Parasternal Short Axis Research Articles

106 Mitral annulus calcification: potential indicator of vascular disease and higher thromboembolic risk

Abstract Background In CHA2DS2-VASc thromboembolic risk score, vascular diseases (V) include either prior myocardial infarction, peripheral arterial disease or aortic plaque, summarizing the patient’s atherosclerotic burden. Despite this, thromboembolic risk scores used in atrial fibrillation (AF) patients do not include mitral annular calcification (MAC) as a potential indicator of vascular disease. Purpose This case-control study retrospectively assessed the relationship between MAC and thromboembolic risk scores (CHADS2 and CHA2DS2-VASc) in non-valvular AF patients (paroxysmal and non-paroxysmal). Methods We compared thromboembolic risk scores value, clinical and transthoracic echocardiographic data in AF patients with and without MAC. The presence and severity of MAC was assessed in parasternal short axis and apical four chamber views. It was qualitatively defined as either mild, moderate or severe based on echodensity and extension in mitral annulus ring. MAC of > 4mm thickness was also considered severe. Results We included 103 patients: mean age 72.6 ± 9.9 years, 44.7% male, 83.5% hypertensive, 30.1% diabetic, 79.6% with heart failure, 40.8% were in atrial fibrillation and 7.8% had a history of stroke/transient ischemic stroke. We identified MAC in 50.5% patients: 15.7% severe, 50.3% moderate, 34% mild. Mean CHADS2 and CHA2DS2-VASc were 2,56 ± 1.213 and 4.57 ± 1.61, respectively. In MAC patients, both scores tended to increase with a mean of 2,88 ± 1,114, p = 0.003 and 5,211 ± 1,51, p < 0.001 as compared with control (2,23 ± 1,06 and 3,92 ± 1,46), respectively. The presence of MAC was a risk factor for vascular disease (OR = 2,47, χ2 = 34,32, p < 0,001). Moreover, the AUC for CHA2DS2-VASc, CHADS2, and MAC was 0.73 (95% CI, 0.63-0.82) and 0.65 (95% CI, 0.54-0.75), respectively. Both scores showed higher AUC in women: 0.79 (95% CI, 0.67-0.91) for CHA2DS2-VASc and 0.68 (95% CI, 0.54-0.82) for CHADS2. Left ventricular ejection fraction (LVEF) negatively correlated with the presence of MAC (r=-0.254, p = 0.01). Sinus rhythm patients with MAC showed significantly decreased LVEF as compared to those without MAC (55.73 ± 12.3% vs 46.96 ± 14.5 %, p = 0.013). The difference was not significant in AF patients (46.83 ± 10.6% vs 45.92 ± 11.59, p= 0.79). Conclusion The presence of MAC, irrespective of severity, correlates very well with both vascular disease and thromboembolic risk scores. Therefore, we consider that MAC might be a potential indicator of vascular disease and of higher thromboembolic risk. This study raises the question whether inclusion of MAC in thromboembolic risk scores as an indicator of vascular disease (V) might increase their predictive value.

P631 A misleading EKG and the saviour echo

Abstract Introduction Floating right heart thrombi (in transit from the legs to the pulmonary arteries) are a severe form of venous thromboembolism, with a high early mortality rate without treatment. Evidence-based recommendations do not adequately address the treatment of right heart thrombi in patients who present with acute symptomatic pulmonary embolism. Case Report Woman, 76 years old. Previous medical history of hypertension, dyslipidaemia, mitral valve repair and hypothyroidism. Recent admission in our cardiology department with de diagnosis of NSTEMI. She performed an echocardiogram that revealed only an enlarged left atrium, with no other changes. EKG only revealed inversion of T waves in V2-V4 with posterior normalization during hospital stay. She underwent to coronary angiography and right dominance without any coronary lesions was showed. The presence of a fistula, with a badly defined route, was also pointed in the coronary angio. One month after this episode she was admitted again in our emergency department due to onset of dyspnoea and productive cough. The physical examination showed SatO2: 90%; BP: 95/53 mmHg; HR: 100 bpm; Respiratory rate: 27 cpm; Apyretic (36,9ºC). Normal pulmonary and cardiac auscultation, without any other pathological findings on physical examination. EKG revealed a sinus tachycardia, HR 122 bpm, with ST elevation in aVR and ST depression in DI, DII, aVL and V2-V6. Presence of S wave in DI and Q wave in DIII. While the EKG was being performed the patient presented a sudden cardiovascular deterioration (with blood pressure (BP: 67/35mmHg) drop and appearance of chest pain). We performed an arterial-blood gas test that revealed: pH7,16; pCO2 26,5; pO78,7; Potassium 4; Sodium 138; lactates 8,8. With these findings we decided to perform an echocardiogram to identify a possible cause for the shock. The echo showed right dilated chambers (with D-shape in parasternal short axis) with dilated IVC. We also point out the presence of a mobile intra-cardiac mass at the level of right atrium, suggestive of thrombus. We assumed the presence of obstructive shock in the context of pulmonary embolism. Thrombolysis was performed with clinical improvement of the patient. Medical therapy was optimized and heparin was initiated after the patient finished alteplase perfusion. During hospital stay the patients didn’t have any other cardiovascular complication and went home after 7 days in hospital. A venous doppler was performed before hospital discharge and it revealed the presence of a deep venous thrombosis at the level of right femoral vein. Conclusion The authors presented a didactic clinical case where the EKG mislead us to a possible Acute Coronary Syndrome involving the left main artery. Although there is no clear consensus for the management of right heart thrombus associated with pulmonary embolism, thrombolysis is readily available and can be effective in carefully selected patients.

Association of epicardial fat thickness assessed by echocardiography with the severity of coronary artery disease.

Introduction: Epicardial fat thickness (EFT) can reflect risk of cardiovascular disease particularly coronary artery disease (CAD). The aim of this study was to investigate the association of EFT assessed by echocardiography and presence as well as severity of CAD. Methods: Two hundred and twenty consecutive patients who candidate for coronary angiography because of possible CAD were studied. EFT was evaluated in standard parasternal long axis (PlAX) and parasternal short axis (PSAX) view from 3 cardiac cycles at the end of systole and diastole. The severity of CAD was defined in two ways: (1) SYNTAX score, (2) number of vessels with significant lesion. Results: PLAX (EFTS) (EFT in systole) and PLAX (EFTd) (EFT in diastole) were significantly higher in patients with CAD in comparison with patients without CAD (P = 0.046, P = 0.041 respectively). There was a significant correlation between PLAX (EFTS) (P = 0.05), PLAX (EFTd) (P = 0.04) and SYNTAX score. There was no statistically significant relationship between EFT and number of diseased vessel (P > 0.05). Multivariate analysis was done for adjusting the effects of confounding factors and it showed that EFT (OR: 10.53, P = 0.004) was significantly correlated severe CAD as assessed by the SYNTAX score. Conclusion: EFT assessed by transthoracic echocardiography was higher significantly in patients with CAD than in normal patients. EFT as an easily available and cost-effective echocardiographic feature might be useful to predict complexity of CAD.

P911 3D echo imaging of tricuspid valve: new look at the tricuspid valve

Abstract Introduction "" En face"" visualisation of the tricuspid valve (TV) leaflets and commissures is not possible using two-dimensional transthoracic echocardiography (TTE) unless the right ventricle (RV) is dilated via parasternal short axis or subcostal views. With the aid of three dimensional echocardiography (3DE) , complete assessment of the TV apparatus including the leaflets, annulus and subvalvular apparatus can be easily accomplished. Aim To use different modes of three dimensional (3D TTE) to assess TV in three standard views in different diseases. Methods : 6 patients with different tricuspid valve diseases (mean age is 29 ± 18 years, 3 were women)were studied.We used three-dimensional echocardiography to acquire zoomed mode and multi-beat, full-volume data sets of the TV to assess the leaflets and commissures. .Moreover, tricuspid valve area(TVA) was assessed by direct planimetry of the valve orifice at the level of the leaflets tips at end diastolic frame in cases of TV stenosis. Results Direct visualization of the leaflets motion and number, commissures and TVA were achieved in all patients.Tricuspid valve posterior leaflet prolapse was seen in two patients (figures A, B).2 patients had tricuspid valve stenosis ; one showed characteristic commissural fusion in a rheumatic heart (3D TVA= 1.2 cm2 )(Figure D) and the other has a peculiar commissural sparing in a carcinoid pathology (3D TVA = 1.9 cm2) (Figure E) .One patient revealed rudimentary anterior leaflet suggesting unguarded TV orifice (Figure F). Regarding the numerical variations: one patient got 4 leaflets (Figure C) while another one had 2 leaflets only. Conclusion Simultaneous visualization of the three TV leaflets is limited by using 2DE.On the other hand, RT-3DE allows better understanding of the anatomy and mechanisms of the TV diseases .Comprehensive assessment of the morphology and function using RT-3DE can provide a valuable road map to guide the intervention according to each individual case. Abstract P911 Figure. Different TV morpholgies.

1163 Diagnostic performance of a new echocardiographic method for coronary arteries abnormalities assessment

Abstract Background The echocardiographic assessment of coronary arteries abnormalities (CCA) has always been challenging. In this view, we aimed to assess the performance of a new echocardiographic-based diagnostic method for CAA in pediatric and young adults’ population. Methods over 5 years, we examined all the outpatients undergoing routine echocardiography in our department. Our method consisted of 4-focused specific view scan: parasternal short-axis, parasternal long-axis, both left and right outflow tract, and apical 5-chamber view. Coronary-CT confirmed the CAA diagnosis. Two independent physicians retrospective reviewed the echocardiographic images, in a double-blinded fashion (coronary-CT and diagnosis), for performance analysis. Results in 2014-18, 5,998 outpatients underwent echocardiography (median age 14 years [6, 21 - IQR]). A total of 27 CAA were diagnosed: overall prevalence 0.0045%, 0.022% of incidence. N = 17/27 were anomalous aortic origin of coronary arteries (AAOCA), N = 3/27 anomalous coronary arteries from the pulmonary artery (ACAPA), and 7/27 fistulas. After the implementation, we found a progressive increment of CAA diagnosis (P for Trend = 0.038), in particular of AAOCA: both left and right coronaries (P-trend = 0.021 and P = trend 0.010, respectively). Our method showed better sensitivity than traditional CAA echocardiographic evaluation: 85% vs 55%, P = 0.032 [AUC 0.77, 95% CI (0.68, 0.87) and AUC 0.92, 95% CI (0.85, 0.99), respectively], with a good interobserver agreement for the adjudicated double-blinded retrospective diagnosis (99.75%, K = 0.73, P < 0.001). Conclusions the application of a new echocardiographic-based method for CAA-detection led to a significantly increased rate of identified anomalies. This approach demonstrated better sensitivity than traditional echocardiographic assessment. Implementing this protocol in clinical practice may improve the CAA diagnosis, and probably reduce the occurrence of CAA-related sudden cardiac death.

P1349 POCUS by general and family physician - advancing physical examination

Abstract BACKGROUND Alongside with the development of hand held equipment, echo is becoming more accessible to nontraditional settings. General and family medicine (GPs) are at the forefront of any health system, but the use of cardiac echo by GPs is still unexplored. PURPOSE: This study aims to evaluate the accuracy of echocardiography assessment performed as an extension of the physical exam by GPs. METHODS: Two GPs underwent standard echocardiography training for 6 months. Subsequently, patients with diabetes or arterial hypertension were submitted to an echocardiogram performed by their GPs using a pocket ultrasound. Views obtained (with and without color Doppler) were parasternal long and short axis, apical and subcostal, with measurements of the posterior wall (PW), interventricular septum (IVS), left ventricle (LV), left atrium (LA), aorta and inferior vena cava (IVC). Studies were reviewed at the workstation and measured by two experts who classified the exams according to the image quality. RESULTS: Sixty echocardiograms were analyzed (mean age of 61y, 42% females and 58% males). In 50% the image quality was considered sufficient, 42% considered good and 8% considered bad. There were statistically significant differences between the GPs and expert measurements on the sinus of Valsalva (30.3 ± 3 to 28.8 ± 3.1mm, p = 0.001), LV in systole (p < 0.001, 28[24,31] for 31[29,34]mm), IVS (p = 0.001, 10.9 ± 1.7 for 10.1 ± 1.5mm), PW (p = 0.018, 8.7 ± 1.1 to 9.2 ± 1.6mm) and TAPSE (p = 0.021, 20.9 ± 2.3 to 20.1 ± 2.7mm). There were no significate differences in the measurements of the ascending aorta, LA, LV in diastole and IVC. Agreement between the GPs and the experts was moderate for the evaluation of LVH (k = 0.48). The concordance was substantial for evaluation of LV function (k = 0.66) and excellent for evaluation of pericardial effusion (k = 1) and right ventricular function (k = 1). Concordance was excellent for mitral insufficiency (k = 0.83) and substantial for aortic insufficiency (k = 0.68) and tricuspid insufficiency (k = 0.61). A case of mitral stenosis was identified by both. GPs signalized a case of mild aortic stenosis that the expert did not consider. CONCLUSION: GPs trained in echocardiography, using pocket ultrasound, can obtain cardiac images with sufficient quality for interpretation by experts in the majority of cases. In this study, differences in dimensions might be explained by interobserver variability and/or by the performance of measurements in different environments, mobile vs workstation. Overall the differences were minor and clinically meaningless.

P1548 Changes in left ventricular deformation with weight loss in obese adolescents with intellectual and developmental delays (IDD)

Abstract Funding Acknowledgements AHA Career Development grant Background Adolescents with IDD have twice the prevalence of obesity as their typically developed peers, leading to frequent early obesity-related subclinical cardiac dysfunction, detected by strain echo. The effects of weight loss on cardiac deformation are unknown in this population. Purpose To evaluate early cardiac dysfunction in overweight IDD adolescents before and after a 6-month caloric restriction-weight loss program. Methods Subjects with IDD co-enrolling in a weight loss program were consented for this strain imaging study, excluding those with congenital heart disease. An echo measuring LVEF (bullet), 2D speckle longitudinal LV global strain (GLS) and strain rate (GLSr) from 3 apical views and global circumferential strain from a parasternal short axis view at the paps (GCS) was performed at baseline and 6 months. Analysis included paired T-test and regression analysis, p ≤ 0.05 significant. Results Overweight (5) and obese (15) adolescents (40% female) had baseline LV strain measurements that were mildly diminished with increased baseline body weight predicting diminished GLS (P = 0.034) and GCS (P = 0.046) on regression modeling. After 6 months, weight and BMI decreased significantly with improvements in GLS and GCS and non-significant trends towards improvement in GLSr and early diastolic global strain rate. BMI change at 6 months predicted change in GLS (p = 0.015) and GCS (p = 0.0087) on regression modeling. At baseline, LVEF and LV end-diastolic volume were normal with no change over 6 months (p > 0.55). Conclusions Baseline abnormalities in LV deformation with preserved LVEF are present in this young, obese IDD population with improvements in BMI predicting those in GLS and GCS after a 6-month caloric restriction-weight loss program. These data provide compelling justification for larger studies in this population. n Baseline (mean ± SD) 6-mo. follow up 0-6 mo. change p-value Age (years) 20 17.0 ± 2.0 17.5 ± 2.1 0.5 ± 0.1 Weight (kg) 20 86.9 ± 22.2 83.1 ± 22.7 -3.7 ± 5.9 0.014 BMI (kg/m²) 20 32.2 ± 5.3 30.4 ± 5.7 -1.8 ± 2.2 0.0031 GLS (%) 20 16.9 ± 1.6 19.2 ± 2.7 2.4 ± 2.0 0.00023 GLSr 20 1.15 ± 0.018 1.22 ± 0.18 0.06 ± 0.16 0.096 EaGLSr 20 1.83 ± 0.038 2.01 ± 0.46 0.18 ± 0.45 0.098 GCS (%) 20 19.1 ± 2.3 22.0 ± 2.6 2.82 ± 2.6 0.00019 LV deformation before and after weight loss. GLS, GLSr, and GCS are reported as positive values (absolute values). Body Mass Index (BMI); Early Diastolic Global Longitudinal Strain Rate (EaGLSr)

P1323 From a suspicion of pulmonary arterial hypertension to a rare form of Takayasu disease

Abstract A 27-year-old female with a history of glomerulonephritis,with diagnosed systemic lupus and retroperitoneal fibrosis was admitted due to fast worsening dyspnoea(NYHA class IV) over the prior four weeks with suspicion for PA hypertension. In 2015, retroperitoneal fibrosis was diagnosed based on MR examination. With the methylprednisolone treatment a regression of changes was obtained. The patient was chronically treated with prednisone 7.5mg/day and mycophenolate mofetil 2g/d. When admitted to the ward, the patient was in a severe condition, with symptoms of resting dyspnea and blood oxygen saturation up to 80%. A loud systolic murmur was audible over the entire chest. In laboratory tests, the NT-proBNP values (11,000 pg/ml) were significantly elevated, arterial blood gases showed tendency to alkalosis, hypoxemia (PO2 45mmHg)with hypocapnia. Parameters of inflammation were moderately elevated (CRP 25mg/l, WBC 12,000/ul), with normal serum IgG4 concentrations. In TTE, significant dilatation of the right ventricle with left chamber compression were observed. Tricuspid ring dilation with no leaflets coaptation and a severe tricuspid regurgitation (Vmax 5m/s, RVSP 100mmHg) were found. In addition, the critical proximal pulmonary artery (PA) stenosis was revealed (left PA Vmax 3.3m/s, Pmax 42mmHg, right PA Vmax 5.2 m/s, Pmax 110mmHg). Angio-CT confirmed critical proximal constriction of both PAs with a flow channelup to 4 mm. Based on angio-CT and cardiac MR study the inflammatory etiology of stenoses was suspected and an empiric diagnosis of the Takayahu disease of pulmonary arteries was made. The patient was qualified for conservative treatment using prednisone and cyclophosphamide. Over the course of two months,2.8 g of cyclophosphamide were administered intravenously in three cycles with good response to the treatment. It resulted in regression of dyspnea and a improvement in exercise tolerance - to the NYHA class II, normalization of saturation. Laboratory tests showed reduction of NT-proBNP (1300 pg/ml). Control TTE revealed reduction in the size of the right ventricle and regression of PAs stenoses (left PA 11mm, right PA 7mm), also reduction of systolic flow gradients (left PA Vmax 3.1 m / s, Pmax 39 mmHg, right PA 4.1 m/s, Pmax 68 mmHg). Because of the significant improvement in patient’s condition,it was decided to continue the treatment. Legend for the Fig.1 A angio-CT, critical proximal constriction of both PA B TTE, parasternal short axis view, imflammatory infiltration C TTE, continuous wave doppler, flow velocity pattern in the PA stenosis D TTE PLAX, dilatation of the right ventricle with left chamber compression fig. 1 Abstract P1323 Figure. Fig.1 artety pulmonary stenosis

Pulmonary vein to pulmonary artery ratio in healthy and cardiomyopathic cats

Introduction/objectivesRecognition of congestive heart failure (CHF) in dyspnoeic cats is crucial for correct intervention. The pulmonary vein (PV) to pulmonary artery (PA) ratio (PV/PA) has been proposed as an index that might help discriminate dogs suffering from CHF but has never been studied in cats. We sought to determine reference intervals for various PV and PA variables in healthy cats. We then examined these variables in cats with subclinical and clinical cardiomyopathies to determine their diagnostic utility in identifying CHF. Animals, materials and methodsWe took a sample of 114 cats: 51 healthy cats, 32 subclinical cardiomyopathy affected cats and 31 cardiomyopathic cats with CHF.PV and PA were measured at the minimal and maximal diameters using M-mode images obtained from a modified right parasternal long axis view. The aorta (Ao) and left atrium were measured using two-dimensional imaging employing the right parasternal short axis view. Resultsmedian PVmin/PAmin value in healthy cats was approximately 0.51 and the PVmax/PAmax value was 0.67. The median distensibility value of the vessels was 23% for ΔPA and 41% for ΔPV. Cats with CHF had higher PVmin/PAmin, PVmax/PAmax, PVmin/Ao, PVmax/Ao values and a smaller ΔPV value compared to subclinical and healthy cats (p < 0.0001). When evaluating the diagnostic performance of these variables (in cardiomyopathic cats), PVmin/PAmin and PVmin/Ao values had higher accuracy compared to the LA:Ao value when identifying cats with CHF. ConclusionsOur study provides reference values for PV and PA variables in cats. Moreover, PV/PA variables were better factors than LA:Ao for discriminating cardiomyopathic cats with and without CHF.

Mitral annular calcification predicted major cardiovascular events in patients presented with acute coronary syndrome and underwent percutaneous coronary intervention

Background: Despite the presence of several clinical studies evaluating the association of atherosclerosis and MAC, no data is present regarding the value of MAC in predicting CV adverse events in patients with acute coronary syndrome (ACS).Methods: Prospective, observational cohort study including 314 patients presented with ACS and underwent percutaneous coronary intervention (PCI). MAC was defined by increased echodensity located at the junction of the atrioventricular groove and posterior mitral leaflet on the parasternal long-axis, short-axis, or apical four-chamber view. Patients were followed for a median 25.1 (23.1–26.5) months for any occurrence of major adverse cardiovascular events (MACE).Results: Among 316 patients 46 (14%) had MAC. Seventy (22.1%) patients had MACE during the follow-up. Patients with MACE had higher creatinine, white blood cell count (WBC), C-reactive protein (CRP), peak troponin I, glucose level at admission compared to those without MACE. Age (HR = 1.026, 95% CI = 1.004–1.049; p = .023), myocardial blush grade (HR = 0.637, 95% CI = 0.480–0.846; p = .008), MAC (HR = 2.429, 95% CI = 1.126–5.239; p = .026), and WBC at admission (HR = 1.079, 95% CI = 1.007–1.157; p = .031) were independent predictors for MACE.Conclusion: In patients presented with ACS and underwent PCI, MAC detected by TTE was an independent predictor for MACE during the long-term follow-up.

Echocardiographic Assessment of Cardiac Anatomy and Function in Adult Rats.

The use of experimental animal models has become crucial in cardiovascular science. Most studies using rodent models are focused on two-dimensional imaging to study the cardiac anatomy of the left ventricle and M-mode echo to assess its dimensions. However, this could limit a comprehensive study. Herein, we describe a protocol that allows an assessment of the heart chamber size, left ventricular function (systolic and diastolic) and valvular function. A conventional medical ultrasound machine was used in this protocol and different echo views were obtained through left parasternal, apical and suprasternal windows. In the left parasternal window, the long and short axis were acquired to analyze left chamber dimensions, right ventricle and pulmonary artery dimensions, and mitral, pulmonary and aortic valve function. The apical window allows the measurement of heart chamber dimensions and evaluation of systolic and diastolic parameters. It also allows Doppler assessment with detection and quantification of heart valve disturbances (regurgitation or stenosis). Different segments and walls of the left ventricle are visualized throughout all views. Finally, the ascending aorta, aortic arch, and descending aorta can be imaged through the suprasternal window. A combination of ultrasound imaging, Doppler flow and tissue Doppler assessment have been obtained to study cardiac morphology and function. This represents an important contribution to improve the assessment of cardiac function in adult rats with impact for research using these animal models.

Echocardiogram Analysis Using Motion Profile Modeling.

Echocardiography is a widely used and cost-effective medical imaging procedure that is used to diagnose cardiac irregularities. To capture the various chambers of the heart, echocardiography videos are captured from different angles called views to generate standard images/videos. Automatic classification of these views allows for faster diagnosis and analysis. In this work, we propose a representation for echo videos which encapsulates the motion profile of various chambers and valves that helps effective view classification. This variety of motion profiles is captured in a large Gaussian mixture model called universal motion profile model (UMPM). In order to extract only the relevant motion profiles for each view, a factor analysis based decomposition is applied to the means of the UMPM. This results in a low-dimensional representation called motion profile vector (MPV) which captures the distinctive motion signature for a particular view. To evaluate MPVs, a dataset called ECHO 1.0 is introduced which contains around 637 video clips of the four major views: a) parasternal long-axis view (PLAX), b) parasternal short-axis (PSAX), c) apical four-chamber view (A4C), and d) apical two-chamber view (A2C). We demonstrate the efficacy of motion profile-vectors over other spatio-temporal representations. Further, motion profile-vectors can classify even poorly captured videos with high accuracy which shows the robustness of the proposed representation.

A Prospective Analysis of Motor and Cognitive Skill Retention in Novice Learners of Point of Care Ultrasound.

To identify the time at which point of care ultrasound static image recognition and image acquisition skills decay in novice learners. The University of Iowa Hospitals and Clinics. Twenty-four subjects (23 first-year medical students and one first-year physician assistant student). The subjects completed an initial didactic and hands-on session with immediate testing of learned image acquisition and static image identification skills. Retesting occurred at 1, 4, and 8 weeks after the initial training session with no retraining in between. Image acquisition skills were obtained on the same healthy male volunteers, and the students were given no immediate feedback on their performance. The image identification skills were assessed with a 10 question test at each follow-up session. For pleural ultrasound by 4 weeks, there was a significant decline of the ability to identify A-lines (p = 0.0065). For pleural image acquisition, there was no significant decline in the ability to demonstrate lung sliding. Conversely, cardiac image recognition did not significantly decline throughout the study, while the ability to demonstrate cardiac images at 4 weeks (parasternal short axis view) did (p = 0.0008). Motor and cognitive skills decay at different times for pleural and cardiac images. Future ultrasound curricula should retrain skills at a maximum of 8 weeks from initial training. They should focus more on didactic sessions related to image identification for pleural images, and more hands-on image acquisition training for cardiac images, which represents a novel finding.

P6458The prevalence of left ventricular non-compaction in newborns

Abstract Background Pronounced trabeculation of the left ventricular myocardium, or non-compaction, may be accompanied by systolic dysfunction in ventricular non-compaction cardiomyopathy (LVNC). It is unclear whether non-compaction represents a fetal development defect or may develop later in life. Previous studies have estimated the prevalence of non-compaction to 0.01–0.31% in adults referred for echocardiography. The prevalences in unselected populations of adults or children are unknown. Purpose To determine the prevalence of non-compaction of the left ventricle in a large population-based cohort of newborns and to assess the relation to left ventricular systolic function. Methods Transthoracic echocardiography was performed according to a standardized protocol in all newborns included in a regional population-based cohort study in 2016–2018. For the present study, the extent of trabeculations were assessed by one of three primary reviewers in apical long-axis views (4-chamber, 5-chamber, and sinus coronarius views), parasternal short (SAX), and long axis (PLAX) views. Based on the presence of pronounced trabeculations, deep intertrabecular recesses and/or an impression of a ratio of &gt;1 of non-compact:compact myocardium (NC:C), the exam was regarded as either possible or not possible non-compaction: In examinations classified as possible non-compaction, an expert reviewer would determine if diagnostic criteria were fulfilled. A ratio of NC:C myocardium ≥2 was considered as non-compaction in accordance with previously suggested criteria. Results As of January 11, 2019, 6,880 neonate echocardiograms (median age 10 days [IQR 5,14], 48.8% females) had been analyzed. In total, 127 (1.8%) were considered as possible non-compaction. Six newborns (median age 14 days [IQR 8,18], 33.3% females) had a ratio of NC:C myocardium ≥2 corresponding to a prevalence of non-compaction of 8.7 per 10,000 newborns (95% CI 0.04–0.19%) (Figure). One of six neonates had a ratio of NC:C myocardium≥2 in more than one segment. Median fractional shortening (FS %), left ventricular end-diastolic (LVIDd) and end-systolic diameter (LVIDs) were 29.5% (IQR 27.0, 31.0), 1.9 cm (IQR 1.8, 2.1) and 1.3 cm (IQR 1.3, 1.5) respectively in the six newborns with non-compaction. The corresponding mean z-scores (standard deviations away from the age-matched reference mean) according to The Boston Children's Hospital z-score Calculator were FS: r=−3.0 (IQR r=−3.8, r=−2.5), LVIDd: r=−1.3 (IQR r=−2.7, r=−0.2), LVIDs: 0.2 (IQR r=−0.1, 1.6). 10-days-old boy with LVNC (FS 22%) Conclusion Echocardiography of an unselected population-based cohort of 6,880 newborns revealed a prevalence of non-compaction of 8.7 per 10,000 newborns. The prevalence is in accordance with previously described prevalences in adults referred for echocardiography and corroborate the view that non-compaction may be a fetal developmental defect. Non-compaction was not associated with left ventricular dilatation but with systolic dysfunction. Acknowledgement/Funding Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Gangsted Found.

P3735Incidence of bicuspid aortic valve in 16,185 neonates by echocardiographic screening in a single institution: is it really congenial?

Abstract Background Bicuspid aortic valve (BAV) has been reported to be the most common congenital heart disease with an incidence of 1 to 2% in the general population; however, its incidence in neonates is still unclear because most of the reported incidence data are based on surgical or autopsy cases in adults. Purpose To elucidate the true incidence of congenital isolated BAV in neonates by echocardiographic screening in a population-based study. Methods We examined a total of 16,185 full-term neonates (male, 48.9%) born in our institution during either of the following two periods: September 1986 to February 2008 and October 2014 to September 2017. Mean gestational age (range) was 39.4 (36 to 42) weeks, and mean birth weight (range) was 3075 (2268 to 4622) g. On the second day after birth, we performed echocardiography and colour-Doppler flow mapping in all subjects. BAV was classified into two types on the basis of morphologicfindings in the parasternal short axis view of the aortic valve: BAV with raphe harbouring two cusps and commissures, showing a congenital fusion of two underdeveloped cusps, and BAV without raphe, showing a fish mouth appearance in systolic images. BAV associated with other congenital heart diseases such as coarctation of the aorta was excluded from this study. Results BAV was identified in 14 neonates (0.09%), an incidence of 0.9 in 1,000 live births. Of the 14 BAV neonates, five had BAV with raphe, whereas nine had BAV without raphe. Of the five BAV neonates with raphe, four had fusion of the right and noncoronary cusps, whereas one had that of the right and left coronary cusps. No aortic regurgitation was detected except trivial one in only one neonate, and no significant valvar stenosis was detected. Conclusion The incidence of BAV in neonates was much lower than previously reported incidence data. An acquired fusion of the cusps may develop in later life, and eventually may result in increased incidence of functional BAV.

Improvement of abnormal systolic motion of the interventricular septum with cardiac resynchronization therapy.

There is no consensus in the literature regarding what is the responsible mechanism of left ventricular dyssynchrony; septal dyskinesia or late movement of left ventricle (LV) lateral wall. We aim to evaluate the abnormal systolic motion in each myocardial segment and the improvement of LV systolic function with pulsed tissue Doppler imaging (TDI) in patients undergoing cardiac resynchronization therapy (CRT) with left bundle branch block (LBBB). A total of 26 patients undergoing CRT implantation with LBBB, wide QRS duration (≥120ms), and low ejection fraction (EF) (<35%) were included. Pulsed TDI was taken from apical 4-chamber view and parasternal short axis view (PSAX). All echocardiographic parameters were measured when CRT is on and off. Systolic ejection time (ET) of anteroseptal and posterolateral wall of LV in PSAX was statistically significantly longer in CRT on group (321.6±62.7vs 237.5±59.3 ms, P<.001; 323.9±58.0vs 289.4±43.7 ms, P=.015, respectively). In apical 4-chamber view, septal annulus systolic ET is significantly longer in CRT on group than CRT off group (315.8±57.2vs 287.3 ± 42.2, P=.014). Also, there was a strong correlation between systolic ET of the septum in PSAX with aortic velocity time integral (VTI), QRS duration and EF (r=.587, P=.002; r=.479, P=.013; r=.440, P=.025; respectively). Circumferential contraction of septal myocardial fibers is improved with CRT and it is strongly correlated with increase of aortic VTI and shortening of QRS duration. These findings predict the deterioration of septal contraction as the main mechanism in patients with LBBB pattern and, CRT may improves myocardial contraction by correcting septal systolic motion.

Percent Deviation from Midline Coaptation- When to Suspect Bicuspid Aortic Valve

Background: Bicuspid aortic valve (BAV) is typically diagnosed by visualization of aortic valve leaflet opening during systole in parasternal short axis (PSAX) echocardiographic images. The leaflets are often seen poorly in PSAX view due to suboptimal acoustic windows or poor imaging techniques but are usually seen well in parasternal long axis (PLAX) view. Although the eccentric leaflet coaptation in PLAX view has been previously described the degree of eccentricity that should alert clinicians of the presence of BAV is not established in children. The …

Clinical study on short axis M-mode echocardiography in Crossbred Holstein Friesian Cows

The present study was conducted in apparently healthy Crossbred Holstein Friesian cows (n=40) to establish normal echocardiographic indices. The short axis M-mode echocardiography was conducted in non-sedated standing Crossbred Holstein Friesian cow using cardiac probe of 2.8 to 3.6 MHz from right parasternal short axis view. The clinico-physiological parameters were within the normal ranges. The mean ± SE of RVIDd was 3.40 ± 0.06 (2.61 - 4.42) cm, IVSd 1.88 ± 0.06 (0.95 -3.17) cm, IVSs 2.72 ± 0.07 (1.77-3.81) cm, LVIDd 7.35 ± 0.14 (4.82-9.23) cm, LVIDs 4.37 ± 0.12 (2.04-5.87) cm, LVPWd 1.76 ± 0.06 (1.03-2.56) cm, LVPWs 2.80 ± 0.08 (1.58-3.96) cm, RWTd 0.50 ± 0.02 (0.35-0.85) cm, RWTs 1.31 ± 0.06 (0.84-2.83) cm, MWTd 1.89 ± 0.06 (1.23-3.03) cm, MWTs 2.76 ± 0.06 (1.85-3.74) cm, IVS % (46.17 ± 2.46), LVPW % (60.39 ± 2.64 ), LVM (1007.35 ± 53.78) g, LV myocardial fraction (0.33 ± 0.01), EPSS (0.86 ± 0.02) cm, FS % (40.68 ± 1.20), heart rate (66.15 ± 0.96) beats /min and body weight was 426.78 ± 7.79 kg. The correlation with the body weight revealed negative correlation (p less 0.01) for the parameters viz RWTs.

ASSOCIATION BETWEEN EPICARDIAL ADIPOSE TISSUE MEASURMENT BY TRANSTHORACIC ECHOCARDIOGRAPHY AND MULTISLICE COMPUTED TOMOGRAPHY IN PATIENTS WITH ABDOMINAL OBESITY

Objective: To assess the correlation between epicardial adipose tissue (EAT) thickness, measured by echocardiography, and the EAT volume, measured by multislice computed tomography (MSCT), in patients with abdominal obesity.Design and method: The study included 68 patients (57.5% - men, 42.5% - women), mean age 37.25 ± 6.88 years with abdominal obesity (waist circumference > 80 cm in women and > 94 cm in men). EAT thickness was measured using transthoracic echocardiography (SystemFive, USA) on the free wall of the right ventricle from both parasternal long and short axis views at end systole and end diastole during three cardiac cycles. EAT volume, intraabdominal visceral adipose tissue volume and subcutaneous adipose tissue volume were measured by MSCT (ToshibaAquillion 640, Japan). Results: EAT volume was positively correlated with intraabdominal visceral adipose tissue volume (r = 0,59). Negative correlation was found between EAT volume and the ratio of subcutaneous adipose tissue to intraabdominal visceral adipose tissue (r = −0,39). EAT thickness at end systole was correlated with EAT volume by MSCT (r = 0,45). There was no correlation between EAT thickness at end diastole and EAT volume. Conclusions: These data suggested that EAT is strongly associated with intraabdominal visceral adipose tissue and could indicated visceral obesity. Echocardiographic measurement of EAT was showed a significant correlation with the MSCT EAT measurements. Echocardiography EAT thickness could be used as an easy and reliable imaging indicator of visceral obesity and cardiovascular risk assessment.

Comparison of Left Ventricular Mass Calculation Methods via Two-Dimensional Echocardiogram in Children, Adolescents, and Young Adults With Systemic Hypertension

Left ventricular (LV) mass is a major determining tool for myocardial injury in hypertensive patients. Issues with LV mass calculations exist given that there are multiple methods to assess mass, including from the parasternal long axis (PLA), parasternal short axis (PSA), and 2-dimensional (2D) volumetric methods. The aim of this study was to compare the agreement of LV mass calculations using the PLA, PSA, and 2D volumetric methods. This study retrospectively reviewed 200 consecutive, initial echocardiograms for the indication of hypertension. A single reader calculated the LV mass in each patient via the PLA, PSA, and 2D volumetric methods. Percent differences for each study were calculated. LV mass threshold cutoffs of 51 g/m2.7 (cardiac organ injury) and 38.6 g/m2.7 (elevated LV mass) were used to compare categorical differences between the different measurement methods. Paired comparisons demonstrated an absolute mean percent difference of 8.46% to 9.41% among the different methods. LV mass calculated by the 2D volumetric method was less compared with PLA and PSA methods (31.64 vs 33.90 vs 35.51 g/m2.7; p < 0.0001). Fewer patients were classified as having cardiac target organ injury or elevated LV mass via 2D volumetric calculation, compared with PLA and PSA methods (p = 0.02 and p = 0.03, respectively). In conclusion, there is a small but important difference in LV mass calculations for patients with hypertension. These results emphasize the need for consistency within echocardiography laboratories as surveillance studies are common in this patient population.