Download Moderated poster session 2

Eur
Abstracts Supplement, December 2006
S48 J Echocardiography
Abstracts
MODERATED POSTER SESSION 2
Thursday, 7 December 2006, 14:00–18:00
Location: Poster Hall
HYPERTENSION/LV HYPERTROPHY
383
Carotid arterial flow control in hypertensive patients- analysis by
wave intensity
K. Niki 1 ; M. Sugawara 2
1
Tokyo Women’s Medical University, Cardiovascular Sciences Dept., Tokyo,
Japan; 2Himeji Dokkyo University, Medical Engineering Dept., Himeji, Japan
Background: Wave reflection from the head and neck augments pressure
and decelerates flow in the carotid artery. Wave intensity (WI) has the potential to separate peripheral (head and neck) effects from ventricular effects on
pressure and flow waves. WI is defined as the product of the time derivatives
of blood pressure (P) and velocity (U): WI=(dP/dt)(dU/dt). The negative value
of WI indicates that the effects of reflected waves are predominant. Therefore, the integral of negative values (NA) of common carotid arterial WI in
a cardiac cycle is attributed to reflection from the head and neck. To elucidate
the characteristics of carotid arterial flow control in hypertensive subjects,
we applied WI analysis.
Methods: We measured WI in 64 hypertensive patients (HT) (mean age 63±4
years, mean systolic/diastolic pressure 149±11/82±10 mm Hg) and 63 agematched normal subjects (N) (mean age 63±7 years, mean systolic/diastolic pressure 121±17/70±10 mm Hg) with a noninvasive WI measuring system (SSD 6500, Aloka Co), which simultaneously measured common carotid arterial blood flow velocity and diameter change. The diameter change
waveform calibrated by blood pressure by upper arm automated sphygmomanometry was used as the pressure waveform. The volume flow rate (Q)
was calculated as the integral of the product of cross-sectional mean velocity and cross-sectional area of the artery over a cardiac cycle, multiplied by
heart rate.
Results: The maximum diameter was larger (8.30±0.7 vs 7.8±0.7 mm,
p<0.0001) and the maximum blood flow velocity was lower (50±14 vs 55±
± 11 cm/s, p<0.05) in HT than N. NA was greater (38±19 vs 26±15 mm Hg m/s2,
p<0.0001) in HT, which suggests higher reflection from the head and neck.
There was no difference in the highest values of WI and Q between HT and
N (WI: 10.6±6.4 vs 8.6±3.6 mm Hg m/s3, Q: 658±158 vs 680±178 ml/min).
Conclusions: The common carotid artery in HT had larger diameter and
lower blood velocity, i.e. reduced shear stress. Q was maintained at the
same values as N with enhanced reflection from the cerebral circulation.
384
Left atrial enlargement and aortic stiffness in newly diagnosed
subjects with essential hypertension
P. Missovoulos 1 ; C. Tsioufis 2 ; E. Taxiarchou 1 ; C. Katsaris 2 ; I. Skiadas 2 ; I. Vlasseros 2 ; C. Stefanadis 2 ; I. Kallikazaros 2
1
Ippokration General Hospital, Cardiology Dept., Athens, Greece
2
Hippokration Hospital, Cardiology Dept., Athens, Greece
Purpose: Both, left atrial (LA) enlargement and aortic stiffness are early sings
of hypertensive heart disease and are associated with adverse cardiovascular outcomes. The possible interrelationship between aortic stiffness and LA
size in hypertensive subjects was investigated in this study.
Methods: We studied 98 consecutive newly diagnosed subjects (aged 51±8
years) with stage I-II untreated essential hypertension (office blood pressure=56/101 mm Hg) and 34 normotensives, matched for age, sex, body
mass index and smoking status. All subjects underwent a complete
echocardiographic study and 24-hour ambulatory blood pressure monitoring. LA volume was measured according to an established method and was
indexed for body surface area to estimate LA volume index (LAVI). More-
Eur J Echocardiography Abstracts Supplement, December 2006
over, aortic stiffness was evaluated on the basis of the carotid-femoral pulse
wave velocity (PWV) measurement by an automatic device (Complior SP).
Results: Hypertensives compared to normotensives had increased left ventricular mass index (LVMI) (105.4±26.5 vs 84.3±14.0 gr/m2, p<0.0001), LA
diameter (39±4 vs 36±5 mm, p<0.0001), left atrial volume (43.7±13.2 vs
36.0±8.8 ml, p=0.005), and LAVI (22.0±6 vs 19.5±5 ml/m 2, p<0.05).
Hypertensives had also greater PWV compared to normotensives (8.5±1.3
vs 7.6±1.1 cm/sec respectively, p=0.001). In the entire study population,
LAVI exhibited positive relationships with LVMI (r=0.405, p<0.0001), 24-hour
pulse pressure (r=0.269, p<0.05) and PWV (r=0.214, p<0.05).
Conclusions: Our results indicated that in patients newly diagnosed uncomplicated essential hypertension LA enlargement is accompanied by impaired aortic elasticity, suggesting that there may be a common pathophysiologic pathway linking these two entities.
VASCULAR FUNCTION/AORTIC DISEASE
385
Non-invasive assessment of arterial pressure wave reflection in
evaluation of large artery function and cardiac load: can we do
without ultrasound?
P. Segers 1 ; E.R. Rietzschel 2 ; M.L. De Buyzere 1 ; D. De Bacquer 1 ; L.M. Van
Bortel 1 ; G. De Backer 1 ; T.C. Gillebert 2 ; P.R. Verdonck 1 on behalf of:
Asklepios Investigators
1
Ghent University, Hydraulics Laboratory, Gent, Belgium; 2Ghent University
Hospital, Cardiovascular Diseases Dept., Ghent, Belgium
Background: Early return of pressure wave reflection increases central (pulse)
pressure and the load on the heart, and indices such as the augmentation
index (AIx) allow quantifying the added contribution of the reflected wave to
the pulse pressure. Computation of AIx, however, fully relies on the identification of characteristic landmarks on the pressure waveform that are associated with the timing of the reflected wave, such as an inflection point. We
hypothesize that a more correct timing of arrival of the reflected wave (and
associated calculated AIx*) can be obtained using Doppler measurement of
aortic flow in conjunction with the central pressure waveform.
Methods: Carotid pressure (Pwf) and central flow (Qwf) waveforms were
acquired non-invasively in 2132 apparently healthy subjects (1093 F/1039 M),
aged between 35 and 55 at inclusion (a subgroup of the ‘Asklepios’ population). Pwf was obtained using applanation tonometry at the common carotid
artery; Qwf was assessed from Doppler flow velocities measured in the left
ventricular outflow tract, multiplied with its cross-sectional area. AIx was assessed directly from Pwf, with the timing of the inflection point (Ti) detected
automatically using a second order derivative algorithm. Alternatively, we
used Pwf and Qwf to separate Pwf into its forward and reflected component,
and the timing of the return of the reflected wave (T*) was defined as the
moment where the reflected waves adds to the forward wave. AIx* was calculated.
Results: T* was systematically larger than Ti, both in women (22.3±1.0 ms;
mean±SEM, p<0.001) as in men (12.8±1.3 ms, p<0.001). AIx, adjusted for
subject height and systolic ejection time, was higher in women than in men
(117.2±0.5 vs 112.8±0.5; p<0.001). In contrast, similarly adjusted AIx*
yielded equal values in both (110.15±0.46 vs 110.21±0.48, p=0.94). Data
analysis further demonstrated that, using T* and measured pulse wave velocity, the distance to the apparent reflection site (effective length of the
arterial tree) moves towards the heart with age - as anticipated - while the
opposite was true when using Ti.
Conclusion: Our data demonstrate that analysis of wave reflection using
a modified AIx*, with timing of the reflected wave obtained from the pressure
Abstracts
and flow waveform, yields more consistent results than „conventional” AIx.
In particular, (adjusted) AIx* is no longer prone to spurious gender differences, and the method yields age-related evolution of the effective length
consistent with standard hemodynamic textbooks.
386
Ventriculo-arterial coupling in uncomplicated obesity: a wave
intensity analysis study
E. Malshi 1 ; C. Morizzo 1 ; M. Kozakova 1 ; E. Muscelli 1 ; S. Camastra 1 ; AG. Fraser 2 ; C. Palombo 1 ; E. Ferrannini 1
1
University of Pisa, Internal Medicine Dept., Pisa, Italy; 2Wales University,
Cardiovascular Research Institute, Cardiff, United Kingdom
Obesity is an insulin resistance (IR) state associated with increased risk of
heart failure (HF). Large artery stiffness may contribute to HF through an unfavorable ventriculo-arterial (VA) coupling. A role of IR in promoting large artery
stiffness independent of other risk factors in obesity is not yet established.
Aim: To explore hemodynamic and metabolic correlates of large artery stiffness, and its impact on VA coupling, in otherwise healthy subjects with isolated obesity and normals.
Methods: Eighty-one subjects (age 41±12; 35 males; BMI 32±9, range
19-59 kg/m2; BP 126±15/76±10 mm Hg), free of heart disease, HBP, diabetes,
dyslipidemia were studied. LV pump function (CO and EF) was assessed by
2D Echo. Arterial mechanics was evaluated at carotid level by vascular ultrasound (Aloka SSD-5500) implemented with a double beam tracking system
providing distension waveforms, diameter-derived pressure and flow. Pressure independent stiffness index (ß) and pulse wave velocity (PWV) were
estimated. By wave intensity analysis (time-dependent product of first derivatives of BP and flow), an index of LV inotropic function was obtained by
the amplitude of the early-systolic peak (forward compression wave, FCW).
Insulin sensitivity was estimated from plasma glucose and insulin responses
to O-GTT (OGIS index).
Results: Waist to hip ratio (W/H) correlated directly with MBP, CO, PWV,
b (r: 0.34-0.41, p<0.01), but not with EF and FCW. OGIS correlated inversely
with W/H, CO, MBP (r: -0.45 to -0.47, p<0.005) but not with stiffness. PWV
and ß correlated directly with age and MBP (r: 0.35-0.63), but not with OGIS.
In a sex-adjusted multivariate model, age and MBP were independent predictors of stiffness (adjusted r2: 0.57). Both PWV and ß were inversely related to FCW (r: -0.27 for both, p<0.05), but not to CO and EF.
Conclusions: In otherwise healthy subjects from lean to morbid obesity,
visceral adiposity is associated with increase in CO, BP and carotid stiffness. Visceral adiposity and changes in systemic hemodynamics are associated with IR. Increased carotid stiffness paralleling visceral adiposity results from increased BP more than from an independent effect of IR.
WI analysis, but not established indices of LV performance, discloses an
unfavorable VA coupling in obesity.
387
Increased Aorta Stiffness Alters The Left Ventricular Rotation In
Patients With Dilated Cardiomyopathy
A. Patrianakos 1 ; F.I. Parthenakis 2 ; J. Karalis 2 ; G. Lyrarakis 2 ; P. Kafarakis 2; E. Foukarakis 2 ; A. Zaharaki 2 ; P.E. Vardas 2
1
Heraklion, Greece; 2Heraklion University Hospital, Cardiology Dept., Crete,
Greece
Aim: The characteristic aortic impedance is a major determinant of the heartarterial interaction. During the cardiac systole the myofibers shortens longitudinal thickens radial and after rotates about its long axis. The magnitude
and characteristics of this torsional deformation have been described to be
sensitive to changes in both regional and global LV function. We hypothesized that increased proximal aorta stiffness would affect this LV rotation.
Methods and patients: We examine 34 angiographically proven non-ischemic dilated cardiomyopathy patients (NIDC, aged 52.6±13.9 years) and
14 healthy volunteers. We evaluate the proximal aorta pulse wave velocity
(PWV) as an index of aorta stiffness using a new echo-method: From the
suprasternal view, the distance between ascending and descending AO was
measured with 2D and the AO flow wave transit time (TT) was measured with
pulsed-wave Doppler (recording sweep speed at 200 mm/s) and PWV was
calculated as AO distance/TT.
The LV diastolic function was evaluated by PW-Doppler, while tissue Doppler velocities from the septal and the base lateral wall were obtained.
The cardiac rotation and rotation rate was evaluated by speckle echocardiography
from the left parasternal short-axis view at the level of the papillary muscles
by automatic frame-to-frame tracking of gray-scale speckle patterns
(EchoPac,GE). Rotation and rotation rate was calculated as the average
angular displacement of 6 myocardial regions (anterior, anteroseptal, lateral, posterior, inferior and septal).
Results: Patients showed increased PWV (6.7±2.1 vs 5.2±1.4 m/s, p=0.01)
and decreased systolic cardiac rotation (-2.6±2.5 vs -4.7±1.70, p=0.01) and
systolic rotation rate (-38.6±18.7 vs -51.7± 22.3 degrees/sec, p=0.04) early
(28.1±20 vs 49.9±35.2 degrees/sec, p=0.01 )and late (24.9±13.2 vs 39.7±10.8
degrees/sec, p=0.002) diastolic untwisting rate compared to the controls.
LV ejection fraction showed no correlation with the LV rotation and rotation
rate in NIDC patients.
S49
In NIDC patients the PWV showed to related with the early transmitral (PWDoppler) to E’ (mean TDI velocity of the septal and the lateral wall) ratio, the
segmental and averaged systolic (r=-0.52, p=0.001) and the early diastolic
(r=0.027, p=0.05) rotation rate.
Conclusion: In this pivotal study we found that NIDC patients had increased
aorta stiffness which impairs the systolic LV rotation movement thus further
affecting the LV systolic and diastolic function. Destiffening vascular therapeutical treatments may be beneficial in heart failure patients.
388
Normal vascular aging evaluated by a new tool: e-tracking
S. Carerj 1 ; C. Nipote 1 ; C. Zimbalatti 1 ; C. Zito 1 ; L. Sutera Sardo 1 ; G. Dattilo 1; G. Oreto 1 ; F. Arrigo 1
1
Policlinico Universitario, Cardiology Dept., Messina, Italy
Background: Aging exerts a number of significant changes in the cardiovascular system, particularly on the large arteries. Previous studies have
suggested that stiffness index increase linearly with age.
Objective: The aim of our study was to assess the usefulness of a new tool
(e-tracking, Aloka-Japan) for the evaluation of stiffness vascular index, used
as a common function in general-purpose ultrasonic diagnostic units. In
this system a radio frequency signal is used to provide an high accuracy of
0.01 mm resolution at 10 MHz transmission/reception. Changes in the artery diameters is evaluated by measuring the distance between two tracking gate. Measurements have been carried out at the level of common
carotid artery before the bifurcation. The following parmeters have been
calculated: Beta (stiffness parameter); Ep (pressure-strain elasticity modulus); AC (arterial compliance); AI (augmetation index); PWV (pulse wave
velocity). The value of blood pressure (systolic and diastolic), measured in
the left arm, has been included in the system for the evaluation of the parameters.
Methods: We studied 60 healthy patients (mean age 34.5±12.9, 29 Men).
Data were analyzed with SPSS software. To provide the relationship between
age and arterial stiffness, data were grouped according to deciles of age.
Results: The results are reported in Table I. All parameters show an agerelated increase, with the exception of AC that is reduced (Figure 1).
Conclusions: The results suggest that relevant age-related changes occur
in vascular system. Our data are similar to previous results obtained by other
invasive or non-invasive tools. E-tracking is a potentially useful, no timeconsuming tool for the clinical diagnostic routinary evaluation of arterial stiffness quantitative parameters. Further research is necessary to validate the
role of this technique in larger populations.
Table 1
age groups
(years)
<30
31-40
41-50
51-60
>60
BETA
Mean
Mean
Mean
Mean
Mean
p
Ep
5±1.8 59.1±20.5
6.6±2.5 78.8±24.2
7.3±3.3 97.8±48.4
9.2±2
115±27.6
9.4±1.7 129±33.2
0.002
<0.001
AC
AI
pW
1.3±0.5
0.9±0.2
0.9±0.3
0.8±0.09
0.6±0.09
0.004
0.8±8.9
3.5±9.1
16.4±15.1
24.2±14.7
26.6±5.9
<0.001
4.5±0.7
5.2±0.7
5.9±1.3
6.4±0.6
6.8±0.9
<0.001
Age related increase of stiffness parameters.
3-D ECHO
389
Three -dimensional-contrast ultrasound in the evaluation of carotid
atherosclerosis
B. Cosyns 1 ; M. Menassel 1 ; S. Velez-Roa 1 ; D. De Clercq 2
CHIREC - Site De Braine, Cardiology Dept., Braine L’alleud, Belgium
2
Philips Medical System, Brussels, Belgium
1
Background: The use of ultrasound (US) contrast agents in the lumen of
the carotid artery permits a clearer visualization of the intima-media thickness (IMT) and plaque luminal morphology (PM). 3D-US improves the
understanding and the measurement of morphological abnormalities in these
vessels. Although 3D is used with other techniques, it has not been studied
in this setting. We studied the diagnostic value of 3D-US in carotid atherosclerosis compared to 2D-US with and without contrast.
Methods: We have prospectively studied 18 patients (mean age: 65±8; 10
male). All patients underwent an examination of their carotid arteries baseline
and after 0.5 cc bolus of Sonovue®. After scanning, 3D images were instantaneously reconstructed (figure). The images were analyzed offline (QLab, Philips®)
in random order. We analyzed the PM following an usual scoring system (from
0 to 5). The IMT anterior (a) and posterior (p) were also measured.
Results: 1. PM: 3D with contrast has improved intra-observer agreement
compared to 2D (kappa 0.98 vs 0.89). There was a good correlation between 2D and 3D severity scores. 2. With 2D, the IMT anterior was not measurable in 80% of patients without contrast. The IMT assessment was not
feasible in 3D without contrast injection. In 2D with contrast, IMTa was significantly higher than IMTp (1.1±0.3 vs 0.8±0.2, p<0.001) and there was no
correlation between IMTa and IMTp. The 3D with contrast allowed measuring the maximal IMT on each segment.
Eur J Echocardiography Abstracts Supplement, December 2006
S50
Abstracts
Conclusions: 3D-contrast US improves intra-observer agreement for assessment of atherosclerosis severity compared to 2D. It allows the measurement
of the maximal IMT but only in combination with contrast agents. Therefore,
3D-contrast US is a promising technique for the assessment of atherosclerosis in carotid arteries.
Material and methods: Intravascular ultrasound (IVUS) examinations were
performed in 30 selected patients with CTOs who have presented an optimal
angiographic effect without residual stenosis or dissection after balloon
angioplasty. Group consisted of 25 males and 5 females with mean age 50
years. To evaluate the time of LAD occlusion we used the date of documented
acute myocardial infarction or last, the strongest episode of stenocardial pain.
For better lesion characterization we used the classification of lesion morphology following balloon angioplasty proposed by Gerber et all. and measure
circumferential distribution and percentage of lesion calcification.
Results: We observed following types of morphology in Gerber classification: Type 1 with smooth walled dilatation of concentric plaque - 2 pts (7%).
Type 2 with superficial tear of concentric plaque - 17 pts (56%). Type 3 with
deep tear to media - 2 pts (7%). Type 6 with smooth-walled dilatation of
eccentric plaque 6 pts (27%). Type 7a with subintimal dissection of eccentric plaque 1 pts (3%). The mean percentage of calcification in all analyzed
group was 55±21% (49% in group with type 1 and 2 and 67% with types 3 - 7a).
Conclusions: Despite of satisfactory angiographic effect following balloon
angioplasty in patients with chronic total occlusion - the use of intravascular
ultrasound showed in more than 30% of patients the complex, substantial
lesions (in Gerber classification) with large degree of coronary calcification.
392
Volumetric intravascular ultrasound parameters assessment
of plaque development in saphenous vein grafts
390
Using 3D volume and velocity vector imaging: magnitude and
deformation of the aorta may display earlier cardiac dysfunction
J.C. Main 1 ; P.E. Esham 1 ; J. Davidson 1
1
Siemens Medical Solutions, Innovations Dept., Mountain View California,
United States of America
Pupose: Recently, non-invasive imaging techniques have detected rotary
blood flow in the ascending and descending aorta. Existence of this rotary
blood flow and its possible relationship to ventricular torsional deformation
is just starting to be explored. It has also been postulated that rotary blood
flow is related to the geometry of the aorta and that the flow may be altered
in certain disease states. (2)
It is also well known that there is a normal helical flow pattern in the aorta, we
looked at VVI which displays the magnitude and direction of the wall as an
indirect result of flow. As reported by HUP ACC 2006, VVI can be used to
visualize the wall mechanics of the aorta. (1) We wanted to observe the biomechanical stresses within the aortic wall. and compare to the LV twist in
a full 3D RT volume data set. Earlier wall mechanic changes may be an earlier
marker of atherogenosis. It has also, been reported that coronary artery
motion has potential significance in the localization of atherogenosis.
Purpose: Can RT3D and VVI be used to look at the arterial ventricular relationship, arterial-ventricular coupling, and to see if the early pattern changes
in the aorta could be observed. Until now the representation of ventricular
arterial coupling has been the Windkessel wave system. Assuming understanding of the Windkessel model as a hydraulic integrator, we attempted to
observe this physiological phenomenon using the RT3D to image the aorta
at the root level and the left ventricular at the level of the apex. VVI uses the
time-domain representation of ventricular arterial coupling.
Methods: We used the newly developed RT3D ACUSON Sequoia C512 system to image the aorta at the root level and the left ventricle at the level of the
apex. VVI allowed us to look at the Aorta and ventricular wall mechanics
(direction of motion and magnitude) of the aortic root and the LV apex on
the same subjects. Velocity Vector Imaging was able to track the volume
images of the aorta and ventricle and display the moving vectors, velocities,
deformation.
Results: The observations were made by the investigators and noted to be
consistent with the wall mechanic pattern observed in the aorta and the
twist and untwist mechanics of the apex (figure below).
Conclusion: This was the first observation that the wall mechanics of the
aorta and apex can indeed be imaged at the same time in the same beat
and the observation in RT3D one sweep assessment of the arterial ventricular coupling can be seen and documented. This is a very early observation
but it does open the possibilities to validate this observation in pathology.
ISCHAEMIC HEART DISEASE
391
An intravascular ultrasound study in morphologic lesion
characteristics of chronic total occlusions of left descending coronary
artery after PTCA
T. Niklewski 1 ; M. Gasior 1 ; M. Gierlotka 1 ; L. Polonski 1 ; A. Lekston 1 ; K. Wilczek 1
1
Silesian Center For Heart Disease, 3Rd Dept. Of Cardiology, Zabrze, Poland
Background: Chronic total occlusion (CTO) lesions of the left descending
coronary artery (LAD) are frequently difficult to cross and are at high risk for
acute reocclusion or chronic vessel renarrowing. CTO was defined as lesions occluded for a period of 2 weeks or more, and TIMI-0 flow.
Eur J Echocardiography Abstracts Supplement, December 2006
P. Weglarz 1 ; A. Filipecki 1 ; J. Drzewiecki 1 ; M. Trusz-Gluza 1 ; M. Krejca 1 ; A. Bochenek 1 ; J. Dijkstra 2 ; J. Reiber 1
1
Silesian Medical School, 1st Departemen of Cardiology, Katowice, Poland;
2
Leiden University Medical Center, Leiden, Netherlands
Background: Atherosclerosis development in saphenous vein grafts (SVG)
has occurred during first year post coronary artery bypass graft (CABG)
surgery. In vivo examination of early stages of plaque development is poorly
described. The aim of this study was to examine and analyze SVG for early
plaque development in patients who underwent CABG.
Material and methods: Simulataneous bypass angiography and IVUS study
were performed in 72 aorto-coronary SVG’s implanted in 34 pts. All examinations were performed during first 2 years after CABG. Analysis concentrated on plaque detection and measurement of plaque volume, lumen volume, external elastic membrane (EEM) volume (measured by tracing outer
border of sonolucent zone), SVG volume (measured by tracing outer border
of the whole vein graft), SVG wall volume (defined as SVG volume minus
EEM volume). All volumetric parameters were measured in 25mm of SVG
using QCU-CMS IVUS analytical software version 4.14, adapted to SVG analysis. Index plaque volume/EEM volume and index plaque volume/ wall volume were calculated for comparative SVG assessment. Data were analyzed
for following time periods: I - 0-6 months (29 grafts), II - 6-12 months (22
grafts) and III - 12-18 months (21 grafts) after CABG.
Results: The first neointimal formation was observed 64 days post CABG. In
period I plaque (neointimal) formation was observed in 12 cases (41%) with
average plaque volume of 32.26 mmł, in 8 cases (36%) in period II (average
plaque volume: 35.99 mmł and in 15 cases (71%) in period III with average
plaque volume: 38.09 mmł. Index plaque vol/EEM vol in periods I, II and III
were 0.10, 0.10, and 0.16 respectively. Index plaque vol/ SVG wall vol. in
periods I, II and III were 0.15, 0.14, and 0.20 respectively. The plaque volume rate increase was 3 mmł per 6 months.
Conclusion: Intravascular ultrasound in vivo showed rapid plaque development in SVG during the first 18 months after CABG. During the first year
plaque can be visualized in about 40% of implanted grafts.
CONGENITAL HEART DISEASE
393
Evaluation of interventricular asynchrony before and after cardiac
resynchronisation therapy (CRT) in patients with congenital heart
defects (CHD) by means of Tissue Doppler Echocardiography (TDE)
R. Schuck 1 ; A. Rentzsch 2 ; M.Y. Abd El Rahman 3 ; M. Yegitbasi 1 ; B. Peters 1; F. Berger 1 ; H. Abdul-Khaliq 1
1
Deutsches Herzzentrum Berlin, Berlin, Germany; 2Universitaetslkinikum des
Saarlandes, Klinic for pediatric cardiology, Homburg/ Saar, Germany;
3
University of Cairo, Clinic for Pediatric Cardiology, Cairo, Egypt
Background: Identification of Patients with heart failure, who may benefit
from CRT is still challenging, due to the limitations of conventional methods
and the heterogeneous morphologies in congenital heart disease. TDE-derived maximal Strain allows quantitative assessment of regional myocardial
function, as well as the time interval to maximal deformation allowing measurement of interventricular delay between RV and LV. Patients and methods: 20 Patients with CHD (ISTA 3, DORV 1, TOF 3,
L-TGA 5, D-TGA 1) and DCM (n=7) underwent conventional Doppler- as
well as TDE-examination (Vingmed, Vivid 7) before, immediately after CRT,
as well as during a follow-up period of six months. In an apical four chamber
view using high frame rates (180-250 bps) strain (%) was analysed. The time
interval from peak Q in the parallel recorded ECG, to the maximum of systolic deformation, in accordance with previously marked aortic valve clo-
Abstracts
sure, was assessed for three segments of the left and right lateral free wall,
as well as the interventricular Septum. In addition interventricular asynchrony
was evaluated with conventional Doppler by determination of pre-ejection
time of the outflow over the aortic as well as the pulmonary valve.
Results: After CRT a significant reduction of the intraventricular and interventricular delay was observed (p<0.05). This was associated with a shortening of the QRS duration and an increase of EF of the systemic ventricle. In
contrast, no similar significant changes were found in the corresponding
Doppler derived ventricular delay.
Conclusion: TDE based Strain allows detection and evaluation of interventricular asynchrony, and monitoring of the response to thus indicated
resynchronisation therapy.
HEART FAILURE – RESYNCHRONISATION
394
The influence of cardiac resynchronization therapy on right
ventricular systolic function in heart failure patients with right
ventricular impairment
M. Szulik 1 ; W. Streb 1 ; R. Lenarczyk 1 ; P. Pruszkowska-Skrzep 1 ; O. Kowalski 1; T. Zielinska 1 ; Z. Kalarus 1 ; T. Kukulski 1
1
Silesian Center for Heart Diseases, Zabrze, Poland
Cardiac resynchronization therapy (CRT) by correction of intra- and interventricular asynchrony, reverse the adverse remodeling of left ventricle (LV),
leading to the reduction of LV volume and the improvement of its systolic
function. However, there is a little data about the influence of CRT on the
systolic function of the right ventricle (RV).
Aim: The echocardiografic assesment of RV systolic function’ parameters in
patients with RV impairment before and during CRT. Methods: We observed 29 patients (pts) with dilated cardiomyopathy (M:F
2:1, aged 57±8; ischaemic-35%) and with subclinical signs of RV failure:
maximal systolic velocity of RV wall in inflow truct during the isovolumetric
contraction time (ICT vel) was 3,4±2 cm/s. The baseline (before CRT) and in
mid-term follow-up (in 3rd month of CRT) parameters were: NYHA 3±0.4 vs
2,05±0,5 (p=0,001), QRS 185±29 ms vs 166±33 ms (p=0,037), NT-proBNP
2594±1712 pg/ml vs 1390±1112 (p=0,024), max. oxygen consumption
13,1±3,7 ml/kg/min vs 15,9±4,6 (p=0,0013), interventricular asynchrony (the
difference between RV and LV preejection period) 69±19 ms vs 22±12 ms;
respectively. We evaluated the global systolic function of LV (aortic valve
velocity time integral - AO VTI, end-diastolic and systolic volume - EDV, ESV,
ejection fraction - EF) and RV (pulmonary valve VTI - PV VTI, fraction of area
change - FAC, RV diastolic and systolic area - RVAd, RVAs) and regional
indexes of RV contractility (ICTvel). The pts were examined at baseline, in
the 3rd day (optimization - opt), 1st, and 3rd month during CRT. Results: are presented in table. Conclusion: 1. CRT has proved to reverse the unfavourable remodeling of LV
and to improve the systolic function of RV. 2. The greatest improvement of RV
functional’ parameters was claimed directly after the pacemaker implantation.
Table 1
RV
RV
RV
Area diastolic (cm2) Area systolic (cm2) FAC (%)
base
opt
1m
3m
17.4±4.0
17.1±5.8
18.7±5.1
18.6±5.1
13.1±4.4
10.5±5.2**
9.9±3.9**
10.1±4.6**
RV
RV
ICTvel (cm/s) PVVTI (cm)
18.9±13.0
3.4±1.9
43.6±11.6** 5.03±2.8*
46.5±13.4** 4.5±3.2
44.7±15.9** 3.9±3.2
14.7±4.6
17.2±4.5*
17.2±5.3**
18.1±4.5**
*p<0.05 vs baseline; **p<0.005 vs baseline
Table 1 continuation
base
opt
1m
3m
LV
EDV biplane (ml)
LV
ESV biplane (ml)
LV
EF biplane (%)
LV
AVVTI (cm)
283±71
262±80*
233±82**
252±74*
217±63
198±62*
163±65**
178±62**
23.5±8.0
24.7±7.4
30.2±8.7**
29.1±6.7**
19.9±5.6
20.2±4.7
20.7±4.6
21.4±4.6
S51
in ventricular performance and clinical parameters. The beneficial effect of
PPVI on left ventricular behaviour is not fully understood. The aim of this
study was to compare the different effects of right ventricular pressure and
volume overload on inter-ventricular synchrony and left ventricular performance.
Methods: We studied 23 consecutive patients with PR (peak gradient
<49 mm Hg and PR grade >2 on echo) and 24 with RVOTO (peak gradient
>49 mm Hg and PR grade <2 on echo), who underwent successful PPVI.
2D/tissue Doppler echo and a 12 lead ECG were performed before and
1 day after intervention. Inter-ventricular delay (IVD) was calculated as the
difference between left ventricular pre-ejection phase (LV PEP) and right
ventricular pre-ejection phase (RV PEP) from pulsed wave Doppler recordings in the outflow tracts.
Results: At baseline, RV ejection time was longer in the RVOTO group
(374.0±38.3 vs. 338.5±32.5 ms, p=0.001) and correlated well with RVOT
gradient (r=0.492, p<0.001). In contrast, RV PEP was unaffected by load
but was strongly associated with QRS duration (r=0.620, p<0.001). QRS
duration tended to be more prolonged in the PR group (142.4±26.1 vs.
130.2±35.3 ms, p=0.300). After PPVI, RV ejection time fell in both groups
(RVOTO: from 376.3±37.3 to 332.8±29.1 ms, p<0.001, PR: from 338.5±32.5
to 310.2±32.7 ms, p<0.001). Relief of PR resulted in prolongation of the RV
PEP (81.6±17.9 vs. 103.4±25.6 ms, p<0.001) and a marked change in IVD
(from 7.1±16.2 to -25.1±27.1 ms, p<0.001), which was not reproduced following relief of RVOTO. In addition, relief of PR resulted in a fall in the LV
PEP/ET ratio (from 0.33±0.09 to 0.28±0.07, p=0.024) and an improvement
in LV stroke volume (62.4±23.9 to 77.6±28.5, p=0.017), which was less
evident following RVOTO relief.
Conclusion: RV ejection time is directly related to afterload whilst RV PEP is
more closely influenced by electrical activation. Relief of PR has important
effects on inter-ventricular synchrony and a measurable effect on LV performance. Further investigation will help develop a better understanding of the
electrical and mechanical components of this improvement.
THE RIGHT HEART
396
Right ventricular ultrasonic tissue indices in atrial septal defect. Can
they reflect an increased pulmonary flow?
M. Kowalski 1 ; E. Kowalik 1 ; P. Hoffman 1
1
Institute Of Cardiology, Warsaw, Poland
Background: Regional myocardial function of the right ventricle (RV) is
poorly characterized both in normal settings and in pathology. It is interesting to know whether the indices of RV regional deformation are altered
by volume overload and to what extent they can reflect an increased pulmonary flow.
Methods: 28 subjects (25 F, 3M) (age 15-72 yr) with atrial septal defect (ASD)
were studied. Among them 25 had ASD II, 2 ASD sinus venosus type and
one had an isolated anomalous pulmonary venous connection to right atrium
(the average Qp/Qs for the group was found as 2.05±0.90). The data on
regional deformation recorded for ASD patients were compared to the ones
obtained from age and sex matched healthy individuals. To calculate regional systolic and diastolic Strain Rate (SR) and maximal strain (S), GE
Echopac 2D was applied. The data were averaged out of three consecutive
heart cycles.
Results: The maximal S recorded for the apical RV segments (api) was higher
in ASD patients when compared to normals (-36% vs -28%, respectively;
p<0.01). Similarly, regional systolic SR recorded for the same api territory
was increased (-2.16 1/s vs -1.52 1/s, respectively; p=0.02). There was
a significant correlation between systolic RV api S and Qp/Qs as well as
between systolic RV api SR and Qp/Qs (fig.1).
Conclusion: In adults with ASD, the ultrasonic tissue indices are altered in
the apical RV segments. Both S and SR recorded from these segments are
substantially higher when compared to the corresponding data obtained
from normals. The larger volume overload is associated with reduced S and
SR in apical RV segments.
*p<0.05 vs baseline; **p<0.005 vs baseline
CONGENITAL HEART DISEASE
395
Ventricular interaction in pressure and volume overloaded right
ventricles
L. Coats 1 ; K. Janagarajan 2 ; S. Khambadkone 3 ; M. Turner 4 ; G. Riley 2 ; D. Pellerin 4 ; P. Bonhoeffer 2 ; J. Marek 2
1
Great Ormond Street Hospital For Children, C/O Pa To Dr P Bonheoffer,
London, United Kingdom; 2The Heart Hospital, Echocardiography Dept.,
London, United Kingdom; 3Great Ormond Street Hospital for Children,
Cardiothoracic Unit, London, United Kingdom; 4Bristol Royal Infirmary,
Cardiology Dept., Bristol, United Kingdom
Background: Percutaneous pulmonary valve implantation (PPVI) can be used
to treat suitable patients pulmonary regurgitation or right ventricular outflow
tract obstruction (RVOTO). This procedure results in an early improvement
Eur J Echocardiography Abstracts Supplement, December 2006
S52
Abstracts
CONGENITAL HEART DISEASE
structural reverse remodeling may play a role in the reduction of arrhythmia
recurrences.
397
Do elderly patients benefit from transcatheter closure of atrial septal
defect?
M. Pieculewicz 1 ; P. Podolec 1 ; T. Przewlocki 1 ; M. Hlawaty 1 ; P. Wilkolek 1 ; L. Tomkiewicz-Pajak 1 ; G. Kopec 1 ; W. Tracz 1
1
Cracow, Poland
Objective: To evaluate the outcomes of transcatheter closure of secundum atrial
septal defect (ASD) using Amplatzer Septal Occluder (ASO) in elderly patients.
Material and methods: Consecutive 35 adult pts over 50 years (25 F, 10 M)
with a mean age of 61.2±15.9 (50-69) with ASD who underwent transcatheter
closure, were analyzed. All patients had an isolated secundum ASD with
pulmonary to systemic blood flow ratio, Qp:Qs: 2.56±1.6 (1.5-3.43).
Quality of life (QoL) was measured using the SF36 questionnaire (SF36q).
SF36q were repeated in all pts before procedure and 6 months of follow-up
as well as symptom-limited treadmill exercise tests with respiratory gas
exchange analysis (Bruce protocol) and transthoracic color Doppler echocardiographic study.
Results: The ASO device was successfully implanted in all pts (procedure
time 37.2+/-4.1 (14-51) minutes, fluoroscopy time 10.1+/-7.9 (5-40) minutes).
The defect echo diameter was 17.6+/-5.1 (8-32) mm. The diameter of the
implanted devices ranged 13-36 mm.
After 6 months of ASD closure, all the pts showed a significant improvement
of exercise capacity. 7 QoL parameters (except mental health) improved at 6
months follow up compared to their baseline data. The right ventricular dimension decreased in 27 pts (77.1%), the right atrium dimension decreased
in 29 pts (82.8%) (Table 1).
Conclusions: Transcatheter closure of secundum ASD in elderly patients is
a safe and effective procedure, with excellent short-term follow-up results.
Closure of ASD in elderly patients caused significant improvement of exercise capacity as well as improvement of quality of life measured by SF36
questionnaire.
In six months observation right heart pressure overload signs were diminished in most of the elderly patients.
Table 1
Parameter
Time of exercise (min)
VO2peak (ml/kg/min)
SF36q scale 0-100
The right ventricular area cm2
The right atrium area cm2
Before
ASD closure
6 months after
ASD closure
p value
9.2±4.1
8.2±3.3
20.3±19
24.1±1.1
19±1.12
12.9±4.1
11.9±5.1
84.2±26.3
19.5±1.1
13.9±1.2
<0.001
<0.001
<0.0001
<0.0001
<0.0001
THE RIGHT HEART
398
Electrical and structural reverse remodeling after transcatheter
closure of atrial septal defects in adults
O.H. Balint 1 ; T. Szili-Torok 1 ; C.S. Liptai 1 ; L. Kornyei 1 ; L. Ablonczi 1 ; A. Szatmari 1 ; A. Temesvari 1
1
Hungarian Institute of Cardiology, Cardiology Dept., Budapest, Hungary
Long standing atrial septal defects (ASD) results in electrical and structural
remodeling of the atria susceptible for supraventricular arrhythmias.
Objective: To determine the effects of transcatheter closure of ASD’s on
electrical and structural remodeling.
Methods: Thirty-seven patients after successful device closure of ASD’s were
studied. Patients (mean age: 40±17 yrs) were assessed by 12-lead electrocardiography (ECG) and transthoracic echocardiography. Data were obtained
before the intervention, at 1-month and 12-month follow-up. The following
ECG parameters were collected: maximal and minimal duration of the P wave
(P max, P min), P dispersion (Pmax-Pmin), QT max, QT dispersion (QTmaxQTmin). Right ventricular (RV) dimensions were assessed by means of Mmode echocardiography (RVm). 2D and Doppler echocardiography were used
to evaluate the maximal inlet diameter (RVmax), right and left atrial areas (RAA,
LAA), end-diastolic RV/LV ratio and the RV systolic pressure (RVSP).
Results: At one-month follow-up P max and QT max showed significant reduction (122±17 ms vs 117±13 ms, p=0.02; 402±18 ms vs 396±17 ms, p=0.02,
respectively). RAA (18±4cm2 vs 7±4 cm2, p=0.02), RVm (31±7 mm vs 27±6,
p<0.0001), RVmax (45±6 mm vs 43±8 mm, p=0.02), RV/LV (0.71±0.18 vs
0.57±0.13, p<0.0001) and RVSP (38±9 mm Hg vs 29±5 mm Hg, p<0.0001)
decreased significantly. At one-year follow up only P max (95±13 ms, p<0.0001),
QT max (387±17 ms, p=0.02), QT dispersion (40±16 ms to 44±18 ms to 40±16 ms,
p=0.001), RAA (15±3 cm2, p=0.02), RVm-mode (23±5 mm, p<0.0001) and
RV/LV (0.48±0.11, p<0.0001) showed further reduction. Sixteen percent of the
patients had atrial arrhythmias before the procedure and 60% of them became
arrhythmia-free during the follow-up. Only atrial dimensions were different between patients with and without arrhythmias (RAA: 23±4 cm2 vs 17±4 cm2,
p=0.04; LAA: 20±4 cm2 vs 16±3 cm2, p=0.01).
Conclusions: Electrical and structural reverse remodeling starts early after
defect closure and continues at one year follow-up. Our data suggest that
Eur J Echocardiography Abstracts Supplement, December 2006
399
Echocardiographic evaluation of right ventricle function in infants with
pulmonary valve stenosis before and after percutaneous balloon
valvuloplasty
V. Khanenova 1 ; A. Kurkevych 1 ; A. Maksymenko 1 ; N. Rudenko 1 ; I. Yemets 1
1
Childrens Cardiac Center, Kyiv, Ukraine
Background: Percutaneous balloon pulmonary valvuloplasty (BPV) is the treatment of choice in children with moderate to severe pulmonary stenosis (PS).
Purpose: The aim of this study was to assess the RV function in patients
with valvular PS before and after BPV by using complex quantitative
echocardiographic method.
Methods: We studied 16 infants with PS (the group 1) and 24 healthy infants
(group 2). We used complex echocardiographic method, which consisted
of some parameters (measurements of LV, RV, LA chambers, thickness of
walls of LV and pressure in RV, PA) and special formulas based on this
parameters for calculation of RV end-diastolic volume (RVEDV) and ejection
fraction (RVEF) as well as Tissue Doppler velocities. RV systolic and diastolic function was assessed by Tissue Doppler according to the following
parameters: peak systolic velocity (Sm), peak early diastolic velocity (Em),
peak late diastolic velocity (Am) and the Em/Am ratio.
All infants with PS underwent complex echocardiographic study before BPV
(subgroup 1a), early after BPV (mean 5 days, subgroup 1b) and at the midterm follow-up (mean 6 months, subgroup 1c).
Results: All parameters of RV systolic and diastolic function (RVEF, Sm,
Em/ Am ratio) were significantly decreased in subgroup 1a compared to the
same parameters in the group 2 (RVEF: 32.3±9.2% and 51.2±5.6%, p<0.01;
Sm: 9.1±1.2 sm/s and 12.0±1.8 sm/s, p<0.01). In addition, the pressure
gradient across pulmonary valve was inversely correlated with RVEF
(r=-0.684) and Em/ Am ratio (r=-0.739). Early after BPV (subgroup 1b) RVEF
and Em/ Am ratio decreased even further, while peak Sm slightly increased.
At mid-term follow-up evaluation (subgroup 1c) all these parameters significantly increased (p<0.001).
Conclusion: After temporary decrease in RV diastolic function early after
BPV for PS in infants, we observed improving of systolic and diastolic RV
function in 6-month follow-up. Our complex echocardiographic quantitative
method could be used for noninvasive RV function evaluation before and
after different procedures and operations in pediatric cardiac surgery.
400
Long axis dysfunction and tricuspid regurgitation relate to ventricular
fibrosis in adults with systemic right ventricle and complete
transposition of the great arteries
D. Prati 1 ; S.V. Babu-Narayan 2 ; K. Dimopoulos 3 ; G. Diller 1 ; O. Goktekin 3 ; P.J. Kilner 3 ; M.A. Gatzoulis 3 ; W. Li 3
1
Policlinico G.B. Rossi, Cardiology Dept., Verona, Italy; 2Royal Brompton
Hospital, Adult Congenital Heart Unit, Cardiology Dept., London, United
Kingdom; 3Imperial College, Adult Congenital Heart Unit, Cardiology Dept.,
London, United Kingdom
Following Mustard procedure (atrial redirection surgery) for complete transposition of the great arteries, the right ventricle remains the systemic ventricle.
Patients are at increasing risk of late ventricular dysfunction and sudden
cardiac death with time. Twenty-two adult patients with transposition of the
great arteries who had undergone the Mustard procedure were evaluated
with echocardiography and late gadolinium enhancement cardiac magnetic
resonance (CMR). Long axis function was particularly studied with the use
of tissue Doppler imaging (TDI) and M-Mode.
Results: Of the 22 patients, 10 had CMR findings suggesting the presence of
myocardial fibrosis (45%). Patients were divided into two groups according to
the presence or absence of myocardial fibrosis in the systemic right ventricle.
Patients presenting right ventricular fibrosis were older (26 vs 18 years; p<0.01),
were older at the time of surgery (3 vs 0.5 years; p<0.01) and were more
symptomatic than patients without signs of fibrosis (NYHA Class ≥2:6/10 vs
1/12; p=0.01). Patients with myocardial fibrosis had decreased total long axis
excursion both of the systemic ventricular free wall (10±2.4 vs 14.1±3.0 mm;
p<0.01) and septum (9.6±2.0 vs 13.3±2.8 mm; p<0.01). In the same way,
myocardial fibrosis related to a decreased peak systolic velocity of the systemic ventricular free wall (4.2±1.2 vs 6.0±1.1 cm/s; p<0.01) and septum
(3.8±0.8 vs 4.8±1.1 cm/s; p<0.05). The systolic velocity of the sub-pulmonary ventricle and the diastolic velocities of both ventricles did not correlate
with the presence of fibrosis. Patients with myocardial fibrosis had worse systemic ventricular systolic function (p<0.01), and bigger systemic ventricular
dimensions (p<0.05). All patients with fibrosis had tricuspid regurgitation (10/
10 vs 4/12; p=0.001). The presence of tricuspid regurgitation (? mild) related
to impaired long-axis function of the systemic ventricular free wall (11,3±3.4
vs 13.9±2.8 mm; p<0.01) and decreased right ventricular ejection fraction
evaluated with CMR (49.2±17.6 vs 62.5±6.3%; p=0.05).
Conclusions: Long-axis dysfunction, assessed by M-Mode or TDI, related
the presence of myocardial fibrosis in patients with systemic right ventricle
after Mustard operation. This relationship suggest that there may well be
Abstracts
more extensive subendocardial pathophysiological changes resulting in long
axis dysfunction. The presence of tricuspid regurgitation, even mild, seems
to be related to myocardial fibrosis and adverse ventricular function.
401
Interventricular septal function in patients with systemic right ventricle
E. Pettersen 1 ; T. Helle-Valle 1 ; H.J. Smith 1 ; K. Andersen 1
1
Rikshospitalet University Hospital, Cardiology Dept., Oslo, Norway
Background: In patients with transposition of the great arteries (TGA) operated with atrial switch, the right ventricle (RV) supports the systemic circulation. The aim of the present study was to investigate whether the interventricular septal function in this setting differs from normal.
Methods: Fourteen TGA patients aged 18.4±0.9 years (mean±SD) operated as infants a. m. Senning and 14 healthy controls aged 27.4±1.2 years
were studied. Longitudinal and circumferential septal shortening as determined by strain at the mid ventricular level were measured by tissue Doppler
imaging and magnetic resonance imaging (MRI) tagging, respectively. Also,
basal and apical peak systolic septal rotation in the transverse plane were
assessed by MRI tagging using the left ventricular (LV) centre of gravity as a
reference point. The basal and apical levels were chosen because in the
normal LV, ventricular rotation is clockwise at the base and counterclockwise at the apex while hardly present at the mid ventricular level. Strain,
however, is uniformly distributed in the normal LV.
Results: There was no significant difference in longitudinal or circumferential septal strain between the TGA patients and the controls (table 1). Both
apical and basal rotation were significantly less in the TGA group than in the
controls (negative values represent counterclockwise rotation, positive values clockwise rotation).
Conclusions: Interventricular septal shortening does not differ from normal
in the setting of a systemic RV, while septal rotation is decreased.
Table 1
Strain (%)
Longitudinal
Circumferential
Rotation (°)
Apical
Basal
402
Dobutamine stress echocardiography is feasible, efficacious, and
safe in the estimation of right ventricular reserve in patients with
repaired Tetralogy of Fallot
S. Brili 1 ; N. Alexopoulos 1 ; C. Chrysohoou 1 ; J. Barbetseas 1 ; J. Karamitros 1 ; S. Massias 1 ; I. Stamatopoulos 1 ; C. Stefanadis 1
1
Athens Medical School, Hippokration Hospital, 1st Cardiology Dept., Athens,
Greece
CONGENITAL HEART DISEASE
S53
Controls
TGA patients
p-value
-18.9±2.6
-20.0±3.0
-19.5±3.3
-18.5±3.6
NS
NS
-11.5±3.7
3.9±2.1
-5.5±3.8
0.6±2.7
0.0006
0.003
Background: The longstanding pulmonary regurgitation in patients with
repaired Tetralogy of Fallot results in right ventricular (RV) failure. The estimation of RV function and reserve in these patients is of great importance,
especially for the determination of the proper timing for pulmonary valve
replacement. Tissue Doppler Imaging (TDI) of the tricuspid annulus has
been proved a valuable tool in the investigation of these patients.
Dobutamine stress echocardiography in low doses detects the reserve of
cardiac myocytes to increase contractility. At this study we aimed at examining the feasibility, efficacy, and safety of dobutamine stress
echocardiography in the evaluation of RV reserve in patients with repaired
Tetralogy of Fallot, and to compare them with controls.
Methods: We studied 20 patients with repaired Tetralogy of Fallot (age
27.9±8.1 years, 18.8±4.2 years after surgery) and 20 age- and gendermatched controls with TDI Doppler at the tricuspid annulus during dobutamine stress echocardiography. TDI measurements were made at baseline
and at the peak of 3 min dobutamine infusion rates of 10 and 20 µg/Kg/min.
Results: All patients had pulmonary regurgitation (5 mild, 12 moderate,
3 severe) and tricuspid regurgitation (mild to moderate). As expected, patients had decreased TDI velocities at baseline compared to controls (Sa,
8.2±1.0 vs. 15.9±2.1; Ea, 8.8±3.0 vs 14.9±3.8; Aa, 5.8±1.8 vs 13.2±1.9,
p<0.001 for all). Although all patients and controls increased the Sa during dobutamine stress echocardiography, the percentage increase of Sa
(Sa%) was less in patients compared to controls (41.5±11.1 vs 56.8±17.4,
p<0.01), denoting decreased RV systolic reserve. None of the patients or
the controls had any adverse event, such as paroxysmal atrial tachycardia,
ventricular tachycardia, or hypotension, during dobutamine stress echocardiography.
Conclusions: Dobutamine stress echocardiography is feasible, efficacious,
and safe in the detection of RV reserve in patients with repaired Tetralogy of
Fallot and may help in the evaluation and follow up of these patients in order
to determine the optimum timing for pulmonary valve replacement.
Eur J Echocardiography Abstracts Supplement, December 2006