P896 Feasibility and accuracy of echocardiographic estimates of tricuspid annular displacement

Background Tricuspid annular plane systolic excursion (TAPSE) is a validated index of right ventricular function in heart failure. Current guidelines recommend that TAPSE be measured employing M-mode echocardiography (TAPSEM). However, TAPSEM is often overlooked during routine clinical assessment. This study aimed to assess the correlation and strength of agreement between other retrospectively obtainable echocardiographic equivalents of tricuspid annular displacement during systole (TAD) and TAPSEM. Methods An echocardiographic review was performed in consecutive subjects in sinus rhythm referred for the assessment of dyspnoea or heart failure. TAD was measured employing 2D (TAD2D), tissue velocity imaging (TADTVI), and speckle tracking echocardiography (TADSTE) and compared with TAPSEM as reference. Results 100 subjects were analysed (age: 61± 14; 49% Female) All methods demonstrated good feasibility. Of all the evaluated methods, TAD2D demonstrated the strongest association with TAPSEM with minimal bias and reasonable limits of agreement (Table 1). Bias between methods was further reduced in subjects with significant pulmonary hypertension (RVSP > 50mmHg (35%); Bland-Altman mean ± SD = 0.09 ± 2.0 mm). A good agreement between TADSTE and TAPSEM was as well observed. In contrast, TADTVI yielded an underestimation of TAPSEM. Conclusions TAD2D and TADSTE provide feasible and accurate alternatives to TAPSEM and maybe useful during retrospective analysis of RV longitudinal function. Feasibility, Correlation & B-A Analysis TAD Methods Feasibility R value P Value Bland-Altman mean difference ± SD TAD2D 92% 0.94 <0.001 0.22 ± 1.87 mm TADTVI 88% 0.86 <0.001 1.59 ± 3.1 mm TADSTE 85% 0.87 <0.001 0.47 ± 2.7 mm TAD, Tricuspid annular displacement; 2D, Two dimensional; TVI, tissue velocity imaging; STE, speckle tracking echocardiography

P2459Do left atrial strain measurements provide information independent from left ventricular function parameters?

Introduction LA strain has been proposed to be a reliable and independent prognostic marker, as well as a useful surrogate of LA function. Purpose To assess if LA deformation measurements add independent information to standard echocardiographic measurements. Methods We included 66 normals and patients with a wide range of pathology and diastolic dysfunction grade from the echo data base of our hospital if image quality was sufficient for both LA and LV strain analysis. Patients with a mobile interatrial septum, arrhythmias and more than mild valvular regurgitation were not considered. Standard echocardiographic measurements including LA and LV volumes were performed according to current guidelines. LA and LV longitudinal strains were assessed by 2D speckle tracking in the same cardiac cycle in apical 4 and 2 chambers views using peak R as time reference. Peak LA and LV strain as well as LA and LV strain at onset of LA contraction were measured to calculate the strain components of all three phases of the cardiac cycle (systolic, early diastolic and late diastolic). Results In our cohort, the ratio of LA and LV systolic strain was directly and strongly related to the volume ratio of the two chambers (R2=0,894, slope=-1.001, p<0.0001, see Figure 1). This was confirmed by a multivariate regression analysis, where systolic LA strain proved to be strongly dependent on systolic LV strain, LA volume and LV volume (R2=0.872, p<0.0001 for the final model). For early diastolic strain, confounders were LV early diastolic strain, LA volume, LV volume and lateral wall E' tissue velocity (R2=0.784, p<0.0001); while LA late diastolic strain was dependent on LV late diastolic strain, LA volume, LV volume and lateral wall A' tissue velocity (R2=0.823, p<0.0001). Strain ratio vs volume ratio Conclusions Our data suggest that systolic LA strain (reservoir strain) is strictly dependent on systolic LV strain and the volume ratio of both chambers and, therefore, its measurement cannot provide additional information beyond classical measurements. Diastolic LA strain components show a less strict dependence on LV function and may therefore provide additional information.

P1496Use of strain, strain rate, tissue velocity imaging and endothelial function for early detection of cardiovascular involvement in young diabetics

Background Subtle structural and functional changes may precede the onset of overt global left ventricular dysfunction and obvious reduction of ejection fraction (EF), especially in young diabetics. Data pertaining to tissue velocity indices (TVI) and strain imaging to assess regional myocardial function and flow mediated vasodilatation is limited in young patients with diabetes. Purpose To evaluate conventional echocardiography parameters, tissue doppler indices, global and regional strain, carotid intimal medial thickness (CIMT), endothelial dependent (FMD) and independent function (NMD) of brachial artery in young patients (age <18 years) with type 1 diabetes and compare them with matched controls. Methods Conventional echocardiography parameters, tissue velocity indices (TVI) parameters along with strain (S), and strain rate (SR) in basal and mid left ventricular (LV) lateral wall, right ventricular (RV) lateral wall and septum were measured in 50 young diabetics (age 15.16±2.95 years, mean HBA1c 8.15±1.37 gm %) and 25 controls (age 15.60±2.51 years). Flow-mediated dilatation (FMD), nitrate mediated dilatation and carotid intimal media thickness (CIMT) were also estimated. Results Conventional echocardiography parameters were similar in patients and controls however deceleration time of the mitral inflow velocity (EDT) was significantly shorter in patients when compared with controls (149.06±31.66 vs. 184.56±19.27 ms, p<0.05). Lateral early diastolic myocardial velocity (LV-Em) was significantly lower (10.30±0.99 vs. 11.67±3.21, p<0.05) whereas lateral late diastolic myocardial velocity (LV-Am) was significantly higher than controls (11.73±1.44 vs. 8.82±1.69, p<0.05), thus a significantly lower ratio of early/late diastolic velocity at the basal segment of lateral LV (LV-Em/Am). Lower strain values at the basal lateral LV (21.39±4.12 vs. 23.78±2.02; p<0.05), mid lateral LV (21.43±4.27 vs. 23.17±1.92; p<0.05), basal septum (20.59±5.28 vs. 22.91±2.00; p<0.05), and mid septum (22.06±4.75 vs. 24.10±1.99; p<0.05) as compared to controls. SR at the basal and mid segments of the lateral LV wall and at the basal septum were also significantly lower in diabetic subjects. Strain rate (SR) in mid septal, basal and mid RV were lower than controls although not statistically significant. Patients also had significantly lower flow mediated dilatation (FMD) (8.36±4.27 vs. 10.57±4.12, p<0.05) implying endothelial dysfunction. Strain rate in diabetic patient Conclusion Left ventricular strain indices are impaired in asymptomatic children and adolescents with type 1 DM despite absence of overt heart failure and normal ejection fraction. Early detection of subclinical regional myocardial dysfunction by deformation analysis including strain and strain rate may be useful in the asymptomatic diabetic population. In addition, evidence of endothelial dysfunction in the form of impaired flow mediated vasodilatation was observed in the diabetic children. Acknowledgement/Funding None

Longitudinal Tissue Velocity and Deformation Imaging in Patients with Significant Stenosis of Left Anterior Descending Artery

Introduction: Myocardial longitudinal tissue velocity imaging (TVI) and strain rate imaging (SRI) indices may have a role in the prediction of significant proximal stenosis of left anterior descending (LAD) by echocardiography. Materials And Methods: Total 20 patients with proximal LAD stenosis >70% by angiography and ejection fraction ≥50%, without wall motion abnormality at resting echo (stenotic group) and 20 angiographically normal coronaries subjects with normal echocardiography (non-stenotic group) were included in the study. SRI and TVI were performed in nine segments of the LAD territory at rest. Parameters of interest included: peak systolic strain (ST, %), strain rate (SR, Second-1), and peak systolic velocity (Sm, cm/s). Results: Overal mean ST and SR showed a significant reduction in the stenotic group compared to non-stenotic group (P<0.001), while the mean Sm had no significant difference. A segment-by-segment comparison revealed a reduction of ST in 4/9 (two apical and two anteroseptal) and SR in 5/9 (three apical, septal, and anteroseptal midportion) in the stenotic group (P<0.05). Both ST and SR showed a significant reduction in three segments: anterior-apical, lateral-apical, and anteroseptal-midportion. When both ST and SR decreased in one segment, specificity and sensitivity for the diagnosis of proximal LAD stenosis was more than 80% and 55%, respectively, by Roc analysis. Conclusion: There is an overall reduction in the mean ST and SR in the segments of LAD territory with significant proximal stenosis and normal wall motion at rest and an acceptable specificity and sensitivity of SRI for the detection of stenosis in these segments.