Echo Parameters Research Articles

Normal Reference Intervals for Cardiac Dimensions and Function for Use in Echocardiographic Practice: A Guideline from the British Society of Echocardiography

This guideline presents reference limits for use in echocardiographic practice, updating previous guidance from the British Society of Echocardiography. The rationale for change is discussed, in addition to how the reference intervals were defined and the current limitations to their use. The importance of interpretation of echocardiographic parameters within the clinical context is explored, as is grading of abnormality. Each of the following echo parameters are discussed and updated in turn: left ventricular linear dimensions and LV mass; left ventricular volumes; left ventricular ejection fraction; left atrial size; right heart parameters; aortic dimensions; and tissue Doppler imaging. There are several important conceptual changes to the assessment of the heart’s structure and function within this guideline. New terminology for left ventricular function and left atrial size are introduced. The British Society of Echocardiography has advocated a new approach to the assessment of the aortic root, the right heart, and clarified the optimal methodology for assessment of LA size. The British Society of Echocardiography has emphasized a preference to use, where feasible, indexed measures over absolute values for any chamber size.

Sacubitril/valsartan improves right ventricular function in a real-life population of patients with chronic heart failure: The Daunia Heart Failure Registry

BackgroundPrevious studies and case-series showed improvement in left ventricular (LV) function and reverse remodeling after sacubitril/valsartan therapy in real-world studies. We therefore aimed to evaluate whether also right ventricular (RV) function may improve after sacubitril/valsartan therapy. MethodsSixty consecutive patients with chronic heart failure and NYHA class II-III were followed up for 12 months after therapy with sacubitril/valsartan. Left and (RV) function was assessed at baseline and after 12 months of therapy. ResultsAt 12-month control, therapy with sacubitril/valsartan was associated with a significant improvement in a series of echo parameters: LVEF (p < 0.05), LV end-systolic volume (p < 0.01), left atrium area (p < 0.05).Right ventricular echo parameters were also improved after sacubitril/valsartan therapy: PAsP (31.0 ± 12.8 vs 34.7 ± 12.5 mmHg, p < 0.05), TAPSE (17.8 ± 3.9 vs 16.5 ± 4.0 mm, p < 0.001); mean PAsP reduction was 3.7 ± 11.4 mmHg (-6.3 ± 37.7%), mean TAPSE increase 1.3 ± 2.5 mm (+9.5 ± 15.7%).Indexed (%) improvement in PAsP (r 0.33, p < 0.01) and TAPSE (r −0.42, p < 0.01) values were proportional to baseline levels. Improvement in PAsP and TAPSE were independent of left ventricular improvements except for PAsP and end-systolic volumes (r 0.44, p < 0.01). ConclusionsIn a real world scenario, sacubitril/valsartan was associated with an improved RV function.

Echocardiographic parameters, speckle tracking, and brain natriuretic peptide levels as indicators of progression of indeterminate stage to Chagas cardiomyopathy

Chronic Chagas cardiomyopathy (CCM) is characterized by a unique type of cardiac involvement. Few studies have characterized echocardiographic (Echo) transitions from the indeterminate Chagas disease (ChD) form to CCM. The objective of this study was to identify the best cutoffs in multiple Echo parameters, speckle tracking, and N-terminal pro B-type natriuretic peptide (NT-proBNP) to distinguish patients without CCM (stage A) vs patients with myocardial involvement (stages B, C, or D). Cross-sectional study conducted in 273 consecutive patients with different CCM stages. Echo parameters, NT-proBNP, and other clinical variables were measured. Logistic regression models (dichotomized in stage A versus B, C, and D) adjusted for age, sex, body mass index, and NT-proBNP were performed. Left ventricular global longitudinal strain (LV-GLS), mitral flow E velocity, LV mass index, and NT-proBNP identified early changes that differentiated stages A vs B, C, and D. The LV-GLS with a cutoff -20.5% showed the highest performance (AUC 92.99%; accuracy 84.56% and negative predictive value (NPV) 88.82%), which improved when it was additionally adjusted by NT-proBNP with a cutoff -20.0% (AUC 94.30%; accuracy 88.42% and NPV 93.55%). Our findings suggest that Echo parameters and NT-proBNP may be used as diagnostic variables in detecting the onset of myocardial alterations in patients with the indeterminate stage of ChD. LV-GLS was the more accurate measurement regarding stage A differentiation from the stages B, C, and D. Prospective longitudinal studies are needed to validate these findings.

Advanced Sea Surface Target Detection System for Shipborne VHF Radar in Log Periodic Dipole Array Antenna

While navigating in sea target detection is an important problem in modern era communication. In the ocean to detect moving targets and to analyze active variables such as wind, waves and current we can make use of Very High Frequency Ground Wave Radar (VHFGWR). In shipborne VHFGWR the brag spectra widened by Doppler Effect of the ship motion, due to this vessel echo easily merged.An orthogonal projection method to suppress the extended Brag spectra using a log periodic dipole array is proposed in this paper. The advanced technique majorly covers two stages: 1) by utilizing sea echo parameters calculate the approximation of sea clutter in spatial domain and 2) design multi frequency classification Doppler bins method to suppress the extended Brag spectra. After echo suppression, for target detection we can use different algorithms. Simulation result gives a proof that signal- to- clutter noise ratio (SCR) is developed and sea clutter got removed. This method gives very good target detection for shipborne VHF radar.

Efecto pronóstico diferencial de la diabetes mellitus tipo 2 en mujeres y varones con insuficiencia cardiaca y fracción de eyección conservada

Introduction and objectivesType 2 diabetes mellitus (DM2) is a common comorbidity in patients with heart failure (HF) with preserved ejection fraction (HFpEF). Previous studies have shown that diabetic women are at higher risk of developing HF than men. However, the long-term prognosis of diabetic HFpEF patients by sex has not been extensively explored. In this study, we aimed to evaluate the differential impact of DM2 on all-cause mortality in men vs women with HFpEF after admission for acute HF. MethodsWe prospectively included 1019 consecutive HFpEF patients discharged after admission for acute HF in a single tertiary referral hospital. Multivariate Cox regression analysis was used to evaluate the interaction between sex and DM2 regarding the risk of long-term all-cause mortality. Risk estimates were calculated as hazard ratios (HR). ResultsThe mean age of the cohort was 75.6±9.5 years and 609 (59.8%) were women. The proportion of DM2 was similar between sexes (45.1% vs 49.1%, P=.211). At a median (interquartile range) follow-up of 3.6 (1-4-6.8) years, 646 (63.4%) patients died. After adjustment for risk factors, comorbidities, biomarkers, echo parameters and treatment at discharge, multivariate analysis showed a differential prognostic effect of DM2 (P value for interaction=.007). DM2 was associated with a higher risk of all-cause mortality in women (HR, 1.77; 95%CI, 1.41-2.21; P<.001) but not in men (HR, 1.23; 95%CI, 0.94-1.61; P=.127). ConclusionsAfter an episode of acute HF in HFpEF patients, DM2 confers a higher risk of mortality in women. Further studies evaluating the impact of DM2 in women with HFpEF are warranted.Full English text available from:www.revespcardiol.org/en

1160 Which parameters do correlate better with functional exercise capacity in children with repaired Tetralogy of Fallot? An echo and CMR study

Abstract Background Severe pulmonary regurgitation (PR) and progressive right ventricular (RV) disfunction are common in patients with repaired Tetralogy of Fallot (r-TOF), and CMR has become the gold standard for PR and RV volumes assessment. However, in paediatric patients CMR use can be limited by the need for general anaesthesia. Purpose The aim of our study was to analyse a paediatric population (&amp;lt;18 years) of r-TOF with at least moderate PR (regurgitant fraction (RF) &amp;gt;20%), assessed by CMR and to assess which Echo or CMR parameter is associated with functional capacity evaluated by cardiopulmonary exercise test (CPET). Methods Consecutive r-TOF patients regularly followed at our Institution, with at least moderate PR (RF &amp;gt;20% by CMR), were included in the study. Echocardiographic and CMR studies were performed within six months. Echo study: 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. RV end-diastolic area (RVEDA), end-systolic area (RVESA), right ventricle outflow tract (RVOT) end-diastolic area, fractional area change (FAC) and TAPSE were calculated. By speckle tracking analysis we measured also RV global longitudinal strain (RVGLS) and right atrial strain (RAS). CMR study: we evaluated PR as RF, end-diastolic and systolic volumes (RVEDV, RVESV) and right ventricle ejection fraction (RVEF). In addition, patients underwent CPET within one month from CMR and peak oxygen consumption (Vo2) values were measured. Results We studied 53 r-TOF patients (aged 13.8 ± 2.5 years, ranged between 7.1 and 17.6 years, male 57%, surgical repair at a mean age of 1.1 ± 0.75 years). Based on CMR data, 38 out of 53 had free PR (RF &amp;gt;35%) and nobody had &amp;gt; mild tricuspid regurgitation. We found a good correlation between RVEDA and CMR RVEDV (p &amp;lt;0.0001, r =0.73), which slightly improved adding RVOT area (p &amp;lt; 0.0001, r =0.75). RVEDA indexed (RVEDAi) &amp;gt; 21.3 cm2/mq was found to have a good sensitivity (83.3%, specificity 64.9%, AUC0.74) for RVEDV indexed (RVEDVi) &amp;gt;150 ml/mq. No correlation was found between TAPSE, FAC, RVGLS measured by echo and RVEF calculated by CMR. No correlation was found between echo Doppler parameters used to assess PR severity and PR RF measured by CMR. None of the CMR studied parameters (RV volumes, RVEF, RF) correlated with peak Vo2. Among the Echo parameters only RAS demonstrated a good correlation (p &amp;lt;0.0001, r =0.70) with peak Vo2. At the multivariate analysis including RAS, TAPSE, FAC, RVGLS, RVEF and RVEDV, RAS was the best independent predictor of peak Vo2 (p &amp;lt;0.0001). Conclusion Echo parameters studied to assess PR are unsatisfactory and showed no correlation with PR RF by CMR. RVEDAi is well correlated with CMR volumes. Right atrial strain is the best predictor of peak Vo2 in young patients with r-TOF and should be included in their follow up. Abstract 1160 Figure.

Impact of Sacubitril/Valsartan on echo parameters in heart failure patients with reduced ejection fraction. A prospective evaluation

Sacubitril/valsartan has been shown to improve mortality and reduce hospitalizations in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Its effects on left ventricular (LV) remodelling and other echo parameters have not been fully prospectively studied. The aim of this prospective study was to evaluate if sacubitril/valsartan impacts LV remodelling based on echo parameters and identify the predictive factors of response or intolerance. From May 2017 to September 2018, 52 HF patients were prospectively enrolled using Paradigm-HF criteria. Echo evaluation was performed before initiating therapy and 3 months after optimal dose adjustment. Patients with absolute improvement in left ventricular ejection fraction (LVEF) ≥ 5% were considered significant responders. The 52 patients completing the study but the final population comprised 41 pts, as 11 did not tolerate therapy. Under sacubitril/valsartan, several echo parameters significantly improved: LVEF from 32.6 ± 5 to 36 ± 6% ( P < 0.0001); LVES volume from 117 ± 40 to 108 ± 46 mL ( P = 0.0051); LVEDD from 60 ± 4 to 57 ± 5 mm ( P = 0.0002). No significant modifications were observed concerning LV diastolic or RV parameters. Sacubitril/valsartan echo responders ( n = 18/41; 42%) had less severe LV remodelling, indeed LVEDV 144 ± 37 vs. 193 ± 47 mL ( P = 0.0009); LVESV 96 ± 28 vs. 133 ± 42 mL ( P = 0.003); LVTDD: 61 ± 4 vs 57 ± 5 mm ( P = 0.02); significant mitral regurgitation 6/18 (33%) vs. 16/23 (69%) ( P = 0.02); no diastolic LV or RV parameters impacted response. Predictors of intolerance were creatinine level 137 ± 99 vs. 100 ± 24 ( P = 0.03); LVEF 29 ± 6 vs 33 ± 5% ( P = 0.04). In HFrEF patients, sacubitril/valsartan significantly improves LV systolic remodelling. The responders exhibit both less severe LV remodelling and less significant mitral regurgitation. Accordingly, this therapy could be used as soon as possible in order to limit LV remodelling, while precluding non-response or intolerance.

Impact of B-Bloker therapy on right ventricular function in heart failure patients with reduced ejection fraction. A prospective evaluation

ß-Blocker Therapy has been shown to improve mortality and reduce hospitalizations in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Its effects on right ventricular (RV) function have not been prospectively well studied. Objective. The aim of this prospective study was to: – evaluate if ß-Blocker Therapy impacts RV remodelling based on echo parameters; – sought the echo predictive factors of ß-Blocker therapy response. From September 2017 to September 2018, HF patients were prospectively enrolled using CIBIS criteria: Class II, III, or IV HF; left ventricular ejection fraction (LVEF) < 40%; hospitalized for HF within the previous 12 months. Echo evaluation was performed before initiating ß-Blocker therapy and 3 months after optimal dose adjustment. Patients with improvement in LVEF ≥ 5% were considered significant ß-Blocker therapy responders. Forty patients completing the study. The final population comprised 32 pts (79%): 2 did not tolerate ß-Blocker therapy, 1 was lost of follow-up, 5 did not pursue the protocol. Several echo parameters significantly improved: LVEF from 31.7 ± 9 to 40.5 ± 9 ( P < 0.0001); LV end-diastolic volume from 154 ± 54 to 143 ± 45 ml ( P = 0.06); LV end-systolic volume from 107 ± 49 to 88 ± 37 ml ( P = 0.0006); LV ES from 46 ± 11 to 64 ± 13 ml ( P = 0.008), right ventricular size decreased (30 ± 4 vs. 27 ± 5; P = 0.03), right ventricular systolic function improved significantly based on the tricuspid annular plane systolic excursion (16.5 ± 4 vs. 19 ± 4 mm; .0006); tricuspid lateral annular systolic velocity wave (10 ± 2 vs. 11.3 ± 3 cm/s; P = 0.03); and Tei index (0.5 ± .1 vs. 0.46 ± .1; P = 0.04). ß-Blocker echo responders ( n = 23/32; 72%) exhibited the same left and right echo parameters. No echo variables predicted the ß-Blocker response ( Fig. 1 ). In HFrEF patients, ß-Blocker therapy significantly improves LV and RV systolic remodelling.

P1516 Detecting right ventricular systolic dysfunction in patients with acute ST-elevation myocardial infarction: echocardiography is good enough

Abstract Background Many recent years" studies confirm the impact of the right ventricle (RV) dysfunction on morbidity and mortality in patients with an acute ST segment elevation myocardial infarction (STEMI). Earlier echocardiography (Echo) was not accurate enough in detecting RV dysfunction. The newest Echo methods allow to directly and accurately assess the RV systolic function. Purpose The aim of this study was to estimate the frequency of both RV segmental and global dysfunction in patients with STEMI using three-dimensional (3D) Echo and myocardial longitudinal strain (LS). Methods A group of 73 patients with first-time acute STEMI of different localization was selected. A control group of 32 people was formed of healthy individuals. As a standard for determining RV systolic dysfunction, changes in the traditional Echo parameters of the RV were accepted. In our study RV 3D ejection fraction (EF) less than 49% (AUC = 0.88, p &amp;lt; 0.001, sens 73%, spec 78%, PPV 50%, NPV 91%) and RV free wall LS less than 24.5% (AUC = 0.95, p &amp;lt; 0.001, sens 88%, spec 89%, PPV 74%, NPV 96%) best predicted RV involvement in STEMI. RV involvement frequency in STEMI was analyzed in 4 levels: 1 - visual estimation only (RV segmental or global dysfunction); 2 – visually + pathologically changed conventional Echo parameters; 3 – visually + pathological conventional Echo parameters + pathological RV EF and RV LS defined by current guidelines; 4 - visually + pathological conventional Echo parameters + new pathological 3D RV EF and RV LS cut-off levels, defined in our study. Results RV involvement in patients with STEMI was found in 26%, if estimation was only visual (presence of segmental and/or global dysfunction). By adding in algorithm pathologically changed conventional Echo parameters, RV dysfunction was detected already in 36% of cases. New Echo parameters (3D RV EF and RV LS) added 6% more to RV involvement cases, resulting in 42% in total, if current guideline-recommended pathological cut-off levels were used. But the highest number of RV involvement cases - 62%, was reached, if visual evaluation and conventional Echo parameters were combined with 3D RV EF and RV LS, using higher pathology cut-off levels, defined in our study. This number is much closer to the data, provided by cardiac magnetic resonance and autopsy. Conclusion Modern echocardiography can provide greatly improved RV dysfunction diagnostics. In the case of STEMI current echocardiography methods show much closer results to the gold standard – cardiac magnetic resonance imaging and autopsy data, detecting RV involvement in more than 60% cases of acute STEMI.

P932 What is new in the assessment of patients with hereditary hemochromatosis - can 2D speckle tracking echocardiography be helpful in the early detection of heart abnormalities?

Abstract Background Hereditary hemochromatosis (HH) is a very common genetic disease. Abnormally increased intestinal iron absorption and accelerated recycling of iron lead to progressive body iron accumulation and the generation of oxidative stress in tissues. In the late stages iron overload of the heart can lead to the left ventricular (LV) dysfunction. It is believed, that two dimensional speckle tracking echocardiography (2D STE) can evaluate LV dysfunction more accurately and earlier than conventional echocardiography. Evaluation of such assessment was the purpose of this paper. Methods We prospectively enrolled 58 patients with genetically confirmed HH; 29 healthy age- and sex-matched volunteers constituted the control group. Classic echocardiographic and 2D STE parameters (GE VIVID E9, EchoPAC v201) were compared between the groups, additionally correlations between echo and iron turnover parameters were performed. Results The HH patients had all standard echo parameters within the normal range. All 2D STE parameters were significantly worse in HH than in control group (Table 1). We did not find any correlation between echo and iron turnover parameters, whilst significant correlation with the time from diagnosis and the numbers of venesections was noticed. Conclusions Novel 2D STE analyzes seem to be helpful in early detection of heart abnormalities in HH patients. The correlations between the echo and iron indices are weak, allowing to suggest the lack of a "direct" relationship between the iron turnover and myocardial function and that myocardial iron overload is not the only mechanism involved in development of HH cardiomyopathy. HH All n = 58 Controls n = 29 p LAVI (ml/BSA) 31 (23-37) 22 (19-27) &amp;lt;0.001 RWT 0.42 (0.38-0.47) 0.38 (0.34-0.43) &amp;lt;0.003 LVMI (g/BSA) 78 (58-96) 66 (53-72) &amp;lt;0.006 E/Em 7.0 (5.6-8.3) 6.7 (5.0-7.5) 0.071 LVEF (%) 60 (54-62) 63 (61-65) &amp;lt;0.006 LV twist (º) 17.2 (13.1-22.2) 24.1 (19.9-32.1) &amp;lt;0.001 LV torsion (º/cm) 2.2 (1.6-2.9) 3.3 (2.7-4.3) &amp;lt;0.001 LV peak rotation velocity (º/s) 118.0 (88.3-146.3) 140.0 (112.7-168.9) &amp;lt;0.015 LV peak untwisting velocity (º/s) -132.0 (-163.5–93.0) -156.0 (-197.0–122.6) &amp;lt;0.039 Peak systolic longitudinal strain (%) -18.3 (-20.0–16.9) -21.0 (-22.0–19.3) &amp;lt;0.001

P660 Arterial hypertension as confounding factor in the echocardiographic assessment of patients with significant aortic stenosis

Abstract Purpose Increased arterial pressure affects the accuracy of clinical conclusions in a number of cardiac pathologies, including valvulopathies. We investigated the influence of increased blood pressure in the assessment of multiple echo variables in patients with significant aortic stenosis of different physiologies. Methods Seventy two patients (33 women, aged 72 ± 12 years old, EF: 56 ± 9%) with significant aortic stenosis [18 (25%) with low flow low gradient (LFLG) and 7 (10%) with paradoxic LFLG (PLFLG) physiology] and arterial systolic pressure ≥140 mmHg on admission, were assessed with a full 2D and Doppler echocardiographic study including non-invasive assessment of pressure recovery and valvuloarterial impedance (z). Echo study was performed on two occasions during their hospitalization, on admission and after normalization of blood pressure. Arterial pressure was controlled by any therapeutic means at the discretion of the referring physician. Significant serial changes between echo variables were assessed by the Student paired t-test. Results Arterial pressure and heart rate were significantly lowered between the two studies (from 152 ± 13 to 116 ± 11 mmHg and 78 ± 7 to 73 ± 5, p&amp;lt; 0,001 respectively). Differences between the echo variables are depicted in the following table. Conclusions Small but significant changes were noticed in several echo parameters after lowering blood pressure in patients with significant aortic stenosis. These patients should always be assessed after normalization of their blood pressure since the degree of stenosis can be erroneously overestimated and affect clinical decision. p &amp;lt; 0,001 Echo variable 1st study 2nd study Stroke vol index (i) (ml/m2) 37,1 ± 9,5 44,1 ± 10* Mean gradient (mmHg) 42 ± 6,2 44 ± 5,8 * Pressure recovery (mmHg) 8,4 ± 2,5 9,5 ± 2,7* Z (mmHg/mL * m2) 5,4 ± 1,5 3,8 ± 1,1* AVAi (cm2/m2) 0,44 ± 0,06 0,49 ± 0,06*

P277 RV remodeling by echo parameters in endurance and strength sport training

Abstract Introduction With regular and long-term exercises, the heart undergoes changes that are called the adaptation of the heart in response to exercise or physiological changes, which contrasts with the pathological changes caused by hypertension and aortic valve stenosis. However, the exact effects of exercise on the structure and function of the heart depend on the type, intensity and duration of exercise, the amount of physical fitness, inheritance, and gender. Materials and Methods In this prospective clinical trial study, 40 subjects, including 20 in the endurance exercise group and 20 in the exercise group, were evaluated. Echocardiography was performed for all of these subjects before and after the exercises that was performed professionally for 8 weeks under the supervision of the trainer and the changes were recorded. The data were analyzed statistically by SPSS20 software. A significant level of 0.05 was considered. Results The mean ± standard deviation of the age was 20/80 ± 1/42 years. Significant decrease in mean RVSM was observed only in the strength group (P = 0.008). There was no significant difference in the endurance group . There was no significant difference between the two groups before the test in the mean TAPSE (P = 0.46). The mean of TAPSE in the endurance group was 0.22 ± 1.99 and in the strength group was 0.31 ± 1.95. There was no significant difference between the two groups (P 0.46). There was no significant difference between the two groups before the test in the mean E / e (P = 0.51). The mean E / e "in the endurance group was 0.47 ± 4.75 and in the strength group was 0.54 ± 5.50, and there was a significant difference between the two groups (P &amp;lt;0.001). The mean SWDT in the endurance group was 0.12 ± 0.95 and in the strength group was 0.11 ± 1.06, and there was a significant difference between the two groups (P = 0.002). There was a significant increase in mean SWDT in the strength group after the test (P &amp;lt;0.001) .There was a significant increase in mean PAP in the strength group (P = 0.007) . There was a significant increase in mean LV mass index in the strength group (P &amp;lt;0.001),with no significant difference between the two groups in mean FAC. Conclusion It seems that any kind of strength and endurance exercise affects the performance status, however, strength exercises have more effects which causes RV dysfunction. All indexes measured changed within normal level except for PAP that had abnormal changes after endurance exercise .

595 A Single Centre Experience of Septal Myectomy

Septal myectomy remains the gold standard for treatment of severely symptomatic hypertrophic obstructive myopathy (HOCM). A retrospective study was performed to determine the efficacy of septal myectomy in reducing dynamic LVOT obstruction and evaluate the rate of complications associated with the procedure. Retrospective data from cardiac operations performed between 2000-2019 at Dunedin Public Hospital were obtained. Search terms used were septal myectomy and Morrow procedure. Twelve patients underwent septal myectomy between the years 2000-2019 however there was insufficient clinical information for two patients so only ten were included in this study. Out of the ten patients analysed, nine patients had HOCM and one patient had a subaortic membrane. All patients had reductions in LVOT velocities, peak LVOT gradients and septal thickness shown on ECHOs performed within 12 months of surgery. No patients required a permanent pacemaker after the procedure and there were no mortalities 30 days post operatively. All patients had a downgrading of NYHA classification to either II or I. One patient required alcohol septal ablation at 2 years post operatively. Despite only performing a small number of myectomies in the last two decades, complication rates were low and effectiveness, in terms of both symptomatology and ECHO parameters, was found to be high. Septal myectomy should continue to be performed for HOCM patients with severe symptoms that are refractory to medical therapy. It is a safe procedure with measurable improvements in morbidity for patients.

546 Machine-learning based exploration of echocardiographic patterns and clinical parameters to understand their relation to death or transplant in pediatric dilated cardiomyopathy

Abstract Background Pediatric dilated cardiomyopathy (DCM) affects left ventricular (LV) function and carries a high risk of death or heart transplantation. However, the relation of LV regional function and inefficiency to clinical outcomes is underexplored. Purpose The aim of this study was to understand the relationship of regional LV mechanics, global LV function and clinical characteristics to the outcomes of death or heart transplant in children with DCM; through the integration of a vast amount of information enabled by unsupervised machine learning techniques. Methods DCM was defined by a LV end-diastolic dimension z-score &amp;gt; 2 and LV ejection fraction (EF) &amp;lt;55%. Longitudinal strain curves were sampled at 6 LV lateral wall and septal locations from the 4ch apical view. In addition, we analyzed other echo parameters including the aortic outflow pattern as a measure of LV pump function, QRS duration, LV EF, indexed end-diastolic LV dimension, global longitudinal strain and patient characteristics including age, weight, body surface area and medications (diuretics, ACE inhibitor, beta-blockers, mineralocorticoid receptor antagonist, digoxin, inotropes, antiarrhythmics). We used an unsupervised machine learning algorithm (multiple kernel learning) to reduce the dimensionality of these data, and position patients based on similarities. We subsequently used k-means clustering to recover homogeneous groups of patients. We then interpreted the data patterns associated to each of the groups for the occurrence of death or transplant through non-linear regression analysis (multi-scale kernel regression). Results 50 children with DCM (age 0 to 18 years) were analyzed. Clustering on the two first dimensions of the low-dimensional space resulted in three clusters (Figure A), with significantly different proportions of the composite outcome of death or heart transplant (Cl1 = 79%, Cl2 = 50%, Cl3 = 20%; p = 0.01). The group with the highest proportion of death or transplant (cluster 1) comprised the oldest and most frequently medicated subjects, with impaired LVEF and GLS, and with the widest QRS duration (p &amp;lt; 0.01) (Figure B). The group with the second highest proportion of death or transplant (cluster 2) comprised patients with the lowest LVEF (p &amp;lt; 0.01) and GLS (p &amp;lt; 0.001), reduced and delayed peak aortic outflow velocity and severely impaired basal and apical LV strain (Figure C). In contrast, the group with highest transplant-free survival (cluster 3) had the highest LVEF and GLS values, the most synchronous LV contraction as assessed by strain and QRS duration and the highest amplitude and earliest peaking aortic flow. Conclusion Our results serve as a proof-of-concept that machine-learning based approaches can be useful to explore and understand which regional and global echo parameters in combination with clinical parameters are associated with a higher risk of death or transplant in pediatric DCM. Abstract 546 Figure

Predictors of mortality after transcatheter aortic valve implantation

Aim: Transcatheter aortic valve implantation has been used widely as an alternative treatment method for patients with symptomatic aortic stenosis carrying high surgical risk. Despite technological advances and increased experience, its early and late mortality rate is still relatively high and it is important to predict upcoming cardiac events and mortality for the management of patients. In this study, we aimed to investigate the clinical and laboratory parameters affecting mortality after these procedures performed in our clinic. Material and Methods: The patients who underwent TAVI due to severe AS between May 2015 and March 2019 were investigated retrospectively. Demographic, echocardiographic and laboratory data of all patients were recorded. During the follow-up period (mean: 556 days), patients were divided into 2 groups; deceased patients (group 1, n=13) and living patients (group 2, n=34). The data of the patients before TAVI procedure were compared between the two groups.Results: Among demograhic data, the ratio of chronic kidney disease was significantly higher in the deceased group. Among echo parameters, left ventricular ejection fraction was significantly lower and pulmonary artery pressure was significantly higher in the deceased group. Of laboratory parameters, blood urea nitrogen and creatinine levels were significantly higher and toral protein levels were significantly lower in the deceased group. Additionally, leukocyte, uric acid, CRP and CRP/albumin ratio were significantly higher and albumin was significantly lower in the deceased patients.Conclusion: The presence of chronic kidney disease, low left ventricular EF, high pulmonary artery pressure, high CRP levels, increased CRP/albumin ratio and high uric acid levels preceding TAVI may be helpful to determine the risk of mortality after the TAVI procedure.

774 30-day Safety and Effectiveness for Transcatheter Aortic Valve Implantation in a Regional Australian Centre

In the last 5 years, Australia has seen an exponential growth in the number of patients undergoing transcatheter aortic valve implantation (TAVI). Gold coast Hospital is a tertiary teaching regional hospital, which started TAVI service 2 years ago. In the current study we analysed the 30-day outcomes of the first 51 patients and compared it with the landmark Partner 2 trial. A prospective cohort analysis was performed on the first consecutive 51 patients who underwent TAVI (30 balloon-expandable and 21 self-expandable/ 3 subclavian and 48 femoral) at the GCUH and had completed 30 day clinical and imaging follow-up. Clinical characteristics and 30-day outcomes were compared with the landmark Partner 2 trial. Univariate analysis was performed to compare outcomes with the Partner 2 TAVI cohort. The average age of the patients was 82.2±7.3 years with 60% men. Two patients underwent emergency TAVI. The average STS score of 6.4±5.3 was slightly higher than the Partner 2 TAVI cohort (p=0.07). All patients had a successful TAVI as per the VARC definition with zero 30-day mortality. There was a significant improvement in the echo parameters at 30 days with only 4% of patients showing moderate + PVL. Only one vascular complication of pseudoaneurysm was noted. Other than the higher PPM rate most of the 30-day outcomes were similar or even better than Partner 2 TAVI cohort as shown in the figure 1. A successful TAVI program can be established in a regional centre by careful selection of patients.

P899 Reduced right ventricular longitudinal function in patients with chronic left ventricular disease can be due to left ventricular forward failure and not right ventricular dysfunction

Abstract Background and aim The occurrence of right ventricular failure (RVF) in patients with chronic left heart disease (LHD) has important therapeutic and prognostic consequences. Echocardiography (Echo) parameters describing the RV longitudinal function (tricuspid annular plane systolic excursion, TAPSE; peak systolic free wall longitudinal strain, RV-Str; tricuspid annulus peak systolic velocity, TAPSm) are today commonly used to define RV dysfunction. In the present study we hypothesised that these parameters are load dependent. Methods We retrospectively included 66 patients with LHD (age 52 ± 13 years, males 79%) that underwent right heart catheterization (RHC) and Echo within 48 hours. RHC was performed as part of diagnostic- or pre-transplant work-up. Fifty-six patients (85%) had left ventricular ejection fraction &amp;lt; 40%. From RHC data the patients were divided into three groups: Patients with RV decompensation and increased right atrial pressure (RAP) ≥10 mmHg (iRAP, n = 21), with normal RAP but reduced stroke volume index (SVI &amp;lt; 35 mL/m2) (rSVI, n = 21) and with normal RAP and normal SVI (nSVI, n = 24). Results Patients with iRAP had compared with rSVI/nSVI more advanced LHD with higher PAMP, PCWP and larger RV diastolic area (RVdA). TAPSE, RV-Str and FAC did not differ between iRAP and rSVI patients. The ratio RVdA/RV-Str was significantly higher in iRAP patients compared with rSVI and nSVI. The rSVI and nSVI patients did not differ regarding RAP response during supine exercise (P = 0.84). Conclusions Reduced RV longitudinal function in patients with chronic LHD and normal RAP can be due to left ventricular forward failure and not RV systolic dysfunction. iRAP (n = 21) rSVI (n = 21) nSVI (n = 24) Overall P-value iRAP vs rSVI iRAP vs nSVI rSVI vs nSVI RAP (mmHg) 13 ± 2 5 ± 3 4 ± 2 &amp;lt;0.001 &amp;lt;0.001 &amp;lt;0.001 0.34 PAMP (mmHg) 33 ± 8 24 ± 8 22±] &amp;lt;0.001 0.001 &amp;lt;0.001 0.34 PCWP (mmHg) 22 ± 5 16 ± 8 11 ± 6 &amp;lt;0.001 0.003 &amp;lt;0.001 0.025 CI (l/min/m2) 2.2 ± 0.4 2.2 ± 0.4 2.8 ± 0.5 &amp;lt;0.001 0.75 &amp;lt;0.001 &amp;lt;0.001 PVR (Wood unit) 2.6 ± 1.2 1.5 ± 1.6 1.9 ± 1.0 0.032 0.022 0.035 0.60 RVdA (cm2) 26 ± 7 21 ± 7 21 ± 5 0.012 0.007 0.017 0.63 TAPSE (mm) 12 ± 3 13 ± 3 18 ± 6 &amp;lt;0.001 0.28 &amp;lt;0.001 0.001 TAPSm (cm/s) 8 ± 2 8 ± 2 10 ± 4 0.06 - - - RV-str (%) -15 ± 5 -17 ± 5 -21 ± 6 0.002 0.11 0.001 0.028 FAC (%) 28 ± 9 29 ± 11 39 ± 11 &amp;lt;0.001 0.72 0.001 0.003 RVdA/RV-str (cm2/%) 2.2 ± 1.3 1.3 ± 0.7 1.1 ± 0.6 &amp;lt;0.001 0.013 0.001 0.27

Assessment of Pulmonary Artery Pressures by Various Doppler Echocardiographic Parameters and its Correlation with Cardiac Catheterization in Patients with Pulmonary Hypertension.

Background:Measuring pulmonary artery pressures is a routine index in Doppler echocardiography to diagnose, risk stratify, and prognosticate patients with pulmonary hypertension (PH). There are numerous methods in use to measure it in routine clinical practice.Objective:The objective of this study was to assess the correlation between the commonly used Doppler-derived parameters such as tricuspid regurgitation (TR)-derived systolic pulmonary artery pressure (SPAP), pulmonary regurgitation (PR)-derived mean pulmonary artery pressure (MPAP), and right ventricular outflow tract acceleration time (RVOT AcT) with right heart catheterization (RHC) data which are the gold standard.Materials and Methods:In this analytical study, we prospectively measured echo and angiogram parameters such as TR-derived SPAP, PR-derived MPAP, and RVOT AcT and studied its association with RHC data of thirty patients for a span of 2 years. Right ventricular AcT was also included in the study. Their relationship was displayed using Bland–Altman scatter plots. P < 0.05 was considered as statistically significant.Results:Although both TR-derived SPAP and PR-derived MPAP had a moderate correlation with RHC-acquired data, the agreement between them was poor. RVOT AcT showed a strong inverse correlation with invasive MPAP.Conclusion:Among the three Doppler methods that were assessed to measure pulmonary pressures, RVOT AcT had a strong correlation with MPAP. RVOT AcT of <80 ms had a high sensitivity to detect severe PH (defined as MPAP >45 mmHg). Hence, it is recommended to include AcT as a routine measure in the armamentarium of echocardiographic parameters used in patients with PH.

P753 Impact of transcatheter aortic valve implantation on concomitant mitral regurgitation in patients with severe aortic stenosis

Abstract Background Severe aortic stenosis (AS) and functional mitral regurgitation (MR) frequently coexist. There is no consensus about the optimal therapeutic strategy for patients with combined valve disease. Evidence has shown that double valve surgery is associated with high complication rates and mortality, whereas MR severity may improve after transcatheter aortic valve implantation (TAVI). Purpose Aim of our study was to evaluate hemodynamic parameters and cardiac function in patients with severe AS and concomitant MR undergoing TAVI. Methods We prospectively enrolled consecutive TAVI patients with concomitant MR. Exclusion criteria were primary cardiomyopathies, prior valve surgery, permanent atrial fibrillation and inadequate echocardiographic imaging. Echo-Doppler assessment, including global longitudinal strain (GLS) and peak atrial longitudinal strain (PALS) (absolute value), was performed before TAVI and after 1-3 months. MR grading was assessed according to quantitative methods (vena contracta and/or PISA). Changes (Δ) of the main echo parameters before and after intervention were computed. On the basis of MR grading changes, the study population was divided in two groups: no improvement in MR grading (NIMR) and improvement in MR grading (IMR). Results Of 49 included patients (M/F = 20/29, age 80.7 ± 5.6 years), 23 had mild MR and 26 moderate to severe MR before TAVI. After the procedure, MR grading improved in 11 (IMR) and remained stable in 38 (NIMR) patients. The two groups were comparable for sex, age, body mass index, blood pressure and heart rate. After TAVI, both groups showed an improvement in GLS (17.8 ± 4.7 to 20.1 ± 4.4%, p &amp;lt; 0.0001 and 16.8 ± 3.8 to 19.0 ± 3.1%, p &amp;lt; 0.01, in NIMR and IMR respectively) and in PALS (20.4 ± 7.4 to 24.2 ± 7.3%, p &amp;lt; 0.0001 in NIMR and 19.5 ± 4.5 to 26.7 ± 6.1%, p &amp;lt; 0.001, in NIMR and IMR respectively), without significant changes in ejection fraction (p = 0.12). Only in IMR group, a significant decrease of systolic pulmonary arterial pressure (sPAP) (45.5 ± 10.6 to 36.3 ± 6.9 mmHg, p &amp;lt; 0.001) and left atrial volume index (54.9 ± 14.8 to 48.9 ± 13.3 ml/m², p &amp;lt; 0.01) was observed after TAVI. Changes of sPAP (ΔsPAP) (9.1 ± 6.4 vs. -0.07 ± 6.7, p &amp;lt; 0.0001) was higher and ΔPALS (-7.2 ± 5.1 vs. -3.8 ± 4.3, p &amp;lt; 0.03) lower in IMR compared with NIMR group (Figure). By a multiple linear regression analysis performed in the pooled population, after adjusting for ΔPALS, Δ aortic valve area and ΔGLS, the association between ΔsPAP and MR grading improvement remained significant (beta = 0.53, p &amp;lt; 0.001) (cumulative R²=0.31, SEE = 6.9 mmHg, p = 0.007). Conclusion Afterload reduction following TAVI may induce hemodynamic changes determining also a reduction in MR severity. This mechanism implies a reduction in left atrial pressure, whose PALS is a reliable marker, and a consequent reduction of post-capillary pulmonary hypertension. The association between MR improvement and ΔsPAP reduction is independent on echocardiographic confounders. Abstract P753 Figure. ΔsPAP and ΔPALS in NIMR and IMR

P1523 Impact of different techniques for mitral valve repair on left ventricular function: a 2D/3D echocardiographic analysis

Abstract Funding Acknowledgements None Aim Different surgical techniques are available for mitral valve (MV) repair in patients with degenerative severe mitral regurgitation (MR). Leaflet resection (LR) and neochordoplasty (NP), both including ring annuloplasty (RA), are the most frequently performed techniques for posterior mitral leaflet prolapse/flail repair. Despite NP technique is supposed to preserve LV physiology more than LR, it is unclear which technique provides the best haemodynamic pattern. In the present study, the results of the two different surgical techniques in terms of left ventricular (LV) dimension and function are investigated. Methods 23 consecutive patients who underwent MV surgical repair were enrolled. All patients underwent, before surgery and after 8 ± 2 months, 2D and 3D echocardiography with automatic (Heart Model, Philips) assessment of LV volumes and ejection fraction (EF), left atrial (LA) volume, right ventricular (RV) dimension and function, pulmonary artery systolic pressure (PASP), MR, tricuspid regurgitation (TR) and MVPG quantification. MR was corrected using 1) NP with polytetrafluoroethylene sutures and 2) triangular LR, both with RA. Patients were divided in 2 groups according to the surgical technique. Results: techniques were able to successfully correct MR. There were no significant differences in baseline echocardiogram and demographic characteristics between the two groups. There were no significant differences in terms of post-surgical MVPG between the two groups. In all patients a trend in reduction in LV dimension at follow-up was observed, but it was statistically significant only in NP patients (pre-surgical EDV 150 ± 41 VS post-surgical EDV 100 ± 27 ml, p = 0.03). Conclusions Both MV repair techniques showed a successful MV repair and an improvement in LV volumes at follow-up, especially in NP group. Further perspective studies are necessary to demonstrate the hypothesis of more physiological haemodynamic pattern associated with NP techniques. Echo parameters pre VS post MV Repair Parameter pre post p value LVEDV RN (ml) 150 ± 41 100 ± 27 0.03 LVESV RN (ml) 58 ± 20 46 ± 14 NS LVEF RN (%) 58 ± 8 55 ± 7 NS LVEDV RR (ml) 160 ± 58 118 ± 31 NS LVESV RR (ml) 62 ±11 51 ±13 NS LVEF RR (%) 59 ± 8 57 ± 4 NS EDV: end-diastolic volume, ESV: end-systolic volume, EF: ejection fraction, RN = Ring + Neochordae; RR= Ring + Resect.