HIT Poster session 2P479Strain concordance in a real-world setting: experience in our laboratory after equipment upgradeP4803D echocardiography is a fast-learning and reliable method for the measurements of left atrial volumesP481Echocardiographic parameters associated with long-term appropriate antiarrhythmic therapies in cardiac resynchronization therapy defibrillator patientsP482Noninvasively measured global wasted myocardial work allows for quantitative assessment of typical left ventricular mechanical dyssynchrony pattern in patients with left bundle branch blockP483The impact of adherence to physical exercise on the improvement of cardiovascular remodeling and metabolic status in healthy untrained postmenopausal womenP484The impact of the latest chamber quantification recommendations on the prediction of left atrial appendage thrombus presenceP485The cardiac-enriched miRNAs plasma levels (miR-1, miR-133a, miR-499) reflect the impaired left ventricular systolic function and correlate with cardiac necrosis markers in early phase of NSTE-ACSP486Acute regional myocardial deformation changes in patients with severe aortic stenosis and preserved ejection fraction after isolated aortic valve replacementP487Left ventricular rotational deformation in asymptomatic patients with chronic aortic regurgitation and normal left ventricular ejection fraction P488The appropriate use of transthoracic echocardiography for the exclusion of infective endocarditisP489In patients with hypertrophic cardiomyopathy, left ventricular mass and shape by three-dimensional echocardiography are related with dynamic obstruction and functional capacityP490Mitral leaflet sizing in hypertrophic cardiomyopathy: impact of method and timingP491Echocardiographic predictors of atrial fibrillation in obese womenP492Echocardiographic risk factors for 30 day mortality after the hybrid procedure for hypoplastic left heart syndromeP493Left ventricular mass is an independent predictor of coronary flow reserve: insights from a single centre stress echo cohortP494Transesophageal echocardigoraphy uner conscious sedation for guiding cryoballoon pulmonary vein isolation in paroxysmal atrial fibrillation - the safety and feasibility studyP495Transesophageal echocardigoraphy under conscious sedation for guiding cryoballoon pulmonary vein isolation in paroxysmal atrial fibrillation - the safety and feasibility studyP496Three-dimensional trans-esophageal echocardiography assessment of the immediate morphological changes of the mitral annulus after percutaneous mitral edge-to-edge repairP497Clinical value of global and regional longitudinal strain in prediction of myocardial ischemia in asymptomatic diabetes type 2 patientsP499Comparison of prognostic operative risk impact on the global longitudinal strain right ventricle (GLS RV) and tricuspid annular plane systolic excursion (TAPSE) values in patients with ischemic cardioP498Right heart function in early diastolic dysfunction: 2D...
Background: Myocardial deformation imaging by speckle tracking (ST) represents one of the latest improvements in echocardiography. Clinical application has been limited by the lack of agreement between different companies. When a laboratory is equipped with new technology, the concordance between vendors should be analyzed. Methods: We performed echocardiographic studies in 36 patients (men: 55,6%, age: 55,8 ± 15,9 years) with several indications (coronary artery disease: 22,2%, heart failure: 16,7%, normal subjects: 36,1%). All images were acquired in the same machine (EPIQ7, Philips®). Afterward we used two software packages to conduct myocardial deformation analysis, first with raw data (QLAB v.10.3, Philips®) and later with images stored in DICOM format (VVI v.2.0, Siemens®), always by the same operator. After checking appropriate identification and tracking of the endocardium, either manual or automatically, values of GLS (global longitudinal strain), LS4C (longitudinal strain in apical 4C), LVEF (left ventricle ejection fraction) and LVEDV (left ventricle end-diastolic volume) were obtained. To assess concordance we used intraclass correlation coefficients (ICC) and Bland-Altman analysis with bias (mean difference) and 95% limits of agreement (LOA).Results: Values of ICC for GLS and LS4C show moderate concordance (Table), meanwhile LVEF and LVEDV have coefficients > 0,90. Bland-Altman plot for GLS (Figure) show a wide range of LOA, which in the understanding of the authors, represents a clinical meaningful difference; particularly in the follow-up of patients (cardiotoxicity, asymptomatic valvular disease, etc), setting in which is often used GLS.Conclusions: Myocardial deformation parameters obtained by ST using different vendors show limited concordance, even when the same operator performs the analysis; whereas echocardiographic data as LVEF and LVEDV has better agreement. All laboratories should be aware of this variation when new equipment is acquired. View this table:Enlarge tableConcordance analysisICC (CI95%)p valueBland-Altman:mean difference (LOA95%)GLS (%)0,63 (0,11-0,86)< 0,05-3,92 (-11,11 a 3,27)LS4C (%)0,74 (0,15-0,91)< 0,05-3,77 (-9,39 a 1,85)LVEF (%)0,90 (0,68-0,96)< 0,053,99 (-7,47 a 15,45)LVEDV (mL)0,94 (0,88-0,97)< 0,05-3,87 (-43,63 a 35,89)ICC: intraclass correlation coefficients, LOA95%: 95% limits of agreement, GLS: global longitudinal strain, LS4C: longitudinal strain in apical 4Ch, LVEF: left ventricle ejection fraction, LVEDV: left ventricle end-diastolic volume.Download figureOpen in new tabDownload powerpoint P479 Figure. Infective endocarditis (IE) is a potentially lethal disease, which is associated with high mortality and severe morbidity. According to the ESC Guidelines transthoracic echocardiography ( TTE ) is the first imaging choice for investigation for IE. The major echocardiographic findings for identifying IE include direct visualization of a vegetation or other hallmarks of the disease such as pseudoaneurysm or abscess formation. Sensitivity for the in native and prosthetic valves is 70% and 50%, respectively for TTE.The modified Duke criteria were proposed as a standardised method of assessing the likelihood of the presence of IE. According to this classification, patients can be categorised in three ways: "definite", "possible", and "rejected". Systematic reviews have shown that TTE is largely over utilised and often provides little additional clinical information.In order to review this hypothesis, 680 patients referred for TTE for possible endocarditis from October 2014 to October 2015 were analysed in a single tertiary referral centre. All patients over 16 years of age that had been referred as an inpatient TTE for endocarditis were included. All patients underwent standard TTE with images and measurements taken according to the British Society of Echocardiography minimum dataset.Statistical analysis was carried out using SPSS version 22, with a p value of < 0.05 considered significant. 91 patients were excluded as they were below the age cut off. In the remaining 589 patients, evidence of IE was seen in 7 (1.18%) patients. The mean age of the population was 60.8 years (range 16 – 98 years), and 54% were male. Univariate analysis was performed. The significant independent predictors for a positive TTE were central venous access, injected drug use and positive blood cultures. Through strict application of the modified Duke criteria, 8 cases (1.3%) were classed as ‘definite’, 14 cases (2.3%) were classed as ’possible’, 567 cases (96.4%) were classed as ‘rejected’.In the current cost-conscious NHS it seems inappropriate to use advanced imaging techniques such as TTE if it adds little additional clinical information in an identifiable patient population. Over 90% of the TTE referrals in our series could have been avoided by the judicious use of appropriate clinical criteria. View this table:Enlarge tableIndependent predictors for IE on TTEClinical criteriaOR (95% CI)p valueCentral venous access7.4 (1.6-33)30 mmHg during Valsalva) and NYHA functional class.Methods. In 75 HCM patients (pts) with preserved LV ejection fraction (EF>50%) and 75 age- and gender-matched controls, LV volumes, LV mass (LVM), sphericity index (SphI) and 3D strain parameters were measured by EchoPac BT13 (GE Vingmed, Horten, N). Pts with more than mild mitral regurgitation were excluded.Results. With respect to controls, HCM pts had smaller LV volumes, larger LVM, LVM/end-diastolic volume and EF, lower 3D strain magnitudes (p83 g/m2 and LVM/EDV>1.8 identified symptomatic patients (AUC=0.66 and 0.65, p30 mmHg during Valsalva) were explored.Results. Both anterior and posterior leaflets were significantly longer in HCM than in controls (total ALL 23±3 vs 19±2 mm; total PLL 20±3 vs 13±2 mm, p<0.001). However, due to the anterior displacement of coaptation in systole, HCM patients had larger closure PLA and smaller closure ALA than controls, even after indexing for MAA (PLA/MAA 0.64±0.12 vs 0.44±0.08; and ALA/MAA 0.53±0.10 vs 0.69±0.09 for HCM vs controls; p<0.0001 for both).By ROC curve analysis, the best ability of discriminating obstructive (n=20) vs nonobstructive HCM pts (n=55) was found for PLA/MAA at MS (AUC=0.88; cutoff of 0.68), better than for ALA/MAA at MS (AUC=0.70; cutoff of 0.48)(p<0.001 for both). Indexation to MAA further improved the ability of leaflet closure areas to separate pts with LVOTO (p<0.01). Total diastolic ALL and PLL by 2DE showed the weakest relationship with LVOTO, even after indexing for LVOT diameter (AUC=0.54-0.58).Conclusions. MV leaflet-to-annulus area ratio measured at MS by transthoracic 3DE showed a significantly stronger relationship with the presence and the severity of LVOTO than total diastolic leaflet lengths measured by 2DE in HCM patients. Quantitative 3DE analysis of MV abnormalities should complement the routine imaging assessment in patients with known or suspected HCM. Background: Obesity and atrial fibrillation (AF) are two major growing epidemics associated with considerable morbidity and mortality. Obesity is a risk factor for AF but there are limited data for structural and functional echocardiographic parameters for predicton of AF occurrence in obese women.Purpose: To identify echocardiographic predictors for AF occurrence in obese women.Methods: Our study enrolled 44 age-matched women with mild obesity ( 30 without AF and 14 with