pm425 a retrospective analysis investigating the yield of transthoracic echocardiogram in patients...

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Introduction: Changes in ratio of E/E` during exercise echocardiography may identifydiastolic dysfunction in patients (pts) who complain of exertional dyspnea.However, the role of exercise E/E`, for the detection of myocardial ischemia, is still an

open question.Objectives: To assess if there is an association between Doppler parameters of left ven-tricular diastolic filling pressure and ischemic wall motion abnormalities (WMA) duringexercise stress echocardiography (ESE).Methods: We studied 75 pts (58 men; mean age 56 years) referred for clinically indicatedESE. In all pts left ventricular filling pressure (E/E`) was estimated from pulsed-waveDoppler measurements of mitral inflow and annular tissue velocities at rest and after bicycleexercise (25W, 3-min increments). ESE identified ischemia by the occurrence of WMA withstress. Before and after ESE, wall motion score index (WMSI) was calculated. Patients wereclassified as having sress induced myocardial ischemia (MI, n¼ 42) or no ischemia (NMI,n¼ 33) on the basis of the development of new WMA during ESE.Results: In NMI group E/E` ratio did not increase during exercise, while in MI group E/E`was significantly higher after ESE compared to baseline values (9,0�0,80 vs 5,2�0,70,P<0.0001). Out of 42 pts with ESE induced myocardial ischemia, in 25 pts (60%) WMSIincreased from the value of 1 at rest up to or equal 1,5 after ESE. In this subgroup of pts E/E` ratio increased from 4,9�0,72 at reast to 8,3�0,82 after ESE, P<0.0001. In 17 pts(40%) WMSI increased from the value of 1 at rest to the value greater than 1,5 after ESE,and the value of E/E` ratio increased from 5,6�0,67 at reast to 10,1�0,77 after ESE,P<0.0001. After ESE, ratio E/E` was higher in the subgroup of pts with WMSI value greaterthan 1,5 than in the subgroup of pts with WMSI value equal or less than 1,5 (P<0.0001).Conclusion: Myocardial ischemia during ESE is associated with an increase in left ven-tricular diastolic filling pressure. Grater increase in E/E` ratio is associated with the presenceof more severe ESE induced myocardial ischemia.Disclosure of Interest: None Declared

PM424

Assessment of Left Ventricular Mechanical Dyssynchrony in Patients with SevereMitral Regurgitation of Rheumatic Etiology

Azza A. M. Farrag*1, Wafaa A. El Aroussy1, Soliman Ghareeb1, Raafat Hasan11Cardiovascular Department, Cairo University, Cairo, Egypt

Introduction: Intraventricular systolic dyssynchrony refers to differences in the timing ofcontraction between the different myocardial segments. It is a common phenomenon inpatients with left ventricular systolic dyssynchrony with or without secondary mitralregurgitation (MR). Very few studies reported mechanical dyssynchrony in patients withprimary mitral regurgitation, but no study was interested in assessing this phenomenon inpatients with severe MR due to rheumatic etiology.Objectives: The aim of this study was to evaluate the phenomenon of mechanical systolicdyssynchrony in patients with primary MR due to rheumatic etiology.Methods: Thirty one female patients (mean age 30.4 � 8 years) with severe MR ofrheumatic etiology, and 15 normal female subjects (mean age 29.7 � 6 years) served as acontrol group were studied by detailed transthoracic echocardiographic examination.Tissue Doppler imaging (TDI) was performed to determine left ventricular systolic dys-synchrony by measuring Ts-SD (SD of time to peak myocardial systolic velocity during theejection period) using the six-basal / six-mid segmental model. In addition, real time 3Dechocardiography (RT3DE) was performed to assess global left ventricular ejection fraction(LVEF) and the systolic dyssynchrony index (SDI).Results: There was no difference between patients and control group as regards LVEF(60.4 � 13.2 vs. 62.8 � 7.7, p ¼ 0.379). Patients had prolonged Ts-SD (43.2 � 10.9 ms)compared to the control group (22.4 � 10.4 ms); p <0.000. By RT3DE, SDI differedsignificantly between patients and controls (2.25 � 2.35 vs. 1.19 � 0.64, p ¼ 0.021).Pearson correlation coefficients showed significant negative correlation between SDI andLVEF (r ¼ -0.532, p ¼ 0.002), and significant positive correlation with left ventricularsystolic volume index (r ¼ 0.553, p ¼ 0.001) in rheumatic patients.Conclusion: This is the first study to document mechanical systolic dyssynchrony inpatients with severe MR due to rheumatic etiology.Disclosure of Interest: None Declared

PM425

A retrospective analysis investigating the yield of Transthoracic Echocardiogram inpatients presenting with falls to a regional tertiary referral center in Australia

Daniel Devenney*1, Ankur Srivastava1, Pathap Hegde11Cardiology, The Wollongong Hospital, Wollongong, Australia

Introduction: In light of our aging population there is an increasing number of patientspresenting to hospital for investigation of syncope/fall. There are indeed well knownstructural cardiac abnormalities that can be confirmed using transthoracic echocardiogra-phy (TTE) that may result in a fall. The European Society of Cardiology recommend, TTEonly when there is previous known heart disease or data suggestive of structural heartdisease or syncope secondary to cardiovascular cause. It appears that it is quite common toperform a TTE as a routine work up for patients presenting with a fall in many instituitions.The evidence is somewhat controversial for using TTE in assessing for the etiology of fallsin the elderly population.Objectives: To assess the the yield of transthoracic echocardiography the this category.Methods: We retrospectively reviewed all TTEs performed over a six month period from1st January 2013 to 30th June 2013. One thousand one hundred TTEs were performed ofwhich, 150 had the indication documented as falls for investigation. We assessed for thefollowing cardiac abnormalities: Severe valvular lesions like AS, AR, MS, MR and HOCMcausing LVOT obstruction, severe left ventricular systolic dysfunction and severe

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pulmonary hypertension as being significant cardiac causes of syncope.All patients had atwo-dimensional and Doppler TTE.Results: We concluded the mean age of the patient cohort was 82 with ages ranging from34 – 98. There were 89 females and 61 males. 1/150 (0.7%) patient had severe AS and 6/150 (4%) patients had severe left ventricular dysfunction (LVD). None of the patients hadother significant echocardiographic abnormality that may result in a fall/ syncope.Conclusion: The population assessed was primarily octogenarian presenting with syncope/fall. TTE is shown to be most feasible when there is proven indication as described bythe European Society of Cardiology or there is high clinical suspicion. We recommend theuse of hand held focused echocardiography in this group of patients rather than a fullformal echocardiography which imposes a burden on the services and increases inpatientstay.Disclosure of Interest: None Declared

PM426

Experimental Validation of Left Ventricular Transmural Strain Gradient withEchocardiographic Velocity Vector Imaging

Chao Yu1, Tiang Gang Zhu*2, Ling Yun Kong11Heart center, Peking University People’ Hospital, Beijing, 2Heart center, Peking UniversityPeople’ Hospital, Beijng, China

Introduction: The myofiber can be divided into three layers，include endomyocardium,mid-wall, and epimyocardium. All three myocardial layers have different mechanicalcontraction, electrophysiologic characteristics and cell types. The latest velocity vectorIimaging(VVI) echocardiography can measure the parameters of three layer respectively.Objectives: To validate transmural strain gradient of endo-, mid-wall, and epimyocardiummeasured by velocity vector imaging (VVI) between healthy subjects and hypertrophiccardiomyopathy (HCM) patients.Methods: 38 healthy subjects and 12 HCM patients were enrolled in this study. By usingVVI automatic analysis software, we calculated radial strain (RS) and all three layers’ lon-gitudinal strain (LS) in apical 4-chamber view, RS and three layers’ circumferential strain(CS) in short-axis view at the level of papillary muscle, and the relevant strain rate (SR),strain gradient.Results: The LS and CS of endo-, mid-wall, and epimyocardium (LSendo, LSmyo, LSepi;CSendo, CSmyo, CSepi) decreased gradually in both healthy subjects and HCM patients(all p<0.001), longitudinal and circumferential SR also have this characteristic (allp<0.01). The strain gradient among the three layers of two set of subjects have no statisticssignificance (all p>0.05). The LS of endo-, mid-wall, epimyocardium and their mean value(LSmean) in healthy subjects are higher than those in HCM patients (all p<0.001). Theejection fraction (EF) of healthy subjects has a significant linear correlation with the RS,LSendo, LSmyo in apical 4-chamber view and RS, CSmyo in short-axis view at the level ofpapillary muscle (p<0.05 or p<0.01).

Conclusion: There is a certain rule in LS and CS gradient, which is inner strain>mid-wall>outer strain, and there is no apparent difference between healthy subjects and HCMpatients. This study demonstrates that LS at three layers and LSmean in healthy subjectswere significantly higher than those in HCM patients. The EF was linearly associated withRS, LSendo, LSmyo and CSmyo, which is something the HCM patients do not have.Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters