Normal Echocardiographic Findings Research Articles

An unusual cause of ventricular fibrillatory arrest.

Myocarditis is an important cause of arrhythmogenic sudden cardiac arrest in the young. A strong index of suspicion is required as not only can arrhythmias be the only clinical manifestation but also because these patients can have normal cardiac biomarkers, electrocardiographic and echocardiographic findings, and inflammatory markers. Patients with ventricular arrhythmias in the setting of viral myocarditis, especially the ones in whom cardiac MRI findings normalise upon follow-up, tend to do well in the long run and an implantable cardioverter-defibrillator should be avoided in these patients; instead, a wearable defibrillator should be temporarily used as we did in this 7-year-old.

SUN-090 STRUCTURAL AND FUNCTIONAL (SYSTOLIC) MYOCARDIAL DYSFUNCTION AND THEIR CORRELATION WITH BLOOD PRESSURE, HEMOGLOBIN AND PARATHORMONE LEVEL IN CHILDREN WITH END STAGE RENAL DISEASE

Myocardial dysfunction is the leading cause of morbidity in children with end stage renal disease (ESRD) and mostly associated with hypertension, anemia and high parathormone (PTH) level. Not only functional but also structural myocardial changes play a role in this event. But these changes are not very well studied in our population. So, with a view of answering the research question, what are the structural and functional changes in myocardium in children with ESRD, we designed this study. Thirty diagnosed children with ESRD (based on eGFR <15ml/min/1.73m2) were included purposively in this prospective cross sectional study in the department of pediatric nephrology of a tertiary care hospital in Bangladesh over 1 year period (from January 2017 to December 2017). All the patients underwent color Doppler echocardiography for evaluation for structural and functional (systolic) cardiac abnormalities. Thirty age and sex match healthy children were taken as comparison and also to get normal echocardiographic findings. Left atrial diameter (LA), left ventricular internal diameter in systole (LVIDs) and diastole (LVIDd), left ventricular posterior wall thickness in systole (LVPWs) and diastole (LVPWd) were considered as structural variables, ejection fraction (EF) and fractional shortening (FS) were considered as systolic function variable. Correlation of blood pressure (BP), hemoglobin (Hb) and PTH level with structural and functional variable were also observed in the study subjects. Twenty one (70%) children were male and 9 (30%) were female and their mean age at presentation was 12.23±3.20 year. Mean systolic BP was 120±16 mm Hg and mean diastolic BP was 77±14 mm Hg, mean Hb level was 8.00±1.48 gm/dl and mean serum PTH level was 548.46±309.01. Echocardiographic findings revealed statistically significant difference in case and comparison group in relation with LA, LVIDd, LVIDs, LVPWs and LVPWd (p<0.001) but no difference in relation to FS (p=0.934) and EF (p=0.754). There was negative correlation of BP, Hb and PTH level with EF (r=-0.098, -0.107 and -0.045 respectively) and FS (r=-0.123, -0.271 and -0.169 respectively) but not statistically significant. BP and PTH level was positively correlated with LVIDs (r=0.099, 0.097) and LVIDd (r=0.109, 0.074) though not statistically significant. Positive correlation was observed between Hb level with LVIDd and LVIDs and was statistically significant (r= 0.518, p=0.016 and r=0.044, p=0.046 respectively). It can be concluded from present study that children with ESRD are prone to develop cardiac dysfunction specially left ventricular structural abnormality and there is negative correlation of BP, Hb and PTH level with functional change and positive correlation of with structural change.

Echocardiographic Screening of Cardiovascular Status in Pediatric Sickle Cell Disease.

Although elevated right ventricular pressure and left ventricular diastolic dysfunction measured by echocardiogram are independent predictors of death in adults with sickle cell disease (SCD), the utility of routine echocardiographic screening in the pediatric population is controversial. We performed a 3-year retrospective review of children ≥ 10years of age with SCD who underwent an outpatient transthoracic echocardiogram as part of a screening program. Of 172 patients referred for screening, 105 (61%) had a measurable tricuspid regurgitation jet velocity (TRV): median 2.4m/s (IQR 2.3-2.5). Elevated right ventricular (RV) pressure (TRV ≥ 2.5m/s, 25mmHg), documented in 30% (32/105), was significantly associated with chronic transfusion therapy and elevated lactate dehydrogenase. Left ventricle (LV) dilation, documented in 25% (44/172), was significantly associated with lower hemoglobin, and higher reticulocyte count, lactate dehydrogenase level, and bilirubin level. There was no association between elevated right ventricular pressure or left ventricle dilation and indices of biventricular systolic or diastolic function. The one death in the cohort during the study period had normal echocardiographic findings. In conclusion, mild RV pressure elevation and LV dilation in children with SCD is associated with abnormal laboratory markers of disease severity, but not with ventricular dysfunction over the 3-year study period.

High Normal Blood Pressure and Left Ventricular Hypertrophy Echocardiographic Findings From the PAMELA Population.

Cross-sectional and longitudinal data analysis of the PAMELA (Pressioni Monitorate E Loro Associazioni) population was performed to assess the association between prehypertension and left ventricular hypertrophy (LVH) at entry and the risk of new-onset LVH associated to this condition in the subset of participants with normal LV mass index (LVMI). A total of untreated 1397 participants with measurable echocardiographic parameters at baseline were considered in the cross-sectional analysis. The longitudinal analysis included 880 participants without LVH at baseline and with measurable LVMI at follow-up examination performed 10 years later. At entry, after adjustment for major confounders LVH prevalence rates (LVM/body surface area) showed a significant, progressive increase from the normotensive (2.1%), to prehypertension (6.7%), and hypertension group (18.3%). The incidence of LVH increased progressively from the normotensive to prehypertension and hypertension group (9.0%, 23.2%, and 36.5%, respectively). The risk of new LVH was significantly greater in prehypertension who progressed to sustained hypertension (odds ratio, 4.21; CI, 1.64-10.83; P=0.003) than in those with persistent prehypertension (odds ratio, 1.89; CI, 0.77-5.11; P=0.21) compared with persistent normotensive participants after adjustment for age, sex, baseline LVMI, obesity, glucose, creatinine, total cholesterol and the use of antihypertensive drugs at follow-up. Further adjustments for changes in body mass index, metabolic variables, and creatinine during the follow-up did not modify the strength of association between prehypertension and new-onset LVH. Our findings offer a new piece of evidence on the association of prehypertension with LVH and support the view that preventive actions for this condition affecting a large fraction of the general population should be intensified.

Evaluation of Cases with Myotonia Congenita for Cardiovascular Risk.

Objective:Myotonia Congenita (MC) is a hereditary neuromuscular disorder caused by a mutation in chloride voltage-gated channel 1 (CLCN1) gene. The incidence of MC is estimated as 1 in 100.000. The absence of left main coronary artery (LMCA) is a rare coronary anomaly. Here we present a family with four members who have MC variation carrier and cardiovascular risk.Method:The demographic features, laboratory findings, anthropometric measurements and cardiological examination of the cases were recorded. In addition, CLCN1 gene was sequenced by NGS (Next Generation Sequencing Method) and possible causes of inherited thrombophilia risk including MTHFR (A1298C), Factor V Leiden (G1691A), Factor II (G20210A), MTHFR (C677T), Factor V Cambridge (G1091C), plasminogen activator inhibitor 1 (PAI-1) 4G/5G, APOE, APOB, ITGB, ACE (ins/del), FVHR2 and FGB gene alterations were evaluated.Results:Case 1 had homozygous c.1886T>C (p.Leu629Pro) alteration in CLCN1 gene and also coronary artery disease, myocardial infarction (MI) history, hyperlipidemia, primary hypertension, vertigo, lomber disc herniation and hearing loss. LMCA was not detected in coronary angiography in Case 1. Cases 2, 3 and 4 had heterozygous c.1886T>C (p.Leu629Pro) alteration with normal electrocardiographic and echocardiographic findings. Additionally, all of family members had genetic risk factors for the related gene, which lead to an increased risk of cardiovascular disease.Conclusion:Since alteration of chloride channels in cardiomyocytes leads to variable myocardial involvement, cases with MC should be regularly followed for cardiovascular risk. Moreover, the cases with MC and with genetic profile associated with high cardiovascular risk should also be regularly followed up by cardiologists.

Clinical characteristics associated with pacing-induced cardiac dysfunction: a high incidence of undiagnosed cardiac sarcoidosis before permanent pacemaker implantation.

Previous studies suggested that right ventricular pacing was associated with pacing-induced cardiac dysfunction (PICD). The purpose of this study was to investigate the clinical characteristics including the incidence of undiagnosed cardiac sarcoidosis (CS) in patients with atrioventricular block (AVB) who manifest PICD. We retrospectively investigated consecutive patients with permanent pacemaker (PPM) undergoing a first-generator replacement surgery with a new PPM or an upgrade procedure to a cardiac resynchronization therapy (CRT) device between December 1, 2011 and June 30, 2017. Patients with AVB showing normal echocardiographic findings before PPM implantation were included and divided into 2 groups: patients with post-PPM left ventricular ejection fraction (LVEF) < 40% and/or undergoing an upgrade procedure to CRT (PICD group) and patients with post-PPM LVEF ≥ 40% who underwent replacement surgery with a new PPM (no-PICD group). There were 15 and 41 patients in the PICD and no-PICD groups, respectively. A wider-paced QRS duration just after the PPM implantation and/or lower pre-PPM LVEF was observed in the PICD group. Furthermore, 46.7% of the PICD patients (7/15) satisfied the diagnostic criteria for CS according to the guideline of the Japanese Circulation Society, although no patients fulfilled these criteria before PPM implantation. In conclusion, a high incidence of CS was observed in patients with AVB who had PICD. However, none of these patients was diagnosed with CS before PPM implantation.

Utility of Normal Findings on Electrocardiogram and Echocardiogram in Subjects ≥65 Years

The lack of abnormalities found on noninvasive cardiac testing possibly improves cardiovascular disease (CVD) risk stratification efforts and conveys reduced risk despite the presence of traditional risk factors. This analysis included 3,805 (95% white and 61% women) participants from the Cardiovascular Health Study (CHS) without baseline CVD. The combination of a normal electrocardiogram (ECG) and echocardiogram was assessed for the development of CVD. A normal ECG was defined as the absence of major or minor Minnesota code abnormalities. A normal echocardiogram was defined as the absence of contractile dysfunction, wall motion abnormalities, or abnormal left ventricular mass. Cox regression was used to compute the 10-year risk of developing coronary heart disease, stroke, and heart failure events. There were 1,555 participants (41%) with normal findings on both measures. After accounting for traditional CVD risk factors, a protective benefit was observed for all outcomes among participants who had normal ECG and echocardiographic findings (coronary heart disease: hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.46, 0.69; stroke: HR 0.57, 95% CI 0.43, 0.76; heart failure: HR 0.36, 95% CI 0.29, 0.41). The addition of this normal profile resulted in significant net reclassification improvement of the Framingham risk score for heart failure (net reclassification improvement 4.3%, 95% CI 1.0, 8.0). In conclusion, normal findings on routine noninvasive cardiac assessment identify subjects in whom CVD risk is low.

OC02_09 Next Generation Data Collection and Organizing System to Support Population-Based Screening for Rheumatic Heart Disease

Introduction: Different echocardiographic definitions of Rheumatic Heart Disease (RHD) have been used for screening for RHD. This led to development of the 2012 evidence-based World Heart Federation (WHF) echocardiographic criteria for RHD. Objectives: To determine if the WHF criteria allow for consistent and reproducible differentiation of normal echocardiographic findings from mild RHD. Methods: Participants were 16 international cardiologists. A standard set of 200 echocardiograms was collated from population-based surveys of school-aged children in regions of high RHD prevalence in Australia and New Zealand. Echocardiograms were uploaded for blinded web-based reporting. Inter-observer variability in categorizing echocardiograms as normal, borderline or definite RHD, as per WHF criteria, was measured by comparing individual readings with a reference reading (majority reading if greater than 2/3 consensus, external panel consensus reading otherwise). Agreement in diagnosis of pathologic mitral and aortic regurgitation and morphologic features of RHD were assessed. One hundred echocardiograms were re-reported blindly for intra-observer assessment. Results: 3112 reports were analysed. Based on the reference readings, distribution of cases were: 67 (33.5%) borderline RHD, 53 (26.5%) definite RHD and 80 (40%) no RHD. Overall agreement in categorising echocardiograms as normal, borderline and definite RHD (primary end-point) was good, kappa 0.68 (95%CI 0.66-0.70; SE 0.0152, p-value <0.0001). Fig 1 shows inter/intra-observer agreement, sensitivity and specificity of individual readers. Agreement for pathologic mitral regurgitation was excellent, kappa 0.87 (95%CI 0.85-0.89), Fig 2. Agreement for subtle morphologic changes of RHD was variable ranging from fair to good.

Very early stage left ventricular endocardial dysfunction of patients with hypereosinophilic syndrome.

Cardiac involvement in hypereosinophilic syndrome (HES) patients entails significant morbidity and mortality. Left ventricular (LV) endocardial damage is important for the development of cardiac involvement in HES patients. However very early stage LV endocardial damage, such as prior to the first stage of an acute necrotic stage, remains uncertain. We studied 32 HES patients, all with normal conventional echocardiographic findings. Global radial and circumferential strain (GRS and GCS) were determined for each peak global strain curve from the mid-LV short-axis view, and global longitudinal strain (GLS) was averaged each peak global strain curve from standard apical views by means of two-dimensional speckle-tracking method. Thirty-one age-, gender-, LV ejection fraction-matched normal subjects were studied for comparison. GRS and GRS were similar for HES patients and normal controls, but GLS for HES patients was significantly lower than that for normal controls (16.2 ± 3.3 % vs 19.3 ± 2.9 %, p < 0.001). Furthermore, receiver operating characteristic curve analysis identified GLS ≤17.0 % as the best predictor of LV endocardial dysfunction with a sensitivity of 66 %, specificity of 78 %, and area under the curve of 0.781 (p = 0.0001). In conclusions, LV endocardial dysfunction pre-existed even in HES patients without apparent cardiac involvement. GLS as assessed with the two-dimensional speckle-tracking method is a promising tool for the better management of very early stage of HES patients.

Association of Neutrophil-Lymphocyte Ratio with the Presence and Severity of Degenerative Aortic Valve Stenosis

Objective: In different studies, it has been shown that degenerative aortic stenosis and atherosclerosis had a common pathogenic mechanism. The goal of this study was to examine the association between NLR and the presence and severity of degenerative aortic valve stenosis. Methods : Echocardiographic data (from May 2011 to September 2013) of our cardiology department was reviewed retrospectively. After evaluation according to exclusion criteria’s, a total of 103 patients with degenerative AS and a control group of 35 age- and gender- matched patients who had normal echocardiographic findings were included in the study. Results: The level of NLR was highest in severe AS. The neutrophil-lymphocyte ratio was significantly higher in severe AS group than for the mild and moderate AS group (1.95±0.42, 2.31±0.69, 2.67±0.73; p<0.001 respectively). In comparison of the degenerative aortic stenosis groups with the control group, NLR in all aortic stenosis groups was found to be significantly higher than the control group (p<0.001). In addition, there was a statistically significant correlation between NLR and transaortic peak pressure gradient in patients with degenerative aortic stenosis (r: 0.626, p<0.001). Conclusion: The NLR, which is an inexpensive and readily available marker of chronic inflammation, may be useful in predicting the presence and severity of degenerative aortic stenosis.

The septal bulge—an early echocardiographic sign in hypertensive heart disease

Patients in the early stage of hypertensive heart disease tend to have normal echocardiographic findings. The aim of this study was to investigate whether pathology-specific echocardiographic morphologic and functional parameters can help to detect subclinical hypertensive heart disease. One hundred ten consecutive patients without a history and medication for arterial hypertension (AH) or other cardiac diseases were enrolled. Standard echocardiography and two-dimensional speckle-tracking-imaging analysis were performed. Resting blood pressure (BP) measurement, cycle ergometer test (CET), and 24-hour ambulatory BP monitoring (ABPM) were conducted. Patients were referred to “septal bulge (SB)” group (basal-septal wall thickness ≥2 mm thicker than mid-septal wall thickness) or “no-SB” group. Echocardiographic SB was found in 48 (43.6%) of 110 patients. In this SB group, 38 (79.2%) patients showed AH either by CET or ABPM. In contrast, in the no-SB group (n = 62), 59 (95.2%) patients had no positive test for AH by CET or ABPM. When AH was solely defined by resting BP, SB was a reasonable predictive sign for AH (sensitivity 73%, specificity 76%). However, when AH was confirmed by CET or ABPM the echocardiographic SB strongly predicted clinical AH (sensitivity 93%, specificity 86%). In addition, regional myocardial deformation of the basal-septum in SB group was significantly lower than in no-SB group (14 ± 4% vs. 17 ± 4%; P < .001). In conclusion, SB is a morphologic echocardiographic sign for early hypertensive heart disease. Sophisticated BP evaluation including resting BP, ABPM, and CET should be performed in all patients with an accidental finding of a SB in echocardiography.

Measurement of right atrial volume and diameters in healthy Nepalese with normal echocardiogram.

The size of right atrium is expected to be different in diverse healthy ethnic groups. It is important to know the normal size of right atrium in our healthy population. The study aimed to find out the normal values of right atrial volume, right atrial short axis diameter and right atrial long axis diameter in healthy Nepalese population with normal echocardiographic findings. It also looked at correlations between right atrial dimensions and the right atrial volume. Verbal consent was taken from all the participants. One hundred participants between the age of 18 and 60 years with normal echocardiographic findings and without any chronic disease were included in this study. Right atrial volume was measured by using area length method. Right atrial short axis diameter and Right atrial long axis diameter were measured in the four chamber view. The mean right atrial volume was 23.64±5.36 ml (range 11.30-40.00 ml).The range of right atrial short axis diameter and right atrial long axis diameter were 1.34-3.80 cm and 2.4-4.7 cm respectively. The size of right atrium in the Nepalese population is smaller compared to western population. Male right atrial volume size is greater than female in Nepalese population similar to western population. The findings of normal value of right atrial volume and right atrial diameter in Nepalese population will help the physician to assess patients with various conditions affecting the right atrium.

Cardiac effects of mitoxanthrone therapy in patients with multiple sclerosis.

Mitoxanthrone (MTX) is a synthetic anthracycline antibiotic that has been used for several years in the treatment of patients with primary progressive, secondary progressive, and relapsing remitting multiple sclerosis (MS) who do not respond to other drugs. MTX has antineoplastic, immunomodulatory, and antibacterial properties. The most common adverse effects of MTX include nausea and vomiting, hair loss, increased risk of urinary and respiratory tract infections, and amenorrhea. Less frequent problems include leukopenia, thrombocytopenia, anaemia, and an increase in hepatic enzyme and bilirubin levels. Other severe sequelae of MTX treatment are drug cardiotoxicity and a potential to induce leukaemia. Drug toxicity results from its affinity to iron ions. The resulting complex strongly induces formation of free oxygen radicals and increases lipid peroxidation. Asymptomatic reduction in left ventricular ejection fraction (LVEF) by two-dimensional (2D) echocardiography, cardiomyopathy, and congestive heart failure have been observed in patients with MS at a rate of about 2.6-5%. Few studies evaluated cardiotoxicity of MTX in MS patients. Most previous studies were performed in small groups of cancer patients and cardiac evaluation was limited to physical examination. To evaluate the effect of MTX treatment on LVEF by 2D echocardiography. We studied 72 MS patients aged 25-63 years who were treated with MTX in 2002-2014. The diagnosis of MS was made using the 2001 McDonald criteria updated in 2005. The study group included primary progressive MS in 40 (56%) patients, secondary progressive MS in 5 (7%) patients, and relapsing remitting MS in 27 (37%) patients. MTX was administered at 12 mg/m2 of body surface area every 3 months (up to the total dose of 140 mg/m2). MTX treatment was initiated in patients with no signs of heart failure on physical examination, normal electrocardiogram (ECG), normal LVEF by 2D echocardiography, and normal laboratory test findings including complete blood count and hepatic and renal function parameters. Each MTX administration was preceded by 2D echocardiography with LVEF measurement, ECG, and physical examination of the cardiovascular system. The effect of MTX treatment on LVEF was evaluated by comparing baseline LVEF with LVEF measurements before the last MTX dose. Statistical analysis was performed using the Student t test. The mean LVEF before administration of the first MTX dose was 65 ± 3.3%. The lowest LVEF at the final 2D echo-cardiographic examination was 60 ± 2.1%. We did not find a significant LVEF reduction during MTX treatment in MS patients compared to baseline values. Severe myocardial dysfunction manifesting with significant LVEF reduction by 2D echocardiography or clinical evidence of heart failure was not noted in any patient in the study group. Our study showed no significant LVEF reduction during MTX monotherapy in MS patients without a history of a cardiac disease and with normal echocardiographic findings at baseline. Long-term cardiac effects of MTX require further studies.

Echocardiographic pattern of heart diseases in a North - Western Nigerian tertiary health institution

Background: Transthoracic Echocardiography is an important non-invasive technique which provides information about cardiac structure and function, thus useful in the evaluation and management of cardiac diseases. Previous studies on echocardiography findings in our environment documented Hypertensive heart disease, Dilated Cardiomyopathy and Rheumatic Heart Disease as the commonest findings in patients with cardiac diseases. This study aimed to provide an update on the common echocardiography findings in this part of the country since previous studies were done over a decade ago. Materials and Methods: We reviewed echocardiographic reports of 1012 consecutive patients aged ≥15 years from September 2011 to August 2014 (3 years). The reports were reviewed for demographic parameters, indications for the procedure and main echocardiography diagnoses. Results: The mean age of the 1,012 individuals studied was 41.28 ± 16.25 years. There were 330 males and 682 females. The commonest clinical indication for echocardiography was Systemic hypertension/Hypertensive heart disease (41%) followed by Peripartum cardiomyopathy (20%) and Congestive cardiac failure (12%) of unknown cause. The most prevalent echocardiographic diagnoses was Hypertensive heart disease seen in 40.3%, followed by Peripartum cardiomyopathy (32%), Dilated cardiomyopathy (5.9%), and Rheumatic heart disease 4.6%. Normal echocardiographic findings were seen in 14.9% of the subjects. Conclusion: Hypertensive heart disease remains the most common echocardiographic indication and diagnosis. Peripartum cardiomyopathy was frequent in our centre and this may be related to the increased availability and accessibility to echocardiographic facility as well as the low socioeconomic status of the category of patients that attend the centre.

Role of Hypertension and Anaemia in Left Ventricular Remodelling in Patient with Renal Allograft in the First Post-transplant Year.

Background:Hypertension (HT) and renal anaemia (RA) are well-established markers of cardiovascular risk in patients with chronic kidney disease (CKD). They appear to be the stimuli for left ventricular hypertrophy (LVH), who significantly participates in cardiac complications in uremic patients. Hypertension is extremely common after kidney transplantation (KTx) and it has been observed in up to 75% of patients. The prevalence of post-renal transplant anaemia (PTA) is variable (up to 30%) and several factors such as graft function contribute towards its pathophysiology.Aim:The aim of this study was to analyze the impact of blood pressure and anaemia on LV remodelling in first year after transplantation comparing echocardiographic findings before and twelve months after transplantation had done.Methods:In five years retrospective-prospective study we followed up 30 patients with renal allograft in first post-transplant year. During the study values of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), blood hemoglobin (Hgb), serum creatinine and creatinine clearance were monitored monthly.Results:Before transplantation (Tx) 86% of patients had HT, and RA was confirmed in all patients. Normal echocardiographic findings had 33% of patients and 67% of patients had echocardiographic sings of LVH. Before renal transplantation group with LVH had statistically higher the mean values of blood pressure (MBP) (p=0.053) compared to group with diastolic (LVDDF) (p=0.0047) and systolic-diastolic dysfunction (LVSDDF) (p=0.0046). The values of SBP and DBP positively correlated with LV mass index (LVMI) in the group of patients with LVH (p=0.0007 and p=0.0142). The values of Hgb was statistically higher in group with normal LV mass index compared to LVH (p=0.019), with negative correlation between LVMI and values of Hgb in the patients group with LV hypertrophy (p=0.009). After the first year of transplantation, 63% of patients showed normal LV mass index and 37% remained with echocardiographic findings of the LVH. The values of SBP and values of Hgb in both groups, as well as values of DBP in group of LVH were statistically different in compare with data before transplantation (p<0.05). The positive echocardiographic remodelling of LV significantly correlated with the increase of Hgb values (p=0.05), but without significant correlation with the decrease of the mean SBP and DBP.Conclusion:These results confirmed that positive echocardiographic remodelling of left ventricle after successful renal transplantation is complex process depended on many risk factors and elimination of uremia- related factors is a priority.

Abstract 15523: Absence of Chordae Tendineae near Valve Coaptation Leads to Mitral Regurgitation in Lone Atrial Fibrillation

Introduction: Mitral annuloplasty is performed to treat mitral valve regurgitation (MR) in lone atrial fibrillation (AF) patients. The mechanisms of the significant MR in lone AF patients are not known well. We assessed the hypothesis that absence of chordae tendineae near the mitral valve (MV) coaptation could lead to the significant functional MR in the lone AF patients. Methods: We analyzed 64 patients with a history of AF with greater than 50 % of the left ventricular (LV) ejection fraction, and no organic abnormality of MV. Of these 31 has mild or lesser MR (AF Groups) and 33 has moderate or severe MR (AFMR Group). We also analyzed 33 sinus rhythm patients with normal echocardiographic findings (Sinus Group). Parameters concerning to MV morphology were measured with commercial software. Chordae attaching points (CAPs) nearest from the coaptation line were detected on the anterior mitral leaflet (Figure). Ratio of the length from CAP to coaptation line against that from anterior annulus to coaptation line was calculated as CAP-C/An-C ratio. Results: Mitral annular area (P &lt; 0.05), leaflets surface area (P &lt; 0.05), and CAP-C/An-C ratio (P &lt; 0.05) were larger in the AFMR Group as compared with the AF Group (Table). With multivariate analysis, the correlation factor of significant MR in AF patients was increase in the CAP-C/An-C ratio (Odds ratio (per 1 % increase) = 1.70; p &lt;0.05). Conclusion: The absence of chordae tendineae near the coaptation line represented by larger CAP-C/An-C ratio is related to the functional MR in AF patients with normal LV function.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

M-mode, two-dimensional and Doppler echocardiographic findings in 40 healthy domestic pet rabbits

ObjectivesThe aim of the study was to report normal two-dimensional, M-mode, and Doppler echocardiographic findings from a large cohort of healthy, manually restrained, adult pet rabbits. Animals and methodsForty healthy pet rabbits [22 Dwarf Lops (DL), 14 French Lops (FL) and 4 Alaskan (AL)] underwent a full physical examination and conscious two-dimensional, M-mode, and Doppler echocardiography. ResultsThe median age of the rabbits was 21.5 months, the median weight was 2.9 kg (DL: 2.4 kg, AL: 4.35 kg, FL: 6.0 kg). Echocardiography with ECG monitoring was feasible in all rabbits. Left atrial and ventricular dimensions were significantly larger in FL as compared to DL; overall, a positive correlation with weight was present. No significant differences between breeds were identified for flow velocities. Trace regurgitation was detected at the aortic valve in 7/40 (17.5%) rabbits, at the tricuspid valve in 5/40 (12.5%) and at the pulmonic valve in 1/40 (2.5%) rabbits. Mitral inflow E and A waves were summated in 60% of cases. ConclusionsThe results of this study can be used as echocardiographic values in FL and DL for comparison with clinical cases, and may also be applicable for other breeds of similar sizes. Breed specific values should be used when measuring left atrial and ventricular sizes. However, no breed or size differences were found for the rest of the echocardiographic parameters, which may therefore be applicable for the general pet rabbit population.

O098 Evaluation of Circulating Markers of Collagen Metabolism in Rheumatic heart valve disease in Indian Subpopulation

R A L A B ST R A C T S Objectives: The objective of this study is to determine if the WHF criteria allow for consistent and reproducible differentiation of normal echocardiographic findings from mild RHD and therefore to assess the usefulness of the diagnostic criteria as a clinical and epidemiologic tool. Methods: Participants consisted of 15 international cardiologists / physicians with considerable experience with RHD. A standard set of 100 echocardiograms was collated from population-based surveys of high risk school-aged children of Australia and New Zealand. Echocardiograms were uploaded for blinded web-based reporting. Inter-observer variability in categorizing echocardiograms as normal, borderline or definite RHD, as per WHF criteria, was measured by comparing the individual readings made by 15 participants with a reference reading. Results: Of the 100 echocardiograms 99 were considered suitable for reporting. A total of 1485 reports were analysed. Based on the reference readings distribution of cases were: 33 borderline RHD, 20 definite RHD and 46 normal or congenital heart disease. Overall agreement in categorising echocardiograms as normal, borderline and definite RHD (primary end-point) was good, kappa 0.68 (95%CI 0.65-0.72) with overall accuracy of 76.77% (95% CI 0.75-0.79). The agreement over secondary endpoints, the presence of pathologic degrees of aortic and mitral valve regurgitation were excellent, kappa of 0.87 (95%CI 0.8 –0.90) and 0.83 (95%CI 0.79-0.86) respectively. Conclusion: WHF echocardiographic criteria for RHD allows for satisfactory level of agreement over the diagnosis of RHD when utilized by experienced physicians. The ability of less experienced physicians and community health workers to diagnose RHD by echocardiography needs to be further evaluated if echocardiographic screening is to have a role in RHD control in resource poor settings. Intra-observer studies of the WHF criteria are in progress.

Global Left Ventricle Myocardial Deformation Observed by Four-Dimensional Echocardiographic Evaluation was Impaired in Patients with Vitamin B12 Deficiency and Normal Conventional Echocardiographic Findings

OP-003 Conflicting effects of vitamin B12 deficiency have been shown on the cardiovascular system. We evaluated left ventricular (LV) myocardial functions with a new imaging method, four-dimensional (4D) real-time full-volume strain echocardiography (SE), and myocardial performance index (MPI or