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OP-085: TRANSESOPHAGEAL 2-DIMENSIONAL SPECKLE TRACKING ECHOCARDIOGRAPHY: DEFINITION NORMAL RANGE
S58
Oral Presentations / International Journal of Cardiology 147S2 (2011) S37–S98
Friday, 25 March 2011
13:30–15:00
Cardiac Imaging: A Futuristic Approach OP-084 QUANTITATIVE ASSESSMENT OF REGIONAL LEFT VENTRICULAR FUNCTIONS BY STRAIN AND STRAIN RATE ECHOCARDIOGRAPHY IN PATIENTS WITH TYPE II DIABETES MELLITUS AND NO MICROVASCULAR COMPLICATIONS; SUB-GROUP ANALYSIS M.S. Alpaydin, E. Aksakal, M.K. Erol, Z. Simsek, M. Acikel, S. Arslan, F. Gundogdu, S. Sevimli, S. Karakelleoglu. Department of Cardiology, Faculty of Medicine, Aziziye Research Hospital, Ataturk University, Erzurum, Turkey Objective: The aim of this study was to evaluate the regional left ventricular (LV) myocardial functions by strain (S) and strain rate (Sr) echocardiography in two sub-groups (G1, G2) of patients with type II diabetes mellitus (DM) no microvascular complications (G1: DM lasting >3 years and, G2: patients treated with oral hypoglisemic agent, insulin, or combination). Methods: Forty patients diagnosed with type II DM and 40 agematched healthy controls were included in this study. There were 24 subjects in G1 and 30 subjects in G2 groups. Patients with ischemic heart disease, LV systolic dysfunction, hypertension, moderate or significant valvular disease and microalbumin-tocreatinine ratio >0.25 on a spot urine sample were excluded. Echocardiographic recordings were obtained from standard apical and parasternal views. Color Doppler myocardial imaging data were acquired at high frame rate (>160 s−1 ). LV diastolic functions were evaluated via measurement of the mitral inflow with conventional Doppler (CD) (E, A, E/A, deceleration time, isovolumic relaxation time) and measurement of the mitral annulus with tissue Doppler (TD) techniques (Em, Am). Regional longitudinal myocardial peak systolic S and Sr indices were calculated from basal, mid and apical segments of LV walls. Results: There were no significant differences between subgroups and controls for LV dimensions, systolic and CD diastolic function variables. The mean duration of DM were 8.1±5.0 years in G1 and 6.4±5.3 years in G2. Comparison of TD variables revealed that only the Em value obtained from the lateral mitral annulus was significantly decreased in the G1 and G2 (9.7±2.7 vs. 11.4±3.2, p < 0.05 and 9.6±2.7 vs. 11.4±3.2, p < 0.05, respectively). Concordantly, the E/Em ratio was increased in the G1 and G2, compared to controls (7.8±2.9 vs. 6.3±2, p < 0.05 and 7.6±2.7 vs. 6.3±2, p < 0.05). There were significant differences in small part of segments between sub-groups and controls for S and Sr values. These differences were distributed heterogeneously among the segments throughout the LV walls. Conclusions: Left ventricular diastolic dysfunction rates were higher in sub-groups of the DM (lasting >3 years and treated medically) than healthy subjects. Irregular distribution of the S and Sr indices in LV segments may indicate that DM leads to heterogeneous myocardial involvement. Our results suggest that a subclinical LV dysfunction with extensive myocardial involvement cannot be detected by S and Sr echocardiography in sub-groups of the type II DM patients without microvascular complications. OP-085 TRANSESOPHAGEAL 2-DIMENSIONAL SPECKLE TRACKING ECHOCARDIOGRAPHY: DEFINITION NORMAL RANGE M. Kurt1 , T. Isik1 , A. Kaya1 , M. Ekinci1 , E. Bilen2 , Z. Simsek1 , E. Bayram1 , I.H. Tanboga1 . 1 Erzurum Edication and Research Hosptital, Erzurum, Turkey; 2 Ankara Ataturk Education and Research Hospital, Ankara, Turkey Objective: 2D strain imaging has been established as a reliable and reproducible technique for assessment of left ventricular function using transthoracic echocardiography (TTE). However, the reliability of LV functions by 2D strain on transesophageal echocardiography
(TEE) remains unclear. In the present study, we sought both to determine normal ranges of 2D strain imaging on TEE as well as to compare 2D strain parameters between TTE and TEE. Methods: Thirty four patients were included in the study. None of the patients had any structural cardiovascular disease. TTE and TEE images of the subjects were recorded and analyzed off-line (EchoPAC 6.1; GE Vingmed Ultrasound AS). Strain and strain rate measurements of the 4 chambers (4C), apical long axis (LAX), 2 chambers (2C) and right ventricle (RV) were obtained for each record of TTE and TEE. Results: The mean age of patients in our study was 36±9.2. Although there was a significant elevation in TEE 4C strain values compared to TTE 4C, Bland–Altman analysis of the TTE and TEE data showed that there were generally good agreement in terms of 4C strain. In addition, there were no significant differences among other strain and strain rate measurements. Moreover, normal ranges of 2D strain and strain rate on TEE were identified. Conclusions: To the best of our knowledge, this is the first study to determine referance values for 2D strain imaging on TEE. Also the differences and agreement for strain and strain rate between TTE and TEE were analized. OP-086 CORRECTION OF TECHNETIUM-99-M-MIBI SPECT BY F18-FDG CARDIAC PET/CT FOR MYOCARDIAL VIABILITY ASSESSMENT PRIOR TO CORONARY REVASCULARIZATION DECISION IN PATIENTS WITH SEVERE VENTRICULAR DYSFUNCTION S. Talay1 , N.B. Talay2 , V. Yurtman3 , M. Ates3 . 1 Department of Cardiovascular Surgery, Erzurum Sifa Hospital, Erzurum, Turkey; 2 Department of Nuclear Medicine, Regional Research and Teaching Hospital, Erzurum, Turkey; 3 Department of Cardiovascular Surgery, Izmir Sifa Hospital, Izmir, Turkey Objective: This multicenter prospective study focuses of assessment of myocardial perfusion and viability by comparison of two different nuclear medicine imaging techniques; technetium 99-m-methoxy-isobutyl-isonitrile single photon emission computed tomography (Technetium-99-m-MIBI SPECT) and cardiac fluorodeoxyglucose positron emisson tomography-computed tomography (F18-FDG Cardiac PET/CT) prior to revascularization decision for severely reduced LVEF cases. Methods: Each patient was evaluated by Technetium-99-mMIBI SPECT and F18-FDG Cardiac PET/CT for myocardial viability detection prior to CABG surgery. Technetium-99-m-MIBI SPECT and F18-FDG Cardiac PET/CT was evaluated in 191 cases preoperatively. This 191 cases (mean age 64±9.1 and male n = 103, 53.9%) with LVEF ≤ 35% were evaluated for coronary revascularization preoperatively. Results: Study data accumulated from cases of CABG (n = 191) with preoperative LVEF measurements between 35% to 20% (n = 154, 80.6%) and lower than 20% (n = 37, 19.3%). Technetium-99-m-MIBI SPECT imaging was performed before F18-FDG Cardiac PET/CT in all cases. By these evaluations, 1896 segments were detailed in total. For Technetium-99-m-MIBI SPECT, 1036 segments displayed normal Technetium-99-m-MIBI uptake (≥70%, classification 2). On the other hand, 860 segments displayed reduced Technetium99-m-MIBI uptake with different digrees (<70%). Elaborations of the latter data, scar tissue with absent Technetium-99-mMIBI uptake (≤30%) was imaged in 441 (23.2%, classification 0), reduced Technetium-99-m-MIBI uptake from 30% to 69% in 419 (22%, classification 1). 1036 segments with normal Technetium99-m-MIBI uptake (≥70%) revealed miocardial viability by F18FDG C-PET/CT in 1036 segments. Predictive value for viability of Technetium-99-m-MIBI SPECT therefore presents a value in 100% in this group. On the other end of the SPECT images, 441 cases with Technetium-99-m-MIBI uptake ≤30% (which otherwise would be accepted as poor candidates for revascularization) presented viability with FDG uptakes in 285 cases. 156 segments from the latter group were verified by FDG uptake as nonviable. The
Oral Presentations / International Journal of Cardiology 147S2 (2011) S37–S98
Friday, 25 March 2011
13:30–15:00
Cardiac Imaging: A Futuristic Approach OP-084 QUANTITATIVE ASSESSMENT OF REGIONAL LEFT VENTRICULAR FUNCTIONS BY STRAIN AND STRAIN RATE ECHOCARDIOGRAPHY IN PATIENTS WITH TYPE II DIABETES MELLITUS AND NO MICROVASCULAR COMPLICATIONS; SUB-GROUP ANALYSIS M.S. Alpaydin, E. Aksakal, M.K. Erol, Z. Simsek, M. Acikel, S. Arslan, F. Gundogdu, S. Sevimli, S. Karakelleoglu. Department of Cardiology, Faculty of Medicine, Aziziye Research Hospital, Ataturk University, Erzurum, Turkey Objective: The aim of this study was to evaluate the regional left ventricular (LV) myocardial functions by strain (S) and strain rate (Sr) echocardiography in two sub-groups (G1, G2) of patients with type II diabetes mellitus (DM) no microvascular complications (G1: DM lasting >3 years and, G2: patients treated with oral hypoglisemic agent, insulin, or combination). Methods: Forty patients diagnosed with type II DM and 40 agematched healthy controls were included in this study. There were 24 subjects in G1 and 30 subjects in G2 groups. Patients with ischemic heart disease, LV systolic dysfunction, hypertension, moderate or significant valvular disease and microalbumin-tocreatinine ratio >0.25 on a spot urine sample were excluded. Echocardiographic recordings were obtained from standard apical and parasternal views. Color Doppler myocardial imaging data were acquired at high frame rate (>160 s−1 ). LV diastolic functions were evaluated via measurement of the mitral inflow with conventional Doppler (CD) (E, A, E/A, deceleration time, isovolumic relaxation time) and measurement of the mitral annulus with tissue Doppler (TD) techniques (Em, Am). Regional longitudinal myocardial peak systolic S and Sr indices were calculated from basal, mid and apical segments of LV walls. Results: There were no significant differences between subgroups and controls for LV dimensions, systolic and CD diastolic function variables. The mean duration of DM were 8.1±5.0 years in G1 and 6.4±5.3 years in G2. Comparison of TD variables revealed that only the Em value obtained from the lateral mitral annulus was significantly decreased in the G1 and G2 (9.7±2.7 vs. 11.4±3.2, p < 0.05 and 9.6±2.7 vs. 11.4±3.2, p < 0.05, respectively). Concordantly, the E/Em ratio was increased in the G1 and G2, compared to controls (7.8±2.9 vs. 6.3±2, p < 0.05 and 7.6±2.7 vs. 6.3±2, p < 0.05). There were significant differences in small part of segments between sub-groups and controls for S and Sr values. These differences were distributed heterogeneously among the segments throughout the LV walls. Conclusions: Left ventricular diastolic dysfunction rates were higher in sub-groups of the DM (lasting >3 years and treated medically) than healthy subjects. Irregular distribution of the S and Sr indices in LV segments may indicate that DM leads to heterogeneous myocardial involvement. Our results suggest that a subclinical LV dysfunction with extensive myocardial involvement cannot be detected by S and Sr echocardiography in sub-groups of the type II DM patients without microvascular complications. OP-085 TRANSESOPHAGEAL 2-DIMENSIONAL SPECKLE TRACKING ECHOCARDIOGRAPHY: DEFINITION NORMAL RANGE M. Kurt1 , T. Isik1 , A. Kaya1 , M. Ekinci1 , E. Bilen2 , Z. Simsek1 , E. Bayram1 , I.H. Tanboga1 . 1 Erzurum Edication and Research Hosptital, Erzurum, Turkey; 2 Ankara Ataturk Education and Research Hospital, Ankara, Turkey Objective: 2D strain imaging has been established as a reliable and reproducible technique for assessment of left ventricular function using transthoracic echocardiography (TTE). However, the reliability of LV functions by 2D strain on transesophageal echocardiography
(TEE) remains unclear. In the present study, we sought both to determine normal ranges of 2D strain imaging on TEE as well as to compare 2D strain parameters between TTE and TEE. Methods: Thirty four patients were included in the study. None of the patients had any structural cardiovascular disease. TTE and TEE images of the subjects were recorded and analyzed off-line (EchoPAC 6.1; GE Vingmed Ultrasound AS). Strain and strain rate measurements of the 4 chambers (4C), apical long axis (LAX), 2 chambers (2C) and right ventricle (RV) were obtained for each record of TTE and TEE. Results: The mean age of patients in our study was 36±9.2. Although there was a significant elevation in TEE 4C strain values compared to TTE 4C, Bland–Altman analysis of the TTE and TEE data showed that there were generally good agreement in terms of 4C strain. In addition, there were no significant differences among other strain and strain rate measurements. Moreover, normal ranges of 2D strain and strain rate on TEE were identified. Conclusions: To the best of our knowledge, this is the first study to determine referance values for 2D strain imaging on TEE. Also the differences and agreement for strain and strain rate between TTE and TEE were analized. OP-086 CORRECTION OF TECHNETIUM-99-M-MIBI SPECT BY F18-FDG CARDIAC PET/CT FOR MYOCARDIAL VIABILITY ASSESSMENT PRIOR TO CORONARY REVASCULARIZATION DECISION IN PATIENTS WITH SEVERE VENTRICULAR DYSFUNCTION S. Talay1 , N.B. Talay2 , V. Yurtman3 , M. Ates3 . 1 Department of Cardiovascular Surgery, Erzurum Sifa Hospital, Erzurum, Turkey; 2 Department of Nuclear Medicine, Regional Research and Teaching Hospital, Erzurum, Turkey; 3 Department of Cardiovascular Surgery, Izmir Sifa Hospital, Izmir, Turkey Objective: This multicenter prospective study focuses of assessment of myocardial perfusion and viability by comparison of two different nuclear medicine imaging techniques; technetium 99-m-methoxy-isobutyl-isonitrile single photon emission computed tomography (Technetium-99-m-MIBI SPECT) and cardiac fluorodeoxyglucose positron emisson tomography-computed tomography (F18-FDG Cardiac PET/CT) prior to revascularization decision for severely reduced LVEF cases. Methods: Each patient was evaluated by Technetium-99-mMIBI SPECT and F18-FDG Cardiac PET/CT for myocardial viability detection prior to CABG surgery. Technetium-99-m-MIBI SPECT and F18-FDG Cardiac PET/CT was evaluated in 191 cases preoperatively. This 191 cases (mean age 64±9.1 and male n = 103, 53.9%) with LVEF ≤ 35% were evaluated for coronary revascularization preoperatively. Results: Study data accumulated from cases of CABG (n = 191) with preoperative LVEF measurements between 35% to 20% (n = 154, 80.6%) and lower than 20% (n = 37, 19.3%). Technetium-99-m-MIBI SPECT imaging was performed before F18-FDG Cardiac PET/CT in all cases. By these evaluations, 1896 segments were detailed in total. For Technetium-99-m-MIBI SPECT, 1036 segments displayed normal Technetium-99-m-MIBI uptake (≥70%, classification 2). On the other hand, 860 segments displayed reduced Technetium99-m-MIBI uptake with different digrees (<70%). Elaborations of the latter data, scar tissue with absent Technetium-99-mMIBI uptake (≤30%) was imaged in 441 (23.2%, classification 0), reduced Technetium-99-m-MIBI uptake from 30% to 69% in 419 (22%, classification 1). 1036 segments with normal Technetium99-m-MIBI uptake (≥70%) revealed miocardial viability by F18FDG C-PET/CT in 1036 segments. Predictive value for viability of Technetium-99-m-MIBI SPECT therefore presents a value in 100% in this group. On the other end of the SPECT images, 441 cases with Technetium-99-m-MIBI uptake ≤30% (which otherwise would be accepted as poor candidates for revascularization) presented viability with FDG uptakes in 285 cases. 156 segments from the latter group were verified by FDG uptake as nonviable. The