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e′ and Ischaemia in Predicting Outcome in Patients Undergoing Exercise Echocardiography
S50
Heart, Lung and Circulation 2009;18S:S1–S286
Abstracts
ABSTRACTS
107 RIGHT VENTRICULAR SIZE AND FUNCTION USING VVI IN SYSTEMIC AMYLOIDOSIS E.M. Chia 1 , M.W. Lin 2 , J. Taper 2 , D. Gottlieb 2 , R. Phoon 2 , G. Stewart 2 , D.A.B. Richards 1 , L. Thomas 1 1 Liverpool
Hospital, University of New South Wales, Sydney,
Australia 2 Westmead Hospital, Sydney, Australia On behalf of the Amyloid investigator group at Westmead Hospital. Background: Left ventricular changes in systemic amyloidosis are well described, however details on right ventricular (RV) size and dysfunction in systemic amyloidosis is unknown. Method: Transthoracic echocardiograms were performed in 21 patients with systemic amyloidosis and compared with 21 age-matched normals. Right atrial (RA) and RV volumes were measured, and RV ejection fraction (RVEF) calculated. RV systolic and diastolic function was measured by velocity vector imaging (VVI), from the basal, mid and apical RV free wall segments. Results: There was no significant difference in RA or RV volumes or in RVEF between patients and normals. However, VVI derived peak S velocity and systolic strain were significantly decreased in amyloidosis. Diastolic parameters including peak E and A velocity, and E strain rate were significantly lower in amyloid patients. Conclusion: Although RA and RV 2D size are unaltered in amyloidosis, there is significant impairment of both systolic and diastolic function. RV dysfunction is absent using traditional 2D techniques, but is detected using the newer VVI modality. Normal (n = 21) RVEF (%) Peak S velocity (cm/s) Peak E velocity (cm/s) Peak A velocity (cm/s) Peak S strain rate (s−1 ) Peak E strain rate (s−1 ) Peak A strain rate (s−1 ) Peak strain (%) ∗
54.7 5.9 5.8 4.7 1.7 1.9 1.1 23.0
± ± ± ± ± ± ± ±
7.4 1.3 2.3 2.0 0.4 0.7 0.4 5.7
Amyloid (n = 21) 58.2 4.7 3.9 3.4 1.5 1.4 1.1 17.9
± ± ± ± ± ± ± ±
9.7 2.1* 2.1* 2.1* 0.6 0.6* 0.5 6.9*
108 ROLE OF EXERCISE E/E AND ISCHAEMIA IN PREDICTING OUTCOME IN PATIENTS UNDERGOING EXERCISE ECHOCARDIOGRAPHY D.J. Holland 1,2 , S.B. Prasad 1 , T.H. Marwick 1 1 School
of Medicine, The University of Queensland, Brisbane, Australia 2 School of Human Movement Studies, The University of Queensland, Brisbane, Australia Background: Raised LV filling pressure after exercise may be accurately measured from exercise E/e . We sought to define the relative contribution of raised exercise E/e and ischaemia to outcomes. Methods: 214 consecutive patients (aged 58 ± 11 years, 64% male) with preserved ejection fraction (≥50%) undergoing exercise stress echocardiography were followed over 2.7 ± 1.7 years. Left ventricular (LV) filling pressure was estimated as the ratio of early diastolic transmitral flow (E-velocity) and early diastolic tissue velocity (septal e ), with E/e > 15 at exercise considered raised. Ischaemia was identified by inducible regional wall motion abnormalities. Deaths and cardiovascular hospitalisations were recorded, and analysed by the Kaplan Meier and Cox regression methods. Results: 69 patients developed ischaemia with stress and 19 had a raised E/e . There were 63 events (7 deaths, 56 cardiovascular hospitalisations). Event-free survival (see Fig. 1) in patients with raised exercise E/e and no ischaemia was comparable to patients with ischaemia alone (p = 0.84). The combination of raised exercise E/e and ischaemia yielded significantly worse survival than patients with normal exercise E/e with or without ischaemia (p < 0.05). Independent, significant predictors of outcome by Cox regression analysis were; exercise E/e > 15 (HR = 2.052; p = 0.041), ischaemia (HR = 1.814; p = 0.021) and peak heart rate (HR = 1.014; p = 0.014). Conclusion: An elevated E/e response to exercise holds similar prognostic outcomes as inducible ischaemia, implicating the importance of measuring E/e during stress echocardiography.
p < 0.05 when compared with normals using independent t-test.
doi:10.1016/j.hlc.2009.05.109
Fig. 1.
doi:10.1016/j.hlc.2009.05.110
Heart, Lung and Circulation 2009;18S:S1–S286
Abstracts
ABSTRACTS
107 RIGHT VENTRICULAR SIZE AND FUNCTION USING VVI IN SYSTEMIC AMYLOIDOSIS E.M. Chia 1 , M.W. Lin 2 , J. Taper 2 , D. Gottlieb 2 , R. Phoon 2 , G. Stewart 2 , D.A.B. Richards 1 , L. Thomas 1 1 Liverpool
Hospital, University of New South Wales, Sydney,
Australia 2 Westmead Hospital, Sydney, Australia On behalf of the Amyloid investigator group at Westmead Hospital. Background: Left ventricular changes in systemic amyloidosis are well described, however details on right ventricular (RV) size and dysfunction in systemic amyloidosis is unknown. Method: Transthoracic echocardiograms were performed in 21 patients with systemic amyloidosis and compared with 21 age-matched normals. Right atrial (RA) and RV volumes were measured, and RV ejection fraction (RVEF) calculated. RV systolic and diastolic function was measured by velocity vector imaging (VVI), from the basal, mid and apical RV free wall segments. Results: There was no significant difference in RA or RV volumes or in RVEF between patients and normals. However, VVI derived peak S velocity and systolic strain were significantly decreased in amyloidosis. Diastolic parameters including peak E and A velocity, and E strain rate were significantly lower in amyloid patients. Conclusion: Although RA and RV 2D size are unaltered in amyloidosis, there is significant impairment of both systolic and diastolic function. RV dysfunction is absent using traditional 2D techniques, but is detected using the newer VVI modality. Normal (n = 21) RVEF (%) Peak S velocity (cm/s) Peak E velocity (cm/s) Peak A velocity (cm/s) Peak S strain rate (s−1 ) Peak E strain rate (s−1 ) Peak A strain rate (s−1 ) Peak strain (%) ∗
54.7 5.9 5.8 4.7 1.7 1.9 1.1 23.0
± ± ± ± ± ± ± ±
7.4 1.3 2.3 2.0 0.4 0.7 0.4 5.7
Amyloid (n = 21) 58.2 4.7 3.9 3.4 1.5 1.4 1.1 17.9
± ± ± ± ± ± ± ±
9.7 2.1* 2.1* 2.1* 0.6 0.6* 0.5 6.9*
108 ROLE OF EXERCISE E/E AND ISCHAEMIA IN PREDICTING OUTCOME IN PATIENTS UNDERGOING EXERCISE ECHOCARDIOGRAPHY D.J. Holland 1,2 , S.B. Prasad 1 , T.H. Marwick 1 1 School
of Medicine, The University of Queensland, Brisbane, Australia 2 School of Human Movement Studies, The University of Queensland, Brisbane, Australia Background: Raised LV filling pressure after exercise may be accurately measured from exercise E/e . We sought to define the relative contribution of raised exercise E/e and ischaemia to outcomes. Methods: 214 consecutive patients (aged 58 ± 11 years, 64% male) with preserved ejection fraction (≥50%) undergoing exercise stress echocardiography were followed over 2.7 ± 1.7 years. Left ventricular (LV) filling pressure was estimated as the ratio of early diastolic transmitral flow (E-velocity) and early diastolic tissue velocity (septal e ), with E/e > 15 at exercise considered raised. Ischaemia was identified by inducible regional wall motion abnormalities. Deaths and cardiovascular hospitalisations were recorded, and analysed by the Kaplan Meier and Cox regression methods. Results: 69 patients developed ischaemia with stress and 19 had a raised E/e . There were 63 events (7 deaths, 56 cardiovascular hospitalisations). Event-free survival (see Fig. 1) in patients with raised exercise E/e and no ischaemia was comparable to patients with ischaemia alone (p = 0.84). The combination of raised exercise E/e and ischaemia yielded significantly worse survival than patients with normal exercise E/e with or without ischaemia (p < 0.05). Independent, significant predictors of outcome by Cox regression analysis were; exercise E/e > 15 (HR = 2.052; p = 0.041), ischaemia (HR = 1.814; p = 0.021) and peak heart rate (HR = 1.014; p = 0.014). Conclusion: An elevated E/e response to exercise holds similar prognostic outcomes as inducible ischaemia, implicating the importance of measuring E/e during stress echocardiography.
p < 0.05 when compared with normals using independent t-test.
doi:10.1016/j.hlc.2009.05.109
Fig. 1.
doi:10.1016/j.hlc.2009.05.110