p1287 left ventricular mass and volume estimation in aortic

P1287

Left ventricular mass and volume estimation in aortic stenosis: a comparison study be-tween echocardiography and cardiovascular magnetic resonance

Guzzetti E.; Tastet L.; Capoulade R.; Annabi MS.; Le Ven F.; Arsenault M.; Bedard E.; Larose E.; Clavel MA.; Pibarot P.

Quebec Heart and Lung Institute, Quebec, Canada

BACKGROUND: Transthoracic echocardiography (TTE) is the reference method for evaluation of aortic stenosis (AS) and it has been exten-sively used to quantify left ventricular (LV) mass and end-diastolic volume (LVEDV). A septal bulge is a frequent finding in AS and may leadto TTE overestimation of LV mass and/or underestimation of LVEDV when using linear methods. There is scarce evidence on the agreementbetween different linear TTE measurements and cardiovascular magnetic resonance (CMR) - the current gold standard for LV mass andvolume quantification – in patients with AS.

OBJECTIVE: To compare different linear TTE measurements of LV mass and LVEDV with CMR.

METHODS: We included 106 patients (63 ± 15 years, 68% male)with mild to severe AS in this sub-study of the PROGRESSA prospectivecohort. TTE and CMR were performed within ≤3 months. Linear 2D TTE LV measurements were made at the basal level (BL, as recommen-ded by guidelines), immediately below the septal bulge (BSB) and at mid-ventricular level (MV). LV mass by TTE was calculated using thecube formula and LVEDV was calculated using Teichholz method. Agreement was evaluated with Bland-Altman analysis.

RESULTS: Patients included had mild (23%), moderate (57%) and severe (20%) AS. In our whole cohort, all TTE measurements markedlyoverestimated LV mass as compared to CMR (bias: BL: +60 ± 3; BSB: +59 ± 32; MV: +54 ± 32 g/m2, p = 0.02) (Figure 1). Regarding LVEDV,there was a significant underestimation using all TTE measurements (bias: BL -39 ± 25, BSB: -27 ± 25, MV: -18 ± 27 ml, p < 0.001). However,overestimation of LV mass and underestimation of LV volumes were significantly lower when measuring at the MV level (p < 0.025 vs BL andBSB).

CONCLUSION: Bidimensional TTE methods systematically overestimated LV mass and underestimated LV volumes as compared to CMR.However, bias was less important when measuring at the MV level. Linear measurements at the basal level (as suggested by guidelines)should be avoided in AS patients.

Abstract P1287 Figure 1. Bland-Altman analysis

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P1288

Echocardiographic reverse left atrial remodeling after primary percutaneous coronaryintervention: Results from the INNOVATION trial

Song PS.1; Kim HM.1; Yu CW.2

1Mediplex Sejong General Hospital, Incheon, Division of Cardiology, Heart Stroke Vascular Center, Incheon, Korea Republic of2Korea University Anam Hospital, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of

Background – A significant reverse left atrial (LA) remodeling (r-LAR, LA volume reduction after potential intervention such as treatmentwith ACEI or ARBs, catheter ablation, or invasive surgery) has been recently described in patients with hypertension, heart failure, or atrialfibrillation and it is a strong predictor of favourable long-term survival and less adverse cardiac events. However, few data are available onthe incidence and determinants of r-LAR after ST-segment elevation acute myocardial infarction (STEMI) in modern clinical practice with asystematic use of primary percutaneous coronary intervention (PCI).

Purpose - We analyzed the INNOVATION trial (NCT02324348) database to investigate incidence, extent, and major determinants of r-LARin a group of STEMI patients treated with primary PCI.

Methods – The INNOVATION trial was a randomized study for STEMI patients who were assigned to the immediate stenting group or defer-red stenting. In the trial, an initial 2D-echocardiography was performed in 114 patients within median 1 day of primary PCI, and follow-up 2D-echocardiography was repeated in 89 patients at median 12 months. We used a reduction in LA volume (LAV) >15% compared with base-line, by 2D-echocardiographic assessment as a measure of r-LAR. Patients were divided into 2 groups according to r-LAR.

Results - A total of 89 consecutive patients (age: 59.5 ± 11.8 years, 83.3% male) were included. The initial LAV was 51.3 ± 16.1 (mL), fol-low-up LAV 54.4 ± 15.7, and ΔLAV was 11.1 ± 32.9 (median: 2.35, interquartile range: -10.18 to 25.89). At 12 months follow-up, 16.9% pa-tients showed r-LAR. The r-LAR group tend to demonstrate a higher prevalence of female gender, non-anterior STEMI as infarct-relatedartery location, and immediate stenting (0.05 ≤ p < 0.10 for all). When comparing patients without r-LAR, initial left ventricular ejection fractionwas higher, E’ was higher, and left ventricular wall motion score index was smaller (p < 0.05 for all) in patients with r-LAR. The infarct sizeand the incidence of microvascular obstruction assessed by cardiac magnetic resonance at 30 days after STEMI were not significantly differ-ent between groups. Medications throughout hospital stay and during the follow-up were similar between groups. At multivariable analysis,independent predictors of r-LAR were initial E’ as continuous variable (adjusted odds ratio [OR]: 1.443, 95% confidence interval [CI]:1.024-2.034, p = 0.036) and initial left ventricular wall motion score index (adjusted OR: 0.029, 95% CI: 0.001-0.653, p = 0.026). Also, femalegender tended to be associated with r-LAR (adjusted OR: 4.608, 95% CI: 0.870-24.390, p = 0.073).

Conclusions - r-LAR occurs not infrequently in STEMI patients treated with primary PCI. E’ and left ventricular wall motion score index oninitial 2D-echocardiography is the major determinant of r-LAR. Long-term clinical follow-up are required to demonstrate a subsequent mor-bidity and/or mortality benefit of r-LAR.

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P1289

Right ventricular apical bulging in repaired tetralogy of Fallot with severe pulmonaryregurgitation

Kojima S.1; Obase K.2; Tsuneto A.3; Kimura Y.1; Kaku N.1; Yoshimuta T.3; Maemura K.3; Eishi K.2; Yanagihara K.1

1Nagasaki University Hospital, Laboratory Medicine, Nagasaki, Japan2Nagasaki University Hospital, Cardiovascular Surgery, Nagasaki, Japan3Nagasaki University Hospital, Cardiovascular Medicine, Nagasaki, Japan

[Introduction]

Right ventricular (RV) apical rounding and basal bulging due to pressure overload has been reported in patients with pulmonary hyperten-sion. In patients with radically repaired tetralogy of Fallot (rTOF), RV volume overload can be caused by severe pulmonary regurgitation(PR), rate after initial surgery. We investigated the RV shape in rTOF with or without severe PR.

[Methods]

Ten patients with rTOF with severe PR (group PR) and 11 with less than moderate PR (group Pr) were studied. RV dimension at base (RV1),mid (RV2) and apical quarter (RV3); distance between RV1 line and the apex (RV4); RV inflow area (RVEDA) were measured with RV-fo-cused apical 4 chamber view in 2D transthoracic echocardiography (TTE), while proximal RV outflow diameter (RVOT prox) and distal RVoutflow diameter (RVOT dist) with parasternal short axis view at aortic valve level (Figure). End-diastolic frames were selected for all themeasurements. Then, the ratios of RV3/RV1 and RV3/RV2 were calculated. Systolic RV pressure (SRVP) was estimated by TTE.

[Results]

In the group PR, RV2, RV3, RV4, RVEDA and RV3/RV2 were significantly larger than those in the group Pr (Table). Multiple logistic analysisidentified RVEDA (p < 0.001) and RV3/RV2 (p = 0.025) were predictors to distinguish the 2 groups. The cut-off values of RVEDA andRV3/RV2 from receiver operating characteristic curve analysis were 25.4cm2 (sensitivity 100%, specificity 73%) and 0.79 (sensitivity 90%,specificity 70%), respectively. There was no statistical difference in SRVP between 2 groups.

[Conclusions]

RV dilatation with apical bulging was observed in rTOF patients with severe PR. The results demonstrate a RV apical rounding in rTOF with-out significant pressure overload but with volume overload. 3D approach and further studies are needed to find out the mechanism and itsclinical perspective.

Results of RV measurements

PR Pr p valueRV1 (mm) 39.4 ± 8.7 36.5 ± 8.1 n.s.RV2 (mm) 39.9 ± 5.5 33.8 ± 4.1 0.018RV3 (mm) 32.6 ± 5.6 24.0 ± 3.3 0.004RV4 (mm) 85.3 ± 8.6 74.5 ± 12.8 0.045EDA (cm2) 31.5 ± 6.2 22.9 ± 3.6 0.003RVOT prox (mm) 31.0 ± 8.3 24.3 ± 3.7 n.s.RVOT dist (mm) 21.7 ± 3.1 21.4 ± 3.7 n.s.RV3/RV1 0.88 ± 0.31 0.69 ± 0.20 n.s.RV3/RV2 0.82 ± 0.08 0.71 ± 0.09 0.027

Abstract P1289 Figure. Measurements and schematic RV

i866 Abstracts -- Poster Session -- Poster session 4

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P1290

The prognostic value of different methods of standardising left atrial sizeOlsen FJ.; Pedersen S.; Jensen JS.; Biering-Sorensen T.

Herlev & Gentofte Hospital, Faculty of Health Sciences, University of Copenhagen, Dept. of Cardiology, Hellerup, Denmark

Funding Acknowledgements: Funding: Herlev & Gentofte Hospital"s internal funds. The dept. of Cardiology"s internal funds: FUKAP.

Background: When assessing left atrial (LA) size, a proper scaling is important to account for differences in body size. Allometric modelshave been suggested as superior to isometric models, and height has been proposed as the most reliable standardization method.

We sought to investigate the influence of the different scalings on the predictive value of LA volumes.

Method: We investigated a prospective cohort of 373 patients with ST-elevation myocardial infarction. Minimal and maximal LA volumes(LAVmin and LAVmax) were measured and standardized isometrically and allometrically to height, weight, body mass index, and body sur-face area. The endpoint was a composite of heart failure and/or cardiovascular death (HF/CVD).

Results: Eighty patients reached the composite endpoint. None of the scaling variables differed between the two groups. LAVmax did notdiffer between the two outcome groups and was not a univariable predictor in any scaling model. The LAVmin differed significantly betweenthe two groups (LAVmin: 32mL vs 27mL, p = 0.001, for HF/CVD and non-HF/CVD respectively) and was a univariable predictor in all scalingmodels. In multivariable Cox regression, the LAVmin remained an independent significant predictor in all scaling models except when in-dexed to height (table).

Conclusion: LAVmin was an independent predictor of HF/CVD after myocardial infarction. In both isometric and allometric models, heightleft the LAVmin as a non-significant predictor of outcome, suggesting that this method may normalize pathology of the LA.

Prognostic value of LA standardizations

LA size Hazard Ratio [95% CI] P-valueIsometric standardizationsLAVmin/BMI 2.29 [1.29;3.73] 0.004LAVmin/weight 9.69 [1.79;52.5] 0.008LAVmin/BSA 1.06 [1.01;1.10] 0.011LAVmin/height 1.04 [1.00;1.08] 0.08Allometric standardizationsLAVmin/BMI-0.03 1.02 [1.00;1.04] 0.040LAVmin/weight0.24 1.07 [1.00;1.14] 0.047LAVmin/BSA0.68 1.04 [1.01;1.08] 0.016LAVmin/height0.86 1.03 [1.00;1.07] 0.08

Multivariable models adjusted for: age, gender, diabetes, troponin level, left ventricular mass index, estimated glomerularfiltration rate, culprit lesion: LAD, TIMI flow grade LA: Left atrium; LAVmin: minimal left atrial volume; BMI: body massindex; BSA: body surface area


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P1291

Sports and aorta. size mattersMasson Juarez G.; Carrero C.; Diaz Babio G.; Constantin I.; Mezzadra M.; Garcia Botta T.; Vera Janavel G.; Stutzbach P.

Cardiovascular Institute of San Isidro-Sanatorio Las Lomas, Buenos Aires, Argentina

Background

There is scarce information about the effect of exercise training on the aorta. Previous studies showed enlargement in elite athletes, howev-er it is not clear if it is due to hemodynamic effects of chronic exercise training, or to different characteristics of the body surface area inathletes. Adequate parameters of indexation has been not clearly described taking into account the great muscular development of this pop-ulation.

Purpose

We studied the heart of international-elite rugby players (RP) and healthy non-trained population (CP) to determine whether systematic rug-by training (SRT) develops aortic dilatation and to describe convenient indexes.

Methods

Between January 2017 and February 2018, a total of 145 healthy male patients without personal or familiar history of aortopathy, rangingfrom 18 to 35 y/o, with (RP, n = 58) or without (CP, n = 87) SRT were prospectively included to be assessed with 2-D transthoracic echocar-diography. Left ventricular end-diastolic diameter (LVEDD), septal thickness (LVST), left ventricular mass (LVM) and aortic diameters weremeasured in 6 levels to obtain maximum aortic diameter (MAD). Body surface area (BSA) was calculated to obtain LVM index (LVMi) andMAD index (MADi). Additionally, ideal body weight (IBW) was calculated for each patient according to World Heart Organization (WHO) rec-ommendations to obtain estimated BSA (BSAe) and MADi (MADe). For aortic dilatation diagnosis, normal cut-off value was set at 40 mm forMAD and 21 mm/m2 for MADi. Group data was compared with equal orunequal variance T-test for independent samples and associationswere tested with Chi-square test for independence with Yates’ correction. Results are reported as mean ± SEMor as percent proportions.Significance was set at p < 0.05.

Results

Included population (RP: 24.2 ± 3.4, CP: 25.6 ± 5.9 y-o, p = NS) had different BSA (RP: 2.2 ± 0.2, CP: 2.0 ± 0.2 m2, p < 0.01). As expectedRP showed greater LVEDD (RP: 56.2 ± 4.1, CP: 51.6 ± 4.4 mm, p < 0.01 ), LVST (RP: 10.5 ± 0.8, CP: 9.3 ± 1.3 mm, p < 0.01) and LVMi (RP:99.9 ± 14.3, CP: 82.7 ± 16.5 mm, p < 0.01).The prevalence of aortic dilatation according to MAD cut off value was similar between groups(RP: 1.7%, CP: 2.3%, p = NS) and no patient had MADi greater than 21 mm. RP had greater MAD (RP: 34.9 ± 2.6 vs CP: 32.4 ± 2.9 mm. p < 0.01) however, MADi was higher in CP (RP: 15.6 ± 1.2 vs CP: 16.2 ± 1.6 mm/m2, p = 0.02). When calculating MADe with BSAe, no differen-ces were found between both groups (RP: 16.6 ± 1.3, CP: 16.3 ± 1.3 mm/m2, p = NS) indicating that aortic size depends on IBW.

Conclusions

Elite athletes showed greater MAD. However, aortic dilation resulted not frequent and similar to non-trained population. Due to greater bodysize of athletes, BSA indexation resulted in unexpected lower MADi. Thus, we conclude that MADi underestimates aortic dimensions andtherefore, the presence of aortopathy in this population. Instead, we propose indexation of aortic diameters with IBW (MADe) in elite ath-letes


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P1292

Relationship of natriuretic peptides with left atrial function within 1 month after electri-cal cardioversion in patients with persistent atrial fibrillation

Rasa Karaliute RK.; Vaida Mizariene VM.; Tomas Kazakevicius TK.; Giedre Stanaitiene GS.; Julija Jurgaityte JJ.; Justina Jureviciute JJ.;Ausra Kavoliuniene AK.

Hospital of Lithuanian University of Health Sciences, Cardiology department, Kaunas, Lithuania

BACKGROUND: The natriuretic peptide system response is closely associated with myocardial tension and is one of the criteria for the di-agnosis of heart failure. Concurrently, atrial fibrillation (AF) is related to increased levels of plasma natriuretic peptides, even in the absenceof congestive heart failure.

Specific natriuretic peptides NTproANP and NTproBNP, in relation to electrical cardioversion (ECV) have not been widely analysed in thepast.

OBJECTIVES: The aim of this study was to determine the changes in NTproANP and NTproBNP plasma levels and to define their relationswith left atrium (LA) volume and function in 1 month after the ECV of persistent AF.

METHODS: The study population included 49 persistent AF patients with preserved left ventricular ejection fraction (> 50%) and successfullyperformed ECV. Plasma levels of natriuretic peptides (NTproANP and NTproBNP) were measured for all the patients before the ECV proce-dure. Transthoracic echocardiography (TTE) was performed within the first 24 hours after successful ECV. The plasma levels of natriureticpeptides and TTE were repeatedly assessed after 1 month of sinus rhythm (SR) restoration.

RESULTS: After 1 month SR was observed in 29 (55.1%) patients. For those patients NTproANP decreased from 5.34 ± 3.35 to 4.63 ± 3.83nmol/l (p = 0.13), NTproBNP decreased from 2115.76 ± 1589.29 to 511.59 ± 390.61 pg/ml (p <0.0001) and LA volume significantly decreasedfrom 51.54 ±13.73 to 45.17 ± 13.33 ml/m2 (p < 0.0001). Positive correlation was detected between NTproBNP concentration and LA volume within the first 24 hours (r 0.471, p = 0.03) and after 1 month of SR restoration (r 0.609, p= 0.003), while no interrelation was found withNTproANP concentration.

Following 1 month of SR restoration, positive change of LA function was observed: significantly increased LA reservoir (from 24.69± 9.69 to38.62± 8.67%, p <0.001), conduit (from 16.87± 7.33 to 20.42± 8.65%, p = 0.006) and pump (from 11.35± 7.60 to 23.13± 8.56, p = 0.001) func-tions. Higher NTproANP concentration before ECV was associated with lower LA reservoir function during the first day after SR restoration(-0.47, p = 0.04), but no significant correlations were detected after 1 month in SR. On the contrary, higher NTproBNP concentration after 1month in SR was significantly related to lower LA reservoir function (-0.59, p = 0.004), and no significant correlations between NTproBNPbefore ECV and on the first day after SR restoration was detected. No correlations between the LA conduit and pump function and the plas-ma concentration of natriuretic peptides were detected neither on the first day nor following 1 month after successful ECV.

CONCLUSIONS: NTproBNP but not NTproANP plasma levels are significantly lower following 1 month of SR restoration by ECV. The con-centration of NTproBNP is directly related to LA volume. NTproBNP plasma level has better correlation with positive changes in LA functionafter SR recovery for patients with persistent AF.


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P1293

How much better than echo is cardiac MRI for diagnosing hypertrophic cardiomyop-athy: real-world experience in the era of prudent healthcare

Galusko V.; Roche L.; Ninan T.; Ionescu A.

Regional Cardiac Centre Morriston Hospital, Swansea, United Kingdom

Background: Cardiac MR (CMR) is the gold standard for the imaging diagnosis (dx) of hypertrophic cardiomyopathy (HCM), but its availa-bility is limited. We assessed whether we could reduce the referrals for CMR by using TTE to target it better.

Methods: We documented clinical features and tentative dx after an interpretable TTE in patients referred to CMR for ?HCM in 2 groups :referrals for screening (Sc) after a family member had been diagnosed with HCM, and de novo (Dn) suspected HCM.

Results: We included 70 consecutive patients (mean age (SD), 56 (17.5)), 40 M; 45 (64%) had HCM confirmed by CMR. Seven out of 15(47%) and 38/55 (69%) had HCM in the Sc and Dn groups respectively. LVH (>14mm) by echo had high sensitivity (91%) and its absence ahigh NPV (73%) for a CMR diagnosis of HCM, while asymmetrical septal hypertrophy (ditto) had a PPV of 100% but a low sensitivity (33%)(table). Echocardiography had sensitivity, specificity, PPV and NPV of 0.8, 0.56, 0.77 and 0.61 respectively for HCM.

Conclusion: With low numbers generalisations are difficult, but in the absence of LVH by echo the diagnostic yield of CMR for suspectedHCM appears limited.

MRI (+)veScreening De novo[n, %] SAM [n, %] LVH [n, %] ASH [n, %] [n, %] SAM [n, %] LVH [n, %] ASH [n, %] TotalEcho (+ve) 3 0 4 2 33 87% 16 37 13 34% 36

43% 0% 57% 29% 42% 98%Echo (-ve) 4 7 3 5 5 22 1 25 66% 9

57% 100% 43% 71% 13% 58% 2%Total 7 38 45

MRI (-)veScreening De novo[n, %] SAM [n, %] LVH [n, %] ASH [n, %] [n, %] SAM [n, %] LVH [n, %] ASH [n, %] Total

Echo (+ve) 2; 25% 0 2 0 9 2 12 0 110% 25% 0% 53% 12% 71% 0%

Echo (-ve) 6; 75% 8 100% 6 8 100% 8 15 88% 5 17 100% 1475% 47% 29%

Total 8 17 25

SAM - systolic anterior motion of the mitral valveLVH - left ventricular hypertrophyASH - asymmetrical septal hypertro-phy


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P1294

Prevalence and characterization of cardiac involvement in haemorragic hereditary tele-angectasia: echocardiographic phenotyping of a rare disease

Locorotondo G.1; Gaetani E.2; Di Matteo G.1; Manfredonia L.1; Gasbarrini A.2; Galiuto L.1; Lanza GA.1; Crea F.1

1Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy2Catholic University of the Sacred Heart, Department of Gastroenterology, Rome, Italy

Background. Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant disorder characterized by severe and recurrentepistaxis and visceral bleedings due to arteriovenous malformations. Direct cardiac involvement is rare: only isolated cases have been previ-ously reported about aortic and coronary artery aneurysms and valvular heart disease. However, chronic high-flow state due to anaemia maycause subtle cardiac changes.

Purpose. To perform a systematic echocardiographic evaluation of HHT patients and to detect prevalence and type of potential cardiac in-volvement

Methods. A consecutive series of 21 patients (female sex 62%, age 55 ± 16 years) admitted to our HHT outpatient clinic was prospectivelyscreened by transthoracic echocardiography. Diagnosis of HHT was based on Curaçao criteria. Left ventricular (LV) end-diastolic and end-systolic volumes (EDV and ESV, respectively) and ejection fraction (EF) were measured by biplane modified Simpson’s method. Interventric-ular septal and poster wall thickness, together with LV end-diastolic diameter, were used to calculate LV mass (LVM) and relative wall thick-ness (RWT). LVEDV, LVESV and LVM were indexed for body surface area (BSA) and expressed as LVEDVi, LVESVi and LVMi, respectively.Left atrial volume was also measured and indexed for BSA (LAVi). Assessment of valvular dysfunction was performed both by semi-quantita-tive and quantitative estimation of vena contracta, effective regurgitant orifice area, transvalvular gradients and area. Diastolic function wasevaluated basing on E/A ratio and E/e’ ratio. Finally, data about right ventricular (RV) dilatation and dysfunction, pulmonary artery systolicpressure (PAPS) and ascending aorta diameter were collected.

Results. The overall study population showed mild LV dilation (LVEDVi 60.12 ± 23.37 mL, LVESV 22.47 ± 10.02) and normal LVEF (63.28 ±4.59). Despite normal RWT (0.39 ± 0.08), LVMi was increased in both male (132.85 ± 39.71 gr/m2) and female (97.01 ± 40.15 gr/m2) sex.Concentric hypertrophy was present in 5 (24%) patients, eccentric hypertrophy in 4 (19%) and concentric remodelling in 2 (10%). Grade 1diastolic dysfunction was found in 7 (33%) patients and grade 2 in 2 (10%), while diastolic function was normal in the remaining patients.Most patients displayed trivial valve regurgitation (62% mitral, 29% aortic, 66% tricuspid). Mild-to-severe regurgitation was found in 38%,19% and 33% of patients, respectively. The most common aetiologies of mitral and aortic regurgitation were rheumatic and degenerative.Aortic dilatation was present in 3 (14%) patients. None of patients had RV dysfunction, but PAPS was 30 ± 11 mmHg. Conclusions. In thissmall series of HHT patients, no specific cardiac phenotype could be identified. However, the increase of LV volume and mass might reflectthe chronic high-flow state and should mandate early echocardiographic screening.


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P1295

Remodelling system classification considering left ventricular volume in patients withaortic valve stenosis: association with adverse cardiovascular outcomes

Bartolacelli Y.; Barbieri A.; Manicardi M.; Bursi F.; Boriani G.

Azienda Ospedaliero-Universitaria Policlinico di Modena, Cardiology Department, Modena, Italy

Background: Left ventricular (LV) remodelling in the setting of aortic valve stenosis (AS) often leads to maladaptive responses.

Purpose: To assess the prevalence and clinical implications of LV remodeling based on LV mass, volume and relative wall thickness at thetime of AS diagnosis.

Methods and results: We retrospectively analysed consecutive patients with AS (area ≤ 1.5 cm2). LV geometric patterns and clinical out-comes (combined death, cardiac hospitalization or aortic valve replacement (AVR)) were evaluated. Between 2008 and 2016, 343 patientswere evaluated (age 79.2 ± 9.5 years, 48.1% males): 276 (80,5%) had severe AS and 67 (19.5%) moderate AS. According to classification17 (4.9%) had normal geometry, 26 (7.5%) concentric remodelling, 135 (39.3%) concentric hypertrophy, 77 (22.4%) mixed hypertrophy, 43(12.5%) dilated hypertrophy, 11 (3.2%) eccentric hypertrophy and 15 (4.3%) eccentric remodelling. During a median follow-up of 2.2 years,260 (75.8%) had the combined endpoint. A significant association between the combined clinical end-point and LV dilation (LV volume>75ml/m2; p = 0.010) or LV remodelling patterns (p = 0.0001) was found. After multivariable adjustment for AVR as time-dependent covari-ate, concentric remodelling (HR 3.12, IC 95% 1.14-8.55; p = 0.02) and dilated LVH (HR 3.48, IC 95% 1.31-9.27; p = 0.01) were strongly as-sociated with death or cardiac hospitalizations.

Conclusions: Patients with moderate or more AS had frequently abnormal remodeling, more commonly concentric, mixed and dilated hy-pertrophy. There was a significant association between LV dilation and incidence of adverse outcome when contemporary proposed indexa-tion methods and partition values are applied. Concentric remodelling and dilated hypertrophy had the worst prognosis even after adjust-ment for AVR.


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P1296

Association of left ventricular diastolic dysfunction with metabolic derangements intype 2 diabetic patients with subclinical diabetic cardiomyopathy

Jovanova S.1; Mitrovska S.2

1University clinic of cardiology, Skopje, Macedonia The Former Yugoslav Republic of2Public Health Institution, Internal Medicine, Skopje, Macedonia The Former Yugoslav Republic of

Background: Diabetic cardiomyopathy is defined as a disease that directly affects the structure and the function of the myocardium in theabsence of coronary artery disease, valve disease or hypertension. Metabolic derangements trigger distinct structural, functional and meta-bolic changes of myocardium which lead to the development of diabetic cardiomyopathy and consecutively to heart failure as a clinical mani-festation of the disease. Diastolic dysfunction is an early alteration of heart function in diabetic patients. It is asymptomatic for long periodand progressively lead to impairment of contractile function.

Purpose: The aim of the study was to assess the association of LV diastolic dysfunction in asymptomatic diabetic patients with metabolicderangements.

Methods:. In a cross-sectional study we evaluated 137 subjects. The study group was composed of 72 asymptomatic normotensive patientswith diabetes mellitus type 2, without coronary artery and valve disease and the control group was composed of 65 apparently healthy sub-jects. All patients underwent 2D echocardiography with Doppler analysis (color, PW, TDI). We evaluate the echo-Doppler parameters of LVdiastolic function and its correlation with BMI, duration of diabetes, glycemic control, lipid profile and CRP. The correlation between Dop-pler-echocardiographic, clinical and biochemical parameters were assessed by Pearson Product Moment of Correlation.

Results: We found significant relationship between metabolic derangements (BMI, duration of diabetes, glycemic control, lipid profile andCRP ) and Doppler parameters of LV diastolic function, assessed with PWD and TDI. In both group (diabetic pts and controls) increased BMIwas associated with reduced E/A ratio (r= -0.5; r= -0.2), and increased E/E’ ratio(r= 0.5; r= 0.2) . There was negative correlation betweenduration of diabetes and glycemic control and E/A ratio (r= -0.5;r= -0.5, respectively) ) and positive correlation with E/E’ ratio (r= 0.7, r= 0.3).There were strong negative correlations between hyperlipidemia and E/A ratio in both groups (r= -0.3; r= -0.4) and strong positive correlationwith E/E’ ratio (r= 0.4; r= 0.4). Pearson’s coefficient was consistent with significant correlation between CRP and LV diastolic function in twogroups

Conclusion: Strong correlations of metabolic derangement with LV diastolic dysfunction suggest their role as predictors of increased risk ofheart failure in patients with asymptomatic type 2 diabetes mellitus.


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P1297

Mitral annular calcification attenuates correlation between age and Doppler derived leftventricular diastolic indices

Okura H.; Nakada Y.; Ishihara S.; Nogi M.; Soeda T.; Okayama S.; Watanabe M.; Kawakami R.; Saito Y.

Nara Medical University, Kashihara, Japan

Background: Doppler derived diastolic indices are known to deteriorate with advancing age. Mitral annular calcification (MAC) restricts mi-tral annular motion and therefore affect tissue Doppler derived diastolic indices. The purpose of this study was to investigate impact of MACon correlation between age and Doppler derived left ventricular diastolic indices.

Methods: A total of 13,472 patients who underwent echocardiographic examination at our institute were enrolled and studies. MAC wasdiagnosed as a presence of high echoic mass at the mitral annulus. Correlation between age and Doppler derived diastolic indices wereassessed using linear regression analysis.

Results: MAC was present in 1,881 patients (MAC group, 14%) and absent in 11,591 patients (non-MAC group, 86%). There were modestbut significant correlations between age and E/A, e’ or E/e’ in non-MAC group (E/A: R = 0.51, P < 0.0001, e’: R = 0.63, P < 0.0001, E/e’: R = 0.35, P < 0.0001). However, correlations between age and E/A (R = 0.13, P < 0.0001), e’ (R = 0.18, P < 0.0001) or E/e’ (R = 0.01, P = 0.643)were poor or absent in MAC group.

Conclusion: MAC affects age dependent changes in LV diastolic indices. Careful interpretation is needed to assess LV diastolic function byDoppler echo in patients with MAC.


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P1299

Left atrial minimum volume may be a more sensitive parameter of diastolic dysfunctionRamis Barcelo MF.; Mas Llado C.; Forteza JF.; Rodriguez A.; Pericas P.; Maristany J.; Pasamar L.; Gonzalez R.; Noris M.; Peral V.

University Hospital Son Espases, Palma de Mallorca, Spain

Introduction: The impairment of left ventricular (LV) diastolic function determines and increases left atrial (LA) size. For these reason, theLA size is considered a robust marker of chronical LV filling pressure. By general consensus, LA size is measured at the end-systolic phase,when its dimension is greatest (LA max volume). Although, in previous studies, the LA minimum (LAmin) volume at the end-diastole hadshown a more pronounced increase with worsening diastolic function. These results suggest that LAmin volume may be a more sensitivemarker of diastolic dysfunction (DD)

Purpose: The aim of this study is to corroborate the correlation between the worsening of DD and the increase of the LA minimum volume inpatients with preserved and reduced LV ejection fraction (EF)

Methods: We performed a retrospective study with patients who underwent a complete 2-dimension transthoracic echocardiography be-tween January 2017 and March 2018. Inclusion criteria required normal sinus rhythm and no significant valvular heart disease (defined asmore than mild regurgitation).

Results: We included 148 patients, 62,2% male, mean age of 58 years (±14,7SD). A 64,9% of them had preserved ejection fraction and35.1% had reduced ejection fraction. 41,2% without DD, 43,9% DD grade 1, and 13,5% DD grade 2 + 3. LAmin volume showed better cor-relation than LAmax volume with global longitudinal strain (R 0.45 vs 0.17), peak LA strain (R -0.49 vs -0.31), septal e’ (R -0.37 vs -0.16), a’(R -0.46 vs -0.34) and E/e’ (R 0.45 vs 0.27) with p< 0.001. LAmin volume showed a significant increase with worsening of DD (Table). Whenwe adjusted for EF and peak LA strain, the results remained statistically significant (p < 0.05; OR 1.218; IC 95% 1.102-1.346). Receiver-operating curve (ROC) demonstrated area under the curve values of 0.791 for differentiating between patients without DD and with anygrade of DD, reflecting a good diagnostic performance.

Conclusions: In our study the LAmin volume gradually increased with the progression of LV diastolic dysfunction. These results suggestthat LAmin volume could be useful to discriminate DD but more studies are needed to resolve if it is also useful to discriminate betweengrades of DD.

Table 1

Diastolic dysfunction LA minimum volume (ml/m²)0 9.3 (±3.6 SD)*1 14.2 (± 5.6 SD)2 23.2 (±12.6SD)*

0: normal diastolic function; 1: DD grade 1; 2: DD grade 2 + 3 *p< 0.05Abstract P1299 Figure. ROC curve


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P1300

TAPSE/PASP ratio as a marker of right ventricle dysfunction in hispanic patients withrheumatoid arthritis: a case-control study

Azpiri-Lopez JR.1; Galarza-Delgado DA.2; Colunga-Pedraza IJ.2; Davila-Jimenez JA.3; Abundis-Marquez EE.3; Guillen-Lozoya AH.3; Torres-Quintanilla FJ.3; Valdovinos-Banuelos A.3; Ramos-Cazares RE.3; Vera-Pineda R.3; Cardenas-De La Garza JA.3; Arvizu-Rivera RI.3; Marti-nez-Moreno A.3

1Universidad Autonoma de Nuevo Leon, UANL, Cardiology, Monterrey, Mexico2Universidad Autonoma de Nuevo Leon, UANL, Rheumatology, Monterrey, Mexico3Universidad Autonoma de Nuevo Leon, UANL, Monterrey, Mexico

Background: Patients with rheumatoid arthritis (RA) are at increased risk for developing cardiovascular (CV) disease, including right heartfailure. Screening for CV disease in RA-patients remains controversial. When right ventricle (RV) systolic function adaptation fails, the RVbecomes uncoupled from pulmonary circulation and dilates to preserve flow output at a price of systemic congestion. It has been reportedthat evaluation of RV functional state by using the relationship between the tricuspid annular plane systolic excursion (TAPSE) and the pul-monary artery systolic pressure (PASP) as a surrogate for the RV length-force, is of clinical prognostic relevance.

Purpose: Assess RV function by TAPSE/PASP ratio in RA-patients and as compared to controls.

Methods: A case-control study with RA-patients aged 40 to 75 years that fulfilled the 2010 ACR/EULAR criteria and matching controls wereincluded. Exclusion criteria: poor acoustic window, prior atherosclerotic CV disease and overlap syndromes. Patients were matched usingage, sex and CV comorbidities. Transthoracic 2-D Doppler echocardiogram was performed by a board-certified cardiologist, and reviewedby two cardiologists unaware of clinical data.

Results: A total of 76 RA-patients and 52 matched controls were included. Demographic characteristics of both groups are shown in Table1. As shown on Table 1, the mean TAPSE/PASP ratio was significantly lower in RA-patients than controls (0.89 ± 0.29 vs 1.02 ± 0.28, P = 0.016). TAPSE/PASP ratio showed significant correlation with age (r= -0.24, P = 0.03) and null correlation with disease duration (r = 0.2, P = 0.08) and DAS 28-CRP (r = 0.05, P = 0.69).

Conclusion: TAPSE/PASP was reduced in RA-patients compared to controls. This ratio correlates with RA-patients age. TAPSE/PASP es-timated by echocardiography may detect early RV dysfunction in RA. Larger studies are needed to determine the utility of TAPSE/PASP ratioto detect CV disease in Hispanic RA-patients.

Table 1

RA Control P(n = 76) (n = 52)Women, n (%) 74 (97.4) 46 (88.5) 0.041Age, mean ± SD 55.71 ± 8.84 53.86 ± 6.14 0.195Disease duration (years), mean ± SD 10.43 ± 8.55 - -DAS 28-CRP, mean ± SD 3.34 ± 1.34 - -TAPSE, mean ± SD 22.8 ± 3.1 23.9 ± 3.1 0.052PASP, mean ± SD 27.14 ± 6.34 24.68 ± 5.44 0.024TAPSE/PASP, mean ± SD 0.89 ± 0.29 1.02 ± 0.28 0.016

DAS 28-CRP - Disease activity score 28 using C-reactive protein


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P1301

Are we there yet?Sousa JP.; Lopes JG.; Reis L.; Negrier C.; Goncalves L.

Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Cardiology, Coimbra, Portugal

Background: 2016 ESC Heart Failure (HF) Guidelines introduced mid-range left ventricular ejection fraction (40 ≤ LVEF ≤ 49%) as a newnosological category (HFmrEF), lying in-between HF with reduced ejection fraction (HFrEF, LVEF ≤ 39%) and HF with preserved ejectionfraction (HFpEF, LVEF≥50%). The discriminatory effect of LVEF for prediction of adverse outcomes has been shown, however, to produce acut-off of 45%.

Purpose: To explore the performance of an alternative LVEF-based classification of HF, in the setting of acute HF.

Methods: Retrospective single-center study comprising patients consecutively admitted into a cardiac intensive care unit, during six years,for de novo or decompensated acute HF. LVEF was comprehensively evaluated during the first 72 hours of hospitalization, by means oftransthoracic echocardiography. Patients were partitioned into four groups based on LVEF: HFrEF, HFmrEF1 (40%≤LVEF ≤ 44%), HFmrEF2(45%≤LVEF ≤ 49%) and HFpEF. Follow-up (FU) targeted hospital readmission for acute HF and all-cause mortality. All statistical analysiswas performed using SPSS version 25.

Results: 263 patients were included. Mean age was 70 ± 14 years and 22% were female. Median FU was 10 months. In-hospital mortalitywas 15%, while hospital readmission for acute HF and death during FU occurred in 46.7% and 42%, respectively. NT-proBNP level at admis-sion was 18521 ± 29068pg/mL. FEVE was 34 ± 12.9%, with distribution among subgroups as follows: 182 patients (69.2%) with HFrEF, 18(6.8%) with HFmrEF1, 16 (6.1%) with HFmrEF2 and 47 (17.9%) with HFpEF. Male sex was predominant in HFrEF (86.8%, with adjustedstandardized residual (ZRES) of 5.4) and HFmrEF1 (77.8%), while there was a gender equilibrium in HFmrEF2 (8 vs. 8, ZRES -2.7) andHFpEF (24 vs. 23, ZRES -4.8). HFrEF patients were younger than those with HFpEF (67.3 ± 14.2 vs. 76.5 ± 10.5 years, p <0,001). Personalhistory of hypertension was more common in HFpEF (85.1%, ZRES 2) than in HFrEF (68.7%, ZRES -2.8), while that of type 2 diabetesmellitus and chronic kidney disease was more prevalent in HFmrEF1 (61.1%, ZRES 2.2, and 72.2%, ZRES 2.7, respectively). Ischemic etiol-ogy for HF was more common in HFrEF (46.2%, ZRES 2.9) and HFmrEF1 (61.1%, ZRES 1.9) and rarer in HFpEF (12.8%, ZRES -4.2).Congestion, as evaluated by NT-proBNP serum value and maximal dose of daily furosemide, was similar among all groups (p 0.087 and p0.334, respectively). In-hospital fatality was also equivalent between categories (p 0.112), whereas, during FU, HFmrEF2 exhibited lessermortality (12.5%, ZRES -2.5) and HFrEF greater readmission rate (50.9%, ZRES 2.0).

Conclusion: Despite being classified as a unique HF category, HFmrEF patients display heterogeneity in epidemiology, clinical presentationand prognosis, which may jeopardize the results of upcoming clinical trials. These findings might prompt reclassification of HF using a LVEFcut-off of 45%.


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P1302

Physiologic predictors of long term survival in patients undergoing CRT

Djordjevic-Dikic A.1; Nikcevic G.2; Markovic F.3; Boskovic N.1; Jovanovic V.2; Beleslin B.1; Giga V.1; Petrovic M.1; Milasinovic G.2

1Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia2Clinical center of Serbia, Pacemaker Center, Belgrade, Serbia3University of Belgrade, School of Medicine, Belgrade, Serbia

Background: Cardiac implantable electronic devices changed the treatment of patients with systolic heart failure . Although, resynchroniza-tion therapy (CRT) has become a mainstay in heart failure management, 30% of patients failed to respond to therapy.

Aim: The aim of the study was to evaluate the predictors of long-term survival in patients with dilatative cardiomyopathy (DCM) who under-went CRT.

Methods: Study population included 40 patients (mean age 58 ± 9 years) with nonischemic DCM (EF 25,7 ± 5,4%) and QRS duration of 158 ± 22ms, planned for CRT. Before CRT implantation, standard echocardiographic measurements were done and also coronary flow reserve(CFR) as the indicator of the state of microcirculation, was measured noninvasively during hyperemia induced with adenosine. Follow-upechocardiography were obtained after 6 months. Responders were defined by decrease in end-systolic volume (ESV) ≥15%. Patients werefollowed for MACE occurrence for the mean period of 49 months. Two patients were lost to follow up.

Results: During long-term follow up 8 (21%) patients died, 5 in non-responders group (p = 0.050). Before CRT implantation, responderscompared with non-responders, showed a greater increase in coronary flow velocity during hyperemia, and consequently higher CFR: 2.41 ± 0.60 vs. 1.61 ± 0.45 (p = 0.001). In univariate analysis, we include variables known to be predictive for CRT response: QRS duration, EF,ES diameter, ED diameter, LBBB. Only end systolic volume (p = 0.009), end-diastolic volume (p = 0.02) and CFR (p = 0.025) were predictorsof hard events. By Kaplan-Meier analysis, patients having CFR > 2 had a significantly higher long -term survival rate (P =0.014).

Conclusion: High end-diastolic and end -systolic volume in DCM are responsible for high wall stress and consequently depressed coronaryflow reserve. These are the indices of highly compromised left ventricular function and less favorable long-term outcome in DCM patientsundergoing CRT. These results should be confirmed in larger studies.


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P1304

Echocardiographic characterization of patients with mid-range ejection fraction: across sectional study to compare reduced and mid range heart failure patients

Malanchini G.1; Sozzi F.2; Diehl L.2; Perolo P.2; Ruggero D.3; Schiavone M.1; Gobbi C.1; Squillace M.1; Gherbesi E.1; Lombardi F.1

1University of Milan, Milan, Italy2IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy3Ospedale Civile di Voghera, Voghera, Italy

The new ESC heart failure (HF) guidelines 2016 brought a revolution in its classification: mid-range EF (mrEF). HFmrEF seems to be similarto HFrEF regarding aetiology and treatment response, according to recent, but limited literature.

The aim of our study is to describe the echocardiographic characteristics of patients with mrEF and to compare HFmrEF patients with thosewith HFrEF.

We collected echocardiographic data of any patient referred to the echocardiographic laboratory in our institution between 1/3/2015 and31/1/2018.

Patients were divided in two groups on the basis of EF: mid-range (49-40%) and reduced (<40%).

Standard echocardiographic parameters were considered together with demographical variables. Quantitative data of patients with mrEF andrEF were then analyzed with paired two sided ttest; significance level was set to 0.05. We used Stata 12.0.

Patients with HFmrEF have a mean left ventricular wall thickness of 10.5 ± 3.5 mm. Left ventricular end-diastolic volume (LVEDV) mean was117.6 ± 39.1 ml; mean EF was found to be 44.8 ± 2.8 %. They showed a normal mean tricuspid annular plane systolic excursion (TAPSE) –21.4 ± 4.0 mm – and only slightly elevated derived systolic pulmonary arterial pressure (sPAP), which mean was 34.2 ± 10.8 mmHg. Meanleft atrial size was found to be of 73.4 ± 32.5 ml.

When compared with HFrEF patients, patients with HFmrEF have smaller LVEDV, smaller left atrial volume. They have also smaller LVEDD,lower LV mass, but no differences in wall thickness were identified. HFmrEF patients showed better right ventricular function and lower sPAP.

Patients with a mid-range ejection fraction are more likely to present with a phenotype that mimic HFrEF at an earlier stage. Our study con-firm that this new classification of EF is able to properly identify patients with initial manifestation of HF.

Table 1

ARIABLE HFmrEF HFrEF p valueBody Mass Index (BMI) 26.0 kg/m2 ± 4.5 25.6 kg/m2 ± 4.9 0.22LVEDD 51.2 mm ± 6.8 56.7 mm ± 8.7 < 0.001LV mean wall thickness 10.5 mm ± 3.5 10.4 mm ± 4.9 0.45LVEDV (4CV) 117.6 ml ± 39.1 150 ml ± 52.0 < 0.001TAPSE 21.4 mm ± 4.0 19.6 mm, ± 4.2 < 0.001sPAP 34.2 mmHg ± 10.8 38.7 mmHg ± 13.2 < 0.001Lef Atrial Volume (4CV) 73.4 ml ± 32.5 86.37 ml ± 39.0 < 0.001Aortic sinuses diameter 32.8 mm ± 4.7 32.9 mm ± 4.4 0.99Ascending Aorta diameter 32.8 mm ± 5.2 32.3 mm ± 4.3 0.19

Patients characteristics


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P1305

Impact of gender on the effects of amiodarone and sotalol on left atrial strain and dia-stolic function in patients with atrial fibrillation and preserved ejection fraction

Kokhan E.; Kiyakbaev G.; Shavarov A.; Kobalava ZH.

RUDN University, Moscow, Russian Federation

Background: Women have higher rates of AF ablation failure and worse response to antiarrhythmic drug therapy compared to men. Previ-ous studies have demonstrated that – more than in men – women with preserved ejection fraction are characterized more pronounced dia-stolic dysfunction (DD), which is one of the main causes of LA remodeling. However, gender-related differences in the effects of antiarrhyth-mic therapy on LA and left ventricle (LV) remodeling remain unclear.

Purpose: To assess the gender-related differences in the effects of amiodarone and sotalol on LA strain and LV DD in AF patients withpreserved ejection fraction.

Methods: Twenty seven men and 28 women (median age of 65 [60;72]) with coronary artery disease, hypertension and recurrent AF wereenrolled in this study and treated with class III antiarrhythmic drugs (amiodarone and sotalol). Beyond conventional echocardiographic proto-col, global peak LA longitudinal strain (PALS, %) in the reservoir (r) and contractile (c) phases was measured using two-dimensional speckletracking echocardiography. We used the diastolic index [(E/E’)/LV-end diastolic volume] as a measure for LV stiffness. Follow-up period was3 months.

Results: Despite DD being significantly more pronounced in women than in men [E/E’ (13 vs 11.2; p = 0.03); diastolic index (0.13 vs 0.09ml-1; p = 0.001)], both groups had similar LA structural and functional parameters. Men and women had comparable changes (Δ) in heartrate (Δ: -2 vs -2; p = 0.41) and blood pressure during the course of treatment; however, LA volume index (Δ: -4 vs -1 ml/m2; p = 0.03) as wellas PALSr (Δ: 2 vs 0.7; p = 0.001) and PALSc (Δ: -1.8 vs -1.6; p = 0.02) improved more significantly in men. Significant improvements of LVsystolic (LV global longitudinal strain) and diastolic (E’, E/E’ and diastolic index) functions were observed in male patients only. Both menand women subgroups with complete and partial antiarrhythmic response had significant differences in PALSr and PALSc, but only womenhad intergroup differences in LV remodeling (E’, E/E’ and diastolic index).

Conclusion: Despite the fact that improvements of LA strain and LV diastolic function being more pronounced in men than in women, onlyin women did diastolic function parameters between the subgroups with complete and partial antiarrhythmic response differ significantly. Itmay indicate that impairment of diastolic function has more influence on AF in women compared to men.


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P1306

12-month kinetics of extracellular matrix fibrosis controlling factors: TGF, CTGF andgalectin-3 in dilated cardiomyopathy patients with different grades of diastolic dys-

function

Wisniowska-Smialek SYLWIA1; Dziewiecka E.1; Holcman K.1; Khachatryan L.1; Szymonowicz M.1; Karabinowska A.1; Wypasek E.1; Lesniak-Sobelga A.2; Hlawaty M.2; Kostkiewicz M.1; Podolec P.1; Rubis P.1

1Jagiellonian University Medical College, Krakow, Poland2John Paul II Hospital, Krakow, Poland

Background: Fibrosis of extracellural matrix (ECM) in dilated cardiomyopathy (DCM) is common and it compromises both systolic and dia-stolic function. Transforming growth factor (TGF1-ß), connective tissue growth factor (CTGF) and galectin-3 are crucial chemokines involvedin fibrotic pathways. Little is known on the long-term relations of fibrotic markers and diastolic dysfucntion (DD) in DCM.

Methods: Over a year we included 70 consecutive DCM patients (48 ± 12.1 years, EF 24.4 ± 7.4%) with completed baseline, 3- and 12-month follow-up echocardiograms and blood sampling. The grade of DD was estimated for each patient, according to the current ASE/EACVI algorithm. Serum levels of TGF1-ß, CTGF and galectin-3 were measured with ELISA at baseline, 3- and 12-month follow up.

Results: Based on the DD grade patients were divided into 3 groups: 1st grade DD (30 pts), 2nd grade DD (18 pts), and 3rd grade DD (22pts). At first, kinetics of TGF1-β rose; however, decreased at 12-month in all three DD groups (Fig.1). CTGF homogeneously decreased over12-month (Fig. 2). Serum concentrations of galectin-3 remained unchanged during observation (Fig. 3).

Conclusions: Kinetics of TGF and CTGF had the same pattern, i.e. decrease of concentration, regardless of DD grade. Contraction of ga-lectin-3 was homogenous in different DD grades and did not change over follow-up. Key-players of fibrosis have distinct patterns in DCMpatients with different DD grades. The clinical meaning of those observations requires further studies.

Abstract P1306 Figure.


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P1307

Prospective randomised comparison of percutaneous coronary intervention and opti-mal medical therapy in chronic total occlusion-assessment of cardiac function by con-

ventional echocardiographyJuricic S.; Petrovic O.; Dobric M.; Tesic M.; Dikic M.; Orlic D.; Tomasevic M.; Vukcevic V.; Beleslin B.; Aleksandric S.; Dedovic V.; ZivkovicM.; Milasinovic D.; Stankovic G.; Stojkovic S.

Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia

Background. Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) of the coronary artery is still high risk procedureand it is doubtful will it became standard of care. There is evidence that it can reduce angina but its effects on global cardiac functions is notfully understood.

Purpose. Our aim was to access effectiveness of PCI when added to optimal medical therapy (OMT) on myocardial function with standardechocardiography.

Methods. We prospectively randomized patients into two groups. First, patients with PCI of CTO with OMT and second group - patients withonly OMT (control group). Standard echocardiographic examinations with pulsed tissue Doppler were performed before randomization andafter 6 months of follow-up. The isovolumetric relaxation time (IVRT) was measured from closure of the aortic valve to opening of the mitralvalve. The isovolumetric contraction time (IVCT) was measured from closure of the mitral valve to opening of the aortic valve. Ejection time(ET) was measured from the opening to the closure of the aortic valve on the left ventricle (LV) outflow velocity profile. MPI was equal to thesum of the IVRT and IVCT divided by the ET. The average peak early diastolic velocity (e") was measured as average value between septaland lateral side of the mitral annulus in the four-chamber view using Doppler tissue imaging. The E/e ratio was calculated to estimate the LVfilling pressures.

Results. A total of 59 age matched CTO patients (30 in PCI + OMT group and 29 in OMT group) were analyzed. Changes in ejection frac-tion (EF), MPI, E/e ratio and average peak early diastolic velocity (e") were compared between groups (table 1.).

Conclusion. At follow up there was significant change in ejection fraction (EF) in OMT group and myocardial performance index (MPI) inPCI + OMT group. There was no significant change in indices of dyastolic dysfunction. When we compared percentage changes betweengroups in PCI + OMT group only MPI remained statistically significantly improved.

PCI CTO improves global myocardial function represented by MPI.

Table 1.

Variable OMT (n = 29) PCI + OMT (n = 30) ΔOMT vs ΔPCI + OMTp value

Baseline At 6month follow up P value Baseline At 6month follow up Pvalue

EF (%) 52,12 ± 11,26 54,29 ± 10,28 0.02* 55,69 ± 8,56 58,42 ± 9,47 0.06 0,960E/e" 12,97 ± 5,00 11,73 ± 4,70 0.056 9,99 ± 5,43 9,69 ± 4,18 0.943 0,930e" (cm/s) 5,51 ± 1,33 6,10 ±1,78 0.168 6,37 ± 2,08 6,92 ± 2,05 0.207 0,923MPI 0,6285 ± 0,15 0,6265 ± 0,12 0.767 0,6811 ± 0,10 0,6440 ± 0,10 0.041* 0,05*

Δ –percentage changes between baseline and at the 6 months follow up


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P1308

Impact of mitral valve repair on arrhythmias in mitral valve prolapseRadulovic J.; Brunec-Keller M.; Berdat P.; Vogt P.; Voegele J.; Scharf C.; Attenhofer-Jost C.

Hirslanden-Klinik im Park, HerzGefässZentrum, Zurich, Switzerland

Background: Patients (pts) with mitral valve prolapse (MVP) have an increased incidence of atrial and/or ventricular arrhythmias. The im-pact of mitral valve repair (MVR) with or without catheter ablation on arrhythmias is still debated. The goal of our study was to analyze theincidence of ventricular and atrial arrhythmias prior to and after MVR in pts with MVP.

Methods: We retrospectively analyzed 39 pts from our institution with diagnosis of MVP that were treated with MVR with or without surgicalablation technique (MAZE) between 2000 and 2017. 19 out of 39 pts had Holter monitoring both prior and after the intervention. In the other20 pts the data were completed through clinical history, pacemaker interrogation or other means e.g. exercise stress test or electrophysiolo-gy study.

Results: 28 pts (72%) were men, mean age at last follow-up was 67 years. Average left ventricular ejection fraction (LVEF) prior to MVR was54.5%. MVR was performed with ring annuloplasty in all pts and artificial chords in 10 pts; MAZE procedure was performed in 15 pts(38.5%). Before MVR, 18 pts (46%) had premature ventricular contractions (PVCs), 7 pts (18%) ventricular tachycardia (VT) and 12 pts(31%) had paroxysmal or chronic atrial fibrillation or flutter (Afib). After MVR, 17 of 39 pts (44%) had VT, which was significantly more fre-quent (p = 0.014, p < 0.05). In 13 of them VT was of a new onset. PVCs were observed in 31 of 39 pts (79%) after MVR (p = 0.014, p < 0.05).There was no significant difference regarding Afib before and after MVR - 12 patients (31%) versus 15 pts (38%) (p = 0.233), respectively.Two pts out of 39 died at 7 and 11 months after MVR suddenly (SCD). One 81 year old pt had MVR and tricuspid valve repair (no coronaryartery disease CAD), postoperatively, his LVEF was 41% and he had preoperatively up to 25% PVCs and documented 4beat VT as well asparoxysmal Afib. The other pt (no CAD) was 55 y old; he had MVR with artificial chords and died suddenly 7 months postoperatively (noautopsy, normal LVEF).

Conclusions: MVP is a known risk factor for increased incidence of both atrial and ventricular arrhythmias. Our study showed a statisticallysignificant increase in ventricular arrhythmias after mitral valve repair in patients with MVP. The occurrence of 2 SCD cases is of concern andneeds further investigation. Therefore we recommend routine Holter monitoring post-operatively and careful evaluation of palpitations andsyncope in pts even after mitral valve surgery.


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P1309

e-heart team: a novel tool for the decision making in high-risk patients with valvularheart disease

Ciampi Q.1; Mazza A.2; Bologna A.1; Martone A.1; Gambarin FI.2; Lauria C.2; Colizzi C.2; Della Porta M.1; Rosenek R.3; Crea F.2; Villari B.1;Massetti M.2

1Fatebenefratelli Hospital, Division of Cardiology, Benevento, Italy2Polyclinic Agostino Gemelli, Cardiology and Cardiac Surgery, Rome, Italy3Medical University of Vienna, Cardiology, Vienna, Austria

Background: The heart team discussion is recommended for the decision-making and management of valvular heart disease (VHD) pa-tients, in centers with departments of cardiology and cardiac surgery on site.

This study sought to compare the decision making of traditional heart team in a high-volume center with cardiac surgery on site (Hub cen-ter), with the decision taken by heart team between Hub-center and a spoke center (Spoke center) without cardiac surgery on site, using avideoconference system (e-heart team)

Methods: Forty two consecutive VHD patients (mean age 70 ± 11, mean ejection fraction: 56 ± 13%) were discussed in the conventional onsite heart-team, and they have been compared to 50 patients (mean age 68 ± 12, mean ejection fraction: 53 ± 11%) discussed in the e-heartteam between the Hub- and the Spoke-center. The e-heart team was made using a videoconference system with dedicated high-speed in-ternet connection, and thepresentation of the patients contained the clinical history, laboratory tests, images and videos of non-invasive andinvasive examinations performed in the Spoke-center.

Results: The two study groups were comparable regarding age, gender, ejection and the principal indication: aortic stenosis (13/50, 26% vs18/42, 43%, p = NS), mitral regurgitation (17/50, 36% vs 13/42, 31%, p = NS) and prosthetic valve failure (7/50, 14% vs 2/42, 5%, p = NS) forpatients in the Spoke- and Hub- centers, respectively. Patients presented in the e-heart team hada higher incidence of previous valve re-placement (18/50, 36% vs 5/42, 12%, p = 0.008), a higher STS score (7.1 ± 8.6% vs 3.3 ± 3.5%, p = 0.012) and higher prevalence for severesymptoms: NYHA functional class ≥ 3 (23/50, 46% vs 12/42, 29%, p = 0.026). We found no difference in the final decision of e-heart teamand traditional heart team about indication for surgery (21/50, 42% vs 21/42, 50%, p = NS), or percutaneous therapy (12/50, 24% vs 12/42,29%, p = NS), or hybrid therapy (1/50, 2% vs 3/42, 7%, p = NS) with high incidence of medical follow-up in e-heart team (16/50, 32% vs 6/42,14%, p = 0.009, Figure). The concordance between decision of e-heart team and traditional heart team and the real treatment performed bythe patients was similar (44/50, 88% vs 34/42, 81%, p = NS). In the median follow-up of 8 months no patients died in either group.

Conclusions: The e-heart team between high volume center with cardiac surgery on site and a spoke center without cardiac surgery onsite, using a videoconference system, is feasible and impacts on clinical decision making. Further studies are warrented to establish whetherdecision making in the e-heart team improves patient outcome of patients with VHD as compared to the traditional heart team.

Abstract P1309 Figure


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P1310

Acute effects of immediate afterload reduction with transcatheter aortic valve replace-ment on left ventricular myocardial performance - what lies beneath?

Chong A.1; Mallouhi M.2; Camuglia A.1; Cole C.3; Cox S.2; Korver K.4; Wahi S.1

1University Of Queensland, Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia2Princess Alexandra Hospital, Department of Cardiology, Brisbane, Australia3University Of Queensland, Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Brisbane, Australia4Princess Alexandra Hospital, Department of Cardiothoracic Surgery, Brisbane, Australia

Background: Transcatheter aortic valve replacement (TAVR) is evolving into the standard of care for the treatment of patients with sympto-matic severe aortic stenosis who are deemed as intermediate to high surgical risk or inoperable candidates. Hemodynamic relief of the pres-sure overload is the underpinning mechanism for left ventricular (LV) reverse remodelling resulting in the observed improvements of function-al class and survival. However limited data exists regarding the immediate effects of acute afterload reduction on LV performance post-TAVR.

Purpose: To undertake a detailed analysis of indices of LV myocardial function using transthoracic echocardiography (TTE) performed pre-and within 24 hours post-TAVR implantation and to define any acute changes in these parameters of LV performance.

Methods: All baseline and day 1 post-TAVR TTEs were retrospectively reviewed and quantitative assessments of LV ejection fraction(LVEF), mitral annular tissue Doppler velocities (E’ and S’), average global longitudinal strain (GLS), and aortic valve Doppler hemodynamicswere performed. A vendor-independent software was used to standardize GLS measurements and eliminate any comparative inter-vendorvariability.

Results: 34 TAVR patients (Mean age 83+/-10 years; 47% female) were included in the analysis. There were observed significant reduc-tions in transvalvular aortic gradients (Peak gradients: Pre 72.4 ± 42.6 vs Post 15.6 ± 11.6mmHg, P < 0.005; Mean gradients: Pre 46.6 ± 24.4vs Post 8.7 ± 6.2mmHg, P < 0.005) in parallel with increases in the effective orifice areas (EOA: Pre 0.72 ± 0.34 vs Post 2.13 ± 0.88cm2, P < 0.005) post-TAVR implantation. No immediate differences were apparent in the LV end diastolic volumes (Pre 127.4 ± 85.6 vs Post 121.6 ± 78.6mL, P = 0.20) or diastolic E/E` parameters (Pre 22.1 ± 19.2 vs Post 22.9 ± 19.3, P = 0.77). TAVR resulted in acute improvements in the LVend systolic volumes (Pre 62.4 ± 60.7 vs Post 52.8 ± 50.3mL, P = 0.003), LVEF (Pre 52.8 ± 17.9 vs Post 57.4 ± 15.6%, P < 0.005), LV S` (Pre6.2 ± 3.7 vs Post 6.8 ± 3.0cms-1, P = 0.03), and GLS (Pre -15.3 ± 6.0 vs Post -17.7 ± 5.0%, P < 0.005).

Conclusions: Acute afterload reduction from TAVR, as evidenced by immediate reduction in the transvalvular gradients and increase inEOA, results in very early functional recovery of LV myocardial systolic performance. Geometrical remodelling and regression of diastolicdysfunction are more latent contributors to longer-term outcomes and overall prognosis.


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P1311

Assessment of the quality of echocardiography performed in specialist valve clinicscompared to general cardiology clinics for valvular heart disease

Thomas K.1; Senaratne DNS2; Townsend C.2; Wheeler S.2; Jacobson I.2; Elkington A.2; Balkhausen K.2; Bull S.2

1Oxford University Hospitals NHS Trust, Cardiology, Oxford, United Kingdom2Royal Berkshire Hospital, Cardiology, Reading, United Kingdom

Background: The European Society of Cardiology (ESC) guidelines for the management of valvular heart disease suggest certain parame-ters should be recorded during echocardiography for valve lesions. In 2016, our hospital started physiology led dedicated valve clinics inaddition to general cardiology clinics.

Purpose: To determine whether good quality echocardiograms have been performed at our hospital, and whether the introduction of dedica-ted valve clinics has led to improvement.

Method: Our echocardiography database was searched for patients with valve lesions between 01/06/2015 and 01/09/2015 (4 months) and01/06/2017 and 01/10/2017 (4 months). Echocardiogram reports were reviewed. Patients with complex valve disease and inpatients wereexcluded, in addition to transoesophageal and stress echocardiograms. Microsoft Excel and SPSS were used for data analysis.

Results: 665 studies for valve lesions were performed – 341 in 2015 and 324 in 2017. 199 patients from 2015 (97f, age 70.4 ± 14.9) and210 patients from 2017 (112f, age 74.1 ± 13.7) remained after exclusion criteria.

Measurement of blood pressure (p = 0.01, chi squared) and body mass index (p < 0.001, chi squared) significantly improved between 2015and 2017. There was a significant decrease in measurement of aortic root size in patients with aortic regurgitation (p = 0.005, chi squared).

Measurement of left ventricular ejection fraction (p = 0.107, chi squared), valve morphology in patients with aortic stenosis (p = 0.878, chisquared), heart rhythm in patients with mitral regurgitation (p = 0.572, chi squared) and mechanism of valve dysfunction in all patients (p = 0.093, chi squared) were not significantly different between 2015 and 2017.

Conclusions: The introduction of physiology led specialist valve clinics has significantly increased recording of general parameters such asblood pressure and body mass index compared to general cardiology clinics. There were no improvements in measurement of other param-eters highlighting the need for continuous quality control.

Table 1

Parameter recorded 2015 2017Blood pressure 66/210 (31.4%) 91/199 (45.7%)Body mass index (BMI) 14/210 (6.6%) 59/199 (29.6%)Left ventricular ejection fraction (LVEF) 188/210 (89.5%) 186/199 (93.5%)Mechanism of valve dysfunction 165/269 (61.3%) 159/293 (54.3%)Aortic stenosis: valve morphology 69/83 (83.1%) 81/113 (71.7%)Aortic regurgitation: aortic root size 70/76 (92.1%) 51/68 (75.0%)Mitral regurgitation: heart rhythm 109/110 (99.1%) 110/112 (98.2%)


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P1312

Echocardiographic and laboratory parameters associated with progression of tricuspidvalve regurgitation

Verikas D.1; Norvilaite R.1; Ziubryte G.1; Bugaite J.2; Gabartaite D.2; Krivickiene A.3; Motiejunaite J.3; Zaliaduonyte-Peksiene D.3; CerlinskaiteK.4; Jurgaitiene R.4; Balciunaite G.4; Zakartaite D.4; Mebazza A.5; Kavoliuniene A.3; Celutkiene J.4

1Lithuanian University of Health Sciences, Kaunas, Lithuania2Vilnius University, Faculty of Medicine, Vilnius, Lithuania3Lithuanian University of Health Sciences, Department of Cardiology, Kaunas, Lithuania4Vilnius University, Clinic of Cardiac and Vascular diseases, Center of Cardiology and Angiology, Vilnius, Lithuania5Hospital Lariboisiere, Paris, France

Funding Acknowledgements: The work was supported by the Research Council of Lithuania, grants Nr. MIP-049/2015 and approved byLithuanian Bioethics Committee, Nr. L-15-01.

OnBehalf: the GREAT network

Introduction: Even though tricuspid valve regurgitation (TR) is a frequent echocardiographic finding in heart failure, the significance of TR toin acute settings is not well studied.

Purpose: To investigate the relationship between echocardiographic and laboratory markers of TR severity in acute dyspnoea patients.

Methods: Echocardiography was performed in 482 patients with acute dyspnoea in prospective multicentre observational study during thefirst 48 hours after presentation to the emergency department. Echocardiographic quantification included the following parameters: tricuspidannular plane systolic excursion (TAPSE), velocity of the tricuspid annular systolic motion (RV S’), RV fractional area change (FAC), RV bas-al diameter, entire RV strain, strain of free RV wall, inferior vena cava (IVC) and left atrium (LA) parameters. The current study included 347patients with full sets of parameters. Patients were divided into groups according to TR severity, as qualitatively assessed by Doppler echo-cardiography: mild - I’ and I’-II’ regurgitation; moderate – II’ and II’-III’; severe – III’ or greater. Data were analysed using One-way ANOVA.

Results: The distribution of echocardiography and laboratory parameters among the TR groups is shown in Table 1.

Conclusions: The progression of tricuspid regurgitation is proportional to right heart remodelling as well as right and left ventricular dysfunc-tion.

Distribution parameters among the groups

Mild TRN = 187 (54%)

Moderate TRN = 105 (30%)

Severe TRN = 55 (16%)

TAPSE (cm) 1.7 ± 0.5 1.5 ± 0.5* 1.4 ± 0.5*RV FAC (%) 36.3 ± 13.2 36.1 ± 14.5 31.8 ± 11.6RV S’ (cm/s) 10.4 ± 2.8 9.6 ± 2.8 8.8 ± 3.4*RV basal diameter (cm) 4.3 ± 0.8 4.7 ± 1.0* 5.0 ± 1.1*RA area (cm2) 23.2 ± 7.3 26.7 ± 9.4* 30.4 ± 9.8*Strain of RV free wall (%) -16.9 ± 6.6 -15.8 ± 6.1 -14.2 ± 4.2Strain of entire RV (%) -13.0 ± 5.3 -12.1 ± 4.6 -10.9 ± 3.6IVC expiration (cm) 2.2 ± 0.5 2.4 ± 0.5* 2.6 ± 0.7*IVC inspiration (cm) 1.3 ± 0.7 1.6 ± 0.8* 1.9 ± 0.8*IVC collapsibility (%) 43.5 ± 23.2 35.3 ± 24.8* 31.0 ± 23.5*LA volume index (mL/m2) 62.1 ± 28.4 72.6 ± 25.2* 88.4 ± 46.2*LVEF (%) 41.8 ± 14.6 37.8 ± 15.6* 30.3 ± 15.7*§

BNP (ng/L) 1063.4 ± 1138.6 1801.9 ± 2164.7* 2395.7 ± 2397.5*Creatinine ( µmol/L) 110.1 ± 71.0 115.1 ± 54.1 125.5 ± 41.9*

*p < 0.05 compared to mild, §p < 0.05 compared to moderate


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P1313

Posterior to anterior mitral valve leaflets length ratio and its association with severityof rheumatic mitral stenosis

Mefriyanni M.

Andalas University, Cardiology and Vascular Medicine, Padang, Indonesia

Background: Rheumatic mitral stenosis (MS) is the cause of mitral valve disease commonly found in developing countries. Determiningseverity of Rheumatic MS is very important, related with prognosis and management of the disease. Current echocardiography methodshave advantages and disadvantages in determining the severity of Rheumatic MS. In rheumatic MS, commisural fusion and shortening ofchordae tendinae might affect the length of mitral valve leaflets and produce higher severity of MS.

Purpose: To assess the association between posterior to anterior mitral valve leaflets length ratio (PMVL/ AMVL ratio) and severity of rheu-matic mitral stenosis.

Method: This was a cross-sectional descriptive analytic study. The subjects were all patients with rheumatic mitral stenosis who underwentechocardiography examination during 2016 until 2017 to measure the PMVL/AMVL ratio as well as determining the severity of mitral steno-sis based on the guidelines. One way ANOVA test was used to assess the association between PMVL/AMVL ratio and severity of the rheu-matic MS.

Result: Of 123 RMS patients included in this study, there were 18 mild RMS, 27 moderate RMS and 78 severe RMS patients. The majorityof subjects were female with median age 41 years old and have atrial fibrillation. In this study, the mean ejection fraction was 53.37 ± 10 %,mean LA Volume index 83 ± 69 ml/m² with mean Systolic PA pressure 56 ± 24 mmHg in all groups. Mean Mitral valve area (MVA) usingplanimetry method was 0.9 ± 0.3 cm² while using PHT mean MVA was 1 ± 0.3 cm² with mean gradient 12 ± 4 mmHg. There was a significantdifference of posterior mitral valve leaflet (PMVL) length in mild, moderate and severe rheumatic MS (28.3 ± 5 mm vs 21 ± 4 mm vs 20 ± 5mm, P = 0.00) but no significant difference of anterior mitral valve leaflet (AMVL) length (35 ± 5 mm vs 33 ± 3 mm vs 31 ± 4 mm, P = 0.15,respectively). Using ANOVA one way test, the mean PMVL/AMVL length ratio had shown statistically significant difference with rheumaticMS severity (P = 0.001). Furthermore, post hoc analysis showed significant difference between groups in mild vs moderate MS and mild vssevere MS.

Conclusion: The PMVL/AMVL ratio was significantly associated with severity of Rheumatic MS. The PMVL/AMVL ratio might be used as aparameter in assessing MS severity which is not affected by hemodynamic profile of the patients.


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P1314

Non performance of transesophageal echocardiography impairs prognosis of elderlypatients with infective endocarditis

Selton-Suty C.1; Roubaud C.2; Delahaye F.3; Vancon AC.4; Dijos M.2; Ennezat PV.5; Fluttaz A.6; Richard B.7; Beaufort C.8; Nazeyrollas P.9;Brasselet C.10; Pineau O.11; Donal E.12; Iung B.13; Forestier E.6

1University Hospital of Nancy - Hospital Brabois, Vandoeuvre les Nancy, France2University Hospital of Bordeaux, Bordeaux, France3Hospital Louis Pradel of Bron, Lyon, France4Hospital of Alès, Alès, France5University Hospital of Grenoble, Grenoble, France6Hospital of Chambéry, Chambéry, France7Hospital of Annecy, Annecy, France8University Hospital of Poitiers, Poitiers, France9University Hospital of Reims, Reims, France10Clinique Courlancy, Reims, France11Hospital of Villeneuve St Georges, Villeneuve St Georges, France12University Hospital of Rennes, Rennes, France13Hospital Bichat-Claude Bernard, Paris, France

Funding Acknowledgements: Fondation Coeur et Recherche

OnBehalf: AEPEI

Background: Infective endocarditis (IE) increasingly involves elderly patients and geriatric status may influence therapeutic decision andimpact prognosis.

Methods: A multicenter prospective observational study (ELDERL-IE) was conducted between March 2015 and April 2016 and included 120patients ≥ 75 yo with definite or possible IE (83.1 ± 5.0 (75-101) yo, 56 female (46.7%)). All patients had an initial comprehensive geriatricassessment (CGE) and 3 months (M3) and 1 year (Y1) follow-up. Comparisons were made between patients who did or who did not undergoa transesophageal echocardiography (TEE) (TEE vs no-TEE groups).

Results: There was a high proportion of patients with intracardiac material (valvular prosthesis 34%, stimulation device 22%) and 46% hadno previously known underlying heart disease. Digestive streptococcacae (17% group D, 19% Enterococci) and Staphylococcus aureus(27%) were the most frequent responsible micro-organisms. Rate of extracardiac complications was 40%.

Echocardiography revealed abnormalities related to IE in 85 pts (71%) with vegetations found in 81 (67%), abscess in 17 (14%) and severeregurgitation in 21 (17%). Only 77 pts (64%) had TEE. Reasons for not performing TEE were that it would not change therapeutic plans in 29(85%) or that transthoracic one was considered of sufficient quality in 19 (54%). Four (11%) patients refused TEE.

No-TEE patients were older (85.4 ± 6.0 vs 81.9 ± 3.9, p = 0.001), had a worse age-ponderated Charlson score (6.2 ± 2.1 vs 5.4 ± 1.5, p = 0.04), more often had no previously known underlying heart disease (27 (63%) vs 29 (38%), p = 0.008), and had a trend toward higher rate ofStaphylococcus aureus infection (15 (35%) vs 17 (22%), p = 0.13) than TEE ones. Abscess was less often diagnosed in those patients (2(5%) vs 17 (22%), p = 0.01). Regarding geriatric assessment, all no-TEE patients had poorer scores of functional (ADL: 2.2 ± 1.8 vs 3.6 ± 2.1,p = 0.0004), nutritional (MNA: 15.9 ± 6.2 vs 18.8 ± 5.9, p = 0.02) and cognitive (MMSE: 17.5 ± 7.5 vs 21.6 ± 6.5, p = 0.006) status than others.Surgery was performed in 19 TEE (16%) and 0 no-TEE pts, was theoretically indicated but not performed in 15 TEE (19%) and 6 (14%) no-TEE pts, and was not indicated in 43 (56%) TEE and 37 (86%) no-TEE patients (p = 0.0006). Mortality was significantly higher in the no-TEEgroup (M3: 22 (51%) vs 17 (22%), p = 0.001; Y1: 25 (58%) vs 26 (34%), p = 0.01).

Conclusion: Despite similar features of IE, surgical indication was less frequently recognized in no-TEE patients. They were less often oper-ated on and had a poorer prognosis. These results let us think that IE cardiac lesions might have been less diagnosed in no-TEE patients,thus hampering the optimal therapeutic management, especially in patients with intracardiac material and S. aureus infection. Frailty shouldnot prevent patients from a proper diagnosis and geriatricians should help cardiologists to better use TEE in the elderly with suspected IE.


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P1315

Detection of longitudinal systolic dysfunction in patients with chronic aortic regurgita-tion with preserved ejection fraction by speckle-tracking echocardiographic mitral an-

nular displacementHozumi T.; Nishi T.; Takemoto K.; Maniwa N.; Kashiwagi M.; Shimamura K.; Kuroi A.; Matsuo Y.; Kitabata H.; Ino Y.; Kubo T.; Tanaka A.;Akasaka T.

Wakayama Medical University, Cardiology, Wakayama, Japan

Background: Chronic aortic regurgitation (AR) with reduced left ventricular ejection fraction (LV-EF) is one of important etiology in patientswith heart failure. Previous reports using LV global longitudinal strain (LV-GLS) analysis have shown LV longitudinal systolic dysfunction priorto reduction in LV-EF and it is useful for the prediction of prognosis in patients with chronic AR. Application of speckle-tracking echocardiog-raphy provides quick and easy assessment of tissue mitral annulus displacement (TMAD) which may be used for detection of LV longitudi-nal systolic dysfunction alternatively to LV-GLS.

Purpose: The purpose of this study was to examine whether TMAD can be used for the detection of LV longitudinal systolic dysfunction inpatients with greater than moderatechronic AR with preserved LV-EF.

Methods: The study population consisted of46 patientswith greater than moderateAR and preserved LV-EF (>50%) who underwent speck-le-tracking echocardiography (Philips, iE33 and EPIQ, QLAB 10). In all the patients, TMAD was automatically and quickly assessed as thebase-to-apex displacement of mid-point of both septal and lateral annuls during systole in apical four-chamber view (figure). Displacement ofthe mid-point of the line between the septal and lateral annulus, and its percentage of LV length at end-diastole (%TMAD) were automatical-ly assessed. LV-GLS from apical 4-chamber, 2-chamber, and long-axisviews was successfully measured in 40 of 46 patients (86%).The finalstudy population of the40patients successfully analyzed by both %TMADand LV-GLS was divided into two groups; 17 patientswith preservedLV longitudinal systolic function (|LV-GLS|>19%; Group-A) and 23 with decreased LV longitudinal systolic function (|LV-GLS|<19%; Group-B)according to the previous reports.

Results: %TMAD was significantly lower in Group-B compared with Group-A (10.5 ± 2.0 % vs 13.6 ± 2.7, p < 0.0001).By multiple regressionanalysis, %TMAD remained an independent predictor of decreased LV-GLS (adjusted R²= 0.55, p = 0.0024). According to ROC curve analy-sis, a cut-off value of %TMAD <13.2 had a sensitivity of 68%, a specificity of 90% for the presence of decreased LV-GLS(area under thecurve: 0.83).

Conclusions: The present results showed that TMAD was useful in the assessment of LV longitudinal systolic dysfunction in patientswith greater than moderateAR and preserved LV-EF. It may suggest that TMAD could be used for the simple detection of LV longitudinalsystolic dysfunction in patientswith chronic AR and preserved LV-EF.


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P1316

Long-term hemodynamic improvement after transcatheter repair of secondary mitralregurgitation

Lavall D.1; Mehrer M.2; Schirmer SH.2; Reil JC.3; Boehm M.2; Laufs U.1

1Leipzig University Hospital, Department of cardiology, Leipzig, Germany2Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany3Medical University, Department of Cardiology, Lübeck, Germany

Background: The correction of mitral regurgitation (MR) alters the loading conditions on the left ventricle (LV). This might be of particularimportance in secondary MR because of LV function is already impaired. The long-term hemodynamic adaptations of the cardiovascular sys-tem after transcatheter mitral valve repair (TMVR) in secondary MR are largely unknown.

Purpose: The aim of this study was a comprehensive hemodynamic assessment using non-invasive pressure-volume analysis before and12 months after TMVR.

Methods: Pressure-volume parameters were calculated from transthoracic echocardiography with simultaneous arm-cuff blood pressuremeasurements using the single-beat method (1). 59 consecutive patients with grade 3+ or 4+ secondary mitral regurgitation and symptomat-ic heart failure (80% NYHA functional class ≥ III) who underwent edge-to-edge transcatheter mitral valve repair were prospectively analyzed.The mean left ventricular ejection fraction (± standard deviation) was 34 ± 10%.

Results: 12 months after TMVR, 23.1% of patients had died, 17.0% were re-hospitalized because of decompensated heart failure. Mitralregurgitation grade was ≤2+ in 97% of surviving patients and 78% were in NYHA functional class ≤II. LV end-diastolic volume decreasedfrom 211 ± 73ml to 187 ± 75ml (p < 0.0001), end-systolic volume changed from 143 ± 63ml to 132 ± 70ml (p = 0.037). Hence, total stroke vol-ume was reduced (68 ± 23ml to 54 ± 14ml, p < 0.0001). Total ejection fraction and global longitudinal peak systolic strain remained at similarvalues. Increased forward ejection fraction (23 ± 9% vs. 29 ± 14%, p = 0.001), cardiac index (1.6 ± 0.4l/min/m2 to 1.8 ± 0.5ml/min/m2, p = 0.018), peak power index (151 ± 62mmHg/s vs. 185 ± 99mmHg/s, p = 0.025) as well as a similar end-systolic elastance at reduced LV vol-umes indicate improved LV performance while LV contractility was not specifically altered. Afterload parameters (arterial elastance, total pe-ripheral resistance) did not change significantly. Cardiac efficiency, measured as cardiac index relative to myocardial energy, was increasedat 12 months (0.0089 ± 0.004mmHg-1 vs. 0.0117 ± 0.006mmHg-1, p = 0.019).

Conclusion: 12 months after TMVR, reverse remodeling and improved LV performance was associated with reduced symptom status. Thishemodynamic improvement supports TMVR as long-term effective therapy for patients with secondary mitral regurgitation.

(1) Chen CH, Fetics B, Nevo E, Rochitte CE, Chiou KR, Ding PA, Kawaguchi M, Kass DA. Noninvasive single-beat determination of leftventricular end-systolic elastance in humans. J Am Coll Cardiol 2001;38:2028-2034.


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P1317

May functional mitral regurgitation in patients with coronary artery disease withoutmyocardial infarction be of non-coronary origin?

Yaroslavskaya EI.; Kuznetsov VA.; Gorbatenko EA.

Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tyumen, Russian Federation

Background: It is known that not only postinfarction remodeling of left ventricle (LV) but also chronic regional myocardial hypoperfusion maycause a compensatory hypertrophy of undamaged areas of the LV. Can chronic LV hypoperfusion lead to the development of functional mi-tral regurgitation (FMR) in coronary artery disease (CAD) patients without previous myocardial infarction?

Purpose: To reveal factors associated with moderated and severe FMR in CAD patients without myocardial infarction depending on gender.

Methods: From local register of coronary angiography we selected men and women with significant coronary stenosis (≥75% of lumen of atleast one epicardial artery) who had no acute or previous myocardial infarction: 1001 men without FMR and 66 men with moderate andsevere one; 183 women without FMR and 20 women with moderate and severe FMR.

Results: According to the mulrivariate analysis, irrespective of gender FMR was independently associated with arrhythmias (OR = 7.92;95% CI 3.21-19.57; p < 0.001 in men and OR = 4.05; 95% CI 1.15-14.35; p = 0.030 in women), index of left atrium dimension (OR = 1.25;95% CI 1.09-1.43; p = 0.002 in men and OR = 1.49; 95% CI 1.15-1.93; p = 0.003 in women), LV ejection fraction (OR = 0.49; 95% CI0.75-0.89; p < 0.001 in men and OR = 0.86; 95% CI 0.76-0.96; p = 0.008 in women). FMR in men was also associated with worse Canadiancardiovascular society angina class (OR = 0.49; 95% CI 0.24-0.98; p = 0.044) and older age (OR = 1.09; 95% CI 1.03-1.16; p = 0.005). Irre-spective of gender, no association between moderate and severe FMR and localization of significant coronary lesions in CAD patients with-out myocardial infarctions was found.

Conclusion: The absence of association between moderate and severe FMR and localization of significant coronary lesions as well as re-vealed FMR associations with arrhythmias, left atrium size and LV ejection fraction suppose mixed (coronary and non-coronary) FMR originin CAD patients without myocardial infarctions irrespective of gender.


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P1318

Inncidence of mitral annular calcification and its association with mitral valvular dis-ease

Okura H.; Nakada Y.; Keshi A.; Nogi M.; Ishihara S.; Toyokawa N.; Okamura A.; Okayama S.; Watanabe M.; Kawakami R.; Saito Y.

Nara Medical University, Kashihara, Japan

Background: Mitral annular calcification (MAC) is increasingly observed in elderly population and patients with chronic kidney disease. Al-though MAC may cause mitral valvular disease (MVD), incidence and characteristics of MVD in MAC is uncertain.

Purpose: The purpose of this study was to investigate incidence of MAC and its association with MVD.

Methods: A total of 13,483 consecutive patients who underwent echocardiographic examination were enrolled and studied. Incidence ofMAC and its association with MVD were studied.

Results: MAC was present in 1,881 of 13,483 patients (14%). Patients with MAC (group MAC) was older and more female gender thanthose without MAC (non-MAC group). Significant (> =moderate) mitral stenosis defined as mean pressure gradient > 5mmHg was present in2.2% of MAC group and in 0.6% of the non-MAC group (P < 0.0001). Significant (> =moderate) mitral regurgitation was present in 11.9% ofMAC group and in 5.0% of the non-MAC group (P < 0.0001).

Conclusion: MAC was present in 14% of the patients who were sent for echo examination.MAC was associated with MVD.


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P1319

The prognostic importance of mitral deformation indexes and left ventricle volumes inpatients with ischemic mitral regurgitation and multivessel disease qualified to cardio-

surgery treatment

Piatkowski R.1; Kochanowski J.2; Scislo P.2; Budnik M.2; Grabowski M.2; Kosior DA.1; Opolski G.2

1Clinical Hospital of the Ministry of Internal Affairs, Department of Cardiology and Hypertension with the Clinical Electrophysiology Lab, War-saw, Poland2Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland

Purpose: In patients (pts) after myocardial infarction (MI) with chronic left ventricle (LV) dysfunction, the presence and degree of ischemicmitral regurgitation (IMR) are predominantly related to LV remodeling and mitral valvular deformation. The purpose of this study was to eval-uate the use of prognostic importance of LV volumes and mitral deformation indexes (MDI) as predictors of hospitalizations due to exacerba-tion of heart failure (HF) in pts with non-severe IMR qualified for cardiosurgical treatment - coronary artery by-pass grafting alone (CABGa)or CABG with mitral repair (CABGmr).

Materials and methods: We prospectively analyzed 100 pts (M 56, 64 ± 8 years) with moderate IMR, 3-24 weeks after MI. Effective regurgi-tation orifice (ERO) was used for quantitative IMR assessment(non-severe ≥10-20 mm²). All the pts were qualified for CABG (multivesselcoronary disease, ejection fraction (EF)- 44 ± 9%, wall motion score index (WMSI)-1.57 ± 0.3). Prior to surgery MDI (tenting area (TA) andcoaptation height (CH)) and LV volumes (end-systolic volume, end-diastolic volume) were assessed using 2D echocardiography. Patientswere referred for CABGa (gr.1; n = 74) or CABGmr (gr.2; n = 26) based on clinical assessment, 2D echo at rest and exercise as well as myo-cardial viability (low dose dobutamine stress echo). Multivariable logistic regression analysis was used to identify the strongest factors ofhospitalizations due to exacerbation of HF.

Results

Multivariable logistic regression analysis revealed that in both CABGa and CABGmr group only preoperative TA and ESV remained the inde-pendent predictors of the risk of hospitalization due to HF exacerbation in 12 months follow-up (table 1).

The best cut-off value for ESV was 96 ml (sensitivity of 100% and specificity of 83% (AUC 0.884) in CABGa group. In CABGmr group thebest cut-off value for ESV was 83 ML (sensitivity 75%, specificity 59%; AUC 0.636). TA diameter >2.1 cm2 provided sensitivity of 100% andspecificity of 77% (AUC 0.886) in CABGa group. In CABGmr group the best cut-off value for TA was 2.6 cm2 (sensitivity 100%, specificity68%; AUC 0.807).

Conclusions:

Preoperative MDI and LV volumes assessment can be used to identify pts with IMR at increased risk of progression of HF and hospitaliza-tions due to exacerbation of HF and should be used for better qualification of pts to the exact surgical approach.

Parameters Odds ratio (OR) 95% confidence interval (CI) pCABGa vs CABGmr 2.723 04-18.512 0.306ESV (increase by every 5 ml) 1.130 1.022-1.249 0.017TA (increase of TA by 0.2 cm²) 1.218 1.003-1.479 0.047


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P1320

Layer-specific myocardial deformation in patients with symptomatic severe aorticstenosis before and after transcatheter aortic valve replacement

Evola V.1; Sorrentino R.2; Lembo M.2; Scalamogna M.2; Avvedimento M.2; Esposito R.2; Novo G.2; Trimarco B.2; Esposito G.2; Galderisi M.2

1University of Palermo, Palermo, Italy2University Hospital Federico II, Naples, Italy

Background: Myocardial wall is a complex structure, composed of 3 layers (endocardial, mid- and epicardial) with specific fiber orientation.These layers may be differently involved depending on pathological conditions, such as ischemia or pressure overload. Speckle tracking al-lows nowadays to analyze multiple layers, whose specific involvement is still not understood in severe aortic stenosis (SAS).

Purposes: We evaluated layer-specific myocardial deformation in patients with symptomatic SAS compared to healthy individuals and then,after transcatheter aortic valve replacement (TAVR).

Methods: After excluding 11 patients with coronary artery disease, pacemaker, left bundle branch block (LBBB) and atrial fibrillation beforeTAVR procedure, 26 consecutive patients (F/M = 18/8, age = 81.3 ± 8.5 years) were enrolled. The control group included 16 healthy subjects.We also compared 11 SAS patients before and after TAVR, after excluding 15 patients who developed post-procedure LBBB. An echo-Dop-pler exam, including global longitudinal strain (GLS), subendocardial longitudinal strain (EndoLS) and subepicardial longitudinal strain (Ep-iLS), was performed before and early after intervention (1-3 months later) and in controls.

Results: SAS and controls had comparable age, body mass index, blood pressure and heart rate. Pre-TAVR patients had greater left ven-tricular mass index (LVMi), and lower ejection fraction (EF), GLS, EndoLS and EpiLS in comparison with controls, with greater impairment ofEpiLS than EndoLS (Table). After TAVR, in absence of significant changes of LVMi and EF, GLS improved (19.6 ±5.3 vs. 22 ± 5.3%, p = 0.03). This improvement was mainly due to increase of EpiLS (17.3 ± 5.1 vs. 19.3 ±4.8; p = 0.04) while EndoLS changes were not significant(23.2 ± 6.7 vs. 24.9 ± 5.8, p = 0.212).

Conclusions: In symptomatic SAS, longitudinal strain impairment involves all myocardial layers, but this involvement is slightly prominent atthe subepicardial level. After TAVR, GLS is improved because of the EpiLS increase while EndoLS does not appear to be modified, thosedemonstrating to be less prone to early recovery after pressure unloading.

Echo parameters in TAVR and controls

Variable SAS patients Controls P valueMean SD Mean SDLVMi (Kg/m2.7) 56.9 14.6 37.49 8.0 <0.0001EF (%) 57.4 8.7 61.9 4.0 0.041GLS (%) 18.9 4.7 21.8 1.6 0.008endoLS (%) 21.9 5.8 24.7 1.7 0.035epiLS (%) 16.6 4.3 19.8 1.4 <0.001


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P1321

Comparison of baseline characteristics and outcomes after transcatheter aortic valveimplantation in women with and without history of breast cancer

Miyazaki S.; Hirose K.; Morimoto R.; Maruyama M.; Kaya E.; Fukase T.; Nishio R.; Doi S.; Okazaki S.; Daida H.

Juntendo University School of Medicine, Department of Cardiology, Tokyo, Japan

Background: Both radiotherapy and chemotherapy for breast cancer may cause cardiovascular complications including pericarditis, valvu-lar stenosis, and myocardial damage. We aimed to compare the baseline characteristics, echocardiographic findings, and outcomes aftertranscatheter aortic valve implantation (TAVI) in women with severe aortic stenosis with and without history of breast cancer.

Methods: This single-center, retrospective observational study included 60 women who underwent TAVI between 2016 and 2018.

Results: Of the 60 patients, 11 (18%) had history of breast cancer (6 left-sided, 4 right-sided, and 1 bilateral). 70% of the patients weretreated using a balloon expandable device and 88% using a transfemoral approach. No patient required conversion to open surgery, and theTAVI prosthesis was successfully deployed in all. Patients in the non-breast cancer (non-BC) group were younger than those in the breastcancer (BC) group (79.6 ± 7.8 vs. 83.8 ± 4.8, p = 0.02). Prevalence of hypertension, diabetes, dyslipidemia, coronary artery disease, atrialfibrillation, and the mean Society of Thoracic Surgeons score were not statistically different between the groups. Echocardiographic findingsincluding the peak flow velocity, mean pressure gradient, aortic valve area, and the ejection fraction were also not statistically different be-tween the groups. The left ventricular mass index was higher in the BC group, although this difference was not statistically significant (137.4 ± 50.2 vs. 122.7 ± 29.6, p = 0.1). More than moderate paravalvular leakage was observed in 2 women in the non-BC but not in the BC group.Duration of hospitalization after TAVI was similar in both groups, and 1 in-hospital death secondary to pneumonia occurred in the non BC-group. The 30-day mortality was 0% in both groups.

Conclusions: Short-term outcome after TAVI was similar in women with and without history of breast cancer. Large-scale studies with alonger follow-up are necessary to evaluate the impact of breast cancer therapy on cardiac function and outcomes after TAVI.


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P1322

Right ventricle dysfunction in severe aortic stenosis: prevalence and risk factorsRamos Jimenez J.; Hernandez S.; Plaza Martin M.; Vieitez Florez JM.; Abellas Sequeiros M.; Zamorano Gomez JL.

University Hospital Ramon y Cajal de Madrid, Madrid, Spain

Introduction

Right ventricle dysfunction (RVD) is a well-established poor prognosis factor in subjects with severe aortic stenosis (AS). Because of sampleheterogeneity, published results are discordant regarding distribution of RVD among severe AS subjects. The present study aims to establishcurrent prevalence and risk factors associated to RVD in a large cohort of patient with severe AS.

Methods

Observational and multicenter study of consecutive cases. Individuals with severe AS, defined as aortic valve area (AVA) <1cm2 and pre-served left ventricle ejection fraction (LVEF≥50%), were prospectively included during a 3-month period in ten tertiary hospitals. RVD wasdefined as tricuspid annular plane systolic excursion (TAPSE) <17mm. A p-value < 0.05 was considered statistically significant.

Results

The study sample consisted of 673 subjects. TAPSE was available in 668 studies, showing 5.7% (n = 38) of them RVD. Mean age was 75.6 ± 10.9 year-old, and 52.5% (n = 351) were males. When compared with subjects with normal RV function, patients with RVD were signifi-cantly older and more frequently females (71% vs 46%; p = 0.003). In addition, rheumatic etiology and atrial fibrillation were more frequentlyencountered, as well as lower mean transaortic gradient (MG) and smaller stroke volumes (SV). Conversely, no differences were present interms of aortic valve area (AVA) or LVEF.

Conclusions

RVD in the context of severe AS, is more frequent in females and is associated to rheumatic etiology and lower flow and gradient state.

Normal RV (n = 630) RVD (n = 38) Mean difference (CI95%) p-valueAge (years) 75.4 79.9 -4.5 (-8.1 to -1.0) 0.01AVA (cm2) 0.77 0.75 0.02 (-0.03 to 0.09) 0.43LVEF (%) 65 63 2 (-1 to 4) 0.19MG (mmHg) 39 32 7 (2 to 12) <0.01Left atrial volume (mL) 76 93 -17 (-29 to -6) <0.01Stroke volume (mL) 69.7 57.4 12.3 (6 to 18.7) <0.01AF 13.0% 42.1% - <0.01Rehumatic 1.9% 10.5% - <0.01Moderate/severe MS 3.1% 7.9% - 0.03Moderate/severe TR 9.1% 39.5% - <0.01

MS: mitral stenosis; MR: mitral regurgitation.


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P1323

3D echocardiography vena contracta area might be useful to identify patients with mi-tral regurgitation persistence after surgical aortic valve replacement in patients with

severe aortic stenosisPosada EL.; Rodriguez-Zanella H.; Fritche-Salazar JF.; Ortiz-Leon XA.; Jordan-Rios A.; Balderas-Munoz K.; Sierra Lara-Martinez D.; Calvil-lo-Arguelles O.; Ruiz Esparza-Duenas ME.; Gaspar-Hernandez J.; Martinez-Rios MA.; Arias-Godinez JA.

National Institute of Cardiology Ignacio Chavez, Department of Echocardiography, Mexico City, Mexico

Funding Acknowledgements: No funding

Background. Mitral valve regurgitation (MR) occurs in up to 50% of patients with severe aortic valve stenosis. Its presence is challengingspecially in patients with mild and moderate MR, for which current ESC guidelines do not recommend intervention. However, without inter-vention MR will persist in nearly half of the patients, in whom prognosis will be worse. Predictors for MR persistence after aortic valve inter-vention have not been previously described.

Purpose: To identify echocardiographic predictors of MR persistence in patients with severe aortic valve stenosis and mild or moderate MR,who will undergo surgical aortic valve replacement (SAVR).

Methods. We prospectively included patients with severe aortic stenosis with class I indication for SAVR, with mild or moderate MR. A com-plete echocardiographic exam was performed within 24 hours before surgery. Mitral valve tenting area, coaptation distance, posterolateraltenting angle, apical displacement of the posteriomedial papillary muscle, interpapillary muscle distance and three-dimensional vena con-tracta (3DVC) area were measured. Bivariate and multivariate logistic regression analysis was performed to analyse the association of eachcovariable with the persistence of MR after SAVR.

Results. We included 24 patients (25% female, age 58± 11 years, LVEF 52± 12%). MR persisted in 9 patients (38%), tenting area (p = 0.27),coaptation distance (p = 0.52), posterolateral tenting angle (p = 0.77), apical displacement of the posteriomedial papillary muscle (p = 0.35)and interpapillary muscle distance (p = 0.78) were not associated with MR persistence. Although not statistically significant there was a trendfor patients with higher 3D VC area (0.28 ±0.1 vs 0.21 ±0.1, p = 0.075) to be free of MR after SAVR. 3D VC area showed a strong trendtoward association with mean aortic gradient (r = 0.35, p = 0.08)

Conclusions. Mitral valve remodelling echocardiographic variables are not good predictors of MR persistence after SAVR. A higher 3D VCarea correlates with higher valve gradient, these patients may have a higher systolic intra-ventricular pressure explaining the improvement ofMR after SAVR. The use of 3DVC area might be useful to identify patients in whom MR will persist after SAVR. Future studies to confirm ourfindings are needed.



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P1324

Can resting segmental strain be used as an indicator for stable coronary artery dis-ease?

Rosner AR.; Sandberg MS.; Kjonaas DK.; Jensen TJ.

University Hospital of North Norway, Department of Cardiology, Tromso, Norway

Funding Acknowledgements: Helse Nord grant; project number: HNF1405-18

Background: The number of patients with chest pain undergoing screening for coronary artery disease is high. Currently used screeningmethods are either invasive or expose patients to radiation or they hamper test-accuracies or availability. Strain-rate imaging (SRI) is a prom-ising technique being able to show discrete changes in myocardial function. We hypothesized that echocardiography with SRI at rest mightreveal subtly decreased myocardial function in patients with stable coronary artery disease (CAD).

Methods: In a retrospective study, 61 patients with stable CAD assigned to coronary artery bypass grafting (CABG) and 61 age- and gendermatched healthy control subjects from a population based study (HUNT) from Trondheim were investigated with tissue Doppler imaging(TDI) strain and speckle- tracking (2D) segmental SRI. The CABG patients displayed low scar load, including 78% of patients without anymyocardial scar in MRI. Segmental strain was expressed as the maximal positive or negative strain-value during systole. TDI and 2D strainanalyses were performed by independent observers.

Results: At a segmental cut-off for hypokinetic strain at >-8% , AUC was 0.95 (CI 0.91-1.00) for TDI and 0.79 (CI 0.70-0.87) for 2D strain.For this cut-off, TDI strain with >1/16 hypokinetic segments identified CAD with a sensitivity of 95%and specificity of 86%, while using 2Dstrain, >2 hypokinetic segments indicated presence of CAD with 90% sensitivity and 62% specificity. In the patient cohort, feasibility of 2Dstrain was higher with 2-3% discarded segments, while segments with TDI strain in the same data-set were discarded in 8%.

Conclusion: Segmental strain identified regions with significantly reduced strain in the majority of patients with stable CAD. TDI strainshowed significantly higher test-accuracies compared to 2D strain but lower feasibility. The study indicates that segmental systolic strain atrest might have the potential for screening chest-pain patients. These promising results need to be evaluated in larger prospective studies.



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P1325

Insights into cardiac functional alterations after a 246 km ultra-marathon race based onsimultaneous 4-chamber longitudinal strain assessment

Pagourelias E.1; Christou G.2; Anifanti M.2; Sotiriou P.2; Christou K.2; Koutlianos N.2; Kouidi E.2; Deligiannis A.2

1Aristotle University of Thessaloniki, Thessaloniki, Greece2Aristotle University of Thessaloniki, Laboratory of Sports Medicine, Thessaloniki, Greece

Background: It is well documented that prolonged intense exercise such as marathon running, transitorily alters cardiac function. However,previous studies have focused on single chamber assessment rather than describing the impact of ultra-endurance (UE) exercise on inter-chamber functional relationships.

Purpose: The aim of the study was the evaluation of the acute effects of UE exercise on intra-, inter- and atrioventricular coupling.

Methods: Echocardiographic assessment was performed the day before and at the finish line of "Spartathlon": A 246 Km ultra-marathon. 2Dspeckle-tracking echocardiography was performed in all 4 chambers in the same cardiac cycle, including the interventricular and interatrialseptum in the longitudinal strain (LS) measurements for both ventricles and atria accordingly (Figure). Peak deformation values and tempo-ral parameters adjusted for heart rate were extracted from the derived curves.

Results: Out of 60 participants initially screened, 25 athletes (19 males, 46.4 ± 6.9 years old) finished the race in 33:16 ± 1:59 hours. Bothleft (LV) (-20.9 ± 2.3 pre- to -18.8 ± 2% post-, p = 0.009) and right ventricular (RV) strain (-22.9 ± 3.6 pre- to -21.2 ± 3% post-, p = 0.04) de-creased post-race, even though remaining within normal range for the vast majority of athletes (85%), whereas peak atrial [right (RA) andleft (LA)] strains did not change (p = 0.12 and 0.95). RV strain alteration after the race was not correlated with athletes’ age or years of train-ing, training distance or training time per week but was inversely associated with finishing time (R²=0.26, p < 0.001) (Figure). RV/LV, LV/LA,RV/RA and RA/LA peak values’ ratios remained unchanged from pre to post-race. Although right chambers’ time-to-peak values were short-er compared to the left ones, all chambers’ strain curves peaked later post-race (p < 0.001 for all).

Conclusions: Despite subtle changes in LV and RV strain, 4 chamber deformation values remained within normal range even after runninga 246 km ultra-marathon, maintaining the inter- and atrioventricular concordance.



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P1326

Identification and defintion of right ventricular cardiotoxicity by trastuzumab

Keramida K.1; Bingcang J.2; Sulemane S.3; Sutherland S.4; Bingcang RA.2; Charalampopoulos G.5; Kouris N.6; Ramachandran K.7; Nihoyan-nopoulos P.8

1Attikon University Hospital, Cardio-Oncology Clinic, Heart Failure Unit, Department of Cardiology, Athens, Greece2Barts Health NHS Trust, Cardiology Department, London, United Kingdom3Hammersmith Hospital, London, United Kingdom4West Hertfordshire Hospitals NHS Trust, Mount Vernon Cancer Centre, London, United Kingdom5Attikon University Hospital, 2nd Radiology Department, Athens, Greece6Thriassio General Hospital, Athens, Greece7Watford Hospital, West Hertfordshire Hospitals NHS Trust, Cardiology, London, United Kingdom8Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom

Background: Trastuzumab therapy although improves significantly the prognosis of patients with HER2+ breast cancer, can lead to cardio-toxicity, often with devastating results. While trastuzumab induced left ventricular (LV) systolic dysfunction has been widely reported, the ef-fect of right ventricular (RV) involvement and its significance has not been elucidated.

Objectives: The aim of this study was to assess deformation mechanics of both ventricles concurrently in patients receiving trastuzumabthroughout treatment and to identify and define cardiotoxicity of the right ventricle using 2D speckle tracking.

Methods: One-hundred and one consecutive women (mean age, 54.3 ± 11.4 years) receiving trastuzumab were included in the study withthe view to assess biventricular function throughout the treatment period. Sixty-two of them (61%) had also previously received anthracy-clines, while 26 (25.7%) received taxanes concurrently according to treatment protocols. Comprehensive 2D echocardiographic assessmentand subsequently off-line analysis of global longitudinal strain of the left (LVGLS) and the right (RVGLS) ventricle, were obtained at baselineand every 3 months up to completing the therapy at 12 months. Images were then taken off line to a vendor independent analysis software(Tomtec ArenaTM, TomTec Imaging Systems) for LV, RV and RV free wall (RVFWLS) speckle tracking analysis. Cardiotoxicity was definedas a decrease of the baseline LVEF more than 10 percentage points to a value below 50%.

Results: At three months, only LVEF and LVGLS were reduced [61.8 ± 4.1 to 59.6 ±5 (p < 0.001) and -19.5 ±2.7 to -18.7 ± 2.8 (p = 0.0410)respectively], while at six months LVGLS, RVGLS and RVFWLS recorded their lowest values (-17.9 ± 6.1, p = 0.002, -19.6 ± .2, p = 0.003 and-19.7 ± 5.6, p = 0.004, respectively) (Figure A). Based on the LVEF, ten women (9.9%) developed cardiotoxicity during follow up, whilechanges in LVGLS suggested risk of cardiotoxicity in sixteen (15.8%). ROC curve analysis (Figure B) showed that the optimal-cut off value ofRVGLS % change for discriminating patients with cardiotoxicity was -14.8% with sensitivity 66.7% and specificity 70.8%. The area under thecurve (AUC) was 0.68 (95% CI: 0.54-0.81). According to this cut off point of RVGLS relative reduction, 90% of women with cardiotoxicity hadsignificant concurrent subclinical impairment of the RV.

Conclusions: Global Longitudinal strain of LV and RV follow a similar temporal pattern in patients on trastuzumab therapy with the worstvalues recorded at 6 months after the initiation of therapy. The optimal cut-off value of relative percent change of RVGLS is similar to LVGLSfor detecting subclinical cardiotoxicity, confirming the global and uniform effect of trastuzumab on myocardial cells.



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P1328

Premature ventricular contractions are presaged by a dyssynchronous sinus beat

Alhede C.1; Hadjis A.1; Bibby D.2; Fang Q.2; Abraham T.2; Schiller NB.2; Gerstenfeld EP.1

1University of California San Francisco, Section of Electrophysiology, San Francisco, United States of America2University of California San Francisco, Department of Echocardiography, San Francisco, United States of America

Funding Acknowledgements: None

Background: Premature ventricular contractions (PVCs) can lead to cardiomyopathy; one potential mechanism is the dyssynchronous con-traction of the PVC. However, the effect of PVCs on sinus rhythm (SR) synchrony is unknown.

Purpose: We aimed to explore myocardial dysfunction and dyssynchrony during SR and PVCs. We hypothesized that there is dyssynchro-ny present during SR, preceding or following PVCs.

Methods: We prospectively included 26 consecutive patients undergoing PVC ablation (64 ± 15 years, 62% females, LVEF 54 ±16%). Leftventricular global longitudinal strain (GLS) and mechanical dispersion (MD) during isolated SR and PVC beats were quantified by speckletracking echocardiography. We analyzed GLS and MD in a SR, pre-PVC, PVC and post-PVC beat.

Results: Mean GLS was -18 ± 3.5% and MD was 67 ± 19 ms for SR beats. For PVC beats, GLS was significantly lower and MD highercompared to SR beats (GLS -13 ± 3.3%, p= 0.005 and MD 124 ± 53.7 ms, p= 0.0001). Notably, the SR beat preceding the PVC had lowerGLS and higher MD than other SR beats (GLS -11 ± 2.6%, p < 0.0001 and MD 79 ± 32 ms, p = 0.03). In post-PVC SR beats GLS was higherand MD equal to SR beats (GLS -19 ± 3.7, p= 0.01 and MD 61 ± 16.5, p = 0.6). Pre-PVC SR beats had lower GLS but less MD than PVCs(GLS: p = 0.005 and MD: p = 0.007).

Conclusion: In patients with frequent PVCs, low GLS and higher MD occurred in pre-PVC SR beats. This suggests a physiologic stimulusleading to SR dyssynchrony must occur prior to the PVC, and may help explain why a low PVC burden may lead to cardiomyopathy in somepatients.

Abstract P1328 Figure. Comparison of GLS in various heart beats


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P1329

Prospective evaluation of atrial function by 2d speckle tracking analysis in HER-2 posi-tive breast cancer patients during trastuzumab therapy

Bragantini G.1; Bergamini C.1; Benfari G.1; Comunello A.1; Setti E.1; Dolci G.1; Truong S.1; Lanza D.2; Fiorio E.1; Carbognin L.1; Dal PortoM.1; Cerrito LF.1; Rossi A.1; Ribichini FL.1

1University of Verona, AOUI VR, Verona, Italy2General Hospital of Rovigo, Cardiology, Rovigo, Italy

Background: Trastuzumab (TZ) has a fundamental role in therapy of HER-2 positive breast cancer (BC) patients. However, it may causeleft ventricular (LV) dysfunction resulting in withdrawal of therapy. A decrease in left ventricular global longitudinal strain (GLS) has beendemonstrated to be a good predictor of subsequent TZ-cardiotoxicity (CT). Left atrial (LA) morphological remodeling during TZ therapy hasalso been shown. Nevertheless, limited data are available regarding LA function in this clinical setting.

Purpose: to investigate the strain pattern of both LV and LA in BC patients treated with TZ, independently of subsequent development of CTas defined by the current ESC guidelines.

Methods: HER-2 positive BC metastasis-free patients referring to our Echo-lab were prospectively recruited. Different lab tests and clinicaldata were collected during follow-up (FU). Trans-thoracic echo was performed before starting TZ and every 3 up to 12 months. LV volumes,LV ejection fraction (LVEF), LA volume and diastolic parameters were measured. 2D-Speckle tracking analysis was performed at baselineand at each subsequent examination. In particular GLS and peak atrial longitudinal strain (PALS) were analyzed using Philips’ QLAB soft-ware. Results: 64 patients formed the study population. 40 of these (62,5 %) had a complete 12 months FU. 53 patients (82,8%) were previ-ously treated with anthracyclines. Mean age was 55,05 ± 12,1 years. CT occurred in 6 (9,3 %) patients. Mean baseline GLS was -21,4 ± 2%and mean baseline PALS was 51,1 ± 12%. GLS analysis was feasible in 91% of patients and PALS analysis in 84%. We reported excellentreproducibility for GLS (intra-observer ICC 0.93, p = 0.8; inter-observer ICC 0.92, p = 0.7) and good reproducibility for PALS (intra-observerICC 0.93, p = 0.1; inter-observer ICC 0.83, p = 0.7). Overall LVEF didn’t show a significant drop over time in our population. Despite the lowrate of CT during the 12 months FU in our population, we reported a trend of decrease in GLS (p for time = 0.06), with an early drop duringthe first 6 months of TZ therapy and a subsequent "plateau" phase, and a significant decrease of PALS over time (p for time = 0.008), with acontinuous gradual decrease for the whole FU (Fig.1).

Conclusions: our results suggest that 2D speckle tracking analysis is feasible and adds useful information about ventricular and atrial func-tional remodeling. Actual recommendations for identification of CT are based upon a joint evaluation of LVEF and GLS, but our study demon-strates that significant variations in GLS and PALS can occur independently of LVEF variations. This could be an indicator of subclinical myo-cardial damage, affecting both ventricular and atrial myocardium. The assessment of LA function by deformation indexes (strain rate) couldadd further information for daily clinical practice, possibly improving the detection of early CT. More studies are needed to further investigatethese exploratory data.

Abstract P1329 Figure. Fig.1 Trend of GLS and PALS during TZ


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P1331

Ejection fraction and global longitudinal strain variability between methodology andexperience. Is this the dawn of the independence day?

Keramida K.1; Kostopoulos V.2; Psarrou G.2; Olympios CD.2; Kouris N.2

1Attikon University Hospital, Cardio-Oncology Clinic, Heart Failure Unit, Department of Cardiology, Athens, Greece2Thriassio General Hospital, Athens, Greece

Although ejection fraction (EF) has been the mainstay of the assessment of left ventricular (LV) systolic function for many years, its meas-urement (msm) faces a number of challenges related to image quality, assumptions of LV geometry and expertise. Global Longitudinal Strain(GLS) derived from speckle tracking echocardiography provides a more direct assessment of cardiac function with good inter-observer re-producibility.

Aim: to test the inter-observer variability of EF and GLS msm in patients (pts) with a broad spectrum of LV function, between operators (Op)with different levels of expertise (E).

Methods: In 110 consecutive pts EF and GLS were measured by 4 blinded to each other Op with different level of experience in echocar-diography: (Op A) resident in cardiology with 3 months training in echo, (Op B) resident in cardiology with 8 months training in echo, (Op C)specialized, with >6 years of experience and (Op D) the head of echolab with > 20 years of experience. EF was measured using 3 methods:visual assessment, biplane Simpson’s method and auto-EF method. GLS was measured from the 3 apical views. All studies were performedat the same echo machine (GE Vivid 7 updated) and msm were obtained off-line using the EchoPac version 110 software. Patients withsuboptimal images were excluded. Significant difference for LVEF was considered to be >10 percentage points, while for LVGLS >8% rela-tive percentage change.

Results: 80.9% of the studies revealed LV wall motion abnormalities and perfect echo windows were present at 42.7%, while in 57.3% theimages were adequate for analysis, according to Op D. EF msm differed significantly between the 4 Op with every method of EF assess-ment used, as well as between the 3 methods of EF assessment in the same Op (Table 1). Also, EF method divergences were inverselyproportional to the level of (E). On the other hand, GLS msm showed no significant difference between the 3 more experienced Op (Table 1)and was found to be less depended on the level of (E). As expected, image quality was found to affect significantly GLS and autoEF msm.

Conclusion: Global Longitudinal Strain is well correlated with accurately estimated EF, but shows better inter-observer variability than EFand most importantly, is less affected by the level of expertise.

Table

EF visual(Mean ± SD)

EF Simpson"s (Mean ± SD)

Auto EF(Mean ± SD)

P*visual vs Simp-son"s

P*visual vs autoEF

P*Simpson"s vsautoEF

GLS(Mean ± SD)

Op A 36.8 ± 11.8 38 ± 13.4 36.7 ± 11.2 0.024 0.596 0.022 -11.3 ± 3.9Op B 39.2 ± 13.1 38.8 ± 12.4 36 ± 12 0.540 <0.001 <0.001 -11.3 ± 5Op C 38 ± 13 40 ± 12 35 ± 13 0.028 0.002 <0.001 -11.4 ± 4.1Op D 40.4 ± 14.4 37.5 ± 12.6 34.7 ± 12.4 <0.001 <0.001 <0.001 -10.9 ± 4.2


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P1332

Myocardial constructive work is additive to left ventricular dyssynchrony and volumet-ric response to CRT in the prediction of mortality after CRT implantation.

Galli E.1; Hubert A.2; Le Rolle V.3; Hernandez A.3; Mabo P.2; Leclercq C.2; Donal E.2

1University of Rennes , Laboratoire Traitement du Signal et de l"Image, INSERM U-1099, Rennes, France2University Hospital of Rennes, Cardiology, Rennes, France3INSERM , Laboratoire du traitement du Signal et de l"Image, RENNES, France

Background: myocardial constructive work (CW) assessed by pressure-strain loops (PSLs) is an independent predictor of a volumetric re-sponse to cardiac resynchronization therapy (CRT). Aim of this study was to evaluate the role of CW in predicting cardiac mortality in heartfailure patients undergoing CRT.

Methods and results: 166 CRT-candidates (ejection fraction ≤35%, QRS duration ≥120 ms) underwent 2D-standard and speckle-trackingechocardiography before CRT and at 6-month follow-up (FU). PSLs were used to assess myocardial constructive work (CW). After a medianFU of 4 years (range: 1.3-5 years), cardiac death occurred in 14 patients (8%). A multivariable Cox regression analysis, CW ≤ 888 mmHg%was the only independent predictor of cardiac mortality (Table 1). After 6 months of CRT, a 15% reduction in left ventricular end-systolic vol-ume was observed in 118 (71%) patients, and a CRT volumetric response was identified. The addition of CW ≤ 888 mmHg% to a modelincluding clinical variables, SF, and CRT-response caused a significant increase in model power for the prediction of cardiac death (Chi-square: 18 vs 26, p = 0.02). Harrel’s C-concordance was also estimated (Figure 1, Table 2).

Conclusions: The estimation of left ventricular CW by PSLs is a relatively novel tool that allows for the prediction of cardiac mortality in CRTcandidates.

Table 1 Univariable analysis Multivariable analysisCardiac death HR 95% CI p-value HR 95% CI p-valueAge, per year 1.08 (1.01-1.15) 0.02 1.07 (1.00-1.15) 0.04Ischaemic disease 3.99 (1.34-11.94) 0.01 2.33 (0.71-1.15) 0.16NYHA > 2 1.39 (0.46-4.24) 0.56LBBB 0.87 (0.27-2.77) 0.81LVEF, per % 0.99 (0.92-1.08) 0.89Septal flash 0.19 (0.06-0.62) 0.006 0.48 (0.12-1.95) 0.30CW < 888 mmHg% 4.76 (1.33-17.12) 0.01 4.23 (1.08-16.51) 0.03CRT-response 0.26 (0.09-0.78) 0.02 0.68 (0.18-2.57) 0.58Table 2 Harrell’s C-concordanceAgeIschaemic disease

0.73

AgeIschemic diseaseSeptal flash

0.75

AgeIschemic diseaseSeptal flashCRT response

0.76

AgeIschemic diseaseSeptal flashCRT responseCW ≤ 888 mmHg

0.82

Abstract P1332 Figure 1


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P1333

Prominent longitudinal strain reduction of left ventricular basal segments at rest andafter exercise in body builder assuming androgenic anabolic steroids

Lo Iudice F.; De Roberto AM.; Buonauro A.; Ferrone M.; Esposito R.; Franco D.; D"andrea A.; Trimarco B.; Galderisi M.

University Hospital Federico II, Naples, Italy

Background: Androgenic anabolic steroids (AAS) abuse is widely diffuse among body builders and has been associated with left ventricular(LV) hypertrophy and impairment of systolic and diastolic function.

Purpose: To evaluate the effect of AAS abuse on LV global and regional longitudinal function at rest and after exercise.

Methods: We enrolled 23 competitive body builders, all male: 12 AAS abusers (AB), 11 with no history of hormonal substances abuse (nAB),of comparable age (33.6 ± 8.0 vs 30.8 ± 8.7 years, p= NS). Among AB, 6 also declared abuse of growth hormone agonists. All subjects un-derwent an echo Doppler exam at rest and soon (within the first minute of recovery) after bicycle exercise (14 minutes, 2 minutes per stage,increase of 25 watts per stage). Speckle tracking was performed at rest and after exercise and global longitudinal strain (GLS) determined.The average longitudinal strain of 6 basal (BLS), 6 middle (MLS) and 5 apical (ALS) segments was also calculated. Systolic blood pressure(SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured at rest and at peak exercise.

Results: HR, SBP and DBP at rest were similar between the two groups but AB had higher body mass index compared to nAB (p = 0.008).AB had higher LV mass index (LVMi) (110.0 ± 22.2 versus 75.4 ± 10.8 g/m², p < 0.0001) and relative wall thickness (0.36 ± 0.07 vs 0.29 ± 0.03,p = 0.0009), while no significant difference emerged in LV end-diastolic and end-systolic volumes, ejection fraction, transmitral E/A ratio, E/e’ratio and left atrial volume index. GLS was lower in AB (-17.2 ± 2.7 vs. -20.3 ± 1.5 %, p = 0.003). BLS (-14.2 ± 3.0 vs. -18 ± 1.9 %, p = 0.002)and MLS (-16.8 ± 2.5 vs. 19.8 ± 1.5, p = 0.002) were also lower in AB, while no significant difference was found in ALS (-22.2 ± 3.1 vs. -24.4 ± 2.1 %, p = NS) (Figure 1). In the pooled population, significant inverse correlations of LVMi emerged with resting GLS (r=-0.43, p = 0.04), BLS(r=-0.48, p = 0.02) and MLS (r=-0.48, p = 0.02), but not with ALS. At multiple linear regression analysis LVMi was associated with BLS(b=-0.50, p = 0.02) independently on age, SBP and HR. After exercise, GLS (-23.5 ± 3.4 vs. -25.2 ± 3.1; p = NS), MLS (-22.2 ± 3.3 vs -24.4 ± 2.3, p = NS) and ALS (-30.1 ± 4.0 vs -30.4 ± 5.2; p = NS) were not different between AB and nAB, but BLS remained lower in AB (-17.6 ± 3.7vs. -21.2 ± 1.6, p = 0.007). HR, SBP and DBP at peak exercise were not significantly different between AB and nAB.

Conclusion: AAS abusing body-builders show impaired LV longitudinal function at rest, involving basal and mid segments with a relativeapical sparing. Reduction of BLS is independently associated with LV hypertrophy. After exercise, GLS is preserved because of the inotropicresponse of apical and mid segments, while BLS remains impaired. Longitudinal dysfunction of LV base could be a marker of myocardialinvolvement in AAS-induced cardiomyopathy.

Abstract P1333 Figure. Strain bull"s eye in nAB and AB


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P1334

Correlation between myocardial strain and non-invasive myocardial work indices: re-sults from the eacvi norre study

Manganaro R.1; Dulgheru R.1; Marchetta S.1; D"amico G.1; Ilardi F.1; Cimino S.1; Sugimoto T.1; Zito C.2; Carerj S.2

1University Hospital of Liege (CHU), Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic , Liege, Belgium2University of Messina, Department of Clinical and Experimental Medicine, Messina, Italy

Funding Acknowledgements: GE Healthcare and Philips Healthcare

Background: Myocardial work (MW) is a parameter of myocardial function, which takes into account deformation as well as afterload. Leftventricle (LV) pressure-strain loops (PSLs) are a novel and reliable tool for the non-invasive assessment of MW.

Purpose: The present study sought to evaluate the correlation between indices of non-invasive MW and LV volumes, traditional and ad-vanced parameters of LV systolic function by 2D echocardiography.

Methods: A total of 226 (mean age: 44.7 ± 13.2 years) healthy subjects were enrolled at 22 collaborating institutions of the Normal Refer-ence Ranges for Echocardiography (NORRE) study. Global Work Index (GWI), Global Constructive Work (GCW), Global Work Waste(GWW) and Global Work Efficiency (GWE) were estimated by LV PSLs using custom software. Peak LV pressure was estimated non-inva-sively from brachial artery cuff pressure. LV end-diastolic (EDV) and end-systolic (ESV) volumes, LV mass, LV stroke volume (SV), LV ejec-tion fraction (EF) were measured. As advanced indices of myocardial performance, global longitudinal (GLS), circumferential (GCS) and ra-dial (GRS) strain were obtained.

Results: On multivariable analysis, GWI was significantly correlated with GLS (p< 0.001), EF (p= 0.005), SBP (p < 0.001) and GRS (p = 0.002), while GCW was correlated with GLS (p < 0.001), SBP (p < 0.001), SV indexed (p = 0.02), and GRS (p = 0.002). GWE was also corre-lated with EF (p= 0.001), while GWW was inversely correlated with EF (p = 0.008).

Conclusions: The non-invasive MW indices show a good correlation with traditional 2DE parameters of myocardial systolic function andmyocardial strain.


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P1335

Left atrial electromechanical delay - A unique predictor of non-AF supraventricular ta-chycardia in patients with hypertrophic cardiomyopathy

Nowak A.; Oko-Sarnowska Z.; Ochotny R.; Mitkowski P.; Lesiak M.

Poznan University of Medical Sciences, 1st Department of Cardiology, Poznan, Poland

Introduction: Atrial fibrillation and supraventricular tachycardia (non-AF) are common arrhythmias in hypertrophic cardiomyopathy (HCM),however they significantly differ in the influence on the clinical course of the disease. The distinction between those two arrhythmias remainsan important clinical problem. Echocardiographic parameters of the left atrial remodeling are potential predictors of different atrial arrhyth-mias.

Purpose: the aim of the study was to determine echocardiographic parameters of left atrial remodeling with prognostic value on non-AFsupraventricular tachycardia incidence in patients with hypertrophic cardiomyopathy.

Material and methods: We evaluated 181 patients diagnosed with HCM (50,3% men) aged 18–82 years (mean 50,5 ± 16,6). The study proto-col comprised echocardiographic examination of the following parameters: LA linear dimensions: antero-posterior (LAa-p), medial-lateral(LAm-l), superior-inferior (LAs-i); LA volume indexed values: LAVI and LAVImin; left atrial electromechanical delay (LA-EMD - time from theonset of P wave (ecg) to the peak of A wave (TDI)). Patients underwent: 12-lead ecg, 24-hour Holter monitoring, implantable cardioverter-defibrilator and pacemaker control. Patients were classified into three groups: I (99 patients - without arrhythmia), II (49 patients with AF), III(33 patients with non-AF SVT).

Results: Patients with SVT were characterized by significantly higher LAVImin dimension (23,5 ± 12,4 vs 17,0 ± 9,1 ml, p = 0,01) when com-pared to patients without arrhythmia. Additionally higher LAa-p (44,5 ± 6,4 vs 41,8 ± 7,7 mm, p > 0,05), LAm-l (45,3 ± 6,6 vs 42,6 ± 5,5 mm, p > 0,05) and LAVI (42,0 ± 15,8 vs 34,9 ± 13,2 ml, p = 0,054) dimesions where observed. LAs-i dimension was significantly lower in non-AFgroup when compared to AF (55,9 ± 9,3 vs 59,9 ± 8,3 mm, p = 0,040). LA-EMD was significantly shorter in non-AF group when compared topatients with AF (68 ± 24 vs 85 ± 27 ms, p = 0,014). LA-EMD = 67 ms was the moderate predictor of SVT (AUC = 0,67; 56% sensibility; 71%specificity, p = 0,009) according to ROC curves analysis. The single predictors of SVT in HCM-patients were: moderate or severe mitral re-gurgitation (MR) (OR = 3,19; CI 1,31-7,75; p = 0,008), LAm-l (OR = 1,08; CI 1,00-1,16; p = 0,028), LAVI (OR = 1,03; CI 1,00-1,06; p = 0,018),LAVImin (OR = 1,06; CI 1,02-1,10; p = 0,004).

Conclusions: Patients with HCM and non-AF supraventricular tachycardia, as well as those with AF, characterize with the higher left atrialremodeling in comparison with patients without arrhythmia. The interval of left atrial electromechanical delay (LA-EMD), along with LAs-i, is aunique parameter differentiating non-AF and AF patients with HCM and is significantly shorter in the first group. The relationship betweenLA-EMD value and the incidence of different supraventricular arrhythmias in patients with HCM requires further studies.


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P1336

Effect of sodium-glucose cotransporter 2 inhibitor on diastolic function and global lon-gitudinal strain (GLS) in patients with heart failure with preserved ejection fraction

(HFpEF).

Sakai T.1; Miura S.2

1Kenwakai Otemachi Hospital, Internal of medicine, Kitakyusyu, Japan2Fukuoka University, School of Medicine, Fukuoka, Japan

OnBehalf: Kenwakai Otemachi

Background/introduction

The sodium-glucose cotransporter 2 (SGLT2) inhibitors have been suggested to improve diastolic function and global longitudinal strain(GLS) in heart failure with preserved ejection fraction (HFpEF).

Purpose: We sought to study GLS and the ratio of early mitral inflow velocity to global diastolic strain rate (E/e’ sr) to determine whether thetreatment with SGLT2 inhibitors was associated with an improvement in LV diastolic functions simultaneously endothelial function in patientswith HFpEF.

Methods:

We studied 114 type 2 diabetes mellitus (T2DM) treated by SGLT2 inhibitors and 75 normal glucose tolerance (NGT) subjects with HFpEF(mean age, 67 ± 13yr). Transthoracic echocardiograms were performed to identify diastolic function and GLS. In addition, the ratio of earlymitral inflow velocity to global diastolic strain rate (E/e’ sr) was valued to estimate of all segments of the myocardial abnormalities. Endothe-lial function was evaluated by measuring the FMD (Flow-Mediated Dilation), and Cardio-Ankle Vascular Index (CAVI) as indices of vascularfunction

Results: There were no differences between T2DM and NGT in patients with HFpEF at the baseline physiological inspection. The reductionof fasting plasma glucose (FPG), hemoglobin A1c (HbA1c) and Insulin Resistance (IR) were significant in T2DM after 3 months (mean⊿±SD; 26.5 ± 3.4mg/dL, 0.66 ± 0.10mg/dL, and 0.86 ± 0.18, P< 0.01). Significantly, short-term SGLT2 inhibitors treatment was associated withan improved GLS (mean⊿±SD; 3.3 ± 1.2% P < 0.01) and diastolic function per the early diastolic filling velocity (E ) /atrial filling velocity (A )ratio (E/A ratio), the early septal annular tissue Doppler velocity (septal e’), the early lateral annular tissue Doppler velocity (lateral e’). Asignificant reduction in E/A ratio, septal E/e’, lateral E/e’ were noted with T2MD (pre vs. post; E/A 1.28 ± 0.33 vs. 1.07 ± 0.32; P=.007; septalE/e": 14.54 ± 2.70 cm/s vs. 8.01 ± 1.99cm/s; P=.003; lateral E/e": 14.67 ± 1.85 vs. 6.44 ± 1.61; P=.044:). FMD was significantly higher andCAVI was significantly lower in T2DM (mean⊿±SD; 2.86 ± 1.20, -0.69 ± 0.28, P < 0.05). There were no improvements in GLS, diastolic func-tion, FMD and CAVI with NGT. Moreover, E/e’ sr with T2DM was much lower than that of NGT significantly (P = 0.015). (mean⊿±SD; 0.11 ± 0.02% P < 0.01, 0.02 ± 0.04% n.s). A multiple logistic regression analysis, which includes LVEF, FMD, CAVI, FPG, HbA1c, IR, E/e’ and GLS,revealed that E/e’ sr was the best independent predictor of an improvement in LV diastolic functions with T2DM (P < 0.05).

Conclusions:

These observations suggest the potential SGLT2 inhibitors improve diastolic function and GLS in subjects with T2MD probably due to stimu-late by production of nitric oxide through the IR improvement. It is suggested that E/e’ sr is a stronger predictor of improving diastolic functionthan E/e’ and could provide independent and incremental prognostic information.


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P1337

Left atrial strain analysis by means of speckle tracking echocardiografphy: a new sen-sitive tool in the diagnosis of acute cellular rejection in heart transplat recipients

Rodriguez Diego S.1; Ruiz Ortiz M.1; Delgado Ortega M.1; Weinsaft JW.2; Kim J.2; Carnero Montoro L.1; Sanchez Fernandez J.1; CarrascoAvalos F.1; Lopez Aguilera J.1; Lopez Granados A.1; Arizon Del Prado JM.1; Luque Moreno A.1; Oneto Fernandez J.1; Pan Alvarez-OssorioM.1; Mesa Rubio D.1

1University Hospital Reina Sofia, CARDIOLOGY, Cordoba, Spain2Weill Cornell Medical College, New York, United States of America

Introduction and purpose: Our objective was to investigate the role of left atrial strain analysis by means of speckle tracking echocardiog-raphy in the non-invasive diagnosis of acute cellular rejection (ACR) in heart transplantation recipients.

Methods: From 15.09.2014 to 31.10.2016 we performed, in 18 consecutive adult HTxR in their first year posttransplantation, an echocardio-graphic exam within 3 hours of the routine surveillance endomyocardial biopsies (EMB), in a single center. End-systolic global, peak averageand end-systolic average longitudinal strains, as well as peak average strain rate were measured in the left atrium in the apical four cham-bers view in all studies, and associations with ACR grades of severity were investigated by analysis of variance (ANOVA).

Results: A total of 147 pairs of EMB and echo exams were performed, 65 with no rejection (grade 0R), 63 with rejection grade 1R and 19with rejection grade ≥ 2R. Association of left atrial longitudinal strain variables with ACR grade are shown in the table. A value of peak aver-age longitudinal strain ≥ 19%, present in 34% of studies, had a negative predictive value of 77% for any grade of ACR (C statistic of 0.74[95%CI 0.65-0.83, p < 0.0005] by ROC curve analysis).

Conclusions: In this monocentric prospective study, left atrial longitudinal strain variables were found to be a sensitive marker of acute cellu-lar rejection in heart transplant recipients. The main discriminative ability appears to be between those studies without rejection and thosewith any grade of rejection.

±Variable Grade of rejection(ISHLT 2005)

p-value

0R 1R 2R-3R Overall* 0R vs 1R** 0R vs 2R-3R** 1R vs 2R-3R**End-systolic global strain (%) 16.2 ± 7.4 11.5 ± 6.4 10.7 ± 7.4 <0.0005 0.001 0.008 0.88Peak average strain (%) 19.1 ± 6.2 14.2 ± 5.4 13.9 ± 5.6 <0.0005 <0.0005 0.006 0.98End-systolic average strain (%) 17.5 ± 6.0 13.0 ± 5.1 13.3 ± 5.4 <0.0005 <0.0005 0.03 0.98Peak average strain rate (%/s) 1.0 ± 0.4 0.8 ± 0.3 0.7 ± 0.2 0.001 0.004 0.01 0.7

Values are shown as mean ± standard deviation. *Analysis of variance; ** Post-hoc subgroup analysis by Tukey test.ISHLT: International Society for Heart and Lung Transplantation.


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P1338

Circulating microRNAs and cardiac dysfunction in patients with coronary artery dis-ease and type II diabetes assessed by 3D and 2D ecocardiography

Gheorghiu L.1; Ciobanu A.1; Butoi E.2; Macarie R.2; Vadana M.2; Ciortan L.2; Tucureanu M.2; Luchian L.3; Copciag R.3; Vinereanu D.1

1Carol Davila University of Medicine and Pharmacy, University and Emergency Hospital Bucharest, Cardiology Department, Bucharest, Ro-mania2Institute of Cellular Biology & Pathology Nicolae Simionescu, Bucharest, Romania3University Emergency Hospital , Bucharest, Romania

Background. MicroRNAs (miR) are short, non-coding small RNAs, involved in pathological pathways of a large amount of cardiovasculardiseases (CVD). However, their role in early diagnosis and prognosis of different CVD is still controversial. Purpose. To determine the asso-ciation of circulating miR, which were suggested to have possible cardiovascular implications (miR126 and miR146), with left ventricularejection fraction (LVEF), global longitudinal strain (GLS), and arterial function, in patients with stable and unstable coronary artery disease(CAD). Methods. 70 patients with CAD (68% men, 58+/-12 years), including 57 patients with ST elevation acute myocardial infarction (STE-MI) (27 patients with diabetes, 30 without diabetes) and 13 patients with stable CAD, were assessed within 24 hours of admission by serummicroRNA analysis, 2D, 3D and speckle tracking echocardiography (for LVEF and GLS), and evaluation of arterial function (EP and β in-dex, CAVI and ABI). Results. For the whole group, higher miR126 was associated with lower 2D LVEF (r=-.32, p = 0.048). In patients withSTEMI and diabetes, higher miR126 was associated with lower 2D LVEF (r=-.54, p = 0.038), while in patients with STEMI without diabeteshigher miR126 was associated with lower 2D GLS (r=-.61, p = 0.035). Furthermore, miR126 was associated with parameters of arterial stiff-ness, assessed by R-CAVI and L-CAVI in all patients with STEMI (r=.35 and r=.39, respectively, p < 0.05), and by EP and β indexes in pa-tients with STEMI without diabetes (r=.72, and r=.59, respectively, p < 0.05). Circulating levels of miR146 were higher in patients with STEMIvs. stable CAD (95% CI 1.46-8.22, p = 0.006). In patients with STEMI and diabetes, higher miR146 was associated with higher troponin I(r=.76, p < 0.0001), while in patients with STEMI without diabetes higher miR146 was associated with lower 3D GLS (r=-.47, p = 0.04). Con-clusions. Circulating micro-RNAs might be new biomarkers for the early diagnosis and detection of cardiac dysfunction in patients with CAD.Transthoracic echocardiography and special techniques such us speckle tracking remain an useful tool in the assessment of myocardialdamage. Further studies are necessary in order to determine their predictive value and their possible involvement in therapeutic strategies.



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P1339

Echocardiographic reference ranges for normal non-invasive myocardial work indices:results from the eacvi norre study

Manganaro R.1; Dulgheru R.1; Marchetta S.1; Cimino S.1; D"amico G.1; Ilardi F.1; Sugimoto T.1; Zito C.2; Carerj S.2; Lancellotti P.1

1University Hospital of Liege (CHU), Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic , Liege, Belgium2University of Messina, Department of Clinical and Experimental Medicine, Messina, Italy

Funding Acknowledgements: GE Healthcare and Philips Healthcare

Background: Myocardial work (MW) is a parameter of myocardial function, which takes into account deformation as well as afterload. Leftventricle (LV) pressure-strain loops (PSLs) are a novel and reliable tool for the non-invasive assessment of MW.

Purpose: the aim of this study was to obtain normal ranges for 2D echocardiographic indices of MW from a large group of healthy volunteersaccording to age and gender.

Methods: A total of 226 (mean age: 44.7 ± 13.2 years) healthy subjects were enrolled at 22 collaborating institutions of the Normal Refer-ence Ranges for Echocardiography (NORRE) study. Global Work Index (GWI), Global Constructive Work (GCW), Global Work Waste(GWW) and Global Work Efficiency (GWE) were estimated by LV PSLs using custom software (Figure). Peak LV pressure was estimatednon-invasively from brachial artery cuff pressure.

Results: The lowest expected values of MW indices calculated as ± 1.96 standard deviation from the mean were 1270.4 mmHg% in menand 1310.3mmHg% in women for GWI, 1649.7 mmHg% and 1543.5 mmHg% for GCW, -2.6 mmHg% and 16.6 mmHg% GWW, and 90.7%and 91.7% for GWE, respectively. Hence, male subjects had lower values of GWE and higher values of GWW. GWI and GCW significantlyincreased with age in female patients.

Conclusions: The NORRE study provides useful 2D echocardiographic reference ranges for novel indices of non-invasive MW.

Abstract P1339 Figure. Measurement of Myocardial Work


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P1340

Quantitative methods for assessing ventricular function in youth population with D -Transposition of the great arteries after

Marinov R.; Hristova K.; Burdarska L.; Dobrev D.; Lekova R.; Parshkevova P.; Kaneva A.

National Heart Hospital, Sofia, Bulgaria

Introduction: Functional assessment of the left and right ventricular function in patients with D- transposition of the great arteries (D-TGA)is important part of long-life clinical evaluation of this patients. The clinical application of myocardial deformation imaging by 2D strain echo-cardiography in children in this setting is still under investigation.

Aim: The aim of the study was to describe the global and regional deformations on the left and right ventricle in youth population with D-TGA after surgical arterial switch procedure using vector velocity imaging echocardiographic technique.

Methods: We compared echocardiographic measures in 75 children - 58 patients (mean age 5.7 ± 4 years) with D-TGA and 17 normalhealthy controls ( mean age 7.6± 4 years). Apical 4CV, 3 CV and 2 CV images were acquired (frame rate 74 ±6 frames/s) and analyzedoffline in order to extract the strain (rate) curves. From these, the maximal systolic strain (PSS) and peak strain rate (PSR) on right and leftventricle were derived, using vector velocity imaging (VVI) software. Tricuspid annular plane systolic excursion (TAPSE), myocardial per-formance index (MPI), systolic eccentricity index (EI) on right ventricle and as well middle -apical and basal peak ejection strain (S) andstrain rate (SR) of the free wall were measured.

Results: Body surface area, ages, LV mass were comparable between the D-TGA and control groups. Relative to controls, the D-TGAgroup had greater average right wall thickness (3,67 ± 0,67 mm vs. 2,9 ± 0,29 mm, p < 0,0001), right ventricle diameter D1 (15.1 ± 4.3 mmvs. 12,9 ± 2,17 mm, p = 0,01).

Global strain measures for the LV were significantly different between groups (PSSLV -16,42 ± 3,08 vs. -19,29 ± 2,17, p = 0,0001) whereasRV strain also was diminished in the D-TGA group (PSS RV -10,03 ± 4,5 vs. -15,5 ± 2,3,p< 0,01). For regional RV function, PSS was lowerin the D-TGA group than the control group in the middle (-16,38 ± 5.47% vs. -22.07 ± 5.22%, p = <0,001) and apical (-11,83 ± 5,31% vs.-24,24 ± 6.15%; p < 0,001). RV free wall, whilst basal PSS was similar (-20,16 ± 7,34% vs. -21,13± 7.03%, p =0,68). TAPSE ( 13.7 ± 2,5 mmvs. 20.5 ± 4.5 mm, P <0.001) did differ between groups and other conventional RV measures were also similar in both groups.

Conclusion: The present study demonstrates that measures of regional RV deformations are reduced in patients with D-TGA secondary .The reduced GPSLS and SR after ASO are associated with an unfavorable trend toward reduced pump function of both ventricles- regard-less the normal values of conventional Echo m but it is a sign of regional dyskinesia with a possible local coronary ischemia.


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P1341

Left atrial contractile function in breast cancer patients undergoing trastuzumab thera-py

Stefanidis E.; Katbeh A.; Pipertzi A.; Michelis I.; Silva E.; Milkas A.; Balogh Z.; De Knijf K.; Van Camp G.; Penicka M.

Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium

Background: Trastuzumab (TZ) therapy is associated with left ventricular (LV) dysfunction due to cardiotoxicity. However, data on left atrial(LA) function in patients receiving TZ are scarce.

Purpose: To compare effects of TZ therapy on LA contractile strain (LASCT) versus on left ventricular global longitudinal strain (LV GLS) andejection fraction (LVEF) in breast cancer patients treated with TZ.

Methods: We have prospectively enrolled 23 consecutive breast cancer patients (age 53 ± 10 years, 100% females) with normal LVEF (>50%) scheduled for TZ therapy. No patient had history of heart or internal disease. Comprehensive transthoracic echocardiography was per-formed pre TZ therapy and then at 3-month intervals. LV GLS and LASCT were assessed using the two-dimensional speckle tracking echo-cardiography as average of segmental values in apical views. Cardiotoxicity was defined by a symptomatic reduction of LV GLS ≥12%.

Results: A total of 9 (39%) patients showed cardiotoxicity at median of 189 days (IQR 167-203) from baseline. Both groups had similarbaseline characteristics (NS). At follow-up, patients with versus without cardiotoxicity showed significant decrease in magnitude of LV GLS (Δ-17 ± 3.6% vs Δ 1 ± 8.3%, p < 0.001), LVEF (Δ -9 ± 9.3% vs Δ 3 ± 9.1%, p = 0.015) and LASCT (Δ -19 ± 9.9% vs Δ -3 ± 21.2%, p = 0.0025). Incontrast, the conventional parameters of LA morphology and function did not change significantly (NS). All patients with diagnosis of cardio-toxicity received ACE inhibitors and/or betablockers, and continued with TZ therapy. Control echocardiography after 3 months showed a sig-nificant improvement of LV GLS, LVEF and LASCT in 4 (44%) patients while no favorable changes or even deterioration were observed inthe remaining individuals (Figure, red color). In patients without LV GLS-derived cardiotoxicity, only LASCT showed mild reduction betweenbaseline and last available echocardiogram. In contrast all the remaining parameters did not change during the entire follow-up.

Conclusion: LASCT appears to be a sensitive parameter to assess effects of TZ therapy on LA. Its incremental value over LV functionalparameters needs to be demonstrated in a large study.



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P1342

Improvement of myocardial and vascular function by inhibition of Interleukin 1 and 6 inpatients with rheumatoid arthritis:a comparative study

Ikonomidis I.1; Pavlidis G.2; Katsimbri P.3; Andreadou I.1; Triantafyllidi H.2; Varoudi M.2; Vlastos D.2; Kostelli G.2; Benas D.2; Lekakis J.2;Boumpas D.3; Iliodromitis E.2

1National & Kapodistrian University of Athens, Athens, Greece2National and Kapodistrian University of Athens, Medical School, 2nd Department of Cardiology, Attikon Hospital, Athens, Greece3National and Kapodistrian University of Athens, 4nd Department of Internal Medicine, Athens, Greece

Background: Interleukin 1 and 6 mediate atherogenesis and coronary vasoreactivity. Anakinra, a recombinant form of human interleukin-1receptor antagonist and tocilizumab, a humanised monoclonal antibody against the human interleukin-6 receptor, are used for the treatmentof rheumatoid arthritis (RA). We investigated the effects of anakinra and tocilizumab on myocardial and vascular function in RA patients.

Methods: Οne hundred and twenty patients with RA (age: 63 ± 10 years) were randomized to receive anakinra (n = 40), tocilizumab (n = 40),or prednisolone (n = 40) for 3 months. At baseline and after 3-month treatment we assessed: a) LV longitudinal strain (GLS), systolic (GLSR)and diastolic (GLSRE) strain rate using speckle tracking echocardiography, b) Flow mediated dilatation (FMD %) of the brachial artery afterhyperemia, c) coronary flow reserve (CFR) of the LAD using Doppler echocardiography, and d) malondialdehyde (MDA) and protein carbon-yls (PCs) plasma levels.

Results: Compared with baseline, all patients had improved GLS (-16% versus -17.8%), CFR (2.56 versus 2.9), MDA (2.0 versus 1.5 μM/L),and PCs (0.0132 versus 0.0115 nmol/mg) post-treatment. Compared with tocilizumab and prednisolone, anakinra treatment resulted in agreater improvement of GLS (18.7% versus 9.3% versus 6%, Fig. 1) and CFR (29% versus 12% versus 1%). Compared with anakinra andprednisolone, tocilizumab resulted in a greater reduction of MDA (44% versus 32% versus 5%) and PCs (20% versus 15% versus 2%) (p < 0.05 for all comparisons). Compared with prednisolone, anakinra and tocilizumab resulted in a same improvement of FMD% (98% versus97% versus -14%). PWV was improved only after tocilizumab treatment (p < 0.05). Total cholesterol, LDL-C and triglycerides increased sig-nificantly in the tocilizumab group (p < 0.05). In all patients the percent decrease of MDA was correlated with percent increase of GLS (r = 0.72, p < 0.001). After treatment with tocilizumab, the percent increase in CFR was related with changes in FMD% (r = 0.63) and GLS (r = 0.57) (p < 0.05 for all associations).

Conclusion: In RA patients, IL-1 inhibition causes a greater improvement of LV myocardial strain and coronary microcirculatory functionthan IL-6 inhibition while IL-6 inhibition results in a greater improvement of arterial stiffness probably by the larger decrease of oxidativestress compared to IL-1 inhibition.

Abstract P1342 Figure 1.


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P1343

Myocardial longitudinal strain predicts in-hospital and post-discharge heart failure inpatients with acute anterior wall ST-segment elevation myocardial infarction

Lee S.; Lee JY.; Jung LY.; Kim YS.; Lee SR.; Rhee KS.; Chae JK.; Kim WH.

Chonbuk National University Hospital, Jeonju, Korea Republic of

Background: Acute MI-related heart failure (HF) is associated with poor outcome. This study was designed to investigate the usefulness ofglobal longitudinal strain (GLS) and mean longitudinal strain of segments supplied by left anterior descending artery (LSant) measured by 2Dspeckle tracking echocardiography (2D STE) in prediction of anterior wall STEMI (ant-STEMI)-related HF.

Methods: A total of 171 patients with ant-STEMI who underwent successful primary coronary intervention and had available 2D STE datawere enrolled. HF was divided into two categories, in-hospital and post-discharge HF.

Results: In-hospital and post-discharge HF developed in 22.8% and 11.7% of patients with ant-STEMI, respectively. Multiple logistic regres-sion analysis showed that GLS (OR 1.314, 95% CI 1.121–1.540, p = 0.001) and hs-CRP (OR 1.020, 95% CI 1.006–1.035, p = 0.005) weresignificant determinants of in-hospital HF. For post-discharge HF, age (OR 1.051, 95% CI 1.007−1.097, p = 0.022) and LSant (OR 1.111, 95%CI 1.005−1.228, p = 0.039) were independent predictors. ROC curve analysis demonstrated better discriminatory power of GLS (AUC 0.756,95% CI 0.685–0.819, p < 0.001) and LSant (AUC 0.710, 95% CI 0.636–0.777, p < 0.001) than LVEF in prediction of in-hospital and post-discharge HF, respectively.

Conclusion: GLS and LSant were, respectively, the most powerful predictors of development of in-hospital and post-discharge HF in pa-tients with reperfused ant-STEMI.

Prediction of HF in pts with ant-STEMI

Variables Univariate Multivariateχ2 OR 95% CI p value χ2 OR 95% CI p value

In-hospital HF GLS 18.52 1.364 1.184-1.570 <0.001 11.38 1.314 1.121-1.540 0.001LSant 10.06 1.118 1.044-1.198 0.002LVEF 17.78 0.869 0.814-0.928 <0.001LVESV 9.56 1.035 0.013-1.057 0.002Significant MR 4.56 3.261 1.102-9.649 0.033RVSP 10.47 1.077 1.030-1.126 0.001 3.86 1.054 1.000-1.111 0.050hs-CRP 12.09 1.022 0.990-1.034 0.001 8.05 1.020 1.006-1.035 0.005Number of diseased vessels 11.74 2.217 1.406-3.496 0.001

Post-discharge HF Age 9.20 1.064 1.022-1.108 0.002 5.21 1.051 1.007-1.097 0.022GLS 4.88 1.197 1.021-1.405 0.027LSant 7.80 1.144 1.041-1.257 0.005 4.23 1.111 1.005-1.228 0.039LVEF 4.97 0.927 0.867-0.991 0.026E/E" ratio 4.69 1.068 1.006-1.134 0.030

LSant, mean longitudinal strain at 11 segments of LAD territory


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P1344

Reduced left atrial myocardial function in young but not old male athletes after cycling3000 km in two weeks

Rasmusen HK.1; Sehestedt T.1; Dela F.1; Frandsen J.2; Sahl RE.2; Helge JW.2

1Bispebjerg Hospital of the Copenhagen University Hospital, Copenhagen, Denmark2University of Copenhagen, Dept of Biomedicine, Copenhagen, Denmark

Background: Left atrium (LA) in athletes adapt to long-term endurance training by increasing size. Studies have demonstrated that despitedilatation of LA the myocardial function in athletes remains normal at rest. The acute effect on LA function of moderate intensity endurancetraining in men remains unknown but ultra-endurance exercise has been shown to reduce left and right ventricular function.

Purpose: To study the morphological and functional adaption of LA to prolonged moderate intensity, long-term exercise in young (Y) and old(O) male athletes.

Methods: 7 Y (30 ± 2 y (mean ± SD); maximal oxygen uptake (V̇O2max) 62 ± 1) and 7 O men (65 ± 2 y; V̇O2max 49 ± 2) were examined withtwo-dimensional echocardiography (GE GE Vivid iq) before and after 3000 km cycling from Copenhagen to Palermo in 2 weeks. Peak atriallongitudinal strain (PALS) was assessed by speckle tracking analysis. Heart rate was monitored during cycling.

Results: The subjects cycled 7-10 hrs/day with a workload of 63% (O) and 65% (Y) of maximal heart rate (HRmax). LA diameter and vol-ume was increased compared to normal limits but unchanged after the intervention and similar in the two groups (Table 1). Mitral inflow inearly diastole (E) decreased in Y, but not in O after the intervention whereas late active filling phase during atrial contraction (A) did notchange with the intervention, but was always lower in Y vs. O. Correspondingly, E/A ratio was higher in Y before and after the interventionvs. O. E/e* were significantly lower in Y vs. O but did not change after the intervention. LA global PALS was higher in Y vs. O but decreasedonly in the Y.

Conclusions: Prolonged moderate intensity endurance training can induce LA functional change in young but not old male athletes. Fur-thermore, atrial enlargement with normal filling pressures were seen in all athletes despite different age groups.

Table 1

Young OldVariable Copenhagen Palermo Copenhagen PalermoLeft atrium (LA) diameter (mm) 37.0 ± 4.8 38.1 ± 3.4 36.6 ± 4.2 40.1 ± 3.1LA volume/BSA (ml/m2) 37.1.0 ± 3.8 40.1 ± 4.8 43.0 ± 6.4 43.2 ± 2.7E (cm/s) 70 ± 11 63 ± 10† 65 ± 18 64 ± 11A (cm/s) 41 ± 11* 39 ± 12* 53 ± 13 62 ± 18E/A ratio 1.8 ± 0.5 1.7 ± 0.6 1.2 ± 0.3 1.1 ± 0.2E/e* 4.2 ± 1.1* 4.7 ± 1.2 6.3 ± 1.4 6.5 ± 1.4LA global PALS (%) -35 ± 4* -30 ± 4† -28 ± 6 -27 ± 5Tricuspid max gradient (mmHg) 19 ± 4* 21 ± 4 24 ± 4 23 ± 4

*P < 0.05 Between groups Y vs. O † different from Copenhagen (P < 0.05)


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P1345

Impact of cumulative dose of cisplatin on cardiac function in testicular cancer survi-vors assessed by traditional and novel echocardiographic methods: a 30-year follow-

up

Bjerring AW.1; Fossa SD.2; Haugaa KH.1; Edvardsen T.1; Sarvari SI.1

1Oslo University Hospital, Center for Cardiological Innovation, Oslo, Norway2The Norwegian Radium Hospital, Oslo, Norway

Funding Acknowledgements: South-Eastern Norway Regional Health Authority

OnBehalf: Center for Cardiac Innovation

Background: Cisplatin-based chemotherapy (CBCT) is essential in the treatment of testicular cancer (TC). CBCT has been implicated inincreased cardiovascular morbidity and mortality decades after treatment. However, it is not known if CBCT, similarly to anthracyclines, cau-ses direct myocardial dysfunction.

Purpose: Our study aimed to assess myocardial function in TC survivors 30 years after CBCT using traditional and modern echocardio-graphic methods.

Methods: Ninety-four TC survivors diagnosed and treated with CBCT between 1980 and 1994 were recruited from the longitudinal Norwe-gian Cancer Study in Testicular Cancer Survivors. Echocardiography was performed in all subjects, including speckle-tracking strain analy-ses and 3D echocardiographic measurements. Patients were divided into three groups according to their cumulative cisplatin dose.

Results: The participants were on average 60 ± 9 years old. There was no correlation between the cumulative cisplatin dose and cardiacfunction. Six (7%) participants had reduced EF (<52%), all in the intermediate dose group. Six-teen (21%) participants had reduced LV GLS(> -18.0%), three in the low-cisplatinum group (15%), seven in the intermediate group (13%) and six in the high dose group (27%); however,the inter-group differences were not significant.

Conclusion: While earlier, smaller studies, with shorter follow-up have suggested possible links between CBCT and long-term myocardialdysfunction, our study did not replicate these findings. Therefore, our results do not support the suspected relationship between myocardialdysfunction and an increase in cardiovascular morbidity and mortality in patients treated with CBCT.

Low dose<600 mg/m2

(n = 20)

Intermediate dose600 - 800 mg/m2

(n = 52)

High dose>800 mg/m2

(n = 22)

p-value

Cumulative cisplatin dose, mg/m2 414 ± 136 740 ± 72 1084 ± 220 <0.0013D LV end-diastolic volume, ml/m2 140 ± 35 131 ± 32 126 ± 21 0.423D LV end-systolic volume, ml/m2 57 ± 19 57 ± 26 51 ± 11 0.693D ejection fraction, % 60 ± 5 58 ± 8 60 ± 5 0.49LV global longitudinal strain, % - 20.3 ± 2.2 - 19.9 ± 2.9 - 19.3 ± 2.1 0.54LV global circumferential strain, % - 21.5 ± 2.5 - 21.6 ± 3.6 - 21.7 ± 2.0 0.98E/e’ 9.1 ± 1.9 10.4 ± 3.8 9.1 ± 2.1 0.15TAPSE, mm 2.3 ± 0.4 2.2 ± 0.4 2.3 ± 0.4 0.32RV fractional area change, % 41 ± 7 40 ± 7 41 ± 6 0.82

Data are presented as mean ± SD. The P-values were derived from analysis of variance. LV, left ventricle; MV, mitral valve;RV, right ventricle; TAPSE, tricuspid annular plane systolic excursion.


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P1346

How to assess left atrial function in patients with paroxysmal atrial fibrillation undergo-ing first or redo catheter ablation: what is the most promising parameter?

Katbeh A.; Silva E.; De Potter T.; Stefanidis E.; Balogh Z.; Iliodromitis K.; Geelen P.; Van Camp G.; Barbato E.; Penicka M.

Cardiovascular Center Aalst, Aalst, Belgium

Background: Both atrial fibrillation (AF) and catheter ablation (CA) may be associated with changes in left atrial (LA) structure and function.However, the data describing acute effects of CA on LA contractile function are scarce.

Purpose: To assess the potential value of different indices of LA morphology and function in patients with paroxysmal AF undergoing thefirst or the redo CA during sinus rhythm.

Methods: We prospectively enrolled 114 consecutive patients (age 63 ± 21 years, 32% females) with symptomatic paroxysmal AF and pre-served left ventricular (LV) ejection fraction (≥ 50%) undergoing CA during sinus rhythm, and 23 healthy controls. Patients with valvular AF,reduced LV ejection fraction or in AF at the time of CA were excluded. All patients underwent comprehensive echocardiography at one-daypre and at one-day post CA. The longitudinal component of LA reservoir, conduit and contractile strain (LAS) and strain rate (LASR) wereassessed using the two-dimensional speckle tracking echocardiography as average of segmental values in apical views. Intra- and interob-server variability was assessed by two operators in 12 randomly selected patients.

Results: A total of 88 (77%) patients underwent the first CA (First-CA) while the remaining 26 (23%) patients had the redo procedure (Redo-CA) after initially successful CA. Pre-ablation, both groups of patients with paroxysmal AF had significantly lower magnitude of all three com-ponents of LAS and LASR compared with controls (all p < 0.01). However, the Redo-CA versus the First-CA group showed significantlylower contractile LAS and LASR, reservoir LAS, and LA emptying fraction (all p < 0.05) (Table 1). In contrast, all remaining indices of LA orLV size and function, including conduit LAS or LSR, were similar. Catheter ablation was associated with significant decrease in contractileand reservoir LAS and LASR in both groups while no significant difference was observed for conduit LAS or LASR (Table 1). Out of theconventional parameters, LA emptying fraction significantly decreased while LA volume index and E/e’ ratio significantly increased in bothgroups (all p < 0.05). The lowest intra- and interobserver variability was observed for contractile and reservoir LASR (<1% and <2%), fol-lowed by contractile and reservoir LAS (<3% and <4%). In contrast, conventional indices of LA size and function showed significantly largervariability (p < 0.05).

Conclusion: In patients with paroxysmal AF undergoing CA, contractile LASR and LAS appear to be the most promising parameters todescribe LA contractile function in both the first and the redo procedure.

Abstract P1346 Table 1: First-CA vs. Re-CA group


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P1347

Determinants of left atrial longitudinal strain in breast cancer patients treated with tras-tuzumab

Comunello A.1; Bergamini C.1; Benfari G.1; Setti E.1; Bragantini G.1; Dolci G.1; Truong S.1; Lanza D.2; Fiorio E.1; Carbognin L.1; Cerrito LF.1;Dal Porto M.1; Rossi A.1; Ribichini FL.1

1University of Verona, AOUI VR, Verona, Italy2General Hospital of Rovigo, Cardiology, Rovigo, Italy

Background: Trastuzumab (TZ) is a key therapy for HER2+ breast cancer (BC) patients with possible negative effect on left ventricular (LV)function, with decrease in ejection fraction (LVEF) and global longitudinal strain (GLS). Left atrial (LA) remodeling during TZ therapy hasbeen demonstrated, while limited data are available on LA function analyzed with 2D speckle tracking. Determinants of peak atrial longitudi-nal strain (PALS) have never been studied in this setting.

Purpose: to analyze the determinant factors of PALS in BC patients treated with TZ.

Methods: HER2+ BC metastasis-free patients were prospectively recruited. Clinical data were collected at baseline and during follow-up(FU). Trans-thoracic echo was performed before starting TZ and every 3 up to 12 months. LV volumes, LVEF, LA indexed volume (LAVI) anddiastolic parameters were measured. PALS was determined through 2D-Speckle tracking analysis (Philips" QLAB software), performed atbaseline and at each subsequent examination.

Results: 64 patients formed the study population. 40 (62,5 %) had a complete 12 months FU. 53 (82,8%) were treated with both TZ andanthracyclines. At univariate analysis age (p = 0.004), left ventricular end diastolic volume (p = 0,02), stroke volume (p = 0,03), LAVI (p = 0,004), E/E’ ratio (p = 0,05) resulted to be determinant factors of PALS. Body surface area and LVEF were not significantly correlated withPALS. At multivariate analysis only age came out as determinant of PALS (p = 0,04) and this was independent of presence or absence ofmitral regurgitation. During FU cardiotoxicity showed a low prevalence (9,3%) but a drop in LVEF was anyway documented with major wor-sening at 6 months of FU. Mean baseline PALS was 51,1 ± 12 %. A significant positive correlation between baseline PALS and LVEF at 6months FU was shown (R² 0.2; p = 0.006). Similar result was obtained analyzing the correlation between LAVI and LVEF at 6 months (R²0,19; p = 0,02).

Conclusion: our results suggest that PALS and LAVI predict the trend of LVEF at 6 months of FU, time of the major LVEF drop documented.The relationship between PALS and determinant factors is complex, with only age resulting significantly correlated. Further studies evaluat-ing PALS in this scenario should consider these demographic characteristics at baseline.

Table 1

Variable Mean ± SD or n (%)Age y 55,0 ± 13,2LV EF % 63,8 ± 2,7LAVI ml/mq 25,3 ± 6,9Mitral insufficiency 27 (42)

Population’s baseline characteristics (n = 64)


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P1348

Biventricular systolic function analysis in patients with Marfan syndrome using speck-le-tracking 2D ecocardiography

Torres Sanabria M.; Mingo Santos S.; Monivas Palomero V.; Garcia-Izquierdo Jaen E.; Martin Lopez CE.; Aguilera Agudo C.; Baena HerreraJ.; Gonzalez Mirelis J.; Navarro Rico S.; Mitroi C.; Forteza Gil A.

University Hospital Puerta de Hierro Majadahonda, Madrid, Spain

Background: Left ventricular systolic disfunction has already been described in patients with Marfan Syndrome (MS) without an associatedsignificative valvulopathy using 2D and 3D ecocardiography Speckle-Tracking (ST) technique. This disfunction has been related to a moresevere causal genetic mutation, which suggest the presence of a primary cardiomiopathy in these patients. Right ventricular function, how-ever, has been less studied so far. Our aim is to evaluate right and left ventricular function in our cohort of MS patients using ST.

Methods: 50 unoperated adult patients with MS and 26 healthy controls were prospectively enrolled. Patients with more tan moderate aorticor mitral regurgitation were excluded. Using ST we obtained left ventricle global longitudinal strain (LVGLS) from the average of 16 seg-ments from the apical four, two and three chamber views, and the right ventricle global longitudinal strain (RVGLS) from the average of 6segments from the apical four chamber view. We also measured the classic parameters of systolic biventricular function (LVEF and TAPSE).

Results: Compared to controls, MS patients showed significantly lower LVGLS and RVGLS values (table 1), even though these values re-mained slightly above the lower limit of normality settled in the last cuantification guidelines. We found bigger differences in the RVGLS andparticularly in the right ventricle free wall longitudinal strain (RVFWLS).

Conclusion: Our study suggests that patients with MS show a lower RVGLS and LVGLS compared to healthy controls. ST technique couldbe useful for the detection of subclinical changes in biventricular function in MS patients, and should be added to routine ecocardiographicevaluation in order to improve the follow-up and treatment of these patients.

Results of statistical anaylisis

MS (n =50) Controls (n = 26) pAge (years) 33.68 ± 11.64 33.62 ± 8.37 0.98SBP (mmHg) 119.81 ± 11.8 121.65 ± 9.41 0.52DBP (mmHg) 71.36 ± 9.64 67.39 ± 8.56 0.10LVGLS (%) -19.8±-2.55 -21.9±-2.32 0.001RVGLS (%) -20.82±-4.04 -24.78±-3.4 < 0.001RV free wall LS (%) -21.72±-4.48 -25.83±-3.69 < 0.001LVEF (%) 60.44 ± 5.19 63.91 ± 4.01 0.04TAPSE (mm) 24.32 ± 4.57 25.85 ± 3.06 0.09

MS = Marfan Syndrome; LVGLS = left ventricle global longitudinal strain; RVGLS = right ventricle global longitudinalstrainAbstract P1348 Figure. LVGLS and RV free wall LS comparison


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P1349

Left atrial global longitudinal strain is an independent predictor for atrial fibrillation re-currence after radiofrequency catheter ablation regardless of CHA2DS2-VASc score

and atrial size

Manolakou P.1; Agelaki M.1; Koudounis P.1; Grapsa J.2; Christou A.1; Zografos T.1; Nihoyannopoulos P.3; Katsivas A.1

1Korgialeneio-Benakio E.E.S.General Hospital, Athens, Greece2Hammersmith Hospital, London, United Kingdom3Hippokration General Hospital , Athens, Greece

Introduction: Recent studies have indicated that left atrial strain measured by 2D speckle-tracking echocardiography may help identify pa-tients at risk for atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFA).

Purpose: The purpose of this study was to assess the role of left atrial global longitudinal strain (LA-GLS) as a prognostic marker accordingto the baseline CHA2DS2-VASc score and left atrial size.

Methods: 90 patients (79% male, mean age 49 ± 12) with paroxysmal AF undergoing RFA had their LA-GLS and left atrial volume index(LAVi) assessed by transthoracic echocardiography at baseline. All patients were assigned to groups according to their CHA2DS2-VAScscore and LAVi.

Results: During the 12 month follow-up, 26 patients (27%) had presented with AF recurrence. No difference in age, gender or LAVi wasfound in this group of patients compared to patients with no recurrence, except for the higher CHA2DS2-VASc score (1.31 ± 1.19 vs 0.63 ± 0.80, P 0.011) and the considerably lower LA-GLS (22.21 ± 4.42 vs 28.26 ± 4.15, P < 0.0001). ROC curve analysis confirmed that LA-GLShas a significant prognostic value for AF recurrence (AUC 0.873, P < 0.0001) with LA-GLS ≤ 25% as optimal cut-off point (sensitivity 88%,specificity 88%). Multivariate logistic regression analysis for age, sex, CHA2DS2-VASc score, LAVI and LA-GLS showed that LA-GLS alonewas an independent predictor for AF recurrence (OR 0.655, 95% CI 0.541-0.793, P < 0.0001). Among patients with low CHA2DS2-VAScscore (0-1) LA-GLS remains a statistically significant prognosticator (AUC 0.873, <0.0001) but with a lower optimal cut-off point (LA-GLS ≤ 24%, sensitivity 81%, specificity 96%) compared to patients with high CHA2DS2-VASc score(≥2) (LA-GLS ≤ 25%, sensitivity 90%, specificity64%). Similarly, LA-GLS retains prognostic significance among different degrees of left atrial dilatation albeit with different cut-off values. Thecutoff value for patients with normal atrial size or even mild dilatation (N = 31, AUC 0.740, P 0.0162) is LA-GLS ≤ 29.25% (sensitivity 90%,specificity 57%), compared to moderate or severe atrial dilatation (N = 59, AUC 1.000, P < 0.0001) which has a cutoff value of LA-GLS ≤ 24%(sensitivity 100%, specificity 100%).

Conclusion: LA-GLS is an independent predictor for atrial fibrillation recurrence after pulmonary vein isolation that retains its prognosticability regardless of CHA2DS2-VASc score or atrial size.


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P1350

Assessment of left ventricular myocardial strain using speckle tracking echocardiogra-phy in an animal model of chagas disease.

Ribeiro FFF; Moreira HT.; Barros-Filho ACL; Tanaka DM.; Fabricio CG.; Oliveira LFL; Simoes MV.; Schmidt A.; Maciel BC.; Marin-Neto JA.;Romano MMD

Hospital of Ribeirao Preto, Department of Cardiology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil

Background: Speckle tracking echocardiography enables early diagnosis of myocardial lesion by evaluating myocardial strain. Purpose:Evaluate the sequential changes in structural and functional parameters of the ventricles during Chagas’ disease progression in an animalexperimental model. Methods: 37 adult female hamsters (Mesocricetus auratus) were inoculated intraperitoneally with 35,000 trypomastigoteforms of Trypanosoma cruzi (Chagas’ group) and another 20 received an equal volume of saline solution (control group). Echocardiographywas performed before the infection (baseline) and repeated for assessment of acute (1 month) and chronic (4, 6 and 8 months after) phases.Left ventricular end-diastolic (LVED) and end-systolic (LVES) diameters, left ventricular ejection fraction (LVEF) and global longitudinal strain(GLS) were measured at parasternal long-axis view. Circumferential strain (GCS) was evaluated at short-axis view. Tricuspid annular planesystolic excursion (TAPSE) was used to assess right ventricular function. The analysis of variance for mixed models of repeated measureswas used to evaluate the differences between the two groups over time. Results: at baseline, the two groups had a mean age of 89 ± 1 daysand there was no significant difference in heart rate (204 ± 18 bpm in control group versus 198 ± 18 bpm in Chagas’ group; p= 0.277). LVEFwas 64 ± 5% in control group and 61 ± 5% in Chagas’ group (p= 0.10), while GLS was -15.2 ± 2.7% in control group and -14.2 ± 3.4% inChagas’ group (p= 0.25). With disease progression (Figure 1), LVEF showed progressive decrease over time in the Chagas’ group and dif-ference between groups was detected 6 months after baseline examination (p-value of groups#time interaction = 0.005). GLS and GCS be-havior in Chagas’ group differed significantly over time compared with control group (p-value of groups#time interaction = 0.003 for GLS and< 0.001 for GCS). There was a pronounced decrease in deformation indices (GLS and GCS) in Chagas’ group and this difference was notedas early as the first month. In Chagas’ group, TAPSE index also presented significantly different behavior over time compared with the con-trol group (p-value of groups#time interaction < 0.009), with difference observed from the first month. Conclusion: results indicated that GLS,GCS and TAPSE were reduced earlier in Chagas’ cardiomyopathy and that change could be detected as early as the acute phase of diseasein this animal experimental model.

Abstract P1350 Figure 1. Longitudinal assessment


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P1351

Importance of septal inward motion to global right ventricular function after hearttransplantation

Tokodi M.; Lakatos BK.; Assabiny A.; Sax B.; Merkely B.; Kovacs A.

Semmelweis University Heart Center, Budapest, Hungary

Background: Heart transplantation (HTX) provides effective treatment with excellent long-term survival rates for end-stage heart failure.Still, right ventricular (RV) failure is one of the major determinants of early postoperative mortality, however, the frequently observed declinein RV free wall longitudinal motion is not a good indicator. Accordingly, we sought to investigate the myocardial deformation of RV free walland the interventricular septum separately, and assess their contribution to global RV function in HTX patients using 3D echocardiography.

Methods: Fifty-one HTX patients (52 ± 11 years, 11/41 f/m) in stable cardiovascular condition without history of relevant rejection episodesand 30 age- and gender matched healthy volunteers were enrolled in our current study. RV end-diastolic volume and total ejection fractionwere measured using 3D echocardiography with dedicated software. After reconstructing the 3D model of the RV, 3D global longitudinal(GLS) and global circumferential strain (GCS) were computed using our in-house MATLAB software. Inward displacement of the free walland the septal surface were assessed separately and partial EF generated by these motions were calculated as well.

Results: There was no difference in RV end-diastolic volume between the two groups (HTX vs control; 101 ± 17 vs 96 ± 27 mL), while EFwas lower in HTX compared to controls (47 ± 7 vs 57 + 4%, p < 0.001). RV GLS and GCS were found to be decreased in HTX patients witha more prominent decline in GLS (GLS: -8 ± 3 vs -19 ± 3% [-58%], p < 0.001; GCS: -18 ± 4 vs -21 ± 4% [-14%]; p = 0.008). Both free wall andseptal longitudinal strain were lower compared to controls (-9 ± 3 vs -23 ± 4% [-63%], -8 ± 3% vs -13 ± 5% [-38%], both p < 0.001, respective-ly). However, free wall circumferential strain was preserved in HTX patients (-23 ± 4 vs -23 ± 5%). Interestingly, contribution of the septal mo-tion to total EF was increased (septal EF/total EF: 0.12 ± 0.04 vs 0.07 ± 0.02, p < 0.001), while the contribution of the free wall to global func-tion was decreased in HTX patients (free wall EF/total EF: 0.89 ± 0.06 vs 0.96 ± 0.04, p < 0.001).

Conclusion: Our results show complex changes in RV myocardial contraction pattern following HTX. Despite the decrease in the contribu-tion of the free wall to total EF, septal inward motion compensates to maintain global RV function. Further investigations are warranted tobetter clarify the importance of septal myocardial deformation and ventricular interdependence in various pathological conditions.


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P1352

Exercise left ventricular end-systolic volume index predicts development of left ven-tricular dysfunction post aortic valve replacement in asymptomatic patients with

chronic aortic regurgitationSato Y.; Izumo M.; Suzuki T.; Koto D.; Tsukahara M.; Teramoto K.; Kamijima R.; Mizukoshi K.; Kou S.; Takai M.; Suzuki K.; Harada T.; AkashiYJ.

St. Marianna University, Division of Cardiology, Department of Internal Medicine, Kawasaki, Japan

Background: Surgical timing of chronic aortic regurgitation (AR) remains a matter of debate because of limited data. This study aimed toinvestigate the value of exercise echocardiography for predicting left ventricular (LV) dysfunction after surgical aortic valve replacement inasymptomatic patients with AR.

Methods: We enrolled twenty-four patients with asymptomatic AR and preserved LV ejection fraction (EF) who underwent symptom limitedsemi-supine bicycle exercise echocardiography. All patients were followed up and operated on when indication for surgery was reached. Weassessed postoperative LVEF at discharge.

Results: Among 24 patients, LV dysfunction (LVEF <50%) was occurred in 11 cases (46%) after surgical AVR. Although LVEF, s’ and globallongitudinal strain at rest and peak exercise did not predict LV dysfunction after surgical AVR, these patients had significantly larger LV end-diastolic and -systolic volume indexes at peak exercise (EDVi: 103.6 ± 24.4 vs. 139.7 ± 31.7, ESVi: 43.5 ± 12.7 vs. 64.6 ± 16.7 ml/m2, both p < 0.01). Receiver operating curve analysis indicated that LVESVi at peak exercise, cut-off value of 55ml/m2, could predict LV dysfunctionafter surgical AVR with sensitivity of 89%, and specificity of 67%.

Conclusions: LVESVi during exercise is associated with LV dysfunction after surgical AVR in asymptomatic patients with chronic AR. Exer-cise echocardiography might be helpful to optimize the timing for surgery.


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P1353

Stress echocardiography in patients with end-stage renal disease pre and post renaltransplantation - single center experience

Sebaiti DANIEL; Briosa A.; Fazendas PR.; Cruz I.; Almeida AR.; Joao I.; Pereira H.

Hospital Garcia de Orta, Department of Cardiology, Almada, Portugal

Ischemic heart disease is the leading cause of mortality in patients (patients) with end stage renal disease (ESRD) candidates for renaltransplantation (RT) or after RT. It is important to risk stratify this population for coronary artery disease to improve survival. The perform-ance of stress echocardiography (SE) for adverse cardiac events has been variable in this population. The optimal non-invasive test for cor-onary artery disease (CAD) diagnosis in this population has yet to be established. The aim of this study was to assess the safety of SE andability for predicting adverse cardiac events in this population.

Methods: retrospective study. From January 2016 to April 2018 a total of 1245 SE were performed. We selected patients referred for riskstratification with ESRD on RT waiting list or after RT. The mean follow up period was 13 months for major adverse cardiovascular events(MACE).

Results: we studied a total of 37 patients; 26 (70,3%) were pre-RT and 11 (29,7) patients post-RT; 24 (64,9%) were male, mean age 59years (SD 9). Risk factors: all patients had hypertension; diabetes 8 (21,6%); hyperlipidemia 23 (62,2%); overweight 9 (24,3%); history oftobacco use 19 (51,4%); previous myocardial infarction 6 (16,2%), 20 (54%) of pts had at least 3 risk factors. 46 % of pts were on beta-blockers. All pts had been on dialysis (mean duration 5 years). 16 (43,2%) pts performed exercise SE, despite an overall they had a normalexercise tolerance: 15 of pts achieved ≥ 4 METs (mean 7 METs), 9 (more than half) had an non-conclusive result; 3 had a positive test: onepatient had significant CAD and underwent single vessel PCI, the second patient had diffuse coronary calcification but no significant epicar-dial stenosis and the third patient refused angiography. 21 patients underwent Dobutamine SE (DSE): 6 pts had a non-conclusive test re-sult, 15 had a negative test result. One patient with negative DSE underwent angiography due to recurrent chestpain and had no significantCAD; one patient with non-conclusive result on DSE had a normal angiography. No other patients that underwent DSE had cardiac catheter-ization until the day of data acquisition. There were no complications of SE in this group of patients.

Conclusions: SE is a safe procedure in patients with ESRD. This population, although young, has a high cardiovascular risk burden. Alarge proportion of SE are non-conclusive, this reflects either beta-blocker effect or chronotropic incompetence common in patients withESRD. Patients with negative or inconclusive tests had no MACE or need for coronary angiography on follow-up.


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P1355

Global longitudinal strain during vasodilator stress echo is associated with coronarymicrovascular function in patients with stable coronary artery disease

Brodin T.1; Svedlund S.1; Gan LM.2

1Sahlgrenska Academy, Gothenburg, Sweden2AstraZeneca R&D, Gothenburg, Sweden

Background

Velocity Vector Imaging (VVI) emerges as a promising tool to quantify myocardial deformation and may serve as a sensitive tool to detectsubtle changes in cardiac function e.g. in the setting of stress echocardiography. Transthoracic Doppler assessed coronary flow reserve(CFR) can be used to evaluate coronary vascular function non-invasively and has shown to confer powerful prognostic information in thispopulation.

Purpose

The aim of this study was to evaluate possible relationships between VVI-assessed global longitudinal strain (GLS) during rest/hyperemicconditions and CFR

Methods

A total of 346 patients with stable CAD (all had documented myocardial infarction from 3 months up to 5 years post index MI), aged 69 ± 7years, underwent transthoracic echocardiography, during which adenosine-assisted CFR was measured in the left anterior descending coro-nary artery and left ventricular hyperemic GLS was assessed using standard B-mode cardiac imaging.

Results

The patients had a mean GLS of -15.7% at rest and -17.0% during hyperemia. Decreased left ventricular deformation was associated withreduced diastolic function, reduced left ventricular ejection fraction (LVEF) and increased levels of triglycerides and LDL-cholesterol in se-rum. Patients with CFR <2 had a significantly lower absolute value of hyperemic GLS (p = 0.03) and strain reserve (p = 0.04) compared topatients with CFR ≥2. In a multivariate analysis, correcting for age, gender, heart rate, systolic blood pressure, BMI and LVEF, hyperemicGLS could independently predict CFR (β=-0.005, p = 0.039).

Conclusion

GLS, as a marker for both systolic and diastolic cardiac function, during vasodilator stress echo, is associated with coronary microvascularfunction. Hyperemic GLS could be a potential risk marker reflecting both cardiac reserve as well as flow reserve.


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P1356

Left atrial volume changes during stress echocardiography

Morrone D.1; D"alfonso MG.2; Djordjevic-Dikic A.3; Re F.4; Simova I.5; Varga A.6; Dekleva M.7; Ryabova T.8; D"andrea A.9; Lattanzi F.1; Ciam-pi Q.10; Olivotto I.2; Carpeggiani C.11; Limongelli G.12; Picano E.11

1University of Pisa, Department of Surgical, Medical and Molecular Pathology and Critic Area, Pisa, Italy2Careggi University Hospital (AOUC), Florence, Italy3University Belgrade Medical School, Belgrade, Serbia4San Camillo Forlanini Hospital, Rome, Italy5City Clinic, Sofia, Bulgaria6University of Szeged, Szeged, Hungary7Medical Hospital Center Zvezdara, Belgrade, Serbia8State Research Institute of Cardiology of Tomsk, Tomsk, Russian Federation9Second University of Naples, Naples, Italy10Fatebenefratelli Hospital of Benevento, Benevento, Italy11Institute of Clinical Physiology, CNR, Pisa, Italy12 AO dei Colli-Monaldi Hospital, Naples, Italy

OnBehalf: Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)

Background: An enlarged left atrial volume index (LAVI) at rest mirrors increased left atrial pressure and/or impairment of LA function. It isassociated to adverse cardiovascular outcomes. A cardiovascular stress may acutely modify LAVI within minutes.

Purpose: To assess the feasibility of LAVI-stress echocardiography (SE)

Methods: SE was performed in 171 patients (age 58 ± 15 yrs, 58 females) with known or suspected coronary artery disease (CAD, n = 48),hypertrophic cardiomyopathy (HCM, n = 78) or heart failure (HF) with preserved (n = 12) or reduced (n = 33) ejection fraction. All had ac-ceptable acoustic window at rest and were referred for clinically-driven SE (semi-supine exercise in 114, dobutamine in 30, dipyridamole in26, adenosine in 1) in 9 quality-controlled laboratories of 5 countries. LAVI was measured with Simpson biplane method from 4- and 2-chamber views at rest and peak stress. The % LAVI changes were defined as: (stress-rest/rest)x100. Two independent observers measureda set of 20 clips (10 at rest and 10 at peak stress) and repeated the measurements after 1 month on the same images. In HF and HCMpatients, systolic pulmonary arterial pressure (SPAP) was also measured from tricuspid regurgitant jet velocity (when present).

Results: A LAVI measurement was obtained in all patients (feasibility = 100%).The off-line analysis time measured by stop-clock in 40 pa-tients was < 50 sec. The intra- and inter-rater variability were 6% and 8% respectively. LAVI was unchanged during SE (rest = 37 ± 16 vsstress = 37± 17 mL/m2, p = ns). At individual patient analysis, 23 patients (13%) showed a stress-induced % LAVI increase ≥ 25 % ("LAVI-dilators"), 126 patients (74 %) a variation ± 25 % ("LAVI-neutral"), and 22 patients (13 %) a % LAVI decrease ≤ 25 % ("LAVI-reducers")."LAVI dilators" were equally prevalent in exercise (13/114,11%) or pharmacological stress (10/57,18%). LAVI-dilators were more frequent in CAD (12/ 48, 25 %) than in HCM (8/78, 10%) or HF (3/45, 7%) groups. In 67 patients with SPAP measurement, there was a significant butweak correlation between stress SPAP and rest LAVI (R2=.118, p = 0.004) and stress LAVI (R2 = 0.062,p=.04)

Conclusion: LAVI measurement is highly feasible during SE. It requires no extra-imaging and very limited extra-analysis time. LAVI is weak-ly correlated to SPAP values, but no single homogeneous LAVI response can be identified during stress. A spectrum of variations occur,from marked increase to marked decrease. They likely mirror underlying stress-induced variations in LA function and/or pressure of potentialclinical relevance.


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P1357

Inflammation-related impairment of left ventricular functional reserve in patients withsystemic lupus erythematosus: a speckle-tracking exercise echocardiographic study

Fan YT.; Tse G.; Shang Q.; Yan BP.; Tam LS.; Lee AP.

The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR People"s Republic of China

Funding Acknowledgements: Health Medical and Research Fund (Grant number: 02130686)

Background: Cardiovascular disease is a leading cause of death in patients with systemic lupus erythematosus (SLE). An overactive inflam-matory response in SLE may lead to myocardial injury and impaired left ventricular (LV) functional reserve. Such abnormalities may not bedetectable at rest.

Purpose: To assess (i) LV systolic functional reserve in SLE using exercise speckle-tracking echocardiography; (ii) relation of systolic func-tional reserve with inflammatory burden.

Methods: 44 patients with SLE and 31 age/sex-matched healthy controls (46 ± 12 years vs. 46 ± 10 years; female/male = 43/1vs. 29/2, p = NS) were studied with bicycle exercise echocardiography. LV ejection fraction and global longitudinal strain (GLS) were measured at rest andlow-level exercise. The average level of erythrocyte sedimentation rate (ESR)in the past 12 months was measured.

Results: Compared with normal controls, ΔGLS from rest to exercise (-5.8% vs. -4.3%, p = 0.005) of SLE patients were significantly impaireddespite preserved LV ejection fraction (61% vs. 59%, p = 0.10) and GLS (-20.5% vs. -19.7%, p = 0.10) at rest (Figure). There was a signifi-cant inverse correlation of average ESR with GLS at peak stress (r=-0.32, p = 0.005).

Conclusion: LV systolic functional reserve is impaired in patients with SLE and is related to inflammatory disease burden. Low-level exer-cise speckle-tracking echocardiography can detect subclinical diminishment of LV functional reserve during SLE progression.



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P1358

Feasibility of the two-dimensional speckle tracking stress echocardiography duringthe physical exercise on the treadmill

Stepanova AI.1; Radova NF.2; Alekhin MN.2

1Central State Medical Academy of Department of Presidential Affairs, Moscow, Russian Federation2Central Clinical Hospital of the Presidential Administration of the Russian Federation, Moscow, Russian Federation

Background: Speckle tracking echocardiography is one of the most perspective techniques to assess myocardial deformation. The aim ofour study was to estimate the feasibility of calculation of the longitudinal systolic deformation of the left ventricular myocardium, using two-dimensional speckle tracking stress echocardiography with physical exercise on the treadmill.

Methods: The study included 90 patients (mean age 62,73 ± 10,87 years, 58 men and 32 women). All patients received stress echocardiog-raphy for various indications. At rest and at postexercise, patients were measured heart rate, blood pressure, electrocardiogram indications,longitudinal systolic deformation values using the speckle tracking technique according to the AFI (Automated functional imaging) algorithm.We registered time of recording of each clip at rest and at postexercise. The total data acquisition time was counted as the difference be-tween the recording time of the first and last clips used in calculation of the longitudinal systolic deformation values. Heart rate variabilitycounted as the difference in heart rate between the first and last clips, which were used to calculate the longitudinal systolic deformationvalues in rest and immediately after the physical exercise on the treadmill.

Results: We succeeded in obtaining the values of the longitudinal systolic deformation of the left ventricular myocardium during stress echo-cardiography with the physical exercise on the treadmill in most cases (global longitudinal systolic deformation (GLSD) in 91.1% of cases,regional longitudinal systolic deformation (RLSD) in 86.7% of cases). Heart rate values at peak exercise was 135,73 ± 17,34 (bpm). Durationof time to get the required positions at rest was 50,1 ± 45,2 (sec.) and at postexercise was 20,6 ± 12,2 (sec.). The heart rate variabilitybetween the saved clips at rest was 1,3 ± 1,9 (sec.) and at postexercise was 6,1 ± 6,7 (sec.). Because of the heart rate limitation the GLSDvalues could not be obtained in 2 patients (2.2%) at postexercise. Due to non-optimal visualization, the GLSD values could not be obtainedin 3 patients (3.3%) at postexercise; the RLSD values in several segments could not be obtained in 12 patients (13.3%) at postexercise.Because of the impossibility of obtaining RLSD values in several segments values GLSD could not be obtained in 3 patients (3.3%).

Conclusions: Calculation of GLSD and RLSD of the left ventricle during stress echocardiography with physical exercise on treadmill is pos-sible in most cases, despite high values of heart rate during the termination of the load and heart rhythm disturbances. Factors hamperingthe adequate calculation of longitudinal systolic deformation are a significant variability of the heart rate during the study and a reducedacoustic availability of the heart.


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P1359

hsTnT in lower risk patients undergoing stress echocardiography with normal result

Medilek K.1; Zaloudkova L.2; Pudil R.1; Cermakova E.3; Krejci P.1; Stasek J.1

1University Hospital Hradec Kralove, Department of Cardioangiology, Hradec Kralove, Czech Republic2University Hospital Hradec Kralove, Department of Biochemistry, Hradec Kralove, Czech Republic3Charles University in Prague, Computer Technology Center, Hradec Kralove, Czech Republic

Funding Acknowledgements: Internal Grant 2016, University Hospital Hradec Kralove (Ministry of Health), Czech Republic

Background:

Adverse events rate is higher in dobutamine stress (DSE) than in dynamic stress (ExSE) echocardiography. ExSE is therefore preferredstress method. We studied whether stress echocardiography increases serum hsTnT level.

Methods:

46 patients with negative diagnostic ExSE or DSE and without (known) IHD, diabetes or LVH (>13 mm) and with EF ≥50%, no RWMA, base-line BP ≤160/100 mmHg, peak pulmonary pressure ≤45mmHg and no significant valvular disease were included in the study. hsTnT wasanalysed before, at 60, 120 and 180 min. after the test.

Results:

ExSE and DSE groups were comparable. hsTnT level was higher in DSE than in ExSE group in 120 min. [14.3 (9.0, 23.9) vs 7.5 (4.5, 11.2)ng/L, p = 0.003] and in 180 min. [18.4 (12.1, 39.9) vs 7.8 (5.3, 16.8) ng/L, p = 0.006]. Rise of TnT in 180 min. from baseline level was signifi-cant in either whole groups (p = 0.013 ExSE, p < 0.001 DSE) and subgroups without atropine (p = 0.004 ExSE, p < 0.001 DSE). No correla-tion between hsTnT levels and max. BP during the test or double product was observed in subgroups without atropine.

Conclusion:

ExSE and DSE increases hsTnT level in lower risk patients with negative result of the test, significantly more in DSE.

ExSE and DSE groups characteristics

VARIABLE ExSE n = 23 DSE n = 23 page, years 60 (46, 65) 63 (46, 69) 0.61male gender, n (%) 6 (26.1%) 8 (37.8%) 0.52pretest IHD probability %* 28.4 ± 15.9 22.8 ± 16.65 0.24smoking, n (%) 8 (34.8) 5 (21.7%) 0.33positive family history of IHD, n (%) 4 (17.4%) 4 (17.4%) 1.00hypercholesterolemia, n (%) 16 (69.6%) 11 (47,8%) 0.13hypertension, n (%) 13 (56.5%) 11 (47,8%) 0.56Sonovue given, n (%) 17 (73.9%) 18 (78,3%) 0.73Sonovue dose (mL) 1.0 ± 0.7 1.3 ± 0.8 0.33test length (min.) 9 (7, 10) 10 (9, 11) 0.12atropine given, n (%) 3 (13.0%) 6 (26.1%) 0.46serum creatinine (umol/L) 76.0 ± 13.6 75.8 ± 11.8 0.95eGFR (mL/min./1.73m2) 1.38 ± 0.23 1.45 ± 0.26 0.30baseline TnT (ng/L) 5.9 (4.1, 7.8) 5.6 (3.7, 9.5) 0.99max. systolic BP (mmHg) 191 ± 22 165 ± 17 ≤0.001double-product 29124 ± 3117 23934 ± 2696 ≤0.001

*as per ESC guidelines on stable coronary artery disease 2013Abstract P1359 Figure. hsTnT (ng/L) in ExSE and DSE groups


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P1360

Type 1 diabetics with end-stage chronic kidney disease prior to transplantation: echo-cardiographic findings at rest and stress

Andrade MJ.1; Calca RITA2; Branco P.2; Horta E.1; Gaspar A.2; Birne RITA2; Reis CARLA1; Carvalho TIAGO2; Mendes MIGUEL1

1Hospital Santa Cruz, Cardiology, Carnaxide, Portugal2Hospital Santa Cruz, Nephrology, Carnaxide, Portugal

Introduction: Diabetes mellitus and chronic kidney disease (CKD) are both known independent risk factors for the development of cardio-vascular (CV) diseases. These conditions have been associated with changes of cardiac structure, function, and an excess risk of coronaryartery disease (CAD). The aim of this study was to evaluate the echocardiographic findings (at rest and with stress) in patients with type 1diabetes and end-stage CKD.

Methods: 48 consecutive patients undergoing dipyridamole (0.84 mg/kg in 10") plus atropine (1 mg) stress echocardiography prior to renal+/- pancreatic transplantation between Dec. 2008 and Dec. 2014 at a single center, were evaluated. At baseline, a complete 2D/Dopplerexam was performed, including evaluation of global longitudinal strain (GLS) by speckle tracking. During and after stress, in addition to seg-mental motion analysis, the coronary flow reserve (CFR) was measured (PW Doppler in distal anterior descending artery).

Results: Mean diabetes duration was 24.4± 6.0 years and mean HbA1c was 8.7 ±1.7%. The prevalence of other major CV risk factors wasas follows: hypertension 69.4%, dyslipidemia 44,4% and smoking 36.1%. Four patients had known history of CAD with previous coronaryangioplasty. At the time of test, 38.5% were on hemodialysis (HD) and 25.6% on peritoneal dialysis (PD); 7.7% had previous renal transplan-tation and 28.3% patients weren’t on RRT.

Left ventricular (LV) hypertrophy (LVMI > 115g/m2 for men, >95g/m2 for women) was present in 63.6% of patients and 45.3% had left atrialenlargement (>34ml/m2). Although LV ejection fraction was preserved (≥ 50%) in 72.9%, LV dysfunction was observed in 72,9%, as as-sessed by abnormal GLS (> -18%). Only 5 patients had neither LV dysfunction nor LV hypertrophy. Rest elevated LV filling pressure (ratioE/e’ >13) was present in 34,4% of patients. By wall motion analysis, an ischaemic response after stress was observed in 6 patients (12,5%),5 of whom submitted to coronary interventions. CFR was 2.3 ± 0,7 for the entire population. During follow-up (5.6, 4.2-6.9 years), 14.3% hadhospitalizations for any cause and 3 for CV causes (2 myocardial infarction). These 3 patients had both LV dysfunction and LV hypertrophyand 1 had ischaemic response. By the end of follow-up 50% of patients had kidney transplant (mostly double kidney and pancreatic); 32.1%were on HD, 14.3% on PD and 3.6% weren’t on RRT. No patient died.

Conclusion: Cardiac structural and functional abnormalities are quite frequent in relatively young patients with type 1 diabetes and end-stage CKD. Most of them have LV hypertrophy and LV dysfunction as assessed by deformation imaging, despite preserved ejection fraction.A significant proportion have LA dilation and elevated LV filling pressure at rest. Coronary artery disease is also frequently present and canbe exposed by stress echocardiography, allowing for appropriate coronary intervention before renal transplantation.


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P1361

Aortic valve area estimated by continuity equation versus simplified method of projec-ted aortic valve area in patients with low-flow low-gradient aortic stenosis

Marques A.1; Gomes AC.1; Congo K.2; Fazendas P.1; Pereira AR.1; Alegria S.1; Sebaiti D.1; Cruz I.1; Almeida AR.1; Joao I.1; Pereira H.1

1Hospital Garcia de Orta, Cardiology, Almada, Portugal2Hospital Espirito Santo de Evora, Evora, Portugal

Introduction: The evaluation of severity of "low-flow low-gradient" aortic stenosis (LFLG AS) is particularly challenging. The TOPAS studydemonstrated that projected aortic valve area (projAVA) at a normal transvalvular flow rate derived from dobutamine stress echocardiogra-phy (DSE) is superior to the traditional Doppler indices to discriminate true severe-AS and pseudosevere-AS.

Purpose:To compare two echocardiographic methods to estimate severity of LFLG AS with DSE: aortic valve area (AVA) estimated by con-tinuity equation (AVA-CE) and simplified method of AVAproj) in patients (pts) with low transvalvular flow rate (<250mL/seg).

Methods:Unicentric, retrospective study, that included pts with LFLG AS undergoing DSE with low dose dobutamine protocol, during a 4-year period. Evaluation at rest and peak DSE of vital signs, echocardiographic parameters, namely, mean transaortic gradient, aortic VTI,LVOT VTI and VTI ratio, valvulo-arterial impedance (ZVA), AVA-CE, simplified method of projAVA and global longitudinal strain (GLS).

Results:Were included 22 pts, mean age of 76 ± 8 years, 86% male. Most frequent comorbidities were arterial hypertension (96%), diabetes(55%), dyslipidaemia (82%), obesity (41%) and chronic kidney disease (41%).

At rest: 60% in sinus rhythm, 23% in atrial fibrillation/flutter and 18% in pacing rhythm. Mean heart rate (HR) was 78 ± 12 bpm, mean systol-ic arterial pressure (SAP) was 123 ± 23 mmHg, mean ZVA 4.3 ± 2 mmHg/ml/m2; mean diameter of LVOT was 21 ± 2cm, mean of mean aort-ic gradients 21 ± 7 mmHg, 59% of pts had a VTI ratio at rest compatible with severe AS and remaining compatible with moderate AS. Meanaortic VTI was 63 ± 13cm. Estimated mean AVA-CE was 0.85 ± 0.3 cm2with 73% of pts classified as severe AS. Mean left ventricular ejec-tion fraction at rest was 32 ± 9%, systolic volume index 27 ± 8 mL/m2 and GLS -6.5%.

During low dose perfusion protocol of dobutamine: 100% patients remained asymptomatic, mean HR was 112bpm, mean SAP was 111 ± 26 mmHg, mean ZVA 3.7 ± 1.9 mmHg/mL/m2, mean of mean aortic gradients 28.8 ± 9mmHg, 36% of pts presented VTI ratio compatiblewith severe AS and remaining compatible with moderate AS. Mean flow reserve was 15 ± 16%, mean transvalvular flow was 247 mL/segand mean GLS-7.8%. AVA-CE was 1 ± 0,34 cm2with 64% of pts classified as severe AS and mean projected AVA was 1.06 ± 0.38cm2, with-out significant difference in AVA estimated by the two methods (p = 0.548). Projected AVA allowed re-classification of AS in 27% of pts, with38% of severe AS reclassified as moderate/mild AS while AVA-CE allowed re-classification in 18%, with 19% of severe AS reclassified asmoderate AS.

Conclusion:The simplified projected valve area calculation is technically feasible and accessible. This study shows a good correlation in ptswith low cardiac flow, however there was no significant therapeutic impact in this group of pts.


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P1362

The diagnostic and prognostic role of a combined stress contrast echo protocol in pa-tients with suspected coronary disease and pacemaker

Aggeli C.; Dimitroglou Y.; Verveniotis A.; Zisimos K.; Raftopoulos L.; Kastellanos S.; Sarri G.; Aggelis A.; Felekos J.; Tousoulis D.

Hippokration General Hospital , Athens, Greece

Background: Stress contrast echo (SCE) is a versatile and accurate method for the diagnosis of myocardial ischemia. Patients with pace-maker may have impaired ejection fraction due to non-synchronized myocardial contraction of the left ventricle (LV), which can render thedetection of wall motion abnormalities more difficult. The aim of this study was to assess the diagnostic and prognostic role of contractilereserve as well as myocardial ischemia in patients with suspected coronary artery disease (CAD) and pacemaker, during a combined SCEprotocol.

Methods: 58 patients with pacemaker (pacing >50% during the 24 hours) and suspected CAD were included in the study. All patients under-went a combined SCE study and coronary angiography in one-month period. The stress protocol included a low-dose dobutamine infusion5-10-20 μg/kg/min followed by an acceleration of heart rate using external alteration of pacemaker rate every 3 minutes during a 4 stageprotocol. An increment of stroke volume >20% during the first part of the protocol revealed positive inotropic reserve of the LV. A positive forischemia study was characterized by the detection of new wall motion abnormalities and/ or perfusion defects in at least two consecutivemyocardial segments. All patients were followed-up for a period of 3 years for the presence of adverse events including death, revascularisa-tion, hospitalisations, and arrhythmias.

Results: The mean age was 73 ± 8years (42 men), 14 of them had CAD. The mean LV ejection fraction was 45 ± 3% and the mean durationof pacemaker implantation was 8 ± 2 years. Eleven patients had no inotropic reserve whereas the SCE demonstrate a sensitivity and specif-icity of 86% and 95 % respectively (per patient analysis), in detecting CAD. During follow-up adverse events were observed in 11 (18.9%)patients. After adjustment for multiple potential confounders (age, gender, hypertension, diabetes, CAD, LV ejection fraction) ischemic re-sponse (Exp(B) 6,6354 , C.I 1,8783 to 23,4408) was the strongest predictor for adverse outcomes.

Conclusion: The combined stress contrast echo study in patients with pacemaker, revealed an excellent diagnostic and prognostic value.Ischemic response was the strongest predictor for adverse outcomes in such patients.


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P1363

Exercise limitation in patients with mitral stenosis: a cardiopulmonary stress echocar-diography study

Badiani S.; Van Zalen J.; Althunayyan A.; Al-Borikan S.; Armado K.; Monteiro R.; Hoare D.; Khanji M.; Timmis A.; Jain A.; Bhattacharyya S.;Lloyd G.

Barts Health NHS Trust, London, United Kingdom

Introduction: Exercise stress echocardiography is recommended in patients with mitral stenosis (MS) where there is a discrepancy be-tween resting echocardiographic findings and clinical symptoms, and can reveal haemodynamic consequences such as changes in mitralvalve gradient and pulmonary artery systolic pressure. However, data on the use of cardiopulmonary exercise testing (CPET) in this patientgroup is limited. This study sought to assess exercise limitation in patients with mitral stenosis using a combined cardiopulmonary stressechocardiography platform.

Methods: An analysis of patients with mitral stenosis undergoing cardiopulmonary stress echocardiography in an enhanced valve surveil-lance clinic was performed. Patients with additional moderate or severe valve lesions and suboptimal echocardiographic windows were ex-cluded. The severity of mitral stenosis was quantified by mean gradient and mitral valve area by planimetry. Symptom limited cardiopulmo-nary exercise testing with respiratory gas exchange analysis was used, and the patients were encouraged to exercise until exhaustion.

Results: 13 patients were included. The mean age was 57.5 ± 15.1 years and 9 (69.2%) of patients were male. The aetiology of mitralstenosis was rheumatic in 8 cases, radiation induced in 2 cases and degenerative in 3 cases. The severity of mitral stenosis at baseline wasmild in 2 patients, moderate in 9 patients and severe in 3 patients. 6 patients with mild and moderate mitral stenosis were symptomatic atbaseline, with dyspnoea.

All patients exercised to respiratory exchange ratio (RER) >1.1 indicating good effort. Mean mitral gradient rose from 8 ± 6 to 18 ± 9mmHgand 8 patients developed an increase in pulmonary artery systolic pressure >60mmHg.

Peak VO2 was 16.9 ± 5ml/min/kg (66 ± 16% age predicted). 10 patients (77%) achieved a peak VO2 less than 84% predicted. VO2 peakwas positively associated with peak exercise longitudinal systolic velocity as measured by S prime (r = 0.61, p = 0.027) but was not associ-ated with an increase in mean gradient (r = 0.5, p = 0.876).

The 6 symptomatic patients with mild and moderate mitral stenosis at baseline had an average peak VO2 of 13.3ml/min/kg (68% of agepredicted) and 5 out of the 6 patients had a peak VO2 less than 84%.

Conclusion: A significant proportion of patients with mitral stenosis exhibit cardiopulmonary limitation. The data suggests that combinationtesting with stress echocardiography can provide incremental information regarding functional limitation, not detected clinically or with exer-cise echocardiography alone. Patients with less than severe mitral stenosis also exhibit

cardiopulmonary limitation. Larger studies are required to support these findings.


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P1364

The value of changes of NT-proBNP level during exercise echocardiography in patientswith moderate functional ischemic mitral regurgitation qualified for cardiosurgical

treatment

Kochanowski J.1; Piatkowski R.2; Scislo P.1; Budnik M.1; Grabowski M.1; Marchel M.1; Opolski G.1

1Medical University of Warsaw, Warsaw, Poland2Central Clinical Hospital of the Ministry of the Interior and Administration, Department of Noninvasive Cardiology and Hypertension, War-saw, Poland

Background:The aim of this study was to assess correlation between baseline NT-proBNP level at rest and after 2D echocardiographysemi-supine exercise test (ExE) in patients (pts) with moderate functional ischemic mitral regurgitation (FIMR) qualified for cardiosurgicaltreatment - coronary artery by-pass grafting alone (CABGa) or CABG with mitral reconstruction (CABGmr).

Materials and methods: A 114 of subsequent pts (M 76, 66 ± 8 years), 3-24 weeks after myocardial infarction, presenting moderate FIMRwere prospectively included into the study. Effective regurgitation orifice area (EROA) was used for quantitative FIMR assessment (moderate≥10 - >20 mm²). All the pts were qualified for CABG (multivessel coronary disease, ejection fraction (EF) 42,4 ± 10%, wall motion score index(WMSI) 1.61 ± 0.35). The pts were referred for CABGa (gr.1; n = 49) or CABGmr (gr.2; n = 65) based on clinical assessment, 2D, 3D echoand 2D ExE. NT-proBNP level was evaluated before and immediately after ExE.

Results: The results of analysis of NT-proBNP level and FIMR size at rest and after ExE in both groups of pts are shown in table 1 (p < 0.05;statistical significance). A positive correlation was found between NT-proBNP and EROA at rest (ro= 0,42, p = 0,0044) and after ExE (ro =0,35, p = 0,015).

Conclusions:

1. Baseline NT-proBNP levels at rest and after ExE are significantly higher in pts with moderate FIMR qualified for CABGmr than in the CAB-Ga group.

2. Significant increase of NT-pro-BNP level after exercise in pts with moderate FIMR was observed.

Table 1

NT-proBNP rest NT-proBNP exe p EROA rest EROA exe pGroup 1 561,3 592,4 0,0002 16 15 0,53Group 2 1216 1314 < 0,0001 18 27 < 0,0001p 0,0026 0,0015 0,0119 <0,0001


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P1365

Right ventricular geometry and septum curvature in group 2 pulmonary hypertensionpatients

Barletta M.1; Palumbo MC.2; Bandera F.1; Giammarresi A.3; Labate V.1; Losito M.3; Caracciolo MM.3; Rovida M.3; Guazzi M.1

1IRCCS, Policlinico San Donato, University Cardiology Department, University of Milan, School of Medicine, San Donato Milanese, Italy2Milan Polytechnic , Dipartimento di Elettronica, Informazione e Bioingegneria, Milan, Italy3IRCCS, Policlinico San Donato, University Cardiology Department, San Donato Milanese, Italy

BACKGROUND. Changes in right ventricle (RV) shape may occur quite before overt ventricular dysfunction, pointing out an early stage inthe pathophysiological process of RV failure.

AIM. To evaluate deformation in RV geometry in patients with group 2 pulmonary hypertension (PH), in comparison to control subjects, un-veiling the link between chamber morphology and degree of pressure overload.

METHODS. Sixty-eight subjects (11 controls; 57 PH patients) underwent RV real-time 3D full volume acquisition during standard echocar-diographic study. The 3D data were analysed off-line using the 4D RV TomTec software. The 3D mesh of the RV model was post-processedusing a custom developed software. Quantification of RV surface curvature for the interventricular septum (IVS) and RV free wall (RVFW),were obtained as a mean of respective apical and mid regional curvatures.

RESULTS. As a convention, positive curvature values reflect a convex geometry, while a negative curvature degree indicates a concavemorphology. In controls subjects the IVS curvature assessed at end-diastole (ED) and end-systole (ES) resulted significantly more concavethan in PH patients. On the opposite, there was no significant difference in RVFW curvature between the two cohorts. Considering curvaturedeformation during the cardiac cycle, in both groups only RVFW changed significantly comparing ES to ED (Table). However, while in con-trols both mid and apical free wall regions significantly shifted toward the chamber, in PH patients apex resulted relatively fixed (p 0,157).Furthermore, IVS curvature was strongly related to systolic pulmonary artery pressure (PAPs) (r 0,712 p < 0,001 at ED; r 0,767 p < 0,001 atES).

CONCLUSION. The analysis of right chamber’s geometrical configuration provides new insights in the pathogenesis of RV failure. PH pa-tients exhibited a loss of the physiological IVS concavity, proportional to the pressure overload, and an impairment of RVFW inward defor-mation.

PH and control curvature at ED and ES

ED ESCONTROL PH p-value CONTROL PH p-value

IVS -0,29 ± 0,09 -0,05 ± 0,16 < 0,001 -0,25 ± 0,08 -0,04 ± 0,14 < 0,001RVFW 0,75 ± 0,04 0,74 ± 0,07 0,632 0,65 ± 0,09

* p 0,0030,69 ± 0,09* p 0,001

0,203

IVS - apex -0,36 ± 0,13 -0,03 ± 0,26 < 0,001 -0,27 ± 0,19 -0,01 ± 0,24 0,001IVS - mid -0,24 ± 0,11 -0,06 ± 0,15 < 0,001 -0,26 ± 0,09 -0,06 ± 0,13 < 0,001FW - apex 0,96 ± 0,12 0,98 ± 0,18 0,787 0,79 ± 0,14

* p 0,0060,92 ± 0,23p 0,157

0,073

FW - mid 0,69 ± 0,06 0,67 ± ,07 0,423 0,61 ± 0,11* p 0,043

0,62 ± 0,07* p < 0,001

0,690

* comparison ED vs ES values

Abstract P1365 Figure. Color-coded RV surface curvature model


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P1366

Accurate quantification of left ventricular mass in patients with non-ischemic dilatedcardiomyopathy based on three-dimensional echocardiography

Sveric K.; Heidrich F.; Rady M.; Quick S.; Speiser U.; Linke A.

Dresden University of Technology, Department for Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Dresden, Ger-many

Background: Left ventricular (LV) myocardial mass (M) is an important marker of LV remodelling in patients with non-ischemic dilated cardi-omyopathy (DCM). Increased LVM is associated with myocardial fibrosis, thus risk for morbidity and mortality are elevated. Therefore, repro-ducible echocardiographic measurements of LVM are of utmost importance.

Purpose: To evaluate the accuracy of three-dimensional (3D) and two-dimensional (2D) echocardiographic (E) measurements of LVM inDCM patients with a broad range of LV size and function against cardiac magnetic resonance (CMR) assumed as the reference standard.

Methods: 45 DCM patients (14 female; LV ejection fraction 15 to 48%; LV end-diastolic volume index 85 to 216 ml/m²) successively under-went CMR, 3DE and 2DE examinations. LVM was measured from 2DE and CMR images by conventional techniques. Apical 3DE endo- andepi-cardial surfaces were semi-automatically identified at end diastole to calculate LVM. Values were indexed to body surface area. Meas-urements of LVM were independently performed by two experienced readers. Analysis methods for accuracy, agreement and reliability weredone as follows: mean bias compared to CMR; limits of agreement (LOA, 1.96 standard deviation); Pearson"s correlation coefficient (r); in-tra-class correlation (ICC).

Results: CMR values for LVM ranged from 63-165 g/m², with a mean of 114 ± 28 g/m² and with an excellent ICC (0.98, p < 0.001). Table 1summarises the main echocardiographic results: 3DE measurement was feasible in all patients and resulted in higher correlation with CMRthan did 2DE; 3DE measurements also had a significantly smaller bias and tighter LOA with CMR than did the 2DE values (p < 0.001); ICCof 3DE was much higher than that of 2DE. Interestingly, measured bias of 3DE did not correlate with increasing LVM (r = 0.11, p = 0.47), but2DE calculations showed a proportional error (r = -0.34, p = 0.02).

Conclusion: 3DE was proven to be a reliable and accurate method, as compared to CMR regarding LVM in patients with DCM.

Table 13DE 2DE P-value

3DE vs 2DELVM (g/m²) 116 ± 28 144 ± 42 < 0.001Mean bias to CMR (g/m²) -2.6 -16.3 < 0.001LOA to CMR (g/m²)[lower : upper level]

±21[-23.6 : 18.4]

±61[-77.3 : 44.7]

< 0.001

Correlation r with CMR 0.93 0.60 -ICC 0.94 0.80 -


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P1367

Low gradient aortic stenosis: can LVOT area evaluation by 3D Transoesophageal echo-cardiogram help?

Marques A.1; Alegria S.1; Carvalheira Santos R.2; Morgado G.1; Fazendas P.1; Pereira AR.1; Gomes AC.1; Cruz I.1; Almeida AR.1; Joao I.1;Pereira H.1

1Hospital Garcia de Orta, Cardiology, Almada, Portugal2Hospital de Vila Franca de Xira, Cardiology, Vila Franca de Xira, Portugal

Introduction: An important proportion of patients (pts) with aortic stenosis (AS) have low-gradient (LG) AS. This can be due to the presenceof a low left ventricle (LV) outflow state, which may occur with reduced LV ejection fraction (LVEF) (classical low-flow, low-gradient (LF-LG))or preserved LVEF (paradoxical LF-LG). Furthermore, a substantial proportion of pts with AS may have normal-flow low-gradient (NF-LG)AS. The management of this subset is challenging because the AVA-gradient discrepancy raises uncertainty about the real stenosis severity.The evaluation of the LV outflow tract (LVOT) by 3D Transoesophageal echocardiogram (TEE) may contribute to a correct classification.

Purpose: To evaluate the proportion of LG AS pts with reclassification of AS severity after LVOT measurement by 3D TEE planimetry, toinvestigate predictors of reclassification and to determine its impact on prognosis. To compare LG AS with a control population of severehighgradient (HG) AS.

Methods: Prospective, unicenter, study that included pts with LG AS according to the conventional criteria submitted to 3D TEE during2012-2017 period and comparison with a control population of pts with severe HG-AS.

Results: Were included 58 pts (57% males, mean age 76 ± 8 years). 42 (72%) pts had LG AS: 8 pts had classical LF-LG, 18 pts had para-doxical LF-LG and 16 pts had NF-LG. 16 pts had HG AS.

Compared to HG AS, LG AS pts had more diabetes (57 vs 25%; p = 0.028), coronary artery disease (55 vs 13%; p = 0.004), chronic renaldisease (49 vs 6%, p = 0.003) and LVOT with a superior eccentricity index (1.3 vs 1.15, p = 0.01).

After assessing the LVOT area by 3D TEE, 19 (45%)pts were reclassified as having moderate AS: 63% of NF-LG, 50% of classical LF-LG,28% of paradoxical LF-LG and 19% of HG AS (p = 0.048).

The predictors of 3D TEE reclassification were: male sex (OR 10; p = 0.001), bicuspid aortic valve (OR 5, p = 0.011), NF-LG (OR 4, p = 0.02),peak transaortic jet velocity < 3.2m/s (OR 6; p = 0.02), mean gradient <30 mmHg (OR 4.2; p = 0.015), VTI ratio ≥0,23 (OR 4.6; p = 0.03),peak gradient <55 mmHg (OR 4, p = 0.02), LVOT diameter ≥19.5cm (OR 4.3, p = 0.01), AVA by continuity equation ≥0.64 cm2 (OR 12, p = 0.02), AVA by 2D planimetry ≥ 0.86 cm2 (OR 6.4, p = 0.04), AVA by 3D planimetry ≥0.75cm2 (OR 24, p = 0.003).

During a mean FUP of 24 ± 18 months, 24 pts (41%) were submitted to valvular intervention. Compared to HG AS, pts with LG AS had lowerlevels of valvular intervention (75 vs 26%, p = 0.001), particularly cardiac surgery (16 vs 56%, p = 0.006). The mortality rate was 22.4% andthe 1-year mortality rate was 13%. There was no association between the groups regarding death rate, number of hospitalizations and NHYAclass.

Conclusion: This study demonstrates that a significant proportion (45%) of pts with LG AS, mainly NF-LG AS, are reclassified into moderateAS, after LVOT area evaluation by 3D TEE. It remains to be clarify whether this evaluation has an impact on therapeutic approach or progno-sis.


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P1368

Segmentation of calcium on the mitral annulus with 3D transesophageal echocardiog-raphy multiplanar reconstruction vs multislice computed tomography.

Binda G.1; Capogrosso C.1; Stella S.1; Ancona F.1; Fisicaro A.1; Altizio S.1; Toscano E.1; Beneduce A.1; Romano V.2; Latib A.2; MontorfanoM.2; Margonato A.1; Colombo A.2; Agricola E.1

1San Raffaele Scientific Institute, Echocardiography Laboratory, Cardio-Thoracic-Vascular Departement, Milan, Italy2San Raffaele Hospital of Milan (IRCCS), Interventional Cardiology Unit, Milan, Italy

Introduction: A precise anatomic characterization of calcium distribution on mitral valve apparatus is essential in the contest of the screen-ing process for the feasibility of percutaneous and surgical mitral valve repair and replacement. Multislice Computed Tomography is consid-ered the gold standard in the evaluation of mitral valve calcium distribution.

Purpose: The aim of our study is to evaluate the role of 3D Transesophageal Echocardiography Multiplanar Reconstruction (MPR) in theanatomic characterization of mitral valve annular calcification using Multislice Computed Tomography (MDSCT) as gold standard.

Methods: 64 patients (mean age = 80 yrs, 39% female) candidates for TAVR, underwent preoperative 3D-TEE and MSCT, in our institution.A 3D zoom volume dataset was acquired containing entire mitral annulus (MA) and the aortic valve, with a frame rate not inferior to 15 fps.We divide the mitral annulus in six segments: anterior leaflet (AML), antero-lateral commissure (AL-C), P1 scallop, P2 scallop, P3 scallopand postero-medial commissure (PM-C). We performed segmentation with MPR (off-line analysis, EchoPAC version 201) to assess thepresence (value 1 point) or the absence (value 0 point) of calcium for each of the six segments and than compare the data with the samesegmentation made with MDSCT. The sum of the segments calcium value (0 for the absence and 1 for presence of calcium) gives a TotalAnnular Score (TAS). The two methods were than compared using Pearson’s linear correlation.

Results: All the segments show a statistically significant correlation. Especially, good correlation was found for the postero-medial commis-sure (PM-L) and for the TAS (r = 0.50, p < 0.0001; r = 0.6, p < 0.0001), fairly good correlation for anterior leaflet (AML) and for P1 scallop (r = 0.45 p = 0.0001; r = 0.45 p = 0.0001). A lower correlation was found for P2 scallop, P3 scallop and AL-C (r = 0.43; p = 0.0003, r = 0.34; P = 0.005, r = 0.30; p = 0.01).

Conclusion: These preliminary data show that there’s a good correlation between the two modalities in the assessment of mitral annuluscalcium in terms of TAS with the tendency of 3D echocardiography to overestimate the presence of calcium (mean difference of -11 points ofthe TAS). The postero-medial commissure (PM-C) show a better correlation probably due to the closest position of the probe leading to abetter echocardiography resolution. The lower correlation between the two methods is observed for spot calcification (such as isolated AMLcalcification) in which 3D echocardiography shows a lower resolution.


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P1370

3D echocardiography parameters phenotype the right ventricle in heart failure patients:analysis of chamber size, function and volume-time curve

Barletta M.1; Bandera F.1; Giammarresi A.2; Labate V.1; Losito M.2; Caracciolo MM.2; Rovida M.2; Guazzi M.1

1IRCCS, Policlinico San Donato, University Cardiology Department, University of Milan, School of Medicine, San Donato Milanese, Italy2IRCCS, Policlinico San Donato, University Cardiology Department, San Donato Milanese, Italy

BACKGROUND. 3D echocardiography (3D-E) has emerged as a promising tool in imaging right ventricle (RV), overcoming bi-dimensional(2D-E) foreshortening.

AIM. To quantify RV volume and function applying 3D-E in heart failure (HF) population.

METHODS. 39 HF patients were studied: 19 with LV EF ≥40%, 20 with LV EF <40%. Real-time full-volume 3D data were analysed off-lineusing 4D RV TomTec software. RV function was evaluated by TAPSE, fractional area change (FAC) and RV free wall strain (RVFWS), incomparison with 3D RV EF. RV dimension was assessed by indexed 2D end-diastolic area (EDAi) and 3D end-diastolic volume (EDVi). Fur-thermore, the software provided a graphic representation of RV mechanics with a volume-over-time (V:T) curve. We analysed 11 controlssubject (LV EF 63,5% ± 8; RV EF 62,2% ± 6,1) to define a reference normal pattern for V:T curve.

RESULTS. According to 2D EDAi, RV dilatation only occurred in HF cases with reduced LV EF, while 3D analysis reported RV equally dilatedin all HF patients (38% reclassified; p 0,013). Similarly, 2D and 3D parameters significantly diverged in identifying RV dysfunction (23% re-classified; p 0,044), demonstrating higher discordance in LV EF > 40% cohort (49% reclassified). However, combined 2D parameters ade-quately predict 3D RV EF (R square 0,443 p < 0,001). We recognised two peculiar V:T curve profiles: (1) preserved RV EF cases exhibited a‘4-element’ pattern curve (normal V:T curve, RV EF 52,5% ± 7,7), resembling control subjects; (2) reduced RV EF cases developed an ab-normal V-shaped curve (V-shaped V:T curve, RV EF 44,3% ± 12,3; p 0,037).

CONSLUSION. 3D analysis performed better in identifying subtler grade of RV dysfunction and dilatation. Next to quantitave analysis, 3Dsoftware enriches our understanding of RV function through the V:T curve providing distinctive patterns according the degree of RV impair-ment.

RV size and function by 3D-E vs 2D-E

EF > 40% (n= 19) EF < 40% (n= 20)RV DILATATION2D EDAi, N (%) 0 5 (25%) Cohen K factor

0,0133D EDVi, N (%) 10 (52,6%) 10 (50%)RV DYSFUNCTION2D TAPSE, N (%) 2 (13,3%) 11 (55%)2D FAC, N (%) 3 (17,6%) 7 (35%)2D RV free wall strain, N (%) 6 (31,6%) 9 (45%)2D combined parameter, N (%) 6 (31,6%) 16 (80%) Cohen K factor

0,0443D RV EF, N (%) 15 (78,9%) 16 (80%)

Abstract P1370 Figure. V:T curve in HF patients based on RV EF


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P1371

Large beat-to-beat variability of mitral annulus dimensions in atrial fibrillation: implica-tions for interventional therapy

Olgun Kucuk H.; Oguz D.; Thaden JJ.; Nkomo VT.; Kane GC.; Pislaru C.; Wiley BM.; Sarano ME.; Rihal CS.; Eleid MF.; Pellikka PA.; PislaruSV.

Mayo Clinic, ECHOCARDIOGRAPHY AND VASCULAR PHYSIOLOGY RESEARCH LAB, Rochester, United States of America

Background

With the rapid evolution of transcatheter mitral therapies, assessment of mitral annular (MA) dimensions and geometry is becoming increas-ingly important. 3D transesophageal echocardiography (3D-TEE) has enabled accurate estimation of MA size and dynamics. Despite thefrequent association between mitral valve disease and atrial fibrillation (AFib), little is known about the dynamic MA dimensions in patientswith AFib.

Objective: We sought to determine beat-to-beat variability in MA circumference and area in patients with AFib and compare these findingswith those of control subjects in sinus rhythm (SR).

Methods

Images were obtained from patients undergoing routine 3D TEE. Patients with paced rhythms, prosthetic heart valves, severe mitral annularcalcification and poor image quality were excluded. Single-beat volume loops (to avoid stitch artifact) were acquired for 6 consecutive heartcycles in each patient and analyzed offline with a commercially available software package. MA was automatically tracked throughout eachcardiac cycle, and maximal per-cycle MA area/circumference was measured for each of the 6 beats. The absolute difference (largest maxi-mal MA area/circumference of the 6 cycles - smallest maximal MA area/circumference of the 6 cycles) and relative difference (absolute dif-ference / smallest maximal MA area/circumference) were calculated.

Results: A total of 70 patients were included: 35 with AFib and 35 with SR. Largest MA area/circumference were usually recorded at end-systole in each cardiac cycle. Afib patients showed significantly larger differences in both maximal MA area and circumference than patientsin SR (Table 1).

Conclusion: Maximal MA area and circumference show intra-individual variability when recorded over 6 heart cycles. Intercycle difference inmaximal MA area is more pronounced than Intercycle difference in maximal MA circumference. Variability in atrial fibrillation is substantial.Our findings have implication for procedural planning in patients considered for percutaneous mitral interventions.

Differences in maximal MA area over 6 cycles Differences in maximal MA circumference over 6 cyclesAbsolutemedian (range)

Relativemedian (range)

Absolutemedian (range)

Relativemedian (range)

Afib(N = 35)

2.0* (0.5-5.2) cm2 15.8* (3.0-129.0) % 1.0* (0.2-1.9) cm 7.7* (1.4-113.0)%

Sinus rhythm(N = 35)

1.0 (0.5-1.2) cm2 7.2 (3.8-7.9) % 0.4 (0.2-0.5) cm 2.7 (1.4-3.8) %

Table 1


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P1372

Evaluation of right atrial and ventricular function with 3D echocardiography in acutepulmonary thromboembolism and its 6-month prognosis

Rascon Sabido R.; Martinez Hernandez CMH; Martinez Hernandez CMH; Ibarra Quevedo DIQ; Ibarra Quevedo DIQ; Carrillo Estrada MCE;Carrillo Estrada MCE; Almeida Gutierrez EAG; Almeida Gutierrez EAG

Mexican Institute for National Security, Echocardiography, Veracruz, Mexico

Introduction: Acute pulmonary embolism (PE) is a serious condition. Tridimensional Ecocardiography (3D ECHO) is an accessible, noveland accurate method for determination of right ventricular and atrial function. To date there are insufficient studies to assess their role in thisentity.

Objective: Determine the usefulness of ECO-3D in evaluating right atrial and ventricular function, and the risk of cardiovascular complica-tions in patients with acute PE.

Material and methods: 50 patients were admitted to the HC CMN SXXI with PE by CT angiogram, we analized 2D and 3D parameters byPhilips iE33, right atrial and ventricular function (TomTec and QLAB 10). Hospital cardiovascular complications were evaluated in hospitaland 6 months later

Results: The relative risk of major combined cardiovascular events for 3D ECHO was: right atrial sphericity index > 1.32; RR 20.3 95% CI2.9-13.8; p = 0.0001, RVEF <38%; RR 7.3 95% CI 2.5-20.9; p = 0.0001, RVEDV > 77 mL; RR 2.56 95% CI 7.3-20.9, p = 0.0001. Multivariateanalysis showed 4 independent risk predictors: right atrial sphericity index > 1.32, RVEF < 38% massive PE and mean arterial pressure. At 6months RVEF < 38% and RAEI > 1.2 was are a independent risk for MACE and hospitalization.

Conclusions: The combined assessment by 3D echocardiography right ventricular and atrial function allow a quantitative assessment, riskprediction for cardiovascular complications and presentation of time-hospital stay in patients with acute PE.

Clinical characteristics versus

(n = 23) MACE (n = 27) No MACE pAge ( years) 55 (47-48) 50 (39-56) 0.38Female (%) 13 5 0.01Mean BP (mmHg) 55.5 ± 8 85.4 ± 8 0.0001Respiratory Rate (BPM) 31 ± 4 25 ± 3 0.001Low risk --- 20 0.001High RIsk 21 -- 0.0001ST segment deviation ECG (%) 12 -- 0.001thrombolysis 23 5 0.0001

MACE: major cardiovascular eventAbstract P1372 Figure. Sensitivity and specificity right atrial


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P1373

Comparison of methods for diagnosing CardiotoxicityGrigoriadis S.; Kapetanakis S.

St Thomas" Hospital, London, United Kingdom

Abstract

Background: Chemotherapy could cause cardiotoxicity, which results in adjusting of doses or terminating therapy altogether. For this rea-son, it is of great significance for the early detection of cardiotoxicity using accurate methods.

Purpose: We tried to determine which method used for detecting cardiotoxicity in our institution is the most accurate.

Methods: 280 patients treated with chemotherapy, either Anthracyclines or Trastuzumab, were repeatedly evaluated for cardiotoxicity usingvarious methods according to our institution"s protocols. The methods used were Simpson’s biplane method and visual assessment for cal-culating left ventricular ejection fraction, as well two commercial programs for analyzing three-dimensional echocardiographic data. GLS wascalculated in all patients. Other echocardiographic measurements for evaluating left ventricular function were also obtained.

Results: 62 patients developed cardiotoxicity clinically, either type 1 or type 2, affecting their chemotherapy treatment. ROC curves werecomputed for all methods. Three-dimensional ejection fraction analyzed by a particular commercial program was the most accurate methodof all (0.978, 95% confidence interval). The other methods for calculating LVEF were also very accurate, as well as, GLS (0.87, 95% confi-dence interval) Analysis of the other echocardiographic measurements didn’t seem to offer anything in the detection of cardiotoxicity.

Conclusion: Given the repeated nature of evaluation of left ventricular function in patients treated with chemotherapy, three-dimensionalechocardiography is the most accurate method. Echocardiographic measurements, other than LVEF, routinely used for assessment of leftventricular function don"t seem to add anything to the diagnostic accuracy.



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P1374

Variability and agreement in the assessment of left ventricular ejection fraction andvolumens applying automated tracking by 2D and 3D echocardiographic Techniques

Ericsson F.1; Tayal B.1; Hay Kragholm K.2; Weinkouff Pedersen M.1; Schnohr P.3; Holmark Andersen N.1; Moegelvang R.4; Soegaard P.1

1Aalborg University Hospital, Cardiology Department, Aalborg, Denmark2Vendsyssel Hospital, Cardiology, Hjorring, Denmark3Speciallæge Peter Schnohr, Copenhagen, Denmark4Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark

Background: Machine learning and use of automated tracking has improved the variability in the measurement of left ventricular (LV) ejec-tion fraction (EF) in both two-dimensional (2D) and three-dimensional (3D) echocardiography techniques. However, further studies are re-quired to verify this.

Purpose: The objective of the current study was to compare the inter-observer variability and agreement in the measurement of EF andvolumes by applying 2D and 3D methods using automated tracings.

Methods: A total of 150 patients, aquired from The Østerbro Study, in sinus rhythm standard 2D apical and 3D full-volume mode over 6consecutive beats in single breath hold were acquired. None of the patients had structural heart disease. All echocardiograms were acquiredusing GE Vivid E9 ultrasound system and off-line analysis were performed using EchoPAC v. 201. EF was determined by automated track-ing using biplane Simpsons rule (2D AutoEF) and automated tracking of 3D volumes (4D AutoLVQ). Results are reported as limits of agree-ment and bias using Bland-Altman plot along with intra class correlation coefficient and coefficient of variability (CV).

Results: The mean EF by 2D AutoEF and 4D AutoLVQ techniques were 59%±5% and 58%±5%. Volumes were smaller by 2D in compari-son to 3D measurements: end-systolic volumes (ESV) 39ml ± 12 vs. 45ml ± 14 and end-diastolic volumes (EDV) 99ml ± 26 vs 108ml ± 28.Among the two techniques 4D AutoLVQ had the best agreement and least variability for measurements of both LV volume and EF (Table).The variability between the two EF estimation methods was limited (Bias 0.2 ± 9%, CV 5%) (Table).

Conclusions: Interobserver agreement was acceptable in the measurement of LV volumes and EF applying 2D and 3D automated techni-ques and can be applied in routine clinical practice."

Abstract P1374 Figure 1


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P1375

Epicardial adipose tissue thickness measured by echocardiography is a useful markerfor predicting in-stent restenosis

Hirata Y.1; Kusunose K.2; Yamada H.3; Torii Y.1; Nishio S.1; Zheng R.2; Saijo Y.2; Bando M.3; Ise T.2; Yamaguchi K.2; Wakatsuki T.2; Sata M.2

1Tokushima University Hospital, Ultrasound Examination Center, Tokushima, Japan2Tokushima University Hospital, Department of Cardiovascular Medicine, Tokushima, Japan3Institute of Health Biosciences, The University of Tokushima Graduate School, Department of Community Medicine for Cardiology, Tokushi-ma, Japan

Background: Effective and accurate methods to identify patients with high risk of in-stent restenosis (ISR) are still unknown. Epicardial adi-pose tissue (EAT), which is located in close proximity to the coronary arteries, is significantly associated with the presence of coronary heartdisease (CAD). EAT can be clearly visualized by echocardiography using a high-frequency linear probe. We previously reported that in-creased EAT thickness, especially adipose thickness in anterior interventricular groove (EAT-AIG), can be a marker for detecting CAD. Thus,we hypothesized that increased EAT-AIG thickness measured by echocardiography may suggest on increased risk of future ISR.

Purpose: The purpose of this study was to assess the relationship between ISR rates and EAT-AIG thickness measured by echocardiogra-phy.

Methods: We retrospectively enrolled 175 patients (mean age 69 ± 9 yrs, 130 males) who underwent percutaneous coronary intervention(PCI) for the first time, and coronary angiography (CA) follow-up for ISR examination within one year. ISR was defined as ≥ 50% luminaldiameter narrowing of the stent segment or peri-stent segment. We measured EAT-AIG thickness by echocardiography before PCI. All pa-tients were classified into 2 groups: the ISR group and the non-ISR group, in order to assess the association between regional EAT thicknessand ISR rates.

Results: During follow-up, ISR was diagnosed in 40 (23%) patients. EAT-AIG thickness was significantly greater in the ISR group comparedwith non-ISR group (10.4 ± 3.4 mm vs. 7.9 ± 3.0 mm, p <0.001). The relation between ISR and EAT-AIG remained significant after adjust-ment for conventional cardiovascular risk factors and angiographic parameters (age, diabetes mellitus, smoking, stent type, and stent diame-ter). The odds ratio was 1.31 (95% CI 1.15−1.50, p < 0.001) for EAT-AIG thickness in predicting ISR.

Conclusions: Increased EAT thickness is associated with increased ISR risk than other conventional risk factors. EAT thickness, measuredby echocardiography, is a useful non-invasive imaging marker for predicting ISR.


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P1376

Assessment of ascending aorta mechanics in hypertensive patients with different leftventricular remodeling patterns

Vijiiac AE.; Onciul S.; Dorobantu M.

Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania

Funding Acknowledgements: CREDO Project ID:49182, financed by the National Authority of Scientific Research and Innovation,co-fi-nanced by the European Regional Development Fund

Thorough evaluation of target organ damage is mandatory in hypertensive patients. Although major vascular changes (macro- and micro-vascular) are well-known to occur with high blood pressure, little has been studied so far concerning the influence of hypertension on themechanics of the ascending aorta.

We sought to evaluate ascending aorta mechanics in a cohort of hypertensive patients and to characterize aortic physiology according to thetype of left ventricular remodeling pattern.

We included in our study 60 hypertensive patients without history of coronary or peripheral artery disease and 60 normal subjects whoformed the control group. We divided the study group into 4 subgroups, depending on the type of left ventricular remodeling pattern: group Awith normal left ventricular geometry, group B with concentric remodeling, group C with eccentric hypertrophy, and group D with concentrichypertrophy. We focused on the evaluation of ascending aorta mechanics and we assessed the aortic strain, elastic modulus, distensibility,compliance and stiffness index using M-mode measurements of the ascending aorta. Statistical analysis was performed using the one-wayanalysis of variance (ANOVA) and we used post-hoc Bonferroni-corrected T tests to analyze where differences occurred between groups.

In the hypertensive group, 28.33% of the patients had normal left ventricular geometry, 41.66% had concentric remodeling, 11.66% had ec-centric hypertrophy and 18.33% had concentric hypertrophy. The mean age in the hypertensive group was 57.12 ± 12.43 years, versus 38.8± 12.34 years in the control group (p = 0.0006). The aortic strain was highest in the control group: 9.02 ± 3.63, versus 4.03 ± 1.34 in group A,4.16 ± 1.68 in group B, 3.58 ± 1.43 in group C and 4.67 ± 2.23 in group D (F (4, 115)=2.45, p < 0.0001). The elastic modulus was lowest inthe control group: 6.16 ± 2.71, versus 18.14 ± 8.43 in group A, 19.71 ± 12.33 in group B, 23.11 ± 9.50 in group C, 17.78 ± 9.61 in group D (p < 0.0001). The aortic stiffness index was lowest in the control group: 0.06 ± 0.02, versus 0.15 ± 0.06 in group A1, 0.16 ± 0.09 in group B,0.18 ± 0.07 in group C, 0.14 ± 0.06 in group D (p < 0.0001). The aortic distensibility was highest in the control group: 0.39 ± 0.19, versus0.13 ± 0.05 in group A, 0.12 ± 0.05 in group B, 0.11 ± 0.09 in group C, 0.16 ± 0.10 in group D (p < 0.0001). The aortic compliance was alsohighest in the control group: 0.057 ± 0.023, versus 0.021 ± 0.008 in group A, 0.020 ± 0.008 in group B, 0.019 ± 0.014 in group C and 0.024 ±0.014 in group D (p < 0.0001).

These results indicate that hypertension is associated with significantly impaired aortic mechanics, irrespective of the type of left ventricularremodeling pattern. This might emphasize the need for strict blood pressure control for all patients, including those with normal ventriculargeometry and it also highlights the importance of thorough evaluation of target organ damage in hypertensive patients.


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P1377

Incidence and predictors of long term cardiotoxicity in antracycline based chemothera-py in breast cancer patients

Mata Caballero R.1; Serrano Antolin JM.2; Gonzalez Garcia IA.2; Muniz Garcia JM.2; Curcio Ruigomez A.2; Gutierrez Landaluce C.2; Del Cas-tillo Arrojo S.2; Graupner Abad C.2; Cristobal Varela C.2; Galan Gil D.1; Lopez Pais J.1; Espinosa Pascual MJ.1; Malon Gimenez D.3; Awam-leh Garcia P.1; Alonso Martin JJ.1

1University Hospital of Getafe, Cardiology, Getafe, Spain2University Hospital of Fuenlabrada, Cardiology, Fuenlabrada, Spain3University Hospital of Fuenlabrada, Oncology, Fuenlabrada, Spain

Funding Acknowledgements: Unrestricted grants from Red Temática de Enfermedades Cardiovasculares (RECAVA) RD06/0014/002 ofthe Instituto de Salud Carlos III

Background: Anthracycline cardiotoxicity (AC) may manifest years after treatment (long-term cardiotoxicity). It represents a limitation for thetreatment of breast cancer patients (pts). The aim of our study was to assess the incidence and predictors of long-term AC in these pts.

Methods: 100 consecutive pts receiving Anthracycline based chemotherapy (CHT) were included in this prospective study. A baseline evalu-ation was performed, at the end and 3 months after the end of CHT, and at 1 and 4 years after the start of CHT. Clinical data, echo parame-ters, and biochemical parameters such as ultrasensitive T troponin, NTproBNP and fatty acid transport protein (H-FABP) were evaluated inall visits. The variable outcome was incidence of long-term AC.

Results: Mean doxorubicin dose was 243mg/m². Median follow-up was 4.5 years. At 1 year incidence of AC was4% and at the end of thefollow-up 18% (long-term AC). Forty nine pts developed diastolic dysfunction (DD) in the first year. In the univariate analysis, DD during thefirst year was the only parameter associated with AC (Table). In the logistic regression model, none of the cardiovascular risk factors wererelated to the development of AC, neither the dose of CHT or radiotherapy. None of the biomarkers was an independent predictor of AC.Four of these 18 pts had received Trastuzumab. Although early decrease in global longitudinal strain (GLS) was associatted with the devel-opment of AC (10.1% en pts who developed AC vs 3.8% in those who did not, p 0.119), only DD was independently related to the develop-ment of AC, odds ratio 7.5 (p 0.005).

Conclusions: The incidence of long-term AC is high. Although early decrease in GLS was associatted with the development of AC, only DDwas independently related to the development of long-term AC.

AC+ (n = 18) AC- (n = 82) p-valueAge [years, mean (s.d.)] 50.3 (9.2) 51.0 (9.1) 0.78Anthracycline dose (mg/m2) 243 ± 4.8 242 ± 4.5 0.73-Hypertension-Diabetes-Hyperlipidemia-Smoking status

33.311.111.138.9

28.09.814.642.7

0.77110.78

Radiotherapy 38.9 42.7 0.8Diastolic dysfunction (%)* 88.2 50.0 0.005GLS decrease from basal to end CHT (%) 10.1 3.8 0.119T troponin end of CHT (ng/L) 13.2 ± 5.8 12.0 ± 5.6 0.44HFABP end of CHT (ng/mL) 2.8 ± 1.4 3.2 ± 2.0 0.43NTproBNP end of CHT (pg/mL) 86 ± 103 60 ± 47 0.10

Abbreviations: AC+, pts developing AC; AC−, pts not developing AC; s.d.: Standard deviation. *denotes p value <0.05.


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P1378

Severely reduced right ventricular fractional area change in patients with chronic leftheart disease indicate increased pulmonary vascular resistance

Bech-Hanssen O.; Ricksten S-E; Gao SA.

Sahlgrenska University Hospital, Gothenburg, Sweden

Background and purpose. Patients with chronic left heart disease (LHD) might develop right ventricular (RV) failure due to pulmonary hy-pertension (PH). In LHD the patients might have normal pulmonary pressure (No-PH), passive PH (P-PH) due to increased filling pressureor reactive PH (R-PH) with increased pulmonary vascular resistance (PVR > 3 Wood units). We investigated the relation between RV func-tion assessed with echocardiography (Echo) and these hemodynamic profiles.

Methods. The study comprised 56 patients undergoing Echo and right heart catheterization (RHC) within 24 hours. The main reasons forRHC were to assess the hemodynamic status as a part of pre-transplant work-up, to evaluate the cause of PH and to perform endomyocar-dial biopsy. The RV function was assessed using indices for a) size (RV area); b) shape (ratio of the short axis diameter and septum length,RVd-SAX/RV-IVS); c) fractional area change (FAC), d) tricuspid annular plane excursion (TAPSE) and e) tissue Doppler peak systolic veloci-ty (S’). The longitudinal component of FAC (L-FAC) was determined by planimetry and the proportion of total FAC was calculated.

Results. The pulmonary artery mean pressure was 30 ± 5 and 36 ± 7 mmHg (P = 0.009) in P-PH and R-PH patients, respectively. The hemo-dynamic profile did not influence RV shape, the relation between longitudinal and radial contribution to FAC or TAPSE. Patients with R-PHhad enlarged RV and reduced S’ compared to No-PH. FAC was lower in patients with R-PH compared to P-PH. The area under the ROC-curve for FAC to detect increased PVR was 0.82. Using FAC < 23% as the cut-off, positive likelihood ratio was 7.2 (95% CI 2.3-23) andnegative likelihood ratio 0.43 (95% CI 0.3-0.8).

Conclusions. RV function assessed by Echo shows the most pronounced dysfunction in patients with increased PVR. Severely reducedFAC in chronic LHD indicate increased PVR.

Table

N0-PH (n = 19 P-PH (n = 17) R-PH (n = 20) Overall P value No-PH vs P-PH No-PH vs R-PH P-PH vs R-PHLVEF 45 ± 18 32 ± 19 29 ± 12 0.01 0.019 0.005 0.9CI 2.6 ± 0.8 2.2 ± 0.6 2.0 ± 0.5 0.018 0.11 0.004 0.18RVd-area 17.3 ± 4.4 21.3 ± 6.1 23.2 ± 5.4 0.007 0.03 0.001 0.32RVd/RV-IVS 0.41 ± 0.09 0.36 ± 0.1 0.39 ± 0.11 0.27 - - -FAC 44 ± 9.4 36 ± 13.5 24 ± 11.9 <0.001 0.06 <0.001 0.008L-FAC% 58 ± 14 57 ± 16 61 ± 24 0.95 - - -TAPSE 19 ± 7 18 ± 5 15 ± 5 0.26 - - -S’ 10 ± 3 9 ± 2 8 ± 2 0.048 0.26 0.012 0.12

LVEF, left ventricular ejection fraction; CI, cardiac index. P value indicating significans 0.016 for comparison betweengroups.


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P1379

Pericardial Decompression Syndrome: Incidence in a Large Consecutive Series ofEchocardiographic-guided Pericardiocentesis Procedures

Lekhakul ANNOP; Assawakawintip CHALAI; Fenstad ERIC; Pislaru SORIN; Sinak LAWREN; Kane GARVAN

Mayo Clinic, Rochester, United States of America

Background: Pericardial decompression syndrome (PDS) has been reported as a spectrum of cardiac decompensation following pericardio-centesis including ventricular failure, cardiogenic shock and pulmonary edema. PDS has been reported in patients undergoing drainage≥450 mL of pericardial fluid. Hence judicious drainage of large volume effusions to avoid complication has been recommended. However, nostudy has sought to assess the prevalence of PDS in a large series of consecutive patients undergoing transthoracic echocardiography(TTE) guided pericardiocentesis.

Methods: Consecutive patients undergoing TTE guided pericardiocentesis at our center from 1/2007 to 12/2016were reviewed. Procedureswere performed in a standard fashion under moderate conscious sedation with TTE determining the location of aspiration and determiningadequate resolution of pericardial fluid post procedure. All fluid was removed at time of centesis regardless of the size of effusion, except forpatients with severe pulmonary hypertension (n = 9), who had staged removal of 100cc every 10 minutes. Post procedure, a pigtail catheterwas left in the pericardial space for ongoing intermittent drainage and removed after the total net output was <50 mL/24 hours. Patients weremonitored in an intermediate level care unit. All patients underwent repeat TTE at the time of catheter removal. Large volume was defined as≥450 mL of fluid. Patients in whom pericardiocentesis was technically unsuccessful were excluded.

Results: Over a 10-year period a total of 1067 patients (57% male, mean age 62 ± 16 years) underwent 1164 technically successful pericar-diocentesis procedures. Of these, 561 patients had large volume (≥450 mL) aspirated (mean 750 ± 345 mL aspirated, range 450 – 4300 mL).Patients had a pericardial catheter in place for a mean 2.9 ± 2 days. One patient with pre-existing severe biventricular dysfunction after aspi-ration of 400cc developed hypotension that improved with reversal of sedation, but proceeded to have PEA arrest and die. No other patientdeveloped clinical events of acute left or right heart failure, ventricular dysfunction, unexplained hypotension, cardiogenic shock or other clini-cal events that could relate to PDS.

Conclusion: At most one episode of was observed following technically successful percutaneous pericardiocentesis in 1164 cases (561were large volume) although whether this was due to PDS is unclear. Although PDS has been reported, it appears to be rare, and stagingpericardial decompression over time may be unnecessary, other perhaps than in patients with severe ventricular dysfunction or severe pul-monary hypertension.


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P1380

In the search of heart barometer - advantage of left atrial dimension over electrocardio-graphic indices in the detection of left ventricular hypertrophy in patients with arterial

hypertensionNowak B.; Nowakowski R.; Gapys A.; Trzos E.; Kurpesa M.; Lipiec P.; Kasprzak JD.; Cieslik-Guerra U.; Uznanska-Loch B.; Wierzbowska-Drabik K.

Medical University of Lodz, Lodz, Poland

Introduction: Left ventricular hypertrophy (LVH) is a common complication of HA. Despite the known limitations of the ECG criteria of LVH,these parameters are routinely used in clinical practice.

Purpose: We assessed the relationship between the electrocardiographic indices of LVH, left atrial dimension (LA) with left ventricularmass index (LVMI) calculated from transthoracic echocardiography (TTE).

Methods: The study included the group of 88 patients: 61 with HA and 27 without HA, 61 males, the average age 59.75 ± 18.6, sinus rhythmin 76, AF in 12, HR 71 ± 16/min, hospitalised in Cardiology Department. In the whole group 12-lead electrocardiogram and TTE were per-formed. We assessed: Sokolov-Lyon index (SLI), Cornell Voltage Criteria (CV), Cornell Product (CP) and Romhilt-Estes Point Score System(RES). The ECG-derived parameters were correlated with TTE data.

Results: According to LVMI 57 (64%) patients were diagnosed LVH. 11 patients (12.5%) fulfilled LVH criteria of according to SLI, 8 (9%) toCV, 12 (13.6%) to CP and 23 (26%) to RES. Among ECG-LVH indicators SLI showed the strongest correlation with LVMI (r = 0.37, p = 0.0008), whereas CV and IC revealed solely positive trend with accordingly r = 0.28, p = 0.0112 and r = 0.25, p = 0.0279. The strongest corre-lation with LVMI was found for the LA dimension r = 0.73, p < 0.0001. In the multivariate analysis, the LA was the only independent predictorof the increased LVMI with R²=0.52, p < 0.0001.

Conclusions: Among the tested ECG–LVH criteria, the strongest correlation with the LVMI was shown for Sokolov-Lyon index, however inthe multivariate analysis the only independent predictor of left ventricular hypertrophy was TTE-derived antero-posterior left atrial dimension.

Characteristic of groups

Parameter HAn = 61

Controln = 27

p

Age (years) 69 ± 10.7 40 ± 18.9 <0.0001Males, n (%) 44 (72%) 17 (63%) <0.0001BMI, kg/m² 29.4 ± 3.8 24.5 ± 4.0 <0.0001HR 71.1 ± 18.8 70 ± 11.8 <0.0001AF, n (%) 12 (20%) 0 (0%) <0.0001LVEF (%) 50 ± 11.1 59.1 ± 14.7 <0.0001LVMI, g/m² 158 ± 29.1 101 ± 43.3 0.0002LA (mm) 45 ± 6.7 31 ± 7.1 <0.0001

AF-Atrial Fibrillation; BMI- Body Mass Index; DM- Diabetes Mellitus; HR- Heart Rate; LA- Left Atrium; LVEF- LeftVentricular Ejection Fraction; LVMI- Left Ventricular Mass Index;Abstract P1380 Figure. Comparison of methods


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P1383

Analysis of right ventricular function by iso-volumetric relaxation time using echocar-diography

Stoebe S.; Fuertig C.; Pfeiffer D.; Laufs U.; Hagendorff A.

University of Leipzig, Department of Cardiology/Angiology, Leipzig, Germany

Purpose: The analysis of the right ventricle (RV) and RV function using echocardiography is still challenging and data about the RV isovolu-metric relaxation time (IVRT) are lacking. The purpose of the present study was to compare the RV and left ventricular IVRT in healthy sub-jects and in patients with RV pressure/volume overload.

Materials and methods: In 57 patients (age 64 ± 16; 20 males) with RV pressure/volume overload, LV eccentricity-index (LV-EI), collapse-index of the inferior vena cava (VC-CI), RV length/transversal diameter/tricuspid annulus diameter were assessed. For IVRT assessmentadditional 4-chamber views with positioning of the tissue Doppler imaging (TDI) sample volume in the basal lateral and inferoseptal (LV IVRT= average value of both regions) and basal region of the free RV wall (=RV IVRT) were documented. According to LV-EI (ratio LV transversaland LV longitudinal diameter at end-diastole and end-systole in the parasternal short axis view) and VC-CI these patients were divided intofour subcohorts: pressure overload (LV-EI end-diastolic and end-systolic > 1) with compensated (VC-CI > 50%) (n = 11) or decompensatedcondition (VC-CI < 50%) (n = 16) and volume overload (only LV-EI end-diastolic > 1) with compensated (n = 8) or decompensated condition(n = 22). The same parameters were assessed in 34 healthy subjects (=control group, 45 ± 14; 18 males).

Results: In healthy subjects, RV IVRT (32 ± 15ms) was significantly shorter than LV IVRT (69 ± 22ms) and no correlation could be observedbetween RV IVRT and RV length.

According to LV-EI and VC-CI patients (n = 57) could be assigned to: pressure overload, compensated (n = 11, RV IVRT 44 ± 16ms) or de-compensated (n = 16, RV IVRT 78 ± 38ms) and volume overload, compensated (n = 8, RV IVRT 49 ± 19ms) or decompensated (n = 22, RVIVRT 47 ± 28ms).

In all patients with pressure/volume overload RV IVRT was no longer significantly shorter than LV IVRT and was prolonged in comparison toRV IVRT of healthy subjects. In patients with decompensated condition due to pressure overload RV IVRT was considerably prolonged (78 ± 38ms) in comparison to the other 3 subcohorts.

In patients with decompensated RV pressure overload the following correlation could be observed: the shorter the RV length, thelonger the RV IVRT. Generally, the RV transversal and tricuspid annulus diameter were higher in all patients with pressure/volume overloadin comparison to RV diameters of healthy subjects, whereas no significant differences could be observed for RV length. LV-EI seemed to beno appropriate parameter to clearly distinguish between RV pressure or volume overload because end-systolic LV-EI value was also > 1 inpatients with volume overload.

Conclusions: In healthy subjects, RV IVRT is significantly shorter than LV IVRT. An increase of RV IVRT is highly suggestive for RV pres-sure/volume overload. In patients with normal ventricular size, an increase RV IVRT is primarily highly suggestive for RV pressure overload.


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P1385

Echocardiographic features of PAH in congenital heart diseases and in idiopathic PAH

Methia N.1; Latreche S.1; Mehenni O.2; Djouhri M.1; Harbi F.1; Benkhedda S.1

1CHU Mustapha, Cardiology, Algiers, Algeria2Bab El Oued Universitary Hospital Centre, Epidemiology, Algiers, Algeria

Background: Idiopathic PAH (IPAH) and PAH in Congenital heart diseases (PAH-CHD) are severe pre-capillary pulmonary hypertension,with similar physiopathological mechanisms, and benefit from the same therapeutic management. PAH-CHD is the most serious form of con-genital heart disease, but seems to have a better prognosis than IPAH.

Purpose: Compare echocardiographic features of patients with (IPAH) and those with PAH-CHD

Methods: Descriptive study covering 60 patients (28 IPAH and 32 PAH-CHD), followed in a dedicated consultation. IPAH is retained afterperforming all invasive (RH catheterization) and non-invasive explorations. A detailed echocardiographic study was performed.

Results: No difference on age between patients with PAH-CHD and those with IPAH (29.5 ± 7.9 VS 32.4 ± 8.87, P = 0.27). Etiologies found:VSD (60%), Atrioventricular septal defect (23%), ASD (10%), Persistence of the arterial canal (3,33%), Troncusartériosus (3,33%).

Pulmonary pressure level is higher in PAH-CHD group compared to IPAH group with respectively a mean velocity of TR of 5m/s VS 4,5m/s(p = 0.0003), a SPAP of 108 mmHg VS 95,6 mmHg (p = 0,005); RAP 5,8 mmHg VS 9,6 mmHg (p = 0,04); RVOT 16,9 cm VS 8,9 cm (p = 0,000001). Right ventricle is more hypertrophic and less dilated in PAH-CHD group compared to IPAH group with respectively a RV wallthickness 9,5mmVS 8,6 mm (p = 0,004); RA area 19.22 cm2 VS 30.28 cm2 (p = 0.04); RA volume 31,6 ml/m2 VS 52,9 ml/m2 (p = 0.03);RVOT prox diameter 29,6 mm VS 36,14 mm (p = 0,5); basal RV diameter 39,9 mm VS 50,6 mm (0,00001); mid cavity RV diameter 31,3 mmVS 42,3 mm (0,003); IVC 16,6 mm VS 20,6 (0,03). RV function is better in PAH-CHD group than IPAH group, with respectively a TAPSE 19,5mm VS 14 mm (p = 0,00001); S′ velocity 11,5 cm/sec VS 8,9 cm/sec (p = 0,00001); RV2DFAC 38,8 % VS 29,5% (0,004). TR is more severein IPAH group 53, 6% of moderate to severe TR in IPAH group VS 12, 5% in PAH-CHD group.

Conclusion: RV remodeling is different between the 2 groups. The RV function is generally better in patients with PAH-CHD, most likelyexplaining the better functional status of these patients.


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P1386

High velocities in coronary arteries during transthoracic echocardiography can predict3-year adverse outcomes

Zagatina A.1; Zhuravskaya N.1; Guseva O.2; Kalinina E.2; Shmatov D.3

1Saint Petersburg State University Clinic of advanced medical technologies, Cardiology, Saint Petersburg, Russian Federation2Northwestern Medical University n.a. I.I. Mechnikov, St. Petersburg, Russian Federation3Saint Petersburg State University Clinic of advanced medical technologies, Cardiosurgery, Saint Petersburg, Russian Federation

Background: Transthoracic visualization of long portions of the three major coronary arteries have previously been described in detail.However, there is a lack of information about the prognostic value of identifying local high velocity in coronary arteries measured duringechocardiography at rest. The aim of the study was to determine the prognostic value of local high flow velocity in the left main (LM), leftanterior descending (LAD) or circumflex (Cx) coronary arteries measured by Doppler method during routine echocardiography.

Methods: In a prospective, single-center study, we evaluated 316 consecutive patients (169 women, 57 ± 13 years old) who underwent rou-tine echocardiography with additional scans for coronary flow to be included in the study. Ninety-eight patients (Group 1) had sites of aliasingflow with a velocity of more than 65 cm/s in the proximal parts, 24 patients (Group 2) had high flow in the middle parts of the arteries. Group3 consisted of 194 patients with normal flow in visualized sites. Eighty-eight patients (28%) had an established diagnosis of CAD beforeechocardiography. Stress-echo and coronary angiography were recommended as a clinical decision. All measurements were obtained off-line blind to other data. Death, nonfatal myocardial infarction (MI), and coronary bypass surgery were defined as major adverse cardiacevents (MACE). The period of follow-up was 3 years.

Results: Over the follow-up period, the ability to contact twenty-six patients (8%) was lost. Deaths occurred more frequently in patients witha high local coronary velocity (6.3% vs. 1.7%; p < 0.04). Patients in Group 1 had the highest rates of cardiac death or MI (18.6% vs. 8.7% vs.1.7%; p < 0.00001 between Group1, 2, 3, respectively). The rates of MACE were 43% vs. 22% vs. 2%; p < 0.0000001.

Conclusion: Patients with local acceleration in LM and/or proximal parts of LAD/Cx observed during non-invasive routine echocardiographyat rest have a serious prognosis for death/MI, >6% per year.



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P1387

Relationship between echocardiography-based and invasive estimates of pulmonaryvascular resistance in left heart disease

Hamade J.1; Abdulrahim H.1; Da Silva C.1; Sequeira C.1; Manouras A.1; Lund LH.2; Kjellstrom B.2; Venkateshvaran A.2

1Karolinska University Hospital, Stockholm, Sweden2Karolinska Institute, Stockholm, Sweden

Funding Acknowledgements: This study was supported by the Swedish association for Pulmonary Hypertension

Introduction. The assessment of pulmonary vascular resistance (PVR) is central to the evaluation of subjects with pulmonary hypertension(PH) secondary to left heart disease (LHD). While numerous echocardiography-based methods to assess PVR have been proposed, a com-parison between multiple methods and gold-standard invasive measurements has not been explored. We aimed to compare 4 previouslyproposed echocardiography-based methods with invasive PVR measurements in subjects with LHD undergoing right heart catheterization(RHC) for evaluation of PH.

Methods. In this prospective study, consecutive subjects referred for RHC due to LHD underwent simultaneous echocardiography. Subjectswith atrial fibrillation or pacemaker therapy were excluded. PVR was assessed by the Abbas (original and revised), Haddad and Scapellatomethods, and associations with invasive PVR were explored.

Results. 119 subjects with left heart were analysed. 45% (n = 53) were women; 50% (n = 59) showcased EF < 50%. During RHC, 58% (n =69) demonstrated a mean pulmonary artery pressure ≥ 25mmHg and 30% (n = 35) demonstrated PVR > 3WU. The Abbas (revised) methoddemonstrated the strongest association with invasive PVR (r = 0.60; p < 0.001) as compared with Haddad (r = 0.55, p < 0.001) and Abbas(original) (r = 0.53, p < 0.001). In contrast, the Scapellato method demonstrated a weak association (r = 0.21, p = 0.02). Greater dispersionwas observed at higher PVR values. On sensitivity analysis, both Abbas (revised) (AUC = 0.78, p < 0.001) and Haddad methods (AUC =0.76, p < 0.001) demonstrated strong ability to identify elevated PVR (>3WU).

Conclusions. In this validation study, previously proposed echocardiographic estimates of PVR demonstrated differential associations withinvasive PVR. The revised method proposed by Abbas and method proposed by Haddad showcased strongest ability to identify elevatedPVR in LHD.


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P1388

New onset diabetes mellitus facilitates aortic stiffening following successful kidneytransplantation

Nemes A.1; Borda B.2; Kormanyos A.2; Kalapos A.1; Domsik P.1; Lazar L.2; Forster T.1

12nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary2University of Szeged, Department of Surgery, Szeged, Hungary

Introduction. New onset diabetes mellitus (NODM) is the serious and frequently observed complications following kidney transplantation(KTX). Kidney transplant recipients who develop NODM is at an increased risk of developing fatal and nonfatal cardiovascular events andother adverse outcome including infection, reduced patient survival, graft rejection and accelerated graft loss. Identification of high-risk pa-tients and implementation of measures to reduce the development of NODM may improve both long-term patient and graft outcome anddecreases the cardiovascular risks. It is known that both chronic kidney failure (CKF) and diabetes mellitus (DM) are associated with in-creased aortic stiffness separately. In the present study it was aimed to examine whether NODM following successful KTX has any additiveeffect on echocardiographic aortic elastic properties.

Methods. The present study comprised of 28 patients with CKF without any history of DM following successful KTX (mean age: 48.2 ± 6.9years, 13 males), from which NODM developed following transplantation. Their results were compared to 26 age- and gender-matched con-trols (53.4 ± 11.5 years, 12 males). All patients and healthy subjects had undergone routine transthoracic echocardiography extended withblood pressure measurement. Echocardiographic aortic elastic properties were calculated from systolic and diastolic aortic diameter andblood pressure data.

Results. Significantly reduced aortic strain (0.057 ± 0.032 vs. 0.092 ± 0.045, p <0.05) and aortic distensibility (1.83 ± 1.18 cm²/dynes 10-6vs. 2.59 ± 1.23 cm²/dynes 10-6, p <0.05) and increased aortic stiffness index (11.2 ± 6.1 vs. 6.7 ± 3.6, p <0.05) could be demonstrated inKTX patients as compared to matched controls. Aortic stiffness index showed further increase in NODM-KTX patients as compared to non-diabetic KTX cases (14.8 ± 7.6 vs. 9.68 ± 4.88, p <0.05).

Conclusion. Increased aortic stiffness could be demonstrated in KTX patients as compared to matched controls. NODM following KTX facil-itates aortic stiffening.


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P1389

Determinants of mitral leaflet size in hypertrophic cardiomyopathy

Chung H.1; Kim JYK2; Min PKM2; Yoon YWY2; Lee BKL2; Hong BKH2; Rim SJR2; Kwon HMK2; Choi EYC2

1Kyunghee University, Cardiology, Seoul, Korea Republic of2Gangnam Severance Hospital, Cardiology department, Seoul, Korea Republic of

Background: Mitral leaflets elongation has been shown to be related to obstructive hypertrophic cardiomyopathy (HCM). However, the de-terminants of mitral leaflet size is controversial.

Purposes: We investigated the determinants of mitral leaflet size in HCM.

Method: We enrolled 149 HCM patient. Among them 54 patients underwent cardiac magnetic resonance imaging (CMR). Anterior mitralleaflet (AML) lengths were measured in parasternal long axis and apical 3 chamber (3CH) views of transthoracic echocardiography and re-peated in age- and sex-matched controls for comparison.

Results: AML of HCM was significantly longer than controls (2.83 ± 0.36 vs. 2.36 ± 0.31 cm in 3CH, p < 0.001). AML-3CH length was signifi-cantly correlated to body surface area (BSA, r = 0.351, p < 0.001), maximal wall thickness (r = 0.208, p = 0.016), left atrial volume (r = 0.250, p = 0.002) in echo, left ventricular (LV) end-diastolic volume (r = 0.436, p = 0.001) and LV mass in CMR (r = 0.373, p = 0.005).

Conclusion: Mitral leaflet elongation is a unique finding of HCM and is related to LV geometry and hemodynamic condition.

Abstract P1389 Figure. Measure of anterior mitral leaflet


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P1390

Myocardial perfusion SPECT defects in patients with MV prolapse

Maroz-Vadalazhskaya N.1; Trisvetova E.1; Vrublevskaya O.2

1Belarusian State Medical University, Minsk, Belarus2Minsk City Diagnostic Centrum, Radiology, Minsk, Belarus

Dipyridamole stress-induced myocardial perfusion defect, which have been clear estimated by technetium SPECT, can be used for classify-ing of patients with subclinical ischemic heart disease. Nevertheless, young patients with atypical chest pain, mitral valve prolapses andmildly depressed ST segment during exercise ECG are still managed as an ischemic patients and have undergone elective coronary angiog-raphy.

Aim: estimation of rest-stress SPECT perfusion defect significance in patients with the prolapse of mitral anterior leaflet and apparently nor-mal coronary arteries.

Methods: twenty-three young (WHO criteria) mens in mean age 33,8 years (20-43) with normal heart chambers size and preserved LVEF0.66 (0.56-0.82) were underwent standard exercise ECG test with non-ischemic ST-T pattern and atypical chest pain. Symptom-limited ECGtest was followed by rest-stress dipyridamole SPECT with technetium. All patients had underwent selective coronaryangiography. The re-sults of myocardial perfusion were analysed separately without knowledge of heart and coronary artery anatomy.

Results: accordingly basal clinical data patients with mitral prolapse 3-9 mm were divided on to two groups: 1-suggested ischemic heartdisease (14 patients, who were admitted to coronary unit because of acute coronary syndrome symptoms), 2- non-ischemic heart disease(myocarditis, arterial hypertension, bicuspid aortic valve with normal pressure gradient, persistent foramen ovale, mitral valve prolap-ses-7pts). Rest perfusion abnormalities in 3,7% (1-9%) of myocardium were revealed in all patients. Severe STRESS perfusion defect wasdetected in 2 patients of group 1 with angiographicaly proven CAD lstenosis. The rest of patients of group 1 and group 2 demonstratedREST perfusion defect from 6% to 10% in inferior or infero-septal wall (65%) and antero-lateral wall (35%), which was related to anteriormitral leaflet prolapses (r = 0.34 p = 0.03 and r = 0.27 p = 0.05). Patients with prolapses and additional transversal and diagonal LV chorddemonstrated more strong link to stress-induced LV perfusion defect (r = 0.37 p = 0.01) in inferoseptal wall. Diastolic radial and longitudinaldeformation was impaired in prolapse patients with odds value for stress perfusion defect 1.4 (CI 1.2-1.7). STRESS distributed defect inpatients of both groups (except ischemic 2 patients of group 1) was not enlarged (p > 0.05).

Conclusion: small REST perfusion defects are common for patients with mitral valve prolapses. Combination of prolapses, additional LVchords and impaired myocardial deformation is positive related to REST and STRESS myocardial hypoperfusion in inferoseptal LV seg-ments. REST-STRESS SPECT can be used for reclassifying of patients for invasive diagnostic strategy with lowering cost of treatment.


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P1393

Oral anticoagulation in patients with atrial fibrillation: the contemporary trends in pri-mary care

Gardezi S K M1; Wilson J.2; Kennedy A.3; Prothero A.3; Myerson SG.2; Prendergast BD.4

1University of Oxford, Radcliffe Department of Medicine, Oxford, United Kingdom2Oxford University Hospitals NHS Trust, Oxford Bomedical Research Centre, Oxford, United Kingdom3Oxford University Hospitals NHS Trust, Oxford, United Kingdom4St Thomas" Hospital, London, United Kingdom

Funding Acknowledgements: National Institute of Health Research (NIHR), Thames Valley Comprehensive Local Research Network,NIHR Oxford Biomedical Research Centre

OnBehalf: OxVALVE Population Cohort Study

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Over 2.2 million Americans and 6 million Europeanssuffer from this arrhythmia. AF confers a 5-fold risk of stroke, and one in five of all strokes is attributed to this arrhythmia. Ischaemic strokesin association with AF are often fatal, and the survivors are left with a disability. Stroke prevention in patients with AF is therefore of para-mount importance. Warfarin (Vitamin-K Antagonist) remains the only recommended oral anticoagulant for use in AF in context of prostheticvalves, rheumatic mitral stenosis and mitral valve repair. Recent ESC guideline update from 2017 advocates the use of novel oral anticoagu-lants (NOACs) for AF patients with concomitant mitral regurgitation, aortic stenosis as well as aortic regurgitation apart from those categor-ised previously as non-valvular AF.

Purpose: The evaluate the trends of oral anticoagulation therapy (OAT) among AF patients in primary care

Methods: Data from 4009 OxVALVE study participants was analysed. All subjects were 65years of age or more, recruited from 7 GP surger-ies between 2009 and 2016. NHS read codes were used to identify patients with known AF. Medical & drug history of AF patients was usedto calculate CHA2DS2VASC score and to ascertain if patients with a score > 2 were on appropriate OAT or not?

Results: 259 subjects were identified with known AF. 205/259 (79.1%) subjects with known AF had a CHA2DS2VASC score of 2 or moreand therefore merited anticoagulation on the basis of current guidelines. Only 100/259 (38.6%) subjects however received appropriate oralanticoagulation therapy. 98/100 (98%) were on Warfarin and only 2/100 (2%) were on NOACs. 75/259 (28.9%) subjects were on Aspirin only.84/259 (32.4%)received neither Aspirin nor Warfarin (Table-1), (Figure-1).

Conclusion: Although a majority of AF patients in primary care were on either OAT or Aspirin monotherapy (67.5%) a significant proportion(32.4%) remain without any formal anticoagulation.

Table-1:OAT among Patients with known AF

CHA2DS2VASC Score of 2 or more 205 (79.1%)On aspirin only 75 (28.9%)On anticoagulants 100 (38.6%)On warfarin 98 (98.0%)On both aspirin and warfarin 5NOACs 2 (2%)Not on aspirin or anticoagulants 84 (32.4%)

NOACs= Novel oral anticoagulants, OAT= Oral anticoagulation therapyAbstract P1393 Figure.


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P1394

Impact of etiology in functional tricuspid regurgitation

Marco Del Castillo A.1; Santoro C.2; Gonzalez Gomez A.1; Monteagudo Ruiz JM.1; Pardo Sanz A.1; Garcia Martin A.1; Jimenez Nacher JJ.1;Moya Mur JL.1; Casas Rojo E.1; Zamorano Gomez JL.1; Fernandez Golfin C.1

1University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain2Federico II University Hospital, Naples, Italy

Background. Tricuspid regurgitation is a known negative prognostic factor, being functional tricuspid regurgitation (FTR) a field under deepevolution for the last few years. However, FTR is the common final pathway of several and heterogeneous entities that entail either RV re-modeling or tricuspid ring enlargement, and it is unclear whether the prognosis is established by the FTR itself or is also influenced by theunderlying cause.

Purpose. To assess the prognostic impact of the various etiologies of FTR. The main endpoints were cardiovascular mortality, hospital ad-mission for congestive heart failure (CHF) and the combination of both.

Methods. During 2013, clinical and echocardiographic data of consecutive patients with previously undiagnosed severe FTR was collected.Etiology was divided into five groups: left valve heart disease (LVHD), left systolic/diastolic dysfunction, type I or III pulmonary hypertension(PHT), idiopathic FTR and lead-related FTR. Patients were followed during 1 year after the initial FTR diagnosis. We used Cox proportionalhazards regression to evaluate the relationship of etiology with cardiovascular mortality and hospital admissions due to decompensatedheart failure.

Results. During 2013, 236 patients with severe FTR were included. Mean age was 79.9 years (SD = 10.2) and 70.2% were women. Etiologydistribution was: LVHD 45.2%, systolic/diastolic dysfunction 17.5%, PHT 18.9%, idiopathic FTR 11.8% and lead-related FTR 6.6%. Meanfollow-up time was 25.9 months (SD = 8.7). During follow-up, sixty-one patients (25.8%) died and eighty-four patients (35.6%) had to undergoin-hospital admission for CHF. A lower hospital admission (p = 0.02, Log-rank) and cardiovascular mortality (p = 0.019, log-rank) rates, aswell as the combined endpoint (p = 0.002, lof-rank) were observed among patients with idiopathic FTR. A Cox regression model for analysisof the combined endpoint was performed. In the initial model, the following variables were included: age, gender, NYHA class at diagnosis,left ventricular ejection fraction (LVEF), pulmonary artery systolic pressure (PASP) and idiopathic FTR etiology. After adjustment for all theaforementioned factors, idiopathic FTR was independently associated with a lower incidence of the combined endpoint (HR 0.28, p = 0.035).PHT-related FTR showed higher mortality (p = 0.008), hospital admission rate (p = 0.028) and combined endpoint rate (p = 0.015, log-rank).However, no significant HR after adjustment for PSAP was found.

Conclusions. In our cohort, severe FTR was associated with high cardiovascular mortality and CHF-related hospital admission rates. How-ever, patients with idiopathic FTR showed better outcomes, and this etiology was independently associated with prognosis.



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P1395

Improvement of endothelial glycocalyx thickness is related with reduced stiffness,wave reflections and arterial blood pressure, after treatment with il-12/23 antagonist, in

psoriasis

Ikonomidis I.1; Varoudi M.2; Papadavid E.3; Makavos G.2; Kostelli G.2; Pavlidis G.4; Triantafyllidi H.2; Kapniari I.3; Theodoropoulos K.3; Vlas-tos D.2; Lekakis J.2; Iliodromitis E.2

1University of Athens, Athens, Greece2National and Kapodistrian University of Athens, Medical School, 2nd Department of Cardiology, Attikon Hospital, Athens, Greece3University of Athens Medical School, Attikon Hospital, 2nd Department of Dermatology & Venereology, Athens, Greece4National and Kapodistrian University of Athens, 4nd Department of Internal Medicine, Athens, Greece

Psoriasis has been associated with an increasing risk for atherosclerosis. The glycocalyx, is an integral component of the endothelial sur-face layer ,composed of glycoconjugates and proteoglycans and an important element in inter- and intracellular communication and tissuehomeostasis.

We investigated whether there was a greater improvement of endothelial glycocalyx aortic elastic properties and vascular function , post -treatment with IL12/23 antagonists , in patients with psoriasis(PS) , compared to treatment with anti-TNFa agents or cyclosporine

Methods: 130 patients (age:50 ± 12 yrs) with psoriasis(PS) (PASI disease activity score:11.5 ± 8) were randomized to receive an anti-TNF-aagent (n = 49),an anti-IL12/23 regimen Ustekinumab , (n = 33) or a combined cyclosporine and methotrexate(n = 48). At baseline and after 4months of treatment, we measured a)the carotid-femoral pulse wave velocity (Complior-PWVc) and augmentation index (AIx) and brachialsystolic blood pressure (SBP) b) perfused boundary region(PBR) of the sublingual arterial microvessels(ranged from 5-25μm) using Side-view Darkfield imaging(Microscan, Glycocheck). Increased PBR is considered an accurate index of reduced endothelial glucocalyx thicknessbecause of a deeper RBC penetration in the glycocalyx. Forty normal subjects (N) served as controls Risk factors age and sex were similarbetween the treatment groups

Results: At baseline patients with psoriasis had higher(PBR) ( 5-25μm) (2.12 ± 0.27 vs. 1.77 ± 0.3), SBP (135 ± 20 vs. 120 ± 10 mmHg),PWV (11 ± 2.4 vs. 9.9 ± 5.1 m/sec) and AIx, (28.3 ± 37 vs. 23.5 ± 16%) than normals (p < 0.05 for all comparison) Four months post-treat-ment, patient, treated with anti-IL12/23 regimen showed a significant improvement of (PBR) ( 5-25μm) (2.13 ± 0.37 vs. 2.09 ± 0.31, p = 0.03) compared to patients treated with anti-TNFa agents (2.14 ± 0.23 vs.2.11 ± 0.27) or those treated with non-biological drugs (PBR)( 5-25μm) (2.04 ± 0.3 vs.1.97 ± 0.34) who showed a small non-significant reduction of PBR (p > 0.05). Risk factors age and sex were similarbetween the treatment groups. Post-treatment improved (PBR) (5-25μm) and (PBR) ( 5-9μm) were associated with lower brachial systolic(r = 0.31 and r = 0.28 ) and diastolic brachial blood pressure (r = 0.20 and r = 0.22) as well as reduced PWV (r = 0.19 and r = 0.167) and Aix(r = 0.17 and r = 0.28 ) (p < 0.05 for all associations) in all patients.

Conclusion: Improvement of endothelial glycocalyx post-treatment is associated with reduced arterial blood pressure ,stiffness and wavereflection. Treatment with IL-12/23 antagonist appears to have a greater effect on endothelial glycocalyx than treatment with anti-TNF an-tagonists or cyclosporine/methotrexate in psoriasis


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P1396

Renal and carotid resistive indexes : the same matter with different layout?Cabac Pogorevici I.; Revenco V.

State University of Medicine and Pharmacy, Cardiology, Chisinau, Moldova Republic of

AIM: The resistive index is a surrogate hemodynamic parameter that is easily determined by Doppler sonography and basically reflects vas-cular resistance of the arterial vascular bed. The aim of our study is to asses the potential interrelationship of resistive indexes determined indifferent sites of the arterial tree (renal and carotid arteries) and its correlation with target organ damage in hypertensive patients.

METHODS: Our study included 84 patients (40 females and 44 males, mean age 42.26 ± 11.2 years) with grade I-III arterial hypertension.All subjects underwent careful clinical history and physical examination to reveal risk factors, cardiovascular history and treatments. Bloodtest, echocardiography, renal Doppler to rule-out renal artery stenosis and estimate the renal resistive index (RRI) and carotid Doppler ultra-sound to calculate the carotid intimamedia wall thickness (IMT) and resistance index of both common carotid arteries (CRI) were performed.

RESULTS: The mean RRI was 0.685 ± 0.092, the mean CRI was 0.81 ± 0.07, the mean IMT was 1.18 ± 0.28, the mean 24 hours systolicblood pressure (SBP) was 142.2 ± 15.8 mmHg, mean 24 hours diastolic blood pressure (DBP) was 77.1 ± 22.4 mmHg. The mean pulse pres-sure (PP) was 59.10 ± 22.90 mmHg. The mean 24 hours heart rate (HR) was 75.14 ± 26.86 beats/minute. RRI was negatively related tomean 24 hours DBP (r = -0.339), HR (r=-0.326) while it was positively associated with mean 24 hours SBP (r = 0.659), ambulatory PP (r =0.366), age (r = 0.253), left ventricular mass (LVM) (r = 0.459) and relative wall thickness (RWT) (r = 0.493), carotid IMT (r = 0.81) and CRI (r = 0.51). Meanwhile CRI was possitively correlated with 24 hours SBP (r = 0.44), 24 hours DBP (r = 0.15), LVM (r = 0.127), RWT (r = 0.311),carotid IMT (r = 0,672) and a negative correlation was found between CRI and HR (r=-0.389). In multiple regression analysis, it was revealedan important interconnection between IRR, IRC and IMT, as well the fact that mean 24 hours SBP, LVM, RWT and carotid IMT were maindeterminants of RRI and CRI.

CONCLUSIONS: The correlation between the resisitive indexes in the renal an carotid arterial beds emphasize the interconnection betweenthe systemic hemodynamics systemic atherosclerotic burden, target organ damage and the intrarenal circulation, suggesting that the centralhemodynamic factors significantly influence the intrarenal arterial patterns.


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P1397

Does orthostatic unload test is able to predict syncope in patients with severe aorticstenosis

Kleczynski P.; Dimitrow PP.; Dziewierz A.; Rakowski T.; Surdacki A.; Dudek D.

Institute of Cardiology, Jagiellonian University, Krakow, Poland

Aim: We aimed to assess effects of orthostatic stress test on changes in carotid and vertebral artery blood flow and its association withsyncope in patients with severe AS.

Methods: We enrolled 108 patients (72 with and 36 patients without syncope) with severe isolated severe AS. Peak systolic blood-flow ve-locity (PSV) and end-diastolic velocity in the carotid arteries and vertebral arteries were measured by duplex ultrasound in the supine posi-tion and at 1–2 min after the assumption of the standing position.

Results: The orthostatic stress test induced a significant decrease in carotid and vertebral arterial flow velocities in all examined arteries (P < 0.001). The median (IQR) of mean change in PSV for carotid arteries was higher for patients with syncope [syncope (-) vs. syncope (+):-0.6 cm/s (-1.8, 1.0) vs. -7.3 cm/s (-9.5, -2.0); P < 0.001] and similarly for vertebral arteries - [-0.5 cm/s (-2.0, 0.5) vs. -4.8 cm/s (-6.5, -1.3); P < 0.001, respectively]. Age, aortic valve area, and mean change in PSV for carotid arteries were independently associated with syncope. Inhealthy controls the velocities in carotid and vertebral arterial flow has been unchanged after maneuver reducing preload.

Conclusion: In patients with AS, a decrease in carotid and vertebral arterial flow velocities in the standing position was observed and wasassociated with syncope. Our findings may support the value of orthostatic test in identifying patients with severe AS prone to syncope.


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P1398

Utility of the superb micro-vascular imaging for assessment of intraplaque neovascula-rization in patients with symptomatic carotid stenosis

Sato W.1; Iino T.1; Nanjo H.2; Shimizu H.3; Watanabe H.1

1Akita University Graduate School of Medicine, Cardiovascular Medicine, Akita, Japan2Akita University Hospital, Division of Clinical Pathology, Akita, Japan3Akita University Graduate School of Medicine, Neurosurgery, Akita, Japan

Funding Acknowledgements: Canon Medical Systems

Background: Intraplaque neovascularization is involved in the progression and rupture of atherosclerotic lesions. Visualization of arterialwall vascularization (AWV) is informative in assessing the instability of atherosclerotic plaques but is challenging. A new ultrasound image-processing technique (superb micro-vascular imaging [SMI]) allows the detection of extremely low-velocity flows without contrast medium.We examined the availability of SMI for the assessment AWV in the carotid plaque.

Methods & Results: This study included eight patients with established symptomatic and severe carotid stenosis who underwent carotid en-darterectomy. Visualized AWVs by SMI were compared with the histopathological findings.

In five of eight patients, preoperative ultrasonography with SMI revealed intraplaque neovascularization at the plaque shoulder. Histopatholo-gy showed that all plaques were vulnerable and confirmed the neovessels in the plaque shoulder corresponding to the four patients withAWV.

Ultrasonography with SMI had a sensitivity of 100%, specificity of 92%, positive predictive value of 80%, and a negative predictive value of100% for diagnosis of AWV. On the ultrasonography with SMI, a false positive finding is caused by motion artifact, and a false negative find-ing is attributed by intraplaque hemorrhage. The diameter of minimum neovessel detected by SMI was 250 micrometers.

Conclusion: SMI allows visualization of the intraplaque neovascularization as a feature of vulnerability in the carotid plaque. SMI has poten-tial as an alternative to contrast-enhanced ultrasound for assessing AWV.

Abstract P1398 Figure. AWV by SMI and histopathology


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P1399

Resting pulmonary pressure cosine curve analysis correlates closely with peak exer-cise pressures in pulmonary hypertension

Tossavainen E.1; Henein MY.1; Eriksson R.2; Wiklund U.3; Lindqvist P.1

1Heart Centre, Umea, Sweden2Surgery and perioperative Sciences, Clinical Physiology, Umeå, Sweden3Umea University, Biomedical engineering and informatics, Umea, Sweden

Funding Acknowledgements: Swedish Heart and Lung foundation

Background: Pulmonary hypertension (PH), irrespective of its etiology, is a known cause for adverse clinical outcome. Right ventricular(RV) dysfunction is an important consequence of PH and itself contributes to clinical deterioration and valve dysfunction. Exercise and in-crease in heart rate are usually associated with accentuated pulmonary pressures with their further impact on RV function. The aim of thisstudy was to evaluate the accuracy of resting RV pressure curve (Pmaxest) measurements in predicting peak exercise pressures (Pmax-exe).

Methods: Thirty patients who underwent right heart catheterization (median age 68 years, range 28-84, 22 females) were included in thisstudy. Ten-second recordings of RV pressure curves were obtained and digitized from paper and cosine curves were fitted based on seg-ments around the maximum derivatives for each beat. For predicting peak pulmonary pressure, the mean of three maximum pressures val-ues were used (Pmaxest). End-systolic elastance (Ees) was calculated as (Pmaxest -mPAPrhc)/SVtermo). Arterial elastance (Ea) wasmeasured as mPAPrhc/SVtermo. RV-PA coupling was calculated as Ees/Ea.

Results: A strong relationship was found between the maximal Pmaxest and Pmaxexe (r2 = 0.85, p < 0.001), figure 1. Pmaxest, Ees and Eawere all higher (p < 0.05 for all) in patients with PH compared to non-PH but Ees/Ea (p = 0.71) was not different.

Conclusion: This study shows that peak RV exercise pressure can accurately be estimated from maximum resting pressure curves. Largersample studies are needed to revalidate these findings in patients with different severity of heart failure.

Abstract P1399 Figure. Fig 1


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P1400

The additional value of cardiopulmonary exercise testing over conventional treadmilltesting in patients with moderate to severe aortic stenosis.

Badiani S.1; Van Zalen J.2; Hart L.2; Topham A.2; Armado K.1; Hoare D.1; Monteiro R.1; Althunayyan A.1; Al-Borikan S.1; Marshall A.2; Bhatta-charyya S.1; Patel N.2; Lloyd G.1

1Barts Health NHS Trust, London, United Kingdom2Eastbourne District General Hospital, Eastbourne, United Kingdom

Introduction: Current guidelines recommend aortic valve replacement in patients with apparently asymptomatic

severe aortic stenosis, who exhibit symptoms or a decrease in blood pressure on exercise testing.

However, the additional information provided by cardiopulmonary exercise testing (CPET) is limited.

This study sought to establish the additional information provided by CPET in this context.

Methods: An analysis of patients with moderate to severe aortic stenosis undergoing CPET in an enhanced valve

surveillance clinic was performed. Symptom limited cardiopulmonary exercise testing with

respiratory gas exchange analysis was used, and the patients were encouraged to

exercise until exhaustion.

Results: 71 patients with moderate to severe aortic stenosis and good left ventricular function (AVVmax 4 ±0.5m/s, MG 38 ± 11mmHg, AVA0.9 ± 0.2cm2, LVEF 60 ± 8%)were included in the analysis. The mean age was 74.2 ± 12.1 years and 51 patients (70.4%) were male. 33patients had a background of hypertension, 12 had diabetes mellitus and 8 coronary artery disease. All patients denied cardiovascular symp-toms at baseline. A total of 119 CPETs were performed. All patients exercised to respiratory exchange ratio (RER) >1.1 indicating good ef-fort.

26 patients (37%) exhibited a peak VO2 <84% predicted. 11 patients (15.5%) developed breathlessness

on exertion, 7 (9.9%) exhibited a fall in blood pressure below baseline and 3 (4.2%) developed ST

depression. 18 patients (25.3%) had a peak VO2 <84% predicted, but without symptoms, fall in blood pressure or ST depression. There wasa significant positive correlation between peak VO2 and aortic valve area (r= 0.24, p = 0.047), but not between peak VO2 and trans-aorticvelocity (r= 0.117, p = 0.339) or peak VO2 and mean gradient (r = 0.139, p = 0.256).

Over a median follow up time of 8 months (IQR 4 to 28 months), 28 patients (39%) were referred for ao

aortic valve intervention and there were 3 deaths.

Logistic regression showed that aortic valve area and peak VO2 were

not significant predictors for cardiovascular events.

Conclusion: Our data demonstrates that a significant proportion of patients with apparently

asymptomatic aortic stenosis exhibit exercise limitation as measured by peak VO2.

Cardiopulmonary exercise testing may provide incremental objective evidence of early deterioration,

over and above parameters obtained from conventional treadmill testing, as suggested by the current guidelines.


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P1402

Ultrasound vascular indexes improve the prediction of coronary revascularization inpatients scheduled for elective coronary angiography

Balys M.; Haberka M.; Szostak-Janiak K.; Maciejewski L.; Matla M.; Gasior Z.

School of Health Sciences, Medical University of Silesia, Cardiology, Katowice, Poland

The utility of clinical cardiovascular (CV) risk factors to predict coronary artery revascularization (CAR) is limited. Therefore our aim wasto evaluate the association between ultrasound vascular indexes, carotid artery stenosis (CAS) and percutaneous or surgical CAR in pa-tients scheduled for coronary angiography (CA).

Methods: Patients with high and very high CV risk scheduled for their first elective CA were enrolled into the study (n = 325 pts; age: 61 ± 7.3 years; males 65%). Several clinical CV risk factors and the following ultrasound indexes were obtained before the CA: carotid intima-media thickness (IMT), carotid extra-media thickness (EMT), epicardial fat thickness (EFT), visceral abdominal fat (ABD) and combined in-dex PATIMA. The Periarterial Adipose Tissue Intima Media Adventitia (PATIMA) calculated as PATIMA[u] = (EMT/BMI x 35) + IMT + (EFT x60) represents different tissue components of the arterial wall.

Results: The study patients had several CV risk factors, including: arterial hypertension (100%) and dyslipidemia (100%), obesity (49%) ordiabetes (37%). Most individuals (72%) had coronary artery disease (³50% stenosis in CA) with similar rates of one, two, or three-vesseldisease. Percutaneous or surgical CAR was performed in 158 patients (48%). Patients CAR(+) had significantly increased CAS (37.7 ± 19 vs31 ± 18%, p = 0.03), IMT (987 ± 525 vs 865 ± 237µm, p = 0.007) and PATIMA 2176 ± 563 vs 1990 ± 404u, p = 0.0008) compared to CAR(-)individuals with no differences in other vascular indexes. The ROC analysis revealed that the number of CV risk factors and ABD index arenot predicitive for CAR (p = ns). Other vascular indexes (IMT, EMT, EFT and PATIMA) showed similar prediction for CAR (AUC = 0,600-0,626) with PATIMA showing the greatest AUC (0,630; SE = 0,031), 70% sensitivity and 52% specificity (PATIMA = 1947u).

Conclusions: Ultrasound vascular indexes (especially CAS, carotid IMT and PATIMA) improve the prediction of coronary revascularizationin patients scheduled for elective CA.


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P1403

Integrated cardio-pulmonary ultrasound - A simple tool to rule out early post-procedur-al complication in cardiac pacing

Atenska-Pawlowska J.1; Syska P.1; Maciag A.1; Zajac D.1; Andruszkiewicz P.2; Pytkowski M.1; Szwed H.1; Lewandowski M.1

1Institute of Cardiology, 2nd Department of Coronary Artery Disease, Warsaw, Poland2Independent Public Central Clinical Hospital, Warsaw, Poland

Funding Acknowledgements: The authors have not received any form of financial contributions to this work and have no other conflicts ofinterest to report.

Background

The rapid development of cardiac implantable electronic devices (CIEDs) therapy causes a growing number of post-procedural complica-tions. The most common of them are lead-related complications and iatrogenic pneumothorax. Lung ultrasound (LUS) has evolved as apromising imaging technique for diagnosis of pneumothorax. Adding LUS to conventional echocardiography allows performing an integratedcardiopulmonary ultrasound exam. This method is most widely used in emergency medicine but seems barely known to cardiologist.

Purpose

The aim of this study was to prospectively examine the accuracy of integrated cardiopulmonary ultrasound in diagnostic work-up of patientsafter CIED implantation.

Methods

The study was conducted over a period of 10 months in a tertiary referral cardiac centre. A total of 86 patients after CIEDs implantation orup-grade as well as following elective lead revision was included into the study. Within 24 hours after the procedure sonographic lung andheart examination was performed in addition to routinely conducted chest X-ray (CXR). Sonographic results were compared with radio-graphic ones as the reference standard. Standard echo sector transducer was sufficient for performing LUS examinations in most cases,rarely a linear probe was used additionally in case of pure visualisation of pleura. The scans were taken in a supine patient from the 2nd to4th intercostal spaces in the mid-clavicular line medially and laterally. The probe was placed perpendicular to the chest wall between theribs. The sonographic images of both lungs were compared with the transducer placed at the same level. The rule-in criteria for pneumothor-ax were : presence of lung point, absence of lung sliding and lung pulse. The rule-out criteria were: presence of lung sliding or of B-lines,presence of lung pulse. During the same exam, using the same machine and probe, an echocardiogram was performed to evaluate the leadposition and seeking signs suggesting perforation such as pericardial effusion and its dynamics as well as extracardiac or deep intramuscu-lar lead location.

Results

In two out of the 86 patients (2.3%) a post-interventional pneumothorax was observed in CXR as well as clinically. Using CXR as a goldstandard, a sensitivity of 100% (2/2), a specificity of 100% (84/84) were calculated for LUS in exclusion of post-interventional pneumothoraxafter CIED procedure. In 4 of 86 patients (4.6%) heart perforation or deep intramuscular lead position with pericardial effusion requiring pro-longed follow-up was diagnosed on the basis of echocardiography.

Conclusion

The integrated cardio-pulmonary ultrasound is a non-invasive, radiation-free, single-probe, all-in-one method allowing immediate bed-sideexclusion of early post-interventional complications following CIED implantation. In our study this user-friendly and easy-to-use techniqueproofed to be as effective and accurate as CXR for exclusion of pneumothorax.

Abstract P1403 Figure. LUS - normal versus pathological.


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P1404

Intrarenal venous flow demodulation and right ventricle-to-pulmonary circulation un-coupling in acute respiratory failure

Bianchi Bosisio NSM1; Raimondi Cominesi D.1; Dei Poli M.1; Resta MV.1; Labate V.2; Bandera F.2; Guazzi M.2

1IRCCS, Policlinico San Donato, General Intensive Care Unit, San Donato Milanese, Italy2IRCCS, Policlinico San Donato, University Cardiology Department , San Donato Milanese, Italy

Background: Intrarenal venous flow (IRVF) patterns strongly correlate with clinical outcome in heart failure (HF). Discontinuous IRVF is as-sociated with poorer prognosis compared to physiological continuous pattern, reflecting a greater degree of hemodynamic congestion.

Purpose: We aimed at studying IRVF in patients with acute respiratory failure (ARF), looking at the pathophysiological role of right ventricle(RV) to pulmonary circulation (PC) uncoupling in affecting normal IRVF.

Methods: Patients admitted with ARF due to primary lung disease (LD) or acute HF were considered. 32 patients (47% LD and 53% HF;age 74 ±9 years; male 53%) have been evaluated by echocardiography, lung ultrasound (US), renal parenchymal Doppler US and biochemi-cal profile in the first 24 hours from admission.

Results: Discontinuous IRVF was observed in 9 out of 32 (28%), 4 of LD group and 5 of HF group. Table 1 reports the main features accord-ing with IRVF patterns.

Discussion: The TAPSE/PASP ratio (fig. 1), a simple index of RV-PC coupling, was significantly lower in patients with non-continuous pat-tern (0,34 ± 0,11 vs 0,47 ± 0,17, p = 0.034), as well as inferior vena cava collapsibility was impaired. NTproBNP and lung US congestionshowed a statistical trend consistent with worse degree of hemodynamic congestion.

Conclusions: In the setting of ARF, of both pulmonary and cardiac origin, the prevalence of abnormal IRVF is relatively high and associatedwith signs of greater hemodynamic congestion. The RV-PC uncoupling seems to play a central pathophysiological role in mediating renalfluid overload responsible of cardio-renal syndrome.

Table 1

Continuous IRVF(n = 9)

Non-continuousIRVF(n = 23)

p Value

Age, yrs 74 ± 10 76 ± 9 0.711TAPSE, mm 16,6 ± 4,3 14,1 ± 3,8 0.133PASP, mmHg 41 ± 16 42 ± 8 0.711TAPSE/PASP, mm/mmHg 0,47 ± 0,17 0,34 ± 0,11 0.034Cardiac index, l/min/ms 2,44 ± 0,76 2,30 ± 0,97 0.651Ejection fraction, % 45 ± 14 40 ± 18 0.379IVC collapsibility, % 44 ± 27 18 ± 11 0.015Lung US congestion, % 4 11 /Renal RI 0,72 ± 0,09 0,67 ± 0,15 0.198NT-pro-BNP, pg/ml 6807 ± 11343 7276 ± 5458 0.078Serum creatinine, mg/dl 1,55 ± 1,14 1,09 ± 0,61 0.198BUN, mg/dl 86 ± 53 66 ± 36 0.321

Population features categorized by IRVF pattern.Abstract P1404 Figure. Fig.1 TAPSE/PASP in different IRVF


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P1405

Very low doses of bisphenol A enhance doxorubicin related cardiotoxicity by stimulat-ing release of proinflammatory interleukins, oxidative stress and lipid peroxidation in

cardiomyocytesQuagliariello V.; Coppola C.; Piscopo G.; Botti G.; Maurea C.; Maurea N.

National Cancer Institute G. Pascale, Naples, Italy

Background: Endocrine disruptors are exogenous substances that interfere with the synthesis, secretion, transport, binding to receptors,action or elimination of natural human hormones; most of these are xenoestrogens or antiandrogens. Recent biological and epidemiologicalstudies correlate endocrine disruptors exposure with obesity, Metabolic Syndrome (MS) , type 2 diabetes and cancer There is growing evi-dence regarding an association between Bisphenol A (BPA) exposure, hypertension, and cardiovascular diseases (CVD). If BPA exposure isindeed associated with raised blood pressure and CVD, it would be a major public health problem but there is a lack of information aboutpossible role of very low doses of BPA during chemotherapy on cardiomyocytes viability.

Purpose: This study was performed to evaluate, for the first time, the biological effects of very low doses of BPA in combination to Doxorubi-cin (DOXO) in cardiomyocytes in order to assess if exposure to endocrine disruptors could increase anthracyclines-dependent cardiotoxicitywith particular attention on the cardiac microenvironment changes.

Methods: H9C2 cells were incubated with very low doses, corresponding to 0.0020, 0.020, 0.20, or 2.0 μM BPA alone or in combinationwith DOXO at 20 µM. Cell viability was evaluated by using a modified MTT method. At the same concentration, the levels of lipid peroxida-tion products (MDA and 4-HNA), interleukins involved in cardiotoxicity (IL-6, IL-8, IL-1β), IL-10, tumour necrosis factor-alpha (TNF-α), nitricoxide (NO) were analyzed using ELISA method according to the instructions of the manufacturer.

Results: A significant additional cardiotoxicity (of around 30-40 % ; p < 0,01), increases in oxidative stress (through oversynthesis of 28% forboth MDA and 4-HNA) and cardiomyocytes release of IL-6, IL-8, IL-1β and TNF-α of around 20- 43 % were observed in cardiomyocytes co-exposed to BPA ( at very low doses) and DOXO, compared to only DOXO exposed cells indicating pro-inflammatory properties of endocrinedisruptors also at very low dose.

Conclusions: The current study demonstrates for the first time the effects of increased cardiotoxicity of very low doses of BPA in DOXO-induced cardiotoxicity. The dose chosen in this study can be considered a ‘very low dose" because estimates of circulating levels of BPA atthe LOAEL define an equivalent low-dose concentration as <2.19 × 10−7 M in vitro culture studies. Collectively, these data indicate that en-docrine disruptors exposure, well associated to cardiovascular risk factors like MS, to cardiomyocytes during DOXO treatments increasecardiotoxicity in significant manner via increasing oxidative lipid damage, NO and cytokines release. These results places interesting biologi-cal evidences for stimulate preventive strategies to limit environmental exposure to endocrine disruptors in cancer patients, also in order todecrease cardiotoxicity during anthracyclines treatments.


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P1406

Development of mixed reality interactive visualization for three-dimensional echocar-diography

Pawlowski J.1; Janc K.1; Kaczor U.1; Kaminski J.1; Kasprzak JI.1; Kierepka M.1; Machura B.1; Witowski J.1; Zebrowski D.1; Wdowiak-OkrojekK.2; Lipiec P.2; Peruga JZ.2; Krecki R.2; Kasprzak JD.2

1MedApp SA, Krakow, Poland2Medical University of Lodz, Lodz, Poland

Aim.Use of three-dimensional (3D) information for optimal understanding of complex anatomy and reliable quantification has become a pre-ferred standard in cardiac imaging. However, displaying 3D information on standard computer monitors limits access to important content.We report on development of innovative technology for navigating 3D echo datasets displayed in HoloLens - mixed reality head-mountedwireless device.

Methods. In initial stage, clinical collection of transthoracic and transesophageal 3D echo datasets converted to Carthesian DICOM hasbeen used to test the feasibility of mixed reality: head-mounted device overlying holographic image of cardiac data onto real-world viewingby operator. Later, the option of live streaming of 3D echo data was explored.

Results. We developed a dedicated software pathway for files conversion, real-time Wi-Fi streaming of 3D rendering from PC to device andmanipulation of spatial data including multiuser interface for data sharing. This custom software proved successful for advanced visualizationof 3D echo (also CT, 3DRA, MR), allowing volume rendering with advanced postprocessing. All 3D echo datasets were successfully conver-ted and displayed in mixed reality as a holographic image. The quality of visualization was diagnostic without content loss in >90% of data-sets as judged by operator, based on datasets with valve disease, congenital disease/percutaneous occluder and cardiac masses. Volume-rendered and maximum intensity views were successfully tested.

Later, raw 3D echo data stream in native resolution was transferred resulting in successful HoloLens display with 80 ms delay interpretationof stream in average. This culminated in successful, first-in-man test of real-time augmented reality display during percutaneous ballooncommissurotomy. Navigation in dataset was accessible via hand gestures and voice commands, including 3D manipulation (translation, rota-tion, scale) and volume cropping. Touchless user interface for head-mounted display was practical for use in interventional theatre withoutcompromising sterility. Figure shows the idea of mixed reality interactive visualization of intraprocedural 3D echocardiography.

Conclusions. Mixed reality display using head-mounted device is feasible and shows promise for fully volumetric, intuitive display and navi-gation in spatial datasets obtained with routine three-dimensional echocardiography. First-in-man experience with mixed reality, voice-con-trolled display of real-time 3D echo data using touchless visualization control proved feasibility in interventional scenario. Cooperation of GEHealthcare teams Poland and Horten, Norway is to be gratefully acknowledged - credits to Gunnar Hansen, Eigil Samset, Katarzyna Ols-zowska-Pawluczuk, and Tomasz Ogonowski. Computer demonstration is planned as a presentation add-on.

Abstract P1406 Figure. 3D echo mixed reality display at PMC


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P1407

Cognitive trajectory following trans-catheter aortic valve implantationTurani M.; Apor A.; Varga A.; Suhai F.; Szilveszter B.; Bartykowszki A.; Papp R.; Karady J.; Kolossvary M.; Jermendy A.; Veress B.; PanajotuA.; Merkely B.; Maurovich-Horvat P.; Nagy AI.

Semmelweis University, Heart and Vascular Centre, Budapest, Hungary

Funding Acknowledgements: János Bolyai Scholarship of the Hungarian Academy of Sciences

Background.Trans-catheter aortic valve replacement (TAVR) has emerged as an efficient therapeutic alternative to open heart surgery. Al-though originally restricted to patients with very high operative risk by today the indication area of TAVR has expanded towards younger andmoderate-risk patients. Neurological injury is a frequent complication of cardiac surgery that may contribute to cognitive decline. It is wellknown that TAVR is associated with a high risk of silent cerebral embolic events. It remains unclear to which extent and how these affect thecognition of patients in the short and the long run.

Purpose.The aim of the current study was to assess the short and long-term effects of TAVR on cognitive performance, to relate cognitivechanges to brain MRI findings as well as to identify potential influenceable determinants of cognitive decline.

Methods. Patients were included from the prospective arm of the Rule out Transcatheter AorticValve Thrombosis with Post-implantationComputed Tomography (RETORIC), NCT02826200 study, ongoing in the Heart and Vascular Center, Budapest. Global cognitive functionand specific cognitive domains were assessed using Mini Mental State Examination (MMSE) and Addenbrooke’s Cognitive Examination(ACE). Tests were performed before (within 24 hours), after (within 3 days), at 6 months and 1 year following the procedure. After the inter-vention and at the 6 months follow-up all patients underwent brain MRI including diffusion tensior imaging (DTI) to identify potential new is-chemic lesions.

Results.As of May 2018, 109 patients have been included in the study (median age: 80 years [53-95], women: 43%), of them 6 months re-sults were available in 56, 1 year results in 14 patients. Global cognitive performance of the patients showed a mild but statistically significantimprovement following intervention (ACE score 71.3 ± 13.2 vs 73.5 ± 13.07 p = 0.04), driven by significant increase in anterograde memo-ry (13,9 ± 6.5 vs 16.1 ± 6.8 p = 0.001) and language skills (19.2 ± 2.5 vs 25.9 ± 2.9 p = 0.03) scores. More importantly this improvement wasmaintained even at the one year visit (ACE score 71.3 ± 13.2 vs 77.1 ±11.5, p = 0.03). Novel lacunar cerebral lesions were detected in 88%of the subjects. When classifying the patients according to the crude number of cerebral lesions, similar peri-operative cognitive trajectorywas observed in all groups (delta ACE: 4.5 ± 6.0, 0.7 ± 7.9 and 3.5 ± 6.5 in patients with no, <10 or ≥10 new ischaemic lesions; p > 0.05 in allcases).

Conclusion.Our initial results indicate no short or long-term cognitive decline following TAVI, despite the high prevalence of peri-operativelydeveloped novel lacunar cerebral lesions.


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P1409

Cardioprotective effects of nanoemulsions loaded with anti-inflammatory nutraceuti-cals against doxorubicin-induced cardiotoxicity

Quagliariello V.1; Coppola C.1; Vecchione R.2; Piscopo G.1; Iaffaioli RV.1; Botti G.1; Netti PA.2; Maurea F.1; Maurea N.1

1National Cancer Institute G. Pascale, Naples, Italy2Center for Advanced Biomaterials for Health Care@CRIB, Istituto Italiano di Tecnologia, Naples, Italy

Doxorubicin is a highly active antineoplastic agent but its clinical use is limited for its well known cardiotoxicity. Nutraceuticals with anti-in-flammatory properties could have cardioprotective activities so potentially used in cardio-oncology management but their pharmacokineticprofile is generally not-sufficient. Nanomedicine offer a new pharmacological tool able to increase bioavailability and protect natural bioac-tives with anti-inflammatory and cardioprotective properties. Combinatorial strategies based on nutraceuticals associated to doxorubicin areproposed in this study. We tested bioavailable nanoemulsions loaded with nutraceuticals (fresh and dry tomato extracts, rich in lycopene,and curcumin) with anti-inflammatory properties, against doxorubicin-induced cardiotoxicity in cardiomyocytes (H9C2 cells). Nanoemulsionswere produced by using a high-pressure homogenizer. H9C2 cells were incubated with nanoemulsions loaded with different nutraceuticalsalone or in combination with Doxorubicin. Cell viability was evaluated by using a modified MTT method. The levels of lipid peroxidation prod-ucts (MDA and 4-HNA), interleukins involved in cardiotoxicity (IL-6, IL-8, IL-1β), IL-10, tumour necrosis factor-alpha (TNF-α), nitric oxide(NO) were also analyzed. Nanoemulsions showed an homogeneous dimension in time with an overall hydrodynamic size of around 100 nm.A marked cell viability enhancement of around 35-40 % compared to only Doxorubicin-treated cells (p < 0,01) and protection against oxida-tive stress was evident through reduction of lipid peroxidation (MDA and 4-HNA) in cardiomyocytes pretreated with nanoemulsions in combi-nation with doxorubicin. Cardioprotective effects of nutraceuticals-loaded nanoemulsions were also 25% and 32 % higher compared to theACE inhibitor Enalapril and the adrenergic blocking agent Carvedilol, respectively. Moreover, nanoemulsions ameliorated the cardiomyo-cytes release of IL-6, IL-8, IL-1β, TNF-α and NO of around 37 and 53 %, respectively and increased IL-10 production of 25-27 % comparedto un-pretreated cells (p < 0,05 for all) indicating anti-inflammatory properties. Based on all biological parameters analyzed, lycopene richnanoemulsions showed always the best cardioprotective profile. In conclusion, this study demonstrate, for the first time, the cardioprotectiveeffects of different nanoemulsions loaded with nutraceuticals against doxorubicin-induced cardiotoxicity through multiple pathways. Theseresults places interesting biological evidences for subsequent studies in preclinical models.


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P1410

Feasibility, accuracy and clinical influence of pocket-sized imaging of the carotid arter-ies performed by non-experts in patients with ischemic stroke or transitory ischemic

attack

Saxhaug LM.1; Hjort-Hansen A.1; Hildrum H.2; Holm KI.3; Ellekjaer H.3; Skjetne K.2; Kleinau JO.2; Stoelen S.2; Graven T.2; Dalen H.1

1Norwegian University of Science and Technology, Trondheim, Norway2Levanger Hospital, Department of Medicine and Rehabilitation, Levanger, Norway3St Olavs Hospital, Stroke Unit, Department of Internal Medicine, Trondheim, Norway

Funding Acknowledgements: The Liaison Committee between the Central Norway Regional Health Authority (RHA) and the NorwegianUniversity of Science and Technology (NTNU)

Feasibility, accuracy and clinical influence of pocket-sized imaging of the carotid arteries performed by non-experts in patients with ischemicstroke or transitory ischemic attack

Background/Introduction: Patients with ischemic stroke or transitory ischemic attack (TIA) require carotid stenosis evaluation due to availabil-ity of treatment by endarterectomy.

Purpose: We present the preliminary results of an ongoing study of the accuracy and clinical influence of a pocket-sized imaging device(PSID) for the evaluation of carotid stenosis by non-expert users in patients admitted with suspected ischemic stroke or TIA.

Methods: Two resident doctors in a community hospital and one in a university hospital stroke unit, without experience in ultrasound of thecarotid arteries, received focused training in the use of PSID including a minimum of 30 patients examined prior to inclusion. 60 patientsadmitted with ischemic stroke or TIA, were first examined by one the residents. Reference method was high-end carotid ultrasound per-formed by an expert (HIGH), blinded to PSID findings.

Results: 4 patients had >50% stenosis on HIGH. Three of these were found on PSID, one 50% stenosis was overlooked by PSID. In thiscase the plaque was hypoechogenic and only visualised by colour Doppler. In 67% (40/60) stenosis was considered ruled out by the resi-dent. In the remaining patient’s, evaluation was either inconclusive or a stenosis was suspected. In total, sensitivity and specificity for >50%internal carotid stenosis were 75% and 70% respectively. Sensitivity for >70% stenosis was 100%.

Conclusions: Point-of-care examinations of the carotid arteries by non-experts using PSID after a focused training was feasible, and able toexclude significant stenosis in the majority of patients. It had a moderate sensitivity and specificity for stenosis >50%, but was able to ex-clude all stenoses requiring surgery. This may have major impact on stroke department workflow and logistics.


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p1287 left ventricular mass and volume estimation in aortic

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