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Reduced Right Ventricular Function is Seen with Tissue Doppler Strain in Systemic Amyloidosis
Abstracts
lower radiation doses without compromising sensitivity or specificity. Aim: To outline the radiation exposure in a series of consecutive patients in Western Sydney having a CTCA using a Siemens Dual FLASH 128-multi-slice new generation CT scanner. Method: Radiation doses and demographics were collected for a series of 195 patients referred for a CTCA in an outpatient setting for a period between July and December 2010. Results: Of the 195 patients, 107 (54.9%) were males and 78 (45.1%) were females. Mean age was 57 ± 14.7 (range 15–86years). Mean total radiation was 2.35 ± 3.19 mSv (range 0.2–24.51). Mean radiation for females 2.22 ± 2.49 mSV and for men 2.49 ± 3.64 (p = 0.16, NS). Mean heart rates were 60.84 ± 9.73 beats per min. Conclusion: There is significant reduction in radiation dose to patients with the new generation dual-flash CT scanners. However, this is still dependent on other factors like heart rate/protocol. Scanning protocol 120 kV retrospective 80 kV Dual FLASH 100 kV Dual FLASH 120 kV Dual FLASH 140 + 120 kV Dual FLASH 100 kV DSCorAd sequence 120 kV DSCorAd sequence
No. of patients 3 (1.5%) 7 (3.6%) 71 (36.4%) 26 (13.3%) 2 (1.1%) 15 (7.7%) 16 (8.2%)
Mean radiation (mSv) 19.68 0.72 0.77 1.54 2.27 3.32 7.78
± ± ± ± ± ± ±
5.24 0.97 0.15 0.43 0.2 1.37 3.72
Range (mSv) 14.11–24.51 0.2–0.32 0.42–1.47 0.43–1.84 2.13–2.4 1.72–4.59 4.0–18.48
*Equal contribution.
doi:10.1016/j.hlc.2011.05.466 463 Reduced Right Ventricular Function is Seen with Tissue Doppler Strain in Systemic Amyloidosis E. Chia 1,∗ , Q. Lo 1,2 , M. Lin 2 , J. Taper 2 , D. Gottlieb 2 , R. Phoon 2 , G. Stewart 2 , D. Richards 1 , L. Thomas 1 1 Liverpool
Hospital, Australia Hospital, Australia
2 Westmead
Aim: To assess right ventricular (RV) function in systemic amyloidosis (AS) using tissue Doppler (TD) derived strain. Method: Transthoracic echocardiograms (TTE) were performed in 55 AS patients referred to a single centre (34/55 had cardiac involvement) and were compared to age-matched normal controls. Parameters for right atrial (RA), RV end-systolic and end-diastolic volumes and systolic function (Simpson’s RV ejection fraction (EF), TD S velocity, TD S strain rate and peak systolic strain (S)) were measured. Diastolic parameters included tricuspid peak E velocity, TD E and E strain rate. Results: AS patients with known cardiac involvement had RA and RV dilatation and hypertrophy. Although RVEF was preserved, TD derived peak systolic S and S were significantly reduced. Tricuspid inflow peak E velocity was similar, however diastolic dysfunction was evident by a reduced TD derived peak E velocity and E strain rate Conclusion: In patients with AS with cardiac involvement there is definite RV systolic and diastolic dysfunction
S189
demonstrated by TD derived velocity, strain and strain rate with associated RV dilatation and hypertrophy. Normal (n = 34) RVEDV (ml/m2 ) RA volume (ml/m2 ) RV wall thickness (mm) S (cm/s) Peak strain E’ velocity (cm/s) Peak E strain rate (s−1 ) ∗ †
15.4 18.1 4.8 11.5 21.4 10.6 2.7
± ± ± ± ± ± ±
4.8 5.1 1.2 1.4 7.8 2.0 0.8
AS: no cardiac involve (n = 21) 14.9 15.7 5.1 10.1 19.6 8.5 1.8
± ± ± ± ± ± ±
7.3 6.3 1.8 2.9 9.3 3.3* 0.9*
AS: cardiac involve (n = 34) 20.5 30.0 7.7 9.0 13.8 7.8 1.4
± ± ± ± ± ± ±
10.4*, † 18.4*, † 3.0*, † 2.6* 8.5*, † 2.6* 1.2*
p < 0.05 vs normal. p < 0.05 vs amyloid pts with no cardiac involve.
doi:10.1016/j.hlc.2011.05.467 464 Reproducibility of Segmental Myocardial Strain and Myocardial Velocity Analysis During Dobutamine Stress Echocardiography D. Sathianathan ∗ , N. Kelly, C. Benjamin, D. Burstow, J. Chan
West, B.
Bolton, A.
The Prince Charles Hospital, Brisbane, Australia Background: Tissue Doppler imaging (TDI) and 2D speckle tracking (2D) strain can potentially improve the diagnostic accuracy of dobutamine stress echocardiography (DSE) but reproducibility of these techniques is unclear. Aim: To assess reproducibility of segmental strain and velocity analysis during DSE. Methods: Eight patients (five male, age 68 ± 6.9 years) underwent DSE. Images were acquired using Vivid E9 (GE-Vingmed, Horten, Norway). Each segment was analyzed offline by two independent, blinded observers. Peak longitudinal strain and peak myocardial velocity were measured by both 2D and TDI techniques. Segments unsuitable for analysis due to suboptimal image quality were excluded. Interobserver agreement was assessed using Bland Altman analysis and Pearson’s correlation (r). Results: A 384 segments were available for analysis (using a conventional 16 segment model of the left ventricle). Results are tabulated below. P < 0.0001 for all r values.
Rest
Low dose
Peak dose
% segments Mean diff ± 2SD r % segments Mean diff ± 2SD r % segments Mean diff ± 2SD r
2D strain (%)
2D velocity (cm/s)
TDI strain (%)
TDI velocity (cm/s)
91 −0.59 ± 8.0 0.72 88 −0.45 ± 9.9 0.69 74 −0.45 ± 8.2 0.84
91 0.07 ± 1.5 0.86 88 −0.09 ± 1.8 0.93 74 −0.18 ± 2.6 0.81
87 −0.44 ± 16.0 0.59 78 −1.18 ± 14.0 0.69 84 0.5 ± 18.6 0.64
88 −0.19 ± 1.2 0.93 74 −0.12 ± 1.6 0.92 84 0.9 ± 6.0 0.64
Conclusions: Longitudinal segmental strain and velocity measurements were highly feasible during DSE with excellent reproducibility especially for velocities. 2D strain has superior interobserver agreement compared to TDI strain during all DSE stages. doi:10.1016/j.hlc.2011.05.468
ABSTRACTS
Heart, Lung and Circulation 2011;20S:S156–S251
lower radiation doses without compromising sensitivity or specificity. Aim: To outline the radiation exposure in a series of consecutive patients in Western Sydney having a CTCA using a Siemens Dual FLASH 128-multi-slice new generation CT scanner. Method: Radiation doses and demographics were collected for a series of 195 patients referred for a CTCA in an outpatient setting for a period between July and December 2010. Results: Of the 195 patients, 107 (54.9%) were males and 78 (45.1%) were females. Mean age was 57 ± 14.7 (range 15–86years). Mean total radiation was 2.35 ± 3.19 mSv (range 0.2–24.51). Mean radiation for females 2.22 ± 2.49 mSV and for men 2.49 ± 3.64 (p = 0.16, NS). Mean heart rates were 60.84 ± 9.73 beats per min. Conclusion: There is significant reduction in radiation dose to patients with the new generation dual-flash CT scanners. However, this is still dependent on other factors like heart rate/protocol. Scanning protocol 120 kV retrospective 80 kV Dual FLASH 100 kV Dual FLASH 120 kV Dual FLASH 140 + 120 kV Dual FLASH 100 kV DSCorAd sequence 120 kV DSCorAd sequence
No. of patients 3 (1.5%) 7 (3.6%) 71 (36.4%) 26 (13.3%) 2 (1.1%) 15 (7.7%) 16 (8.2%)
Mean radiation (mSv) 19.68 0.72 0.77 1.54 2.27 3.32 7.78
± ± ± ± ± ± ±
5.24 0.97 0.15 0.43 0.2 1.37 3.72
Range (mSv) 14.11–24.51 0.2–0.32 0.42–1.47 0.43–1.84 2.13–2.4 1.72–4.59 4.0–18.48
*Equal contribution.
doi:10.1016/j.hlc.2011.05.466 463 Reduced Right Ventricular Function is Seen with Tissue Doppler Strain in Systemic Amyloidosis E. Chia 1,∗ , Q. Lo 1,2 , M. Lin 2 , J. Taper 2 , D. Gottlieb 2 , R. Phoon 2 , G. Stewart 2 , D. Richards 1 , L. Thomas 1 1 Liverpool
Hospital, Australia Hospital, Australia
2 Westmead
Aim: To assess right ventricular (RV) function in systemic amyloidosis (AS) using tissue Doppler (TD) derived strain. Method: Transthoracic echocardiograms (TTE) were performed in 55 AS patients referred to a single centre (34/55 had cardiac involvement) and were compared to age-matched normal controls. Parameters for right atrial (RA), RV end-systolic and end-diastolic volumes and systolic function (Simpson’s RV ejection fraction (EF), TD S velocity, TD S strain rate and peak systolic strain (S)) were measured. Diastolic parameters included tricuspid peak E velocity, TD E and E strain rate. Results: AS patients with known cardiac involvement had RA and RV dilatation and hypertrophy. Although RVEF was preserved, TD derived peak systolic S and S were significantly reduced. Tricuspid inflow peak E velocity was similar, however diastolic dysfunction was evident by a reduced TD derived peak E velocity and E strain rate Conclusion: In patients with AS with cardiac involvement there is definite RV systolic and diastolic dysfunction
S189
demonstrated by TD derived velocity, strain and strain rate with associated RV dilatation and hypertrophy. Normal (n = 34) RVEDV (ml/m2 ) RA volume (ml/m2 ) RV wall thickness (mm) S (cm/s) Peak strain E’ velocity (cm/s) Peak E strain rate (s−1 ) ∗ †
15.4 18.1 4.8 11.5 21.4 10.6 2.7
± ± ± ± ± ± ±
4.8 5.1 1.2 1.4 7.8 2.0 0.8
AS: no cardiac involve (n = 21) 14.9 15.7 5.1 10.1 19.6 8.5 1.8
± ± ± ± ± ± ±
7.3 6.3 1.8 2.9 9.3 3.3* 0.9*
AS: cardiac involve (n = 34) 20.5 30.0 7.7 9.0 13.8 7.8 1.4
± ± ± ± ± ± ±
10.4*, † 18.4*, † 3.0*, † 2.6* 8.5*, † 2.6* 1.2*
p < 0.05 vs normal. p < 0.05 vs amyloid pts with no cardiac involve.
doi:10.1016/j.hlc.2011.05.467 464 Reproducibility of Segmental Myocardial Strain and Myocardial Velocity Analysis During Dobutamine Stress Echocardiography D. Sathianathan ∗ , N. Kelly, C. Benjamin, D. Burstow, J. Chan
West, B.
Bolton, A.
The Prince Charles Hospital, Brisbane, Australia Background: Tissue Doppler imaging (TDI) and 2D speckle tracking (2D) strain can potentially improve the diagnostic accuracy of dobutamine stress echocardiography (DSE) but reproducibility of these techniques is unclear. Aim: To assess reproducibility of segmental strain and velocity analysis during DSE. Methods: Eight patients (five male, age 68 ± 6.9 years) underwent DSE. Images were acquired using Vivid E9 (GE-Vingmed, Horten, Norway). Each segment was analyzed offline by two independent, blinded observers. Peak longitudinal strain and peak myocardial velocity were measured by both 2D and TDI techniques. Segments unsuitable for analysis due to suboptimal image quality were excluded. Interobserver agreement was assessed using Bland Altman analysis and Pearson’s correlation (r). Results: A 384 segments were available for analysis (using a conventional 16 segment model of the left ventricle). Results are tabulated below. P < 0.0001 for all r values.
Rest
Low dose
Peak dose
% segments Mean diff ± 2SD r % segments Mean diff ± 2SD r % segments Mean diff ± 2SD r
2D strain (%)
2D velocity (cm/s)
TDI strain (%)
TDI velocity (cm/s)
91 −0.59 ± 8.0 0.72 88 −0.45 ± 9.9 0.69 74 −0.45 ± 8.2 0.84
91 0.07 ± 1.5 0.86 88 −0.09 ± 1.8 0.93 74 −0.18 ± 2.6 0.81
87 −0.44 ± 16.0 0.59 78 −1.18 ± 14.0 0.69 84 0.5 ± 18.6 0.64
88 −0.19 ± 1.2 0.93 74 −0.12 ± 1.6 0.92 84 0.9 ± 6.0 0.64
Conclusions: Longitudinal segmental strain and velocity measurements were highly feasible during DSE with excellent reproducibility especially for velocities. 2D strain has superior interobserver agreement compared to TDI strain during all DSE stages. doi:10.1016/j.hlc.2011.05.468
ABSTRACTS
Heart, Lung and Circulation 2011;20S:S156–S251