516
Target organ damage in hypertension / Cardiomyopathy
Figure 1. Age at onset of elevated BP versus cIMT
2894 | SPOTLIGHT 2013
BNP and renal resistive index in essential hypertension
G. Moustakas, E. Chatzistamatiou, D. Papoutsis, E. Chrystakopoulos, I. Skiadas,
S. Sideris, A. Androulakis, C. Avgeropoulou, I. Vlaseros, I. Kallikazaros.
Hippokration General Hospital, Cardiology Department, Athens, Greece
Purpose: Renal resistive index (RI) reflects not only intrarenal, but also systemic
hemodynamic conditions. Brain natriuretic peptide (BNP) is released by ventricular myocardium in response to high loading conditions. Aim of our study was
to explore the relationship between BNP levels and RI in essential hypertensive
(EH) patients.
Methods: We studied 409 consecutive, newly diagnosed, never treated EH patients. All patients underwent renal Doppler ultrasound with RI measurement. The
mean value of RI from both kidneys was used for this analysis. Measurement
of brain natriuretic peptide (BNP) was performed by an immunoassay method.
Based on BNP levels the study population was split into quartiles (A ≤5.2, B 5.2–
11.9, C 11.9–24.5, D >24.5 pg/ml).
Results: RI was significantly and positively correlated with BNP levels (r=0.393,
p<0.001). Compared to lowest (A), patients in the highest quartile (D) were older,
female, with lower diastolic blood pressure and heart rate (Table). Moreover, indices of left ventricular diastolic dysfunction and aortic stiffness were more prevalent in group D, while there was no difference with regard to indices of systolic
function. Finally, according to multivariate regression analysis BNP (b=0.032,
95% CI: 0.0028–0.062, p=0.032) remained an independent predictor of RI, adjusting for age, gender, BMI, GFR and BP.
Variables
BNP quartiles
Age, years
Gender, % female
24 hour diastolic BP, mmHg
24 hour heart rate
TDI mean annular Em/Am ratio
E/Em ratio
Carotid femoral pulse wave
velocity (PWV), m/sec
Augmentation index (Aix@75)
Renal resistive index (RI)
p
A
(≤5.2
pg/ml)
B
(5.2–11.9
pg/ml)
C
(11.9–24.5
pg/ml)
D
(>24.5
pg/ml)
43±14
26
77±9
76±8
1.1±0.5
7±2
47±14
32
76±9
73±10
1±0.4
7±2
56±11
54
77±10
72±8
0.88±0.3
8±2
61±10
69
71±11
69±9
0.9±0.3
9±3
<0.001
<0.001
0.0029
0.0013
<0.001
<0.001
7.9±1.3
21±14
0.60±0.049
8.1±1.7
23±13
0.60±0.06
8.7±1.6
28±8
0.63±0.06
9±2.2
28±7
0.66±0.06
0.0019
0.011
<0.001
Conclusion: In EH, factors that increase cardiac loading conditions, increase
renal RI. Despite the fact that BNP and renal RI are age- and gender-dependent,
higher BNP levels represent an independent determinant of higher renal RI.
POSTER SESSION 4
CARDIOMYOPATHY
P2911 | BEDSIDE
Presence of plakophilin-2 mutation in arrhythmogenic right
ventricular dysplasia cardiomyopathy is associated with worse left
ventricular mechanics
H.Y. Liang 1 , L. Tops 2 , H. Tandri 2 , C. James 2 , C. Tichnell 2 , J. Bax 3 , D. Judge 2 ,
H. Calkins 2 , T. Abraham 2 . 1 China Medical University Hospital, Medicine,
Cardiology, Taichung, Taiwan; 2 Johns Hopkins University School of Medicine,
Baltimore, United States of America; 3 Leiden University Medical Center, Leiden,
Netherlands
Background: Arrhythmogenic right ventricular dysplasia cardiomyopathy
(ARVDC) is an inherited disease typified by fibro-fatty replacement of the RV myocardium and presenting with RV failure and life-threatening ventricular arrhythmias. Recently, several desmosomal mutations have been identified in ARVD with
plakophilin-2 (PKP2) gene mutation being the most common. We investigated
the impact of the PKP2 mutation on RV and LV cardiac mechanics using tissue
Doppler echocardiography (TDE).
Methods and results: Conventional and TDE was performed in 52 ARVD/C
patients fulfilling 2010 Task Force criteria. Detailed morphologic and functional
evaluation of the RV and LV were performed including RV end-diastolic and systolic area, RV fractional area change (RV FAC), RV outflow tract (RVOT) diameter, LV volume and ejection fraction (EF); peak systolic velocity (Sm), maximal
strain in basal RV, ventricular septum, LV lateral and posterior walls. Mechanical dyssynchrony was calculated as difference in time to peak Sm. Mean age
was 41±12 years and 28 (54%) were male. The RVOT diameter, RV FAC and LV
EF were 3.8±0.8 cm, 0.30±0.10 and 0.57±0.06, respectively. Thirty-four (65%)
patients were positive for PKP2 mutation and we compared those with (PKP2+)
and without (PKP2-) the mutation. Other than a preponderance of males (65%
vs. 33%, respectively, p= 0.03) in the PKP2+ group there were no differences in
age, RVOT diameter, RV FAC, LV EF, Sm, strain of RV, RV intraventricular dyssynchrony (RV to LV septum delay: 64±49 in PKP2+ group vs. 58±46 ms in PKP2group, respectively, p= 0.54) between the groups. However, mean LV strain was
lower (-17.6±4.6 vs. -20.6±4.4%, respectively, p= 0.03) and RV-LV mechanical
delay longer (RV to LV lateral wall delay: 79±58 vs. 41±63 ms, respectively, p=
0.017) in the PKP2+ compared to PKP2- group. This mechanical dyssynchrony
was characterized by longer septal to LV lateral wall mechanical delays (LV septum to lateral wall: 15±49 vs. -16±57 ms, respectively, p= 0.012) in the PKP2+
compared to PKP2- group.
Conclusion: RV morphology and function are similarly affected in ARVDC patients with or without a PKP2 mutation. However, presence of PKP2 mutation is
associated with worse LV systolic mechanics and interventricular dyssynchrony
indicating a propensity for LV involvement in this population. Our results suggest
that closer monitoring of LV function is likely warranted in PKP2+ ARVDC patients.
P2910 | BEDSIDE
Predictive value of cardiac CT scan in patients undergoing
catheter ablation of atrial fibrillation: beyond left atrial size
P2912 | BEDSIDE
Global longitudinal 2D strain for evaluation of myocarditis as
proven by endomyocardial biopsy
R.A. Providencia, J.P. Albenque, N. Combes, A. Bouzeman, B. Casteigt,
H. Hireche, S. Fazaa, S. Combes, S. Boveda. Clinic Pasteur of Toulouse,
Toulouse, France
M. Kasner, D.L. Sinning, F. Escher, D. Lassner, U. Kuehl, H.-P. Schultheiss,
C. Tschoepe. Charite - University Medicine, Campus Benjamin Franklin,
Department of Cardiology and Pulmonology, Berlin, Germany
Background: Cardiac CT scan is frequently performed before catheter ablation
Background: Making the diagnosis of acute myocarditis (AMC) remains chal-
Downloaded from https://academic.oup.com/eurheartj/article/34/suppl_1/P2912/409492 by guest on 06 December 2023
normotensives: 0.666±0.109mm prehypertensives: 0.689±0.122mm, hypertensives: 0.704±0.130mm, P<0.001). 30% of subjects with elevated BP were receiving anti-hypertensive medication and their cIMT was no different from those
with equivalent BP and no treatment. BP rose progressively from 118±14 mmHg
at 36y to 135±18mmHg at 60-64y and at each age was associated with a higher
cIMT at 60-64y (all adjusted for classical CV risk factors). The earlier the BP elevation, the greater the impact on cIMT (Figure 1). There was no critical time
period in this relationship.
Conclusions: Long term elevation in BP, even at modest levels, results in cumulative vascular damage in later life. This argues for early intervention for BP
control.
of atrial fibrillation (AF) in order to clarify the anatomical variations that exist in
the pulmonary veins, and anticipating potential difficulties during the procedure.
CT scan also provides information concerning left atrial volume (LAV), a known
predictor of AF relapse after catheter ablation. The incremental predictive value of
pulmonary vein variants to LAV has not yet been fully elucidated and contradictory
results are present in the literature. Furthermore, debate exists if LAV indexed to
body surface area, rather than LAV should be used.
Methods: During a 15 months period all patients performing a CT scan (64-slice
Siemens dual source CT scan) before undergoing catheter ablation of AF were
assessed. LAV, indexed LAV and pulmonary vein morphology were assessed and
comparisons were performed according to the presence of early (<72hours) or
late relapse. ROC curves were traced for defining best cutoff values for LAV.
Results: 470 patients performed a CT scan before undergoing catheter ablation of AF (58.1% paroxysmal) and 27.4% of relapse was observed after 12±6
months. An indexed LAV of 39.0ml/m2 and LAV of 87.5ml were identified as the
best cutoff points for LA dimensions for relapse. On univariate analysis these were
predictors of late relapse (OR 2.17 CI95% 1.4-3.4 p<0.001 and OR 2.27 CI95%
1.5-3.5 p<0.001, respectively) and indexed LAV a predictor of early relapse (OR
3.17 CI95% 1.4-7.2 p=0.004). The presence of right supranumerary veins and
a common left pulmonary vein trunk were the most common abnormalities and
were described in 20.4% and 22.3% of patients, respectively. Left supranumerary
veins (1.3%) and a right common pulmonary trunk (0.8%) were rare findings. The
presence of these pulmonary vein anomalies (homolateral or bilateral common
trunk or supernumerary veins; presence of any pulmonary vein anomaly) was not
associated with a higher rate of early or late relapse. On multivariate analysis only
LAV was a predictor of both early and late AF relapse.
Conclusions: Our findings do not confirm the predictive role of anatomical variations of the pulmonary veins and reinforce the predictive power of LAV, even when
not indexed to body surface area.
Cardiomyopathy
P2913 | BEDSIDE
2D strain: ready to reduce the number of endomyocardial byopsies
in heart trasplant recipients
V. Monivas Palomero, S. Mingo Santos, C. Mitroi, I. Garcia Lunar, B. Rivero,
J. Gonzalez Mirelis, P. Beltran Correas, M. Cavero Gibanel, M. Gomez
Bueno, J. Segovia Cubero. University Hospital Puerta de Hierro Majadahonda,
Department of Cardiology, Madrid, Spain
Repeated endomyocardial biopsy (EB) the first year after heart transplant (HT) is
the only validated procedure to diagnose allograft rejection (AR). Recent development of myocardial deformation parameters may be an alternative. Our aim is
to demostrate its utility in the detection of AR.
Methods: From 2010 we included prospectively 34 HT recipients. During the first
year after HT, EB were performed the same day as echo (median 7/patient). We
obtained longitudinal strain (Long.S) in 4 and 2-chamber views and classic LV
parameters. AR by EB was graded according to ISHLT.
Results: We analyzed 224 EB and echo exams. AR was detected en 59 EBs
(48 1R, 8 2R and 3 3R). LV parameters associated with AR are shown in
table. On multivariate analysis we identified septal thickness (RR 1.28, [1.011.62], p=0.04), Long.S (RR1.19[1.08-1.32], p=.001) and Isovolumic Relaxation
time (RR1.03[1.01-1.04], p=.007) as independent predictors of AR. Global LV
Long.S better than -18% excludes AR with a negative predictive value of 81.1%
(p<0.005).
Table 1. Univariate analysis
AR (n=59)
No AR (n=165)
p value
LV Long. S
(4C)
LV Long. S
(2C)
Global
LV Long. S
ST
IVRT
Lateral
E-wave
−15.2±3.3
−17.6±3.0
<0.005
−15.8±3.9
−18.9±4.2
<0.005
−14.6±3.5
−17.8±3.5
<0.005
12.4±2.1
11.3±1.8
<0.005
80.6±19.4
93.3±17.9
<0.005
11.7±3.4
13.1±3.6
0.015
ST, septal thickness; IVRT, isovolumic ralaxation time; Lateral E-wave, diastolic wave measured
by tissue Doppler in lateral mitral annulus.
P2914 | BEDSIDE
Early detection of left atrial strain abnormalities by
speckle-tracking in patients with chronic kidney disease and
normal left atrial size
Y. Ohara, Y. Yoshimura, Y. Fukuoka, H. Matsumi, T. Miyaji, S. Sahara, S. Hosogi,
M. Nishimoto, K. Yamamoto. Kochi Health Sciences Center, Kochi, Japan
Purpose: Increased Left Atrial (LA) volume has been considered a powerful predictor of cardiovascular morbidity and mortality. In conjunction with LA volume,
the evaluation of LA performance, including reservoir, conduit, and booster pump
function, provides incremental information pertaining to LA function. Chronic Kidney Disease (CKD) is associated with impaired LA function, but whether LA functional abnormalities also occur in patients with CKD who have normal LA size is
unknown.
The aim of this study was to explore LA strain using speckle–tracking echocardiography in patients with CKD and normal LA size.
Methods: LA strain was studied by speckle-tracking echocardiography in 20 patients with CKD (eGFR < 60ml/min/1.73m2 ) with LA volume indexes < 28 ml/m2
and 40 control subjects. Global atrial longitudinal strain was measured by averaging all atrial segments. Resorvoir (S-LAs), conduit (S-LAe), and contractile
(S-LAa) phase strain were obtained.
Results: S-LAs and S-LAe were significantly correlated with eGFR (S-LAs:
r=0.43, p<0.0005; S-LAe: r=0.38, p<0.005). However, S-LAa was not significantly
correlated with eGFR. There was no significant difference in LVEF between the
CKD group and the control group. E/Ea was significantly greater in the CKD group
than that in the control group (p<0.05). S-LAs was significantly decreased in the
CKD group compared with that in the control group. CKD patients had significantly
decreased values of S-LAe compared with those in controls (S-LAs: 17.7±3.7 vs.
21.4±4.9, p<0.005; S-LAe: 8.0±2.5 vs. 10.4±4.6, p<0.05).
Conclusions: LA function, especially reservoir and booster pump function, are
significantly impaired in patients with CKD with normal LA size. Speckle-tracking
echocardiography may be considered a promising tool for the early detection of
LA strain abnormalities in CKD patients.
P2915 | BEDSIDE
Left atrial longitudinal strain: early alterations in young patients
with mild hypertension
H.A. Deschle, J. Gantesti, N. Casso, G. Culaciati, L. Alfie, M. Gingins,
M. Fernandez, P. Ottonello, A. Deviggiano. Diagnóstico Maipú, Ciudad Autónoma
de Buenos Aires, Argentina
Purpose: Hypertension is one of the most important causes of heart failure, especially in patients with preserved ejection fraction. The aim of this study was to
evaluate in young patients with mild hypertension controlled with medical therapy, early changes in left atrial (LA) longitudinal strain, based on speckle tracking
method (ST) and LA stiffness index.
Methods: We enrolled and prospectively studied a total of 84 patients (30 to 50
years of age, 66.7% male): 22 were healthy subjects, 32 had mild controlled hypertension and 30 were healthy recreational athletes, using 2D echocardiographic
assessment, color and spectral tissue Doppler and calculating atrial volume. LA
volume and LV mass were indexed by body surface area. Left ventricular strain,
strain rate and left atrial peak strain during the reservoir period was obtained. LA
stiffness index was calculated based on the ratio (E/e)/atrial peak strain. ANOVA
test was used to compare the groups followed by Bonferroni test. A p <0.01 value
was considered statistically significant.
Results: There were no significant differences between groups in 2D echocardiographic measurements values, LV strain and strain rate. In contrast, individuals with mild controlled hypertension demonstrated a LA Strain and Stiffness
Index significantly lower and higher, respectively. Both parameters were similar in
normal subjects and athletes. (Table 1)
Table 1. Results
Mass index/m2
E TDI
E/e
LA vol./m2
Strain LV
Strain LA
E/e/LA
strain ×100
Healthy
HBP
Recreational Athletes
82.89±16.11
9.45±1.96
8.23±1.75
29.66±4.75
20.67±2.09
47.48±8.95
87.71±23.19
8.75±1.97
10.39±3.06
28.95±7.09
19.05±2.31
37.25±6.64
94.26±25.56
10.65±1.84
8.16±1.67
32.87±7.74
19.85±2.84
46.98±8.78
CI 95%
–
ns
0,42–3,38 0,001 (2 vs. 3)
0,44–4.01 0,001 (2 vs. 3)
–
ns
–
ns
3.51–15,94 <0,000 (2 vs. 3)
p
18.01±5.94
28.87±9.86
18.13±6.07
4.80–16.67 <0,000 (2 vs. 3)
Conclusions: The results suggest that in patients with mild controlled hypertension, LA longitudinal strain during reservoir period and LA stiffness index are early
altered before detecting other echocardiographic changes.
ROC curves of LV parameters
Conclusion: Long.S. and LV classic echo parameters are significantly diminished
even with subclinical rejection and if validated in future studies may reduce number of EB.
Downloaded from https://academic.oup.com/eurheartj/article/34/suppl_1/P2912/409492 by guest on 06 December 2023
lenging since none of routine non-invasive methods are reliable. We aimed to
investigate the diagnostic accuracy and prognostic role of 2D strain rate imaging
in patients with AMC as confirmed by immunohistology.
Methods: In 34 patients (41 (18-67) years) with suspected AMC, in whom endomyocardial biopsies had been taken, strain rate imaging was performed by
speckle tracking analysis at initial presentation and at 3 months follow-up. According to the immunohistological findings (inflammation, myocyte lysis and viral
genome detection) patients were divided into 3 groups: no inflammation (N), borderline myocarditis (BL) and AMC.
Results: No differences in conventional 2D echocardiography were found between the groups. AMC and BL patients showed a significantly reduced longitudinal strain (-10.24±4.12%, p=0.005 and -8.51±4.88%, p=0.008) and strain rate
(0.79±0.27/s, p=0.006 and 0.65±0.31/s, p=0.005) without regional differences.
According to the ROC-analysis, a cut-off Strain value of below -14% yielded a
sensitivity of 92% and a specificity of 89% in diagnosing myocarditis. AMC patients who showed an improved EF and end-diastolic diameter at 3 month followup had shown higher strain rate already at baseline (1.02/s ±0.15/s vs. 0.56/s
±0.11/s, p=0.009).
Conclusion: Strain rate imaging obtained by 2D speckle tracking can recognize
myocardial dysfunction in patients with suspected acute myocarditis as proven by
immunohistology, even in patients with preserved conventional echocardiography.
Strain rate imaging may help in assessing the prognosis and in differentiating the
patients in of need further diagnostic procedures such as myocardial biopsies.
517
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Bruno Buchholz
Universidad de Buenos Aires
Soma Jyothula
The University of Texas Health Science Center at Houston
Ashraf M Anwar
AlAzhar University cairo
Lucia Florio
Universidad de la República (Uruguay)
