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Can Strain and Strain Rate Useful in Assessing Left Ventricular Filling Pressure?
S162
Abstracts
ABSTRACTS
398 Can Strain and Strain Rate Useful in Assessing Left Ventricular Filling Pressure? K. Kadappu 1,2,∗ , K. Eagle 1 , R. Rajaratnam 1,2,3 , S. Lo 1,2 , D. Leung 1,2 , J. French 1,2 , L. Thomas 1,2,3 1 Liverpool
Hospital, Australia of New South Wales, Australia 3 University of Western Sydney, Australia 2 University
LV end diastolic pressure (LVEDP) is determined invasively; echocardiographic E/e ratio using transmitral flow and tissue Doppler imaging (TDI) correlates with LVEDP. Few reports indicate that 2D diastolic strain (Ds) and early diastolic strain rate (Dsr) can be used to assess the LVEDP non invasively. Methods: Fifty-two patients (62 ± 12 years) had an echocardiogram just prior to their angiogram. Transmitral peak E velocity was measured. Mitral annular e velocities (septal and lateral) were averaged. 2D diastolic strain and early diastolic strain rate were measured from six annular segments from three apical views and the six segment average was used for analysis. LVEDP was measured with a fluid-filled catheter in the left ventricle. Results: Mean LVEDP was 14 ± 6 mmHg; 32 had an LVEDP ≥ 12 mmHg. E/e as well as E/Ds correlated significantly with LVEDP. E/e had an area under the ROC curve of 0.71 in identifying LVEDP of ≥12 mmHg (sensitivity 60%, specificity 70% for an E/e ratio >6.5). E/Ds from six segment model had a similar area under the ROC curve (0.7) with sensitivity 60%, specificity 70% for an E/Ds ratio >4.7 and E/Dsr had a lower area under the ROC curve (0.63) with sensitivity 60%, specificity 50% for E/Dsr > 0.79. Conclusion: E/Ds by 2D speckle tracking using the 6 segment model correlates well with invasively measured LVEDP and is comparable to TDI E/e . Future studies examining outcomes are required to determine its clinical relevance. doi:10.1016/j.hlc.2011.05.402 399 Cardiac Magnetic Resonance: Clinical Experience in a High Volume Centre K. Williams 1 , J. Richardson 1,2,∗ , A. Bertaso 1 , D. Wong 1,2 , J. Young 1 , B. Koschade 1,2 , M. Cunnington 1 , A. Nelson 1,2 , H. Tayeb 1 , V. Cox 1,2 , P. Molaee 1 , M. Brown 1 , M. Worthley 1,2 , K. Teo 1,2 , S. Worthley 1,2 1 Royal
Adelaide Hospital, Adelaide, SA, Australia of Adelaide, Adelaide, SA, Australia
2 University
Background: Cardiac magnetic resonance (CMR) is increasingly the cardiac imaging modality of reference. CMR is the gold-standard method of evaluating LV systolic function, complex congenital heart disease and non-invasive ischaemia testing. Flow assessments are attainable in any plane across many structures (valves, stenoses, conduits). Myocardial scar/fibrosis is readily
Heart, Lung and Circulation 2011;20S:S156–S251
demonstrated with late gadolinium enhancement. The data obtained is highly reproducible, independent of imaging windows and does not require ionising radiation. We describe the CMR experience in a large volume Australian centre. Methods: A retrospective analysis of the category and indication of CMR scans performed at a tertiary referral CMR unit from December 2007 to December 2010. All scans performed on a machine primarily dedicated to cardiac imaging. Results: A total of 4302 scans were performed. The dominant indications comprised ischaemia stress testing (1273 cases – 1112 adenosine perfusion, 151 dobutamine), cardiomyopathy /myocarditis assessment (1007), and aortic valvular/ aorta studies (453). Other frequently performed scans include myocardial viability studies with gadolinium ± low-dose dobutamine (316), congenital (259), ARVC (182) and atrial/pulmonary venous evaluations (136). MR angiography was performed on 326 occasions with the remaining examinations including thrombus, masses and coronary artery assessment. Recently scans of patients’ post-TAVI or with MRI compatible pacemakers have been undertaken. Conclusion: This description of our experience highlights the numerous and varied indications for CMR. It reinforces the view that a sufficient workload exists to ensure an MRI service dedicated to cardiac imaging is a viable option. doi:10.1016/j.hlc.2011.05.403 400 Cardiac MRI and Non-compaction: Incidence and Clinical Patterns H. Jangwal ∗ , D. Celermajer, B. Bailey, S. Singarayar, C. Semsarian, D. Richmond, R. Puranik Royal Prince Alfred Hospital, Australia Background: Non-compaction (NC) is an apparently rare cardiomyopathy characterised by the persistence of numerous marked ventricular trabeculations and deep intertrabecular recesses. However, abnormal compaction (AC) can also be associated with various cardiac pathologies. NC can ultimately lead to heart failure, thrombus formation, arrhythmia/sudden death. Aims: To investigate the incidence and clinical patterns of NC and AC using cMRI (1.5 T). Methods: Consecutive CMRI scans were reviewed from October 2008 to January 2011 where NC (NC/C ratio >2.3 in end-diastole) and AC (prominent trabeculations but the NC/C ratio <2.3) were identified. Results: 796 patients were scanned during the study period. NC was diagnosed in 28 cases (3.5%) and AC in 19 cases (2.3%). The age range was 11–86 yr and M/F ratio was 27/20. Scan indications included; SOB/chest pain 19%, CCF 9%, VT/Syncope 15%, congenital HD 26% and echo abnormalities (often to confirm HCM) 32%. NC cases
Abstracts
ABSTRACTS
398 Can Strain and Strain Rate Useful in Assessing Left Ventricular Filling Pressure? K. Kadappu 1,2,∗ , K. Eagle 1 , R. Rajaratnam 1,2,3 , S. Lo 1,2 , D. Leung 1,2 , J. French 1,2 , L. Thomas 1,2,3 1 Liverpool
Hospital, Australia of New South Wales, Australia 3 University of Western Sydney, Australia 2 University
LV end diastolic pressure (LVEDP) is determined invasively; echocardiographic E/e ratio using transmitral flow and tissue Doppler imaging (TDI) correlates with LVEDP. Few reports indicate that 2D diastolic strain (Ds) and early diastolic strain rate (Dsr) can be used to assess the LVEDP non invasively. Methods: Fifty-two patients (62 ± 12 years) had an echocardiogram just prior to their angiogram. Transmitral peak E velocity was measured. Mitral annular e velocities (septal and lateral) were averaged. 2D diastolic strain and early diastolic strain rate were measured from six annular segments from three apical views and the six segment average was used for analysis. LVEDP was measured with a fluid-filled catheter in the left ventricle. Results: Mean LVEDP was 14 ± 6 mmHg; 32 had an LVEDP ≥ 12 mmHg. E/e as well as E/Ds correlated significantly with LVEDP. E/e had an area under the ROC curve of 0.71 in identifying LVEDP of ≥12 mmHg (sensitivity 60%, specificity 70% for an E/e ratio >6.5). E/Ds from six segment model had a similar area under the ROC curve (0.7) with sensitivity 60%, specificity 70% for an E/Ds ratio >4.7 and E/Dsr had a lower area under the ROC curve (0.63) with sensitivity 60%, specificity 50% for E/Dsr > 0.79. Conclusion: E/Ds by 2D speckle tracking using the 6 segment model correlates well with invasively measured LVEDP and is comparable to TDI E/e . Future studies examining outcomes are required to determine its clinical relevance. doi:10.1016/j.hlc.2011.05.402 399 Cardiac Magnetic Resonance: Clinical Experience in a High Volume Centre K. Williams 1 , J. Richardson 1,2,∗ , A. Bertaso 1 , D. Wong 1,2 , J. Young 1 , B. Koschade 1,2 , M. Cunnington 1 , A. Nelson 1,2 , H. Tayeb 1 , V. Cox 1,2 , P. Molaee 1 , M. Brown 1 , M. Worthley 1,2 , K. Teo 1,2 , S. Worthley 1,2 1 Royal
Adelaide Hospital, Adelaide, SA, Australia of Adelaide, Adelaide, SA, Australia
2 University
Background: Cardiac magnetic resonance (CMR) is increasingly the cardiac imaging modality of reference. CMR is the gold-standard method of evaluating LV systolic function, complex congenital heart disease and non-invasive ischaemia testing. Flow assessments are attainable in any plane across many structures (valves, stenoses, conduits). Myocardial scar/fibrosis is readily
Heart, Lung and Circulation 2011;20S:S156–S251
demonstrated with late gadolinium enhancement. The data obtained is highly reproducible, independent of imaging windows and does not require ionising radiation. We describe the CMR experience in a large volume Australian centre. Methods: A retrospective analysis of the category and indication of CMR scans performed at a tertiary referral CMR unit from December 2007 to December 2010. All scans performed on a machine primarily dedicated to cardiac imaging. Results: A total of 4302 scans were performed. The dominant indications comprised ischaemia stress testing (1273 cases – 1112 adenosine perfusion, 151 dobutamine), cardiomyopathy /myocarditis assessment (1007), and aortic valvular/ aorta studies (453). Other frequently performed scans include myocardial viability studies with gadolinium ± low-dose dobutamine (316), congenital (259), ARVC (182) and atrial/pulmonary venous evaluations (136). MR angiography was performed on 326 occasions with the remaining examinations including thrombus, masses and coronary artery assessment. Recently scans of patients’ post-TAVI or with MRI compatible pacemakers have been undertaken. Conclusion: This description of our experience highlights the numerous and varied indications for CMR. It reinforces the view that a sufficient workload exists to ensure an MRI service dedicated to cardiac imaging is a viable option. doi:10.1016/j.hlc.2011.05.403 400 Cardiac MRI and Non-compaction: Incidence and Clinical Patterns H. Jangwal ∗ , D. Celermajer, B. Bailey, S. Singarayar, C. Semsarian, D. Richmond, R. Puranik Royal Prince Alfred Hospital, Australia Background: Non-compaction (NC) is an apparently rare cardiomyopathy characterised by the persistence of numerous marked ventricular trabeculations and deep intertrabecular recesses. However, abnormal compaction (AC) can also be associated with various cardiac pathologies. NC can ultimately lead to heart failure, thrombus formation, arrhythmia/sudden death. Aims: To investigate the incidence and clinical patterns of NC and AC using cMRI (1.5 T). Methods: Consecutive CMRI scans were reviewed from October 2008 to January 2011 where NC (NC/C ratio >2.3 in end-diastole) and AC (prominent trabeculations but the NC/C ratio <2.3) were identified. Results: 796 patients were scanned during the study period. NC was diagnosed in 28 cases (3.5%) and AC in 19 cases (2.3%). The age range was 11–86 yr and M/F ratio was 27/20. Scan indications included; SOB/chest pain 19%, CCF 9%, VT/Syncope 15%, congenital HD 26% and echo abnormalities (often to confirm HCM) 32%. NC cases