echo-Doppler Study Research Articles

The Impact of Extracellular Histones and Absence of Toll-like Receptors on Cardiac Functional and Electrical Disturbances in Mouse Hearts.

In polymicrobial sepsis, the extracellular histones, mainly released from activated neutrophils, significantly contribute to cardiac dysfunction (septic cardiomyopathy), as demonstrated in our previous studies using Echo-Doppler measurements. This study aims to elucidate the roles of extracellular histones and their interactions with Toll-like receptors (TLRs) in cardiac dysfunction. Through ex vivo assessments of ECG, left ventricle (LV) function parameters, and in vivo Echo-Doppler studies in mice perfused with extracellular histones, we aim to provide comprehensive insights into the mechanisms underlying sepsis-induced cardiac dysfunction. Langendorff-perfused hearts from both wild-type and TLR2, TLR3, or TLR4 knockout (KO) mice were examined. Paced mouse hearts were perfused with histones to assess contractility and relaxation. Echo-Doppler studies evaluated cardiac dysfunction after intravenous histone injection. Histone perfusion caused defects in contractility and relaxation, with TLR2 and TLR3 KO mice being partially protected. Specifically, TLR2 KO mice exhibited the greatest reduction in Echo-Doppler abnormalities, while TLR4 KO exacerbated cardiac dysfunction. Among individual histones, H1 induced the most pronounced abnormalities in cardiac function, apoptosis of cardiomyocytes, and LDH release. Our data highlight significant interactions between histones and TLRs, providing insights into histones especially H1 as potential therapeutic targets for septic cardiomyopathy. Further studies are needed to explore specific histone-TLR interactions and their mechanisms.

How is a Doppler echo study in patients with chronic venous insufficiency in category C6?

How is a Doppler echo study in patients with chronic venous insufficiency in category C6?

Right ventricular systolic function and mechanical dyssynchrony in ischemic or non-ischemic dilated cardiomyopathy: A speckle-tracking study.

This study assessed RV dyssynchrony (irrespective to QRS duration) and RV systolic function in non-ischemic dilated cardiomyopathy (NIDCM) versus ischemic dilated cardiomyopathy (IDCM) patients by using different echo-Doppler modalities. Eighty-five cases (48 patients with DCM [whether ischemic or non-ischemic] and 37 age-matched healthy controls) were studied. Conventional echo-Doppler study, tissue Doppler (TDI), and speckle tracking (STE) were carried out to measure LV and RV systolic function. Time-to-peak negative longitudinal strain at the four RV sites were assessed by TDI derived strain and 2D speckle tracking. Patients with DCM (whether ischemic or non-ischemic) had significantly lower fractional area change, RV tricuspid annular systolic velocity (p<.001 for both), tricuspid annular plane systolic excursion (p=.01), RV-GLS whether TDI or 2D derived (p<.001). Twenty-nine patients (60%) showed right intraventricular delay (RV4SD>60ms). The RV-dyssynchrony index was negatively correlated to %FAC (r=-.362, p=.01), RV Sm (r=-.312, p=.04), and 2D-RV GLS (r=-.305, p=.05). Insignificant higher RV-dysynchrony index was detected in NIDCM compared to IDCM group; however, the basal septal segment was significantly delayed in dilated group. More impaired RV systolic function was detected in ischemic group. 2D STE and TDI showed a significant correlation in the assessment of the right-intraventricular delay (p=.001). Right-intraventricular dyssynchrony are detectable in patients with dilated cardiomyopathy (whether ischemic or non-ischemic) with a higher statistically insignificant value in non-ischemic group by using tissue Doppler imaging and 2D speckle tracking. More impairment of the RV systolic function was noticed in the ischemic group. Impaired RV systolic function was associated with right intraventricular delay.

The Incidence and Severity of Pulmonary Hypertension among Patients with Chronic Kidney Disease

Purpose: Chronic kidney disease (CKD) is a major health problem and is closely linked with cardiovascular disease. Pulmonary hypertension (PH) is considered a common comorbidity in CKD patients. This study aimed at assessing the correlation between CKD and pulmonary hypertension.&#x0D; Methodology: This is a retrospective study that recruited 100 Egyptian patients with stage 3 and above Chronic Kidney Disease (CKD) (KDOQI guidelines). The study sample was composed of 100 patients with 60% overall prevalence of PH. Transthoracic echo Doppler study was performed to measure pulmonary artery systolic pressure based on tricuspid jet in the sample.&#x0D; Findings: There was significant association between PH and severity of renal disease. The hemodialysed group showed a higher prevalence of PH with a more severe PH compared to groups not on regular dialysis. The study had provided evidence that PH is a common comorbidity in CKD patients and is directly proportional with the stage and duration of CKD.&#x0D; Recommendations: Pulmonary hypertension should be regularly assessed using echocardiography in CKD patients specially those on regular dialysis.&#x0D;

Role of albumin creatinine ratio in predicting of coronary artery disease

The present study was done to investigate the association between the level of micro albuminuria and the severity of coronary artery disease angiographically. The study is conducted on 70 patients who underwent coronary angiography in many cardiac centres (NHI, PAMCC) in National heart Institute and Arar cardiac centre Saudi Arabia. The population study was divided into 2 groups according to micro albuminuria. Group (I) include 46 patients with angiographic evidence of coronary heart disease and without micro albuminuria. Group (II) include 24 patients with angiographic evidence of coronary heart disease and having micro albuminuria. Patients are subjected to full medical history, through physical examination. 12 lead ECG, fasting blood sugar, Lipid profile, blood urea and serum creatinine levels are obtained. Urinary albumin was measured by Stanbio Total Protein LiquiColor based on the procedure developed by Watanabe et al. Creatinine was measured by creatinine jaffe`reaction.. The ratio of urine albumin to creatinine (ACR) was used to define microalbiminuria .The upper normal limit is 30 mg/g. Conventional Echo Doppler study using (Vivid 7, General Electric-Vingmed) was done to assess EF%. A diagnostic coronary angiogram was performed to assess the severity of CAD according to number of vessels affected and Gensini score estimation. Our study group comprised 70 patients; 56% were men and 44% women; 64% of them were hypertensive, 68% of them were dyslipidemics, 58 of them were smokers, 43% of them were with high BMI and 48% of them have a positive family history of CHD. The mean age was 58.850 ± 11.949 years (ranges from 33 to 81 years). As per Cath Results; 36% CA results were normal, 38% CA results had a one vessel disease and 26% CA results had multivessel disease. For Albumin Creatinine ration 60% had normal results and 40% had abnormal albumin creatinine ratio; of those with high ALB/CR ratio 42% of them had a one vessel disease and 58% of them had multivessel disease. It is also found that micro albuminuria is productive for CAD independently with other risk factors It seems that micro albuminuria increase severity and number of CAD lesions and aggressive treatment of micro albuminuria may beneficial in CAD patients

Double-Inlet Left Ventricle.

Double-inlet left ventricle (DILV) is most frequent among univentricular atrioventricular connections. In DILV, there is a single functioning ventricle, most commonly with left ventricular structure. This chamber receives both atrioventricular valves and is connected to an outlet chamber with morphologic features of the right ventricle. The great vessels are often transposed, and pulmonary stenosis is seen in two-thirds of patients. The anatomy and pathophysiology can be defined by echo-Doppler studies with a rare need for other imaging studies. The management is mostly related to the nature of associated heart defects and the degree of pathophysiological abnormality. When the infants present initially, treatment to address the hemodynamic issues is undertaken. Subsequently, these babies need staged total cavo-pulmonary connection, i.e., the Fontan procedure which is undertaken in three stages; these stages are described in this review. The existence of inter-stage mortality and post-Fontan complications is recognized and was reviewed. The paper concludes that DILV can be successfully diagnosed with echo-Doppler studies and this heart anomaly can be effectively treated with the currently prevailing medical, catheter interventional, and surgical treatment practices.

Mitral Atresia with Normal Aortic Root.

Mitral atresia with normal aortic root is a rare complex congenital heart defect (CHD) and constitute less than 1% of all CHDs. In this anomaly, the mitral valve is atretic, a patent foramen ovale provides egress of the left atrial blood, either a single ventricle or two ventricles with left ventricular hypoplasia are present, and the aortic valve/root are normal by definition. Clinical, roentgenographic and electrocardiographic features are non-distinctive, but echo-Doppler studies are useful in defining the anatomic and pathophysiologic components of this anomaly with rare need for other imaging studies. Treatment consists of addressing the pathophysiology resulting from defect and associated cardiac anomalies at the time of initial presentation, usually in the early infancy. These children eventually require staged total cavo-pulmonary connection (Fontan) in three stages. Discussion of each of these stages were presented. Complications are observed in-between the stages of Fontan surgery and following completion of Fontan procedure. Attempts to monitor for early detection of these complications and promptly addressing the complications are recommended.

Role of Echocardiography in the Diagnosis and Interventional Management of Atrial Septal Defects.

This review centers on the usefulness of echo-Doppler studies in the diagnosis of ostium secundum atrial septal defects (ASDs) and in their management, both in children and adults. Transthoracic echocardiography can easily identify the secundum ASDs and also differentiate secundum ASDs from other kinds of ASDs, such as ostium primum ASD, sinus venosus ASD and coronary sinus ASD, as well as patent foramen ovale. Preliminary selection of patients for device occlusion can be made by transthoracic echocardiograms while final selection is based on transesophageal (TEE) or intracardiac (ICE) echocardiographic studies with optional balloon sizing of ASDs. TEE and ICE are extremely valuable in guiding device implantation and in evaluating the position of the device following its implantation. Echo-Doppler evaluation during follow-up is also useful in documenting improvements in ventricular size and function, in assessing the device position, in detecting residual shunts, and in identifying rare device-related complications. Examples of echo images under each section are presented. The reasons why echo-Doppler is very valuable in diagnosing and managing ASDs are extensively discussed.

Diabetes Is the Strongest Predictor of Limited Exercise Capacity in Chronic Heart Failure and Preserved Ejection Fraction (HFpEF).

Background and AimType 2 diabetes mellitus (T2DM) is a known risk factor in patients with heart failure (HF), but its impact on phenotypic presentations remains unclear. This study aimed to prospectively examine the relationship between T2DM and functional exercise capacity, assessed by the 6-min walk test (6-MWT) in chronic HF.MethodsWe studied 344 chronic patients with HF (mean age 61 ± 10 years, 54% female) in whom clinical, biochemical, and anthropometric data were available and all patients underwent an echo-Doppler study and a 6-MWT on the same day. The 6-MWT distance divided the cohort into; Group I: those who managed ≤ 300 m and Group II: those who managed >300 m. Additionally, left ventricular (LV) ejection fraction (EF), estimated using the modified Simpson's method, classified patients into HF with preserved EF (HFpEF) and HF with reduced EF (HFrEF).ResultsThe results showed that 111/344 (32%) patients had T2DM, who had a higher prevalence of arterial hypertension (p = 0.004), higher waist/hips ratio (p = 0.041), higher creatinine (p = 0.008) and urea (p = 0.003), lower hemoglobin (p = 0.001), and they achieved shorter 6-MWT distance (p < 0.001) compared with those with no T2DM. Patients with limited exercise (<300 m) had higher prevalence of T2DM (p < 0.001), arterial hypertension (p = 0.004), and atrial fibrillation (p = 0.001), higher waist/hips ratio (p = 0.041), higher glucose level (p < 0.001), lower hemoglobin (p < 0.001), larger left atrium (LA) (p = 0.002), lower lateral mitral annular plane systolic excursion (MAPSE) (p = 0.032), septal MAPSE (p < 0.001), and tricuspid annular plane systolic excursion (TAPSE) (p < 0.001), compared with those performing >300 m. In the cohort as a whole, multivariate analysis, T2DM (p < 0.001), low hemoglobin (p = 0.008), atrial fibrillation (p = 0.014), and reduced septal MAPSE (p = 0.021) independently predicted the limited 6-MWT distance.In patients with HFpEF, diabetes [6.083 (2.613–14.160), p < 0.001], atrial fibrillation [6.092 (1.769–20.979), p = 0.002], and septal MAPSE [0.063 (0.027–0.184), p = 0.002], independently predicted the reduced 6-MWT, whereas hemoglobin [0.786 (0.624–0.998), p = 0.049] and TAPSE [0.462 (0.214–0.988), p = 0.041] predicted it in patients with HFrEF.ConclusionPredictors of exercise intolerance in patients with chronic HF differ according to LV systolic function, demonstrated as EF. T2DM seems the most powerful predictor of limited exercise capacity in patients with HFpEF.

C46 A RARE CASE OF LANGERHANS CELLS HISTIOCYTOSIS CARDIO–VASCULAR INVOLVMENT

Abstract A 54–year–old woman presented at our department for clinical follow–up. She was affected by hypertension, hypercholesterolemia, diabetes insipidus and autoimmune hypotiroidism in substitutive therapy. She had chronic coronary syndrome treated by medical therapy after unsuccessfull left anterior descending artery percutaneous revascularization and underwent to left common iliac artery stenting. The echo–doppler study showed a thickening of both common and internal carotid. Moreover, the patients underwent a skin biopsy of nodular, purple lesions which showed a xanthomatous infiltration suggestive of Langherans cell histiocytosis (CD1A+ e S100+). A subsequent PET–TC total body demonstrated a FDG uptake tissue around the great vessels and a focal increased uptake in the proximal thirds of the left tibia and in the distal thirds of fibula. The patient underwent to a new skin biopsy which confirmed histiocytosis (S100+, langherin+, CD1a+, BRAFV600E negative) and to a negative bone biopsy. Since the diagnosis of histiocytosis was confirmed the association of mercaptopurine and steroid therapy was started. In our department we performed a follow–up echocardiography which showed normal left and right ventricle dimensions and a good bi–ventricular function (LVEF according to Simpson 55% and FAC 50%) and surprisingly a focal right atrial wall thinckening of 3 mm. Therefore, the cardiac MRI showed no oedema in triple T2, no late gadolinium enhancement inIR–GRE T1 and at the posteriori wall of the right ventricle a focal thickening of 2.3 x 2.4 cm of increased intensity and a disomogenous enhancement after contrast agent administration (Figure 1); the same non stenotic tissue was showed along the aortic arch and the discending aorta (Figure 2). The MRI characteristic of these cardio–vascular lesions are consistent with the diagnosis of Langeran’s cells histiocytosis.

Echocardiography: an overview - part I

This review describes principles of echocardiography and Doppler, outlines the techniques of echo-Doppler studies, presents methods of assessment of pressure in the pulmonary artery, reviews methodology for appraisal of ventricular function, and demonstrates the usefulness of echo in evaluating multiple neonatal issues including distressed neonate, infant of a diabetic mother, tracheo-esophageal fistula, Down syndrome, and cardiomegaly.

Value of troponin T as a screening test of cardiac structure and function in chronic kidney disease

Background: Cardiovascular disease starts early in the course of chronic kidney disease (CKD) and is the leading cause of death in patients with end-stage renal disease. Since high-sensitivity cardiac troponin T (hs-cTnT) can detect much lower levels of myocardial injury than conventional assays, it may be useful for studying the earliest stages of heart disease in patients with CKD.Objective: To evaluate the association of circulating hs-cTnT with LV structural and functional abnormalities detected by echocardiography among dialysis dependent and non-dialysis dependent CKD patients.Methods: This study was conducted on 107 subjects divided into three groups.Group I consisted of CKD patients on conservative treatment (n=42), Group II: hemodialysis patients (n=42), Group III: control group: age and sex matched healthy volunteers (n=23). All subjects were subjected to clinical examination, biochemical evaluation including estimation of hs-cTnT and Echo-Doppler study of cardiac structure and function.Results: There was a significant increase in LAV (p&lt;0.01), LVM (p&lt;0.01) in both patient groups compared to the control group. Mitral annular plane systolic excursion (MAPSE) was significantly decreased in both patient groups compared to the control group (p&lt;0.01, p&lt;0.05) and in group I compared to group II (p&lt;0.05) with a significant decrease in S velocity in group I compared to groups II and III (p&lt;0.01). There was a significant decrease in Vp (p&lt;0.01) with a significant increase in AEF (p&lt;0.01) in both patients’ groups compared to the control group and AEF was significantly increased in group II compared to group I (p&lt;0.01). Ea velocity and Ea/Aa decreased significantly (p&lt;0.01) with significant increase in Aa velocity (p&lt;0.05, p&lt;0.01), E/Ea (p&lt;0.01) and E/Vp (p&lt;0.05) in both patient groups compared to the control group. There was a significant increase in hs-cTnT levels in both patient groups compared to the control group (P&lt;0.01). We found a positive correlation between hs-cTnT levels and LAV (r=0.291, p&lt;0.03), IVST (r=0.374, p&lt;0.004), PWT (r=0.309, p&lt;0.02), LVM (r=0.282, p&lt;0.03), A wave velocity (r=0.271, p&lt;0.04), E/Ea (r=0.506, p&lt;0.0001), PCWP (r=.507, p&lt; 0.0001) and a negative correlation between hs-cTnT and MAPSE (r=-0.300, p&lt;0.02), S wave velocity (r= -0.259, p&lt;0.05), Ea (r=-626, p&lt;0.0001), Ea/Aa (r=-0.543, p&lt;0.0001). Troponin at the cut-off value of &gt;5 ng/L, revealed 100% sensitivity and 95% specificity with areas under curve (AUC) of 0.998 and accuracy of 95.65% (P&lt;0.01) for discrimination of Group I vs control group and 76.2% sensitivity and 95.7% specificity with AUC 0.796 and accuracy 71.84% (P&lt;0.01) for discrimination of group II vs control group. Conclusion: Structural and functional cardiac abnormalities are common in CKD patients. Serum hs-cTnT levels increased in CKD patients and was associated with LVH, LAV and some of the echocardiographic parameters of LV systolic and diastolic dysfunction. Our research suggests that hs-cTnT levels may be important for early screening of cardiac structure and function in CKD patients to provide evidence for early intervention.

Value of troponin T as a screening test of cardiac structure and function in chronic kidney disease.

Background: Cardiovascular disease starts early in the course of chronic kidney disease (CKD) and is the leading cause of death in patients with end-stage renal disease. Since high-sensitivity cardiac troponin T (hs-cTnT) can detect much lower levels of myocardial injury than conventional assays, it may be useful for studying the earliest stages of heart disease in patients with CKD.Objective: To evaluate the association of circulating hs-cTnT with LV structural and functional abnormalities detected by echocardiography among dialysis dependent and non-dialysis dependent CKD patients.Methods: This study was conducted on 107 subjects divided into three groups.Group I consisted of CKD patients on conservative treatment (n = 42), Group II: hemodialysis patients (n = 42), Group III: control group: age and sex matched healthy volunteers (n = 23). All subjects were subjected to clinical examination, biochemical evaluation including estimation of hs-cTnT and Echo-Doppler study of cardiac structure and function.Results: There was a significant increase in LAV (p < 0.01), LVM (p < 0.01) in both patient groups compared to the control group. Mitral annular plane systolic excursion (MAPSE) was significantly decreased in both patient groups compared to the control group (p < 0.01, p < 0.05) and in group I compared to group II (p < 0.05) with a significant decrease in S velocity in group I compared to groups II and III (p < 0.01). There was a significant decrease in Vp (p < 0.01) with a significant increase in AEF (p < 0.01) in both patients’ groups compared to the control group and AEF was significantly increased in group II compared to group I (p < 0.01). Ea velocity and Ea/Aa decreased significantly (p < 0.01) with significant increase in Aa velocity (p < 0.05, p < 0.01), E/Ea (p < 0.01) and E/Vp (p < 0.05) in both patient groups compared to the control group.There was a significant increase in hs-cTnT levels in both patient groups compared to the control group (P < 0.01). We found a positive correlation between hs-cTnT levels and LAV (r = 0.291, p < 0.03), IVST (r = 0.374, p < 0.004), PWT (r = 0.309, p < 0.02), LVM (r = 0.282, p < 0.03), A wave velocity (r = 0.271, p < 0.04), E/Ea (r = 0.506, p < 0.0001), PCWP (r = .507, p < 0.0001) and a negative correlation between hs-cTnT and MAPSE (r = − 0.300, p < 0.02), S wave velocity (r = − 0.259, p < 0.05), Ea (r = − 626, p < 0.0001), Ea/Aa (r = − 0.543, p < 0.0001).Troponin at the cut-off value of >5 ng/L, revealed 100% sensitivity and 95% specificity with areas under curve (AUC) of 0.998 and accuracy of 95.65% (P < 0.01) for discrimination of Group I vs control group and 76.2% sensitivity and 95.7% specificity with AUC 0.796 and accuracy 71.84% (P < 0.01) for discrimination of group II vs control group.Conclusion: Structural and functional cardiac abnormalities are common in CKD patients. Serum hs-cTnT levels increased in CKD patients and was associated with LVH, LAV and some of the echocardiographic parameters of LV systolic and diastolic dysfunction.Our research suggests that hs-cTnT levels may be important for early screening of cardiac structure and function in CKD patients to provide evidence for early intervention.

Assessment of the Relationship between Reperfusion Success and T-peak to T-end Interval in Patients with ST Elevation Myocardial Infarction Treated with Percutaneous Coronary Intervention or Pharmacoinvasive Therapy

Background: Acute coronary syndrome encompasses unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). STEMI is mostly caused by coronary artery occlusion which treated either by fibrinolytic therapy or primary percutaneous coronary intervention (pPCI). The aim of this work was to investigate the relationship between therapeutic plasma exchange (TPE) interval and successful perfusion in patients with STEMI treated with pPCI or pharmaco-invasive therapy.&#x0D; Methods: This cohort prospective study was carried out on 60 patients admitted to cardiology department in Tanta University Hospitals with STEMI. All patients were subjected to full medical history taking, clinical examination, laboratory investigations, electrocardiography, transthoracic echo Doppler study, coronary angiography, follow up for early outcome during hospital stay and late outcome after 3 months and assessment of thrombolysis in myocardial infarction (TIMI) flow.&#x0D; Results: There was a statistically non-significant difference regarding age, gender, hypertension and diabetes between both groups. Regarding vessel affected, in group I, there were 20% with RCA lesion, 46.7% with LAD lesion and 33.3% with LCX lesion while in group II there were 30% with RCA lesion, 43.3% with LAD lesion, 20% with LCX lesion and 6.7% was LM with statistically non-significant difference between the groups. In comparison TPE preprocedural and TPE post-procedural in successful PCI group, there was statistically highly significant difference with P value 0.001. While comparing TPE preprocedural and TPE Postprocedural in failed PCI group, there was statistically non-significant difference with P value =0.09. ROC curve analysis was done to pick up the best cut off value of TPE at admission for prediction of Pharmaco-invasive group which revealed TPE at admission more than 104.5 with sensitivity 73.3% and specificity 63.3%. Area under the curve 0.725 with 95% CI ranged from 0.596 to 0.854.&#x0D; Conclusions: The present study demonstrated that prolonged TPE interval is associated with ischemia and thus shortened TPE could be used as a marker for reperfusion success. TPE prolongation also associated with poor prognosis in patients with STEMI

Echocardiography in the Diagnosis and Management of Tricuspid Atresia

This review focuses on the utility of echocardiographic studies in the diagnosis of tricuspid atresia (TA) and in its management. Tricuspid atresia is a cyanotic congenital heart defect (CHD) accounting for nearly 1.5% of all CHDs. It is generally classified according to the morphology of the atretic tricuspid valve and associated heart defects. Following the description of the anatomic features of TA, echocardiographic features characteristic for TA were illustrated. Subsequent to a review of palliative and corrective procedures to treat TA, echocardiographic evaluation at each stage of Fontan was detailed. The role of echocardiography in the assessment of cardiac defects responsible for interstage mortality was also addressed. It was concluded that echo-Doppler studies are useful in the diagnosis and management of TA.

How predict right ventricular-pulmonary circulation coupling improvement in chronic heart failure

Abstract Background Right ventricular-pulmonary circulation coupling (RVPAC), which can be measured by the relation between tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) by echocardiography, has been postulated as an independent prognostic factor of hospitalizations and mortality in heart failure (HF) patients. Purpose Our aim was to know the predictors of RVPAC improvement in a chronic HF cohort. Methods Retrospective analysis of a prospectively studied cohort of HF outpatients of different aetiologies attended in a multidisciplinary HF Unit. Prospectively scheduled echo-Doppler studies were performed at first visit and 1 year. A TAPSE/SPAP ratio &amp;lt;0.36 mm/mmHg was identified as the most deleterious. Significant RVPAC improvement at 1 year was defined as TAPSE/SPAP ratio ≥0.36 mm/mmHg together with a ≥10% improvement from baseline RVPAC. Multivariable logistic regression analysis (conditional backward stepwise) was performed to select variables independently associated with significant RVPAC improvement. A predictive model including age and the previously selected variables was created. Results From August 2001 to July 2017, 554 patients with TAPSE and SPAP data in the initial visit were included. Mean follow-up time was 4.6±3.7 years. At first visit 252 (45.5%) patients had RVPAC &amp;lt;0.36 mm/mmHg. Out of them, RVPAC at 1 year improved in 55 (21.8%). In multivariable analysis, the presence of baseline atrial fibrillation/flutter (OR 0.12 [95% CI 0.05–0.28], p&amp;lt;0.001), SPAP (OR 0.96 [95% CI 0.92–0.99], p=0.014) and female gender (OR 0.34 [95% CI 0.12–0.91], p=0.03) were related to lesser probability of RVPAC improvement at 1 year. A model with such variables, together with age, showed an AUC of 0.824 to predict significant RVPAC improvement. Conclusions Atrial fibrillation/flutter, increasing SPAP and female gender hamper RVPAC improvement at 1 year in HF patients with baseline TAPSE/SPAP ratio &amp;lt;0.36. Funding Acknowledgement Type of funding sources: None. Multivariate regression analysis

Echocardiographic comparison between pulmonary valve preservation and transannular patch techniques in children with repaired Tetralogy of Fallot

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Many centers have recently adopted pulmonary valve (PV) preservation procedures to prevent the detrimental long-term effects of chronic pulmonary regurgitation after tetralogy of Fallot (ToF) repair. PURPOSE The aim of our study was to investigate pulmonary valve (PV) and right ventricular function by echocardiography in paediatric patients with repaired Tetralogy of Fallot (ToF), comparing PV preservation surgical strategies to standard transannular patch (TAP) repair. METHODS All patients undergoing transatrial-transpulmonary repair for ToF at our institution between January 2007 and May 2020 were reviewed retrospectively. Patients were divided into 2 main groups, according to the different techniques used: patients undergoing a PV preservation strategy and patients undergoing TAP repair. All patients underwent standard echo-Doppler study including RV end-diastolic area (RVEDA), end-systolic area (RVESA), fractional area change (FAC) and TAPSE; PR was assessed by Color Doppler, continuous-wave (CW) Doppler and derived parameters such as pressure half time (PHT) and pulmonary regurgitation (PR) index. By speckle tracking we measured also, in a subgroup of patients, right atrial strain (RAS), RV and left ventricle (LV) global longitudinal strain (RVGLS, LVGLS) and their time to peak (TTP) values. RESULTS Overall, 82 patients underwent a successful PV preservation strategy while 34 underwent a standard TAP repair. At index surgery, BSA (0.31 ± 0.1 m2, P = 0.3), age (4.8 ± 0.3 months, P = 0.5) and preoperative PV Z-score (-3.20 ± 0.1, P = 0.1) did not different between groups. Five-year actuarial freedom from moderate/severe PV regurgitation was significantly higher in the PV preservation group compared to the TAP (61.3% [95% CI: 48-73%] vs 25.9% [95% CI: 12-43%], respectively; p = 0.02). After adjusting for age, gender, BSA, and type of PV, the use of a TAP was still significantly associated with an increased risk for PV regurgitation at follow up (HR: 1.85, 95% CI: 1.09, 3.15; p = 0.02). At a mean follow-up of 6.9 ± 0.3 years, patients undergoing PV preservation showed an increased right ventricular fractional area change (46.9 ± 0.8% vs 42.5 ± 1.7%, P &amp;lt; 0.001) and tricuspid annular plane systolic excursion (TAPSE) z-score (-3.36 ± 0.3% vs -4.7 ± 0.4%, P = 0.005), while maintaining better PV competence in terms of pulmonary regurgitation index (87.9 ± 1.2% vs 82.7 ± 2.4%, P = 0.02). At speckle tracking subanalysis, patients undergoing PV preservation (n= 23), compared to the TAP group (n = 13) showed also higher values of RAS (37.5 ± 6.0% vs 29.3 ± 8.2% , P &amp;lt; 0.006), shorter right TTP (319 ± 39ms vs 357.5 ± 45.2 ms, P &amp;lt; 0.01) and higher values of LVGLS (-20,6 ± 4,2% vs -17.5 ± 3.0, P &amp;lt; 0.03). CONCLUSIONS Surgical repair of ToF with PV preservation provides excellent outcomes in terms of PV competence and right ventricular function and should be advocated whenever possible. Abstract Figure. Degree of pulmonary regurgitation

Patent Hemostasis Impact in Clinical Routine: Large Monocentric Echo-Doppler Study of Radial Artery Patency After Coronary Catheterization.

Radial access is currently the first line of access in interventional cardiology. Nevertheless, this technique carries a 1%-10% risk of radial artery occlusion (RAO) based on series. We conducted a large-scale echo-Doppler evaluation of radial patency including prospectively all patients who underwent coronary angiography and/or angioplasty with radial catheterization at our center in 2018. A total of 1106 patients were enrolled in the cohort. Average patient age was 70 years, 24.5% were females and 75.5% were males, and 28.3% were diabetics. Five Fr and 6 Fr devices were used in 527 procedures and 565 procedures, respectively. Our study highlighted a very low RAO rate (0.99%). These results are mainly due to the high attention given to patent hemostasis, which was achieved in 1091 patients (98.6%). According to the literature, female gender is a multivariate predictive factor of RAO (P<.01). Furthermore, we confirm the protective nature of heparin (P=.04) with an average heparin dose of 69.73 IU/kg. Our study focused on a large population with 1106 patients who underwent radial catheterization shows that a very low rate of RAO (0.99%) can be achieved. These results are correlated with a high attention to patent hemostasis and a close collaboration between the medical and paramedical staff.

138 Pulmonary valve preservation and transannular patch techniques in children with repaired tetralogy of Fallot; echocardiographic comparison

Abstract Aims To investigate pulmonary valve (PV) and right ventricular function by echocardiography in paediatric patients with repaired Tetralogy of Fallot (ToF), comparing PV preservation surgical strategies to standard transannular patch (TAP) repair. Methods and results All patients undergoing transatrial-transpulmonary repair for ToF at our institution between January 2007 and May 2020 were reviewed retrospectively. Patients were divided into 2 groups, according to the different techniques used (PV preservation strategy vs TAP repair). All patients underwent standard echo-Doppler study including RV areas, fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE); Pulmonary regurgitation (PR) was assessed by Color Doppler, continuous-wave (CW) Doppler, pressure half time (PHT) and PR index. By speckle tracking we measured also, in a subgroup of patients, right atrial strain (RAS), RV and left ventricle (LV) global longitudinal strain (RVGLS, LVGLS) and their time to peak (TTP) values. Eighty-two patients underwent a PV preservation strategy while 34 underwent a standard TAP repair. Five-year actuarial freedom from moderate/severe PV regurgitation was significantly higher in the PV preservation group compared to the TAP (61.3% [95% CI: 48-73%] vs 25.9% [95% CI: 12-43%], respectively; p = 0.02). After adjusting for age, gender, BSA, and type of PV, the use of a TAP was still significantly associated with an increased risk for PV regurgitation at Follow-up (HR: 1.85, 95% CI: 1.09, 3.15; p = 0.02). At a mean follow-up of 6.9 ± 0.3 years, patients undergoing PV preservation showed an increased right ventricular fractional area change (46.9 ± 0.8% vs 42.5 ± 1.7%, P &amp;lt; 0.001) and (TAPSE) z-score (-3.36 ± 0.3% vs -4.7 ± 0.4%, P = 0.005), while maintaining better PV competence in terms of pulmonary regurgitation index (87.9 ± 1.2% vs 82.7 ± 2.4%, P = 0.02). At speckle tracking subanalysis, patients undergoing PV preservation (n = 23), compared to the TAP group (n = 13) showed also higher values of RAS (37.5 ± 6.0% vs 29.3 ± 8.2%, P &amp;lt; 0.006), shorter right TTP (319 ± 39ms vs 357.5 ± 45.2 ms, P &amp;lt; 0.01) and higher values of LVGLS (-20,6 ± 4,2% vs -17.5 ± 3.0, P &amp;lt; 0.03). Conclusion Surgical repair of ToF with PV preservation provides excellent outcomes in terms of PV competence and right ventricular function and should be advocated whenever possible.

Echocardiography and cardiac magnetic resonance in children with repaired tetralogy of fallot and their correlations with exercise capacity

Abstract Background Severe pulmonary regurgitation (PR) and progressive right ventricular (RV) dilation and disfunction are common in patients with repaired Tetralogy of Fallot (r-TOF) and should be carefully monitored during the follow up of these patients. In this contest, Echocardiography and Cardiac Magnetic Resonance (CMR) have a complementary diagnostic role. Purpose To correlate Echo and CMR parameters in children (&amp;lt;18 years) with r-TOF with at least moderate PR assessed by Echocardiography and to analyse which parameter was associated with peak oxygen consumption (Vo2). Methods Paediatric patients with r- TOF with at least moderate PR at the echo evaluation who underwent a CMR study within six months were included by using hospital databases. All patients underwent standard echo-Doppler study including RV end-diastolic area (RVEDA), end-systolic area (RVESA), fractional area change (FAC) and TAPSE; PR was assessed by Color Doppler, continuous-wave (CW) Doppler and derived parameters such as pressure half time (PHT), PR index, ratio of diastolic and systolic time-velocity integrals (DSTVI) of the main pulmonary artery. By speckle tracking we measured also RV global longitudinal strain (RVGLS) and right atrial strain (RAS). All the patients underwent CMR to assess PR and right ventricular volumes and ejection fraction (EF). Of these, 36 patients underwent cardiopulmonary exercise test (CPET). Results Fourty-six children (aged 13.7±3.0 years) were included. Echo derived RV areas correlated significantly with CMR RV volumes (r=0.72, p&amp;lt;0.0001). RVEDA &amp;gt;21.9 cm2/m2 had a good sensitivity (83.3%) and specificity (73.5%) to identify a RV end-diastolic volume (RVEDV) ≥150 ml/m2. No correlation was found among TAPSE, FAC, RVGLS and RVEF calculated by CMR nor between PHT, PR index and DSTVI and PR-RF. Only A' wave velocity showed a significant but modest correlation with CMR RF (r=0.57, p&amp;lt;0.0001). Flow reversal in pulmonary branches showed a sensitivity of 95.8% and a specificity of 59.1% to identify PR RF ≥35%. RVEF by CMR was preserved in all patients, while TAPSE was reduced in 78.2% and RVGLS in 60.8%. None of the CMR parameters correlated with peak Vo2. At the multivariate analysis RAS was the best independent predictor of peak Vo2 (p&amp;lt;0.0001). Conclusion In children, flow reversal in pulmonary branches identifies hemodynamically significant PR at CMR. RV area by echocardiogram is a valid first-line parameter to screen RV dilation. Our study suggests that, also for the RV, there is longitudinal systolic dysfunction in presence of preserved RV EF. RAS is the best predictor of peak Vo2 and should be added in the follow up of these patients. Funding Acknowledgement Type of funding source: None