identified as the center point between the LCG of the 4ch image and that of the 2ch image using an original application. Results: LV dimensions were significantly greater and ejection fractions significantly lower in the DCM and OMI groups compared to the control (LVDd/Ds: 58 ± 5/44 ± 6 mm, 58 ± 9/44 ± 10 mm, and 48 ± 5/30 ± 5 mm, respectively P < 0.00001; LVEF: 43 ± 7%, 38 ± 11%, and 61 ± 5%, respectively, P < 0.00001). The width of the LCG in the lateral direction for both DCM and OMI groups was significantly larger than control (0.67 ± 0.21 mm, 0.73 ± 0.28 mm, and 0.56 ± 0.17 mm, respectively P < 0.00001). That of DCM in the longitudinal direction was reduced compared to control (1.26 ± 0.42 mm, 1.32 ± 0.33 mm, and 1.47 ± 0.40 mm, respectively P = 0.00617). Furthermore, the ratio of longitudinal movement length to that in the lateral direction was clearly decreased in the diseased group (2.06 ± 0.88 mm, 2.05 ± 0.81 mm, and 2.78 ± 0.97 mm, respectively P < 0.00001). Maximum and minimum acceleration of the LCG in diseased hearts was diminished compared to the control (maximum: 679 ± 210 mm/sec2, 748 ± 241 mm/sec2, and 938 ± 301 mm/sec2, respectively P < 0.00001; minimum: -662 ± 234 mm/sec2, -691 ± 303 mm/sec2, and -863 ± 270 mm/sec2, respectively, P = 0.00001). Stroke volume (SV) of diseased hearts correlated weakly with the total length and maximum acceleration of the LCG (y = 50.4778 + 2.5895x, r = 0.313, p = 0.007437, y = 59.1352 + 0.0328x, r = 0.325, p = 0.005414, respectively) although SV of normal heart was not related to acceleration of the LCG. Conclusion: Use of the LCG may provide a novel insight into evaluation of abnormal LV contraction. The potential of this tool to select CRT non-responders should be exploited. P1703 Dyssynchronous motion of the left ventricle during early diastole is an important factor that decreases intraventricular pressure difference in pediatric cancer survivors K Matsui K Matsui Juntendo University, pediatric, Tokyo, Japan K Takahashi K Takahashi Juntendo University, pediatric, Tokyo, Japan S Shigemitsu S Shigemitsu Juntendo University, pediatric, Tokyo, Japan T Iso T Iso Juntendo University, pediatric, Tokyo, Japan M Ifuku M Ifuku Juntendo University, pediatric, Tokyo, Japan K Yazaki K Yazaki Juntendo University, pediatric, Tokyo, Japan M Yamada M Yamada Juntendo University, pediatric, Tokyo, Japan M Kobayashi M Kobayashi Juntendo University, pediatric, Tokyo, Japan H Tamaichi H Tamaichi Juntendo University, pediatric, Tokyo, Japan J Fujimura J Fujimura Juntendo University, pediatric, Tokyo, Japan K Itatani K Itatani Kyoto Prefectural University of Medicine, Division of cardiovascular and pediatric cardiovascular surgery department of surgery , Kyoto, Japan T Shimizu T Shimizu Juntendo University, pediatric, Tokyo, Japan Juntendo University, pediatric, Tokyo, Japan Kyoto Prefectural University of Medicine, Division of cardiovascular and pediatric cardiovascular surgery department of surgery , Kyoto, Japan Background: The mechanism of decreasing intraventricular pressure difference during early diastole, which is the suction force of blood from the left atrium to the left ventricular apex, among the pediatric cancer survivors remains unclear. The aim of this study was to investigate the mechanism underlying the intraventricular pressure difference decrease among pediatric cancer survivors. Methods: We included 24 pediatric cancer survivors (age range: 9.6-25.1 years) in group C and 19 healthy individuals (age range: 7.3-26.7 years) in group N. The left ventricular myocardium motions were obtained using speckle tracking imaging at apical left ventricular four and two chamber views. The left ventricle was divided into 10 slices from base to apex, and diameter changes were assessed in each slice. The onset of dilation at mid to apical segments, which are thought to be the segments that create the intraventricular pressure difference, was measured, and the coefficient of variation of the timing was calculated. The intraventricular pressure differences were also measured through color Doppler M-mode, using Euler equations. Results: The intraventricular pressure difference in group C was smaller than that in group N (2.37 + 0.54 vs. 3.36 + 0.55 mmHg, P < 0.001). The coefficient of variation in group C was significantly larger than that in group N (0.046 + 0.033 vs. 0.027 + 0.017, p = 0.027). Among 10 patients in group C, in whom the coefficient of variation was larger than the average value + SD of group N, the diastolic phase onset was delayed at apical segments in six patients, at mid segments in three, and at both segments in one. We found moderate negative correlation between coefficient of variation and intraventricular pressure difference (r = -0.55, p < 0.001), and coefficient of variation was found to be the only independent predictor of intraventricular pressure difference in a multivariate analysis. Conclusion: Dyssynchronous motion during early diastole was an important factor that caused a decrease in intraventricular pressure difference in pediatric cancer survivors. View largeDownload slide Abstract P1703 Figure. analysis of left ventricle motion View largeDownload slide Abstract P1703 Figure. analysis of left ventricle motion P1704 Echo-derived hemodynamic profiles and BNP are useful to risk stratify patients with chronic heart failure and reduced ejection fraction NR Pugliese NR Pugliese University of Pisa, Scuola di Specializzazione in Malattie Cardiovascolari, Pisa, Italy I Fabiani I Fabiani Cisanello Hospital, Department of Cardiac-Thoracic and Vascular, Pisa, Italy A D"agostino A D"agostino University of Pisa, Scuola di Specializzazione in Malattie Cardiovascolari, Pisa, Italy GG Galeotti GG Galeotti University of Pisa, Scuola di Specializzazione in Malattie Cardiovascolari, Pisa, Italy DA Luisi DA Luisi University Hospital of Ferrara, Cardiac Unit, Ferrara, Italy G Pestelli G Pestelli University Hospital of Ferrara, Cardiac Unit, Ferrara, Italy C Santini C Santini University of Pisa, Scuola di Specializzazione in Malattie Cardiovascolari, Pisa, Italy I Rovai I Rovai University of Pisa, Scuola di Specializzazione in Malattie Cardiovascolari, Pisa, Italy R Pedrinelli R Pedrinelli Cisanello Hospital, Department of Cardiac-Thoracic and Vascular, Pisa, Italy FL Dini FL Dini Cisanello Hospital, Department of Cardiac-Thoracic and Vascular, Pisa, Italy University of Pisa, Scuola di Specializzazione in Malattie Cardiovascolari, Pisa, Italy Cisanello Hospital, Department of Cardiac-Thoracic and Vascular, Pisa, Italy University Hospital of Ferrara, Cardiac Unit, Ferrara, Italy D Mele D Mele University Hospital of Ferrara, Cardiac Unit, Ferrara, Italy Background. Doppler echocardiography is useful for noninvasive determination of left ventricular filling pressure (LVFP) by the ratio of mitral E peak velocity and averaged e’ velocity (E/e’) and it can also provide reliable and repeatable measures of cardiac index (CI): this information can be used to identify hemodynamic profiles. Integration of echocardiographic estimates of LVFP with B-type natriuretic peptide (BNP) circulating levels and measures of CI can be utilized to predict outcome of heart failure (HF) patients in an ambulatory setting. Aim. We analysed different hemodynamic profiles based on echo assessment of LVFP and CI, together with BNP levels, to risk stratify patients with chronic HF and reduced ejection fraction (HFrEF). Methods and results. A population of 310 outpatients (age: 66 ± 12 years, EF: 33 ± 8) with chronic HFrEF were classified according to the echo-derived hemodynamic profile: A) well-perfused, without congestion: CI ≥ 2.0 l/min/m2 and E/e’<13; B) low-perfused, without congestion: CI < 2.0 l/min/m2 and E/e’< 13; C) well-perfused and congested: CI ≥ 2.0 l/min/m2 and E/e’≥13; D) hypo-perfused and congested: CI < 2.0 l/min/m2 and E/e’≥13. The best outcome was observed in patients with profile A (90% survival at 60-months), while profile D was associated to the worst prognosis (54%; p < 0.0001). In order to assess whether the predictive value of hemodynamic profiles was improved by the assessment of BNP, patients were further stratified according to BNP levels (Figure). Patients with profile A and BNP < 150 pg/ml had a 94% survival at follow-up (p < 0.0001). Moreover, BNP > 150 mpg/ml provided additional information (c2 = 51.9; p = 0.005) to an interactive stepwise model that included demographic and clinical parameters (c2 = 30.6), EF < 30% (c2 = 37.6; p = 0.003) and hemodynamic profile D (c2 = 48.8; p = 0.007). Conclusion. Survival analyses showed that echo-directed hemodynamic profiles and BNP significantly predict outcome in HFrEF. View largeDownload slide Abstract P1704 Figure. View largeDownload slide Abstract P1704 Figure. P1705 Improved diastolic function in non-diabetic patients with metabolic syndrome treated with metformin: 1 year results from MET-DIME randomized clinical trial R Ladeiras-Lopes R Ladeiras-Lopes Gaia Hospital Centre, Department of Cardiology, Vila Nova de Gaia, Portugal F Sampaio F Sampaio Gaia Hospital Centre, Department of Cardiology, Vila Nova de Gaia, Portugal S Leite S Leite Faculty of Medicine, University of Porto, Porto, Portugal N Bettencourt N Bettencourt Faculty of Medicine, University of Porto, Porto, Portugal A Leite-Moreira A Leite-Moreira Faculty of Medicine, University of Porto, Porto, Portugal V Gama V Gama Gaia Hospital Centre, Department of Cardiology, Vila Nova de Gaia, Portugal P Braga P Braga Gaia Hospital Centre, Department of Cardiology, Vila Nova de Gaia, Portugal R Fontes-Carvalho R Fontes-Carvalho Gaia Hospital Centre, Department of Cardiology, Vila Nova de Gaia, Portugal Gaia Hospital Centre, Department of Cardiology, Vila Nova de Gaia, Portugal Faculty of Medicine, University of Porto, Porto, Portugal Background: Metabolic syndrome (MetS) is highly prevalent and has a complex pathophysiology with insulin resistance as a key player. Furthermore, MetS is associated with preclinical diastolic dysfunction that impairs functional capacity and quality of life (QoL). Purpose: This randomized trial was designed to evaluate if the addition of metformin to the standard treatment of non-diabetic patients with MetS improves diastolic dysfunction, functional capacity and QoL. Methods: In this randomized, open-label, blinded-endpoint trial, 54 non-diabetic adults (40 to 65 years old) with MetS and diastolic dysfunction (mean e’<10.2 cm/s if 40-59 years old; mean e’<7.2 cm/s if 60-65 years old), were recruited. Patients were randomized to lifestyle counseling or lifestyle counseling plus metformin (target dose 1000 mg bid). Primary endpoint was improvement in mean e’ velocity (assessed at baseline, 6 and 12 months). Secondary endpoints were improvements in insulin resistance (HOMA-IR), functional capacity (peak oxygen uptake during cardiopulmonary exercise test), quality of life (using the SF-36 questionnaire). Linear mixed effects modelling was used for longitudinal data analysis. Results: Fifty patients were included in this analysis (mean age = 51.8 ± 6.3; 54% males). Evaluating MetS criteria at baseline, all patients had elevated waist circumference (mean = 105.1 ± 9.6 cm), 92% were hypertensive, 58% had low HDL-cholesterol, 56% showed abnormal glucose homeostasis (median HOMA-IR = 3.7, IQR 2.6-5.1) and 50% had elevated triglycerides. Metformin treatment was associated with a significant decrease in HOMA-IR at 1 year. Between-group change in the mean e’ velocity during the first year of follow-up was not significantly different in the intention-to-treat analysis (-0.34 cm/s in the control group vs +0.26 cm/s in the metformin group; p = 0.132) but the difference was significant in the as-treated analysis (-0.52 cm/s in the control group vs +0.46 cm/s in the metformin group; p = 0.009), adjusting for age, gender, baseline grade of diastolic dysfunction, treatment with modifiers of the renin-angiotensin-aldosterone axis and presence of symptoms of heart failure. During the 1-year follow-up there was no significant change in peak oxygen uptake (+0.1 mL/kg/min in the control group vs +0.8 mL/kg/min in the metformin group; p = 0.401). In addition, there was a non-significant increase in mental component score of SF-36 (+4.83 points in the control group vs +2.17 points in the metformin group; p = 0.173) and a significant increase in the physical component score of SF-36 (+3.75 points in the control group vs +4.75 points in the metformin group; p = 0.023) that was not affected by treatment group. Conclusion: In this pragmatic randomized trial, metformin treatment was associated with improved diastolic function in non-diabetic patients with MetS and diastolic dysfunction. P1706 Cardiac resynchronisation therapy - leaving the right ventricle as a lonely rider P Storsten P Storsten Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway J Aalen J Aalen Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway CK Larsen CK Larsen Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway E Boe E Boe Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway J Duchenne J Duchenne KU Leuven, Dep. of Cardiovascular Sciences, Leuven, Belgium JU Voigt JU Voigt KU Leuven, Dep. of Cardiovascular Sciences, Leuven, Belgium OA Smiseth OA Smiseth Dep. of Cardiology and Institute for Surgical Research, University of Oslo, Oslo University Hospital, Oslo, Norway H Skulstad H Skulstad Dep. of Cardiology and Institute for Surgical Research, University of Oslo, Oslo University Hospital, Oslo, Norway Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway KU Leuven, Dep. of Cardiovascular Sciences, Leuven, Belgium Dep. of Cardiology and Institute for Surgical Research, University of Oslo, Oslo University Hospital, Oslo, Norway Background: Right ventricular (RV) function affects prognosis in patients with left ventricular (LV) heart failure and left bundle branch block (LBBB). Thus, the ventricular interaction may be of great importance in this clinical situation. Purpose: To investigate the effect of LBBB and CRT on RV function and how it relates to LV function. Methods: 14 patients with LBBB and non-ischaemic cardiomyopathy (QRS 169 ± 17ms) were studied with echocardiography shortly before and after CRT implantation. Ventricular function was assessed as left ventricular (LV) ejection fraction (EF) and RV fractional area change (FAC), respectively. RV and septal longitudinal strain was measured by speckle tracking echocardiography. Results: During LBBB, there was typical septal contraction pattern with a preejection shortening of -6 ± 2% coinciding with an early systolic contraction of -6 ± 4% (figure, A, arrow) in the RV free wall (r = 0.77, p < 0.01). CRT removed (n = 8) or reduced (n = 3) the RV free wall early systolic shortening (Figure, A, right panel). CRT increased LVEF to 35 ± 9 from 31 ± 7% during LBBB (p < 0.05), while RVFAC tended to decrease (49 ± 8 vs 52 ± 12% in LBBB, NS). During CRT there was weaker correlation and a flatter slope in the relationship between LVEF and RVFAC (Figure, B). Conclusions: During LBBB there was abnormal RV free wall early systolic shortening which was an equivalent to septal pre-ejection shortening. The coupling between the RV and LV function which was a feature of LBBB, was markedly attenuated with CRT. This could imply that CRT removes the supportive role that the LV provides to the RV in LBBB and could be a challenge for a failing RV. View largeDownload slide Abstract P1706 Figure. View largeDownload slide Abstract P1706 Figure. P1707 The clinical presentation and outcome of aortic coarctation associated with left ventricular inflow and outflow tract obstruction in adult patients: Shone syndrome and beyond K Dimopoulos K Dimopoulos Royal Brompton Hospital, London, United Kingdom Royal Brompton Hospital, London, United Kingdom W Li W Li Royal Brompton Hospital, London, United Kingdom T Shaw T Shaw Royal Brompton Hospital, London, United Kingdom A Kempney A Kempney Royal Brompton Hospital, London, United Kingdom Background: Aortic coarctation (AoC) is congenital narrowing of the aorta, which often co-exists with other congenital heart defects. Parachute mitral valve, supravalvular mitral ring, subaortic stenosis and AoC is known as "Shone syndrome". These lesions cause significant left ventricular inflow tract (LVIT) and outflow tract (LVOT) obstruction. Hypothesis: LVIT/LVOT obstruction causes significant morbidity and mortality at long-term follow-up in adult AoC patients. Methods: In this retrospective study, data from 406 AoC patients (56.2% males) was collected. Demographic, clinical and echocardiographic data was collected from their oldest full assessment within the study period (2010-2018), which was considered baseline. Outcomes were assessed from their most recent full assessment. Results: Mean age at baseline was 36.8 ± 13.6 years, with a median follow-up of 1,517 days. At baseline, 31 (7.6%) patients had LVIT obstruction, 239 (58.9%) patients had LVOT obstruction and 155 (38.2%) had neither. These three subgroups of patients were used for further analysis. At baseline, diastolic dysfunction was found in 2.4% of patients with no obstruction, 13.0% with LVIT obstruction, 14.1% with LVOT obstruction and 20.0% with true Shone syndrome. Patients with LVIT obstruction had higher mortality than those with LVOT obstruction (p = 0.02) or no obstruction (p = 0.0005), and had a higher heart failure-related morbidity than those with no obstruction (p = 0.03). Patients with LVIT/LVOT obstruction had a higher number of hospitalisations during the follow-up period than those with no obstruction (p = 0.0003 and p = 0.04 respectively). Conclusions: LVIT/LVOT obstruction leads to diastolic dysfunction and hospitalisation in long-term follow-up of AoC. Patients with LVIT obstruction also had higher mortality and heart failure-related morbidity. These findings suggest that follow-up for AoC patients with LVIT/LVOT obstruction should be more regular to improve outcomes in these patients. View largeDownload slide Abstract P1707 Figure. View largeDownload slide Abstract P1707 Figure. P1709 Indices of noninvasive global left ventricular myocardial work: relationships with regional wall peak systolic strain in a normal population I Armenis I Armenis Onassis Cardiac Surgery Center, pireaus Greece, Greece K Koutsiari K Koutsiari Onassis Cardiac Surgery Center, pireaus Greece, Greece G Athanassopoulos G Athanassopoulos Onassis Cardiac Surgery Center, pireaus Greece, Greece Onassis Cardiac Surgery Center, pireaus Greece, Greece A novel noninvasive method for measuring global as well as regional left ventricular (LV) myocardial work based has been recently proposed, based on 2D speckle tracking strain analysis combined with estimated pressure curve. Aim of the study was to assess the range of the global LV work indices in a normal population and their relationship with regional peak wall systolic strain (PSS). Methods: 59 normals, males (M)/females(F): 27/32, age: 50 + 15 years, range 25-75 /similar between M/F: 48 + 13 / 52 + 16) were selectively studied, provided that they had an efficient image quality to apply AFI analysis (EchoPAC GE). Estimated pressure curve was generated by adjusting the profile of a reference LV pressure curve according to the duration of isovolumic and ejection phase measured by echo timing of aortic –mitral events. Peak LV pressure was estimated by brachial artery cuff pressure. The following indexes of global myocardial work were estimated: GWI (global wall index = total work from mitral valve closure to mitral valve opening), GCW (global contructive work = total work contributing to pump function), GWW (global wasted work = elongation during systole and shortening against a closed aortic valve), GWE (global work efficiency = fraction of GCW/GWI). Regional LV PSS was estimated by AFI analysis (18 segments were considered, 6 per basal (B), mid (M) and apical (A) bull’s eye arrangement). Results: In a stepwise multivariate analysis including all regional PSS, the following predictive models were found for myocardial work indexes (for each model: R squared = R2, b standardized coefficients for parameted selected stepwise): For GWI: R2 = 0.64, p = 0.03, A anterior =-0.43, M posterior = -0.49, M anterior/septal = -0.43, M septal = 0.23 For GCW: R2 = 0,65, p = 0.23, A anterior = -0.44, M posterior = -0.53, M anterior/septal = -0.40, M septal =0.23 For GWE: R2 = 0,39, p = 0.04: B septal = -0.38, B anterior =-0.28, B inferior = -0.21 For GWW: R2 = 0,33, p = 0.034: B septal =0.45, B inferior =0.30, A anterior-septal =- 0.26 Conclusion: In a normal population: 1. GWI and CCW are both affected mainly by mid LV level strain performance. 2. GWW is induced mainly by basal septal /inferior strain 3. GWE is related strongly with basal strain. These insights might provide a new framework for LV myocardial work application in clinical scenaria. P1710 LVAD pre-treatment impede recovery of right ventricular contractility after heart transplantation A Ingvarsson A Ingvarsson Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden A Werther Evaldsson A Werther Evaldsson Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden G Radegran G Radegran Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden J Waktare J Waktare Liverpool Heart and Chest Hospital, Liverpool, United Kingdom G Smith G Smith Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden A Roijer A Roijer Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden C Meurling C Meurling Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden Liverpool Heart and Chest Hospital, Liverpool, United Kingdom OnBehalf: Lund Echocardiography research network Background: Left ventricular assist device (LVAD) causes unloading of the left ventricle (LV) which might affect right ventricular (RV) function through reduced pulmonary vascular resistance (PVR) and increased venous return. The consequences of prior LVAD treatment on RV function following heart transplantation (HTx) is not well described. The aim of this study was to echocardiographically evaluate RV function in HTx-patients pre-treated with LVAD compared to no prior LVAD treatment. Methods: We prospectively included 28 consecutive HTx patients, 24 males (LVAD n = 12, non-LVAD n = 16). Patients were examined with 2-dimensional echocardiography 1 and 12 months post HTx (Philips iE33). Data were analyzed using Xcelera (Philips) and RV global longitudinal strain (RVGLS) and RV free-wall strain (RVfree) were calculated offline (Philips Q-lab 10.1). Intra-group differences were compared using paired t-test and inter-group differences were compared using unpaired t-test. Values are expressed as mean ± SD. Results: Invasively measured PVR were similar in the two groups pre-HTx (2.4 ± 1 in the non-LVAD group and 2.3 ± 1 in the LVAD group, n.s). No correlation between PVR and any echocardiographic RV function parameter were detected. LVAD patients had higher RVGLS and RVfree than non-LVAD group 1 month after HTx (-17.7 ± 2,5% vs. -15.2 ± 2.7% and -18.2%± 2.9% vs. -15.1 ± 3.0% respectively, p < 0.05). Twelve months post HTx RVGLS was -16.4 ± 2.9% in the LVAD group vs. -17.9 ± 4.5% in the non-LVAD group (n.s) and the corresponding values for RVfree was -17.3 ± 2.9% vs. -18.1 ± 4.3% (n.s). In the non-LVAD group, RVGLS and RVfree increased significantly (p < 0.05) during follow-up. We found no significant differences in Tricuspid annular plane systolic excursion, systolic tissue Doppler and fractional area change between the two groups or between the two time-points. Conclusion: Our study demonstrates that HTx patients, independent of pre-treatment with LVAD, fail to reach normal RV strain values 1 year post HTx. We found an initially better RV longitudinal contractility in patients pre-treated with LVAD. However, at 12 months this difference were no longer detectable. Conventional parameters of RV function failed to show any inter- or intra-group differences indicating that strain is superior in detecting small but potentially clinically relevant differences in HTx-patients. Our results suggest that LVAD pre-treatment are beneficial and might accelerate recovery of RV function after HTx. Additional studies to understand how LVAD affect RV adaptation post HTx are needed. P1712 Serial changes in maternal cardiac function in women with severe features of preeclampsia before and within first days after delivery J Ambrozic J Ambrozic University Medical Centre of Ljubljana, Department of Cardiology, Ljubljana, Slovenia M Cvijic M Cvijic University Medical Centre of Ljubljana, Department of Cardiology, Ljubljana, Slovenia K Prokselj K Prokselj University Medical Centre of Ljubljana, Department of Cardiology, Ljubljana, Slovenia M Lucovnik M Lucovnik University Medical Centre of Ljubljana, Department of Perinatology, Division of Obstetrics and Gynecology, Ljubljana, Slovenia University Medical Centre of Ljubljana, Department of Cardiology, Ljubljana, Slovenia University Medical Centre of Ljubljana, Department of Perinatology, Division of Obstetrics and Gynecology, Ljubljana, Slovenia Introduction. Preeclampsia may lead to pulmonary edema not only before delivery, but also in the early postpartum period due to mobilization of extravascular fluids following delivery. Previous studies have shown that preeclampsia is associated with diastolic dysfunction; however, dynamic changes in cardiac function immediately before and in the first days after delivery are poorly defined. Purpose. To evaluate serially changes in echocardiographic parameters of diastolic, systolic function and myocardial deformation in severe preeclamptic women and healthy controls before and post-delivery. Methods. Thirty women with severe features of preeclampsia and 30 healthy term controls underwent echocardiography (2D, pulsed wave and tissue Doppler, speckle tracking imaging) 1 day before delivery, 1 and 4 days post-delivery. Global longitudinal strain (GLS) and global early diastolic strain rate (SRe) were estimated from the average of the 18 left ventricular segments. Beside standard parameters for diastolic dysfunction and left ventricular filling pressures, also new potential markers were calculated (e’/s’ and E/SRe ratio). Results. Women with severe features of preeclampsia had significantly higher arterial blood pressures (p < 0.001), while heart rate and stroke volumes were comparable between both groups at all examinations. Ejection fraction was similar in both groups except for the higher values 1 day post-delivery in severe preeclamptic group (65% [62-70] vs. 63% [60-65]; p = 0.02). Severe preeclamptic group had lower s’ velocities and lower GLS values compared to controls only after delivery. Tissue e’ velocities were significantly lower and the E/e’ ratios significantly higher in severe preeclamptic group compared to controls before delivery and persisted also post-delivery. The e’/s’ ratios were significantly lower in severe preeclamptic group 1 day and 4 days post-delivery. Similarly, lower values for SRe and higher E/SRe ratios were detected in severe preeclamptic group than in controls (Figure). Conclusions. Parameters of left ventricular diastolic function and left ventricular filling pressures, although within normal ranges, were impaired among women with severe features of preeclampsia before and in the first days after delivery. Slight decrease of systolic deformation parameters in severe preeclamptic women after delivery might be related to subtle systolic dysfunction, which could be uncovered with the effect of augmented volume load related to fluid mobilization in the postpartum period. View largeDownload slide Abstract P1712 Figure View largeDownload slide Abstract P1712 Figure P1713 Systolic ventricular function in Fontan patients before transition to adult care T Moller T Moller Hospital for Sick Children, Division of Cardiology, Toronto, Canada D Yim D Yim Hospital for Sick Children, Division of Cardiology, Toronto, Canada W Hui W Hui Hospital for Sick Children, Division of Cardiology, Toronto, Canada C Fackoury C Fackoury Hospital for Sick Children, Division of Cardiology, Toronto, Canada EJ Hickey EJ Hickey Hospital for Sick Children, Department of Surgery, Toronto, Canada L Mertens L Mertens Hospital for Sick Children, Division of Cardiology, Toronto, Canada Hospital for Sick Children, Division of Cardiology, Toronto, Canada Hospital for Sick Children, Department of Surgery, Toronto, Canada Funding Acknowledgements: The first author has received a post-doctoral research grant from the South-Eastern Norway Regional Health Authority Background / introduction Limited data is available about systolic ventricular function in patients with univentricular heart defects at different stages after the Fontan operation. Purpose The aim of this study was to assess systolic ventricular function in a single centre cohort of Fontan patients at the time of their last echocardiogram before transition to adult care. The relationship of important clinical factors with ventricular function was investigated. Methods We retrospectively analysed the last available echocardiogram of Fontan patient in our hospital database before transition. We assessed systolic ventricular function by visual impression, fractional area change (FAC) and longitudinal strain (LS), and we graded regurgitation of the atrioventricular and semilunar valves. From the ECG we analysed rhythm origin (atrial, non-atrial), QRS-duration and presence of conduction delay. Results We identified 100 patients (born June 1987 – April 1998, median age 17.6 years, 11.5 – 18.7) with offline analysable echocardiograms. Male/female ratio was 58/42. Fifty-nine patients had a predominant LV morphology, 36 had RV, and 5 indifferent or common morphology. Surgical modifications comprised extra-cardiac (N = 55), lateral tunnel (N = 35), classic RA-PA (N = 7) and Kawashima (N = 3) type of palliation. We found a normal distribution of functional parameters (FAC 38.3 ± 6.85 %, LS -18.3 ± 4.7 %) and no association between FAC / LS and any of the anatomical, valvular, surgical, or electrophysiological factors (figure 1). Ventricular function by visual impression was lower with RV morphology, but the visual assessment was less reliable in terms of intra-/inter-observer agreement compared to FAC and strain analysis. Conclusion: Systolic ventricular function in our study group was mainly preserved at the time of transition to adult care. There was no negative association between anatomical, valvular, surgical or electrophysiological factors and systolic function. Figure 1: systolic ventricular function assessed by FAC and LS in association with AV valve regurgitation, ventricular morphology and Fontan modification. View largeDownload slide Abstract P1713 Figure 1 View largeDownload slide Abstract P1713 Figure 1 P1714 Right heart function in patients with diastolic heart failure ESRA Kaya ESRA Kaya Ege University, Izmir, Turkey CANSU Akdeniz CANSU Akdeniz Florence Nightingale Hospital, Istanbul, Turkey TAYLAN Sahin TAYLAN Sahin Florence Nightingale Hospital, Istanbul, Turkey TUĞBA Aktemur TUĞBA Aktemur Florence Nightingale Hospital, Istanbul, Turkey CAVLAN Ciftci CAVLAN Ciftci T.C. Istanbul Bilim University - Florence Nightingale Hospital, Istanbul, Turkey Florence Nightingale Hospital, Istanbul, Turkey Ege University, Izmir, Turkey T.C. Istanbul Bilim University - Florence Nightingale Hospital, Istanbul, Turkey SELEN Yurdakul SELEN Yurdakul Florence Nightingale Hospital, Istanbul, Turkey Aims: We aimed to determine right atrial (RA) and right ventricular (RV) dysfunction in patients with preserved left ventricular (LV) ejection fraction (EF) heart failure (HF) , using speckle tracking echocardiography (STE) based strain (S) analysis and real time three dimensional echocardiography (3DE). Subjects and Methods: We studied 45 patients (55 ± 14 years, 57% male) with diastolic HF and 20 age and sex matched healthy controls. Right atrial and RV volumes by real time 3DE were measured.Two dimensional STE based strain analysis was performed for RA and RV . Reservoir phase strain, conduit (SR-C), and contractile phase (SR-A) strain rates were obtained. Results: There was no difference between the patients and the control group, regarding conventional echocardiographic parameters including RA and RV diameters,fractional area change, tricuspid annular plane systolic excursion and pulmonary artery systolic pressure. Maximum RA volume was increased in patients with diastolic HF (24.28 ± 0.38 ml ; 16.25 ± 0.35 ml, p = 0.0001). RV global longitudinal strain was decreased in patients (12.61 ± 1.65 % to 23.87 ± 2.5 %; p = 0.0001). RA reservoir phase strain was significantly impaired in patients’ group (27.11 ± 5.12 % to 41.02 ± 2.93 %; p = 0.0001) when compared to the healthy controls . RA SR-C and RA SR-A were similar(1.42 ± 0.44 s¯¹ to 1.57 ± 0.51 s¯¹;p= 0.37 and 1.55 ± 0.35 s¯¹ to 1.56 ± 0.51 s¯¹ ; p = 0.96) between the groups. Conclusions: Right atrial and RV systolic dysfunction is common in patients with preserved EF HF. Real time 3DE and STE based strain imaging are detailed techniques which provide additive data about cardiac mechanics. P1715 Can mitral annular calcification (MAC) cause systolic anterior motion (SAM) of the mitral valve? R Ranjan R Ranjan Albert Einstein Medical Center, Philadelphia, United States of America MC Roderiguez Ziccardi MC Roderiguez Ziccardi Albert Einstein Medical Center, Philadelphia, United States of America BS Abdulhadi BS Abdulhadi Albert Einstein Medical Center, Philadelphia, United States of America YS Alhamshari YS Alhamshari Albert Einstein Medical Center, Philadelphia, United States of America HD Jeon HD Jeon Albert Einstein Medical Center, Philadelphia, United States of America EJ Friend EJ Friend Albert Einstein Medical Center, Philadelphia, United States of America GS Pressman GS Pressman Albert Einstein Medical Center, Philadelphia, United States of America Albert Einstein Medical Center, Philadelphia, United States of America Background: Anterior displacement of the mitral valve (MV) and elongation of the anterior MV leaflet contribute to systolic anterior motion (SAM) of the MV and dynamic left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic cardiomyopathy. Severe mitral annular calcification (MAC) can produce bulky deposits in the posterior annulus that might cause anterior displacement of the valve. However, it is unknown if this phenomenon contributes to SAM and dynamic outflow tract obstruction. Hypothesis: We hypothesized that severe MAC can produce dynamic LVOT obstruction via anterior displacement of the MV coaptation plane. Methods: We reviewed echocardiograms of 130 patients with moderate/severe MAC and identified 16 patients with SAM and septal contact. We measured the following parameters in these patients: indexed left ventricular end systolic and end diastolic volumes, left ventricular ejection fraction, length of the anterior leaflet of the MV and distance between the MV coaptation point and ventricular septum at end diastole. Results: Mean age was 75 ± 12 years, 13 were women. Subjects tended to be normal weight or overweight; only 5 had BMI ≥30. Indexed left ventricular end diastolic volume (LVEDVi) was normal to small. The distance from the coaptation point of the MV to the septum (C-sept) was reduced (1.38 ± 0.4) in all cases. Anterior mitral leaflet length was increased in most subjects. Conclusions: SAM of the MV can occur in the presence of MAC. In all cases the coaptation plane of the mitral valve was anteriorly displaced, possibly due to the presence of calcium deposits in the posterior annulus. However, anterior mitral leaflet length was also increased in these subjects suggesting that both features are necessary to produce SAM. Age (years) 75 ± 12 Sex (female) 81% BMI (kg/m2) 27.8 ± 7.7 LVEDVi (ml/m2) 49 ± 11 EF range (%) 52 - 74 Anterior leaflet length (mm) 27 ± 3 C-sept (mm) 13 ± 3 Age (years) 75 ± 12 Sex (female) 81% BMI (kg/m2) 27.8 ± 7.7 LVEDVi (ml/m2) 49 ± 11 EF range (%) 52 - 74 Anterior leaflet length (mm) 27 ± 3 C-sept (mm) 13 ± 3 View Large Age (years) 75 ± 12 Sex (female) 81% BMI (kg/m2) 27.8 ± 7.7 LVEDVi (ml/m2) 49 ± 11 EF range (%) 52 - 74 Anterior leaflet length (mm) 27 ± 3 C-sept (mm) 13 ± 3 Age (years) 75 ± 12 Sex (female) 81% BMI (kg/m2) 27.8 ± 7.7 LVEDVi (ml/m2) 49 ± 11 EF range (%) 52 - 74 Anterior leaflet length (mm) 27 ± 3 C-sept (mm) 13 ± 3 View Large View largeDownload slide Abstract P1715 Figure. View largeDownload slide Abstract P1715 Figure. P1716 Impact of valvulo-arterial impedance on longitudinal myocardial function after transcatheter aortic valve implantation (TAVI) F Avci Demir F Avci Demir Kings College Hospital, London, United Kingdom M Eskandari M Eskandari Kings College Hospital, London, United Kingdom O Aldalati O Aldalati Kings College London, London, United Kingdom V Tzalamouras V Tzalamouras Kings College Hospital, London, United Kingdom R Dworakowski R Dworakowski Kings College Hospital, London, United Kingdom J Byrne J Byrne Kings College Hospital, London, United Kingdom O Wendler O Wendler Kings College Hospital, London, United Kingdom P Maccarthy P Maccarthy Kings College Hospital, London, United Kingdom M Monaghan M Monaghan Kings College Hospital, London, United Kingdom Kings College Hospital, London, United Kingdom Kings College London, London, United Kingdom Background: Global longitudinal strain (GLS) is a sensitive marker of myocardial function in patients with a pressure loaded left ventricle secondary to aortic stenosis. Reduced arterial compliance adds to the Left ventricular (LV) afterload beyond the load contributed by aortic stenosis (AS) and is not expected to resolve after TAVI. Purpose: We sought to assess the relationship between the change in global afterload and myocardial longitudinal function after TAVI in patients with severe AS. Method: 50 consecutive patients who underwent TAVI in 2016 were studied. Patients had Transthoracic echocardiography (TTE) at baseline, 6 and 12 months after TAVI. GLS and valvulo-arterial impedance (ZVa - as the marker of global afterload) were calculated with each TTE. Results: ‏46% were female (23/50) and the mean age was 81.5 (7.8). Mean aortic valve area and peak gradient were 0.8cm2 (0.2) and 74 mmHg (29) respectively. Mean EF was 56%(19). Mean ZVa and GLS at baseline were 4.2 mmHg/ml/m and -16.4% respectively. There was a significant decrease in ZVa at 12 months (3.2 mmHg/ml/m, p < 0.001). GLS initially worsened at 6 months (-14.5, p = 0.008) but was back to baseline at 12 months (-15.5, p = 0.051). Using linear mixed modelling, there was a significant correlation between GLS and ZVa; for every unit rise in ZVa (1 mmHg/ml/m), there was a 0.6 rise (worsening) in GLS (β = 0.606 ± 0.23, 95% CI 0.13-1.07, p = 0.011). Conclusion: Valvulo-arterial impedance may have a role in identifying TAVI patients that show a suboptimal improvement in LV function after TAVI. P1717 Differences in layer-specific longitudinal strain and myocardial work in symptomatic and asymptomatic patients with severe aortic stenosis R Dulgheru R Dulgheru University Hospital of Liege (CHU), Department of Cardiology , Liege, Belgium S Marchetta S Marchetta University Hospital of Liege (CHU), Department of Cardiology , Liege, Belgium S Cimino S Cimino University Hospital of Liege (CHU), Department of Cardiology , Liege, Belgium G D"amico G D"amico University Hospital of Liege (CHU), Department of Cardiology , Liege, Belgium R Manganaro R Manganaro University Hospital of Liege (CHU), Department of Cardiology , Liege, Belgium P Lancellotti P Lancellotti University Hospital of Liege (CHU), Department of Cardiology , Liege, Belgium University Hospital of Liege (CHU), Department of Cardiology , Liege, Belgium F Ilardi F Ilardi University Hospital of Liege (CHU), Department of Cardiology , Liege, Belgium Background: Global longitudinal strain (GLS) was used to detect early myocardial dysfunction in patients with aortic stenosis (AS), however little is known about the different susceptibility of specific myocardial layer to pressure overload and its effects on myocardial work (MW) in this condition. Purpose: The aim was to evaluate the differences in layer-specific myocardial deformation and MW according to symptomatic status in patients with severe AS and preserved systolic function. Methods: We included in the analysis 211 patients (56% males, mean age 73 ± 12 years old) with severe AS and preserved left ventricle ejection fraction (LVEF≥50%), divided in two groups: symptomatic (n = 114) and asymptomatic (n = 97). Symptomatic status was defined according to occurrence of syncope, heart failure, dyspnoea or positive echocardiographic stress test. Patients with moderate-to-severe concomitant valvulopathy and inadequate acoustic windows for evaluation by speckle tracking analysis were excluded. Clinical, demographic and resting echocardiographic data were recorded, including quantification of 2D GLS, subendocardial longitudinal strain (EndoLS), subepicardial longitudinal strain (EpiLS), global work index (GWI), global constructive work (GCW) and global wasted work (GWW). Results: The two groups were similar for demographic characteristics and risk factors. Symptomatic patients had increased LV wall thickness and LV mass index than asymptomatic ones (p < 0.001), higher transaortic mean pressure gradients (48 ± 14 vs 44 ± 13 mmHg, p = 0.004), lower aortic valve areas (0.42 ± 0.09 vs 0.45 ± 0.08 cm2/m2, p < 0.017) and greater left atrial volumes (45 ± 20 vs 35 ± 12 ml/m2, p < 0.001). Layer-specific myocardial deformation analysis revealed that, compared with the asymptomatic group, symptomatic patients had significant impairment of GLS (-18 ± 3 vs 19 ± 3%, p = 0.006), which was reflected both by the impairment of both EndoLS (-20 ± 5 vs -22 ± 4%, p = 0.002) and EpiLS (-16 ± 3 vs -17 ± 3%, p = 0.019). Moreover, in symptomatic patients, a significant reduction of GWI (1869 ± 451 vs 2004 ± 397 mmHg%, p = 0.024) and GCW (2206 ± 538 vs 2345 ± 468, p = 0.049) was observed. At multivariable logistic regression analysis, EndoLS was independently associated to symptomatic status (OR = 1.14, p = 0.007), together with LV mass index (OR = 1.02, p = 0.033). Conclusion: In patients with severe AS, longitudinal strain impairment involves all myocardial layers and is more prominent in the advanced phases of the disease (i.e. when the symptoms occur). In this setting, the subendocardial longitudinal strain appears to be independently associated to symptoms than subepicardial longitudinal strain. P1718 Left ventricular and mitral valve geometry in patients with mitral valve prolapse and mild regurgitation: a three-dimensional echocardiographic study RC Ochoa-Jimenez RC Ochoa-Jimenez Mount Sinai Medical Center, New York, United States of America AC Guta AC Guta University of Medicine and Pharmacy Carol Davila, Bucharest, Romania S Civera S Civera University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy V Guida V Guida University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy P Aruta P Aruta University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy C Palermo C Palermo University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy M Previato M Previato University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy H Shehata H Shehata University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy M De Lazzari M De Lazzari University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy A Cipriani A Cipriani University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy S Iliceto S Iliceto University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy LP Badano LP Badano University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy D Muraru D Muraru University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy Mount Sinai Medical Center, New York, United States of America University of Medicine and Pharmacy Carol Davila, Bucharest, Romania University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy Background: Left ventricular (LV) abnormalities as potential substrates leading to ventricular electrical instability in mitral valve prolapse (MVP) without significant regurgitation (MR) remain unclear. Purpose: (1) to assess the LV geometry in MVP patients with trivial/mild MR with respect to controls; (2) to assess the relationship between MV and LV geometry and the potential relationship with arrhythmic burden. Methods: A total of 76 pts (32% men, 49.2 ± 14.7 years) with isolated MVP - 37 pts with fibroelastic deficiency (FED) and 39 pts with Barlow disease (BD) - were prospectively enrolled and compared with 81 controls matched for age, sex and body size. Pts with abnormal LV function (ejection fraction <54%), previous surgery, or known ischemic heart disease were excluded. LV end-diastolic (EDV) and end-systolic volumes (ESV), end-diastolic sphericity index (LVSI) and basal diameter (EDD), and MV 3D annulus area (MAA) and sphericity index (MASI) were assessed using 3D echocardiography. In a subgroup of 39 pts (54%), 24-hours ambulatory ECG monitoring data were collected. Complex VA were defined as ≥grade III Lown. Results: Despite still within the normal range, MVP pts had significantly larger LV volumes than controls (EDV 72 ± 15 vs 59 ±12 mL, ESV 30 ±8 vs 23 ±6, p < 0.001) and increased SpI (0.41 ± 0.1 vs 0.36 ± 0.1, p = 0.003, Figure), due to basal LV remodelling (basal diameter (46 ± 6 vs 43 ± 4 mm, p = 0.0025). LV ejection fraction was slightly higher in MVP than in controls (62 ± 5 vs 60 ± 6%, p = 0.01). MVP pts had also larger and more elliptical MV annuli than controls (MAA 12.4 ± 3.8 cm2 vs 9.2 ± 1.7 cm2; MASI 0.83 ± 0.08 vs 0.90 ± 0.08, p < 0.001 for both). MAA correlated with LV EDV (r = 0.64, p < 0.001) and LVSI (r = 0.22, p = 0.006). BD pts had larger MAA (13.8 ± 4.1 cm2 vs 11.0 ± 2.7 cm2, p = 0.001), but similar LV EDV and LVSI, than FED pts (p > 0.5). Pts with complex VA (n = 19, 50%) had similar LV and MV geometry, but showed an increased QT dispersion (49 ± 12 vs 37 ± 12 ms, p = 0.011) compared to MVP pts without VA. Conclusion: Patients with MVP and mild/trivial MR showed subtle changes in LV and mitral annulus geometry with respect to normal subjects, that did not seem to be related with prolapse extension or presence of ventricular arrhythmias. The clinical significance of these findings requires further study. View largeDownload slide Abstract P1718 Figure View largeDownload slide Abstract P1718 Figure P1719 Discriminating severity in aortic stenosis: are left atrial mechanics the right tool? R Martins R Martins University Hospitals of Coimbra, Cardiology, Coimbra, Portugal L Goncalves L Goncalves University Hospitals of Coimbra, Cardiology, Coimbra, Portugal University Hospitals of Coimbra, Cardiology, Coimbra, Portugal P Marques-Alves P Marques-Alves University Hospitals of Coimbra, Cardiology, Coimbra, Portugal V Marinho V Marinho University Hospitals of Coimbra, Cardiology, Coimbra, Portugal C Domingues C Domingues University Hospitals of Coimbra, Cardiology, Coimbra, Portugal R Baptista R Baptista University Hospitals of Coimbra, Cardiology, Coimbra, Portugal Background: Left atrial (LA) strain is a prognostic marker in mitral valvulopathy and is correlated to pulmonary hypertension. In aortic valve stenosis (AS) there is limited information regarding LA mechanics. We assessed LA mechanics in AS through speckle-tracking (STE) to determine variations in different levels of disease severity and prognosis. Methods: We included 102 patients diagnosed with severe AS (sAS) and 80 patients with moderated AS (mAS). All patients had preserved ejection fraction and no coronary artery disease. LA mechanics was assessed through STE: global LA strain and LA strain rate during systole (LA ɛsys and SRs), early diastole (LAɛe, SRe), and late diastole (LAɛa, SRa) were measured, corresponding to LA reservoir, conduit and contractile functions, respectively. STE-derived left ventricle global longitudinal strain (LV-GLS) was also calculated. The cohort was followed up during a median of 30 [IQR 12.6-50] months and outcomes (admission for heart failure [HF] and death) determined. Results: The mean age was 76 ± 7.9 years and 51% were male. Mean values of LV-GLS were -17.7 ± 3.9%, indexed LA volume (LAVi) 41 ml.m-2, E/e’ ratio 17.2 ± 2%, TAPSE 20.3 ± 3.5 mm, RV/RA gradient 24.1 ± 10 mmHg. LV-GLS (-18.5% vs -17.1, p = 0.025), E/e’ ratio (15.8 vs 18.4, p = 0.03) and global LA mechanics (LA ɛsys 23% vs 13.8%, p < 0.001) had worse values in sAS. However, LA ɛsys (AUC 0.85, 95%CI 0.78-0.90, p < 0.001), ɛe (AUC 0.83, 95%CI 0.75-0.88, p < 0.001) and ɛa (AUC 0.80, 95%CI 0.70-0.84, p < 0.001) were the best discriminators of sAS, with sensitivities higher than 85%. LA ɛsys showed a stronger correlation with both aortic valve area (r2= 0.6, p < 0.001) and mean LV-aortic gradient (r2 = 0.55, p < 0.001), than LV-GLS (r2 = 0.3 and r2 = 0.25, p = 0.01). Regarding the combined outcome of HF and death, both LV-GLS (HR 1.16, 95%CI 1.06-1.27, p = 0.002) and LA ɛsys (HR1.13, 95%CI 1.02-1.26, p = 0.038), but not E/e ratio, TAPSE or RV/RA gradient, were significant predictors. Conclusions: LA global strain was the best discriminator of severity, surpassing E/e’ ratio and LV-GLS, and a significant predictor of prognosis in aortic stenosis. P1720 Characteristics and outcomes of low-flow low-gradient severe aortic stenosis after aortic valve replacement or TAVI L Galian-Gay L Galian-Gay Hospital Vall d"Hebron, Barcelona, Spain RA Escalona Silva RA Escalona Silva Hospital Vall d"Hebron, Barcelona, Spain E Ferrer-Sistach E Ferrer-Sistach Germans Trias i Pujol University Hospital, Badalona, Spain C Mitroi C Mitroi University Hospital Puerta de Hierro Majadahonda, Madrid, Spain S Mingo S Mingo University Hospital Puerta de Hierro Majadahonda, Madrid, Spain V Monivas V Monivas University Hospital Puerta de Hierro Majadahonda, Madrid, Spain V Sanchez V Sanchez University Hospital 12 de Octubre, Madrid, Spain A Bouzas A Bouzas University Hospital Complex A CoruÇña, A Coruña, Spain M Noris Mora M Noris Mora University Hospital Son Espases, Palma de Mallorca, Spain F Calvo F Calvo Hospital of Meixoeiro, Vigo, Spain A Gonzalez A Gonzalez University Hospital Ramon y Cajal de Madrid, Madrid, Spain C Fernandez-Golfin C Fernandez-Golfin University Hospital Ramon y Cajal de Madrid, Madrid, Spain A Lorente A Lorente University Hospital Ramon y Cajal de Madrid, Madrid, Spain MA Arnau Vives MA Arnau Vives Hospital Universitario y PolitǸcnico La Fe, Valencia, Spain A Evangelista A Evangelista Hospital Vall d"Hebron, Barcelona, Spain Hospital Vall d"Hebron, Barcelona, Spain Germans Trias i Pujol University Hospital, Badalona, Spain University Hospital Puerta de Hierro Majadahonda, Madrid, Spain University Hospital 12 de Octubre, Madrid, Spain University Hospital Complex A CoruÇña, A Coruña, Spain University Hospital Son Espases, Palma de Mallorca, Spain Hospital of Meixoeiro, Vigo, Spain University Hospital Ramon y Cajal de Madrid, Madrid, Spain Hospital Universitario y PolitǸcnico La Fe, Valencia, Spain Background: Low-flow low-gradient (LFLG) aortic stenosis (AS) with preserved EF has been considered a worse prognostic entity compared to high gradient AS. Objectives: To analyse characteristics and outcomes after the surgery. Methods and results: 315 patients with severe AS (AVA <1 cm2) and normal EF consecutively assessed in the outpatient clinic and classifiedaccording to AS type: 60 (19%) LFLG, 78 (24.8%) NFLG and 177 (56.2%) high-gradient (HG). After 5 ± 2.5 years, 33 (55%) LFLG patients , 49 (63%) NFLG and 135 (76%) HG received AVR or TAVI (p = 0.029). Early and long-term mortality did not differ between groups. 45% LFLG patients did not receive surgical treatment/TAVI and after 4.1 ± 1 years, a significant increase in maximum velocity (3.4 ± 0.4 vs. 3.9 ± 0.5 m/s; p = 0.002) and mean gradient (37.9 ± 6 vs 38.5 ± 11 mmHg; p = 0.0014) were observed without significant changes in LVEF (70.3 ± 7 vs. 68.6 ± 7.5%, p = 0.139) and AVA (0.72 ± 0.1 vs 0.67 ± 0.2; p = 0.336). Conclusions: LFLG AS was prevalent in our population (19%). No significant differences were observed in demographic or clinical variables between different types of AS. The echocardiographic severity profile suggests that the LFLG group corresponds to an intermediate entity between moderate AS (NFLG) and HGAS. Characteristics according to AS type LFLG 60 (19%) NFLG 78 (24.8%) HG 177 (56.2%) p Anthropometric/clinical data Age, years 76.4 ± 7.8 74.1 ± 9.2 75.1 ± 9.7 0.287 Women, N (%) 36 (60) 49 (62.8) 105 (59.6) 0.890 Hypertension, N (%) 45 (75) 57 (73.1) 138 (77.9) 0.680 Dislipidemia, N (%) 33 (55) 44 (56.4) 102 (57.6) 0.6936 Diabetes Mellitus, N (%) 20 (33.3) 19 (24.4) 63 (35.6) 0.207 Echocardiographic data End-diastolic diameter, mm 43.8 ± 5.9 44.7 ± 5.8 46.2 ± 6.6 0.012 End-systolic diameter, mm 27.3 ± 5.7 28 ± 6.2 29.3 ± 5.6 0.026 IVS, mm 13.4 ± 2.6 13.4 ± 2.3 14.7 ± 2.4 0.0001 Posterior wall, mm 11.8 ± 1.9 11.6 ± 1.9 12.8 ± 1.9 0.0001 LVEF, % 66.2 ± 7.9 65.7 ± 8.2 65.5 ± 7.1 0.864 Indexed mass, g/m&sup2; 108.1 ± 25.2 111.3 ± 27.2 144.4 ± 39.2 0.0001 Maximum velocity, m/s 3.5 ± 0.4 3.7 ± 0.3 4.5 ± 0.5 0.0001 Mean Gradient, mmHg 28.9 ± 6 32.4 ± 4.7 52.9 ± 12.2 0.0001 AVA, cm&sup2; 0.74 ± 0.1 0.87 ± 0.1 0.69 ± 0.2 0.0001 LFLG 60 (19%) NFLG 78 (24.8%) HG 177 (56.2%) p Anthropometric/clinical data Age, years 76.4 ± 7.8 74.1 ± 9.2 75.1 ± 9.7 0.287 Women, N (%) 36 (60) 49 (62.8) 105 (59.6) 0.890 Hypertension, N (%) 45 (75) 57 (73.1) 138 (77.9) 0.680 Dislipidemia, N (%) 33 (55) 44 (56.4) 102 (57.6) 0.6936 Diabetes Mellitus, N (%) 20 (33.3) 19 (24.4) 63 (35.6) 0.207 Echocardiographic data End-diastolic diameter, mm 43.8 ± 5.9 44.7 ± 5.8 46.2 ± 6.6 0.012 End-systolic diameter, mm 27.3 ± 5.7 28 ± 6.2 29.3 ± 5.6 0.026 IVS, mm 13.4 ± 2.6 13.4 ± 2.3 14.7 ± 2.4 0.0001 Posterior wall, mm 11.8 ± 1.9 11.6 ± 1.9 12.8 ± 1.9 0.0001 LVEF, % 66.2 ± 7.9 65.7 ± 8.2 65.5 ± 7.1 0.864 Indexed mass, g/m&sup2; 108.1 ± 25.2 111.3 ± 27.2 144.4 ± 39.2 0.0001 Maximum velocity, m/s 3.5 ± 0.4 3.7 ± 0.3 4.5 ± 0.5 0.0001 Mean Gradient, mmHg 28.9 ± 6 32.4 ± 4.7 52.9 ± 12.2 0.0001 AVA, cm&sup2; 0.74 ± 0.1 0.87 ± 0.1 0.69 ± 0.2 0.0001 View Large Characteristics according to AS type LFLG 60 (19%) NFLG 78 (24.8%) HG 177 (56.2%) p Anthropometric/clinical data Age, years 76.4 ± 7.8 74.1 ± 9.2 75.1 ± 9.7 0.287 Women, N (%) 36 (60) 49 (62.8) 105 (59.6) 0.890 Hypertension, N (%) 45 (75) 57 (73.1) 138 (77.9) 0.680 Dislipidemia, N (%) 33 (55) 44 (56.4) 102 (57.6) 0.6936 Diabetes Mellitus, N (%) 20 (33.3) 19 (24.4) 63 (35.6) 0.207 Echocardiographic data End-diastolic diameter, mm 43.8 ± 5.9 44.7 ± 5.8 46.2 ± 6.6 0.012 End-systolic diameter, mm 27.3 ± 5.7 28 ± 6.2 29.3 ± 5.6 0.026 IVS, mm 13.4 ± 2.6 13.4 ± 2.3 14.7 ± 2.4 0.0001 Posterior wall, mm 11.8 ± 1.9 11.6 ± 1.9 12.8 ± 1.9 0.0001 LVEF, % 66.2 ± 7.9 65.7 ± 8.2 65.5 ± 7.1 0.864 Indexed mass, g/m&sup2; 108.1 ± 25.2 111.3 ± 27.2 144.4 ± 39.2 0.0001 Maximum velocity, m/s 3.5 ± 0.4 3.7 ± 0.3 4.5 ± 0.5 0.0001 Mean Gradient, mmHg 28.9 ± 6 32.4 ± 4.7 52.9 ± 12.2 0.0001 AVA, cm&sup2; 0.74 ± 0.1 0.87 ± 0.1 0.69 ± 0.2 0.0001 LFLG 60 (19%) NFLG 78 (24.8%) HG 177 (56.2%) p Anthropometric/clinical data Age, years 76.4 ± 7.8 74.1 ± 9.2 75.1 ± 9.7 0.287 Women, N (%) 36 (60) 49 (62.8) 105 (59.6) 0.890 Hypertension, N (%) 45 (75) 57 (73.1) 138 (77.9) 0.680 Dislipidemia, N (%) 33 (55) 44 (56.4) 102 (57.6) 0.6936 Diabetes Mellitus, N (%) 20 (33.3) 19 (24.4) 63 (35.6) 0.207 Echocardiographic data End-diastolic diameter, mm 43.8 ± 5.9 44.7 ± 5.8 46.2 ± 6.6 0.012 End-systolic diameter, mm 27.3 ± 5.7 28 ± 6.2 29.3 ± 5.6 0.026 IVS, mm 13.4 ± 2.6 13.4 ± 2.3 14.7 ± 2.4 0.0001 Posterior wall, mm 11.8 ± 1.9 11.6 ± 1.9 12.8 ± 1.9 0.0001 LVEF, % 66.2 ± 7.9 65.7 ± 8.2 65.5 ± 7.1 0.864 Indexed mass, g/m&sup2; 108.1 ± 25.2 111.3 ± 27.2 144.4 ± 39.2 0.0001 Maximum velocity, m/s 3.5 ± 0.4 3.7 ± 0.3 4.5 ± 0.5 0.0001 Mean Gradient, mmHg 28.9 ± 6 32.4 ± 4.7 52.9 ± 12.2 0.0001 AVA, cm&sup2; 0.74 ± 0.1 0.87 ± 0.1 0.69 ± 0.2 0.0001 View Large P1721 Severe aortic stenosis: measurement of energy loss index using 3d echocardiography without geometrical assumptions ... is the stenosis really severe? M Lombardero M Lombardero Sanatorio de la Trinidad Palermo, Cardiac Imaging, Buenos Aires, Argentina A Arrioja A Arrioja Sanatorio Trinidad Ramos Mejia, Cardiac Imaging, Buenos Aires, Argentina R Henquin R Henquin Sanatorio de la Trinidad Palermo, Statistics and Epidemiology, Buenos Aires, Argentina Sanatorio de la Trinidad Palermo, Cardiac Imaging, Buenos Aires, Argentina Sanatorio Trinidad Ramos Mejia, Cardiac Imaging, Buenos Aires, Argentina Sanatorio de la Trinidad Palermo, Statistics and Epidemiology, Buenos Aires, Argentina Background: It is known that in the evaluation of aortic stenosis (AS) through 2D transthoracic echo(2D TTE) the effective valve area (eAVA) tends to underestimate the real area (AVA) because it does not take into account the pressure recovery and it assumes the left ventricular outflow tract (LVOT) as circular. The Energy Loss Index (ELI) by 2D TTE is the eAVA that involves the pressure’s recovery. In patients with AS, measurement of the LVOT area and STJ by 3D transesophageal echo (3D TEE) with planimetry should be a more accurate measurement of ELI. Objectives: 1.To evaluate the size and geometry of the STJ by 3D TEE,compare it with 2D TEE measurement and with 3D LVOT geometry. 2. To compare the measurement of the eAVA and ELI by 2D TTE and ELI by 2D TTE replacing the LVOT (LVOTa) and STJ areas (STJa) by 3D TEE areas (fusion 2D/3D ELI) versus Anatomical 3D ELI using anatomical 3D AVA (aAVA) and 3D aSTJ. Methods: We studied 41 patients with severe AS (AVA <1cm²) with 2D TTE and 3D TEE,prospectively. The 2D TTE eAVA was estimated by Continuity Equation. In the 3D TEE, 3 captures were done and analyzed off line (QLAB). The LVOT and STJ areas and aAVA were measured in mid systole,same frame by planimetry; anteroposterior (AP) and lateral (L) diameters of the LVOT and STJ were measured. The sphericity index (AP/L diameter) was performed. To calculate ELI, we used the formula = eAVA*STJa/STJa-eAVA. When replacing the 2D LVOTa with 3D in the eAVA, fusion 2D/3D eAVA was obtained. When replacing 2D LVOTa and STJa by the values obtained with 3D TEE in the ELI formula, fusion 2D/3D ELI was obtained. Anatomical 3D ELI was obtained using the 3D aAVA and STJa. Data are reported as mean ± SD. Results: Average age was 74.9 (±9), 25% male.Ejection Fraction was 55.5%(±11). Peak and mean aortic gradients: 61(±18) and 37 (±13)mmHg,respectively. 2D TTE LVOTa was 3.19(±0.8)cm² vs 3D LVOTa 3.9 (±0.9)cm² (p = 0.0001). 2D STJa was 5.4(±1.6)cm² vs 3D STJa 4.66(±1.3)cm² (p < 0001). The LVOT sphericity index was 0.79(±0.09) and STJ 1.07(±0.08), p <0001. LVOT and STJ AP diameter: 1.9(±0.2)cm and 2.5(±0.3)cm; respectively (p < 00001). LVOT and STJ L diameter: 2.5(±0.3)cm and 2.3(±0.3)cm; respectively (p < 00001). Comparing the 2D eAVA, difference with fusion 2D/3D eAVA was 19% (p < 0.001), 3D aAVA 16% (p < 0.001), 2D TTE ELI 14% (p < 0.001), fusion 2D/3D ELI 35% (p < 0.001) and Anatomical 3D ELI 32% (p < 0.001). Comparing 2D/3D fusion eAVA with fusion 2D/3D ELI and 3D aAVA with Anatomical 3D ELI,the difference was 19%. Conclusions: With 3D echo the STJ geometry tends to be more spherical than LVOT but the larger diameter of the LVOT turns out to be the inverse of the STJ. With 2D echo the size of the LVOT is underestimated while the STJ is overestimated. If any geometrical assumptions are not taking into account with 3D echo there will be implications in the calculation of eAVA and ELI: the smaller STJ size and the larger LVOT size reflect less AS severity in regard to 2D methods. P1722 Global longitudinal strain as a marker of LV hypertrophy with electrocardiogram strain predicts LV mass regression in severe aortic stenosis patients undergoing transcatheter aortic valve replacement S Nakatani S Nakatani Osaka University Graduate School of Medicine, Division of Functional Diagnostics, Osaka, Japan K Sengoku K Sengoku Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan T Mukai T Mukai Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan M Tsuda M Tsuda Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan Y Ichibori Y Ichibori Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan I Mizote I Mizote Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan T Ohtani T Ohtani Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan K Maeda K Maeda Osaka University Graduate School of Medicine, Department of Cardiovascular Surgery, Osaka, Japan T Kuratani T Kuratani Osaka University Graduate School of Medicine, Department of Cardiovascular Surgery, Osaka, Japan Y Sawa Y Sawa Osaka University Graduate School of Medicine, Department of Cardiovascular Surgery, Osaka, Japan Y Sakata Y Sakata Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan Osaka University Graduate School of Medicine, Division of Functional Diagnostics, Osaka, Japan Osaka University Graduate School of Medicine, Department of Cardiovascular Surgery, Osaka, Japan T Onishi T Onishi Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan Background: Left ventricular hypertrophy (LVH) with electrocardiogram (ECG) strain pattern is associated with LV decompensation in aortic stenosis (AS). We investigated if global longitudinal strain (GLS) by speckle tracking echocardiography could be used as a marker of LVH with ECG strain and predicted LV mass regression. Methods: Of 155 consecutive patients undergoing transcatheter aortic valve replacement (TAVR) from October 2009 to April 2014, 76 with severe AS (aortic valve area [AVA] <1.0cm2, age = 82 ± 7 years, LV ejection fraction [LVEF] = 66 ± 11%) were analyzed. ECG and echocardiography were performed before TAVR, and echocardiography was done 6-month after TAVR. ECG-LVH was defined by Sokolow and Cornell voltage indices (SV1 + RV5≥3.5mV for LVH). ECG-strain was assessed by summing ST-segment depression and T-wave inversion in leads V4 to V6. LV meridional end-systolic wall stress (ESSm) was calculated by the method of Grossman et al. and Reichek et al., in which ESSm (×l03 dyne/cm2)=0.334×(systolic blood pressure + peak pressure gradient)×(LVDs + PWTs)/PWTs[1 + PWTs/(LVDs + PWTs)]. LV mass regression was defined as ≥10% decrease in LV mass indexed to body surface area (LVMI) 6 months after TAVR. Results: Twenty-two patients had no ECG-LVH (LVH (-)). Of the remaining 54 patients with ECG-LVH, 25 patients showed ECG-strain (LVH (+) Strain (+)) and 29 did not (LVH (+) Strain (-)). AVA had no difference among three groups, while mean pressure gradient was significantly different. LVMI and E/e’ were significantly different, but LVEF was not among them. Compared with patients with LVH (-) and those with LVH (+) Strain (-), GLS was significantly reduced in those with LVH (+) Strain (+), although ESSm had no difference among them (Table). Furthermore, GLS before TAVR predicted LV mass regression in patients with LVH (+) Strain (+) with sensitivity of 78%, specificity of 83%, and predictive accuracy of 79% (cut off=-10.4%, area under the curve [AUC] = 0.85, p = 0.003). Conclusion: GLS was a marker of LVH with ECG strain and predicted LV mass regression in patients with severe AS. These observations have clinical prognostic utility. View largeDownload slide Abstract P1722 Figure. View largeDownload slide Abstract P1722 Figure. P1723 Long-term prognosis of patients with non-severe ischemic mitral regurgitation undergoing coronary artery bypass grafting R Piatkowski R Piatkowski Clinical Hospital of the Ministry of Internal Affairs, Department of Cardiology and Hypertension with the Clinical Electrophysiology Lab, Warsaw, Poland J Kochanowski J Kochanowski Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland M Budnik M Budnik Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland P Scislo P Scislo Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland M Grabowski M Grabowski Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland DA Kosior DA Kosior Clinical Hospital of the Ministry of Internal Affairs, Department of Cardiology and Hypertension with the Clinical Electrophysiology Lab, Warsaw, Poland G Opolski G Opolski Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland Clinical Hospital of the Ministry of Internal Affairs, Department of Cardiology and Hypertension with the Clinical Electrophysiology Lab, Warsaw, Poland Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland Background: Optimal management of patients (pts) with non-severe ischemic mitral regurgitation (IMR) qualified for coronary artery bypass grafting (CABG) is still controversial. This study aimed to prospectively assess long-term prognosis of pts with non-severe IMR qualified for the appropriate surgical procedure: CABG (CABGa) or CABG + mitral annuloplasty (CABGmp). Methods: A total of 100 pts aged 18-75, with a history of myocardial infarction and non-severe IMR, eligible for CABG were included into a prospective study. Patients were referred for CABGa (gr.1; n = 74) or CABGmp (gr.2; n = 26) based on clinical assessment, 2D echo at rest and exercise as well as myocardial viability (low dose dobutamine stress echo - DBX). Effective regurgitation orifice area (EROA) was used for IMR assessment (non-severe: EROA≥10 and < 20 mm²). Prior to surgery, mitral deformation parameters at rest and during DBX, left ventricle volumes were assessed: tenting area (TA), coaptation height (CH), end-systolic volume (ESV) and end-diastolic volume (EDV). One year after the surgery each pts underwent the evaluation of cardiovascular events. Stepwise Cox proportional hazards models were used to identify predictors of composite end-point (deaths/CV hospitalizations/stroke). Results: In both groups (CABGa vs CABGmp) no significant differences were observed in: 12-month mortality (3% vs 12%; p = 0.075), hospitalizations due to the heart failure exacerbation (5% vs 15%; p = 0.107), and incidence of stroke (1% vs 8%; p = 0.103). The analysis of the composite end-point (deaths/CV hosp/stroke) revealed a statistically significant difference between CABGa and CABGmp groups (9% vs 35% pts; p = 0.003). The most important predicting factors for the composite end-point were: atrial fibrillation (AF) before surgery (p = 0.035) and TA diameter at rest (p = 0.005) (table 1). The best cut-off value for preoperative TA at rest was 2.1 cm2 (sensitivity 75%, specificity 69%; AUC 0.741, p < 0.01) in both groups. Other variables (ESV, TAdbx) didn’t reach statistical significance. Conclusions: AF before the surgery and TA were strong predictive factors of cardiovascular events in pts qualified for CABG with non-severe IMR in 12-month follow-up. Parameters Hazard Ratio (HR) 95% confidence interval (CI) p CABGa vs CABGmp 1.062 0.286-3.938 0.928 AF 3.073 1.083-8.273 0.035 TA (increase of TA by 0.2 cm&sup2;) 1.223 1.063-1.408 0.005 TAdbx 1.672 0.974-2.868 0.062 EDV 1.086 0.974-1.211 0.135 Parameters Hazard Ratio (HR) 95% confidence interval (CI) p CABGa vs CABGmp 1.062 0.286-3.938 0.928 AF 3.073 1.083-8.273 0.035 TA (increase of TA by 0.2 cm&sup2;) 1.223 1.063-1.408 0.005 TAdbx 1.672 0.974-2.868 0.062 EDV 1.086 0.974-1.211 0.135 Prognostic factors for the composite endpoint. View Large Parameters Hazard Ratio (HR) 95% confidence interval (CI) p CABGa vs CABGmp 1.062 0.286-3.938 0.928 AF 3.073 1.083-8.273 0.035 TA (increase of TA by 0.2 cm&sup2;) 1.223 1.063-1.408 0.005 TAdbx 1.672 0.974-2.868 0.062 EDV 1.086 0.974-1.211 0.135 Parameters Hazard Ratio (HR) 95% confidence interval (CI) p CABGa vs CABGmp 1.062 0.286-3.938 0.928 AF 3.073 1.083-8.273 0.035 TA (increase of TA by 0.2 cm&sup2;) 1.223 1.063-1.408 0.005 TAdbx 1.672 0.974-2.868 0.062 EDV 1.086 0.974-1.211 0.135 Prognostic factors for the composite endpoint. View Large P1724 Left atrial strain correlates with cardiovascular events in patients with rheumatic mitral stenosi 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 A Lourenco A Lourenco Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal FA Castro FA 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 B Faria B Faria Hospital Senhora da Oliveira, Serviço de Cardiologia, Guimarães, Portugal Introduction: Left atrial (LA) dysfunction, expressed as impaired LA strain, has been observed in association with rheumatic mitral stenosis (RMS). This pathology carries a high risk of cardiovascular (CV) events and the clinical role of speckle tracking echocardiography – LA strain –has rarely been studied in RMS. The prognostic value of atrial strain parameters is not established in patients with RMS. Aim: To assess 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 RMS. Methods: We included 55 patients with mild to severe RMS, in sinus rhythm. All subjects underwent transthoracic echocardiogram, including evaluation of PALS (Peak atrial longitudinal strain) and PACS (Peak atrial contraction strain) 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 data (including hospitalization for cardiac cause) and electrocardiographic findings were collected to identify predictors of prognosis. The combined endpoint of CV events at 3,3 year follow-up was composed by atrial fibrillation (AF), percutaneous valvuloplasty, mitral valve replacement and pulmonary hypertension (PHT). Results: Patients were predominantly females (87,3%), with mean age of 59 ± 12 years and presented a low PALS (18,2 ± 7.1%) and PACS (10,6 ± 5.4%). Hospitalization for cardiac cause occurred in 21,8% of cases. Mitral valve replacement was performed in 12,7% of cases. PHT developed in 30,9% of patients and AF in 32,7%. The combined endpoint of CV events occurred in 45,5% of cases. There was a significant decrease of LA strain parameters, PALS and PACS, in patients who present hospitalization for cardiac cause (PALS = 14,1% vs 19,3%, p = 0,029; PACS = 7,5% vs 11,5; p = 0,017), PHT (PALS = 11,4% vs 21,1%; PACS = 6,4% vs 12,4; p < 0,001), AF (PALS = 13% vs 20,6%; PACS = 7% vs 11,9; p = 0,000) and the combined endpoint of CV events(PALS = 13,7% vs 21,9%, PACS = 7,7% vs 13, p = 0,000), compared to patients that do not present these events. Upon multivariate regression analysis, PALS was as an independent predictor of PHT (p = 0,027). Mitral valve area by pressure half time method was as an independent predictor of the combined endpoint of CV events (p = 0,025). Conclusion: LA strain parameters, PALS and PACS, were significantly decreased in patients who present hospitalization for cardiac cause, PHT, AF or the combined endpoint of CV events. In this study, PALS was an important independent predictor of PHT while mitral valve area by pressure half time was an important independent predictor of CV events in patients with RMS. P1725 A reappraisal of bioprosthetic structural valve degeneration after aortic valve replacement: mode, outcome and effect of treatment JM Serfaty JM Serfaty University Hospital of Nantes Nord Laennec, Nantes, France L Guerma L Guerma University Hospital of Nantes Nord Laennec, Nantes, France JC Roos JC Roos University Hospital of Nantes Nord Laennec, Nantes, France R Capoulade R Capoulade Research unit of lInstitut du thorax, Nantes, France G Guimbretiere G Guimbretiere University Hospital of Nantes Nord Laennec, Nantes, France C Cueff C Cueff University Hospital of Nantes Nord Laennec, Nantes, France P Jaafar P Jaafar University Hospital of Nantes Nord Laennec, Nantes, France V Padler-Karavani V Padler-Karavani Tel Aviv University, Tel Aviv, Israel R Manez Mendiluce R Manez Mendiluce University Hospital of Bellvitge, Barcelona, Spain V Letocart V Letocart University Hospital of Nantes Nord Laennec, Nantes, France JP Soulilou JP Soulilou University Hospital of Nantes Nord Laennec, Nantes, France E Cozzi E Cozzi University of Padova, Padua, Italy T Senage T Senage University Hospital of Nantes Nord Laennec, Nantes, France JC Roussel JC Roussel University Hospital of Nantes Nord Laennec, Nantes, France T Le Tourneau T Le Tourneau University Hospital of Nantes Nord Laennec, Nantes, France University Hospital of Nantes Nord Laennec, Nantes, France Research unit of lInstitut du thorax, Nantes, France Tel Aviv University, Tel Aviv, Israel University Hospital of Bellvitge, Barcelona, Spain University of Padova, Padua, Italy Background: Structural valve degeneration (SVD) remains the main complication of aortic bioprosthesis. The study aimed to evaluate SVD mode, outcome and effect of treatment. Methods: Patients with presumed aortic SVD by echocardiography in our institution between January 2010 and December 2016 were included. All-cause mortality, cardiovascular morbidity, and effect of treatment were assessed. Results: After exclusion of 4 patients with others causes of increased gradients, 220 patients were analyzed (78 ± 9 years, 52% men). Regurgitant SVD (n = 94, 43%) occurred later than stenotic (n = 126, 57%) SVD (9.2 ± 3.7 vs 7.9 ± 3.0 years; P = 0.003). Patients with a regurgitant SVD were more symptomatic, had a larger bioprosthesis, and were more often referred to invasive management. Exclusive medical care (Med) was retained in 67 patients, redo-surgery in 89 and VinV in 64. Macroscopic examination of explanted bioprostheses (n = 71) demonstrated severe calcifications in 56.3%, mainly in stenotic SVD (71 vs 42%, P = 0.02), and leaflet tear in 28%. Overall survival at 35 months was significantly associated with the type of management (VinV: 85.3 ± 4.9%, redo-surgery 86.7 ± 3.8%, Med 60.1 ± 7.7%, P <0.0001). In multivariable analysis, predictive factors of overall survival were bioprosthesis type, Nt proBNP level (HR = 1.52 [95% CI: 1.17-1.97], P = 0.002), transvalvular maximal velocity, and invasive management (Redo-surgery: HR = 0.35 [95% CI: 0.15-0.81], P = 0.014; VinV: HR = 0.32 [95% CI: 0.13-0.77], P = 0.011) as compared to Med. Conclusion: Structural valve degeneration remains a matter of concern. Regurgitant SVD occurs later than stenotic SVD which is characterized by a more severe calcification process. Redo-surgery and VinV are associated with a better outcome, independently of failure mode, and should be considered in most SVD patients. Although VinV was proposed to older and higher-risk patients, its effect on overall survival was comparable to redo-surgery in multivariable analysis. P1726 The long term prognostic impact of mitral regurgitation in STEMI patients treated with primary PCI JP Alves Guimaraes JP Alves Guimaraes Hospital Center of Tras-os-Montes and Alto Douro, Vila Real, Portugal F Goncalves F Goncalves Hospital Center of Tras-os-Montes and Alto Douro, Vila Real, Portugal M Moz M Moz Hospital Center of Tras-os-Montes and Alto Douro, Vila Real, Portugal S Borges S Borges Hospital Center of Tras-os-Montes and Alto Douro, Vila Real, Portugal PS Mateus PS Mateus Hospital Center of Tras-os-Montes and Alto Douro, Vila Real, Portugal J Trigo J Trigo Hospital Center of Tras-os-Montes and Alto Douro, Vila Real, Portugal JI Moreira JI Moreira Hospital Center of Tras-os-Montes and Alto Douro, Vila Real, Portugal Hospital Center of Tras-os-Montes and Alto Douro, Vila Real, Portugal Introduction: Mitral regurgitation (MR) is an adverse event marker in acute coronary syndrome (ACS) patients. However, data regarding its long-term prognosis impact after ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI) is scarce. We sought to evaluate the prognostic impact of MR on long-term outcomes in STEMI patients treated with pPCI. Methods: 428 patients with non-fatal STEMI treated with pPCI who underwent a comprehensive echocardiographic examination during index hospitalization were included. MR was classified in 3 groups: No/trace (no) MR; mild MR; moderate/severe (mod/sev) MR. The endpoint was a composite of re-infarction, unplanned revascularization, heart failure and all-cause death during the follow-up. Results: No MR was observed in 59% patients, mild MR in 31% and mod/sev MR in 10% of patients. Those with higher MR degrees were older (No MR 62 ± 13 years, mild MR 68 ± 13 years, mod/sev MR 72 ± 12 years; p <0,001), more likely to be women (No MR 24%, mild MR 30%, mod/sev MR 46%; p = 0,012) and to have arterial hypertension (No MR 54%; mild MR 65%, mod/sev MR 71%; p = 0,03). Patients with higher MR degrees had an higher T troponin level peak (No MR 5.1ng/mL IQR 2.2-10; mild MR 6.3 ng/mL IQR 3.1-10, mod/sev MR 9.2ng/mL IQR 5.2-10; p < 0,001), an higher incidence of heart failure during hospitalization (Killip class >1: No MR29%, mild MR 36%, mod/sev MR 59%; p < 0,001) and showed lower ejection fraction (no MR 49 ± 9%, mild MR 46 ± 10%, mod/sev MR 45 ± 9%; p = 0,001). The most frequent culprit artery in patients with no MR was the anterior descending artery in 55% of cases and in mod/sev MR was the right coronary artery (46%, p = 0.031). After a median follow-up of 24 months (IQR: 14-42), 44 patients died and 111 achieved the composite endpoint. Patients with higher MR degrees had an higher incidence of death (no MR: 5.9%; mild MR: 32.1%; mod/sev MR: 45.0%; p < 0.001), heart failure (no MR 8.6%, mild MR 17.5%; mod/sev MR 22.5%; p = 0.002) and of the composite endpoint (no MR 20.3%, mild MR 32.1%, mod/sev MR 45%; P < 0.001). In multivariate Cox regression analysis, after adjusting for confounders, MR degree was an independent predictor of the composite endpoint (HR: 1.96; 95%IC: 1,1-3,5; P = 0.021). Conclusions: MR is a common finding in the setting of STEMI treated with pPCI and its severity is associated with worse long-term prognosis. View largeDownload slide Abstract P1726 Figure. View largeDownload slide Abstract P1726 Figure. P1727 Comparison of echocardiographic variables in severe degenerative and rheumatic mitral stenosis R Ruanjan R Ruanjan Albert Einstein Medical Center, Philadelphia, United States of America MC Rodriguez Ziccardi MC Rodriguez Ziccardi Albert Einstein Medical Center, Philadelphia, United States of America BS Abdulhadi BS Abdulhadi Albert Einstein Medical Center, Philadelphia, United States of America YS Alhamshari YS Alhamshari Albert Einstein Medical Center, Philadelphia, United States of America HD Jeon HD Jeon Albert Einstein Medical Center, Philadelphia, United States of America EJ Friend EJ Friend Albert Einstein Medical Center, Philadelphia, United States of America CY Shim CY Shim Yonsei University College of Medicine, Seoul, Korea Republic of DH Park DH Park Yonsei University College of Medicine, Seoul, Korea Republic of GR Hong GR Hong Yonsei University College of Medicine, Seoul, Korea Republic of GS Pressman GS Pressman Albert Einstein Medical Center, Philadelphia, United States of America Albert Einstein Medical Center, Philadelphia, United States of America Yonsei University College of Medicine, Seoul, Korea Republic of Introduction: Little is known about echocardiographic and Doppler variables in degenerative/calcific mitral stenosis (DMS). Methods: We studied 2 groups of patients with severe MS (valve area ≤ 1.5 cm2 by planimetry): 511 patients with rheumatic mitral stenosis (RMS) and 88 patients with DMS. We compared echocardiographic and Doppler variables in these 2 groups. We further compared these variables in patients with very severe MS (valve area ≤ 1.0 cm2) versus less severe MS (1.1 – 1.5 cm2). Results: Patients with RMS were significantly younger (57 ± 12 vs. 74 ± 11 years, P <0.001)). In the DMS group mitral valve area (MVA) by pressure-half time (PHT) was substantially greater than by planimetry (1.5 ± 0.4 cm2 vs 1.2 ± 0.2 cm2); in RMS the two methods yielded similar results (1.1 ± 0.4 cm2 vs 1.1 ± 0.3 cm2). In the DMS patients E-wave slope was greater and PHT less than in RMS patients (table). E-wave and A-wave velocities were greater in RMS subjects while E:A ratio, mean MV gradient, and pulmonary artery systolic pressure (PASP) were similar. Left atrial volume index and ejection fraction were greater in RMS subjects. Among patients with very severe MS, E and A wave velocities were again greater in RMS. However, E:A ratio was greater in patients with DMS, as was PASP. Similar to the overall group E-wave slope was greater and PHT less in patients with DMS and they also had smaller left atria. Conclusions: PHT significantly overestimated valve area in DMS subjects. PASP was similar between the two types of MS. Interestingly, LAVI was greater in RMS subjects. In very severe MS the E-wave velocity was higher in RMS patients while PASP was higher in DMS patients. 　 Severe MS (n = 586) Very Severe MS (n = 238) 　 DMS RMS P value DMS RMS P value E vel (cm/s) 165.9 ± 48.4 181.6 ± 45.5 0.003 172.6 ± 62.2 204.7 ± 43.7* 0.002 A vel (cm/s) 162.4 ± 45.6 176.0 ± 41.9 0.02 157.7 ± 52.4 200.8 ± 41.0* 0.0004 E:A 1.14 ± 0.79 1.03 ± 0.28 0.07 1.24 ± 0.57 1.05 ± 0.21 0.02 E-wave slope 0.33 ± 0.15 0.27 ± 0.10 <0.0001 0.30 ± 0.17 0.23 ± 0.08* 0.002 PHT 153.5 ± 42.5 209.4 ± 68.2 <0.0001 173.5 ± 49.5^ 214.3 ± 74.4 0.01 MVG 8.3 ± 4.2 8.5 ± 4.2 NS 10.3 ± 4.0^ 11.4 ± 4.3* NS PASP 49.4 ± 17.1 46.5 ± 15.8 NS 58.4 ± 17.8^ 46.9 ± 15.0 0.003 EF 59.5 ± 11.2 61.8 ± 9.1 0.04 56.9 ± 9.7 62.1 ± 9.2 0.01 LAVI 57.1 ± 24.2 82.1 ± 40.3 <0.0001 48.1 ± 31.0 83.5 ± 44.6 0.004 　 Severe MS (n = 586) Very Severe MS (n = 238) 　 DMS RMS P value DMS RMS P value E vel (cm/s) 165.9 ± 48.4 181.6 ± 45.5 0.003 172.6 ± 62.2 204.7 ± 43.7* 0.002 A vel (cm/s) 162.4 ± 45.6 176.0 ± 41.9 0.02 157.7 ± 52.4 200.8 ± 41.0* 0.0004 E:A 1.14 ± 0.79 1.03 ± 0.28 0.07 1.24 ± 0.57 1.05 ± 0.21 0.02 E-wave slope 0.33 ± 0.15 0.27 ± 0.10 <0.0001 0.30 ± 0.17 0.23 ± 0.08* 0.002 PHT 153.5 ± 42.5 209.4 ± 68.2 <0.0001 173.5 ± 49.5^ 214.3 ± 74.4 0.01 MVG 8.3 ± 4.2 8.5 ± 4.2 NS 10.3 ± 4.0^ 11.4 ± 4.3* NS PASP 49.4 ± 17.1 46.5 ± 15.8 NS 58.4 ± 17.8^ 46.9 ± 15.0 0.003 EF 59.5 ± 11.2 61.8 ± 9.1 0.04 56.9 ± 9.7 62.1 ± 9.2 0.01 LAVI 57.1 ± 24.2 82.1 ± 40.3 <0.0001 48.1 ± 31.0 83.5 ± 44.6 0.004 * p < 0.0001 compared with same group in Severe MS; ^ p ≤ 0.01 compared with same group in Severe MS View Large 　 Severe MS (n = 586) Very Severe MS (n = 238) 　 DMS RMS P value DMS RMS P value E vel (cm/s) 165.9 ± 48.4 181.6 ± 45.5 0.003 172.6 ± 62.2 204.7 ± 43.7* 0.002 A vel (cm/s) 162.4 ± 45.6 176.0 ± 41.9 0.02 157.7 ± 52.4 200.8 ± 41.0* 0.0004 E:A 1.14 ± 0.79 1.03 ± 0.28 0.07 1.24 ± 0.57 1.05 ± 0.21 0.02 E-wave slope 0.33 ± 0.15 0.27 ± 0.10 <0.0001 0.30 ± 0.17 0.23 ± 0.08* 0.002 PHT 153.5 ± 42.5 209.4 ± 68.2 <0.0001 173.5 ± 49.5^ 214.3 ± 74.4 0.01 MVG 8.3 ± 4.2 8.5 ± 4.2 NS 10.3 ± 4.0^ 11.4 ± 4.3* NS PASP 49.4 ± 17.1 46.5 ± 15.8 NS 58.4 ± 17.8^ 46.9 ± 15.0 0.003 EF 59.5 ± 11.2 61.8 ± 9.1 0.04 56.9 ± 9.7 62.1 ± 9.2 0.01 LAVI 57.1 ± 24.2 82.1 ± 40.3 <0.0001 48.1 ± 31.0 83.5 ± 44.6 0.004 　 Severe MS (n = 586) Very Severe MS (n = 238) 　 DMS RMS P value DMS RMS P value E vel (cm/s) 165.9 ± 48.4 181.6 ± 45.5 0.003 172.6 ± 62.2 204.7 ± 43.7* 0.002 A vel (cm/s) 162.4 ± 45.6 176.0 ± 41.9 0.02 157.7 ± 52.4 200.8 ± 41.0* 0.0004 E:A 1.14 ± 0.79 1.03 ± 0.28 0.07 1.24 ± 0.57 1.05 ± 0.21 0.02 E-wave slope 0.33 ± 0.15 0.27 ± 0.10 <0.0001 0.30 ± 0.17 0.23 ± 0.08* 0.002 PHT 153.5 ± 42.5 209.4 ± 68.2 <0.0001 173.5 ± 49.5^ 214.3 ± 74.4 0.01 MVG 8.3 ± 4.2 8.5 ± 4.2 NS 10.3 ± 4.0^ 11.4 ± 4.3* NS PASP 49.4 ± 17.1 46.5 ± 15.8 NS 58.4 ± 17.8^ 46.9 ± 15.0 0.003 EF 59.5 ± 11.2 61.8 ± 9.1 0.04 56.9 ± 9.7 62.1 ± 9.2 0.01 LAVI 57.1 ± 24.2 82.1 ± 40.3 <0.0001 48.1 ± 31.0 83.5 ± 44.6 0.004 * p < 0.0001 compared with same group in Severe MS; ^ p ≤ 0.01 compared with same group in Severe MS View Large P1728 Echocardiographic findings in patients with bicuspid aortic valve with and without raphe enrolled in REBECCA registry R Citro R Citro University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy S La Carrubba S La Carrubba Villa Sofia Hospital, Cardiology Department, Palermo, Italy A Moreo A Moreo Niguarda Ca" Granda Hospital, Cardiology Department, Milan, Italy I Dentamaro I Dentamaro Polyclinic Hospital of Bari, Cardiology Department, Bari, Italy M Bellino M Bellino University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy I Monte I Monte University Hospital Vittorio Emanuele, Cardiology Department Echocardiography Laboratory, Catania, Italy V Manuppelli V Manuppelli UTIC Universitaria Ospedali Riuniti OO.RR , Cardiology Department, Foggia, Italy A Posteraro A Posteraro S.Giovanni Evangelista Hospital-Tivoli, Cardiology Department, Rome, Italy F Antonini-Canterin F Antonini-Canterin Ospedale Riabilitativo, Division of Rehabilitation Cardiology, Motta di Livenza, Italy F Benedetto F Benedetto Bianchi Melacrino Morelli Hospital (BMM), Cardiology Department, Reggio Calabria, Italy P Colonna P Colonna Hospital Santa Maria di Ca Foncello, Cardiology Department, Treviso, Italy University Hospital San Giovanni di Dio e Ruggi d"Aragona, Department of Cardiology, Salerno, Italy Villa Sofia Hospital, Cardiology Department, Palermo, Italy University Hospital of Pisa, Cardio-Angiology Department, Pisa, Italy University Hospital Riuniti, Cardiology Department, Trieste, Italy Azienda Ospedaliero Universitaria, Cardiology Department, Modena, Italy Misericordia Hospital, Cardiology Department, Grosseto, Italy Niguarda Ca" Granda Hospital, Cardiology Department, Milan, Italy Polyclinic Hospital of Bari, Cardiology Department, Bari, Italy University Hospital Vittorio Emanuele, Cardiology Department Echocardiography Laboratory, Catania, Italy UTIC Universitaria Ospedali Riuniti OO.RR , Cardiology Department, Foggia, Italy S.Giovanni Evangelista Hospital-Tivoli, Cardiology Department, Rome, Italy Ospedale Riabilitativo, Division of Rehabilitation Cardiology, Motta di Livenza, Italy Bianchi Melacrino Morelli Hospital (BMM), Cardiology Department, Reggio Calabria, Italy Hospital Santa Maria di Ca Foncello, Cardiology Department, Treviso, Italy I Fabiani I Fabiani University Hospital of Pisa, Cardio-Angiology Department, Pisa, Italy G Faganello G Faganello University Hospital Riuniti, Cardiology Department, Trieste, Italy A Barbieri A Barbieri Azienda Ospedaliero Universitaria, Cardiology Department, Modena, Italy A Cresti A Cresti Misericordia Hospital, Cardiology Department, Grosseto, Italy Background:Bicuspid aortic valve (BAV) is the most common congenital heart disease, affecting 0.5%–2% of the general population. It is associated with valvular risk (aortic stenosis and/or regurgitation, endocarditis) but also with aortopathy with a wide spectrum of unpredictable clinical presentations, including aneurysmal dilation of the aortic root and/or ascending aorta, isthmic coarctation, aortic dissection, or wall rupture. Methods:The REgistro della Valvola Aortica Bicuspide della Società Italiana di ECocardiografia e CArdiovascular Imaging is a retrospective (from January 1, 2010)/prospective, multicenter, observational registry, with definitive diagnosis of BAV made by transthoracic (TTE) and/or transesophageal echocardiography, computed tomography, cardiovascular magnetic resonance, or at surgery. Anamnestic, demographic, clinical, and instrumental data are collected into dedicated software at first evaluation and during follow‑up. Aortic ectasia is defined for diameters >40 mm for the root, while values >37 mm defined ectasia for ascending aorta. Results: At May 2018, 442 patients with BAV (Male, 70%; M:F ratio 2.3; Mean Age at diagnosis 48 +/-20 years) have been included in the registry. Prevalence of hypertension was 27%, diabetes mellitus 3%, smoking-habit 13%. We reported a majority (43%, 193) of patients of type 1, followed by type 2 (8%, 35) and type 3 (3%, 11). We did not report type 3 without raphe subjects. In 3% (15) of cases, valve phenotype was not assessable at TTE. No gender differences were observed according to BAV phenotypes or calcifications, while male gender was associated to an higher prevalence of aortic valve regurgitation (p = 0.0002). There is an higher prevalence of aortopathy in patients with raphe compared with those without raphe (63.7% vs 36.3%; p= 0.012). Conclusion: Preliminary data from Italian Multicenter REBECCA registry underline the high risk of aortopathy in BAV patients with raphe. P1729 Quadricuspid and bicuspid aortic valves: similarities and differences D Sharif D Sharif Bnai Zion Medical Center, Haifa, Israel E Azzam E Azzam Bnai Zion Medical Center, Haifa, Israel Y Sharif Y Sharif Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel A Sharif-Rasslan A Sharif-Rasslan Technion, Haifa, Israel M Ganaim M Ganaim Bnai Zion Medical Center, Haifa, Israel U Rosenschein U Rosenschein Bnai Zion Medical Center, Haifa, Israel Bnai Zion Medical Center, Haifa, Israel Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel Technion, Haifa, Israel While bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly, quadricuspid aortic valve (QAV) is a rare entity. The usual three-leaflet aortic valve is characterized by engineering advantages with superior long term performance and thus degenerative changes and significant functional deterioration appear at advanced age. Aim: Evaluation of long term performance, similarities and differences between QAV and BAV. Methods: Screening of 19000 consecutive echocardiographic studies was performed. Results: BAV was reported in 131subjects with a prevalence of 0.7% while QAV was seen in 11with a prevalence of 0.06%, P < 0.00001. Age of BAV patients was younger, 45 ± 20yrs vs 62 ± 17 yr in QAV, p < 0.05, with higher proportion of females in those with QAV, 40% vs 30%. Chamber diameters were similar in both groups. Higher atrial contraction-A-wave mitral peak velocities and longer E-wave deceleration times were found in subjects with QAV, p < 0.05 for both. Dilated ascending aorta was found in 25% of patients with BAV and in 18% of those with QAV, p = 0.2. Moderate and severe aortic valve stenosis were found in 21% of patients with BAV and in 27% of those with QAV, p = ns. More than moderate aortic regurgitation was found in 15.5% of BAV patients and in 9% of QAV, p = ns. Aortic valve infective endocarditis was found in 1.5% of BAV patients and in 9% of those with QAV. Conclusions: BAV is a common congenital anomaly while QAV is rare. Similar prevalence of significant valve disease and aortopathy is encountered in both anomalies, though at younger age in BAV patients. P1730 Transseptal puncture in congenital heart disease for intervention procedures: the added value of RT3D echocardiography E Barbieri E Barbieri "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy L Lanzoni L Lanzoni "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy G Molon G Molon "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy S Bonapace S Bonapace "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy C Dugo C Dugo "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy A Chiampan A Chiampan "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy A Cecchetto A Cecchetto "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy Background: Access to the left atrium (LA) for several interventional procedures is obtained by transseptal puncture(TSP) that permits direct passage to the LA via the interatrial septum (IAS) and systemic venous system. Careful knowledge of anatomy of IAS and its anatomical variations is important for the success of the procedure and the safety of the patient in particular if congenital heart diseases are present. Methods: RT3DTEE permits good images of IAS and a correct evaluation of the distance from aorta and left atrium walls, if present permits good characterization of anomalous structure in the LA. May be extremely useful in patients with different anatomy of IAS and LA such as in Cor triatriatum (Panel A) where a fibromuscular membrane originates just above the upper edge of the fossa ovalis. In this case is necessary to guide the TSP below the membrane in order not to interfere with it and to reach easily the left atrial appendage.Patients who have undergone surgical or percutaneous repair, access from the RA to the LA could be challenging and the use of RT3DTEE could be very helpful. A case of previous ASD closure with Amplatzer device n.22 (PANEL B) in which is possible to see the close relationship between the device, the aortic root and the roof of LA. Clearly to access the LA without puncturing the device is possible only in the inferior part of IAS just below the device through the adjacent native septum. 3DTEE imaging facilitates the procedure by providing in one single view detailed pictures of the targets in relation to each other. Congenital corrected transposition of great arteries (ccTGA) in situs viscerum inversus is a rare cardiac malformation characterized by the combination of discordant atrio-ventricular and ventriculo-arterial connections (PANEL C). The great arteries are parallel to each other.By far the most important structure to avoid puncturing is in our case the pulmonary trunk due to its close position with IAS. Conclusions: performing TSP the role of RT3DTEE is an added value showing anatomical images in multiple perspective, even more if complex congenital heart disease or previous percutaneous repair are present. View largeDownload slide Abstract P1730 Figure. role of 3D TEE perfoming transseptal pun View largeDownload slide Abstract P1730 Figure. role of 3D TEE perfoming transseptal pun P1731 Clinical vs echocardiographic parameters in the prediction of left atrial thrombosis A Garcia Martin A Garcia Martin University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain M Abellas Sequeiros M Abellas Sequeiros University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain A Pardo Sanz A Pardo Sanz University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain JL Moya Mur JL Moya Mur University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain LM Rincon Diaz LM Rincon Diaz University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain E Casas Rojo E Casas Rojo University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain A Marco Del Castillo A Marco Del Castillo University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain A Lorente Ros A Lorente Ros University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain C Santoro C Santoro University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain A Gonzalez Gomez A Gonzalez Gomez University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain R Hinojar R Hinojar University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain JJ Jimenez Nacher JJ Jimenez Nacher University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain S Ruiz Leira S Ruiz Leira University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain JL Zamorano JL Zamorano University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain C Fernandez-Golfin C Fernandez-Golfin University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain Introduction: Atrial fibrillation (AF) leads to an increase in morbidity and mortality due to the association with embolic phenomena. Chronic anticoagulation allows to reduce this load, being CHA2DS2-VASC the recommended score to select candidates for it. This score does not include echocardiographic parameters, however, it would be expected that these would have some value in the prediction of intraatrial thrombosis. The purpose of this study is to identify parameters of conventional echocardiography that are associated with an increase in thrombogenicity. To approximate the relationship of clinical and echocardiographic parameters in the formation of thrombi, we selected a sample with a high prevalence of atrial thrombosis. Method: We included consecutive non-valvular patients with thrombus in the left atrial appendige (LAA) (2015-2018) diagnosed by transesophageal echocardiography (TEE), and a control group of consecutive patients with TEE prior to AF ablation in the last year. Standard clinical and echocardiographic parameters of the left atrium (LA) and left ventricle were recorded by transtoracic echocardiogram (TTE). The parameters of the CHA2DS2-VASC scale and echocardiographic variables were collected and compared between both groups. Results: A total of 95 patients were included (18 patients with thrombus in LAA and 77 without thrombus). Patients with thrombus presented a significantly lower LVEF (55.9 ± 10.2 vs 60.7 ± 8.1 p: 0.04), greater presence of hypertrophy of the left ventricular wall (p: 0.004), higher left atrial volume (LAV) (49.4 ± 26 vs 34.1 ± 14.6, p: 0.002) and higher E/e" ratio (17.9 ± 9 vs 9.5 ± 2.9 p <0.001). The combination of these parameters (Hypertrophy> 1.2cm, LVEF <55%, Vol AI> 39ml / m2, E / e"> 14) allows a discrimination of those patients with higher risk of intraatrial thrombus (EcoSCORE). Table 1. Conclusion: LVEF, ventricular wall thickness, left atrial volume and E/e" ratio are easily reproduced parameters and included in any routine echocardiographic study in patients with AF. Its use could be a useful tool in order to recommend or not anticoagulation in these patients, especially in those groups where the indication is less evident. More studies are needed in this regard to verify this utility Table 1 Score 0 1 2 3 4 5 6 7 p CHADSVASC 0% 14.3% 19% 45% 27% 100% 0% 100% 0.005 EcoSCORE 5.7% 12.4% 26.7% 87.5% <0.001 Score 0 1 2 3 4 5 6 7 p CHADSVASC 0% 14.3% 19% 45% 27% 100% 0% 100% 0.005 EcoSCORE 5.7% 12.4% 26.7% 87.5% <0.001 View Large Table 1 Score 0 1 2 3 4 5 6 7 p CHADSVASC 0% 14.3% 19% 45% 27% 100% 0% 100% 0.005 EcoSCORE 5.7% 12.4% 26.7% 87.5% <0.001 Score 0 1 2 3 4 5 6 7 p CHADSVASC 0% 14.3% 19% 45% 27% 100% 0% 100% 0.005 EcoSCORE 5.7% 12.4% 26.7% 87.5% <0.001 View Large P1732 Left atrial appendage volume and orifice area measured by three-dimensional transesophageal echocardiography associates with severity of heart failure in patients with persistent atrial fibrillation M Suzuki M Suzuki Nara Prefectural Seiwa Medical Center, Cardiovascular Medicine, Nara, Japan S Hattori S Hattori Nara Prefectural Seiwa Medical Center, Cardiovascular Medicine, Nara, Japan N Toyokawa N Toyokawa Nara Prefectural Seiwa Medical Center, Cardiovascular Medicine, Nara, Japan S Sakai S Sakai Nara Prefectural Seiwa Medical Center, Cardiovascular Medicine, Nara, Japan H Yano H Yano Nara Prefectural Seiwa Medical Center, Cardiovascular Medicine, Nara, Japan A Iwai A Iwai Nara Prefectural Seiwa Medical Center, Cardiovascular Medicine, Nara, Japan K Nogi K Nogi Nara Prefectural Seiwa Medical Center, Cardiovascular Medicine, Nara, Japan H Fujimoto H Fujimoto Nara Prefectural Seiwa Medical Center, Cardiovascular Medicine, Nara, Japan H Iwama H Iwama Nara Prefectural Seiwa Medical Center, Cardiovascular Medicine, Nara, Japan T Nakai T Nakai Nara Prefectural Seiwa Medical Center, Cardiovascular Medicine, Nara, Japan N Doi N Doi Nara Prefectural Seiwa Medical Center, Cardiovascular Medicine, Nara, Japan Nara Prefectural Seiwa Medical Center, Cardiovascular Medicine, Nara, Japan Background: In patients with non-valvular atrial fibrillation (AF), clinical significance of left atrial appendage volume (LAA) is still unclear. Poupose: The aim of this study is to estimate the relationship between LAA volume and severity of heart failure, predictive index for thromboembolic events or recurrence of AF after radio-frequency catheter ablation (RFCA). Methods: We analysed 68 patients (72 ± 8 years, 66% male) with paroxysmal (PAF) or persistent AF (PsAF) for whom RFCA was performed. LAA volume and orifice area were measured by real time three-dimensional transesophageal echocardiography (RT3D-TEE) using an application of QLAB10.5 on EPIQ7, and predictive index for thromboembolic events (CHA2DS2-VASc score), plasma B-type natriuretic peptide (BNP) level and left ventricular end-diastolic volume (LVEDV) were assessed before the procedure of RFCA. Results : In 68 AF patients, 32 were PAF (20 men, mean age, 72 ±7 years) and 36 were PsAF (25men, mean age, 72 ± 8 years)．LAA volume measured by RT3D-TEE were 4.7 ± 2.9 mL in PAF and 6.2 ± 4.0 mL in PsAF. Successful RFCA was performed in all patients who were followed up for 12 months without discontinuation of anticoagulants. Recurrence of AF occurred in 8 patients (12%) in the follow-up period. Not only LAA volume correlated with plasma BNP level (r = 0.53, p < 0.001) and LVEDV (r = 0.37, p < 0.05) but also orifice area correlated with plasma BNP level (r = 0.42, p = 0. 01) and LVEDV (r = 0. 42, p = 0. 01) in patients with PsAF, whereas there was no relationship between LAA volume or orifice area and BNP level or LVEDV in patients with PAF. Correlation between LAA volume or orifice area and CHA2DS2-VASc score was not detected in PsAF or PAF. There was no significant diference of LAA volume between the patients in whom recurrence of AF occurred and those in whom not occurred. Conclusions: Left atrial appendage volume and orifice area measured by RT3D-TEE indicates severity of heart failure in patients with PsAF. However, LAA volume do not predict the recurrence of AF in the period of one year follow-up after successful RFCA in patients with PsAF or PAF. P1733 LAA percutaneous closure: experience of 90 cases G Molon G Molon "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy G Canali G Canali "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy S Bonapace S Bonapace "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy A Cecchetto A Cecchetto "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy A Chiampan A Chiampan "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy C Dugo C Dugo "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy E Barbieri E Barbieri "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy L Lanzoni L Lanzoni "Sacred Heart" Hospital of Negrar, Department of Cardiology, Negrar-Verona, Italy Introduction: percutaneous closure of left atrial appendage (LAA) is an alternative approach to chronic oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). More than 90% of all left atrial thrombi originate in the LAA. Methods: we performed 90 procedures over a period of 4,5 years (56 males, mean age 75,8 ± 5.2 yrs with a follow up of 39 ± 12 months) in patients with contraindication for OAC.Patients were at high risk of stroke with an average CHA2DS2-VASc Score of 4,07 ± 1,1 and HASBLED Score 3,7 ±0,6. The LAA anatomy was most often "cauliflower" and "cactus" like (40% and 36%) whereas "windsock" and "chicken wing" morphology were less common in our patients. In 71 pts we implanted the Watchman device and in 19 pts the Amplatzer Cardiac Plug/Amulet device because of a reduced depth of LAA. 2D/3D TEE is a key tool to evaluate the complex anatomy of LAA, for a correct sizing of ostium, landing zone and depth. Prior the procedure TEE has to exclude the presence of clots. Even more TEE has a pivotal role to guide the different phases of the procedure, in particular the transseptal puncture and the correct positioning of the device with no complications. Results: no deaths in the periprocedural period. We had two major acute complications: one pericardial effusion with tamponade and one device embolization. Both were resolved during the procedure percutaneously. No periprocedural stroke and no reintervention due to incomplete LAA seal were experienced. Significant residual leaks (≥ 5 mm) were detected with TEE at 6 months control in 3 patients (3,3%), no leak in 54% of cases. At long term follow up, there were 3 deaths, whose 1 for cardiac reason (likely not related with the procedure) and 2 pts (4%) experienced an ischemic stroke. At 45 days TEE control: clot on the atrial surface of the device was documented in 5 patients: 5,5%. Only in one case, clot was correlate to ischemic stroke. Conclusions: transcatheter exclusion of the LAA could be an alternative therapy in pts with AF and contraindications for OAC . It seems to be an effective and safe procedure if performed by operators experienced in transseptal puncture and structural heart disease. 3DTEE is a powerful additional tool that may help in improving the safety profile of procedure. Acute complications and follow up result Patients 90 Age 75.8 ± 5.2 CHAD2DS2-VASc 4,07 ± 1,1 Devive Embolization 1 Pericardial Tamponade 1 Thrombus on Device (45 days TEE) 5 Ischemic Stroke 2 Residual Leak (1-4 mm) 41% Patients 90 Age 75.8 ± 5.2 CHAD2DS2-VASc 4,07 ± 1,1 Devive Embolization 1 Pericardial Tamponade 1 Thrombus on Device (45 days TEE) 5 Ischemic Stroke 2 Residual Leak (1-4 mm) 41% View Large Acute complications and follow up result Patients 90 Age 75.8 ± 5.2 CHAD2DS2-VASc 4,07 ± 1,1 Devive Embolization 1 Pericardial Tamponade 1 Thrombus on Device (45 days TEE) 5 Ischemic Stroke 2 Residual Leak (1-4 mm) 41% Patients 90 Age 75.8 ± 5.2 CHAD2DS2-VASc 4,07 ± 1,1 Devive Embolization 1 Pericardial Tamponade 1 Thrombus on Device (45 days TEE) 5 Ischemic Stroke 2 Residual Leak (1-4 mm) 41% View Large P1734 Comparison of effectiveness in left atrial appendage thrombus preventing between warfarin and non-vitamin K anticoagulants - are the treatment options equivalent? K Kosmalska K Kosmalska St Vincent Hospital in Gdynia and Medical University of Gdansk, Cardiology department in St Vincent Hospital and First Department of Cardiology in Medical Universit, Gdynia, Gdansk, Poland NGM Natasza Gilis-Malinowska NGM Natasza Gilis-Malinowska Medical University of Gdansk, Gdansk, Poland P-M Pawel Miekus P-M Pawel Miekus St Vincent Hospital in Gdynia and Medical University of Gdansk, Cardiology department in St Vincent Hospital and First Department of Cardiology in Medical Universit, Gdynia, Gdansk, Poland M-F Marcin Fijalkowski M-F Marcin Fijalkowski Medical University of Gdansk, Gdansk, Poland St Vincent Hospital in Gdynia and Medical University of Gdansk, Cardiology department in St Vincent Hospital and First Department of Cardiology in Medical Universit, Gdynia, Gdansk, Poland Medical University of Gdansk, Gdansk, Poland Introduction: Meta-analysis comparing NOACs and VKA revealed lower incidence of thromboembolism, haemorrhage and decreased mortality in group of NOACs but despite this AF treatment guidelines still present VKA with good therapeutic-time-ratio (TTR) as an equipotent method for avoiding thrombembolic complications. In this study we have discovered, that VKA with sufficient TTR might be less effective in prevention of thrombus formation than NOACs Methods Prospective analysis of group of 269 consecutive patients with AF or AFl and with indications for cardioversion; 124 (46%) females, av. age 74 ± 9. Excl. criteria were: no consent and arrhythmia shorter than 48 hours . There was questionnaire regarding previous anticoagulation performed. All patients were subjected to TOE. Endpoint group were patients with both thrombus and „sludge" in left atrial appendage and those subjects were disqualified from cardioversion. Patients with no thrombus or sludge formed control group and they were subjected to cardioversion. There were no thrombembolic complications in cardioverted group. We have analyzed the frequency of thrombus in warfarin group and NOACs group Results Based on the results of univariate analysis we have revealed NOACs safer in terms of thrombus formation : these drugs were used in 48% (38 patients) of a thrombus group and 64% (122 patients) in patients with no thrombus.(p = 0,014) Warfarin with TTR > 80% was used in 37% (29 patients) of a thrombus group and 23% (43 patients) with no thrombus. Warfarin treatment is attached to higher incidence of thrombus (p = 0,018) Multivariate analysis showed tendency of superiority of NOACs but without statistically significance: p : 0,381, HR 0,69 (95% CI 0.31 – 1.58) Conclusions Despite current guidelines considering warfarin equally effective treatment as NOAC in AF/AFl, above mentioned analyses may suggest higher utility of NOACs in these arrhythmias P1735 Cardiac chamber and structural quantification by transoesophageal versus transthoracic echocardiography: retrospective and real time comparisons and a call for a standard plane for quantification E Rauseo E Rauseo Department of Heart and Great Vessels "Attilio Reale", University of Rome "La Sapienza", Rome, Italy JP Khoo JP Khoo Glenfield Hospital, Department of Cardiology, Leicester, United Kingdom DJ Newton DJ Newton John Radcliffe Hospital, Department of Cardiology, Oxford, United Kingdom DT Chin DT Chin Glenfield Hospital, Department of Cardiology, Leicester, United Kingdom RC Chelliah RC Chelliah Glenfield Hospital, Department of Cardiology, Leicester, United Kingdom SS Hothi SS Hothi New Cross Hospital, Heart and Lung Centre, Wolverhampton, United Kingdom Department of Heart and Great Vessels "Attilio Reale", University of Rome "La Sapienza", Rome, Italy Glenfield Hospital, Department of Cardiology, Leicester, United Kingdom John Radcliffe Hospital, Department of Cardiology, Oxford, United Kingdom New Cross Hospital, Heart and Lung Centre, Wolverhampton, United Kingdom Funding Acknowledgements: Nothing to declare Background: The central role of transoesophageal echocardiography (TOE) in the operative, interventional and diagnostic settings has made important to determine to what extent quantification of various cardiac structures by TOE correlate with the equivalent measurements taken by transthoracic echocardiography (TTE). Interestingly, while the PLAX view is a key view for TTE quantification, the equivalent ME-LAX view is not widely used for quantification. We therefore sought to assess the relationship between these two views further. Purpose: To assess the correlation between measurements of the left ventricle (LV) dimensions, right ventricle (RV), left atrial diameter (LAD) and aortic root diameters taken by TOE versus TTE through both retrospective (RETRO) and real-time (RT) comparisons. Methods: An initial retrospective study was performed. RETRO comparison: Patients underwent TOE and TTE within 3 months of each other (n = 55). This was followed by a real-time, RT comparison: TOE and TTE studies were performed in the same setting (n = 50). In both studies, parasternal long axis (PLAX) TTE measurements were compared with the analogous mid-oesophageal long axis (ME-LAX) TOE measurements. All imaging was performed using a Phillips iE33 system using S5-1 (TTE) and X7-2t (TOE) probes (Phillip Healthcare, UK). Results: TOE measurements were similar (Student’s t-test, P > 0.05) and significantly correlated with the corresponding TTE measurements in both groups. The correlation was even higher in the RT group (RT: r = 0.81-0.96; RETRO: r = 0.65-0.91; P < 0.0001). LVOT and aortic annular dimensions showed the highest correlations in both groups (RETRO: r = 0.90 and r = 0.84; RT: r = 0.96 and r = 0.95, respectively; P < 0.0001). Marginally better correlations for LVIDd were observed in the RT versus RETRO group (r = 0.91 vs r = 0.80), while LAD showed similar correlations in both groups (RETRO: r = 0.88 vs RT: r = 0.87). Conclusions: TOE 2D measurements obtained in the ME-LAX TOE view are statistically equivalent to those acquired from the PLAX TTE view either when examinations are performed in the same settings or within a three-month period of each other. The implications are that TOE has value in chamber quantification. Moreover, the ME LAX TOE view in particular could be considered as the key view for quantification analogous to the TTE PLAX view, and TTE reference values can be used for such TOE measurements. View largeDownload slide Abstract P1735 Figure View largeDownload slide Abstract P1735 Figure P1736 Relationship between aortic calcifications and coronary stenosis S Latreche Sekoum S Latreche Sekoum CHU MUSTAPHA, CARDIOLOGIE, ALGER, Algeria N Methia N Methia CHU MUSTAPHA, CARDIOLOGIE, ALGER, Algeria M Djouhri M Djouhri CHU DOUERA, CARDIOLOGIE, ALGER, Algeria F Harbi F Harbi CHU MUSTAPHA, CARDIOLOGIE, ALGER, Algeria D Saidouamar D Saidouamar CHU MUSTAPHA, CARDIOLOGIE, ALGER, Algeria S Benkhedda S Benkhedda CHU MUSTAPHA, CARDIOLOGIE, ALGER, Algeria CHU MUSTAPHA, CARDIOLOGIE, ALGER, Algeria CHU DOUERA, CARDIOLOGIE, ALGER, Algeria Funding Acknowledgements: governmental grants Background : Aortic sclerosis is an active phenomenon, significantly associated with vascular and coronary atherosclerosis and shares the cardiovascular risk factors. Purpose: Correlation between the presence of aortic button calcifications on chest X-ray, Calcifications of the ring and aortic sigmoids on transesophageal echocardiography(TOE) and angiographic coronary stenosis. Methods : Prospective Study.150 patients (male-female sex ratio: 0.89, mean age 53 ± 2 years)were randomly recruited with the only requirement the need for a coronary assessment. The maximum delay between chest x-ray , TOE and coronarography was 1 month. Results: Chest aortic button calcifications were found in 44.66%, calcifications of the ring and aortic sigmoids at ETO in 44%. 80 patients had coronary artery stenosis. Among them: "single-vessel"25%, 35%" two-vessel" and 40% "Triple vessel». There is a significant relationship between the presence of Chest aortic button calcifications coronary stenosis with OR = 7.85 (CI= [3.51 - 17.85]).And a significant relationship between the presence of calcifications of the ring and aortic sigmoids and the existence of coronary stenosis with OR = 7.85 (CI: [3.70 - 16.50]). In multiple linear regression analysis, diabetes, age and obesity are important risk factors that influence the presence of aortic calcifications. Diabetes, hypercholesterolemia, heredity, and smoking are significant risk factors that influence the presence of coronary stenosis. And two independent predictive risk factors for coronary stenosis are identified: aortic calcifications and hypercholesterolemia. The presence of aortic calcifications is the most significant predictor with OR = 102.040 (CI: [9.764 - 1066.429]). Conclusion :The discovery of aortic calcifications on chest x-ray or echocardiography in a relatively young subject should therefore be an incentive to search for other potentially threatening arterial diseases, such as coronary artery disease. P1737 Should we routinely perform transesophageal echocardiography before electrical cardioversion? A real world contemporary study F Bursi F Bursi san paolo hospital, cardiology, milan, Italy A Pugno A Pugno san paolo hospital, cardiology, milan, Italy L Massironi L Massironi san paolo hospital, cardiology, milan, Italy L Bosotti L Bosotti san paolo hospital, cardiology, milan, Italy S Persampieri S Persampieri san paolo hospital, cardiology, milan, Italy G Ferrante G Ferrante san paolo hospital, cardiology, milan, Italy F Valli F Valli san paolo hospital, cardiology, milan, Italy C Bencini C Bencini san paolo hospital, cardiology, milan, Italy MS Negroni MS Negroni san paolo hospital, cardiology, milan, Italy D Torta D Torta san paolo hospital, cardiology, milan, Italy S Carugo S Carugo san paolo hospital, cardiology, milan, Italy san paolo hospital, cardiology, milan, Italy Background: Rhythm control with electrical cardioversion (ECV) is useful to reduce symptoms in atrial fibrillation (AF), but it is associated with an increased risk of thromboembolic events. Current guidelines recommend at least 3 weeks of systemic anticoagulation prior to ECV, or transesophageal echocardiography (TEE) to exclude left atrial thrombi. Accordingly, most centers do not routinely perform TEE to all patients scheduled for ECV. Yet, this practice is controversial, as studies have reported that atrial thrombi may occur despite anticoagulation. Purpose: We sought to determine the prevalence of left atrial thrombi in contemporary real life practice. Methods: At our institution all patients scheduled for ECV undergo TEE regardless of the duration of AF and the type of anticoagulant employed. We examined the time period between January 2014 and December 2017. Results: Of 211 consecutive patients (64.5% men, mean age 71 ± 10 years, CHA2DS2-VASc 3.1 ± 1.4), 151 had persistent AF of these 111 were on anti vitamin K agents (AVK) and 40 on direct oral anticoagulants (DOAC) for at least 4 weeks before ECV; 60 (28.4%) patients with paroxysmal AF treated with low molecular weight heparin (LMWH) were also considered. At the TEE thrombus was detected in 14 patients (6.6%): 7 on VKA, 3 on DOAC, and 4 on LMWH. In the 141 patients on effective oral anticoagulation, thrombus was detected in 3 patients on VKA and 1 receiving DOAC, p=.929. High CHA2DS2VASc (p=.023), low LV EF (p<.001), spontaneous echo contrast (p=.001), ineffective anticoagulation (p=.004) were associated with a higher risk of thrombus. Stroke or TIA within 4 weeks of the ECV occurred in 2 patients, one was treated with LMWH and the other one with DOAC, in both the TEE was negative for thrombus at the time of ECV. Conclusions: Among consecutive patients with AF scheduled for ECV, the prevalence of left atrial thrombus at TEE was not negligible even in patients receiving effective anticoagulation and was similar under VKA or DOAC. TEE to exclude atrial thrombus is prudent before ECV and is mandatory in patients in whom an unsuccessful anticoagulation is proved or suspected. Total  (N = 211) VKA N = 111 (52.6%) DOAC N = 40 (19%) LMWH N = 60 (28.4%) P Median (25th-75thpercentile)  duration of AF, days 90 (40-153) 90 (28-180) 3 (2.3-5) Thrombus 14(6.6%) 7 (6.3%) 3(7.5%) 4 (6.7%) .967 Ineffective anticoagulation 10(4.7%) 8 (7.3%) 2 (5%) NA Thrombus among patients on effective anticoagulation (N = 141) 4 (2.8%) 3 (2.9%) 1(2.6%) NA .929 Total  (N = 211) VKA N = 111 (52.6%) DOAC N = 40 (19%) LMWH N = 60 (28.4%) P Median (25th-75thpercentile)  duration of AF, days 90 (40-153) 90 (28-180) 3 (2.3-5) Thrombus 14(6.6%) 7 (6.3%) 3(7.5%) 4 (6.7%) .967 Ineffective anticoagulation 10(4.7%) 8 (7.3%) 2 (5%) NA Thrombus among patients on effective anticoagulation (N = 141) 4 (2.8%) 3 (2.9%) 1(2.6%) NA .929 View Large Total  (N = 211) VKA N = 111 (52.6%) DOAC N = 40 (19%) LMWH N = 60 (28.4%) P Median (25th-75thpercentile)  duration of AF, days 90 (40-153) 90 (28-180) 3 (2.3-5) Thrombus 14(6.6%) 7 (6.3%) 3(7.5%) 4 (6.7%) .967 Ineffective anticoagulation 10(4.7%) 8 (7.3%) 2 (5%) NA Thrombus among patients on effective anticoagulation (N = 141) 4 (2.8%) 3 (2.9%) 1(2.6%) NA .929 Total  (N = 211) VKA N = 111 (52.6%) DOAC N = 40 (19%) LMWH N = 60 (28.4%) P Median (25th-75thpercentile)  duration of AF, days 90 (40-153) 90 (28-180) 3 (2.3-5) Thrombus 14(6.6%) 7 (6.3%) 3(7.5%) 4 (6.7%) .967 Ineffective anticoagulation 10(4.7%) 8 (7.3%) 2 (5%) NA Thrombus among patients on effective anticoagulation (N = 141) 4 (2.8%) 3 (2.9%) 1(2.6%) NA .929 View Large P1738 Transesophageal echocardiography guidance of perventricular device closure of ventricular septal defects without cardiopulmonary bypass IV Tkachev IV Tkachev Federal Center of cardiovascular surgery , Astrakhan, Russian Federation VI Gerasimenko VI Gerasimenko Federal Center of cardiovascular surgery , Astrakhan, Russian Federation MV Plotnikov MV Plotnikov Federal Center of cardiovascular surgery , Astrakhan, Russian Federation SM Smirnov SM Smirnov Federal Center of cardiovascular surgery , Astrakhan, Russian Federation MA Tungusova MA Tungusova Federal Center of cardiovascular surgery , Astrakhan, Russian Federation OY Alexandridi OY Alexandridi Federal Center of cardiovascular surgery , Astrakhan, Russian Federation IV Barkov IV Barkov Federal Center of cardiovascular surgery , Astrakhan, Russian Federation Federal Center of cardiovascular surgery , Astrakhan, Russian Federation Introduction: Perventricular closure of of ventricular septal defects (VSD) is a relatively new technique that combines features of open heart surgical correction and transcatheter occlusion. The procedure is performed in the operating room under the control of transesophageal echocardiography Purpose: To describe the role of transesophageal echocardiography in perventricular closure of VSD without cardiopulmonary bypass. Materials and methods: Transesophageal echocardiography (TEE) was performed in 116 patients (mean age 31.5 ± 32.6 months) during perventricular closure of VSD’s in order to determine the anatomy of defects, guiding device implantation, assessing the residual shunts and the degree of valvular regurgitation, Results. The success rate of the procedure was 96%.VSD size measured by intraoperative TEE varied from 4 to 14 mm (6.01 ± 1.5 mm). The overwhelming number of defects were perimembranous -103 (muscular – 8). There were 19 cases with VSD in aneurysm and in 7 patients defects were multiple (2 or more). In 32 cases an asymmetric device was implanted due to the small aortic margin of VSD according to the data of the TEE. There were no significant residual shunts during postoperative TEE control. Tricuspid regurgitation after surgery was the same or lesser degree. In 20% of patients, postoperative control revealed trivial aortic regurgitation. Conclusions: TEE plays a crucial role in the success of the perventricular closure of the VSD due to careful intraoperative evaluation of the anatomy of the VSD, guiding device implantation, exclusion of the compromising of adjacent intracardiac structures and device-induced valvular regurgitation. P1739 Left ventricular longitudinal strain is associated with mitral annular fractional area change in healthy subjects - a three-dimensional speckle-tracking echocardiographic study A Nemes A Nemes 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary Z Kovacs Z Kovacs Szent Rókus Hospital, Department of Cardiology, Baja, Hungary A Kormanyos A Kormanyos 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary P Domsik P Domsik 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary A Kalapos A Kalapos 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary C Lengyel C Lengyel University of Szeged, 1st Department of Medicine, Szeged, Hungary N Ambrus N Ambrus 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 Szent Rókus Hospital, Department of Cardiology, Baja, Hungary University of Szeged, 1st Department of Medicine, Szeged, Hungary Introduction. The mitral annulus (MA) plays a significant role in promoting left atrial and left ventricular (LV) filling and emptying, which is dependent on LV functional properties. The present study aimed to investigate the relationship between LV longitudinal strain (LS), quantitative feature of longitudinal contractility and MA size and function in healthy subjects. Methods. The present study comprised 178 healthy adults (mean age: 32.0 ± 11.3 years, 92 males) who were primarily recruited on voluntary bases. Complete two-dimensional Doppler echocardiography and three-dimensional speckle-tracking echocardiography were performed in all cases. Results. The global and mean segmental LV-LS proved to be -16.1 ± 2.5% and 16.9 ± 2.4%, respectively. In the present study, LV‑LS ≤13% was considered to be reduced. In ROC analysis, the cut-off value for MA fractional area change (MAFAC) to predict impaired LV-LS was ≤44%, with 67% sensitivity (95% CI 38–88%) and 69% specificity (95% CI 61–76%) and ROC area under curve 0.73 (p = 0.0005). Significantly increased LV volumes and LV mass and reduced MAFAC could be demonstrated in healthy subjects with global LV-LS ≤13% as compared to cases with global LV-LS >13%. Significantly larger ratio of subjects with global LV-LS ≤13 % had MAFAC ≤44% as compared to cases with global LV-LS >13% (31% vs. 67%, p =0.009). Patients with MAFAC ≤44% had significantly reduced global and mean segmental LV-LS, reduced end-diastolic and increased end-systolic MA sizes. Significantly larger ratio of subjects with MAFAC ≤44% had global LV-LS ≤13% as compared to cases with MAFAC >44%(4% vs. 16%, p =0.009). MAFAC showed no correlations with global or mean segmental LV-LS. Conclusions. There is a strong relationship between LV longitudinal and MA function. MAFAC predicts global LV-LS. P1741 LV deformation mechanics impairment in chronic AF even with preserved systolic function G Tsimekas G Tsimekas Thriassio General Hospital, Athens, Greece P Kostakou P Kostakou Thriassio General Hospital, Athens, Greece K Keramida K Keramida Attikon University Hospital, Cardio-Oncology Clinic, Heart Failure Unit, Department of Cardiology, Athens, Greece CD Olympios CD Olympios Thriassio General Hospital, Athens, Greece N Kouris N Kouris Thriassio General Hospital, Athens, Greece Thriassio General Hospital, Athens, Greece Attikon University Hospital, Cardio-Oncology Clinic, Heart Failure Unit, Department of Cardiology, Athens, Greece V Giannaris V Giannaris Thriassio General Hospital, Athens, Greece V Kostopoulos V Kostopoulos Thriassio General Hospital, Athens, Greece E Tryfou E Tryfou Thriassio General Hospital, Athens, Greece 2D speckle tracking echocardiography can assess subclinical myocardial dysfunction by strain at the longitudinal, circumferential and radial level, even when classical echocardiographic parameters, like ejection fraction (EF) are within the normal limits. The aim of this study was to test the hypothesis that chronic atrial fibrillation (AF), apart from the diastolic function impairs systolic deformation of the left ventricle (LV), even if it is not apparent from the reduction of EF. Patients and methods: 40 consecutive patients (29 males and 11 females) with chronic AF and preserved EF (58 ± 4%) and 20 healthy controls (9 males and 11 females) underwent a comprehensive 2D echocardiographic study, while strain analysis was performed off-line by GE EchoPac software version 110. Global longitudinal strain of the LV (LVGLS) was assessed from the standard three apical views, while circumferential strain (LVCS) from the parasternal short axis view at the level of papillary muscles. Exclusion criteria were presence of moderate/severe valvular disease, coronary artery disease and LV hypertrophy. Results: Patients with chronic AF revealed significantly impaired LVGLS (-13.6 ± 3.5% vs -21.2 ± 1.3%, p < 0.0001) and LVCS (-15 ± 4.8 vs -22.5 ± 2.2, p < 0.0001). LVEF and LV end-diastolic diameter (LVEDD) did not differ between the two groups, while left atrial dimensions [left atrial diameter (LAD) and left atrial volume indexed (LAVi)] were significantly larger in patients with AF, as expected (Table 1). Conclusion: Chronic AF impairs the deformation properties of LV despite the preserved EF. This observation is in line with the diastolic dysfunction of this group of patients that is almost always present, proving the interaction and the probable common pathophysiologic mechanism of systolic and diastolic dysfunction. Table 1. Chronic AF Controls p value LVEDD (mm) 48.8 ± 4.5 47.5 ± 3.4 0.29 LVEF (%) 58 ± 4 60 ± 3 0.20 LAD (mm) 43 ± 5.5 35 ± 2.4 <0.0001 LAVi (ml/m2) 43.4 ± 10.6 23.5 ± 4.2 <0.0001 LVGLS (%) -13.6 ± 3.5 -21.2 ± 1.3 <0.0001 LVCS (%) -15 ± 4.8 -22.5 ± 2.2 <0.0001 Chronic AF Controls p value LVEDD (mm) 48.8 ± 4.5 47.5 ± 3.4 0.29 LVEF (%) 58 ± 4 60 ± 3 0.20 LAD (mm) 43 ± 5.5 35 ± 2.4 <0.0001 LAVi (ml/m2) 43.4 ± 10.6 23.5 ± 4.2 <0.0001 LVGLS (%) -13.6 ± 3.5 -21.2 ± 1.3 <0.0001 LVCS (%) -15 ± 4.8 -22.5 ± 2.2 <0.0001 Echocardiographic LV parameters of patients with chronic AF and healthy controls. View Large Table 1. Chronic AF Controls p value LVEDD (mm) 48.8 ± 4.5 47.5 ± 3.4 0.29 LVEF (%) 58 ± 4 60 ± 3 0.20 LAD (mm) 43 ± 5.5 35 ± 2.4 <0.0001 LAVi (ml/m2) 43.4 ± 10.6 23.5 ± 4.2 <0.0001 LVGLS (%) -13.6 ± 3.5 -21.2 ± 1.3 <0.0001 LVCS (%) -15 ± 4.8 -22.5 ± 2.2 <0.0001 Chronic AF Controls p value LVEDD (mm) 48.8 ± 4.5 47.5 ± 3.4 0.29 LVEF (%) 58 ± 4 60 ± 3 0.20 LAD (mm) 43 ± 5.5 35 ± 2.4 <0.0001 LAVi (ml/m2) 43.4 ± 10.6 23.5 ± 4.2 <0.0001 LVGLS (%) -13.6 ± 3.5 -21.2 ± 1.3 <0.0001 LVCS (%) -15 ± 4.8 -22.5 ± 2.2 <0.0001 Echocardiographic LV parameters of patients with chronic AF and healthy controls. View Large P1742 Additional value of speckle-tracking echocardiography during of myocardial contractile reserve evaluation OV Tereshina OV Tereshina Samara State Medical University, Samara, Russian Federation OA Germanova OA Germanova Samara State Medical University, Samara, Russian Federation Samara State Medical University, Samara, Russian Federation Introduction. The main traditional index of contractile reserve is the increase of ejection fraction more than 5%. The speckle-tracking echocardiography (STE) gives the information of global left ventricle contractile function and may serve as additional parameter of contractile reserve. In addition, STE provides information of predominant subepicardial, predominant subendocardial and transmural injury of myocardium. Purpose. To determine the capabilities of speckle-tracking echocardiography on myocardial contractile reserve evaluation. Materials and methods. We included 40 patients in our study. There were 22 men and 18 women, mean age - 57 ± 4,2 years old. Twelve patients had ischemic heart disease, eleven - myocarditis, seventeen of them had chemotherapy associated cardiotoxic injury. Mean baseline ejection fraction was 42 ± 6%. We studied the contractile reserve with low dose dobutamine test (2,5 mcg/kg/min, 5 mcg/kg/min, 10 mcg/kg/min). We evaluated ejection fraction, global longitudinal strain (GLS), circumferential strain (GCS), before dobutamine injection and at each level of dosage. Results. According changes in ejection fraction during test we divided all patients into 3 groups 1. Patients (n = 11) with increase of ejection fraction more than 5% (mean increase 6 ± 1,1%). 2. Patients (n = 10) without increase of ejection fraction – lower than 5% (mean increase 2,3 ± 1,2%) . 3. Patients (n = 19) with decrease of ejection fraction (mean decrease – 2,1 ± 1,1%). In the first group GLS and GCS were both increased. In the second group it was decrease of one of these parameters with simultaneously increase of other, while the ejection fraction did not change significantly. Seven patients showed the decrease of GLS, while GCS was increased. However, three patient showed opposite changes with predominant decrease of GCS. In the third group, GLS and GCS were both decreased, that indicated the transmural dysfunction. Conclusion. Speckle-tracking echocardiography gave additional insight on cardiac mechanic during contractile reserve evaluation. P1743 Interventricular septum thickness and mechanical dispersion by strain echocardiography may be used as predictive parameters of potential arrhytmogenecity in patients with HFpEF A Sustar A Sustar University Hospital Center Rijeka, Department of Cardiovascular disease, Rijeka, Croatia L Tudor L Tudor Rudjer Boskovic Institute, Zagreb , Division of Molecular Medicine, Zagreb, Croatia S Matulic S Matulic University Hospital Center Rijeka, Department of Cardiovascular disease, Rijeka, Croatia S Matijevic Roncevic S Matijevic Roncevic University Hospital Center Rijeka, Department of Cardiovascular disease, Rijeka, Croatia Z Diklic Z Diklic University Hospital Center Rijeka, Department of Cardiovascular disease, Rijeka, Croatia A Ruzic A Ruzic University Hospital Center Rijeka, Department of Cardiovascular disease, Rijeka, Croatia University Hospital Center Rijeka, Department of Cardiovascular disease, Rijeka, Croatia Rudjer Boskovic Institute, Zagreb , Division of Molecular Medicine, Zagreb, Croatia Background : It has already been shown that increased mechanical dispersion (MD) predicts ventricular arrhytmias in patients with ishemic heart disease and in patients with hypertrophic cardiomyopathy. Except the change in ventricular size and tissue composition after myocardial injury, ventricular remodeling in herat failure (HF) includes also the changes in wall thickness. Interventricular septum (IVS) as an important site of collateral circulatory network supplyed both from branches of LAD and RCA is known as an origin of idiopathic arrhytmias. The thickness of IVS has been investigated as a predictor of mortality in patients with coronary artery disease. The purpose of this study was to evaluate the association between IVS thickness and MD as a predictive parameter for arrhytmogenecity among three HF subgroups: HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction (HFmrEF) and HF with preserved ejection fraction (HFpEF). Methods: Transthoracic echocardiography with speckle tracking strain imaging was performed in 41 consecutive patients with HFrEF (N = 15), HFmrEF (N = 9), HFpEF (N = 8), and one control group of healthy individuals (N = 9). Global longitudinal strain (GLS) was assessed from the apical four and two chambre and long axis view. MD was defined as the standard deviation of time to peak negative strain in 16 segments. Thickness of IVS was measured at end diastole taken from M-mode recordings. Non-parametric statistical analysis was performed on all data due to the limited number of subjects, using SPSS Statistics v. 17.0. Connection between IVS and MD parameters was tested in each group separately using Spearman’s correlation. Results: The GLS parameters were significantly different between all groups (H = 30,949, df = 3, p= < 0.001).There was a significant difference between HFrEF, HFmrEF and HFpEF subgroups of patients (Kruskal-Wallis test, H = 13.399, df = 2, p = 0.001).We found no significant correlation in HFrEF (ρ=0.007, p = 0.982) and HFmrEF (ρ=0.456, p = 0.217) subgroup of patients, however IVS and MD significantly correlated in HFpEF subgroup (ρ=0.781, p = 0.022). Conclusions: The thickness of IVS in HFpEF patients is associated with increased MD which may indicate that this subgroup of patients may be prone to potential arrythmogenecity. View largeDownload slide Abstract P1743 Figure. MD and IVS association in HF subgroups View largeDownload slide Abstract P1743 Figure. MD and IVS association in HF subgroups P1745 Interest of echocardiography in evaluating structural and atria function in elite athletes C Ketfi C Ketfi Hospital Bichat-Claude Bernard, Paris, France Hospital Bichat-Claude Bernard, Paris, France AIMS : The aim of this study was to establish the effect of training on structure and function of the left and right atria in elite athletes compared with sedentary controls . METHODS :Thirty-one elite atheletes underwent a complete echocardiographic analysis and matched with seventeen healthy sedentary subjects used as controls. Measured variables included LA indexed volumes, DTI of the LV, RA and LA sizes. MST allowed the assessment of atrial strain, during the reservoir (RES s), conduit (CON s), and booster (BOO s) phases of the cardiac cycle. RESULTS : There was no significant difference on indexed LA volume although it remains higher in athletes (20.7 +/- 9.6 ml / m2 versus 3.02 +/- 2.6 ml / m2). It was a significant difference for the surface of the RA (13.7 +/- 3.7 cm2, 11.1 +/- 2.9 cm2, P <0.03). Athletes had a higher Peak E velocity (P < 0.005), a lower A peak (P < 0.002), and a higher peak E/A ratio (<0.002) .They had a higher peak é (p = 0.0049) and no significant différénce for E/é ratio. Global PACS was lower in athletes compared with controls (p < 0.0026) and BOO s was also lower in athletes (p < 0.02).There was no significant differences between group for any parameter for OD strain. CONCLUSION : High-level Training can be the cause of atrial remodeling with an impact on atrial function . MST imaging is a new useful tool to demonstrate the remodeling of LA and RA in athletes. parameters of the left and right atrial Athletes Controls P value LA GLS max (%) 40,8+/-12,1 41,7+/-9,5 0,77 GLS med (%) 10,0+/-5,5 15,0+/-4,7 0,0026 GLS min (%) - 2,3+/-1,9 - 2,1+/-1,3 0,7 RES s (%) 42,9+/-11,8 43,7+/-10 0,8 CON s (%) 30,7+/-8,7 27,9+/-7,9 0,28 BOO s (%) 12,6+/-4,7 16,1+/-5,3 0,02 RA RES s (%) 25+/-9,2 24+/-6,5 0,69 CON s (%) 32,7+/-11 34+/-10,7 0,7 BOO s (%) 8,3+/-5,8 10,4+/-6,2 0,26 Athletes Controls P value LA GLS max (%) 40,8+/-12,1 41,7+/-9,5 0,77 GLS med (%) 10,0+/-5,5 15,0+/-4,7 0,0026 GLS min (%) - 2,3+/-1,9 - 2,1+/-1,3 0,7 RES s (%) 42,9+/-11,8 43,7+/-10 0,8 CON s (%) 30,7+/-8,7 27,9+/-7,9 0,28 BOO s (%) 12,6+/-4,7 16,1+/-5,3 0,02 RA RES s (%) 25+/-9,2 24+/-6,5 0,69 CON s (%) 32,7+/-11 34+/-10,7 0,7 BOO s (%) 8,3+/-5,8 10,4+/-6,2 0,26 LA : left atrium, RA : right atrium , GLS : Global longitudinal strain , RES : reservoir , CON : contraction , BOO : Booster View Large parameters of the left and right atrial Athletes Controls P value LA GLS max (%) 40,8+/-12,1 41,7+/-9,5 0,77 GLS med (%) 10,0+/-5,5 15,0+/-4,7 0,0026 GLS min (%) - 2,3+/-1,9 - 2,1+/-1,3 0,7 RES s (%) 42,9+/-11,8 43,7+/-10 0,8 CON s (%) 30,7+/-8,7 27,9+/-7,9 0,28 BOO s (%) 12,6+/-4,7 16,1+/-5,3 0,02 RA RES s (%) 25+/-9,2 24+/-6,5 0,69 CON s (%) 32,7+/-11 34+/-10,7 0,7 BOO s (%) 8,3+/-5,8 10,4+/-6,2 0,26 Athletes Controls P value LA GLS max (%) 40,8+/-12,1 41,7+/-9,5 0,77 GLS med (%) 10,0+/-5,5 15,0+/-4,7 0,0026 GLS min (%) - 2,3+/-1,9 - 2,1+/-1,3 0,7 RES s (%) 42,9+/-11,8 43,7+/-10 0,8 CON s (%) 30,7+/-8,7 27,9+/-7,9 0,28 BOO s (%) 12,6+/-4,7 16,1+/-5,3 0,02 RA RES s (%) 25+/-9,2 24+/-6,5 0,69 CON s (%) 32,7+/-11 34+/-10,7 0,7 BOO s (%) 8,3+/-5,8 10,4+/-6,2 0,26 LA : left atrium, RA : right atrium , GLS : Global longitudinal strain , RES : reservoir , CON : contraction , BOO : Booster View Large View largeDownload slide Abstract P1745 Figure. myocardial strain of right atrium View largeDownload slide Abstract P1745 Figure. myocardial strain of right atrium P1746 Comparison of RV strain between takotsubo syndrome and left anterior descending artery disease IH Jung IH Jung Inje University, Seoul, Korea Republic of JH Park JH Park Inje University, Seoul, Korea Republic of Inje University, Seoul, Korea Republic of Background: It is confused to discriminate between Takotsubo syndrome (TTS) and the acute coronary syndrome of left anterior descending artery (LAD) by only transthoracic echocardiography (TTE) without the absence of angiographic evidence of obstructive coronary artery disease. The aim of this study is to investigate the difference of RV strain between TTS and LAD disease by using two-dimensional speckle-tracking. Methods: We reviewed medical records and analyzed echocardiographic data of 73 patients (38 LAD disease, 35 TTS) who had been detected regional wall motional abnormality of LV apex on TTE and underwent angiography at our institute from January 2015 to December 2017. Results: No significant differences between the two groups were noted in terms of age, sex and comorbidities of hypertension or diabetes. Even though the patients with LAD disease had similar LV wall motion score index of TTS patients, they were more likely to have smaller LVEF and LV global longitudinal strain. With respect to the RV functional echocardiographic parameters, patients with TTS had smaller RV fractional area change and RV free-wall longitudinal strain as well. ROC curve analysis showed that the optimal RV strain cut-off value to identify patients with TTS > -18.0% (area under the curve = 0.650, 95% CI, 0.501 – 0.763). Conclusion: Assessment of RV longitudinal strain might be helpful to identify TTS among the patients with regional wall motion of LAD disease. Baseline characteristics All patients (n = 73) LAD disease (n = 38) Stress CMP (n = 35) p-value Age 68.4 ± 13.4 66.8 ± 13.0 70.1 ± 13.8 0.301 BNP 1167.1 ± 1482.9 563.9 ±1233.4 1479.9 ± 1524.8 0.046 Troponin-I 18.2 ± 28.9 34.0 ± 33.9 2.4 ± 6.0 <0.001 CK-MB 65.8 ± 95.0 116.7 ± 113.3 16.3 ± 22.2 <0.001 LVEF (%) 38.2 ± 10.6 42.8 ± 9.1 33.3 ± 10.0 <0.001 WMSI 2.2 ± 0.2 2.2 ± 0.2 2.2 ± 0.1 0.083 E/e’ ratio 12.7 ± 6.1 12.4 ± 6.1 13.1 ± 6.1 0.645 LV GLS (- %) 10.7 ± 3.2 11.9 ± 3.2 9.5 ± 2.8 0.001 RV FAC(%) 44.0 ± 10.3 47.6 ± 7.5 40.1 ± 11.6 0.002 TAPSE 2.0 ± 0.3 2.0 ± 0.2 1.9 ± 0.4 0.100 RV s’ (cm/sec) 11.6 ± 2.8 11.2 ± 1.9 12.0 ± 3.6 0.266 RV free LS (- %) 21.1 ± 7.4 23.0 ± 6.2 19.0 ± 8.3 0.025 All patients (n = 73) LAD disease (n = 38) Stress CMP (n = 35) p-value Age 68.4 ± 13.4 66.8 ± 13.0 70.1 ± 13.8 0.301 BNP 1167.1 ± 1482.9 563.9 ±1233.4 1479.9 ± 1524.8 0.046 Troponin-I 18.2 ± 28.9 34.0 ± 33.9 2.4 ± 6.0 <0.001 CK-MB 65.8 ± 95.0 116.7 ± 113.3 16.3 ± 22.2 <0.001 LVEF (%) 38.2 ± 10.6 42.8 ± 9.1 33.3 ± 10.0 <0.001 WMSI 2.2 ± 0.2 2.2 ± 0.2 2.2 ± 0.1 0.083 E/e’ ratio 12.7 ± 6.1 12.4 ± 6.1 13.1 ± 6.1 0.645 LV GLS (- %) 10.7 ± 3.2 11.9 ± 3.2 9.5 ± 2.8 0.001 RV FAC(%) 44.0 ± 10.3 47.6 ± 7.5 40.1 ± 11.6 0.002 TAPSE 2.0 ± 0.3 2.0 ± 0.2 1.9 ± 0.4 0.100 RV s’ (cm/sec) 11.6 ± 2.8 11.2 ± 1.9 12.0 ± 3.6 0.266 RV free LS (- %) 21.1 ± 7.4 23.0 ± 6.2 19.0 ± 8.3 0.025 Takotsubo syndrome (TTS), left anterior descending artery (LAD), brain natriuretic peptide (BNP), LV ejection fraction (LVEF), LV wall motion score index (WMSI), LV global longitudinal strain (LV GLS), RV free-wall longitudinal strain (RV free LS) View Large Baseline characteristics All patients (n = 73) LAD disease (n = 38) Stress CMP (n = 35) p-value Age 68.4 ± 13.4 66.8 ± 13.0 70.1 ± 13.8 0.301 BNP 1167.1 ± 1482.9 563.9 ±1233.4 1479.9 ± 1524.8 0.046 Troponin-I 18.2 ± 28.9 34.0 ± 33.9 2.4 ± 6.0 <0.001 CK-MB 65.8 ± 95.0 116.7 ± 113.3 16.3 ± 22.2 <0.001 LVEF (%) 38.2 ± 10.6 42.8 ± 9.1 33.3 ± 10.0 <0.001 WMSI 2.2 ± 0.2 2.2 ± 0.2 2.2 ± 0.1 0.083 E/e’ ratio 12.7 ± 6.1 12.4 ± 6.1 13.1 ± 6.1 0.645 LV GLS (- %) 10.7 ± 3.2 11.9 ± 3.2 9.5 ± 2.8 0.001 RV FAC(%) 44.0 ± 10.3 47.6 ± 7.5 40.1 ± 11.6 0.002 TAPSE 2.0 ± 0.3 2.0 ± 0.2 1.9 ± 0.4 0.100 RV s’ (cm/sec) 11.6 ± 2.8 11.2 ± 1.9 12.0 ± 3.6 0.266 RV free LS (- %) 21.1 ± 7.4 23.0 ± 6.2 19.0 ± 8.3 0.025 All patients (n = 73) LAD disease (n = 38) Stress CMP (n = 35) p-value Age 68.4 ± 13.4 66.8 ± 13.0 70.1 ± 13.8 0.301 BNP 1167.1 ± 1482.9 563.9 ±1233.4 1479.9 ± 1524.8 0.046 Troponin-I 18.2 ± 28.9 34.0 ± 33.9 2.4 ± 6.0 <0.001 CK-MB 65.8 ± 95.0 116.7 ± 113.3 16.3 ± 22.2 <0.001 LVEF (%) 38.2 ± 10.6 42.8 ± 9.1 33.3 ± 10.0 <0.001 WMSI 2.2 ± 0.2 2.2 ± 0.2 2.2 ± 0.1 0.083 E/e’ ratio 12.7 ± 6.1 12.4 ± 6.1 13.1 ± 6.1 0.645 LV GLS (- %) 10.7 ± 3.2 11.9 ± 3.2 9.5 ± 2.8 0.001 RV FAC(%) 44.0 ± 10.3 47.6 ± 7.5 40.1 ± 11.6 0.002 TAPSE 2.0 ± 0.3 2.0 ± 0.2 1.9 ± 0.4 0.100 RV s’ (cm/sec) 11.6 ± 2.8 11.2 ± 1.9 12.0 ± 3.6 0.266 RV free LS (- %) 21.1 ± 7.4 23.0 ± 6.2 19.0 ± 8.3 0.025 Takotsubo syndrome (TTS), left anterior descending artery (LAD), brain natriuretic peptide (BNP), LV ejection fraction (LVEF), LV wall motion score index (WMSI), LV global longitudinal strain (LV GLS), RV free-wall longitudinal strain (RV free LS) View Large View largeDownload slide Abstract P1746 Figure. ROC View largeDownload slide Abstract P1746 Figure. ROC P1747 Are there differences in left atrial function due to myocardial deformation techniques in patients with severe aortic stenosis according to flow conditions ? C Santoro C Santoro University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain R Hinojar R Hinojar University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain A Marco Del Castillo A Marco Del Castillo University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain A Gonzalez-Gomez A Gonzalez-Gomez University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain L Salido L Salido University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain JJ Jimenez-Nacher JJ Jimenez-Nacher University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain R Hernandez Antolin R Hernandez Antolin University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain JL Zamorano Gomez JL Zamorano Gomez University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain C Fernandez-Golfin C Fernandez-Golfin University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain A Garcia A Garcia University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain JM Vieitez Florez JM Vieitez Florez University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain E Ortega E Ortega University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain Background Comparisons in left atrial (LA) function in patients with normal flow (NF) and low-flow (LF) aortic stenosis (AS) have not been examined.The pressure overload caused by severe AS can affect not only the left ventricular function (LV) but also the dimension and functioning of LA. The aim of our study is to investigate the differences in the function of LA and LV according of the flow conditions of the LV. Methods Patients with severe aortic stenosis were prospectively included from January 2016 to January 2017. Analysis of the LA function was performed by volumetric technique and speckle tracking echocardiography (STE) (AI-eR). Global lognitudinal strain (GLS) of LV was also calculated. LA volume, LVEF, and diastolic function were evaluated according to recent recommendations Results The study population consisted of 47 patients with a mean age of 83.9 ± 3.5 years, 60% men. The two groups were comparable by age and sex. Atrial fibrillation was present in 21.3% of the study population and was more prevalent in patients with LF (p <0.002). The risk of Euroscore was lower in patients with NF (p <0.01). Among the LV systolic function parameters, LVEF and GLS were more impaired in the LF group (p <0.001 for both). When analysing the standard parameters of volumes and LA function, neither the LA volume index nor the volumetric parameters of the LA function were different in the two groups. In contrast, AI-eR was significantly reduced in patients with LF (p = 0.003), without differences in the E / e "ratio in the two groups. In the subgroup of patients in sinus rhythm, atrial function showed a tendency to be lower in LF AS compared to those with NF (19.3 ± 6.0 vs 14.1 ± 6.1, p = 0.06) Conclusion. Patients with severe AS with LF have a more impaired LA function than patients with NF, as measured by STE. LA strain analysis by STE is more sensitive than conventional volumetric echocardiographic techniques to detect changes in LA function. Their role in risk stratification and their ability to predict the development of AF should be evaluated prospectively in future studies. Echo parameters NF (n = 33) LF (n = 14) p value LVEF (%) 64.5 ± 12.4 49.8 ± 12.3 0.001 LV GLS (%) -18.4 ± 3.6 13.9 ± 4.5 0.001 LA volindex (ml/m2) 48.3 ± 24.9 61.8 ± 26.1 ns LA-eR (%) 18.4 ± 6.7 11.4 ± 5.5 0.003 LA reservoir(%) 41.7 ± 13.6 31.4 ± 21.8 ns E/E’ ratio 19.1 ± 7.1 18.1 ± 7.9 ns Echo parameters NF (n = 33) LF (n = 14) p value LVEF (%) 64.5 ± 12.4 49.8 ± 12.3 0.001 LV GLS (%) -18.4 ± 3.6 13.9 ± 4.5 0.001 LA volindex (ml/m2) 48.3 ± 24.9 61.8 ± 26.1 ns LA-eR (%) 18.4 ± 6.7 11.4 ± 5.5 0.003 LA reservoir(%) 41.7 ± 13.6 31.4 ± 21.8 ns E/E’ ratio 19.1 ± 7.1 18.1 ± 7.9 ns View Large Echo parameters NF (n = 33) LF (n = 14) p value LVEF (%) 64.5 ± 12.4 49.8 ± 12.3 0.001 LV GLS (%) -18.4 ± 3.6 13.9 ± 4.5 0.001 LA volindex (ml/m2) 48.3 ± 24.9 61.8 ± 26.1 ns LA-eR (%) 18.4 ± 6.7 11.4 ± 5.5 0.003 LA reservoir(%) 41.7 ± 13.6 31.4 ± 21.8 ns E/E’ ratio 19.1 ± 7.1 18.1 ± 7.9 ns Echo parameters NF (n = 33) LF (n = 14) p value LVEF (%) 64.5 ± 12.4 49.8 ± 12.3 0.001 LV GLS (%) -18.4 ± 3.6 13.9 ± 4.5 0.001 LA volindex (ml/m2) 48.3 ± 24.9 61.8 ± 26.1 ns LA-eR (%) 18.4 ± 6.7 11.4 ± 5.5 0.003 LA reservoir(%) 41.7 ± 13.6 31.4 ± 21.8 ns E/E’ ratio 19.1 ± 7.1 18.1 ± 7.9 ns View Large P1748 Conventional and speckle-tracking echocardiographic assessment of patients with newly diagnosed hereditary haemochromatosis with consideration of age L Danilowicz-Szymanowicz L Danilowicz-Szymanowicz Medical University of Gdansk, Department of Cardiology and Electrotherapy, Gdansk, Poland K Rozwadowska K Rozwadowska Medical University of Gdansk, Department of Cardiology and Electrotherapy, Gdansk, Poland M Fijalkowski M Fijalkowski Medical University of Gdansk, First Department of Cardiology, Gdansk, Poland K Sikorska K Sikorska Medical University of Gdansk, Department of Tropical Medicine and Epidemiology, Gdansk, Poland G Raczak G Raczak Medical University of Gdansk, Department of Cardiology and Electrotherapy, Gdansk, Poland Medical University of Gdansk, Department of Cardiology and Electrotherapy, Gdansk, Poland Medical University of Gdansk, First Department of Cardiology, Gdansk, Poland Medical University of Gdansk, Department of Tropical Medicine and Epidemiology, Gdansk, Poland Background. Hereditary haemochromatosis (HH) is an inherited disease in which gene mutation leads to excessive iron absorption and accumulation in different organs, including the heart, which causes damage. It is believed that two dimensional speckle tracking echocardiography (2D STE) can evaluate LV dysfunction more accurately than conventional echocardiography. This seems to be clinically important in the early stages of hereditary hemochromatosis before a substantial damage of the LV. Evaluation of such assessment of patients with newly diagnosed HH with special consideration of their age was the purpose of this paper. Materials and methods. We enrolled 24 patients with newly diagnosed HH (without any history of cardiovascular disease) and 23 healthy age- and sex-matched volunteers. Analysis of standard and 2D STE parameters were performed and compared between subgroups ≥50 and <50 years old (yo). Results: The standard echo parameters were within the normal range, but revealed the differences between HH and healthy persons in diastolic function in the older subgroup, whereas younger patients had lower LVEF. 2D STE differences were shown in the both subgroups in rotation and strain parameters (Table). Conclusions: Newly diagnosed HH is associated with some changes in diastolic parameters in the older patients and in systolic in the younger, whereas 2D STE seems to be more sensitive in detecting LV abnormalities in both subgroups. The results of this study may be clinically useful in the early stages of hereditary hemochromatosis. Table Healthy 50- n = 13 HH 50- n = 12 p Healthy 50+ n = 10 HH 50+ n = 12 p age 39 (33-34) 34 (29-38) 0.911 60 (59-62) 55 (53-64) 0.189 LADs 35 (34-39) 36 (34-40) 0.100 33 (32-38) 38 (36-41) 0.092 LAAI 8.5 (8.1-9.0) 9.1 (8.8-10.2) 0.198 8.3 (7.2-9.3) 11.6 (10.1-12.4) <0.010 LAVI 22.0 (20.0-28.0) 25.5 (24.6-28.6) 0.207 21.8 (21.2-27.6) 34.9 (29.8-46.9) <0.015 LVMI 68.0 (66.9-76.0) 56.5 (49.4-78.0) 0.105 65.0 (56.4-73.0) 74.0 (67.4-80.8) <0.030 Em 0.14 (0.12-0.14) 0.14 (0.11-0.17) 0.311 0.10 (0.09-0.12) 0.09 (0.07-0.10) <0.046 E/Em 6.5 (5.5-7.8) 6.4 (5.3-7.9) 0.421 6.7 (6.3-7.5) 9.0 (8.2-9.0) <0.019 LVEF 63 (62-65) 58 (55-61) <0.001 64 (60-63) 59 (58-60) 0.070 LV global twist 22.5 (19.4-25.6) 11.1 (9.4-14.2) <0.001 26.2 (24.6-32.5) 20.3 (15.3-21.4) <0.022 LV torsion 2.9 (2.5-3.9) 1.5 (1.1-1.7) <0.001 3.9 (3.5-4.4) 2.7 (2.1-3.0) <0.020 LV peak rotation velocity 151.1 (114.8-213.3) 95.2 (83.4-136.9) <0.027 150.2 (124.5-170.7) 117.03 (105.6-130.7) <0.047 LV peak untwisting velocity -151.3 (-169.6/118.7) -86.4 (-114.6/-54.5) <0.001 -203.8 (-261.7/-158.9) -123.6 (-141.0/-107.2) <0.037 Peak systolic longitudinal strain -21.0 (-21.5/-19.8) -18.9 (-20.1/-16.3) <0.047 -19.7 (-22.5/-18.5) -19.6 (-22.0/-18.4) 0.193 Healthy 50- n = 13 HH 50- n = 12 p Healthy 50+ n = 10 HH 50+ n = 12 p age 39 (33-34) 34 (29-38) 0.911 60 (59-62) 55 (53-64) 0.189 LADs 35 (34-39) 36 (34-40) 0.100 33 (32-38) 38 (36-41) 0.092 LAAI 8.5 (8.1-9.0) 9.1 (8.8-10.2) 0.198 8.3 (7.2-9.3) 11.6 (10.1-12.4) <0.010 LAVI 22.0 (20.0-28.0) 25.5 (24.6-28.6) 0.207 21.8 (21.2-27.6) 34.9 (29.8-46.9) <0.015 LVMI 68.0 (66.9-76.0) 56.5 (49.4-78.0) 0.105 65.0 (56.4-73.0) 74.0 (67.4-80.8) <0.030 Em 0.14 (0.12-0.14) 0.14 (0.11-0.17) 0.311 0.10 (0.09-0.12) 0.09 (0.07-0.10) <0.046 E/Em 6.5 (5.5-7.8) 6.4 (5.3-7.9) 0.421 6.7 (6.3-7.5) 9.0 (8.2-9.0) <0.019 LVEF 63 (62-65) 58 (55-61) <0.001 64 (60-63) 59 (58-60) 0.070 LV global twist 22.5 (19.4-25.6) 11.1 (9.4-14.2) <0.001 26.2 (24.6-32.5) 20.3 (15.3-21.4) <0.022 LV torsion 2.9 (2.5-3.9) 1.5 (1.1-1.7) <0.001 3.9 (3.5-4.4) 2.7 (2.1-3.0) <0.020 LV peak rotation velocity 151.1 (114.8-213.3) 95.2 (83.4-136.9) <0.027 150.2 (124.5-170.7) 117.03 (105.6-130.7) <0.047 LV peak untwisting velocity -151.3 (-169.6/118.7) -86.4 (-114.6/-54.5) <0.001 -203.8 (-261.7/-158.9) -123.6 (-141.0/-107.2) <0.037 Peak systolic longitudinal strain -21.0 (-21.5/-19.8) -18.9 (-20.1/-16.3) <0.047 -19.7 (-22.5/-18.5) -19.6 (-22.0/-18.4) 0.193 View Large Table Healthy 50- n = 13 HH 50- n = 12 p Healthy 50+ n = 10 HH 50+ n = 12 p age 39 (33-34) 34 (29-38) 0.911 60 (59-62) 55 (53-64) 0.189 LADs 35 (34-39) 36 (34-40) 0.100 33 (32-38) 38 (36-41) 0.092 LAAI 8.5 (8.1-9.0) 9.1 (8.8-10.2) 0.198 8.3 (7.2-9.3) 11.6 (10.1-12.4) <0.010 LAVI 22.0 (20.0-28.0) 25.5 (24.6-28.6) 0.207 21.8 (21.2-27.6) 34.9 (29.8-46.9) <0.015 LVMI 68.0 (66.9-76.0) 56.5 (49.4-78.0) 0.105 65.0 (56.4-73.0) 74.0 (67.4-80.8) <0.030 Em 0.14 (0.12-0.14) 0.14 (0.11-0.17) 0.311 0.10 (0.09-0.12) 0.09 (0.07-0.10) <0.046 E/Em 6.5 (5.5-7.8) 6.4 (5.3-7.9) 0.421 6.7 (6.3-7.5) 9.0 (8.2-9.0) <0.019 LVEF 63 (62-65) 58 (55-61) <0.001 64 (60-63) 59 (58-60) 0.070 LV global twist 22.5 (19.4-25.6) 11.1 (9.4-14.2) <0.001 26.2 (24.6-32.5) 20.3 (15.3-21.4) <0.022 LV torsion 2.9 (2.5-3.9) 1.5 (1.1-1.7) <0.001 3.9 (3.5-4.4) 2.7 (2.1-3.0) <0.020 LV peak rotation velocity 151.1 (114.8-213.3) 95.2 (83.4-136.9) <0.027 150.2 (124.5-170.7) 117.03 (105.6-130.7) <0.047 LV peak untwisting velocity -151.3 (-169.6/118.7) -86.4 (-114.6/-54.5) <0.001 -203.8 (-261.7/-158.9) -123.6 (-141.0/-107.2) <0.037 Peak systolic longitudinal strain -21.0 (-21.5/-19.8) -18.9 (-20.1/-16.3) <0.047 -19.7 (-22.5/-18.5) -19.6 (-22.0/-18.4) 0.193 Healthy 50- n = 13 HH 50- n = 12 p Healthy 50+ n = 10 HH 50+ n = 12 p age 39 (33-34) 34 (29-38) 0.911 60 (59-62) 55 (53-64) 0.189 LADs 35 (34-39) 36 (34-40) 0.100 33 (32-38) 38 (36-41) 0.092 LAAI 8.5 (8.1-9.0) 9.1 (8.8-10.2) 0.198 8.3 (7.2-9.3) 11.6 (10.1-12.4) <0.010 LAVI 22.0 (20.0-28.0) 25.5 (24.6-28.6) 0.207 21.8 (21.2-27.6) 34.9 (29.8-46.9) <0.015 LVMI 68.0 (66.9-76.0) 56.5 (49.4-78.0) 0.105 65.0 (56.4-73.0) 74.0 (67.4-80.8) <0.030 Em 0.14 (0.12-0.14) 0.14 (0.11-0.17) 0.311 0.10 (0.09-0.12) 0.09 (0.07-0.10) <0.046 E/Em 6.5 (5.5-7.8) 6.4 (5.3-7.9) 0.421 6.7 (6.3-7.5) 9.0 (8.2-9.0) <0.019 LVEF 63 (62-65) 58 (55-61) <0.001 64 (60-63) 59 (58-60) 0.070 LV global twist 22.5 (19.4-25.6) 11.1 (9.4-14.2) <0.001 26.2 (24.6-32.5) 20.3 (15.3-21.4) <0.022 LV torsion 2.9 (2.5-3.9) 1.5 (1.1-1.7) <0.001 3.9 (3.5-4.4) 2.7 (2.1-3.0) <0.020 LV peak rotation velocity 151.1 (114.8-213.3) 95.2 (83.4-136.9) <0.027 150.2 (124.5-170.7) 117.03 (105.6-130.7) <0.047 LV peak untwisting velocity -151.3 (-169.6/118.7) -86.4 (-114.6/-54.5) <0.001 -203.8 (-261.7/-158.9) -123.6 (-141.0/-107.2) <0.037 Peak systolic longitudinal strain -21.0 (-21.5/-19.8) -18.9 (-20.1/-16.3) <0.047 -19.7 (-22.5/-18.5) -19.6 (-22.0/-18.4) 0.193 View Large P1749 Assessment of age-related changes in cardiac function using speckle tracking echocardiography in patients with type 1 diabetes mellitus T Iso T Iso Juntendo University, Pediatrics, Tokyo, Japan K Takahashi K Takahashi Juntendo University, Pediatrics, Tokyo, Japan M Ifuku M Ifuku Juntendo University, Pediatrics, Tokyo, Japan K Yazaki K Yazaki Juntendo University, Pediatrics, Tokyo, Japan H Haruna H Haruna Juntendo University, Pediatrics, Tokyo, Japan N Takubo N Takubo Juntendo University, Pediatrics, Tokyo, Japan M Kurita M Kurita Juntendo University, Medicine, Metabolism and Endocrinology, Tokyo, Japan F Ikeda F Ikeda Juntendo University, Medicine, Metabolism and Endocrinology, Tokyo, Japan H Watada H Watada Juntendo University, Medicine, Metabolism and Endocrinology, Tokyo, Japan T Shimizu T Shimizu Juntendo University, Pediatrics, Tokyo, Japan Juntendo University, Pediatrics, Tokyo, Japan Juntendo University, Medicine, Metabolism and Endocrinology, Tokyo, Japan Background: Patients with type 1 diabetes mellitus (T1DM) demonstrate a higher incidence of heart failure and cardiovascular disease over time. DM may lead to diabetic cardiomyopathy (DCM), defined as myocardial dysfunction independent of coronary artery disease and hypertension. Most previous studies demonstrated DCM in patients with type 2 DM. Therefore, the incidence of DCM in patients with T1DM, especially the age-related changes in cardiac function between childhood and adulthood, remains unknown. Purpose: We evaluated the age-related changes in cardiac function in patients with T1DM by using speckle tracking echocardiography. Methods: We recruited 35 patients with T1DM aged between 5 and 40 years, and 39 age- and sex-matched healthy controls. The patients were classified into 3 groups according to age (D1: 5–15 years, D2: 16–25 years, and D3: 26–40 years old). The controls were divided into 3 corresponding groups (C1, C2, and C3). By using speckle tracking echocardiography, circumferential strain (CS) was assessed using parasternal short-axis views at the basal, papillary muscle, and apical levels, and longitudinal strain (LS) was assessed using the apical four-chamber view. Results: In conventional echocardiographic parameters such as left ventricular ejection fraction and diastolic cardiac parameters obtained from tissue Doppler assessment, only e¢ in D3 decreased as compared with that in C3 (p < 0.001). In the LV strain, LS in D2 decreased as compared with that in C2 (p = 0.034). CS at the basal level and LS in D3 decreased as compared with that in C3 (p = 0.039 and p < 0.001, respectively). CS at the papillary muscle and apical level did not show any significant difference between the patients and the controls. It is interesting that CS at the basal level correlated with the duration of morbidity (r = 0.470, p = 0.004). Conclusions: The cardiac function of the patients with T1DM declined since late teens, correlating with disease duration. Compared with the conventional echo parameter, LS can be a sensitive parameter for early detection of DCM in T1DM. Thses are new insights into mechanisms of cardiac dysfunction in patients with T1DM. P1750 The role of epicardial longitudinal strain in the follow-up of patients with myocarditis C Evdoridis C Evdoridis Elpis General Hospital, Athens, Greece G Michas G Michas Elpis General Hospital, Athens, Greece C Grigoriou C Grigoriou Elpis General Hospital, Athens, Greece V Tzamou V Tzamou Elpis General Hospital, Athens, Greece G Blazakis G Blazakis Elpis General Hospital, Athens, Greece C Panourgia C Panourgia Elpis General Hospital, Athens, Greece T Thomopoulos T Thomopoulos Elpis General Hospital, Athens, Greece E Malaxianaki E Malaxianaki Elpis General Hospital, Athens, Greece A Trikas A Trikas Elpis General Hospital, Athens, Greece Elpis General Hospital, Athens, Greece Introduction: Left ventricular peak longitudinal strain (LS) during acute myocarditis correlates significantly with the amount of edema as assessed by cardiovascular magnetic resonance (CMR) but its role in the detection of myocardial fibrosis at midterm follow-up is not well established. Purpose: To detect myocardial fibrosis in patients with myocarditis at follow-up, by estimation of peak LS in all 3 (epicardial, mid-wall and endocardial) myocardial layers. Methods: We included 15 patients with acute myocarditis and preserved EF (> 55%) on the day of discharge. Definition of myocarditis was based on clinical, biochemical and cardiovascular magnetic resonance (CMR) information. At the 6-month follow-up visit we estimated 1) the location and extent of intramyocardial fibrosis by using late gadolinium enhancement (LGE) during CMR. 2) the overall transmural and layer-specific LS (TLS and LLS respectively) in myocardial territories (anterior, inferior-posterior, lateral) which were shown to exhibit LGE, and the overall TLS and LLS in all other territories without LGE. TLS and LLS analysis was conducted offline in a workstation using dedicated software. Results: All patients exhibited LGE on CMR, of which 12 presented a subepicardial, and 3 subepicardial and intramural pattern. TLS in territories with LGE was not statistically different from TLS in areas without LGE (19.4 ± 1.3 vs. 20.2 ± 2.6, p: NS). On the contrary, LLS of the epicardial layer was lower in areas with LGE (12.5 ± 2.1 vs. 17.6 ± 1.5, p <0.05). Conclusion: Persistent myocardial fibrosis in patients with previous myocarditis can be detected by estimation of the epicardial longitudianal strain P1751 Transmural myocardial involvement in cardiac amyloidosis from early stages R Callizo R Callizo Hospital Dr. Peset, Valencia, Spain V Mora V Mora Hospital Dr. Peset, Valencia, Spain I Roldan I Roldan Hospital Dr. Peset, Valencia, Spain R Arbucci R Arbucci Investigaciones medicas de Buenos Aires, Servicio de cardiodiagnóstico, Buenos Aires, Argentina E Romero E Romero Hospital Dr. Peset, Valencia, Spain MM Perez-Gil MM Perez-Gil Hospital Dr. Peset, Valencia, Spain R Serrats R Serrats Hospital Dr. Peset, Valencia, Spain V Faga V Faga Hospital Dr. Peset, Valencia, Spain A Saad A Saad Investigaciones medicas de Buenos Aires, Servicio de cardiodiagnóstico, Buenos Aires, Argentina J Lowenstein J Lowenstein Investigaciones medicas de Buenos Aires, Servicio de cardiodiagnóstico, Buenos Aires, Argentina Hospital Dr. Peset, Valencia, Spain Investigaciones medicas de Buenos Aires, Servicio de cardiodiagnóstico, Buenos Aires, Argentina Background: Heart failure with preserved ejection fraction (EF) is mainly caused by an initial subendocardial involvement in some heart diseases, with the consequent decrease in longitudinal strain (LS) and compensatory increase in circumferential strain (CS) and torsion. In infiltrative diseases such as cardiac amyloidosis (CAMY) the involvement could be different. Objective: To quantify the different parameters that contribute to the contractility of the left ventricle (LV) in CAMY. Methods: Comparative study between 23 patients (p) affected by heart failure secondary to CAMY (15 p with LVEF > 50% and 8 p with LVEF ≤ 50%), and 15 healthy volunteers as control group (CO). We analyzed LV strain and rotational parameters with 2D speckle-tracking echocardiography. Transversal views of the left ventricle (LV) were obtained to calculate circumferential strain (CS), radial strain (RS) and left ventricular twist, while three apical planes were acquired to determine longitudinal strain (LS). Twist was calculated as the sum of the apical and basal rotation (º) and the Deformation Index (Def-I) was obtained dividing Twist by LS (º /%). The Def-I describes the dynamic torsion of the LV including in its formula the simultaneous movement of rotation and longitudinal shortening (expressed by the LS) that occurs during systole. Results: There were no differences in age between CO, p with CAMY-LVEF > 50% and p with CAMY-LVEF ≤ 50% (63.7 ± 2.8, 67.1 ± 11.5, 66.9 ± 11.5 years). LS, CS and RS were decreased in p affected by CAMY in comparison with CO, being the difference more marked in those with LVEF ≤ 50% (table). In CAMY-LVEF > 50% group Def-I was increased in comparison with CO and CAMY-LVEF ≤ 50% (table). Conclusion: Unlike other heart diseases, in CAMY myocardium seems to have transmural involvement from early stages, as reflected by the simultaneous decrease in LS and CS. LVEF is initially preserved in p with CAMY probably due to compensatory increase in LV dynamic torsion, as indicated by the increase of the Def-I. Its subsequent decrease results in the onset of LV systolic dysfunction. Results table LVEF LS CS RS Twist Def-I Controls, n = 15 68.2 ±6.3 -20.6 ±2.5 -22.7 ±4.9 32.2 ±11.9 21.7 ± 6.1 -1.0 ±0.3 CAMY (LVEF > 50%), n = 15 59.5 ±6.1* -12.6 ±4.3* -18.1 ±4.6* 21.5 ±7.6* 20.2 ± 8.4 -1.7 ±0.9* CAMY (LVEF ≤50%), n= 8 41.0 ±7.1& -8.0 ±2.8& -12.7 ±2.5& 10.8 ±3.4& 9.5 ± 5.9& -1.3 ±0.8 LVEF LS CS RS Twist Def-I Controls, n = 15 68.2 ±6.3 -20.6 ±2.5 -22.7 ±4.9 32.2 ±11.9 21.7 ± 6.1 -1.0 ±0.3 CAMY (LVEF > 50%), n = 15 59.5 ±6.1* -12.6 ±4.3* -18.1 ±4.6* 21.5 ±7.6* 20.2 ± 8.4 -1.7 ±0.9* CAMY (LVEF ≤50%), n= 8 41.0 ±7.1& -8.0 ±2.8& -12.7 ±2.5& 10.8 ±3.4& 9.5 ± 5.9& -1.3 ±0.8 Abbreviations shown in the text; *:p < 0.01 between control group vs CAMY > 50%; &:p < 0.01 between CAMY > 50% vs CAMY ≤50 %. View Large Results table LVEF LS CS RS Twist Def-I Controls, n = 15 68.2 ±6.3 -20.6 ±2.5 -22.7 ±4.9 32.2 ±11.9 21.7 ± 6.1 -1.0 ±0.3 CAMY (LVEF > 50%), n = 15 59.5 ±6.1* -12.6 ±4.3* -18.1 ±4.6* 21.5 ±7.6* 20.2 ± 8.4 -1.7 ±0.9* CAMY (LVEF ≤50%), n= 8 41.0 ±7.1& -8.0 ±2.8& -12.7 ±2.5& 10.8 ±3.4& 9.5 ± 5.9& -1.3 ±0.8 LVEF LS CS RS Twist Def-I Controls, n = 15 68.2 ±6.3 -20.6 ±2.5 -22.7 ±4.9 32.2 ±11.9 21.7 ± 6.1 -1.0 ±0.3 CAMY (LVEF > 50%), n = 15 59.5 ±6.1* -12.6 ±4.3* -18.1 ±4.6* 21.5 ±7.6* 20.2 ± 8.4 -1.7 ±0.9* CAMY (LVEF ≤50%), n= 8 41.0 ±7.1& -8.0 ±2.8& -12.7 ±2.5& 10.8 ±3.4& 9.5 ± 5.9& -1.3 ±0.8 Abbreviations shown in the text; *:p < 0.01 between control group vs CAMY > 50%; &:p < 0.01 between CAMY > 50% vs CAMY ≤50 %. View Large P1752 Role of longitudinal mechanics in cardiotoxicity monitoring of breast cancer patients initially assessed with MUGA CH Arce Salinas CH Arce Salinas National Cancer Institute (INCAN), Mexico City, Mexico O Calvillo Arguelles O Calvillo Arguelles National Cancer Institute (INCAN), Mexico City, Mexico HG Rodriguez Zanella HG Rodriguez Zanella National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico JD Sierra Lara-Martinez JD Sierra Lara-Martinez National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico JF Fritche Salazar JF Fritche Salazar National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico A Jordan Rios A Jordan Rios National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico DF Flores Diaz DF Flores Diaz National Cancer Institute (INCAN), Mexico City, Mexico K Balderas Munoz K Balderas Munoz National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico LE Posada Martinez LE Posada Martinez National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico XA Ortiz Leon XA Ortiz Leon National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico ME Ruiz-Esparza Duenas ME Ruiz-Esparza Duenas National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico JA Arias Godinez JA Arias Godinez National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico National Cancer Institute (INCAN), Mexico City, Mexico National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico Background: Different imaging modalities can be used for cardiotoxicity monitoring of breast cancer patients receiving anthracyclines (AC) or trastuzumab (T). Although guidelines recommend using the same imaging technique for each assessment, patients who are found to have a drop in LVEF when initially assessed with MUGA are sometimes referred for an echocardiographic evaluation. The prognostic role of longitudinal mechanics in this setting is unknown. Purpose: The aim of this study was to assess whether multilayer strain and mechanical dispersion differ among patients with cardiotoxicity (as assessed with MUGA) and those without cardiotoxicity, and to explore a potential relationship between longitudinal mechanics and clinical outcomes related to cardiotoxicity. Methods: This is a prospective pilot study including breast cancer patients who received AC within 12 months of enrollment and were receiving T at the time of initial assessment. Patients who had at least 2 LVEF measurements with MUGA before referral were eligible. Standard 2D echocardiography measurements, 3D LVEF, and speckle-tracking transmural longitudinal strain (TransLS), subendocardial longitudinal strain (SendoLS), subepicardial LS (SepiLS), and mechanical dispersion (MD) measured as the standard deviation of time to peak longitudinal strain from 17 segments, were obtained. Longitudinal strain gradient (LS gradient) was calculated as the difference between SendoLS and SepiLS. Patients were divided into two groups according to whether MUGA defined cardiotoxicity was present or not (decline in LVEF ≥ 10% to a value < 50%). Patients were followed up for the occurrence of a combined outcome (CO) of development of HF symptoms (≥ NYHA 2), HF admission, or T interruption. Results: Between January and October, 2017, 23 eligible patients with a mean age of 47.8 ±11 years and mean baseline LVEF 62.6% ±4.2 were referred to the echocardiography laboratory of a tertiary care center. The mean T exposure time was 7.4 ± 3.7 months. Six patients (26%) developed cardiotoxicity according to MUGA assessment. Patients with cardiotoxicity had lower 3D LVEF (45.6% ± 7.8 vs 58.7% ± 6.2, p < 0.001) lower absolute TransLS (12.0% ±3.2 vs 20.1% ±2.6, p <0.001), SendoLS (13.3% ± 3.7 vs 22.5% ± 3.1, p <0.001), SepiLS (10.8% ± 2.7 vs 18.0% ± 2.3, p <0.001) values and LS gradients (2.4 ± 1.1 vs 4.5 ± 1.2, p= 0.002), and greater MD (60.9 mseg ± 15.8 vs 38.9 mseg ± 9, p < 0.001) than patients without cardiotoxicity, respectively. Within a mean follow up of 6.6 ± 3 months, 9 (39%) patients reached the CO. Both, LS gradient (77.8% sensitivity, 85.7% specificity) and MD (88.9% sensitivity, 71.4% specificity) where able to predict the CO with cut-off values of 3.5 and 40 mseg, respectively. Conclusions: The predictive value of longitudinal mechanics in patients who are referred for cardiotoxicity identified by MUGA should be further explored. View largeDownload slide Abstract P1752 Figure. Mechanical Dispersion and CO-ROC Curve View largeDownload slide Abstract P1752 Figure. Mechanical Dispersion and CO-ROC Curve P1755 Alterations in left ventricular torsion mechanics by septal shift in patients with precapillary pulmonary hypertension R Kaiser R Kaiser Saarland University Hospital, Homburg, Germany D Liu D Liu University Hospital Würzburg, Department of Internal Medicine I, Comprehensive Heart Failure Center, Würzburg, Germany P Arias P Arias University Hospital Würzburg, Department of Internal Medicine I, Comprehensive Heart Failure Center, Würzburg, Germany K Hu K Hu University Hospital Würzburg, Department of Internal Medicine I, Comprehensive Heart Failure Center, Würzburg, Germany KC Grotemeyer KC Grotemeyer Saarland University Hospital, Homburg, Germany P Nordbeck P Nordbeck Saarland University Hospital, Homburg, Germany Saarland University Hospital, Homburg, Germany University Hospital Würzburg, Department of Internal Medicine I, Comprehensive Heart Failure Center, Würzburg, Germany Funding Acknowledgements: the German Federal Ministry of Education and Research (BMBF 01EO1504, MO.6) Background: In patients with pulmonary hypertension (PH), the left ventricle (LV) can become deformed by the expanding, pressure overloaded right ventricle, recognized as D-sign in echocardiography. Left ventricular torsion and performance are directly related to muscle fiber orientation, which is disturbed by this septal flattening, potentially altering myocardial integrity and function. This study examined alterations in left ventricular torsion due to this deformation in patients with precapillary PH. Methods: Fifty-two patients with precapillary PH and thirteen healthy controls received extended echocardiographic examinations including 4D-measurements, tissue velocity imaging, and optimized short axis views suitable for speckle tracking analysis for characterization of ventricular function. Raw data were obtained from rotation plots and standardized for heart cycle length. Results: PH was associated with hypoplastic dimensions of the LV with preserved LV ejection fraction resulting in decreased stroke volume (median: PH 45ml vs. control 83.5ml, p < 0.001). PH patients showed geometric changes reflected by an increased eccentricity index (1.39 vs. 1.08, p < 0.001). Systolic pulmonary artery pressure (64 vs. 29mmHg, p < 0.001) and right-sided index of myocardial performance (0.55 vs. 0.28, p = 0.007) were increased while TAPSE (19.0 vs. 26.5mm, p < 0.001) was significantly decreased in PH patients. With increasing eccentricity of LV, torsion was both decreased and delayed. Torsion rate paralleled this pattern during systole, but not during diastole. Conclusion: The echocardiographic methodology applied in this study provides novel insights in the interrelation of right- and left ventricular function. The results reveal that right ventricular pressure overload directly affects left ventricular torsion mechanics. Future studies are warranted to define if torsion disturbance relay correlates with prognosis and therapeutic outcomes in precapillary PH patients. P1756 Left atrial mechanics in hypertensive women with surgical and natural menopause MY Kolesnyk MY Kolesnyk Zaporizhzhya State Medical University, Zaporizhzhya, Ukraine MV Sokolova MV Sokolova Zaporizhzhya State Medical University, Zaporizhzhya, Ukraine Zaporizhzhya State Medical University, Zaporizhzhya, Ukraine Background. Surgical menopause (SM) is considered to be the cardiovascular risk factor due to rapid loss of endogenous estrogen level. However, previous studies demonstrated conflicting results related to this problem. Speckle tracking echocardiography has better sensitivity in detection of subclinical myocardial changes than conventional parameters. The left atrial (LA) deformation has never been tested in hypertensive women with SM. The purpose of the study was to estimate the impact of SM on LA deformation in women with arterial hypertension (AH). Methods. The study enrolled 76 hypertensive women (mean age 57 ± 4 years), divided into two groups. The 1st group consisted of 25 patients with SM, whereas the 2nd group included 51 women with natural menopause (NM). All the patients underwent 24-hour ambulatory blood pressure monitoring and conventional two-dimensional echocardiography. The left ventricle (LV) and LA myocardial deformation was assessed by two-dimensional speckle tracking echocardiography. Global LA longitudinal strain was measured by averaging 12 segmental values, obtained from 4- and 2-chamber apical positions. We used both P- and R-wave types of ECG synchronization. Strain was measured in LA contractile and reservoir phase, calculating LA global strain as sum of these values (P-wave variant). We assessed the LA global strain as maximal peak of deformation curves with R-wave triggering. Results. The groups were comparable by age, AH and menopause duration, blood pressure level and standard echocardiographic parameters, including LA volume index. The LV global longitudinal strain was -19.2 ± 3 % in patients with SM versus -19.3 ± 2.4 % in women with NM (p > 0.05). We didn"t find any significant difference in LA longitudinal strain parameters between hypertensive women with SM and NM (Table). The global LA longitudinal strain correlated inversely with LA volume index (r=-0,38; p < 0.05), LV mass index (r=-0,36; p < 0.05) and LV E/e" ratio (r=-0,33; p < 0.05). Conclusion. The present study revealed no significant impact of menopause type on left atrium longitudinal strain in cohort of hypertensive women. LA longitudinal strain Parameter AH + SM (1st group) AH + NM (2nd group) p P-wave ECG-triggering LA strain in contractile phase, % -15.5 ± 4.2 -15.5 ± 3.4 >0.05 LA strain in reservoir phase, % 13.7 ± 5.6 14.2 ± 4.7 >0.05 LA global strain, % 29.3 ± 5.5 29.7 ± 6.2 >0.05 R-wave ECG triggering LA global strain, % 33.7 ± 7.3 32.4 ± 8.4 >0.05 Parameter AH + SM (1st group) AH + NM (2nd group) p P-wave ECG-triggering LA strain in contractile phase, % -15.5 ± 4.2 -15.5 ± 3.4 >0.05 LA strain in reservoir phase, % 13.7 ± 5.6 14.2 ± 4.7 >0.05 LA global strain, % 29.3 ± 5.5 29.7 ± 6.2 >0.05 R-wave ECG triggering LA global strain, % 33.7 ± 7.3 32.4 ± 8.4 >0.05 View Large LA longitudinal strain Parameter AH + SM (1st group) AH + NM (2nd group) p P-wave ECG-triggering LA strain in contractile phase, % -15.5 ± 4.2 -15.5 ± 3.4 >0.05 LA strain in reservoir phase, % 13.7 ± 5.6 14.2 ± 4.7 >0.05 LA global strain, % 29.3 ± 5.5 29.7 ± 6.2 >0.05 R-wave ECG triggering LA global strain, % 33.7 ± 7.3 32.4 ± 8.4 >0.05 Parameter AH + SM (1st group) AH + NM (2nd group) p P-wave ECG-triggering LA strain in contractile phase, % -15.5 ± 4.2 -15.5 ± 3.4 >0.05 LA strain in reservoir phase, % 13.7 ± 5.6 14.2 ± 4.7 >0.05 LA global strain, % 29.3 ± 5.5 29.7 ± 6.2 >0.05 R-wave ECG triggering LA global strain, % 33.7 ± 7.3 32.4 ± 8.4 >0.05 View Large P1758 Performance of left ventricular strain quantification by cardiac magnetic resonance compared to echocardiography E Perez Contreras E Perez Contreras Hospital de la Santa Creu i Sant Pau, Cardiac Imaging Unit, Barcelona, Spain D Vilades Medel D Vilades Medel Hospital de la Santa Creu i Sant Pau, Cardiac Imaging Unit, Barcelona, Spain C Li C Li Hospital de la Santa Creu i Sant Pau, Cardiac Imaging Unit, Barcelona, Spain E Bertoli Ingles E Bertoli Ingles Hospital de la Santa Creu i Sant Pau, Cardiac Imaging Unit, Barcelona, Spain R Leta Petracca R Leta Petracca Hospital de la Santa Creu i Sant Pau, Cardiac Imaging Unit, Barcelona, Spain F Carreras Costa F Carreras Costa Hospital de la Santa Creu i Sant Pau, Cardiac Imaging Unit, Barcelona, Spain Hospital de la Santa Creu i Sant Pau, Cardiac Imaging Unit, Barcelona, Spain Introduction Evaluation of myocardial strain is paramount in advanced cardiac imaging for a better understanding of the systolic function. Purpose This pilot study pretends to prove the reliabilty of left ventricular longitudinal strain (LVLS) measurement by cardiac magnetic resonance (CMR) feature tracking (FT) compared to 2D transthoracic echocardiography (2DTTE) speckle tracking (ST). Methods Of a group of 61 patients in which a CMR and 2DTTE were performed consecutively in the same day by several clinical reasons, after excluding 6 due to technical issues and 4 because had atrial fibrillation, we retrospectively compared in 51 patients on sinus rhythm LVLS, ejection fraction (LVEF), telediastolic (LVTDV) and telesistolic volume of the left ventricle (LVTSV) in the apical 4 chamber (A4C) view measured by CMR-FT and 2DTTE-ST. Results The mean age of the patients examined was 59 ± 16 years, 45‰ had coronary heart disease, 23‰ severe aortic valve disease and aortic dilation and 12‰ cardiomyopathies. The correlation between the LVTDV and LVTSV was adequate, with a significant systematic infraestimation of LV volumes by 2DTTE-ST in comparison with CMR-FT. A good correlation among LVLS and LVEF was determined as well, without significant differences between them (see table 1). Conclusions CMR-FT has proven to be a reliable tool to measure LVLS in comparison with 2DTTE-ST, and therefore it can be used as an additional parameter besides LVEF in the evaluation of ventricular function. Table 1 A4CLVLS A4CLVEF A4CLVTDV A4CLVTSV 2D TT ECHO SPECKLE TRACKING -16,47 ± 4,12 56 ± 9 104 ± 38 49 ± 24 CMR FEATURE TRACKING -17,67 ± 4,47 58 ± 10 147 ± 44 64 ± 32 p VALUE 0,16 0,25 <0,01 <0,01 PEARSON CORRELATION COEFFICIENT 0,69 0,72 0,83 0,86 LIN CONCORDANCE COEFFICIENT 0,66 0,69 0,52 0,72 A4CLVLS A4CLVEF A4CLVTDV A4CLVTSV 2D TT ECHO SPECKLE TRACKING -16,47 ± 4,12 56 ± 9 104 ± 38 49 ± 24 CMR FEATURE TRACKING -17,67 ± 4,47 58 ± 10 147 ± 44 64 ± 32 p VALUE 0,16 0,25 <0,01 <0,01 PEARSON CORRELATION COEFFICIENT 0,69 0,72 0,83 0,86 LIN CONCORDANCE COEFFICIENT 0,66 0,69 0,52 0,72 View Large Table 1 A4CLVLS A4CLVEF A4CLVTDV A4CLVTSV 2D TT ECHO SPECKLE TRACKING -16,47 ± 4,12 56 ± 9 104 ± 38 49 ± 24 CMR FEATURE TRACKING -17,67 ± 4,47 58 ± 10 147 ± 44 64 ± 32 p VALUE 0,16 0,25 <0,01 <0,01 PEARSON CORRELATION COEFFICIENT 0,69 0,72 0,83 0,86 LIN CONCORDANCE COEFFICIENT 0,66 0,69 0,52 0,72 A4CLVLS A4CLVEF A4CLVTDV A4CLVTSV 2D TT ECHO SPECKLE TRACKING -16,47 ± 4,12 56 ± 9 104 ± 38 49 ± 24 CMR FEATURE TRACKING -17,67 ± 4,47 58 ± 10 147 ± 44 64 ± 32 p VALUE 0,16 0,25 <0,01 <0,01 PEARSON CORRELATION COEFFICIENT 0,69 0,72 0,83 0,86 LIN CONCORDANCE COEFFICIENT 0,66 0,69 0,52 0,72 View Large P1759 Noninvasive assessment of regional pressure strain loop in hypertensive patients K Hristova K Hristova National Heart Hospital, Sofia, Bulgaria R Marinov R Marinov National Heart Hospital, Sofia, Bulgaria N Tselov N Tselov Medical center for cardiovascular diseases, Sofia, Bulgaria SV Tsonev SV Tsonev Acebadem City Clinic, Sofia, Bulgaria V Bogdanova V Bogdanova Private clinic of Louvre, Paris, France National Heart Hospital, Sofia, Bulgaria Medical center for cardiovascular diseases, Sofia, Bulgaria Acebadem City Clinic, Sofia, Bulgaria Private clinic of Louvre, Paris, France Hypertension is associated with reversible and non-reversible changes in both systolic and diastolic mechanics, consistent with an increase in preload and decrease in afterload and systemic vascular resistance. End of stages is developing LV hypertrophy and diastolic dysfunction. The aim of the study is to evaluate left ventricular cardiac mechanics via speckle tracking echocardiography in a population of patients with arterial hypertension with and without LV hypertrophy/LVH/. Design and method: The study population included 33 hypertensive patients / 12 male/ and 20 healthy volunteers / 10 males/ in same ages (33 ± 4years).Apical and basal short axis and apical view for three, two and four chamber for 2D images were acquired (65 ± 7 frames/s) . The curves of longitudinal (GLS), circumferential(GCS), radial strain(GRS) and LVT /LVUR were extracted using a commercial software. Regional myocardial work (ejection work density [EWD]) was the area of the pressure-strain loop during ejection and was extracted also. Results: Peak LVT and LVUR increased significantly in the group with AH and LVH. (13.48 ± 2.90°,13 vs 16.83 ± 3.61°,P < 0.001; and -111.52 ± 23.54°/sec, vs,-144.30 ± 45.14°/sec, P< 0.001 . Longitudinal strain decreased significantly (p < 0.001) in the group with AH and LVH. Global longitudinal strain measures of the LV were non-significantly different between the different groups - new onset AH without LVH and volunteers (GLS-20.6 ± 3,14 vs.-19,29 ± 2,17).There are not found significant differences for GCS and GRS also. Longitudinal LV strain decreased in participants with hypertension with LV hypertrophy (P .008). Only in subjects with normal blood pressure EWD significantly increased (+14.7%, P = .0009) Conclusions: Although patients with hypertension and LVH compared with those with normal blood pressure, have increased LV systolic stiffness and regional myocardial work to match arterial load at rest, they might have diminished cardiac reserve to increase myocardial performance. So, LVH is leading cause of developing diastolic dysfunction and heart failure in patients with AH. P1760 Strain 2D contribution to differentiate hypertrophic cardiomyopathy from amyloidosis R Arbucci R Arbucci Investigaciones Médicas, Cardiodiagnóstico, Buenos Aires, Argentina A Saad A Saad Investigaciones Médicas, Cardiodiagnóstico, Buenos Aires, Argentina M Casella M Casella Investigaciones Médicas, Cardiodiagnóstico, Buenos Aires, Argentina N Gastaldello N Gastaldello Investigaciones Médicas, Cardiodiagnóstico, Buenos Aires, Argentina P Merlo P Merlo Investigaciones Médicas, Cardiodiagnóstico, Buenos Aires, Argentina G Rousse G Rousse Investigaciones Médicas, Cardiodiagnóstico, Buenos Aires, Argentina C Perez Olivares C Perez Olivares Hospital Dr. Peset, Echocardiography, Valencia, Spain J Perez Gozalbo J Perez Gozalbo Hospital Dr. Peset, Echocardiography, Valencia, Spain V Mora V Mora Hospital Dr. Peset, Echocardiography, Valencia, Spain JA Lowenstein JA Lowenstein Investigaciones Médicas, Cardiodiagnóstico, Buenos Aires, Argentina Investigaciones Médicas, Cardiodiagnóstico, Buenos Aires, Argentina Hospital Dr. Peset, Echocardiography, Valencia, Spain Introduction: the ejection fraction(EF) is a weak parameter to assess ventricular function in ventricular hypertrophy. As hypertrophic cardiomyopathy(HCM) and cardiac amyloidosis(CAM) often present with preserved EF,it is of importance to analyze ventricular mechanics and its possible differences Objective: compare longitudinal strain behaviour and other parameters of ventricular mechanics with 2D speckle tracking . among patients( p) with MCH ( G1) and CAM (G2 ) both with preserved EF. Methodology: 15p with CAM and 15p with HCM with EF >50% were compared prospectively. Analized with VVID E95 echocardiograph Global Longitudinal Strain(GLS) in 4,3, and 2 apical chambers, Circumferential Strain(CS),ventricular rotation parameters(short axes at the LV basal and apical levels),Twist(apical + basal rotation(º)).Torsion(Twist/LV Base-Apex distance(°/mm), Deformation Indices(DI):Twist/LS(º/%),GLS x apical CLS, EF/GLS Index. Results: significant differencies in age G1 69.9 ± 14.3 vs G2 52 ± 19.7 p0.016 in EF,GLS,basal LS,GLS x apical CS and EF/GLS rate (Table1) No significant differencies were found in apical and mid LS, CS , twist and torsión . GLS value below -10% in CAM p and basal LS value above -14% HCM p may make it possible to diagnose 93% of the p. Conclusion: comparing amyloidosis to HCM,GLS decreases significantly in amyloidosis as a consequence of the behaviour of the BLS. Lower values of the product between GLS and Apical CS. The relation between EF and GLS was significantly higher in patients with amyloidosis. Differences in ventricular mechanics Parameters CAM 15p HCM 15p p EF% 58 ± 6.2 67.1 ± 8.09 0.012 GLS% -12.6 ± 4.3 -17.1 ± 3.9 <0.008 Apical LS% -18.3 ± 4.6 -21.2 ± 6.7 NS Mid LS% -14.6 ± 4.4 -15.5 ± 4 NS Basal LS% -8.4 ± 4.2 -12.7 ± 4.4 0.014 CS % -18.2 ± 4.6 -19.8 ± 5.9 NS Twist º 20.7 ± 8.5 23.8 ± 8.5 NS Apical Rotacion º 12.8 ± 6.6 15 ± 5.5 NS Basal Rotacion º -7.4 ± 3.2 -8.5 ± 5.3 NS Twist/GLS º/% 1.7 ± 0.9 1.7 ± 0.5 NS GLS x Apical CS 316.6 ± 172.6 519.6 ± 192.6 0.007 Torsion º/cm 2.6 ± 1.1 2.6 ± 1.3 NS EF/GLS -5.2 ± 1.8 -4.1 ± 0.8 0.030 Parameters CAM 15p HCM 15p p EF% 58 ± 6.2 67.1 ± 8.09 0.012 GLS% -12.6 ± 4.3 -17.1 ± 3.9 <0.008 Apical LS% -18.3 ± 4.6 -21.2 ± 6.7 NS Mid LS% -14.6 ± 4.4 -15.5 ± 4 NS Basal LS% -8.4 ± 4.2 -12.7 ± 4.4 0.014 CS % -18.2 ± 4.6 -19.8 ± 5.9 NS Twist º 20.7 ± 8.5 23.8 ± 8.5 NS Apical Rotacion º 12.8 ± 6.6 15 ± 5.5 NS Basal Rotacion º -7.4 ± 3.2 -8.5 ± 5.3 NS Twist/GLS º/% 1.7 ± 0.9 1.7 ± 0.5 NS GLS x Apical CS 316.6 ± 172.6 519.6 ± 192.6 0.007 Torsion º/cm 2.6 ± 1.1 2.6 ± 1.3 NS EF/GLS -5.2 ± 1.8 -4.1 ± 0.8 0.030 View Large Differences in ventricular mechanics Parameters CAM 15p HCM 15p p EF% 58 ± 6.2 67.1 ± 8.09 0.012 GLS% -12.6 ± 4.3 -17.1 ± 3.9 <0.008 Apical LS% -18.3 ± 4.6 -21.2 ± 6.7 NS Mid LS% -14.6 ± 4.4 -15.5 ± 4 NS Basal LS% -8.4 ± 4.2 -12.7 ± 4.4 0.014 CS % -18.2 ± 4.6 -19.8 ± 5.9 NS Twist º 20.7 ± 8.5 23.8 ± 8.5 NS Apical Rotacion º 12.8 ± 6.6 15 ± 5.5 NS Basal Rotacion º -7.4 ± 3.2 -8.5 ± 5.3 NS Twist/GLS º/% 1.7 ± 0.9 1.7 ± 0.5 NS GLS x Apical CS 316.6 ± 172.6 519.6 ± 192.6 0.007 Torsion º/cm 2.6 ± 1.1 2.6 ± 1.3 NS EF/GLS -5.2 ± 1.8 -4.1 ± 0.8 0.030 Parameters CAM 15p HCM 15p p EF% 58 ± 6.2 67.1 ± 8.09 0.012 GLS% -12.6 ± 4.3 -17.1 ± 3.9 <0.008 Apical LS% -18.3 ± 4.6 -21.2 ± 6.7 NS Mid LS% -14.6 ± 4.4 -15.5 ± 4 NS Basal LS% -8.4 ± 4.2 -12.7 ± 4.4 0.014 CS % -18.2 ± 4.6 -19.8 ± 5.9 NS Twist º 20.7 ± 8.5 23.8 ± 8.5 NS Apical Rotacion º 12.8 ± 6.6 15 ± 5.5 NS Basal Rotacion º -7.4 ± 3.2 -8.5 ± 5.3 NS Twist/GLS º/% 1.7 ± 0.9 1.7 ± 0.5 NS GLS x Apical CS 316.6 ± 172.6 519.6 ± 192.6 0.007 Torsion º/cm 2.6 ± 1.1 2.6 ± 1.3 NS EF/GLS -5.2 ± 1.8 -4.1 ± 0.8 0.030 View Large P1761 Utility of myocardial deformation imaging early after primary pci in stemi patients to predict heart failure development during the first 12 months of follow up D Trifunovic D Trifunovic Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia G Krljanac G Krljanac Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia L Savic L Savic Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia M Asanin M Asanin Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia J Dudic J Dudic Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia L Cucic L Cucic Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia M Vorkapic M Vorkapic Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia I Mrdovic I Mrdovic Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia Contemporary medical treatment with primary percutaneous coronary intervention (pPCI) significantly improved outcomes in patients with ST- segment elevation myocardial infarction (STEMI). However, heart failure still develops in this population and better risk stratification is still needed. Aim: of this study was to test the utility of myocardial deformation imaging based on speckle tracking echocardiography to improve heart failure prediction during the first year of follow-up after pPCI . Methods: in 154 consecutive STEMI patients treated with pPCI early echo (4 ± 2 days) was done including conventional parameters and comprehensive speckle tracking LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S;%) and systolic strain rate (SR;1/s) on endocardial (endo), medial (mid) and epicardial (epi) level. Parameters of left ventricular (LV) rotation were also analyzed. Echo studies were done on VIVID 9-GE echo platform and EchoPack (Ver 113) used for speckle tracking analysis. ROC analysis was performed to identify the best parameters to predict MACE. Results: Results: total population included 75% male, mean age was 57.4 ± 10.2 year. Patient distribution according to NYHA functional status 12 months after PCI was as follow: NYHA I vs NYHA II vs NYHA III vs NYHA IV: 55% vs 29.4% vs 10.5% 4.6%. Pts with NYHA ≥2 were at similar age, insignificantly more were diabetics and insignificantly higher SYNTAX score compared to NYHA I pts. Peak systolic global LS on the epicardial level had the largest area under the ROC (0.655, p = 0.004, 95% CI 0.536-0.747) with the best sensitivity (Sens) and specificity (Spec) (for -13.0%, sens 71% and spec 51%). Peak CS at the endocardium of the LV apex (ROC area = 0.644, p = 0.005, 95% CI 0.550-0.759) had sensitivity of 70% and spec of 54% (cut-off for peak CS -23.2%). LVEF (by biplane Simpson method) had lower area under the ROC (0.635, p = 0.001, 95% CI 0.541-0.729) and sens and spec for cut off 50%, 65% and spec 51%). Conclusion: peak global longitudinal LV strain, peak circumferential strain of the LV apex measured at the level of endocardium could be used for early stratification of STEMI patients treated by pPCI for development of heart failure during the first year, with better sensitivity and specificity compared to conventional LV EF. P1762 Can speckle-tracking echocardiographic strain analysis be used for the detection of late gadolinium enhancement by magnetic resonance imaging in patients with nonischemic cardiomyopathy ? N Maniwa N Maniwa Wakayama Medical University, Cardiology, Wakayama, Japan M Kashiwagi M Kashiwagi Wakayama Medical University, Cardiology, Wakayama, Japan K Shimamura K Shimamura Wakayama Medical University, Cardiology, Wakayama, Japan A Kuroi A Kuroi Wakayama Medical University, Cardiology, Wakayama, Japan Y Matsuo Y Matsuo Wakayama Medical University, Cardiology, Wakayama, Japan H Kitabata H Kitabata Wakayama Medical University, Cardiology, Wakayama, Japan Y Ino Y Ino Wakayama Medical University, Cardiology, Wakayama, Japan T Kubo T Kubo Wakayama Medical University, Cardiology, Wakayama, Japan A Tanaka A Tanaka Wakayama Medical University, Cardiology, Wakayama, Japan T Akasaka T Akasaka Wakayama Medical University, Cardiology, Wakayama, Japan Wakayama Medical University, Cardiology, Wakayama, Japan T Hozumi T Hozumi Wakayama Medical University, Cardiology, Wakayama, Japan S Ota S Ota Wakayama Medical University, Cardiology, Wakayama, Japan K Takemoto K Takemoto Wakayama Medical University, Cardiology, Wakayama, Japan Background: Previous studies have reported the presence of late gadolinium enhancement by cardiovascular magnetic resonance (CMR-LGE) suggests myocardial fibrosis and is useful as prognostic index in patients with nonisichemic cardiomyopathy (NICM). Left ventricular (LV) global longitudinal strain by speckle-tracking echocardiography (STE-GLS) has been reported to be suggesting myocardial damage, which may be used for the detection of CMR-LGE in patients with NICM. Purpose: The purpose of this study was to investigate whether STE-GLS can be used for the detection of CMR-LGE in patients with NICM. Methods: The study patients consisted of 50 patients with NICM who underwent both STE and CMR. STE-GLS was evaluated from 3 apical views using STE analysis software (Vivid 7, E9, and EchoPac, GE). Presence of LGE, LV end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were calculated from multiple short-axis views in CMR (Intera Achieva,Philips). In 40 of 50 patients, STE-GLS was successfully analyzed while CMR-LGE in all the patients. Thus, the final study population was divided into two groups; 20 patients with CMR-LGE(Group-A) and 20 without CMR-LGE(Group-B). Results: There were no significant differences in LVEDV, LVESV and LVEF betweenGroup-A and Group-B(245 ± 84 vs 238 ± 63ml, 192 ± 78ml vs 175 ± 67ml, 23 ± 8% vs 28 ± 9%). STE-GLS in Group-A was significantly reduced compared with Group-B (-7.5 ± 3.0% vs -10.3 ± 3.2%, p = 0.003). |STE-GLS|< 8.2% was the best threshold value for identifying presence of LGE (sensitivity 80%, specificity 75%, positive predict value 76%, negative predict value 79%, accuracy 78%, AUC 0.77). Conclusions: The present results showed that STE-GLS is useful for the detection of CMR-LGE in patients with NICM. It suggests that STE-GLS can be used for the selection of the candidate for CMR examination in patients with NICM. P1763 Improvements in early cardiac dysfunction with weight loss in overweight adolescents with intellectual and developmental disabilities D Forsha D Forsha University of Missouri - Kansas City, Mercy Children"s Hospital Cardiology, Kansas City, United States of America L Ptomey L Ptomey University of Kansas Medical Center, Kansas City, United States of America D White D White University of Missouri - Kansas City, Mercy Children"s Hospital Cardiology, Kansas City, United States of America T Johnson T Johnson University of Missouri - Kansas City, Mercy Children"s Hospital Cardiology, Kansas City, United States of America L Kuzava L Kuzava University of Missouri - Kansas City, Mercy Children"s Hospital Cardiology, Kansas City, United States of America R France R France University of Missouri - Kansas City, Mercy Children"s Hospital Cardiology, Kansas City, United States of America M Kathol M Kathol University of Missouri - Kansas City, Mercy Children"s Hospital Cardiology, Kansas City, United States of America N Goth N Goth University of Missouri - Kansas City, Mercy Children"s Hospital Cardiology, Kansas City, United States of America M Artman M Artman University of Missouri - Kansas City, Mercy Children"s Hospital Cardiology, Kansas City, United States of America G Shirali G Shirali University of Missouri - Kansas City, Mercy Children"s Hospital Cardiology, Kansas City, United States of America J Donnelly J Donnelly University of Missouri - Kansas City, Mercy Children"s Hospital Cardiology, Kansas City, United States of America University of Missouri - Kansas City, Mercy Children"s Hospital Cardiology, Kansas City, United States of America University of Kansas Medical Center, Kansas City, United States of America Funding Acknowledgements: AHA Career Development Grant Background: Early cardiovascular (CV) disease caused by obesity begins in childhood and leads to increased morbidity and mortality in adulthood. Adolescents with intellectual and developmental disabilities (IDD) have twice the frequency of obesity as non-IDD populations. Purpose: To evaluate early cardiac dysfunction and CV fitness in overweight participants before and after undergoing a 6 month diet/exercise weight loss program. Methods: Overweight (4) and obese (11) subjects with mild-moderate IDD (IQ 40-74) enrolling in a weight loss program were consented. Subjects with congenital heart disease were excluded. An echo with LVEF and 2D longitudinal LV global peak strain (3 apical views; GLVS) and RV strain (1 apical view; GRVS) and treadmill stress test were performed blinded to other results (adequate stress test defined as RER ≥ 1). Analysis included T-test and simple linear regression, p ≤ 0.05 significant. Results: Participants had Down syndrome (6) or autism spectrum (9), with nearly equal genders (47% female). Baseline GLVS was low-normal to mildly diminished in 14 (93%) subjects with preserved LVEF (all > 55%) and normal LV volume. Increased baseline body weight predicted diminished GLVS (P = 0.034). VO2max < 5th%ile in all 12 subjects with maximal tests. Weight, BMI, GLVS and VO2max improved at 6 months. Improvements in GLVS and BMI over the 6 months were associated (p = 0.049). There were no significant differences in GLVS (baseline or 6 month change) between autism and Down syndrome groups (p = 0.81). Conclusions: Baseline abnormalities in biventricular strain (preserved LVEF/TAPSE) and decreased VO2max are present in this small IDD population. These disease processes appear reversible with 6 months of weight loss. These data provide compelling justification for larger studies to better define associated variables and preventive strategies. Anthropomorphic and CV outcome data n Baseline (mean, SD) 6 month  follow-up Change P Age (yr) 15 16.9, 2.3 17.4, 2.3 0.5, 0.1 Weight (kg) 15 86.1, 21.9 81.8, 21.5 -4.3, 6.2 0.018 BMI (kg/m2) 15 31.7, 5.3 29.8, 5.8 -1.8, 2.2 0.008 GLVS (%) 15 -17.2, 1.6 -19.7, 2.7 -2.5, 2.4 0.001 LVEF (%) 15 61.7, 3.2 61.1, 4.3 -0.6, 3.8 0.550 LVEDVi (ml/m2) 15 79.3, 18 83.0, 14.4 3.7, 9.2 0.139 GRVS (%) 14 -20.4, 3.4 -21.4, 2.1 -1.0, 2.5 0.343 TAPSE (mm) 15 22.5, 4.6 21.2, 6.6 -0.3, 5.5 0.817 VO2max (ml/kg/min) 12 24.3, 5.2 26.4, 5.7 2.1, 2.5 0.016 n Baseline (mean, SD) 6 month  follow-up Change P Age (yr) 15 16.9, 2.3 17.4, 2.3 0.5, 0.1 Weight (kg) 15 86.1, 21.9 81.8, 21.5 -4.3, 6.2 0.018 BMI (kg/m2) 15 31.7, 5.3 29.8, 5.8 -1.8, 2.2 0.008 GLVS (%) 15 -17.2, 1.6 -19.7, 2.7 -2.5, 2.4 0.001 LVEF (%) 15 61.7, 3.2 61.1, 4.3 -0.6, 3.8 0.550 LVEDVi (ml/m2) 15 79.3, 18 83.0, 14.4 3.7, 9.2 0.139 GRVS (%) 14 -20.4, 3.4 -21.4, 2.1 -1.0, 2.5 0.343 TAPSE (mm) 15 22.5, 4.6 21.2, 6.6 -0.3, 5.5 0.817 VO2max (ml/kg/min) 12 24.3, 5.2 26.4, 5.7 2.1, 2.5 0.016 View Large Anthropomorphic and CV outcome data n Baseline (mean, SD) 6 month  follow-up Change P Age (yr) 15 16.9, 2.3 17.4, 2.3 0.5, 0.1 Weight (kg) 15 86.1, 21.9 81.8, 21.5 -4.3, 6.2 0.018 BMI (kg/m2) 15 31.7, 5.3 29.8, 5.8 -1.8, 2.2 0.008 GLVS (%) 15 -17.2, 1.6 -19.7, 2.7 -2.5, 2.4 0.001 LVEF (%) 15 61.7, 3.2 61.1, 4.3 -0.6, 3.8 0.550 LVEDVi (ml/m2) 15 79.3, 18 83.0, 14.4 3.7, 9.2 0.139 GRVS (%) 14 -20.4, 3.4 -21.4, 2.1 -1.0, 2.5 0.343 TAPSE (mm) 15 22.5, 4.6 21.2, 6.6 -0.3, 5.5 0.817 VO2max (ml/kg/min) 12 24.3, 5.2 26.4, 5.7 2.1, 2.5 0.016 n Baseline (mean, SD) 6 month  follow-up Change P Age (yr) 15 16.9, 2.3 17.4, 2.3 0.5, 0.1 Weight (kg) 15 86.1, 21.9 81.8, 21.5 -4.3, 6.2 0.018 BMI (kg/m2) 15 31.7, 5.3 29.8, 5.8 -1.8, 2.2 0.008 GLVS (%) 15 -17.2, 1.6 -19.7, 2.7 -2.5, 2.4 0.001 LVEF (%) 15 61.7, 3.2 61.1, 4.3 -0.6, 3.8 0.550 LVEDVi (ml/m2) 15 79.3, 18 83.0, 14.4 3.7, 9.2 0.139 GRVS (%) 14 -20.4, 3.4 -21.4, 2.1 -1.0, 2.5 0.343 TAPSE (mm) 15 22.5, 4.6 21.2, 6.6 -0.3, 5.5 0.817 VO2max (ml/kg/min) 12 24.3, 5.2 26.4, 5.7 2.1, 2.5 0.016 View Large P1764 Rotational mechanics and left ventricular strain in morbid obesity: evaluation of subclinical myocardial impairment by speckle-tracking echocardiography V Mora Llabata V Mora Llabata Hospital Dr. Peset, Cardiology department, Valencia, Spain C Morillas Arino C Morillas Arino Hospital Dr. Peset, Endocrinology department, Valencia, Spain J Bertolin Boronat J Bertolin Boronat Hospital Dr. Peset, Cardiology department, Valencia, Spain V Faga V Faga Hospital Dr. Peset, Cardiology department, Valencia, Spain M Perez Gil M Perez Gil Hospital Dr. Peset, Cardiology department, Valencia, Spain R Serrats Lopez R Serrats Lopez Hospital Dr. Peset, Cardiology department, Valencia, Spain R Callizo Gallego R Callizo Gallego Hospital Dr. Peset, Cardiology department, Valencia, Spain R Fernandez Galera R Fernandez Galera Hospital Dr. Peset, Cardiology department, Valencia, Spain I Roldan Torres I Roldan Torres Hospital Dr. Peset, Cardiology department, Valencia, Spain Hospital Dr. Peset, Cardiology department, Valencia, Spain Hospital Dr. Peset, Endocrinology department, Valencia, Spain E Romero Dorta E Romero Dorta Hospital Dr. Peset, Cardiology department, Valencia, Spain Background and purpose. Deformation and rotation parameters of the left ventricle (LV) can be useful to identify early alterations in cardiac mechanics. The aim of this study was to analyze the existence of subclinical myocardial involvement in patients (p) with morbid obesity (MO) and preserved ejection fraction (EF). Methods. Comparative study of 31 p with MO and 31 healthy controls (CO). We analyzed LV rotation and strain parameters using 2D speckle-tracking echocardiography (STEc). Circumferential strain (CS), radial strain (RS) and left ventricular twist were obtained from the LV transversal views. The three apical views were used to determine longitudinal strain (LS). The Twist was determined as the net difference between apical and basal rotation, in degrees (o). The Deformation Index (Def-I) was calculated as a quotient between Twist and GLS, representing a dynamic torsion parameter that involves systolic events which occur simultaneously. We proposed the Combined Deformation Parameter (CDP), which consists of: 1. Deformation Product: Def-P (Twist x GLS, ox%), that assesses the global myocardial function, and 2. Def-I (Twist/GLS, o/%), which estimates the contribution of both parameters to myocardial dysfunction. Results. No differences were observed in terms of age (42.2 years[10.5] vs 46.5 years[8.7], p = 0.09), prevalence of arterial hypertension (12.9% vs 22.6%; p = 0.3) or diabetes mellitus (10% vs 0%, p = 0.08). Female gender was more frequent in MO (81% vs 39%, p = 0.001). The EF was preserved in both groups, although lower in MO (62.9%[5.8] vs 67.8%[5.5], p = 0.001). LS, CS, RS and twist were lower in MO (table). The CDP showed a decreased Def-P in MO compared to the CO group, without differences in the Def-I. This indicates myocardial impairment with similar affectation of LS and twist, which is linked fundamentally to CS. Conclusions. The morbid obesity is associated with alterations in LS and twist despite of preserved EF, which indicates subclinical impairment of myocardial function in terms of a transmural affectation. LV deformation and rotation parameters MO (n 31) CO (n 31) p LS (%) - 18.2 [2.9] - 21.1 [2.4] 0.0001 CS (%) - 16.1 [2.7] - 20.5 [3.1] 0.0000 RS (%) 27.2 [10.4] 35.9 [10.3] 0.002 Twist (°) 13.6 [7.1] 17.2 [5.9] 0.03 Combined Deformation Parameter Def-P (°x%) - 251.1 [140.6] - 371.8 [163.2] 0.003 Def-I (°/%) - 0.8 [0.4] - 0.8 [0.3] 0.5 MO (n 31) CO (n 31) p LS (%) - 18.2 [2.9] - 21.1 [2.4] 0.0001 CS (%) - 16.1 [2.7] - 20.5 [3.1] 0.0000 RS (%) 27.2 [10.4] 35.9 [10.3] 0.002 Twist (°) 13.6 [7.1] 17.2 [5.9] 0.03 Combined Deformation Parameter Def-P (°x%) - 251.1 [140.6] - 371.8 [163.2] 0.003 Def-I (°/%) - 0.8 [0.4] - 0.8 [0.3] 0.5 Abbreviations used in text. View Large LV deformation and rotation parameters MO (n 31) CO (n 31) p LS (%) - 18.2 [2.9] - 21.1 [2.4] 0.0001 CS (%) - 16.1 [2.7] - 20.5 [3.1] 0.0000 RS (%) 27.2 [10.4] 35.9 [10.3] 0.002 Twist (°) 13.6 [7.1] 17.2 [5.9] 0.03 Combined Deformation Parameter Def-P (°x%) - 251.1 [140.6] - 371.8 [163.2] 0.003 Def-I (°/%) - 0.8 [0.4] - 0.8 [0.3] 0.5 MO (n 31) CO (n 31) p LS (%) - 18.2 [2.9] - 21.1 [2.4] 0.0001 CS (%) - 16.1 [2.7] - 20.5 [3.1] 0.0000 RS (%) 27.2 [10.4] 35.9 [10.3] 0.002 Twist (°) 13.6 [7.1] 17.2 [5.9] 0.03 Combined Deformation Parameter Def-P (°x%) - 251.1 [140.6] - 371.8 [163.2] 0.003 Def-I (°/%) - 0.8 [0.4] - 0.8 [0.3] 0.5 Abbreviations used in text. View Large P1765 Left ventricular rotational abnormalities following successful kidney transplantation as assessed by three-dimensional speckle-tracking echocardiography A Kormanyos A Kormanyos 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary B Borda B Borda University of Szeged, Department of Surgery, Szeged, Hungary A Kalapos A Kalapos 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 G Lazar G Lazar University of Szeged, Department of Surgery, Szeged, Hungary T Forster T Forster 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 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary University of Szeged, Department of Surgery, Szeged, Hungary Introduction. Kidney transplantation (KTX) is the most common organ transplantation method around the world. Cardiovascular effects of chronic kidney failure are well documented, however there are only few studies describing cardiovascular effects of KTX using novel imaging modalities. In the present three-dimensional (3D) speckle-tracking echocardiographic (3DSTE) study it was aimed to assess left ventricular (LV) rotational and twisting abnormalities in KTX patients otherwise previously free of any cardiovascular disease. Methods. The study comprised 60 patients following successful KTX, from which 18 patients were excluded due to insufficient image quality (mean age: 46.3 ± 8.2 years, 29 males). Control group consisted of 81 age- and gender-matched healthy individuals (mean age: 43.7 ± 10.8 years, 51 males). Complete two-dimensional (2D) Doppler echocardiography and 3DSTE were performed in all cases. Results. Three out of 42 KTX patients showed near absence of LV twist called as LV "rigid body rotation" (RBR)-like movement. Out of the 2D echocardiography data left atrial diameter (41.3 ± 4.7 mm vs. 37.3 ± 4.3 mm, p < 0.001), LV end-diastolic diameter and volume, (51.9 ± 4.5 mm vs. 48.4 ± 3.9 mm, p < 0.001; 132.1 ± 26.5 ml vs. 109.8 ± 24.3 ml, p < 0.001, respectively) interventricular septum and LV posterior wall thickness (10.8 ± 1.6 mm vs. 9.5 ± 1.4 mm, p < 0.001; 10.8 ± 1.6 mm vs. 9.6 ± 1.6 mm, p < 0.001, respectively), LV ejection fraction (67.1 ± 10.9 % vs. 64.4 ± 3.8 %, p < 0.001), E and A velocities (82.9 ± 22.9 cm/s vs. 74.4 ± 17.6 cm/s, p= 0.04; and 84.9 ± 17.7 cm/s vs. 63.2 ± 17.1 cm/s, p < 0.001, respectively) and E/A ratio (1.00 ± 0.31 vs. 1.23 ± 0.36, p= 0.002) differed significantly between the groups. KTX patients had a significantly lower LV basal rotation (-3.34 ± 1.81 degree vs. -4.22 ± 2.14 degree, p= 0.05), while LV apical rotation showed only tendency to increase as compared to controls (10.55 ± 3.34 degree vs. 9.68 ± 4.00 degree, p =ns) resulting in an undiffered LV twist 13.89 ± 3.72 degree vs. 13.90 ± 4.33 degree, p = ns). Conclusions. LV basal rotation is impaired after KTX. LV-RBR is a relatively frequent phenomenon in patients following KTX. P1766 Tissue Doppler echocardiography as a predictor for left ventricular systolic function recovery after percutaneous intervention A Youssif A Youssif Suez Canal University, Department of Cardiology, Ismailia, Egypt A Ali A Ali Suez Canal University, Department of Cardiology, Ismailia, Egypt A Salem A Salem Suez Canal University, Department of Cardiology, Ismailia, Egypt M Oraby M Oraby Suez Canal University, Department of Cardiology, Ismailia, Egypt Suez Canal University, Department of Cardiology, Ismailia, Egypt Background: Experiments suggest that analysis of pre-ejection myocardial velocities is greatly sensitive to blood supply. Accordingly, wall motion can be quantified by TDI and can predict its recovery. Purpose: To assess the value of Tissue Doppler Imaging echocardiography in predicting recovery of myocardial function after revascularization in patients with CAD. Methods: 24 patients with known CAD based on diagnostic coronary angiography were included. Baseline echocardiography with 2D measurements, global systolic function and longitudinal myocardial velocities (Isovolumic contraction peak velocity [IVCPv], S wave velocity, Isovolumic contraction time [IVCT], Contraction time [CT] and Isovolumic relaxation time [IVRT]) of the affected segments were recorded 24 hours before revascularization and 6 months after revascularization. Recovery of global LV systolic function is defined as increased LVEF ≥ 5% after 6 months. Results: All patients underwent revascularization. Most of TDI-PW parameters changed significantly with revascularization, however only mean IVCPv and S wave velocity of dysfunctional segments at rest correlated significantly with recovery of global systolic function. On the other hand, none of them can predict regional recovery of dysfunctional segments after revascularization. Mean IVCPv> 2.8 cm/s and mean S wave >4.6 cm/s at baseline are objective indicator of global systolic function recovery with sensitivity, specificity and accuracy for IVCPv (85%, 70%, 79% respectively) and the PPV was estimated to be 80% (AUC = 0.789, CI = 0.603 -0.975, P value = 0.02), while for S wave (87%, 77%, 83% respectively) and PPV was estimated to be 87% (AUC = 0.833, CI = 0.664 -1.000, P value = 0.007). Conclusions: The resting pattern of myocardial IVCPv and S wave by TDI accurately predicts the recovery of global systolic function with high PPV but not the regional function after revascularization in patients with CAD. Table 1 Parameter Δ LVEF % Mean ±SD P value IVCPv Not recovered Recovered 2.8 (±0.4) 3.5 (±0.8) 0.03 S wave Not recovered Recovered 4.5 (±0.9) 5.8 (±1.1) 0.005 IVCT Not recovered Recovered 89.6 (±16) 103.75 (±25) 0.1 CT Not recovered Recovered 266.9 (±22) 278.8 (±22) 0.2 IVRT Not recovered Recovered 128.7 (±31.3) 125.9 (±28.4) 0.8 Parameter Δ LVEF % Mean ±SD P value IVCPv Not recovered Recovered 2.8 (±0.4) 3.5 (±0.8) 0.03 S wave Not recovered Recovered 4.5 (±0.9) 5.8 (±1.1) 0.005 IVCT Not recovered Recovered 89.6 (±16) 103.75 (±25) 0.1 CT Not recovered Recovered 266.9 (±22) 278.8 (±22) 0.2 IVRT Not recovered Recovered 128.7 (±31.3) 125.9 (±28.4) 0.8 Relationship between mean TDI parameters of dysfunctional segments for all patients at baseline versus recovery of global systolic function. View Large Table 1 Parameter Δ LVEF % Mean ±SD P value IVCPv Not recovered Recovered 2.8 (±0.4) 3.5 (±0.8) 0.03 S wave Not recovered Recovered 4.5 (±0.9) 5.8 (±1.1) 0.005 IVCT Not recovered Recovered 89.6 (±16) 103.75 (±25) 0.1 CT Not recovered Recovered 266.9 (±22) 278.8 (±22) 0.2 IVRT Not recovered Recovered 128.7 (±31.3) 125.9 (±28.4) 0.8 Parameter Δ LVEF % Mean ±SD P value IVCPv Not recovered Recovered 2.8 (±0.4) 3.5 (±0.8) 0.03 S wave Not recovered Recovered 4.5 (±0.9) 5.8 (±1.1) 0.005 IVCT Not recovered Recovered 89.6 (±16) 103.75 (±25) 0.1 CT Not recovered Recovered 266.9 (±22) 278.8 (±22) 0.2 IVRT Not recovered Recovered 128.7 (±31.3) 125.9 (±28.4) 0.8 Relationship between mean TDI parameters of dysfunctional segments for all patients at baseline versus recovery of global systolic function. View Large View largeDownload slide Abstract P1766 Figure. TDI before and after revascularization View largeDownload slide Abstract P1766 Figure. TDI before and after revascularization P1768 The role of two-dimensional speckle tracking echocardiography for immediate invasive strategy in patients with non-ST-elevation acute coronary syndromes R Shamoyan R Shamoyan Institute of Cardiology of Yerevan, Yerevan, Armenia Institute of Cardiology of Yerevan, Yerevan, Armenia Purpose: The aim of this study was to detect whether two-dimensional speckle tracking echocardiography(2D STE) is informative for immediate invasive strategy(<2 hours) in patients with non-ST-elevation acute coronary syndromes(NSTE-ASC), if there are not baseline pathological changes by electrocardiogram (ECG), conventional echocardiography and cardiac troponin T (cTn T) test. Methods: We examined 25 patients (16 males and 9 females, 58 ± 12 years) with clinical symptoms of acute coronary syndromes(ACS) first time in life and without pathological changes by ECG, conventional echocardiography and cTn T test. All patients did not already have chest pain at admission. Left ventricular (LV) longitudinal strain (LS) by 2D STE(GE Vivid 7 equipment) from apical 2-chamber, 4-chamber and long axis views was performed at admission. Results: There were LV reduced regional LS (from -9,2% to -15,1%), although all patients LV global longitudinal strain (GLS) were near the normal values (from -16,3% to -18,6%). It was calculated each patient GRACE risk score(<140). After 2-12 hours 19 in 25 cases (76%) were diagnosed non-ST-elevation myocardial infarction(NSTEMI) by positive cTn T test and/or pathological changes of ECG (ST and T), conventional echocardiography (hypokinesis) compared with baseline data. So, LV reduced regional LS may be considered as an earlier diagnostic parameter in patients with suspected NSTEMI. Conclusion: In some difficult cases, 2D STE LV reduced regional LS may be considered as a time sensitive parameter for immediate invasive strategy in patients with NSTE-ACS. P1769 Ventricular deformation indices trend in thalassemic patients L Micali L Micali University of Catania, Catania, Italy M Monte M Monte University of Catania, Catania, Italy M Sanfilippo M Sanfilippo University of Catania, Catania, Italy S Licciardi S Licciardi ASP 03, Catania, Italy L D"urso L D"urso University of Catania, Catania, Italy DC Faro DC Faro University of Catania, Catania, Italy F Privitera F Privitera University of Catania, Catania, Italy C Tamburino C Tamburino University of Catania, Catania, Italy University of Catania, Catania, Italy ASP 03, Catania, Italy IP Monte IP Monte University of Catania, Catania, Italy V Losi V Losi University of Catania, Catania, Italy Background Cardiovascular complications are the main cause of death in thalassemic (Th) pts due to iron overload. Few studies had used 2D strain speckle tracking (STE) and tissue Doppler imaging (TDI) applied on both ventricles (LV, RV). Purpose To highlight the alterations and the differences between LV and RV in Th pts using STE-DTI. Methods We have examined 30 pts with Th major (TM) and 31 pts with Th intermedia (TI) divided into 2 groups based on the frequency of blood transfusions: Multiple transfusions group (MTG) 30 TM, 10 TI: 18 M, 22 F (43 ± 13 y old) Non multiple transfusions group (NMTG) 21 TI: 7 M, 14 F (39 ± 14 y old). Echo parameters included LVEF; peak velocity E and DT of mitral flow; TDI velocities at septum and lateral wall of mitral annulus (s’, e’) and at lateral wall of tricuspid annulus (sr’, er’); LV myocardial performance index (LV-MPI), RV-MPI; LV E/E’; pulmonary artery systolic pressure (PASP); LV global longitudinal strain (LV-GLS) and RV-GLS. Data have been compared to 23 healthy subjects (N) aged 28 ± 9 y old. Results Both groups showed normal LVEF and similar Hb values. MTG, on iron chelation therapy, had higher ferritin values than NMTG (708 ± 595 vs 304 ± 232 μg/L; p < 0,004) and lower values of TDI lateral s’ (0,08 ± 0,02 vs 0,09 ± 0,01 m/s; p < 0,08) and LV-GLS (-21 ± 3 vs -22 ± 2 %; p < 0,05). Compared to N, both groups revealed higher values of LAVi (32 ± 14 and 30 ± 9 vs 19 ± 5 ml/m2; p < 0,000 and <0,000), E/E’ (8 ± 2 and 7 ± 2 vs 5 ± 1; p < 0,000 and <0,008), LV-MPI (0,53 ± 0,08 and 0,53 ± 0,06 vs 0,49 ± 0,07; p < 0,04 and <0,03) and lower values of TDI septum e’ (0,11 ± 0,03 and 0,11 ± 0,02 vs 0,13 ± 0.02 m/s; p < 0,000 and <0,001) and TDI lateral s’ (0,08 ± 0,02 and 0,09 ± 0,01 vs 0,11 ± 0.03 m/s; p < 0,000 and <0,001). Compared to N, NMTG showed higher PASP values (36 ± 17 vs 29 ± 5 mmHg; p < 0,08) and lower TDI lateral e’ values (0,13 ± 0,03 vs 0,17 ± 0,04 m/s; p < 0,007). MTG had higher RAVi values (24 ± 8 vs 18 ± 5 ml/m2; p < 0,000). In MTG, TM and TI were identified as subgroups, TM compared to TI had higher values of E/A (1,61 ± 0,63 vs 1,11 ± 0,24; p < 0,000), RV-MPI (0,50 ± 0,11 vs 0,41 ± 0,07; p < 0,01), TDI lateral e’ (0,13 ± 0,02 vs 0,10 ± 0,03 m/s; p < 0,06) and lower values of LV-GLS (-20.4 ± 3 vs -22.4 ± 3 %; p < 0,08) and LV-MPI (0,51 ± 0,1 vs 0,57 ± 0,05; p < 0,03). Among TM pts mean T2* value was 34 ± 9. Analysis of correlation showed moderate relations between LV and RV parameters with r > 0.50 in comparing RV-GLS and LV-GLS (0,57), RV-MPI and LV-MPI (0,51). Conclusions In our study, despite the differences we have found, mean values were within normal range. Major differences were related to TDI parameters for both ventricles. GLS correlation between LV and RV may be expression of physiological dependency between ventricles. These parameters may early identify myocardial damage. P1770 Machine learning for recognition of athlete"s heart using 3D volumetric and motion analysis of the right ventricle M Tokodi M Tokodi Semmelweis University Heart Center, Budapest, Hungary BK Lakatos BK Lakatos Semmelweis University Heart Center, Budapest, Hungary O Kiss O Kiss Semmelweis University Heart Center, Budapest, Hungary A Fabian A Fabian Semmelweis University Heart Center, Budapest, Hungary N Sydo N Sydo Semmelweis University Heart Center, Budapest, Hungary M Babity M Babity Semmelweis University Heart Center, Budapest, Hungary CS Bognar CS Bognar Semmelweis University Heart Center, Budapest, Hungary A Kovacs A Kovacs Semmelweis University Heart Center, Budapest, Hungary B Merkely B Merkely Semmelweis University Heart Center, Budapest, Hungary Semmelweis University Heart Center, Budapest, Hungary Background: Repetitive vigorous physical exercise induces significant changes in myocardial structure and function in all four cardiac chambers. However, less is known about the adaptation of the right ventricle (RV) and conventional echocardiographic parameters fail to represent a universal marker of athlete" heart. We hypothesized that machine learning would be able to discriminate athlete’s heart using 3D structural and functional parameters of the RV. Methods: Sixty water polo athletes (19 ± 4 years, 30 females, 30 males, average of 17 hours of training/week) and 40 age and gender matched untrained, healthy controls were enrolled. Detailed medical history and training regime were obtained followed by 3D echocardiography. After reconstruction of the 3D model of the RV, motion components were decomposed along the three anatomically relevant axes. The study population was randomly split to training and testing cohort (70:30) and a random forest ensemble classifier with 10-fold cross-validation was trained on the training dataset. The model with the highest accuracy was applied on the testing cohort to predict whether the given subject is an athlete. To visualize the continuum of RV morphological and functional remodeling, a network was created by connecting each subject to its four nearest neighbor based on the Jaccard distance of the RV variables used in the random forest algorithm. Results: Left ventricular (LV) and RV end-diastolic volumes were higher in athletes (athletes vs control, LV end-diastolic volume: 176 ± 36 vs 116 ± 19mL, RV end-diastolic volume: 174 ± 37 vs 112 ± 17mL, both p < 0.001), along with increased LV mass (194 ± 44 vs 113 ± 22g, p < 0.001). Both LV and RV ejection fraction (EF) were lower compared to non-trained individuals (LV EF: 57 ± 5 vs 62 ± 3%, RV EF: 56 ± 4 vs 61 ± 5, both p < 0.001). In athletes, a functional shift was observed in the dominance of longitudinal versus radial motion to global RV function, as longitudinal EF/total EF ratio was higher (0.50 ± 0.07 vs 0.43 ± 0.07, p < 0.001), whereas radial EF/total EF was lower (0.33 ± 0.08 vs 0.45 ± 0.08, p < 0.001) compared to controls. Using the composite of RV end-diastolic-volume, RV ejection fraction, longitudinal EF/total EF ratio and radial EF/total EF ratio, the area under the receiver-operating characteristic curve for the identification of athlete’s heart was 0.99 (95% Confidence Interval: 0.97 – 1.00) (Fig A). The separation between athletes’ and controls’ RVs could be clearly observed on the similarity network as well (Fig B). Conclusion: The exercise-induced adaptive remodeling also includes a functional shift between the different motion components of the RV. Harnessing the indices of the altered RV mechanics with machine learning algorithms provides a highly accurate identification of athlete’s heart. Recognition of such patterns may enable a better understanding of exercise physiology and potentially the diagnosis of underlying pathological conditions. View largeDownload slide Abstract P1770 Figure. View largeDownload slide Abstract P1770 Figure. P1771 Relative importance of reduced left and right ventricular ejection fraction to predict prognosis in a large cohort of unselected patients with cardiac diseases: a 3D echocardiography study S Iliceto S Iliceto University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy E Surkova E Surkova Royal Brompton Hospital, London, United Kingdom D Genovese D Genovese University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy D Muraru D Muraru University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy P Aruta P Aruta University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy LP Badano LP Badano University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy Royal Brompton Hospital, London, United Kingdom University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy Funding Acknowledgements: Dr Elena Surkova has revived EACVI Training and ESC Research grants Background. Three-dimensional echocardiography (3DE) -derived left ventricular (LV) and right ventricular (RV) ejection fraction (EF) have proven to be accurate and prognostically important indexes of systolic function. However, the prognostic value of different combinations of LV and RV EF is yet to be established. Purpose: to assess the relative importance of reduced and preserved LV and RV EF to predict all-cause mortality and cardiac death. Methods. We used 3DE to measure LV and RV end-diastolic (EDV), end-systolic volumes (ESV) and EF in 394 unselected patients with various cardiovascular diseases (median age 58 years, 65% men). Patients were divided into 4 groups according to EF: 1. normal LVEF (≥50%) and normal RVEF (≥45%) (N = 183); 2. reduced LVEF (<50%) and normal RVEF (≥45%) (N = 75); 3. normal LVEF (≥50%) and reduced RVEF (<45%) (N = 61); 4. reduced LVEF (<50%) and reduced RVEF (<45%) (N = 75). The patients were followed up for 3.73 ± 1.04 years to record all-cause mortality and cardiac death. Results. During follow-up, 59 deaths (including 47 cardiac deaths) occurred. Patients who died were older and had poorer LV and RV EF (Table). Kaplan-Meier analysis showed that both LV EF and RV EF were significant predictors of all-cause mortality (log-rank p = 0.0007 and p < 0.0001, respectively). Both all-cause mortality and proportion of cardiac death in the 4 subgroups were significantly different (Figure). Patients with reduced RV EF and normal LV EF had significantly poorer survival than those with reduced LV EF and normal RV EF (log-rank p = 0.0007 and p = 0.0091 for all-cause mortality and cardiac death, respectively) and did not differ significantly from patients with reduced EF of both ventricles (log-rank p = 0.2198 and p = 0.0846 for all-cause mortality and cardiac death, respectively). Conclusions. LV and RV EF were significant predictors of all-cause mortality and cardiac death in unselected patients with cardiovascular diseases. Impairment of RV function carried a significantly higher risk of mortality independent on LV function. Patients" characteristics Parameter Dead (N = 59) Alive (N = 335) P value Age, years 71 (61; 79) 56 (42; 67) <0.0001 3D LV EDV index, ml/m2 81 (59; 124) 75 (63; 92) 0.1014 3D LV ESV index, ml/m2 45 (26; 86) 32 (24; 47) 0.0021 3D LV EF, % 41.5 (29; 56) 56.5 (46; 62) <0.0001 3D RV EDV index, ml/m2 99.7 (77.5; 117.6) 80.0 (66.4; 95.5) <0.0001 3D RV ESV index, ml/m2 61.0 (45.5; 84.6) 39.9 (32.75; 51.95) <0.0001 3D RV EF, % 36.7 (26.5; 41.2) 48.8 (44.6; 52.6) <0.0001 Parameter Dead (N = 59) Alive (N = 335) P value Age, years 71 (61; 79) 56 (42; 67) <0.0001 3D LV EDV index, ml/m2 81 (59; 124) 75 (63; 92) 0.1014 3D LV ESV index, ml/m2 45 (26; 86) 32 (24; 47) 0.0021 3D LV EF, % 41.5 (29; 56) 56.5 (46; 62) <0.0001 3D RV EDV index, ml/m2 99.7 (77.5; 117.6) 80.0 (66.4; 95.5) <0.0001 3D RV ESV index, ml/m2 61.0 (45.5; 84.6) 39.9 (32.75; 51.95) <0.0001 3D RV EF, % 36.7 (26.5; 41.2) 48.8 (44.6; 52.6) <0.0001 Values are reported as median (25th;75th percentile) View Large Patients" characteristics Parameter Dead (N = 59) Alive (N = 335) P value Age, years 71 (61; 79) 56 (42; 67) <0.0001 3D LV EDV index, ml/m2 81 (59; 124) 75 (63; 92) 0.1014 3D LV ESV index, ml/m2 45 (26; 86) 32 (24; 47) 0.0021 3D LV EF, % 41.5 (29; 56) 56.5 (46; 62) <0.0001 3D RV EDV index, ml/m2 99.7 (77.5; 117.6) 80.0 (66.4; 95.5) <0.0001 3D RV ESV index, ml/m2 61.0 (45.5; 84.6) 39.9 (32.75; 51.95) <0.0001 3D RV EF, % 36.7 (26.5; 41.2) 48.8 (44.6; 52.6) <0.0001 Parameter Dead (N = 59) Alive (N = 335) P value Age, years 71 (61; 79) 56 (42; 67) <0.0001 3D LV EDV index, ml/m2 81 (59; 124) 75 (63; 92) 0.1014 3D LV ESV index, ml/m2 45 (26; 86) 32 (24; 47) 0.0021 3D LV EF, % 41.5 (29; 56) 56.5 (46; 62) <0.0001 3D RV EDV index, ml/m2 99.7 (77.5; 117.6) 80.0 (66.4; 95.5) <0.0001 3D RV ESV index, ml/m2 61.0 (45.5; 84.6) 39.9 (32.75; 51.95) <0.0001 3D RV EF, % 36.7 (26.5; 41.2) 48.8 (44.6; 52.6) <0.0001 Values are reported as median (25th;75th percentile) View Large View largeDownload slide Abstract P1771 Figure. View largeDownload slide Abstract P1771 Figure. P1772 Right ventricular functional shift assessed by three-dimensional echocardiography: characteristic feature of athlete"s heart? A Kovacs A Kovacs Semmelweis University Heart Center, Budapest, Hungary BK Lakatos BK Lakatos Semmelweis University Heart Center, Budapest, Hungary O Kiss O Kiss Semmelweis University Heart Center, Budapest, Hungary N Sydo N Sydo Semmelweis University Heart Center, Budapest, Hungary Z Toser Z Toser Argus Cognitive Inc., Dover, DE, United States of America Z Komocsin Z Komocsin Semmelweis University Heart Center, Budapest, Hungary A Fabian A Fabian Semmelweis University Heart Center, Budapest, Hungary D Major D Major Semmelweis University Heart Center, Budapest, Hungary M Babity M Babity Semmelweis University Heart Center, Budapest, Hungary M Tokodi M Tokodi Semmelweis University Heart Center, Budapest, Hungary B Merkely B Merkely Semmelweis University Heart Center, Budapest, Hungary Semmelweis University Heart Center, Budapest, Hungary Argus Cognitive Inc., Dover, DE, United States of America Regular physical training is associated with pronounced cardiac adaptation, also referred as the athlete’s heart. While the majority of studies have focused on the left ventricle, right ventricular (RV) response to chronic exercise may also be of high interest. Our aim was to determine the morphological and functional characteristics of the RV in a large cohort of elite athletes using three-dimensional echocardiography. 116 top-level athletes (19 ± 4 years, 36% female) and 40 age- and gender matched healthy, sedentary controls were enrolled in our current study. Beyond conventional echocardiography, 3D acquisitions focused on the RV were also obtained. We determined RV end-diastolic volume index (RVEDVi), stroke volume index (RVSVi) and ejection fraction (RVEF) by dedicated software. Using the ReVISION method, we have decomposed the motion of the RV to determine longitudinal (LEF) and radial ejection fraction (REF). The ratio of LEF or REF to RVEF quantifies the relative contribution of longitudinal or radial (bellows effect) wall motions to global function. Athletes had significantly higher RVEDVi and RVSVi compared to controls (athletes vs. controls; RVEDVi: 87 ± 12 vs. 65 ± 10 mL/m2; RVSVi: 48 ± 6 vs. 40 ± 5 mL/m2, both p < 0.0001), however, they also demonstrated lower RVEF (56 ± 4 vs. 61 ± 5%, p < 0.0001). When examining the relative contribution of longitudinal and radial motion to global function, athletes had more pronounced RV longitudinal motion with lower contribution of the radial motion (LEF/RVEF: 0.50 ± 0.07 vs. 0.42 ± 0.07; REF/RVEF: 0.33 ± 0.08 vs. 0.45 ± 0.08, both p < 0.0001). Intense exercise training results in complex morphological and functional changes of the RV. Along with increased volumes, a characteristic functional shift can be seen with an increased longitudinal motion, however, with decreased radial shortening. This contraction pattern may serve as a new resting marker of athlete’s heart. View largeDownload slide Abstract P1772 Figure. RV functional shift in athletes View largeDownload slide Abstract P1772 Figure. RV functional shift in athletes P1773 Multi-parametric on board evaluation of right ventricular function using 3D echocardiography: feasibility and accuracy against traditional 2- and 3 dimensional echocardiographic measurements G Tamborini G Tamborini Centro Cardiologico Monzino, IRCCS., Milan, Italy C Cefalu C Cefalu Centro Cardiologico Monzino, IRCCS., Milan, Italy F Celeste F Celeste Centro Cardiologico Monzino, IRCCS., Milan, Italy L Fusini L Fusini Centro Cardiologico Monzino, IRCCS., Milan, Italy V Mantegazza V Mantegazza Centro Cardiologico Monzino, IRCCS., Milan, Italy M Muratori M Muratori Centro Cardiologico Monzino, IRCCS., Milan, Italy P Gripari P Gripari Centro Cardiologico Monzino, IRCCS., Milan, Italy S Ghulam Ali S Ghulam Ali Centro Cardiologico Monzino, IRCCS., Milan, Italy A Garlasche A Garlasche Centro Cardiologico Monzino, IRCCS., Milan, Italy G Berna G Berna Centro Cardiologico Monzino, IRCCS., Milan, Italy M Pepi M Pepi Centro Cardiologico Monzino, IRCCS., Milan, Italy Centro Cardiologico Monzino, IRCCS., Milan, Italy Background. Three-dimensional echocardiographic (3DE) quantification of right ventricle (RV) has been validated in many clinical settings. However, the necessity of complicated and off–line dedicated softwares has reduced the diffusion of 3DE RV evaluation in daily practice. Recently, a new simplified "on board" 3DE software (OB) has been developed to obtain RV volumes and ejection fraction (EF) together with some of the most used traditional parameters of RV function, automatically derived from 3DE: tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), longitudinal strain (LS). Purpose The aims of this study were to evaluate the feasibility and accuracy of RV analysis with OB in a large series of patients. Methods We studied 140 subjects: 35 normals and 105 patients: 26 valvular, 20 coronary artery diseases, 33 idiopathic dilated cardiomyopathy and 26 congenital or acquired pathologies associated with RV pressure or volume overload. Each patient underwent a complete 2DE and 3DE with OB 3DRV evaluation. Results were compared with the conventional off-line software (OFL) and with the traditional two-dimensional echocardiographic (2DE) derived corresponding functional values. A subgroup of 22 patients underwent cardiac CMR and 3DE OB data were compared with CMR RV volumes results. Results: OB RV reconstruction was feasible in 133/140 cases (95%). Imaging quality was good in most of them (84%). Mean time for 3DE acquisition was 73.8 ± 24 sec, for RV OB reconstruction 97,5 ± 33 sec and for OFL analysis 129 ± 52 sec in addition to the time spent for the RV dataset loading (80 ± 24 sec). No significant differences were observed between OB and OFL 3DE RV volumes and EF. 3DE derived FSA and LS (but not TAPSE, which suffers from suboptimal alignment) were similar to 2DE values and significantly correlated with tissue Doppler systolic peak velocity, RV dP/dt, systolic pulmonary pressure and RV myocardial performance index. Normals were characterized by smaller RV volumes and higher RVEF, FAC, TAPSE and LS in comparison to patients. In the 22 patients who underwent CMR, OB RV volumes and EF correlated tightly with the CMR values (EDV: r2 0.922, bias -21.5 ml; ESV r2 0,928, bias -6.3 ml; EF r2 0.833, bias -0.8%), likewise OFL RV data (EDV: r2 0.950, bias -18.5 ml; ESV r2 = 0,39, bias -7.3 ml; EF r2 0.8689, bias -0.7%) Conclusion. This new OB 3DE method is feasible, time saving and accurate in comparison with CMR. It easily provides 3DE RV volumes and ejection fraction and multiple functional parameters including FAC and LS. Off-line operator border adjustment is actually recommended to obtain a more accurate 3DE derived TAPSE (easily obtained by proper alignment) . P1774 Right ventricular function in acute pulmonary embolism: a three-dimensional strain study B Sartre B Sartre University Hospital of Nice - Hospital Pasteur, Nice, France M Sermesant M Sermesant INRIA, Asclepios Research Project, Sophia-Antipolis, France E Ferrari E Ferrari University Hospital of Nice - Hospital Pasteur, Nice, France University Hospital of Nice - Hospital Pasteur, Nice, France University Claude Bernard of Lyon, CREATIS, Lyon, France INRIA, Asclepios Research Project, Sophia-Antipolis, France P Moceri P Moceri University Hospital of Nice - Hospital Pasteur, Nice, France N Duchateau N Duchateau University Claude Bernard of Lyon, CREATIS, Lyon, France Funding Acknowledgements: CHU de Nice, France (AO2I-2013) Introduction: Pulmonary embolism (PE) is a common and serious life-threatening disease. Mortality is related to right ventricular (RV) dysfunction secondary to the increased RV afterload. RV function assessment is challenging and limited using 2D ultrasound. Purpose: To study 3D global and regional right ventricular strain in patients with acute PE and at 1 month, as compared to a control population. Methods: We conducted a longitudinal prospective study, including 23 consecutive intermediate-risk PE patients. All patients underwent 2D and 3D transthoracic echocardiography at baseline (within 12 hours of PE diagnosis) and 1-month after hospital discharge. A control group was recruited, consisting of healthy volunteers, matched on age and sex with PE patients. 3D RV echocardiographic sequences were analyzed by a commercial RV-specific software and output meshes were post-processed to extract regional deformation. One-month 3D echocardiographic follow-up was only available in 18 patients. Results: During acute PE, area strain was substantially altered in the RV free wall (except in the right ventricular outflow tract) and within the trabecular septum. PE patients initially had RV dysfunction using 2D and 3D parameters, with, on average, 1-month normalization of 2D parameters. However, at 1-month, RV area and circumferential strains remained altered as compared to the control group. Acute PE seems to affect preferentially the circumferential rather than the longitudinal strain. The presence of a McConnell sign was identified in 83% of patients and was associated with reduced apical and global RV area strain. Conclusion: 3D RV strain study demonstrates an incomplete recovery of area and circumferential strain, 1 month after an episode of intermediate-risk acute PE, despite normal 2D parameters. Further studies are required to assess the prognostic role and the implications of this residual RV strain impairment after PE. Moreover, in our study, the Mc Connell sign is related to the intensity of RV strain impairment during the acute phase of PE. This sign may be explained by a mechanical traction of the RV apex by the left ventricle, rather than by an increased apical function. View largeDownload slide Abstract P1774 Figure. 3D RV area strain in PE and controls View largeDownload slide Abstract P1774 Figure. 3D RV area strain in PE and controls P1775 Three-dimensional geometrical and functional atrial remodeling in competitive athletes AA Molnar AA Molnar Semmelweis University, Heart and Vascular Center, Budapest, Hungary B Lakatos B Lakatos Semmelweis University, Heart and Vascular Center, Budapest, Hungary B Solymossi B Solymossi Semmelweis University, Heart and Vascular Center, Budapest, Hungary Z Tarcza Z Tarcza Semmelweis University, Heart and Vascular Center, Budapest, Hungary T Kovats T Kovats Semmelweis University, Heart and Vascular Center, Budapest, Hungary C Bognar C Bognar Semmelweis University, Heart and Vascular Center, Budapest, Hungary A Kovacs A Kovacs Semmelweis University, Heart and Vascular Center, Budapest, Hungary N Sydo N Sydo Semmelweis University, Heart and Vascular Center, Budapest, Hungary O Kiss O Kiss Semmelweis University, Heart and Vascular Center, Budapest, Hungary B Merkely B Merkely Semmelweis University, Heart and Vascular Center, Budapest, Hungary Semmelweis University, Heart and Vascular Center, Budapest, Hungary INTRODUCTION: Athlete"s heart is a term used to describe morphological and functional cardiac changes in athletes including atrial and ventricular enlargement. Three-dimensional speckle-tracking echocardiography (3D STE) is an accurate technique for the assessment of atrial and ventricular volumes and function with the potential to overcome the limitations of two-dimensional imaging. Normal cut-off values for atrial volumes and functions in athletes have not been established yet. PURPOSE: The aim of this study was to investigate atrial remodeling of elite endurance athletes. METHODS: One hundred fifty-one long-term training endurance athletes (mean age 17.6 ± 4 years, 29% females, mean training time 13.8 ± 7.5 hours/week) were enrolled. Beyond conventional two-dimensional echocardiography, 3D STE was performed to evaluate left atrial and ventricular morphology and function using dedicated software for each chamber. All athletes underwent cardiopulmonary exercise testing to assess oxygen uptake and exercise capacity. RESULTS: Average left atrial volumes and function were normal in athletes (LAVi 30.6 ± 5.7 mL/m2, LAGLS: 32.8 ± 8.5 mL/m2), however, 29% of athletes had LAVi values above the non-sportive normal cut-off value and 79% had left atrial global longitudinal strain (LAGLS) under proposed 39% non-sportive normal cut-off value. Left ventricular volumes were larger in athletes (LVEDVi 86.1 ± 11.1 mL/m2), nevertheless left ventricular mass, left ventricular global longitudinal and circumferential strain parameters were normal (LVMi 90.4 ± 13.2 g/m2; LVGLS -19.4 ± 1.9%; LVGCS -27.7 ± 2.9%). Using multiple regression analysis, LAVi, LVEDVi, LVMi, LVGLS, gender and age independently predict maximal functional capacity (adjusted R2: 0.49). CONCLUSION: Atrial and ventricular enlargement in athletes represents physiologic adaptation to higher cardiac output and both of them can predict maximal functional capacity. However, decreased atrial function might be an early stage of mal-adaptive atrial remodeling. Athletes with decreased LAGLS should be examined more extensively because of the higher risk of atrial fibrillation. Further large-scale studies are needed with standardized measurement method to establish normal cut-off values of atrial volumes and function in athletes. P1776 Feasibility and accuracy of automated software for transthoracic three-dimensional left ventricular and atrial volumes and function analysis in mitral valve degenerative regurgitation G Pontone G Pontone Centro Cardiologico Monzino IRCCS, Milan, Italy D Andreini D Andreini Centro Cardiologico Monzino IRCCS, Milan, Italy F Trotta F Trotta Centro Cardiologico Monzino IRCCS, Milan, Italy G Tamborini G Tamborini 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 M Guglielmo M Guglielmo Centro Cardiologico Monzino IRCCS, Milan, Italy G Italiano G Italiano Centro Cardiologico Monzino IRCCS, Milan, Italy M Mantegazza M Mantegazza Centro Cardiologico Monzino IRCCS, Milan, Italy C Cefalu" C Cefalu" Centro Cardiologico Monzino IRCCS, Milan, Italy P Gripari P Gripari Centro Cardiologico Monzino IRCCS, Milan, Italy S Ghulam Ali S Ghulam Ali Centro Cardiologico Monzino IRCCS, Milan, Italy M Pepi M Pepi Centro Cardiologico Monzino IRCCS, Milan, Italy Centro Cardiologico Monzino IRCCS, Milan, Italy Background.Timing of mitral valve (MV) surgery in pts with severe degenerative MV regurgitation (MR) is crucial, mainly based on echo left ventricular (LV) parameters, MV morphology and Doppler parameters. Advancements in 3D transthoracic echocardiography (3DTTE) allow a comprehensive evaluation of morpho-functional parameters of the MV and left side cavities. A new software package (HeartModel) was developed to obtain 3D LV and left atrial (LA) volumes using a model-based algorithm (MBA). We recently demonstrated that, in unselected pts, optimization of the user-adjustable slider position improved the correlation and markedly reduced the bias among MBA,3DTTE full-volume (3DFV), and cardiac magnetic resonance (CMR) volumes. Purpose.We sought to assess feasibility and accuracy of MBA (with different slider position) in measurements of LV and LA volumes in pts with severe MR. Methods.We prospectively enrolled 119 consecutive pts. LV and LA volumes,and LV ejection fraction (EF) were obtained using the standard MBA (MBA50-50,sliders 50-50) and compared with the 2D-biplane method, 3DFV modality and, in 36 pts, with CMR measurements.To evaluate the optimal position of the sliders with respect to the 3DFV and CMR, settings of a previous study were applied to optimize data vs 3DFV (MBA39-22,sliders 39-22) or CMR (MBA75-57,sliders 75-57). Linear correlation and Bland-Altman analysis were performed. Results.MBA was feasible in 111 pts (93%) in a mean time of 29 sec. MBA-derived LV volumes correlated significantly with all methods, with slight overestimation of 2D-biplane and slight underestimation of CMR measurements. Higher agreements were found between MBA39-22 and 3DFV, and between MBA75-57 and CMR, with negligible differences both in volumes and LVEF and a remarkable reduction of bias. MBA allowed a very accurate estimation of LA volumes (Table). Conclusions.MBA is highly feasible, reproducible, and rapid, and it correlates highly with 3DTTE and CMRI.It may represent an ideal method to evaluate pts with volume overload due to MV degenerative regurgitation in whom accurate measurements of LV and LA volumes are crucial. Table End diastolic volume End systolic volume Ejection Fraction Left Atrium r bias ± Limits of Agreement r bias ± Limits of Agreement r bias ± Limits of Agreement r bias ± Limits of Agreement MBA50-50 vs 2D-biplane 0.89 23.2 ± 40.9 0.82 21.1 ± 26.2 0.50 -7.7 ± 12.2 0.78 -0.7 ± 50.0 MBA50-50 vs 3DFV 0.93 20.0 ± 31.9 0.88 17.5 ± 22.0 0.62 -6.1 ± 10.3 0.88 4.4 ± 34.2 MBA39-22 vs 3DFV 0.93 10.4 ± 31.2 0.87 2.3 ± 19.3 0.60 1.1 ± 10.7 MBA50-50 vs CMR 0.85 -49.0 ± 55.1 0.81 -15.8 ± 33.1 0.65 -2.8 ± 9.4 MBA75-57 vs CMR 0.89 -23.5 ± 50.5 0.82 -10.8 ± 32.5 0.64 0.3 ± 8.8 End diastolic volume End systolic volume Ejection Fraction Left Atrium r bias ± Limits of Agreement r bias ± Limits of Agreement r bias ± Limits of Agreement r bias ± Limits of Agreement MBA50-50 vs 2D-biplane 0.89 23.2 ± 40.9 0.82 21.1 ± 26.2 0.50 -7.7 ± 12.2 0.78 -0.7 ± 50.0 MBA50-50 vs 3DFV 0.93 20.0 ± 31.9 0.88 17.5 ± 22.0 0.62 -6.1 ± 10.3 0.88 4.4 ± 34.2 MBA39-22 vs 3DFV 0.93 10.4 ± 31.2 0.87 2.3 ± 19.3 0.60 1.1 ± 10.7 MBA50-50 vs CMR 0.85 -49.0 ± 55.1 0.81 -15.8 ± 33.1 0.65 -2.8 ± 9.4 MBA75-57 vs CMR 0.89 -23.5 ± 50.5 0.82 -10.8 ± 32.5 0.64 0.3 ± 8.8 Comparisons between the MBA, 2D-biplane, 3DFV and CMR measurements View Large Table End diastolic volume End systolic volume Ejection Fraction Left Atrium r bias ± Limits of Agreement r bias ± Limits of Agreement r bias ± Limits of Agreement r bias ± Limits of Agreement MBA50-50 vs 2D-biplane 0.89 23.2 ± 40.9 0.82 21.1 ± 26.2 0.50 -7.7 ± 12.2 0.78 -0.7 ± 50.0 MBA50-50 vs 3DFV 0.93 20.0 ± 31.9 0.88 17.5 ± 22.0 0.62 -6.1 ± 10.3 0.88 4.4 ± 34.2 MBA39-22 vs 3DFV 0.93 10.4 ± 31.2 0.87 2.3 ± 19.3 0.60 1.1 ± 10.7 MBA50-50 vs CMR 0.85 -49.0 ± 55.1 0.81 -15.8 ± 33.1 0.65 -2.8 ± 9.4 MBA75-57 vs CMR 0.89 -23.5 ± 50.5 0.82 -10.8 ± 32.5 0.64 0.3 ± 8.8 End diastolic volume End systolic volume Ejection Fraction Left Atrium r bias ± Limits of Agreement r bias ± Limits of Agreement r bias ± Limits of Agreement r bias ± Limits of Agreement MBA50-50 vs 2D-biplane 0.89 23.2 ± 40.9 0.82 21.1 ± 26.2 0.50 -7.7 ± 12.2 0.78 -0.7 ± 50.0 MBA50-50 vs 3DFV 0.93 20.0 ± 31.9 0.88 17.5 ± 22.0 0.62 -6.1 ± 10.3 0.88 4.4 ± 34.2 MBA39-22 vs 3DFV 0.93 10.4 ± 31.2 0.87 2.3 ± 19.3 0.60 1.1 ± 10.7 MBA50-50 vs CMR 0.85 -49.0 ± 55.1 0.81 -15.8 ± 33.1 0.65 -2.8 ± 9.4 MBA75-57 vs CMR 0.89 -23.5 ± 50.5 0.82 -10.8 ± 32.5 0.64 0.3 ± 8.8 Comparisons between the MBA, 2D-biplane, 3DFV and CMR measurements View Large P1777 Errors in regurgitant flow measurement using 3D-PISA: mathematical model of the ISO-Doppler surface compared with in vitro measurements P Decurtins P Decurtins University of Bern, Bern, Switzerland S Brugger S Brugger Numerical Solutions LLC, Zurich, Switzerland C Seiler C Seiler Bern University Hospital, Department of Cardiology, Bern, Switzerland F Zuercher F Zuercher Bern University Hospital, Department of Cardiology, Bern, Switzerland N Brugger N Brugger Bern University Hospital, Department of Cardiology, Bern, Switzerland University of Bern, Bern, Switzerland Numerical Solutions LLC, Zurich, Switzerland Bern University Hospital, Department of Cardiology, Bern, Switzerland Funding Acknowledgements: Swissheart Fondation Introduction: Due to the angle dependency of color Doppler, 3D-PISA cannot be properly imaged: only the 3D ISO-Doppler surface can be displayed and measured. The impact on regurgitant flow measurement of this technical limitation can be modelled mathematically, but has not yet been directly evaluated using 3D echocardiography. Method: A test bench with LV and LA cavities separated by a valve linked to a pulsatile pump mimicking the cardiac cycle was used. Sixteen regurgitant flow rates were simulated (39-225 ml/s) and color Doppler volumes focused on the proximal flow convergence zone were acquired by transesophageal echocardiography (TOE). Real flow rates were obtained by a flow meter. Using a customized software, 3D-PISAs were reconstructed (fig. 1a) from the TOE volumes, using 3 Nyquist velocities (NV) 20.5, 30.8 and 41.1 cm/s; flow rates were calculated as PISA*NV. For each real flow rate, a mathematical model based on the hemispheric 2D PISA formula and accounting for the angle dependency and the line density of the color Doppler was used for the 3 NVs to create 3D ISO-Doppler surfaces (fig. 1b); simulated flow rates were calculated as ISO-Doppler-surface-Area*NV. Results: For technical reasons, 6 of the 48 reconstructed 3D-PISAs were excluded from the analysis: The NV was too low for the flow rates creating big PISAs distorted by the valve annulus and fused with intra-LV flows. The correlations between the 3D-PISA derived flow rates and the real flow rates (fig. 2) show a systematic underestimation irrespective of the NV used for the reconstruction of the 3D PISAs (no difference between the correlation slopes, P = 0.79). The underestimation of the real flow rates observed was significantly smaller than the one predicted by the mathematical model as shown by steeper correlation slopes (fig. 2, P = 0.009) and a smaller percentage (22.9 ± 6.2 vs. 29.1 ± 2.3% underestimation of the real flow rate, p < 0.001). Conclusion: The in vitro measurements confirmed the prediction done by the mathematical model of an underestimation of the regurgitant flow due to the angle dependency of color Doppler when using 3D-PISA. The error observed was smaller than the predicted but still high enough to impact the ability of this technique to grade regurgitations. View largeDownload slide Abstract P1777 Figure. View largeDownload slide Abstract P1777 Figure. P1778 Solving the conundrum of the left ventricular outflow tract diameter for assessment of the aortic valve area in bicuspid aortic valves - defining where and how to measure? A Frampton A Frampton Mater Adult Hospital, Department of Cardiology, Brisbane, Australia A Chong A Chong University Of Queensland, Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia P Cramp P Cramp Mater Adult Hospital, Department of Cardiology, Brisbane, Australia K Davies K Davies Mater Adult Hospital, Department of Cardiology, Brisbane, Australia K Kostner K Kostner Mater Adult Hospital, Department of Cardiology, Brisbane, Australia S Wahi S Wahi University Of Queensland, Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia Mater Adult Hospital, Department of Cardiology, Brisbane, Australia University Of Queensland, Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia Background: Accurate assessment of aortic valve area (AVA) defines the severity of aortic stenosis and determines timing of appropriate intervention. Calculation of AVA using the Doppler-derived continuity equation (CE) is the accepted echocardiographic approach where AVA = 0.785 x (LVOTd)2 x LVOTVTI / AVVTI (LVOTd = left ventricular outflow tract diameter; AV = aortic valve; VTI = velocity-time integral). The "weakest link" remains the LVOTd due to the common underestimation by 2D imaging techniques and the ongoing lack of consensus regarding which anatomic level represents the correct site of measurement (0.5-1cm "apical" in the LVOT (LVOTdApi) vs "annulus" level (LVOTdAnn)). Extrapolating this method of AVA calculation to bicuspid aortic valves (BAV) is more complex given the elliptical orifices and eccentric transvalvular flow patterns. Purpose: To determine the optimal LVOTd measurement using 3D transthoracic echocardiography (TTE; LVOTdApi vs LVOTdAnn by 2D vs 3D TTE) for calculation of the AVA by the CE in patients with BAVs. AVA by 3D TTE planimetry (AVA3D) was used as the reference standard. Methods: All TTEs performed for the assessment of BAVs with 3D imaging datasets of the AV complex were included in the analysis. 2D-LVOTdApi and 2D-LVOTdAnn were measured from the standard parasternal long-axis images. 3D-LVOTd values were derived from multi-planar reconstructed measurements of circumference, area and average of major-minor dimensions at the "apical" (3D-LVOTdApi-Circ; 3D-LVOTdApi-Area; 3D-LVOTdApi-Ave) and "annulus" (3D-LVOTdAnn-Circ; 3D-LVOTdAnn-Area; 3D-LVOTdAnn-Ave) levels from the acquired 3D TTE datasets. 3D planimetry of the BAV orifices (AVA3D) were similarly performed. LVOTVTI and AVVTI parameters were obtained from the AV spectral Doppler tracings. Results: 61 TTEs were included (38 ± 14years; 44% females). Mean AVA3D was 3.46 ± 1.92cm2. Estimated AVAs by CE using 2D-LVOTdApi, 2D-LVOTdAnn, 3D-LVOTdApi-Circ, 3D-LVOTdApi-Area, 3D-LVOTdApi-Ave, 3D-LVOTdAnn-Circ, 3D-LVOTdAnn-Area, and 3D-LVOTdAnn-Ave were 2.72 ± 1.82cm2, 2.93 ± 2.02cm2, 3.41 ± 2.14cm2, 3.21 ± 2.00cm2, 3.11 ± 1.96cm2, 3.34 ± 2.08cm2, 3.23 ± 2.00cm2, and 3.11 ± 1.96cm2 respectively. AVA by CE using 3D-LVOTdApi-Circ (Intraclass correlation (ICC) 0.98) and 3D-LVOTdAnn-Circ (ICC 0.97) correlated best with AVA3D. The use of both conventional 2D-LVOTd resulted in consistent underestimation of the AVA although 2D-LVOTdAnn outperformed 2D-LVOTApi (ICC 0.87 vs 0.79). Conclusions: BAV AVA assessments by CE incorporating LVOTd by 3D circumference (either 3D-LVOTdApi-Circ or 3D-LVOTdAnn-Circ) were superior to other LVOTd measurements. 2D-LVOTdAnn resulted in a more "accurate" estimation of the AVA in comparison to 2D-LVOTApi, highlighting the "annulus" level as the preferred anatomic site for conventional 2D TTE LVOTd measurements, if 3D imaging was not readily available. P1779 The diagnostic role of 3D stress contrast echo in patients with known or suspected coronary artery disease. a single center 3D Stress contraSt echo Study (3D SSS) C Aggeli C Aggeli Hippokration General Hospital , Athens, Greece I Dimitroglou I Dimitroglou Hippokration General Hospital , Athens, Greece A Verveniotis A Verveniotis Hippokration General Hospital , Athens, Greece L Raftopoulos L Raftopoulos Hippokration General Hospital , Athens, Greece K Zisimos K Zisimos Hippokration General Hospital , Athens, Greece A Aggelis A Aggelis Hippokration General Hospital , Athens, Greece P Tolis P Tolis Hippokration General Hospital , Athens, Greece E Tolis E Tolis Hippokration General Hospital , Athens, Greece D Tousoulis D Tousoulis Hippokration General Hospital , Athens, Greece Hippokration General Hospital , Athens, Greece Background: The dobutamine stress contrast echo (DSCE) is a versatile and accurate method in clinical practice. The application of 3D echocardiography during dobutamine stress protocol has not been extensively studied. The purpose of this study was to evaluate the diagnostic role of 3D DSCE in patients with suspected coronary artery disease (CAD). Methods: 120 patients with known or suspected coronary artery disease have undergone dobutamine stress contrast study and coronary angiography, within a 1-month period. An X5 probe was used and two-dimensional (2D) apical four, two, and three chamber view as well as three-dimensional (3D) pyramidal full-volume data sets were acquired at rest and peak stress using LVO modality. The 17-segment division of the left ventricle was used and each segment was evaluated. The Wall Motion Score Index (WMSI) was assessed in 2D and 3D echo studies. Results: The mean age was 64 ± 7 years, 75 men. The LVEF was in normal range (58 ± 3%) while 98 patients had CAD. The acquisition time for 2D views was significantly higher compared to 3D views (65 ± 3ms vs 32 ± 2ms, p < 0.05). The WMSI derived by 2D and 3D evaluation at rest and at peak of DSCE were similar (1.02 ± 0.2 vs 1.05 ± 0.3 and 1.28 ± 0.4 vs 1.30 ± 0.5 respectively). Excellent correlation was demonstrated between 2D WMSI and 3D WMSI (r = 0.92). Wall-motion analysis per patient revealed that the sensitivity (90 %) and specificity (62 %) of 2D and 3D analysis were identical. Conclusion: 3D stress contrast echo can be considered as an alternative technique to evaluate myocardial wall motion in patients with known or suspected coronary artery disease. It has identical diagnostic accuracy with 2D analysis with the advantage of markedly shorter acquisition time. P1780 The echocardiographic ratio between tricuspid regurgitation peak velocity and left atrial global strain differentiates pre-capillary from post-capillary pulmonary hypertension A Venkateshvaran A Venkateshvaran Karolinska Institute, Stockholm, Sweden A Manouras A Manouras Karolinska University Hospital, Stockholm, Sweden C Da Silva C Da Silva Karolinska University Hospital, Stockholm, Sweden H Abdulrahim H Abdulrahim Karolinska University Hospital, Stockholm, Sweden AI Nagy AI Nagy Semmelweis University Heart Center, Budapest, Hungary A Lundberg A Lundberg Karolinska University Hospital, Stockholm, Sweden B Kjellstrom B Kjellstrom Karolinska Institute, Stockholm, Sweden LH Lund LH Lund Karolinska Institute, Stockholm, Sweden Karolinska Institute, Stockholm, Sweden Karolinska University Hospital, Stockholm, Sweden Semmelweis University Heart Center, Budapest, Hungary C Sequeira C Sequeira Karolinska University Hospital, Stockholm, Sweden Funding Acknowledgements: This study was supported by the Swedish association for Pulmonary Hypertension and the Janos Bolyai Scholarship of Hungarian Academy of Sciences Background. A clear distinction between pre-capillary and post-capillary pulmonary hypertension (PH) is imperative for optimal therapeutic management. We hypothesized that the ratio between echocardiographic tricuspid regurgitation peak velocity (TRVmax) and left atrial global strain (LA-GS) can differentiate these two groups. Methods. We enrolled consecutive subjects referred for right heart catheterization for assessment of unexplained dyspnoea or heart failure. Simultaneous echocardiography was performed. Subjects with significant valvular disease, atrial fibrillation or pacing therapy, and those that did not fulfil invasive hemodynamic criteria for PH were excluded from analysis. TRVmax was measured employing CW Doppler. LA-GS was assessed by speckle tracking echocardiography during the reservoir phase. Results. 134 subjects were analysed (pre-capillary: n = 68, post-capillary: n = 66). Pre-capillary PH subjects demonstrated significantly higher invasive pulmonary vascular resistance (PVR: 7.8 ± 3 vs 3.2 ± 2 WU; p < 0.001), TRVmax (3.9 ± 1.1 vs. 3.3 ± 0.5m/s; p < 0.001) and LA-GS (26 ± 9 vs 12 ± 7%; p < 0.001) as compared with post-capillary PH. The TRVmax/LA-GS ratio demonstrated a significant association with invasive PVR (r = 0.30; p = 0.02) and was significantly lower in pre-capillary PH as compared with post-capillary PH (0.19 ± 0.14 vs. 0.51 ± 0.78m/s/%; p = 0.02). At a cut-off of 0.18, the ratio yielded a 92% sensitivity and 70% specificity to identify pre- vs. post-capillary PH (AUC: 0.83, CI: 0.76 -0.90; p < 0.01). Conclusions. The novel TRVmax/LA-GS ratio can differentiate pre-capillary from post-capillary PH patient groups and may be of value in candidate selection for pulmonary vasodilator therapy, heart / heart-lung transplantation, and durable mechanical circulatory support. P1781 Non homogenous deformation pattern of the left ventricle in familial amyloid polyneuropathy: is this the norm? S Goncalves S Goncalves centro hospitalar norte lisboa- hospital de Santa Maria, lisboa, Portugal N Cortez-Dias N Cortez-Dias Serviço de Cardiologia, Hospital Universitário de Santa Maria, CHLN, CAML, CCUL, FMUL, Lisboa, Portugal L Santos L Santos Serviço de Cardiologia, Hospital Universitário de Santa Maria, CHLN, CAML, CCUL, FMUL, Lisboa, Portugal T Guimaraes T Guimaraes Serviço de Cardiologia, Hospital Universitário de Santa Maria, CHLN, CAML, CCUL, FMUL, Lisboa, Portugal G Silva G Silva Serviço de Cardiologia, Hospital Universitário de Santa Maria, CHLN, CAML, CCUL, FMUL, Lisboa, Portugal AR Francisco AR Francisco Serviço de Cardiologia, Hospital Universitário de Santa Maria, CHLN, CAML, CCUL, FMUL, Lisboa, Portugal J Agostinho J Agostinho Serviço de Cardiologia, Hospital Universitário de Santa Maria, CHLN, CAML, CCUL, FMUL, Lisboa, Portugal I Goncalves I Goncalves Serviço de Cardiologia, Hospital Universitário de Santa Maria, CHLN, CAML, CCUL, FMUL, Lisboa, Portugal I Conceicao I Conceicao Centro Hospitalar Lisboa Norte - Hospital de Santa Maria, Lisboa, Portugal AG Almeida AG Almeida Centro Hospitalar Lisboa Norte - Hospital de Santa Maria, Lisboa, Portugal FJ Pinto FJ Pinto Centro Hospitalar Lisboa Norte - Hospital de Santa Maria, Lisboa, Portugal C Azevedo Coutinho C Azevedo Coutinho Centro Hospitalar Lisboa Norte - Hospital de Santa Maria, Lisboa, Portugal centro hospitalar norte lisboa- hospital de Santa Maria, lisboa, Portugal Serviço de Cardiologia, Hospital Universitário de Santa Maria, CHLN, CAML, CCUL, FMUL, Lisboa, Portugal Centro Hospitalar Lisboa Norte - Hospital de Santa Maria, Lisboa, Portugal Introduction: Transthyretin V30M familial amyloid polyneuropathy (FAP) is characterized by progressive amyloid accumulation in the heart, although the typical changes of cardiomyopathy are seen only in advanced stages of the disease. The echocardiographic modalities such as 2 dimensional (2D) strain and strain rate may allow the detection of early changes in ventricular dysfunction and identify a pattern of left ventricular myocardial deformation that helps to stratify the prognosis in these patients. Purpose: To evaluate the pattern of regional myocardial deformation (strain and strain rate) using the 2D speckle tracking in a group of symptomatic and asymptomatic patients with V30M-TTR. Methods: Prospective study of patients with V30M-TTR mutation, in sinus rhythm, age ≥18 years and conserved ejection fraction (calculated by the Simpson method ³55%). All patients underwent clinical and laboratory evaluation and performed echocardiographic study with analysis of the longitudinal myocardial deformation by speckle tracking imaging. The myocardial deformation was performed in post-processing in the three apical views (4, 3 and 2 chambers) and the values of the longitudinal deformation [Longitudinal Peak Systolic Strain (LS), Longitudinal Peak Systolic Strain Rate (SRsL), Longitudinal Protodiastolic Peak Strain Rate (SRpL), Longitudinal Telediastolic Peak Strain Rate (SRtL)] in 18 segments. Symptomatic patients were compared with asymptomatic patients. For detection of segmental myocardial compromise we used the cut-offs for normality. Results: A total of 186 patients (mean age = 46 ± 13 years, 51% female, 67.2% with neurological involvement) were included. The regional values of longitudinal strain showed compromise of systolic function in the basal and median segments of left ventricle (-16.3%±6.42 and -17.48 ±5.28%). The comparison between symptomatic and asymptomatic patients demonstrated that symptomatic patients had significantly lower strain and strain rates. Conclusions: Patients with V30M-TTR FAP have compromised regional systolic myocardial deformation in basal and median segments. This pattern of alteration of regional deformation in which the apex is spared was already seen in asymptomatic patients. However, the strain rate was significantly decreased in symptomatic patients. It is possible that these new parameters may be useful for better characterization of the spectrum of the disease. P1782 Impact of right ventricular size and function on prognosis in left ventricular non-compaction cardiomyopathy L Erhart L Erhart University Heart Center, Cardiology, Zurich, Switzerland BA Kaufmann BA Kaufmann University Hospital Basel, Basel, Switzerland B Gencer B Gencer Geneva University Hospitals, Geneva, Switzerland PK Haager PK Haager Cantonal Hospital St. Gallen, St. Gallen, Switzerland H Muller H Muller Geneva University Hospitals, Geneva, Switzerland FC Tanner FC Tanner University Heart Center, Cardiology, Zurich, Switzerland University Heart Center, Cardiology, Zurich, Switzerland Flury Stiftung, Hospital of Schiers, Internal Medicine, Schiers, Switzerland University Hospital Basel, Basel, Switzerland Geneva University Hospitals, Geneva, Switzerland Cantonal Hospital St. Gallen, St. Gallen, Switzerland SF Stampfli SF Stampfli University Heart Center, Cardiology, Zurich, Switzerland TG Donati TG Donati University Heart Center, Cardiology, Zurich, Switzerland J Hellermann J Hellermann Flury Stiftung, Hospital of Schiers, Internal Medicine, Schiers, Switzerland Introduction – Left ventricular non-compaction cardiomyopathy (LVNC) is a potentially life threatening disease of left ventricular myocardium characterized by a thin, compacted, epicardial layer and a thick trabeculated endocardial layer. While left ventricular impairment correlates with outcome, the prognostic role of right ventricular (RV) size and function remains unclear. Purpose – This study aimed at assessing the prognostic role of RV size and function on prognosis in LVNC patients. Methods – All patients from a Swiss multi-center LVNC registry were included in this retrospective study. RV dimension and function, right atrial (RA) size and RV/RA pressure gradients were assessed. By use of multi- and univariate Cox regression analysis the composite-endpoint of death and need for heart transplantation was analyzed. Receiver operating characteristic curves were used to assess cut-off values. Results – 127 patients with a mean age of 53 years were included in the study. During a median follow-up of 7.7 years (longest 16.3), 11 patients died and 6 underwent heart transplantation. As shown in Table 1 RV and RA dimensions as well as TAPSE and RV/RA gradients were significantly different in patients reaching the endpoint, whereas FAC did not reach statistical significance. In the multivariate regression analysis including left ventricular end-diastolic volume, RV end-diastolic area was independently associated with death or heart transplantation (p = 0.0003) and a cut-off of 19.8 cm2 provided the best discrimination (Figure 1). Conclusion – This study in a large LVNC cohort provides evidence that dilatation of right-sided cardiac chambers and decrease in RV function is associated with increased mortality. RV end-diastolic area was observed to be a strong independent predictor of outcome, as assessed in a multi-variate model including left ventricular end-diastolic volume. This data suggests that RV involvement is a bad prognostic sign in LVNC patients. All Patients (n = 127) Patients reaching endpoint (n = 17) Patients not reaching endpoint (n = 110) P Value Age (years; mean ± SD) 53.2 ± 17.8 55.2 ± 18.6 (n = 17) 52.9 ± 17.7 (n = 110) 0.5929 Median follow-up (years, median, IQR) 7.7 (4.5-11.1) 6.4 (1.8-10.3) (n = 17) 8.9 (4.7-11.1) (n = 110) 0.0919 TAPSE (mm, mean ± SD) 20.4± 5.2 18.1 ± 4.2 (n = 15) 20.8 ± 5.3 (n = 84) 0.042 RVED Area (cm2,median, IQR) 17.3 (14.0-20.7) 22 (17.3-26.1) (n = 13) 16.8 (14.0-19.7) (n = 90) 0.0016 FAC (%, median, IQR) 45 (35-52) 30 (24.5-49.5) (n = 13) 45 (37-52) (n = 89) 0.059 RV/RA gradient (mmHg, mean ± SD) 27.8± 12.3 37.4 ± 21.3 (n = 12) 26.0 ± 8.7 (n = 60) 0.032 LVEF (%, mean ± SD) 41.6 (16.8) 24.7 ± 12.2 (n = 17) 44.3 ±15.9 (n = 107) <0.001 LVEDV (ml, mean ± SD) 144.5 ± 74.5 219.8 ± 91.7 (n = 16) 131.3 ± 62.8 (n = 91) <0.001 All Patients (n = 127) Patients reaching endpoint (n = 17) Patients not reaching endpoint (n = 110) P Value Age (years; mean ± SD) 53.2 ± 17.8 55.2 ± 18.6 (n = 17) 52.9 ± 17.7 (n = 110) 0.5929 Median follow-up (years, median, IQR) 7.7 (4.5-11.1) 6.4 (1.8-10.3) (n = 17) 8.9 (4.7-11.1) (n = 110) 0.0919 TAPSE (mm, mean ± SD) 20.4± 5.2 18.1 ± 4.2 (n = 15) 20.8 ± 5.3 (n = 84) 0.042 RVED Area (cm2,median, IQR) 17.3 (14.0-20.7) 22 (17.3-26.1) (n = 13) 16.8 (14.0-19.7) (n = 90) 0.0016 FAC (%, median, IQR) 45 (35-52) 30 (24.5-49.5) (n = 13) 45 (37-52) (n = 89) 0.059 RV/RA gradient (mmHg, mean ± SD) 27.8± 12.3 37.4 ± 21.3 (n = 12) 26.0 ± 8.7 (n = 60) 0.032 LVEF (%, mean ± SD) 41.6 (16.8) 24.7 ± 12.2 (n = 17) 44.3 ±15.9 (n = 107) <0.001 LVEDV (ml, mean ± SD) 144.5 ± 74.5 219.8 ± 91.7 (n = 16) 131.3 ± 62.8 (n = 91) <0.001 View Large All Patients (n = 127) Patients reaching endpoint (n = 17) Patients not reaching endpoint (n = 110) P Value Age (years; mean ± SD) 53.2 ± 17.8 55.2 ± 18.6 (n = 17) 52.9 ± 17.7 (n = 110) 0.5929 Median follow-up (years, median, IQR) 7.7 (4.5-11.1) 6.4 (1.8-10.3) (n = 17) 8.9 (4.7-11.1) (n = 110) 0.0919 TAPSE (mm, mean ± SD) 20.4± 5.2 18.1 ± 4.2 (n = 15) 20.8 ± 5.3 (n = 84) 0.042 RVED Area (cm2,median, IQR) 17.3 (14.0-20.7) 22 (17.3-26.1) (n = 13) 16.8 (14.0-19.7) (n = 90) 0.0016 FAC (%, median, IQR) 45 (35-52) 30 (24.5-49.5) (n = 13) 45 (37-52) (n = 89) 0.059 RV/RA gradient (mmHg, mean ± SD) 27.8± 12.3 37.4 ± 21.3 (n = 12) 26.0 ± 8.7 (n = 60) 0.032 LVEF (%, mean ± SD) 41.6 (16.8) 24.7 ± 12.2 (n = 17) 44.3 ±15.9 (n = 107) <0.001 LVEDV (ml, mean ± SD) 144.5 ± 74.5 219.8 ± 91.7 (n = 16) 131.3 ± 62.8 (n = 91) <0.001 All Patients (n = 127) Patients reaching endpoint (n = 17) Patients not reaching endpoint (n = 110) P Value Age (years; mean ± SD) 53.2 ± 17.8 55.2 ± 18.6 (n = 17) 52.9 ± 17.7 (n = 110) 0.5929 Median follow-up (years, median, IQR) 7.7 (4.5-11.1) 6.4 (1.8-10.3) (n = 17) 8.9 (4.7-11.1) (n = 110) 0.0919 TAPSE (mm, mean ± SD) 20.4± 5.2 18.1 ± 4.2 (n = 15) 20.8 ± 5.3 (n = 84) 0.042 RVED Area (cm2,median, IQR) 17.3 (14.0-20.7) 22 (17.3-26.1) (n = 13) 16.8 (14.0-19.7) (n = 90) 0.0016 FAC (%, median, IQR) 45 (35-52) 30 (24.5-49.5) (n = 13) 45 (37-52) (n = 89) 0.059 RV/RA gradient (mmHg, mean ± SD) 27.8± 12.3 37.4 ± 21.3 (n = 12) 26.0 ± 8.7 (n = 60) 0.032 LVEF (%, mean ± SD) 41.6 (16.8) 24.7 ± 12.2 (n = 17) 44.3 ±15.9 (n = 107) <0.001 LVEDV (ml, mean ± SD) 144.5 ± 74.5 219.8 ± 91.7 (n = 16) 131.3 ± 62.8 (n = 91) <0.001 View Large View largeDownload slide Abstract P1782 Figure. View largeDownload slide Abstract P1782 Figure. P1783 Bicuspid aortic valve: insights into natural history of the disease according to phenotype J Rigueira J Rigueira Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal A Nunes-Ferreira A Nunes-Ferreira Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal I Aguiar-Ricardo I Aguiar-Ricardo Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal JR Agostinho JR Agostinho Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal I Santos-Goncalves I Santos-Goncalves Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal R Santos R Santos Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal T Rodrigues T Rodrigues Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal N Cunha N Cunha Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal R Placido R Placido Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal C David C David Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal FJ Pinto FJ Pinto Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal AG Almeida AG Almeida Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology Department, Lisbon, Portugal Introduction: Bicuspid aortic valvulopathy (BAV) is one of the most common congenital heart diseases, being associated with valvular dysfunction and severe complications such as endocarditis and aortic dissection. Phenotypically there are 3 types according to the presence / absence of raphe and the involved cusps. The natural history of the disease, the clinical impact of these phenotypes remain a matter of study. Objective: To characterize a population of patients with BAV and to determine the clinical impact of the valvular phenotype Methods: Retrospective, single-center study of consecutive pts with BAV documented on echocardiogram in the last 8 years. Demographic, clinical and echocardiographic data were obtained. Clinical and echocardiographic progression of valvular disease was evaluated. Factors associated with BAV phenotype were identified by the Student-T and Chi-Square (X2) tests. Results: A total of 200 patients (age 50.7 ± 15.2 years, 74% men) were included; 28,6% were smokers and 47,3% with arterial hypertension. 46.8% had aortic regurgitation, 27.2% had aortic stenosis, 4.6% had mixed valvular disease and 21.4% had no valvular dysfunction. 46.2% had aortic dilatation. During an average follow-up of 3.01 ± 3.3 years, 28.7% underwent aortic valve intervention (54% with mechanical prosthesis, 41% biological and 5% percutaneous) and 15% had aortic surgery. ). 5,3% of patients had endocarditis at follow-up and 11% died. In the assessment of the valvular phenotype, 69.5% pts were type 1 (BAV 1), 25.8% type 2 (BAV 2) and 4.6% type 3 (BAV 3). BAV 1 was associated with regurgitation (p = 0.023), aortic aneurysm (p =0.04) and progression of the disease to valvular intervention (p =0.031), in comparison to BAV 2 phenotype. On the other hand, in comparison to BAV 1 phenotype, BAV 2 was associated with valvular stenosis, greater interventricular septum (mean 11.7 vs 10.8mm, p = 0.039) and posterior wall (11.0 vs 10.3mm, p < 0.05) thickness, and higher left atrium volume (82.6 vs 58.7mL, p = 0.01). Conclusion: The natural history of the disease seems to differ according to the BAV phenotype, with BAV 1 being associated with regurgitation, aortic aneurysm and the need of valvular intervention. P1784 Emergence of intracavitary vortex in isovolumic relaxation period in dyssynchronized left ventricle induced by right ventricular pacing T Iino T Iino Akita University Graduate School of Medicine, Department of Cardiovascular Medicine, Akita, Japan W Sato W Sato Akita University Graduate School of Medicine, Department of Cardiovascular Medicine, Akita, Japan H Watanabe H Watanabe Akita University Graduate School of Medicine, Department of Cardiovascular Medicine, Akita, Japan Akita University Graduate School of Medicine, Department of Cardiovascular Medicine, Akita, Japan Background & purpose: Right ventricular pacing (RVP) induces left ventricular (LV) dyssynchrony, which affects LV diastolic filling as well as systolic function. However, effects of RVP on LV intracavitary flow dynamics are not fully understood. Recently, we can evaluate LV intracavitary flow dynamics by using Vector Flow Mapping (VFM), which can display and quantify the vortex which occurs in the heart cavity. We aimed to characterize LV vortex in patients with RVP. Methods: A total of 49 patients (33 patients with RV apical pacing after pacemaker implantation and 16 healthy volunteers), of whom LV vortex was assessed with VFM, were enrolled. In patients with pacemaker implantation (PM group), echocardiographic study with VFM was conducted under RVP-on and -off. Patients with coronary artery disease or valvular diseases were excluded. Results: In comparison to RVP-off condition, RVP-on induced significant longer QRS duration (108 ± 21 vs. 163 ± 25 msec., RVP-off vs. RVP-on; p < 0.001), greater standard deviation of the time to the peak longitudinal strain (61 ± 12 vs. 86 ± 17, p < 0.001), longer isovolumic relaxation (IVR) time (90 ± 17 vs. 112 ± 13 msec., p < 0.0001), and decreased filling time of the cardiac cycle (%FT) (56 ± 5.8 vs. 47 ± 6.1%, p < 0.001), suggesting RVP induced LV dyssynchrony. Regardless of PM group or healthy volunteers, transient vortex formations in anterior and posterior side of LV inlet were observed in the rapid filling period. Subsequently, a single large vortex formed at the center of LV during diastole and the ejection flow streamed out smoothly to the aorta. In IVR period, the vortex disappeared in almost all healthy volunteers. On the other hand, careful observation revealed an occurrence of vortex in IVR period (Vo-IVR) in PM group. The prevalence of Vo-IVR was significantly higher under RVP-on (82%) compared with 21% under RVP-off (p < 0.0001) in PM group. In patients with having Vo-IVR, significant correlations were found between the vorticity (index for vortex intensity) of Vo-IVR and QRS duration (r = 0.55, p < 0.01) or changes in %FT (r=-0.50, p < 0.05). These results suggest that RVP-induced LV dyssynchrony may result in the occurrence of Vo-IVR and abnormal LV diastolic filling. Conclusion: RVP-induced LV dyssynchrony increases the occurrence of Vo-IVR. Vo-IVR has a potential as a marker of LV dyssynchrony. View largeDownload slide Abstract P1784 Figure. Occurrence of vortex in IVR period View largeDownload slide Abstract P1784 Figure. Occurrence of vortex in IVR period P1785 Comprehensive detection of aortic stenosis in the general population requires low-threshold access to echocardiography Results from the population-based STAAB cohort study G Gelbrich G Gelbrich University of Wuerzburg, Institute of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, Wuerzburg, Germany T Tiffe T Tiffe University of Wuerzburg, Institute of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, Wuerzburg, Germany M Wagner M Wagner University of Wuerzburg, Institute of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, Wuerzburg, Germany PU Heuschmann PU Heuschmann University of Wuerzburg, Institute of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, Wuerzburg, Germany S Stoerk S Stoerk University Hospital Wuerzburg, Comprehensive Heart Failure Center and Dept. of Medicine I, Wuerzburg, Germany University Hospital Wuerzburg, Comprehensive Heart Failure Center and Dept. of Medicine I, Wuerzburg, Germany University of Wuerzburg, Institute of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, Wuerzburg, Germany C Morbach C Morbach University Hospital Wuerzburg, Comprehensive Heart Failure Center and Dept. of Medicine I, Wuerzburg, Germany M Breunig M Breunig University Hospital Wuerzburg, Comprehensive Heart Failure Center and Dept. of Medicine I, Wuerzburg, Germany Funding Acknowledgements: The study is supported by the German Ministry of Research and Education within the CHFC Würzburg (BMBF 01EO1004 and 01EO1504) Background Aortic valve stenosis (AS) is the most frequent valvular disease in Western countries. Untreated AS has a poor prognosis in terms of survival. In general practice, the trigger for further evaluation of the aortic valve is either the patient presenting with typical symptoms or the physician noticing a systolic murmur during physical examination. Purpose To determine population-based prevalence rates and determinants of AS and to evaluate the diagnostic impact of cardiac auscultation and clinical assessment. Methods We report data of a planned interim analysis of the prospective Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study investigating a representative sample of residents of the City of Würzburg, Germany, aged 30 to 79 years and reporting no previous history of HF. Participants undergo detailed clinical evaluation including assessment of cardiac murmurs, pulmonary rales, peripheral edema, and dyspnea on exertion, as well as transthoracic echocardiography including a dedicated evaluation of the aortic valve. AS was graded according to current recommendations into mild, moderate, and severe (aortic valve maximal velocity >2.5 m/s, >3 m/s, >4 m/s; aortic valve mean gradient <20 mmHg, 20-40 mmHg, >40 mmHg, respectively). Results Of 2473 individuals, 2456 (52% female) had valid echocardiography including evaluation of aortic valve. Of these, n = 19 (0.8%) had aortic valve stenosis (AS; 11 mild, 4 moderate, 4 severe), 10 (53%) were females, 1/ 4/ 14 were in the 6th/ 7th/ 8th decade of life. Thus, prevalence rates of AS were 0% (95%CI 0-0.4%)/ 0.2% (95%CI <0.1-0.9%)/ 0.6% (95%CI 0.1-1.6%)/ 5.5% (95%CI 3.0-9.1%) in the 4-5th/ 6th/ 7th/ 8th decade, respectively. 11/19 (58%) individuals exhibited signs & symptoms compatible with AS (8 dyspnea on exertion, 7 edema, 1 pulmonary rales) compared to 54% of individuals of comparable age without AS. Four subjects with AS were asymptomatic: 2 with mild, 1 with moderate, and 1 with severe AS. 2167 individuals had a complete physician-based clinical evaluation. Systolic murmur over the aortic listening post was found in 15/19 (79%) individuals with AS, but also in 124/2148 (6%) of individuals without AS thus yielding a positive predictive value of 11%. Conclusions Assessing population-based prevalence rates, we found AS a condition of advanced age reaching a prevalence of 5.5% in the 8th decade. Individuals with AS did not have more symptoms compared to individuals of comparable age but without AS, and even higher grades of AS could be asymptomatic. Further, cardiac auscultation was of limited diagnostic value. These findings highlight the challenge of correct diagnosis of AS in general practice based on clinical evaluation and the need for low-threshold availability of echocardiographic evaluation in individuals with suspected AS. P1786 Cardiac left ventricular structure and function in healthy subjects older than 80 year O Vriz O Vriz King Faisal Hospital & Research Center, Cardiology-Echocardiography, Riyadh, Saudi Arabia D Galzerano D Galzerano King Faisal Hospital & Research Center, Cardiology-Echocardiography, Riyadh, Saudi Arabia M Adam M Adam King Faisal Hospital & Research Center, Cardiology-Echocardiography, Riyadh, Saudi Arabia M Al Humaid M Al Humaid King Faisal Hospital & Research Center, Cardiology-Echocardiography, Riyadh, Saudi Arabia K Alassas K Alassas King Faisal Hospital & Research Center, Cardiology-Echocardiography, Riyadh, Saudi Arabia G Di Salvo G Di Salvo Royal Bromptom Hospital, Cardiology, London, United Kingdom B Fadel B Fadel King Faisal Hospital & Research Center, Cardiology-Echocardiography, Riyadh, Saudi Arabia E Bossone E Bossone Cava deTirreni-Amalfi Coast Hospital, Salerno, Italy King Faisal Hospital & Research Center, Cardiology-Echocardiography, Riyadh, Saudi Arabia Royal Bromptom Hospital, Cardiology, London, United Kingdom Cava deTirreni-Amalfi Coast Hospital, Salerno, Italy Propose. The very old population is the world’s most rapid growing age group but despite its rapidly increasing numbers it still not clearly known how is the left ventricular (LV) adaptation. The aim of the study was to define the cardiac structure and function of a group of healthy old subjects, compared to a younger population. Methods. 618 healthy subjects aged 18-100 years (335 males, 283 females) were enrolled. The had a complete medical medical evaluation and a comprehensive TTE with structural and functional parameters, included LV-arterial coupling. The population was divided in four groups: 18-50 group 1 (311 subjects), 50-60 group 2 (100 subjects), 60-80 group 3 (170 subjects) and 80-100 group 4 (37 subjects), compared by ANOVA and adjusted by gender and physical activity. The oldest subjects were completely independent in daily living activities. Results. Body mass index increased with age but than declined in the oldest group. Systolic blood pressure (BP) and diastolic BP kept increasing with age. Left atrial volume (p < 0.0001), LV mass/ body surface area and relative wall thickness increased significantly with age (p < 0.0001). Diastolic function was inversely related to age (E/A and E/Em p < 0.0001). The ejection fraction slightly decreased although the difference did not reach the statistical significance while Sm wave, an index of systolic function decreased significantly (group 1: 9.3 ± 1.8; group 2 9.2 ± 2.1; group 3: 8.6 ± 2.0; group 4: 7.8 ± 1.8 cm/s, p < 0.0001). The arterial elastance (Ea), a measure of impedence or ventricular afterload, increased with age (group 1: 1.76 ± 0.41; group 2 1.71 ± 0.38; group 3: 1.88 ± 0.44; group 4: 1.88 ± 0.44 mmHg/ml , p < 0.0001), ventricular elastance (Ees) index or LV systolic stiffness also increase but did not reached the statistical significance (group 1: 2.13 ± 0.6; group 2 2.06 ± 0.55; group 3: 2.19 ± 0.64; group 4: 2.45 ± 1.2 mmHg/ml, p = 0.004). The ratio Ea/Ees, index of ventricular-arterial coupling, did no change among the groups (group 1: 0.86 ± 0.18; group 2 0.89 ± 0.23; group 3: 0.85 ± 0.14; group 4: 0.91 ± 0.22, p = 0.07). Stroke volume index increased according to age (group 1: 35.9 ± 8.2; group 2 38.3 ± 8.5; group 3: 38.1 ± 7.9; group 4: 39.8 ± 7.6 ml/m2, p = 0.001) and ejection time index by heart rate as well (group 1: 414.7 ± 25.1; group 2 417.1 ± 21.9; group 3: 425.0 ± 26.2; group 4: 429.7 ± 33.4 sec, p < 0.0001). Also LV stress and stroke work index (SWI) increased accordingly to age (group 1: 61.36 ± 18.4; group 2 61.36 ± 18.4; group 3: 55.36 ± 17.3; group 4: 62.7 ± 28.3 dyne/cm2, p = 0.006; group 1: 44.3 ± 10.9; group 2 49.97 ± 10.7; group 3: 49.7 ± 10.7; group 4: 54.0 ± 12.0 g/min/m2, p = 0.0001 respectively). Conclusion. LV systolic function in the older healthy subjects is similar to the other age groups but this is obtain with concentric LV hypertrophy, increasing in systolic work and wall stress. Most likely the normal LV function is mantained at the expense of contractility reserve and flow reserve. P1788 Analysis of the changes in left ventricular regional performance by speckle tracking imaging in patients with Takotsubo cardiomyopathy after subarachnoid hemorrhage K Sugimoto K Sugimoto Fujita Health University, Toyoake, Japan A Yamada A Yamada Fujita Health University, Toyoake, Japan K Nakamura K Nakamura Fujita Health University Hospital, Clinical Laboratory, Toyoake, Japan M Amano M Amano Fujita Health University Hospital, Clinical Laboratory, Toyoake, Japan K Sugimoto K Sugimoto Fujita Health University Hospital, Clinical Laboratory, Toyoake, Japan Y Kawada Y Kawada Fujita Health University, Toyoake, Japan N Hoshino N Hoshino Fujita Health University, Toyoake, Japan M Hoshino M Hoshino Fujita Health University, Toyoake, Japan K Takada K Takada Fujita Health University, Toyoake, Japan E Sakaguchi E Sakaguchi Fujita Health University, Toyoake, Japan Y Ozaki Y Ozaki Fujita Health University, Toyoake, Japan Fujita Health University, Toyoake, Japan Fujita Health University Hospital, Clinical Laboratory, Toyoake, Japan Background: Takotsubo cardiomyopathy (TC) is well known to be complicated with subarachnoid hemorrhage (SAH). Left ventricular (LV) wall motion abnormality (WMA) of TC is usually transient, however, the process of recovery from WMA remains to be clarified. The aim of this study is to examine LV regional performance of TC after SAH and to clarify the recovering process using 2D speckle tracking analysis. Methods: We studied 16 TC cases with SAH (15 females, 67.1 ± 11.9 years). They were admitted to the neuro care unit of our institution because of SAH within 24 hours of the onset between June 2009 and July 2016. We performed echocardiography including speckle tracking imaging (Vivid E9, GE) on admission (day 1) and 5 days later (day 5). Longitudinal peak strain and post-systolic shortening (PSS) time were measured. PSS time was corrected by R-R interval (corrected PSS). Results: LV ejection fraction increased significantly in day 5 (40.9 ± 6.8% vs 51.6 ± 9.6%, day 1 vs day 5, p = 0.004). Longitudinal peak strain in apex also improved significantly in day 5 (-11.5 ± 5.4% vs -20.5 ± 6.7%, day 1 vs day 5, p < .0001), whereas that in base did not change (-13.5 ± 0.6% vs -14.3 ± 5.1, day 1 vs day 5, ns). On the other hand, there were no significant differences in corrected PSS in both apex (119.4 ± 66.2 vs 93.4 ± 99.8, day 1 vs day 5, ns) and base (84.0 ± 68.0 vs 86.5 ± 73.6, day 1 vs day 5, ns). Conclusion: These results suggest that LV dispersion in apex would remain even after LV apical longitudinal strain improves in TC patients after SAH. P1789 Epicardial adipose tissue predicts outcome in patients with systolic heart failure R Formisano R Formisano University of Naples Federico II, Department of Translational Medical Sciences , Naples, Italy FV Grieco FV Grieco University of Naples Federico II, Department of Translational Medical Sciences , Naples, Italy M Conte M Conte University of Naples Federico II, Department of Translational Medical Sciences , Naples, Italy S Provenzano S Provenzano University of Naples Federico II, Department of Translational Medical Sciences , Naples, Italy L Ferrante L Ferrante University of Naples Federico II, Department of Translational Medical Sciences , Naples, Italy A Caruso A Caruso Casa di cura San Michele, Maddaloni, Italy MG Grimaldi MG Grimaldi Casa di cura San Michele, Maddaloni, Italy D Bruzzese D Bruzzese Federico II University of Naples, Department of Public Health, Naples, Italy N Ferrara N Ferrara University of Naples Federico II, Department of Translational Medical Sciences , Naples, Italy D Leosco D Leosco University of Naples Federico II, Department of Translational Medical Sciences , Naples, Italy V Parisi V Parisi University of Naples Federico II, Department of Translational Medical Sciences , Naples, Italy University of Naples Federico II, Department of Translational Medical Sciences , Naples, Italy Casa di cura San Michele, Maddaloni, Italy Federico II University of Naples, Department of Public Health, Naples, Italy L Petraglia L Petraglia University of Naples Federico II, Department of Translational Medical Sciences , Naples, Italy Funding Acknowledgements: none Background. In patients with systolic heart failure (HF), we previously reported that epicardial adipose tissue (EAT) is increased, is a marker of cardiac denervation and represents a local source of catecholamines. It is well known that adrenergic impairment drives the progression of HF and predicts outcome. Purpose. In the present study we sought to investigate the predictive value of EAT on outcome of high-risk patients with HF undergoing implantation of cardioverter defibrillator (ICD) for primary prevention. Methods. We prospectively enrolled 104 patients with systolic HF at the time of the ICD implantation and followed up them for a maximum of 5 years (median FU 17.2 months). At baseline all patients underwent standard echocardiographic study providing assessment of EAT maximal thickness. We considered a composite outcome including post-ICD atrial and ventricular tachyarrhythmic events, revealed by ICD check, and clinical events, including new hospital admissions for HF and cardiac deaths. Arrhythmic and clinical events were also considered as separate outcomes in the final analysis. Results. At FU, we recorded 36 atrial and 29 ventricular tachyarrhythmic events events; 47 HF-related hospital readmissions and 14 deaths. Of note, EAT was not correlated with left ventricular ejection fraction (LVEF) (p = 0.3). At univariate analysis, considering both arrhythmic and clinical events, both lower LVEF (p < 0.001), betablockers therapy (p = 0.033) and increased EAT (p < 0.001) were associated with the composite outcome. Interestingly, only EAT remained predictor of outcome at multivariate analysis (p < 0.001). When we considered the separate outcomes, we observed that EAT significantly predicted both arrhythmic and clinical events (p < 0.001 and p = 0.093, respectively). The figure illustrates Kaplan Meier curves for the composite outcome (a) and arrhythmic (b) and clinical outcomes (c). Conclusion. EAT thickness significantly predicts outcome in patients with systolic HF. The inclusion of EAT thickness measurement in the routinely echocardiographic studies could represent a novel prognostic predictive marker in HF patients other than LVEF. View largeDownload slide Abstract P1789 Figure. View largeDownload slide Abstract P1789 Figure. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2019. For permissions please email: Journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - Poster Session - Poster session 6
JF - European Heart Journal – Cardiovascular Imaging
DO - 10.1093/ehjci/jey274
DA - 2019-01-01
UR - https://www.deepdyve.com/lp/oxford-university-press/poster-session-poster-session-6-mNAN8bLh3c
SP - i1210
VL - 20
IS - Supplement_1
DP - DeepDyve
ER -