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S 132
Abstracts
876
Myocardial performance index and flow propagation velocity in left
ventricular function assessment in patients with low ejection fraction
and different types of diastolic dysfunction
A. Wojlarowicz, M. Peregud-Pogorzelska, E. Plonska. Klinika Kardiologii PAM,
Cardiology Dept., Szczecin, Poland
Purpose: Similar grade el the lell ventricular (LV) syslolic injury can coexisl wilh
diflerenl grade of diastolic dysfunction. Patients wilh reslriclive inflow pallern have
more severe dysfunction than those wilh impaired relaxalion. Myocardial pedormance index (MPI) (Tel inde(), and flow propagation velocily (Prop) are helplul
in LV global lunction estimation, but their uselulness in diflerenl types of diastolic
dyslunction is not well recognized.
Methods: We studied 71 pts with ischemic hearl disease or primary dilaled cardiomyopathy, with LV ejection lraclion (EF) <45%, on sinus rhythm, and wilhoul
valvular disease. In 41 pls there was impaired LV relaxalion (E/A ralio<0,7), (group
REL), and in 30 reslrictive inflow pattern (E/A ralio>2,0), (group RES). We assessed: LV endsyslolic and enddiastolic dimensions, lelt alrial (LA) dimension, LV
EF, velocily el mitral E and A waves and E/A ratio, E wave deseleralion lime, and
Prop. MPI and Prop/E ralio was calculated.
Results: Mean age, body sudace and heart rate in assessed groups were comparable. In RES there were higher dimensions el LV in diastole (6,94-1,1 cm vs
6,44-0,8 cm; p<0,05) and in systole (5,74-1,1 cm vs 5,04-0,9cm; p<0,01) and LA
(4,84-0,5 cm vs 4,24-0,6cm; p<0,02), than in REL. In RES EF was lower than
in REL (26,34-7,2% vs 35,54-8,2%; p<0,001). E,'Prop ratio was higher in RES
(2,64-0,6) than in REL (1,64-0,5); p<0,0001. Paradoxically, MPI was higher in
REL (0,724-0,2 vs 0,624-0,2; p<0,05) and Prop in RES (38,44-7,5cm/s, in REL
30,44-9,7cm/s; p<0,001). In REL we observed significant correlations between:
Prop and EF (r=0,55), MPI and EF (r= -0,43), Prop and E/A (r=0,58), and Prop and
MPI (r= -0,44). In RES there were no significant correlations between eslimaled
paramelers.
Conclusion: Myocardial performance index and flow propagation velocity is more
useful in global LV function assessmenl in patients with mild diastolic dyslunction than in those wilh restriclive inflow patlern. The reason can be more complex
mechanism of severe diastolic dysfunction.
877
Could tissue Doppler reflect the degree of myocardial dysfunction in
patients with dilated cardiomyopathy?
AN.A. Galrinho, R. Soares, L.i Moura Branco, A. Timoleo, A. Fiarresga,
J.~. Abreu, A. Leal, J. Quininha. Lisboa, Portugal
Tissue Doppler (TDI) is a recent echocardiographic technique that analyzes the
velocity el myocardial segments and long-axis venlricular funclion. Several sludies
showed the importance el this technique in the sludy el palienls (pls) with impaired
left ventricular function. The purpose of our sludy was the analysis el a populalion
with idiopathic dilated cardiomyopathy (DCM), comparing TDI profile wilh the degree el left ventricular dysfunclion, also evalualed by nalriurelic peplide (proBNP)
and maximal VO2 measured in cardiorespiralory e(ercise test.
Material and methods: Our population consisted in 33 pls with DCM, medium
ejection lraction (EF) el 31%. We divided the patients (pls) in two groups: Group I
(GI)-pls with EF < or = to 30% (n= 15 pts, mean EF-) and Group II (GII)-pls wilh
EF > 30% (n= 1810is, mean EF -).
We analyzed the following echocardiographic characterislics: dimensions el lell
atrium (LA) and lell ventricle (LV) in diastole (LVDD) and syslole (LVSD), endvolumes of LV in diastole (EDV) and systole (ESV), mitral flow velocilies (E, A, E to
A ratio, deceleration time (DT), TDI of mitral ring in two dilferent points - seplum
(m) and lateral wall (I) with measuremenls el E', A' and syslolic (S') velocilies and
E to Em ratio.
Results: There were no dilferences concerning gender, pls el GI were older (GI:
55,1 versus (vs) 47,8 years; p= 0,028). GI had grealer LV in diastole and systole, grealer EDV and ESV, all ,31these parameters wilh significant value (p<0,01).
There were no dilferences regarding milral flow velocilies and DT. In GI, DTI el
milral ring (seplum) were (in cm/sec) E'm: 4,6; A'm: 5,5; S'm: 3,8 and lateral wall
velocities - E'I: 8; A'I: 6,2; S'I: 4,9. In GII the velocities were the followings: E'm:
6,2; A'm: 7,2; S'm: 5,3; and in the lateral wall: E'I: 10; A'I: 7,6; S'I: 6,7, wilh significant values between the two groups lot E', A' and S'. There were differences
belween the two groups concerning proBNP (GI - 5464pg/ml vs GII -1119pg/ml;
p=0,0038) and VO2 max (G1:17,8 vs GII: 22,7; p=0,009).
In conclusion: TDI is an echocardiographic sensitive marker el lell venlricular impairemenl and reflects the severity and the degree of the dyslunclion in dilaled
cardiomyopathy; lower velocilies are oblained in patients wilh higher loll venlricular impairemenl (and higher pro-BNP values).
the isovolumic lime intervals to the sum el the helerovolumic lime intervals (ejeclion lime and filling lime). The IM inde< has been evalualed in a population of
palienls (pls) wilh acute myocardial inlarclion, demonslraling a prognostic value
comparable to the Tolal Ejection Isovolume (TEl) index, a well validaled parameter
o! syslo-diaslolic cardiac pedormance (Chest. 2003;124:1645). Aim el the presenl
sludy is to assess the behaviour el I/H, TEl, and lelt ventricular ejection lraclion
(LVEF) in a population with chronic heart lailure (CHF), and their correlations with
symptoms (NYHA class).
Methods: The study population consists of 10910is wilh CHF studied consecutively
(71 males, 38 females, mean age 714-11). By PW Doppler, 3 lime inlervals were
measured in all pls: a) interval between two mitral inflow periods, b) ejection time
and c) the milral filling period. TEl index was calculated, as previously described,
as [Ca - b)/b]; 1/14was calculated as [(a - b)/(b + c)].
Resulls: Mean LVEF was 444-1 00/0, mean TEl index was 0.654-0.32, mean I/H
index was 0.254-0.12. Linear correlation TEl inde(-LVEF was r=-0.49 (p<0.0001),
I/H index-LVEF was -0.57 (p<0.0001). The direcl TEl inde(-I/I-I index correlation
was highly significant (r=0.84; p<0.0001). The areas under the ROC curves to
idenlily 10is in NYHA class Ill-IV were respeclively 0.79 lor LVEF (besl cul-olf =
41%), 0.72 for I/H index (best cul-ofl = 0.26), 0.69 lor TEl index (besl cul-olf =
0.64).
Table shows the mean values of the 3 indexes in pts wilh NYHA class I-II and Ill-IV.
Table I
LVEF
TEl index
I/H index
NYHA I-II (n=73)
474-10
0604-033
0224-010
NYHA Ill-IV (n=36)
374-8
0754-028
0314-013
P<0 0001
P<0.05
P<0.001
Conclusions: In our series of pls with CHF, LVEF is the parameter more correlaled to symploms. Among global myocardial pedormance measures, the I/H index
seems to be al least as elfeclive as or even superior to the more known TEl index.
Furlher sludies are needed to assess the additional prognostic value el IM index
in pls wilh CHF.
879
Mitrat annulus motion predicts EF alter aortic valve replacement in the
patients with aortic stenosis
T. Kalova 1, M. Beyer 2, V. Yolova 1, V. Koslova 1. I National Heart Hospital,
Department of Non-lnvasive Cardiology, Sofia, Bulgaria; 2Zentralklinikum, Klinik
fur Herz und Thoraxchirurgie, Augsburg, Germany
Echocardiography determination ol the amplilude of milral annulus displacement
(AMAD) is uselul melhod clinically used for assessment of the lelt ventricular func-
lion.
The goal el the study was the verilying el hypothesis whether AMAD could predicl the ejeslion lraclion (EF) in the early posloperalive period afler aortic valve
prosthesis in adull palienls with degenerative valve slenosis as well as analyze the
relalionship of AMAD and EF with the extent el aorlic valve slenosis.
Methods: 37 patients with degenerative aortic valve slenosis and without significanl CAD hospilalised lor operation in the Clinic of Cardio Surgery, Augsburg, were
included in this sludy.Echocardiography analysis was made in the day before the
operation as well as in 5-1h and 7-th days alter the operation.
Resulls: AMAD was shown according to aortic valve area (AVA) and postoperative
EF on the table: 1 .The preoperative magnilude of AMAD was 10.84-9.4 mm, and
posloperalive magnitude of AMAD was additionally decreased al maximum in the
seplal zone el the annulus (lrom 10.74-3.6 mm to 8.84-4 mm)
The sensilivily of AMAD used for prediction el aorlic slenosis severity al resolution
value el 1,0 cm 2 was 92% - 25/27, specificity: 50% - 5/10, posilive predicting
value:&3% - 25/30 and negative predicting value: 71% - 5/7.
The sensilivily of AMAD used lor prediction el posloperalive EF el the lelt ventricle
was 30/31 - £'7%, spesificily: 4/6 - 66%, positive prediclin9 value: 30/32. - 93%
and negative predicting value: 4/5 - 80% respeclively.
Table 1
Preoperative
Postoperative
AVA < 1.0 crn2
AVA > 1.0 cm2
EF <55%
EF > 55%
AMAD< 10mm
25
5
0
2
AMAD >10ram
2
5
1
4
Conclusions: Our results allow consideration lot the predicling value of the amplilude el milral annulus displacement in the echocardiography constellation of indexes lot aorlic valve prosthesis indication in adult patients.
878
Comparison of global myocardial performance indexes and lelt
ventricular ejection fraction in patients with chronic heart failure
880
Long term follow-up of patients undergoing surgical left ventricular
reduction of leR ventricular aneurysm
F. Antonini Canlerin 1, F. Baldessin 1, D. Rivaben 1, BA. Popescu 2,
A.C. Popescu 3, R. Piazza 1, G.L. Nicolosi ~. ~Azienda Ospedaliera "S. Maria degli
S. Fralini 1, S. Romano 1, U. Minuli 2, R. Gregorini 2, A. Mazzola 2 , M. Penco 1.
Angeli", Cardiologia, Pordenone, Italy; 2Institute of Cardiology, Bucharest,
Romania; 3Elias Hospital, Bucharest, Romania
Background: A new myocardial perlormance i n d ~ has been recently developed:
the isovolumic/heterovolumic lime ratio (I/H), that is obtained by relating the sum ol
Eur J Echocardiography Abstracts Supplement, December 2005
I L'Aquila Universily, Cardiology, L'Aquila, Italy; 2 Teramo Hospital Cardiac
Surgery, Teramo, Italy
Background: The endovenlricular patch aneurysmeclomy, initially proposed by
Jalene and subsequently modified by Dor, is pedormed wilh the aim of restoring
the morphology ol the lell venlricular cavity and improving its perlormance. The