277 Temporal trends of advanced 2D-speckle tracking echocardiography in trastuzumab treated patients

Aims Trastuzumab (TZ) is widely used for his key role in HER2 positive breast cancer. However, it may have different side effects on the cardiovascular system. One of the most concerning complication is cardiotoxicity. Many studies have highlighted the importance of the screening for subclinical myocardial dysfunction using left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). However, there are few studies investigating the left atrial function in relation to the development of early cardiac damage. Aim of this study is to analyse the modification of GLS and PALS in patients undergoing therapy with TZ in a follow-up period of 12 months. The eventual fluctuation of left atrial function under chemotherapy was evaluated and the correlation between subclinical atrial disfunction and early left ventricular impairment was searched. Methods One hundred and five women affected by non-metastatic HER-2 positive breast cancer treated with TZ were enrolled. Each patient underwent a complete echocardiography every 3 months, for a total of five exams pro patient. Thirty-seven patients (35%) were excluded from the left atrial function analysis while LV function evaluation was performed in 83 patients (21%). Exclusion criteria were poor quality imaging and lack of a complete Follow-up with consequent missing data. 2D-Speckle tracking analysis was performed at baseline and at each examination using Tomtec software in order to analyse both atrial and left ventricular function. Subclinical LV disfunction was defined as a GLS reduction of ≥ 15% compared to the baseline value. Left atrial impairment was arbitrary defined as a PALS reduction of ≥ 25% compared to the initial value. Finally, trends of GLS and PALS during 12 months-Follow-up periods were analysed. Results A total of 48.9% patients developed subclinical LV dysfunction. Similarly, 48.3% patients showed a left atrial impairment. Interestingly a significant (P = 0.0001) reduction in GLS was observed during the follow-up, particularly in the first 6 months of treatment. PALS showed a similar trend with a significant decrease during the whole 12 months-follow-up (P = 0.0001) and mostly in the first 6 months. Only 11% patients showed a significant reduction of LVEF defined as an absolute reduction of LVEF >10% from baseline. Conclusions In HER 2 positive breast cancer patients treated with Trastuzumab development of left atrial impairment in not uncommon and PALS modifications follow a similar pattern to GLS variations during the treatment course, suggesting a possible cardiotoxic effect of such therapy on both atrial and left ventricular myocardium and physiology. However, the potential role of an early atrial impairment detection in predicting subsequent cardiotoxicity in terms of significant LVEF reduction still needs to be tested with further studies.

322 Atrial morphological and functional parameters in hypertrophic cardiomyopathy: cardiovascular outcome implication

Aims The impact of atrial function measured by standard and advanced echocardiographic techniques is emerging in various clinical settings but remains poorly explored in patients with hypertrophic cardiomyopathy (HCM). Methods and results Consecutive patients with HCM referred to the heart failure outpatient clinic were prospectively enrolled. Complete clinical and echocardiographic evaluation was performed, including fully automated 2D speckle tracking analysis software (AutoStrain, TomTec). Atrial function was assessed by means of left atrial (LA) volume, LA diameter, a’-TDI, and global peak atrial longitudinal strain (PALS). The primary endpoint was a composite of cardiovascular (CV) events (cardiovascular death or hospitalization, new-onset atrial fibrillation, surgical myectomy, sustained ventricular tachycardia or ventricular fibrillation) during the follow-up. A total of 40 patients with confirmed HCM diagnoses and complete follow-up were included, mean age was 61 ± 14 years, 62% male, ejection fraction 64 ± 8%. LA was frequently enlarged (indexed LA volume 43 ± 14 ml/m2, LA diameter 39 ± 7 mm), and dysfunctional (a’-TDI 7.1 ± 2.2 cm/s, PALS 21 ± 7%). During a mean follow-up of 460 ± 300 days, seven patients had a CV event. Among LA parameters, septal a’-TDI seems to characterize patients with events the most (5.5 ± 2.1 vs. 7.5 ± 2.3, P = 0.03). This was confirmed in an age-adjusted survival model [HR: 0.62 (0.39–0.92), P = 0.03]. The spline curve in the Figure illustrates the relationship between a’-TDI and the age-adjusted probability of CV events; the association began at about 7 cm/s and increased steeply for lower values. Of note, the association between PALS and CV events was highly significant in younger patients (<70 years, P < 0.001). Conclusions According to our pilot study, a’-TDI can be considered a simple, feasible, and routinely available parameter of left atrial function, which can help to identify HCM patients at higher risk of CV events.

681 Ventricular fibrosis affects diastolic function and atrial remodelling long-term after aortic valve replacement for aortic valve stenosis

Aims Aortic stenosis (AS) is characterized both by progressive valve narrowing and left ventricular remodelling response. Myocardial fibrosis has significant functional consequences and is the key pathological process driving left ventricular decompensation. Furthermore, studies suggest that myocardial fibrosis is irreversible, despite surgical aortic valve replacement (SAVR). The study aims to define the association between myocardial fibrosis and long-term diastolic and atrial function after SAVR, which are both markers of poor clinical outcomes. Methods We evaluated patients with isolated AS and no-coronary artery disease referred for SAVR in 2015. All of them received a biological valve and a left ventricular biopsy was performed at the time of surgery. Clinical and echocardiographic evaluation was performed before surgery and after about 6 years, including fully automated 2D speckle tracking analysis software (TomTec). Atrial function was evaluated with PALS, PACS, and LAVi/septal a’ TDI. Results Nineteen patients completed the follow-up and formed the study cohort, age 72 ± 6 years, 42% female, ejection fraction 63 ± 6.4%, mean fibrosis 26.4 ± 12.7%. Significant myocardial fibrosis (> 33%) was found in 13/19 patients (68%). Although similar at baseline, after 5.6±0.5 years, PACS was significantly higher in patients with low myocardial fibrosis (13.7±4.2 vs. 8.0±3.8, P=0.01), the same trends were observed for PALS (24.1±7.9 vs. 17.0±6.6, P=0.07) and LAVi/septal a’TDI (5.4±1.3 vs. 7.4±2.8, P=0.06). The diastolic profile at long term follow-up was also significantly worsened in patients with LV fibrosis: E/A 0.9±0.3 vs. 1.3±0.4 P= 0.03 and E/e’ 10.6±3.3 vs. 16.6±4.5 P=0.01). Conclusions Myocardial fibrosis at the time of SAVR strongly influences long-term diastolic Doppler profile and atrial function with potentially harmful consequences on clinical status and ventricular performance.