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JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging POSTER฀SESSION 1024฀฀ 1024-65฀ Strain฀and฀Strain฀Rate฀Imaging Altered฀Diastolic฀Function฀in฀Asymptomatic฀Patients฀ Who฀Were฀Newly฀Diagnosed฀With฀Hereditary฀ Hemochromatosis:฀Utilization฀of฀Strain฀Rate฀Imaging Yukitaka฀Shizukuda,฀Charles฀D.฀Bolan,฀Dorothy฀J.฀Tripodi,฀Vandana฀Sachdev,฀Tammy฀ Nguyen,฀Ernst฀Inez,฀Yu฀Ying฀Yau,฀Susan฀F.฀Leitman,฀Douglas฀R.฀Rosing,฀NHLBI/NIH,฀ Bethesda,฀MD Sunday,฀March฀06,฀2005,฀9:00฀a.m.-12:30฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀9:00฀a.m.-10:00฀a.m. 1024-63฀ 255A A฀New฀Phase฀Analysis฀Method฀for฀Evaluating฀ Abnormal฀Wall฀Motion฀From฀Myocardial฀Ischemia฀and฀ Desynchronization฀Generated฀by฀Pacing Xiaokui฀Li,฀Lei฀Sui,฀Helene฀Houle,฀James฀Pemberton,฀Jian-Feng฀Chen,฀Patrick฀von฀ Behren,฀Robert฀I.฀Lowe,฀Timothy฀Thigpen,฀Michael฀Jerosch-Herold,฀David฀J.฀Sahn,฀Oregon฀ Health฀&฀Science฀University,฀Portland,฀OR,฀Siemens฀Ultrasound,฀Mountain฀View,฀CA Background:฀ We฀ tested฀ a฀ simple฀ rapid฀ wall฀ motion฀ phase฀ analysis฀ software฀ program฀ running฀on฀2D฀DICOM฀echo฀images฀to฀evaluate฀myocardial฀wall฀motion฀and฀ventricular฀ synchronization. Methods:฀4฀pigs฀were฀underwent฀an฀open฀chest฀procedure฀for฀multiple฀site฀pacing฀[left฀ circumflex฀ (LCX),฀ LV฀ Septum฀ (S),฀ LV฀ posterior฀ wall฀ (LV฀ P)฀ and฀ right฀ ventricle฀ (RV)]฀ to฀ create฀ desynchronize฀ rhythm฀ and฀ occlusion฀ (proximal,฀ middle฀ or฀ lower฀ LAD฀ and฀ LCX)฀ to฀ create฀ ischemia฀ simultaneously.฀ An฀ ACUSON฀ SequoiaTM฀ echocardiography฀ system฀ (5MHz)฀(SIEMENS฀Ultrasound)฀was฀used฀for฀scanning฀at฀each฀state฀analyzed฀for฀systolic฀ phase฀delay฀(SPD)฀relative฀to฀the฀R-wave.฀SPD฀=฀[(initial฀time฀÷฀R-R฀duration)฀x฀360º]฀and฀ the฀standard฀deviation฀(SD)฀on฀peak฀contraction฀as฀an฀indicator฀of฀synchrony. Results:฀For฀all฀base฀line฀states:฀SPD฀<฀180º,฀mean฀=฀119.76฀±38.85.฀During฀pacing฀(LCX,฀ LVP,฀LVS,฀RV฀and฀RVP)฀without฀ischemia,฀SPD฀was฀still฀<฀180º฀but฀averaged฀mean฀and฀ SD฀was฀raised฀to฀152.43฀±฀53.05.฀All฀occluded฀(OCC)฀segments’฀SPD฀>฀180º฀averaged฀ mean฀and฀SD฀=฀219.2฀±฀91.6฀for฀OCC฀with฀pacing฀and฀216.71฀±฀72.92.64฀for฀OCC฀with฀ no฀pacing฀and฀215.83฀±฀54.70฀for฀released฀OCC.฀Color฀codes฀Parametric฀color฀maps฀of฀ phase฀showed฀thedelay฀allowed฀rapid,฀efficient,฀visualization฀of฀abnormal฀phase฀delay. Conclusions:฀This฀new฀method฀is฀feasible฀and฀fast฀for฀future฀detection฀of฀abnormal฀heart฀ motion฀and฀cardiac฀desynchronization. Background:฀Abnormal฀diastolic฀function฀has฀been฀reported฀in฀patients฀with฀hereditary฀ hemochromatosis฀ (HH),฀ particularly฀ advanced฀ stage฀ patients;฀ however,฀ little฀ is฀ known฀ when฀ the฀ abnormalities฀ begin.฀ We฀ hypothesized฀ that฀ diastolic฀ functional฀ alteration฀ develops฀at฀the฀early฀stages฀of฀iron฀overload. Methods:฀ Through฀ an฀ NHLBI-sponsored฀ “Heart฀ study฀ of฀ hemochromatosis”฀ protocol,฀ we฀recruited฀11฀consecutive฀newly฀diagnosed฀HH฀patients฀(ND,฀aged฀49±11,฀2฀female,฀ mean±SD)฀ and฀ 9฀ normal฀ controls฀ without฀ any฀ known฀ mutations฀ of฀ HH฀ (aged฀ 45±6,฀ 4฀ female).฀ All฀ HH฀ patients฀ had฀ confirmed฀ C282Y฀ homozygosity฀ and฀ documented฀ iron฀ overload.฀ All฀ subjects฀ were฀ NYHA฀ Functional฀ Class฀ I.฀ Left฀ ventricular฀ (LV)฀ diastolic฀ function฀was฀comprehensively฀assessed฀by฀echocardiography฀using฀conventional฀Doppler฀ measurements฀(CD),฀pulsed฀wave฀tissue฀Doppler฀(PW),฀and฀strain฀rate฀imaging฀by฀the฀ Vivid฀7฀system฀(SRI)฀in฀the฀apical฀views฀prior฀to฀the฀third฀phlebotomy฀therapy. Results:฀ The฀ serum฀ ferritin฀ (1348±1008฀ vs฀ 51±39฀ µg/L,฀ P=0.0016)฀ and฀ transferrin฀ saturation฀ (72±20฀ vs฀ 22±8%,฀ P<0.0001)฀ were฀ significantly฀ higher฀ in฀ ND฀ compared฀ to฀ controls.฀ Echocardiographically฀ measured฀ LV฀ mass฀ (136±38฀ vs฀ 118±30g,฀ P=NS)฀ and฀ systolic฀ function฀ by฀ strain฀ imaging฀ were฀ comparable฀ between฀ the฀ two฀ groups.฀ No฀ subjects฀had฀more฀than฀mild฀mitral฀regurgitation.฀CD฀detected฀altered฀diastolic฀LV฀filling฀ demonstrated฀ by฀ significantly฀ lower฀ mitral฀ inflow฀ propagation฀ slope฀ (54±17฀ vs฀ 75±13฀ cm/sec2,฀ P=0.005),฀ increased฀ pulmonary฀ vein฀ systolic฀ and฀ diastolic฀ peak฀ velocity฀ ratio฀ (1.2±0.2฀ vs฀ 1.0±0.1,฀ P<0.05),฀ and฀ increased฀ differences฀ in฀ duration฀ of฀ pulmonary฀ vein฀ atrial฀ (A)฀ filling฀ to฀ mitral฀ inflow฀ A฀ filling฀ (-38±39฀ vs฀ -7±15฀ msec,฀ P<0.05)฀ in฀ ND.฀ SRI฀ demonstrated฀ increased฀ peak฀ diastolic฀ A฀ strain฀ rate฀ in฀ both฀ the฀ basal฀ septum฀ (1.9±0.6฀ vs฀ 1.2±0.4฀ sec-1,฀ P<0.01)฀ and฀ lateral฀ wall฀ (1.3±0.5฀ vs฀ 0.8±0.3฀ sec-1,฀ P<0.05)฀ without฀ showing฀significant฀differences฀in฀early฀filling฀strain฀rate.฀PW฀failed฀to฀detect฀any฀changes฀ of฀diastolic฀function฀in฀ND. Conclusions:฀Our฀results฀suggest฀that฀altered฀LV฀diastolic฀filling฀including฀changes฀in฀ active฀atrial฀filling฀mechanics฀is฀present฀in฀newly฀diagnosed฀HH฀patients. 1024-66฀ Longitudinal฀and฀Radial฀Regional฀Strain฀Obtained฀From฀ Gray-Scale฀Conventional฀Echocardiography Maria฀Jesus฀Ledesma-Carbayo,฀Andres฀Santos,฀Patricia฀Mahía,฀Miguel฀Angel฀García฀ Fernández,฀Jan฀Kybic,฀Norberto฀Malpica,฀Esther฀Pérez฀David,฀Manuel฀Desco,฀Hospital฀ General฀Universitario฀Gregorio฀Marañón,฀Madrid,฀Spain Two-Dimensional฀Strain฀Imaging฀Echocardiography฀for฀ the฀Evaluation฀of฀Global฀Left฀Ventricular฀Function:฀Early฀ Validation฀Studies Christian฀S.฀Lopez,฀Rush฀University฀Medical฀Center,฀Chicago,฀IL Background:฀Novel฀computer฀software฀(General฀Electric฀Ultrasound,฀Milwaukee,฀WI)฀is฀ capable฀of฀automatic฀frame-by-frame฀tracking฀of฀natural฀acoustic฀markers฀during฀the฀heart฀ cycle,฀yielding฀objective฀measures฀of฀contractility. Methods:฀Computer฀generated฀left฀ventricular฀ejection฀fraction฀(LVEF),฀global฀longitudinal฀ strain฀ (GLS),฀ and฀ GLS฀ rate฀ (GLSR)฀ were฀ calculated฀ from฀ 20฀ normal฀ and฀ 23฀ abnormal฀ apical฀2,฀3,฀and฀4-chamber฀loops฀and฀compared฀to฀manual฀endocardial฀tracing฀LVEF. Results:฀Mean฀±฀1SD฀and฀significance฀of฀difference฀between฀normal฀and฀abnormal฀loops: ฀ Loops n All Normal Abnormal 43 20 23 t-statistic Tracing LVEF฀(%) 50.7±20.3 67.8±฀5.7 35.9±16.3 6.4& 46.9±16.6 60.1±฀6.5 35.5±13.9 GLS (%) -13.7±7.4 -20.2±3.0 -฀8.1±5.1 GLSR (%/second) -0.66±0.36 -0.98±0.19 -0.37±0.19 5.3& 7.0& 7.1& Computer฀LVEF฀(%) m±SD Sr Sl Optison®฀(+฀in฀the฀left฀figure)฀n=12,฀r=0.98. Conclusion:฀ early฀ validation฀ studies฀ suggest฀ excellent฀ correlation฀ between฀ computergenerated฀global฀systolic฀parameters฀and฀traditionally฀traced฀LVEF. Hypokinetic฀(n=9) 20.8±8.7฀% -8.5±6.8% Akinetic฀(n=13) 13.9±10.7฀% -0.5±7.6% POSTER฀SESSION 1025฀฀ Tissue฀Velocity฀and฀Strain฀in฀Ischemic฀ Disease Sunday,฀March฀06,฀2005,฀9:00฀a.m.-12:30฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀9:00฀a.m.-10:00฀a.m. 1025-87฀ &฀-฀p<฀0.001฀ Normal฀(n=24) 55.8฀±21.8฀% -15.2±6.0฀% Detection฀of฀Significant฀Stenotic฀Lesion฀in฀the฀Left฀ Anterior฀Descending฀Coronary฀Artery฀using฀Adenosine฀ Triphosphate฀Stress฀Strain฀Imaging:฀Comparison฀with฀ Coronary฀Flow฀Velocity฀Reserve฀Measurement฀using฀ Transthoracic฀Doppler฀Echocardiography Tsutomu฀Takagi,฀Junichi฀Yoshikawa,฀Takagi฀Cardiology฀Clinic,฀Kyoto,฀Japan,฀Osaka฀City฀ University,฀Osaka,฀Japan Background฀ Usefulness฀ of฀ adenosine฀ triphosphate฀ (ATP)฀ stress฀ strain฀ imaging฀ in฀ diagnosis฀of฀coronary฀artery฀disease฀remains฀unclear. Methods฀ To฀ evaluate฀ the฀ usefulness฀ of฀ ATP฀ stress฀ strain฀ imaging฀ in฀ diagnosis฀ of฀ coronary฀ artery฀ disease,฀ 25฀ patients฀ were฀ studied;฀ 8฀ patients฀ had฀ significant฀ stenotic฀ Noninvasive Imaging 1024-64฀ Background:฀ Strain฀ measurements฀ using฀ echocardiography฀ are฀ obtained฀ as฀ the฀ spatial฀ gradient฀of฀Doppler฀velocities,฀inheriting฀its฀limitations฀due฀to฀the฀angular฀dependency.฀Our฀work฀ presents฀a฀preliminary฀validation฀of฀a฀new฀method฀to฀compute฀the฀longitudinal฀(Sl)฀and฀axial฀ (Sr)฀strain฀components฀from฀conventional฀gray฀scale฀echocardiographic฀images฀using฀non-rigid฀ spatio-temporal฀registration฀based฀on฀semilocal฀parametric฀models฀of฀the฀deformation. Methods:฀ A฀ total฀ number฀ of฀ 46฀ echocardiographic฀ basal฀ and฀ mid฀ segments฀ from฀ the฀ septum฀and฀inferior฀wall฀were฀analysed.฀These฀segments฀were฀qualitatively฀classified฀into฀ three฀different฀contractility฀patterns.฀Cardiac฀motion฀field฀was฀obtained฀for฀each฀pixel฀in฀the฀ regions฀of฀interest฀extracting฀Sr฀and฀Sl.฀Results฀were฀assessed฀by฀means฀of฀a฀one-way฀ analysis฀of฀variance฀(ANOVA)฀with฀Sheffé฀post-hoc฀correction฀for฀multiple฀comparisons. Results:฀ Strain฀ components฀ Slong฀ and฀ Sax฀ showed฀ significant฀ differences฀ (p<0.05)฀ between฀ segments฀ with฀ normal฀ contractility฀ and฀ hypokinetic฀ and฀ akinetic฀ ones.฀ Slong฀ showed฀also฀significant฀differences฀between฀akinetic฀and฀hypokinetic฀segments. Conclusion:฀ Obtaining฀ Sr฀ and฀ Sl฀ from฀ echocardiographic฀ conventional฀ imaging฀ using฀ spatio-temporal฀ non-rigid฀ registration฀ techniques฀ allows฀ to฀ quantify฀ regional฀ systolic฀ function฀,฀overcoming฀the฀limitations฀of฀the฀Doppler฀based฀techniques. 256A ABSTRACTS - Noninvasive Imaging JACC February 1, 2005 lesion฀in฀the฀left฀anterior฀descending฀coronary฀artery฀(LAD),฀and฀17฀patients฀did฀not฀have฀ significant฀LAD฀lesion.฀All฀patients฀underwent฀ATP฀stress฀strain฀imaging฀and฀coronary฀flow฀ velocity฀ reserve฀ (CFVR)฀ measurement฀ using฀ transthoracic฀ Doppler฀ echocardiography฀ simultaneously.฀Peak฀strain฀and฀time฀to฀peak฀strain฀(TPS)฀in฀the฀mid-apical฀septal฀segment฀ were฀ measure฀ at฀ baseline฀ and฀ during฀ intravenous฀ ATP฀ infusion฀ (0.14mg/kg/min).฀ TPS฀ ratio฀was฀calculated฀as฀the฀ratio฀between฀TPS฀during฀ATP฀and฀TPS฀at฀baseline.฀Coronary฀ flow฀velocities฀of฀the฀distal฀LAD฀were฀measure฀at฀baseline฀and฀during฀ATP฀infusion.฀CFVR฀ was฀calculated฀as฀the฀ratio฀between฀mean฀diastolic฀flow฀velocity฀during฀ATP฀infusion฀and฀ mean฀diastolic฀flow฀velocity฀at฀baseline. Results฀ CFVR฀ in฀ patients฀ with฀ the฀ LAD฀ lesion฀ was฀ significantly฀ smaller฀ than฀ that฀ in฀ patients฀ without฀ LAD฀ lesion฀ (1.7฀ +/-฀ 0.2฀ vs฀ 2.3฀ +/-฀ 0.6,฀ respectively,฀ p฀ =฀ 0.007).฀There฀ were฀no฀significant฀deference฀between฀two฀groups฀in฀peak฀strain฀at฀baseline฀(-฀22.7฀+/-฀ 5.8%฀vs฀-฀19.8฀+/-฀7.7%,฀respectively,฀p฀=฀0.356),฀peak฀strain฀during฀ATP฀(-฀22.2฀+/-฀5.0%฀ vs฀ -฀ 22.3฀ +/-฀ 6.5%,฀ respectively,฀ p฀ =฀ 0.961),฀ or฀TPS฀ at฀ baseline฀ (439฀ +/-฀ 70ms฀ vs฀ 451฀ +/-฀ 49ms,฀ respectively,฀ p฀ =฀ 0.638).฀ However,฀TPS฀ during฀ ATP฀ in฀ patients฀ with฀ the฀ LAD฀ lesion฀ was฀ significantly฀ greater฀ than฀ that฀ in฀ patients฀ without฀ LAD฀ lesion฀ (552฀ +/-฀ 45ms฀ vs฀ 404฀ +/-฀ 67ms,฀ respectively,฀ p฀ <฀ 0.001).฀ As฀ well฀ as,฀ TPS฀ ratio฀ in฀ patients฀ with฀ LAD฀ lesion฀ was฀ significantly฀ greater฀ than฀ that฀ in฀ patients฀ without฀ LAD฀ lesion฀ (1.3฀ +/-฀ 0.2฀ vs฀ 0.9฀ +/-฀ 0.1,฀ respectively,฀ p฀ <฀ 0.001).฀ A฀ cut-off฀ value฀ <฀ 2.0฀ of฀ CFVR฀ had฀ a฀ sensitivity฀ of฀ 100%,฀ a฀ specificity฀ of฀ 82%,฀ diagnostic฀ accuracy฀ of฀ 88%฀ for฀ the฀ presence฀ of฀ significant฀ LAD฀lesions.฀A฀cut-off฀value฀>/=฀1.1฀of฀TPS฀ratio฀had฀a฀sensitivity฀of฀88%,฀a฀specificity฀of฀ 88%,฀diagnostic฀accuracy฀of฀88%฀for฀the฀presence฀of฀significant฀LAD฀lesions. Conclusions฀ATP฀stress฀strain฀imaging฀is฀useful฀in฀diagnosis฀of฀significant฀LAD฀lesions. 1025-88฀ Systolic฀Pulsed฀Tissue฀Doppler฀Parameters฀are฀Highly฀ Predictive฀of฀TIMI-III฀flow฀in฀the฀Infarct฀Related฀Artery฀ Following฀Primary฀Percutaneous฀Intervention฀in฀ Acute฀Anterior฀Myocardial฀Infarction.฀Correlation฀with฀ Myocardial฀Blush฀Grade,฀ST-Segment฀Resolution,฀and฀ Myocardial฀Salvage฀Index Noninvasive Imaging Amal฀E.฀Ayoub,฀Ghada฀S.฀AL-Shahed,฀Waleed฀A.฀AL-Hammadi,฀Mohamed฀S.฀AbdelWahab,฀Hany฀M.฀Awadalla,฀Ain฀Shams฀University,฀Cairo,฀Egypt Background฀and฀Aim:฀Despite฀an฀apparently฀normal฀flow฀in฀the฀epicardial฀infarct-related฀ artery฀(IRA),฀even฀patients฀with฀TIMI-3฀flow฀in฀the฀IRA฀may฀not฀achieve฀adequate฀myocardial฀ reperfusion฀at฀the฀tissue฀level.฀The฀aim฀of฀this฀study฀is฀to฀evaluate฀the฀clinical฀applicability฀ of฀pulsed฀wave฀tissue฀Doppler฀parameters฀in฀patients฀with฀acute฀ST฀segment฀elevation฀ myocardial฀infarction฀(MI)undergoing฀primary฀percutaneous฀coronary฀intervention฀(PCI)฀ as฀an฀indicator฀of฀successful฀myocardial฀reperfusion฀at฀the฀tissue฀level. Methods:฀100฀patients฀with฀acute฀anterior฀(MI)฀within฀6฀hours฀were฀enrolled.฀All฀patients฀ underwent฀PCI,฀after฀loading฀with฀Clopidogrel.฀All฀100฀patients฀underwent฀pulsed฀wave฀ tissue฀Doppler฀(PTD)฀examination฀within฀2฀days฀of฀the฀acute฀myocardial฀infarction,฀and฀ 2฀weeks฀later.฀The฀machine฀mode฀was฀switched฀to฀tissue฀velocity฀imaging฀(TVI)฀mode฀to฀ encode฀ myocardial฀ velocities.฀ PTD฀ samples฀ were฀ recorded฀ from฀ six฀ different฀ locations฀ at฀ the฀ level฀ of฀ the฀ mitral฀ annulus฀ (anterior,฀ inferior,฀ lateral,฀ posterior,฀ anterior฀ septum,฀ posterior฀septum),฀using฀the฀apical฀two-฀and฀four-฀chamber฀and฀long-axis฀views.฀At฀each฀ point฀of฀examination,฀peak฀systolic฀wave฀(S)฀was฀determined.฀The฀peak฀value฀of฀the฀Swave฀was฀taken฀as฀a฀determinant฀of฀systolic฀function.฀ Results:฀Systolic฀PTD฀measurements฀at฀the฀mitral฀annular฀level฀in฀patients฀with฀anterior฀ MI฀ and฀ Myocardial฀ Blush฀ Grade฀ (MBG)฀ 0-1฀ sinificantly฀ deteriorated฀ between฀ 2nd฀ day฀ and฀ 2nd฀ week฀ (6.5฀ m/second฀ and฀ 5.3฀ m/second,฀ respectively;฀ p=0.01).฀ Systolic฀ PTD฀ parameters฀at฀48฀hours฀and฀2฀weeks฀improved฀significantly฀in฀patients฀with฀anterior฀MI฀ and฀ MBG฀ 2-3฀ (5.4฀ m/second฀ and฀ 7.1฀ m/second,฀ repsectively;฀ p=0.005).฀ There฀ was฀ a฀ significant฀direct฀correlation฀between฀TIMI-3฀flow฀in฀the฀infarct฀related฀artery฀(IRA)฀and฀ improvement฀of฀Systolic฀PTD฀measurements฀at฀two฀weeks฀(p=0.03).฀A฀significant฀direct฀ correlation฀ between฀ ST-segment฀ resolution,฀ Myocardial฀ Salvage฀ Index฀ (MSI),฀ and฀ improvement฀of฀the฀Systolic฀PTD฀parameters฀at฀two฀weeks฀was฀also฀seen฀(P=0.01,฀and฀ 0.03;฀respectively). Conclusion:฀Systolic฀pulsed฀tissue฀doppler฀parameters฀directly฀correlate฀with฀TIMI-III฀flow฀ in฀the฀IRA,฀MBG,฀and฀ST-Resolution฀following฀primary฀PCI฀in฀AMI. 1025-89฀ Transmural฀Myocardial฀Postsystolic฀Thickening฀and฀ Dyssynchrony฀in฀Myocardial฀Infarction฀Assessed฀by฀ Strain฀M-Mode฀Imaging. 1025-90฀ Can฀Assessments฀of฀Subepicardial฀Function฀with฀ Myocardial฀Strain฀Rate฀Imaging฀and฀Integrated฀ Backscatter฀Distinguish฀Transmural฀Extent฀of฀ Infarction? Jonathan฀Chan,฀Rodel฀Leano,฀Thomas฀H.฀Marwick,฀University฀of฀Queensland,฀Brisbane,฀ Australia Background:฀Transmural฀ extent฀ of฀ infarction฀ (TME)฀ may฀ be฀ an฀ important฀ determinant฀ of฀ functional฀ recovery฀ and฀ remodeling.฀ Recent฀ animal฀ data฀ suggest฀ that฀ strain฀ rate฀ imaging฀ (SRI)฀ maybe฀ able฀ to฀ identify฀ subendocardial฀ ischemia.฀We฀ compared฀ SRI฀ and฀ cyclic฀variation฀of฀integrated฀backscatter฀(CVIB)฀for฀predicting฀TME฀and฀in฀the฀quantitative฀ assessment฀of฀regional฀subepicardial฀function. Methods:฀ 49฀ post฀ myocardial฀ infarct฀ (MI)฀ patients฀ (61±10฀ y.o,฀ EF฀ 41±10%)฀ underwent฀ tissue฀ Doppler฀ echocardiography฀ (TDE)฀ and฀ contrast฀ enhanced฀ magnetic฀ resonance฀ imaging฀(CMR).฀A฀15mm฀x฀2mm฀sampling฀volume฀(tracked฀to฀wall฀motion)฀was฀placed฀ over฀the฀long฀axis฀subepicardial฀region฀of฀each฀segment฀during฀TDE฀offline฀analysis฀to฀ measure฀peak฀longitudinal฀systolic฀strain฀rate,฀peak฀longitudinal฀systolic฀strain,฀and฀CVIB.฀ Findings฀were฀compared฀with฀TME฀classified฀into฀2฀categories฀of฀scar฀thickness฀by฀CMR:฀ Non-transmural฀(TME<50%),฀and฀transmural฀(TME>=50%). Results฀Of฀213฀segments฀identified฀with฀resting฀wall฀motion฀abnormalities,฀145฀segments฀ showed฀ delayed฀ hyperenhancement฀ on฀ CMR.฀ Peak฀ strain,฀ strain฀ rate฀ and฀ CVIB฀ were฀ similar฀ with฀ no฀ significant฀ differences฀ between฀ transmural฀ and฀ non-transmural฀ infarcts฀ regardless฀of฀the฀echo฀modality.฀ CMR฀Scar฀Thickness Non-transmural฀Scars (n=73) Transmural฀Scars (n=72) P฀value Peak฀Strain Strain฀Rate -13.3฀±฀5.3 -0.8฀±฀0.5 CVIB 5.1฀±฀2.9 -12.5฀±฀6.2 -0.8฀±฀0.4 4.6฀±฀3.3 NS NS NS Conclusions:฀ In฀ contrast฀ to฀ previous฀ findings฀ in฀ animal฀ models,฀ neither฀ SRI฀ nor฀ CVIB฀ can฀differentiate฀TME฀in฀humans.฀These฀results฀suggest฀that฀subendocardial฀dysfunction฀ results฀in฀early฀loss฀of฀long฀axis฀function฀despite฀tissue฀integrity฀in฀the฀subepicardium. 1025-91฀ Diastolic฀Strain฀Rate฀Patterns฀Allow฀Ischemia฀Detection฀ at฀Rest Takeshi฀Maruo,฀Satoshi฀Nakatani,฀Yin-Tie฀Jin,฀Kazunori฀Uemura,฀Masaru฀Sugimachi,฀ National฀Cardiovascular฀Center,฀Osaka,฀Japan,฀National฀Cardiovascular฀Center฀ Research฀Institute,฀Osaka,฀Japan Hsin-Yueh฀Liang,฀Sanderson฀Cauduro,฀Stig฀Urheim,฀Chiranjit฀Rihal,฀Marek฀Belohlavek,฀ Bijoy฀Khandheria,฀Fletcher฀Miller,฀Patricia฀Pellikka,฀Theodore฀P.฀Abraham,฀Mayo฀Clinic,฀ Rochester,฀MN Background:฀ By฀ using฀ a฀ newly฀ developed฀ strain฀ M-mode฀ imaging฀ system,฀ we฀ can฀ assess฀spatio-temporal฀distribution฀of฀myocardial฀strain฀on฀the฀myocardial฀wall.฀Ischemic฀ myocardium฀exhibits฀postsystolic฀thickening฀(PST).฀We฀investigated฀if฀there฀was฀PST฀in฀ the฀subendocardium฀and฀subepicardium.฀฀ Methods:฀We฀created฀subendocardial฀infarction฀(SMI)฀by฀90-min฀left฀circumflex฀coronary฀ occlusion฀ and฀ subsequently,฀ transmural฀ infarction฀ (TMI)฀ by฀ intracoronary฀ microbeads฀ injection฀in฀11฀open-chest฀dogs.฀Spatio-temporal฀strain฀distribution฀was฀analyzed฀at฀the฀ basal฀and฀mid฀posterior฀walls฀obtained฀from฀tissue฀strain฀left฀ventricular฀short-axis฀image.฀ We฀measured฀the฀time฀from฀Q-wave฀to฀the฀timing฀of฀peak฀subendocardial฀strain฀(Endo-T)฀ and฀that฀of฀peak฀subepicardial฀strain฀(Epi-T).฀.฀ Results:฀Endo-T฀in฀SMI฀(340±42ms,฀p=0.017)฀and฀TMI฀(320±49ms,฀p=0.004)฀were฀longer฀than฀ that฀in฀the฀control฀(264±44ms).฀Epi-T฀in฀TMI฀(304±69ms)฀was฀longer฀than฀that฀in฀the฀control฀ (261±45ms,฀ p=0.044)฀ and฀ SMI฀ (214±67ms,฀ p=0.004).฀ Accordingly,฀ the฀ difference฀ between฀ Endo-T฀and฀Epi-T฀in฀SMI฀(127±51ms)฀was฀longer฀than฀that฀in฀the฀control฀(3±10ms,฀p<0.001)฀ and฀TMI฀(16±41ms,฀p<0.001),฀suggesting฀significant฀transmural฀dyssynchrony฀in฀SMI.฀ Conclusions:฀The฀subendocardium฀in฀SMI฀showed฀PST,฀while฀the฀subepicardium฀did฀not.฀ Strain฀M-mode฀imaging฀was฀useful฀to฀estimate฀the฀transmural฀dyssynchrony฀in฀myocardial฀ infarction.฀ Background:฀Energy฀dependent฀early฀diastolic฀relaxation฀is฀thought฀to฀be฀affected฀earlier฀ in฀ ischemia฀ than฀ systole.฀ We฀ used฀ strain฀ echocardiography฀ (SE)฀ to฀ evaluate฀ whether฀ regional฀ diastolic฀ strain฀ rates฀ can฀ detect฀ segments฀ subtended฀ by฀ stenosed฀ coronary฀ arteries฀at฀rest.฀ Methods:฀We฀prospectively฀imaged฀54฀consecutive฀patients฀during฀coronary฀angiography.฀ Longitudinal฀ systolic฀ (SRs),฀ early฀ (SRe)฀ and฀ late฀ (SRa)฀ diastolic฀ strain฀ rates฀ were฀ measured฀ in฀ the฀ 3฀ major฀ vascular฀ territories.฀ Regions฀ subtended฀ by฀ ≥70%฀ coronary฀ stenosis฀were฀labeled฀ischemic฀and฀compared฀to฀the฀same฀region฀in฀patients฀with฀nonsignificant฀coronary฀stenosis.฀ Results:฀Of฀54฀patients฀(34฀males),฀40฀had฀>70%฀coronary฀stenosis฀(1฀vessel฀in฀9,฀2฀vessel฀ in฀18,฀3฀vessel฀in฀13)฀and฀14฀had฀normal฀coronaries.฀There฀were฀no฀significant฀differences฀ between฀the฀normal฀and฀ischemic฀group฀with฀regards฀to฀age฀(64±10฀vs.฀62±11,฀p฀=NS),฀clinical฀ variables฀(hypertension,฀diabetes,฀dyslipidemia),฀systolic฀or฀diastolic฀blood฀pressure฀(137±28฀ vs.฀130±25฀and฀70±11฀vs.฀68±12,฀both฀p=NS,฀respectively)฀and฀ejection฀fraction฀(57±12฀vs.฀ 55±12,฀p=NS).฀Peak฀SRe฀was฀significantly฀reduced฀in฀ischemic฀compared฀to฀normal฀regions฀ in฀all฀3฀vascular฀territories.฀Peak฀SRs฀and฀SRa฀were฀similar฀in฀both฀regions฀(Figure). Conclusions:฀Abnormal฀early฀diastolic฀mechanics฀in฀regions฀subtended฀by฀significantly฀ stenosed฀ coronary฀ arteries฀ are฀ recognizable฀ by฀ a฀ reduced฀ SRe฀ at฀ rest฀ despite฀ similar฀ SRs.฀SE฀may฀provide฀a฀novel,฀quantitative฀means฀of฀detecting฀ischemia฀at฀rest.฀ JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging 257A Conclusion:฀ X-ray฀ diffraction฀ study฀ on฀ hearts฀ in฀ living฀ subjects฀ could฀ be฀ a฀ novel฀ and฀ useful฀tool฀to฀explore฀the฀molecular฀basis฀of฀cardiac฀disease. 1025-94฀ Identifying฀Ventricular฀Dyssynchrony:฀Comparison฀ of฀Pulsed฀Doppler฀Tissue฀Imaging฀to฀Other฀ Echocardiographic฀Techniques Shrikanth฀P.฀Upadya,฀Craig฀McPherson,฀Sheikh฀Mahfuzul฀Hoq,฀Jeffrey฀Banker,฀Na฀ Chu,฀Gilead฀Lancaster,฀Stuart฀Zarich,฀Yale฀University฀School฀of฀Medicine(฀Bridgeport),฀ Bridgeport,฀CT 1025-92฀ Novel฀Myocardial฀Viability฀Index฀Assessed฀by฀Strain฀ Rate฀Imaging฀Correlates฀With฀Left฀Ventricular฀Diastolic฀ Function฀in฀the฀Early฀Phase฀After฀Acute฀Coronary฀ Syndrome Wook-Jin฀Chung,฀Eun฀Ok฀Shim,฀Kyung฀Leem฀Choi,฀Woong฀Chol฀Kang,฀Seung฀Hwan฀ Han,฀Kwang฀Kon฀Koh,฀Tae฀Hoon฀Ahn,฀In฀Suck฀Choi,฀Eak฀Kyun฀Shin,฀Gil฀Heart฀Center,฀ Gachon฀Medical฀School,฀Incheon,฀South฀Korea 1025-93฀ In฀Vivo฀Evaluation฀of฀X-ray฀Diffraction฀from฀the฀Left฀ Ventricular฀Wall฀of฀Mouse฀Hearts Ryuji฀Toh,฀Naoto฀Yagi,฀Seinosuke฀Kawashima,฀Tomoya฀Yamashita,฀Masakazu฀Shinohara,฀ Tomofumi฀Takaya,฀Shigeru฀Masuda,฀Mitsuhiro฀Yokoyama,฀Kobe฀University฀Graduate฀ School฀of฀Medicine,฀Kobe,฀Japan,฀Spring-8/JASRI,฀Sayo,฀Hyogo,฀Japan Background:฀ Equatorial฀ x-ray฀ diffraction฀ patterns฀ have฀ been฀ studied฀ in฀ isolated฀ heart฀ muscles.฀It฀is฀confirmed฀that฀the฀relative฀intensity฀of฀the฀two฀main฀equatorial฀reflections,฀ (1,0)฀and฀(1,1),฀depends฀on฀both฀the฀sarcomere฀length฀and฀the฀state฀of฀the฀muscle.฀Here฀ we฀show฀x-ray฀diffraction฀from฀the฀left฀ventricular฀wall฀of฀a฀murine฀beating฀heart฀without฀ thoracotomy,฀which฀is฀the฀first฀occasion฀to฀study฀them฀in฀this฀way.฀ Methods฀and฀Results:฀The฀experiments฀were฀made฀in฀the฀third฀generation฀synchrotron฀ radiation฀ facility,฀ SPring-8.฀ Briefly,฀The฀ beam฀ was฀ set฀ at฀ the฀ free฀ wall฀ of฀ the฀ left฀ ventricle฀ via฀ the฀ 3rd฀ intercostal฀ space฀ from฀ the฀ anterior฀ chest฀ vertically.฀To฀ fix฀ the฀ position฀ of฀ the฀ heart฀in฀the฀thorax฀during฀irradiation,฀animals฀were฀kept฀apnea฀for฀a฀while฀after฀mechanical฀ hyperventilation.฀With฀the฀beam฀at฀the฀epicardium฀surface฀of฀the฀left฀ventricle,฀well-oriented฀ strong฀ equatorial฀ reflections฀ were฀ observed.฀The฀ reflections฀ became฀ vertically฀ split฀ arcs฀ when฀the฀beam฀passed฀through฀myocardium฀deeper฀in฀the฀wall,฀and฀rings฀were฀observed฀ when฀ the฀ beam฀ passed฀ in฀ the฀ inner฀ myocardium฀ of฀ the฀ wall.฀ To฀ evaluate฀ the฀ global฀ changes฀of฀whole฀heart฀structure฀in฀pathological฀condition฀using฀this฀technique,฀we฀used฀ the฀doxorubicin฀(DOX)-induced฀cardiomyopathic฀mouse฀model.฀Male฀C57฀BL/6฀mice฀were฀ randomly฀ assigned฀ to฀ DOX-treated฀ group฀ (n=7)฀ or฀ control฀ group฀ (n=10).฀ Animals฀ were฀ treated฀with฀5฀mg/kg฀of฀DOX฀or฀the฀same฀volume฀of฀saline฀intraperitoneally฀every฀3฀days฀ over฀a฀week,฀resulting฀in฀a฀total฀cumulative฀dose฀of฀15฀mg/kg,฀and฀subsequently฀left฀for฀a฀ week฀to฀leave฀only฀a฀damaged฀heart.฀The฀(1,0)฀lattice฀spacing,฀which฀is฀equal฀to฀√3/2฀of฀the฀ distance฀between฀centers฀of฀nearest฀thick฀filaments,฀was฀obtained฀from฀the฀peak฀position฀of฀ the฀(1,0)฀reflection.฀The฀(1,0)฀lattice฀spacing฀in฀diastole฀was฀significantly฀larger฀in฀DOX฀group฀ than฀that฀in฀control฀(41.8±0.2฀vs.฀40.4±0.2฀nm,฀p<0.001).฀We฀speculate฀that฀this฀was฀due฀to฀ the฀increase฀in฀swelling฀of฀myocardium฀resulting฀from฀the฀administration฀of฀DOX.฀ POSTER฀SESSION 1026฀฀ Coronary฀Calcification฀for฀Detection฀฀ of฀Subclinical฀Atherosclerosis Sunday,฀March฀06,฀2005,฀9:00฀a.m.-12:30฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀9:00฀a.m.-10:00฀a.m. 1026-79฀ Racial฀Differences฀In฀The฀Presence฀And฀Severity฀Of฀ Coronary฀Calcification฀In฀USA Khurram฀Nasir,฀Roger฀S.฀Blumenthal,฀Matthew฀J.฀Budoff,฀Johns฀Hopkins฀Medical฀ Institutions,฀Baltimore Background฀ &฀ Methods:฀ Although฀ cardiovascular฀ risk฀ factor฀ levels฀ are฀ substantially฀ different฀ in฀ Caucasians฀ (CS),฀ African฀ American฀ (AA)฀ and฀ Hispanics฀ (HS)฀ in฀ the฀ USA,฀ the฀relative฀rates฀of฀coronary฀heart฀disease฀(CHD)฀in฀the฀3฀groups฀are฀not฀consistent฀with฀ these฀differences.฀The฀objective฀of฀the฀study฀is฀to฀assess฀the฀differences฀in฀the฀prevalence฀ and฀severity฀of฀coronary฀artery฀calcification฀(CAC)฀in฀these฀ethnic฀groups. Electron-beam฀ tomography฀ was฀ performed฀ in฀ 11,282฀ asymptomatic฀ men฀ and฀ women฀ (CS=9742,฀AA=475,฀HS=1065)฀aged≥฀45฀years฀referred฀for฀CHD฀evaluation. Results:฀In฀this฀study฀population฀(67%฀males,฀52±8฀years),฀CS฀was฀more฀likely฀to฀present฀ with฀dyslipidemia฀and฀a฀family฀history฀of฀CHD฀(p<0.0001).฀On฀the฀other฀both฀AA฀and฀HS฀ had฀a฀higher฀prevalence฀of฀smoking,฀diabetes฀and฀hypertension฀as฀compared฀to฀the฀CS฀ counterparts฀(all฀p<0.001).฀After฀adjusting฀for฀age฀and฀risk฀factors,฀as฀compared฀to฀CS,฀ AA฀ men฀ were฀ least฀ likely฀ to฀ have฀ any฀ CAC฀ (OR:฀ 0.49;฀ 95%฀ CI:0.36-0.68)฀ and฀ severe฀ CAC฀ (≥400)฀ with฀ an฀ OR฀ of฀ 0.35฀ (CI:฀ 0.22-0.56)฀ (table).฀ In฀ women,฀ however฀ AA฀ had฀ a฀ significantly฀ higher฀ OR฀ of฀ any฀ CAC฀ and฀ severe฀ CAC฀ (1.51;฀ CI:฀ 1.06-2.17฀ and฀ 1.89;฀ CI:฀ 7.1-26,฀respectively)฀when฀compared฀with฀the฀CS฀women. Conclusions:฀ Our฀ study฀ results฀ demonstrate฀ significant฀ difference฀ in฀ the฀ presence฀ as฀ well฀as฀severity฀of฀CAC฀according฀to฀ethnicity.฀We฀also฀demonstrate฀that฀among฀men,฀AA฀ were฀least฀likely฀to฀have฀CAC,฀whereas฀in฀women฀the฀most฀likely฀to฀have฀CAC฀among฀the฀ different฀ethnic฀groups,฀respectively. MEN฀(7583) Caucasian฀(n=6670) Hispanics฀(n=630) AA฀(n=283) Women฀(3699) Caucasian฀(n=3072) Hispanics฀(n=435) AA฀(n=192) Any฀(>0) 0.1-9.9 10-99.9 100-399.9 ≥400 1.00 0.79฀(0.62-1.02) 0.49฀(0.36-0.68)† 1.00 0.75฀(0.57-0.97)* 1.51฀(1.06-2.17)* 1.00 0.74฀(0.53-1.04) 0.74฀(0.49-1.12) 1.00 0.91฀(0.64-1.27) 1.68฀(1.08-2.63)* 1.00 0.87฀(0.65-1.16) 0.45฀(0.30-0.67)† 1.00 0.63฀(0.43-0.91)* 1.62฀(1.04-2.51)* 1.00 0.80฀(0.58-1.11) 0.45฀(0.29-0.70)† 1.00 0.62฀(0.39-0.97)* 0.86฀(0.47-1.56) 1.00 0.68฀(0.48-0.96)* 0.35฀(0.22-0.56)† 1.00 0.83฀(0.51-1.36) 1.89฀(1.08-3.29)* Noninvasive Imaging Background:฀ Experimental฀ studies฀ showed฀ myocardial฀ viability฀ may฀ influence฀ on฀ the฀ diastolic฀function฀of฀left฀ventricle฀(LV)฀in฀the฀early฀phase฀after฀acute฀coronary฀syndrome฀ (ACS).฀But฀there฀were฀few฀reports฀about฀this฀relationship฀in฀human.฀ Methods:฀ 93฀ consecutive฀ patients฀ with฀ ACS฀ and฀ akinetic฀ wall฀ motion฀ in฀ at฀ least฀ two฀ segments฀ underwent฀ low฀ dose฀ dobutamine฀ stress฀ echocardiography฀ (upto฀ 10฀ mcg/kg/ min)฀to฀assess฀myocardial฀viability฀on฀7±2฀days฀after฀the฀event.฀Myocardial฀viability฀was฀ quantitatively฀evaluated฀by฀a฀strain฀rate฀imaging฀parameter,฀the฀percent฀change฀of฀time฀ to฀the฀onset฀of฀regional฀relaxation฀(TR)฀as฀well฀as฀wall฀motion฀score฀index.฀At฀the฀same฀ time,฀various฀echocardiographic฀diastolic฀parameters฀were฀measured.฀Within฀6฀hours฀after฀ the฀study,฀left฀and฀right฀heart฀catheterizations฀for฀recording฀of฀pressures฀were฀performed.฀ Myocardial฀ viability฀ index฀ (MVI)฀ was฀ newly฀ devised฀ as฀ a฀ multiplicaion฀ of฀ numbers฀ of฀ akinetic฀segment฀and฀binary฀viability฀determinant฀by฀the฀percent฀change฀of฀TR.฀ Results:฀Patients฀(฀68.8%฀men,฀mean฀age฀59.9±1.3฀years,฀59.2%฀anterior฀wall,฀48.9%฀STsegment฀elevation)฀were฀tolerated฀low฀dose฀dobutamine฀stress฀echocardiography฀without฀ significant฀complications.฀MVI฀showed฀significant฀linear฀correlations฀with฀left฀atrial฀volume฀ index,฀duration฀of฀pulmonary฀venous฀atrial฀flow฀reversal,฀deceleration฀time฀of฀transmitral฀ E฀wave,฀systolic฀fraction฀of฀pulmonary฀venous฀flow฀and฀transmitral฀peak฀E฀/mitral฀annular฀ peak฀ E’velocity฀ ratio฀ (r=0.44,฀ p=0.00฀ and฀ r=0.31,฀ p=0.00฀ and฀ r=-0.29,฀ p=0.01฀ and฀ r=0.25,฀p=0.02฀and฀r=0.22,฀p=0.04,฀respectively).฀Also,฀interestingly,฀MVI฀showed฀significant฀ linear฀correlation฀with฀invasive฀pulmonary฀capillary฀wedge฀pressure฀(r=0.72,฀p=0.00).฀But฀ changes฀ of฀ wall฀ motion฀ score฀ index฀ didn’t฀ showed฀ any฀ significances฀ in฀ correlation฀ with฀ diastolic฀functional฀parameters.฀ Conclusions:฀ Novel฀ MVI฀ correlates฀ with฀ LVdiastolic฀ functional฀ parameters฀ reflecting฀ chamber฀ remodeling฀ after฀ ACS.฀ So,฀ MVI฀ acquired฀ by฀ strain฀ rate฀ imaging฀ on฀ low฀ dose฀ dobutamine฀stress฀echocardiography฀may฀provide฀a฀useful฀prognostic฀information฀for฀LV฀ remodelling฀in฀the฀early฀phase฀of฀ACS. Background:฀ Emerging฀ echocardiographic฀ technologies,฀ including฀ pulsed฀ Doppler฀ tissue฀imaging฀(PDTI),฀are฀being฀increasingly฀used฀to฀identify฀ventricular฀dyssynchrony฀ and฀select฀patients฀(pts)฀for฀cardiac฀resynchronization฀therapy.฀While฀technically฀simpler฀ methods฀ involving฀ M-mode฀ or฀ differences฀ in฀ the฀ time฀ between฀ aortic฀ and฀ pulmonary฀ ejection฀ have฀ been฀ used฀ in฀ some฀ studies,฀ they฀ have฀ not฀ been฀ compared฀ directly฀ with฀ more฀complex฀PDTI฀techniques. Methods:฀ Indices฀ of฀ PDTI฀ included:฀ 1)฀ Intraventricular฀ delay฀ (LVD)฀ =฀ differences฀ in฀ electro-mechanical฀systolic฀delay฀in฀the฀lateral,฀septal,฀anterior฀inferior฀and฀posterior฀LV฀ walls฀ (abnormal:฀ >฀ 40฀ ms);฀ 2)฀ Interventricular฀ delay฀ (RLVD)฀ =฀ difference฀ between฀ the฀ RV฀free฀wall฀and฀the฀most฀delayed฀left฀ventricular฀free฀wall฀(abnormal:฀>฀40฀ms);฀3)฀Sum฀ dyssynchrony฀(Sum฀D)฀=฀LVD฀+฀RLVD฀(abnormal:฀>฀100฀ms);฀and฀4)฀Septal฀to฀lateral฀delay฀ (SLD)฀ =฀ difference฀ in฀ electro-mechanical฀ systolic฀ delay฀ between฀ the฀ septal฀ and฀ lateral฀ walls฀by฀color฀M-mode฀DTI฀(abnormal:฀>฀60฀ms).฀Other฀methods฀measured฀were฀1)฀Septal฀ to฀posterior฀wall฀delay฀(SPWMD)฀=฀difference฀in฀systolic฀delay฀between฀the฀septal฀and฀ posterior฀walls฀by฀M-mode฀(abnormal:฀>฀130฀ms);฀2)฀Pulmonary-Aortic฀Delay฀(Q_PW/Q_ A)฀=฀difference฀in฀electro-mechanical฀delay,฀using฀flow฀Doppler,฀from฀pulmonary฀ejection฀ to฀aortic฀ejection฀(abnormal:฀>฀40฀ms). Results:฀Twenty฀pts฀(15฀men,฀mean฀age฀=฀70฀years,฀17฀with฀ischemic฀cardiomyopathy)฀ were฀ evaluated.฀ Dyssynchrony,฀ defined฀ as฀ abnormal฀ LVD฀ by฀ PDTI,฀ was฀ noted฀ in฀ 12฀ pts.฀When฀ compared฀ to฀ LVD,฀ the฀ Pearson฀ correlation฀ coefficient฀ (r)฀ for฀ other฀ indices฀ of฀ ventricular฀dyssynchrony฀were฀as฀follows:฀Sum฀D฀=฀0.98;฀RLVD฀=฀0.899;฀SLD฀=฀0.972;฀ Q_PW/Q_A฀=฀-฀0.237;฀and฀SPWMD฀=฀0.412. Conclusions:฀Thus฀simpler฀methods,฀using฀either฀M-mode฀or฀the฀difference฀in฀pulmonaryaortic฀ejection฀delay฀did฀not฀correlate฀well฀with฀dyssynchrony฀as฀measured฀by฀LVD.฀Sum฀D฀ and฀also฀SLD฀(which฀is฀also฀measured฀with฀DTI)฀had฀the฀best฀correlation฀with฀LVD. 258A 1026-80฀ ABSTRACTS - Noninvasive Imaging JACC February 1, 2005 No฀Evidence฀for฀Increased฀Coronary฀Risk฀in฀an฀ Unselected฀US-American฀Population฀Compared฀With฀a฀ European฀(German)฀Unselected฀Population Axel฀Schmermund,฀Nils฀Lehmann,฀Lawrence฀F.฀Bielak,฀Andrea฀E.฀Cassidy,฀Patrick฀ F.฀Sheedy,฀II,฀Susanne฀Moebus,฀Stefan฀Mohlenkamp,฀Andreas฀Stang,฀Klaus฀Mann,฀ Stephen฀T.฀Turner,฀Karl-Heinz฀Jockel,฀Raimund฀Erbel,฀Patricia฀A.฀Peyser,฀University฀Clinic฀ Essen,฀Essen,฀Germany,฀University฀of฀Michigan,฀Ann฀Arbor,฀MI Noninvasive Imaging European฀investigators฀have฀reported฀overestimation฀of฀coronary฀artery฀disease฀(CAD)฀ risk฀ in฀ European฀ populations฀ when฀ applying฀ the฀ Framingham฀ algorithm.฀We฀ examined฀ possible฀differences฀in฀coronary฀artery฀calcification฀(CAC)฀and฀risk฀factors฀in฀the฀general฀ population฀(45฀-฀74฀years)฀in฀Germany฀and฀US-America. Methods:฀ The฀ Heinz฀ Nixdorf฀ Recall฀ (HNR)฀ study฀ and฀ the฀ Epidemiology฀ of฀ Coronary฀ Calcification฀(ECAC)฀study฀combined฀their฀data฀(subjects฀with฀no฀clinical฀CAD฀or฀stroke,฀ n฀=฀3,120฀in฀HNR,฀n฀=฀703฀in฀ECAC).฀CAC฀was฀determined฀using฀electron-beam฀CT฀and฀ the฀Agatston฀score฀in฀an฀identical฀fashion฀in฀both฀studies. Results:฀The฀Framingham฀risk฀score฀was฀higher฀in฀HNR฀than฀ECAC฀(10.6฀±฀7.6฀vs.฀9.3฀ ±฀7.1,฀p฀<฀0.001),฀and฀CAC฀scores฀were฀greater฀(median,฀11.9฀versus฀2.4;฀p฀<฀0.001).฀ When฀subjects฀were฀matched฀on฀CAD฀risk฀factors,฀presence฀and฀quantity฀of฀CAC฀were฀ similar.฀Risk฀factors฀significantly฀associated฀with฀CAC฀in฀both฀studies฀included:฀age,฀male฀ sex,฀current฀and฀former฀smoking,฀systolic฀blood฀pressure,฀and฀non฀HDL-cholesterol.฀Using฀ the฀same฀risk฀factor฀variables฀for฀modeling,฀the฀predicted฀CAC฀scores฀were฀comparable฀ in฀both฀cohorts฀(Figure). Conclusions:฀Despite฀differences฀in฀absolute฀risk฀in฀these฀large,฀unselected฀cohorts,฀risk฀ factor฀associations฀with฀CAC฀were฀very฀similar.฀CAC฀provided฀an฀early฀measure฀of฀target฀ organ฀damage฀associated฀with฀risk฀factor฀exposure.฀As฀opposed฀to฀studies฀concerning฀ clinical฀endpoints,฀we฀could฀not฀demonstrate฀substantially฀higher฀CAC฀scores฀in฀the฀USAmerican฀cohort.฀ 1026-81฀ Corrected฀“Normal฀Values”฀for฀Subclinical฀Coronary฀ Atherosclerosis฀in฀Truly฀Healthy฀Subjects฀With฀no฀Use฀ of฀Cardiovascular฀Medication฀in฀a฀Large฀PopulationBased฀Survey:฀Heinz฀Nixdorf฀Recall฀Study Axel฀Schmermund,฀Stefan฀Mohlenkamp,฀Sina฀Berenbein,฀Heiko฀Pump,฀Susanne฀ Moebus,฀Ulla฀Roggenbuck,฀Andreas฀Stang,฀Rainer฀Seibel,฀Dietrich฀Gronemeyer,฀KarlHeinz฀Jockel,฀Raimund฀Erbel,฀Heinz฀Nixdorf฀Recall฀Study฀Investigative฀Group,฀University฀ Clinic฀Essen,฀Essen,฀Germany The฀distribution฀of฀coronary฀artery฀calcification฀(CAC)฀scores฀in฀the฀unselected฀general฀ population฀is฀not฀well฀defined,฀and฀the฀influence฀of฀cardiovascular฀medication฀(CV฀med)฀ use฀has฀never฀been฀reported. Methods:฀The฀Heinz฀Nixdorf฀Recall฀study฀is฀a฀population-based฀study฀which฀recruited฀ a฀ total฀ of฀ 4,814฀ unselected฀ participants฀ aged฀ 45฀ -฀ 74฀ years฀ in฀ the฀ German฀ Ruhr฀ area.฀ Medication฀use฀was฀meticulously฀recorded,฀allowing฀to฀delineate฀CAC฀scores฀in฀subjects฀ with฀ no฀ CV฀ meds.฀These฀ were฀ defined฀ as฀ antihypertensive,฀ lipid-lowering,฀ antidiabetic,฀ and฀antiplatelet฀therapy.฀CAC฀scores฀were฀determined฀using฀electron-beam฀CT฀(EBCT)฀ and฀the฀Agatston฀method. Results:฀Of฀the฀4,472฀(92.9%)฀subjects฀with฀no฀history฀of฀coronary฀artery฀disease,฀the฀ CAC฀score฀was฀available฀in฀4,259฀(95%)฀(2,017฀men,฀2,242฀women).฀The฀2,306฀subjects฀ (54%)฀with฀no฀CV฀meds฀were฀younger฀than฀subjects฀using฀CV฀meds฀(57฀±฀7฀vs.฀62฀±฀8฀ years,฀p฀<฀0.001),฀whereas฀gender฀distribution฀was฀similar฀(47%฀males฀in฀both฀groups,฀p฀ =฀0.9).฀In฀all฀male฀5-year฀age-groups฀except฀the฀highest฀(70฀-฀74฀years฀of฀age),฀subjects฀ with฀no฀CV฀meds฀had฀significantly฀lower฀CAC฀scores.฀In฀women,฀this฀was฀true฀in฀the฀age฀ groups฀between฀50฀and฀69฀years.฀The฀figure฀shows฀median฀CAC฀scores฀in฀men฀with฀no฀ CV฀meds฀compared฀with฀the฀total฀study฀group. Conclusions:฀In฀subjects฀with฀no฀CV฀meds,฀there฀appeared฀to฀be฀a฀time-lag฀of฀up฀to฀5฀ years฀before฀the฀same฀levels฀of฀CAC฀developed฀as฀in฀the฀total฀group.฀These฀lower฀values฀ may฀be฀used฀as฀a฀reference฀for฀“truly฀healthy”฀individuals.฀ 1026-82฀ Association฀Of฀Traditional฀Risk฀Factors฀With฀Subclinical฀ Coronary฀Atherosclerosis฀Varies฀In฀Different฀Ethnic฀ Groups Raul฀D.฀Santos,฀Khurram฀D.฀Nasir,฀John฀A.฀Rumberger,฀Matthew฀J.฀Budoff,฀Joel฀B.฀ Braunstein,฀Jose฀AM฀Carvalho,฀Paolo฀Raggi,฀Roger฀S.฀Blumenthall,฀Johns฀Hopkins฀Medical฀ Institutions,฀Baltimore,฀MD,฀Lipid฀Clinic฀Heart฀Institute฀(InCor)฀University,฀São฀Paulo,฀Brazil Introduction:฀ The฀ aim฀ of฀ the฀ present฀ study฀ is฀ to฀ assess฀ whether฀ the฀ association฀ of฀ traditional฀ risk฀ factors฀ (RF)฀ with฀ coronary฀ artery฀ calcification฀ (CAC)฀ varies฀ in฀ a฀ large฀ asymptomatic฀white฀U.S.฀and฀Brazilian฀(BR)฀population,฀and฀may฀explain฀the฀difference฀in฀ sub฀clinical฀atherosclerosis฀observed฀in฀these฀groups. Methods฀ &฀ Results:฀The฀ study฀ population฀ consisted฀ of฀ 10,971฀ white฀ males฀ (20%฀ BR)฀ and฀ 4,659฀ females฀ (9.5%฀ BR)฀ who฀ underwent฀ electron฀ beam฀ tomography.฀ For฀ all฀ ages฀ except฀<฀45฀years฀old฀group,฀BR฀males฀were฀less฀likely฀to฀have฀any฀CAC฀compared฀to฀ US฀ males฀ (45-54฀ yrs:฀ OR฀ 0.6,฀ 55-64฀ yrs:฀ 0.5฀ and฀ ≥65฀ yrs:0.4,฀ all฀ p<0.0001).฀ No฀ such฀ differences฀were฀observed฀in฀females.฀In฀the฀full฀multivariate฀model฀adjusting฀for฀all฀risk฀ factors,฀ US฀ men฀ had฀ a฀ higher฀ odds฀ of฀ having฀ any฀ CAC฀ (95%฀ CI)฀ with฀ increasing฀ age฀ compared฀to฀BR฀men฀(45-55฀yrs:฀1.6,฀55-64฀yrs:฀2.1,฀≥65฀yrs:฀3.5,฀all<0.0001)฀as฀well฀with฀ smoking฀status฀(1.5,฀p=0.004),฀whereas฀BR฀men฀had฀a฀higher฀association฀with฀diabetes฀ (1.7,฀p=0.0005)฀compared฀to฀US฀men฀(table).฀On฀the฀other฀hand,฀Brazilian฀women฀had฀ 3.7฀higher฀odds฀of฀having฀any฀CAC฀with฀diabetes฀(p<0.0001)฀as฀compared฀to฀US฀females,฀ whereas฀US฀females฀had฀2.1฀higher฀odds฀of฀any฀CAC฀with฀smoking฀as฀compared฀to฀BR฀ females฀(p=0.006) Conclusions:฀In฀this฀study฀increasing฀age฀and฀smoking฀were฀more฀strongly฀associated฀ with฀presence฀of฀CAC฀in฀the฀US฀population,฀whereas฀diabetes฀was฀a฀stronger฀risk฀factor฀in฀ the฀BR฀men฀and฀women.฀Further฀studies฀are฀needed฀to฀confirm฀our฀findings. OR฀(95%฀CI)฀for฀CAC฀ Age* Hypertension Smoking Dyslipidemia Diabetes 1.5฀(1.2-1.9) 1.6฀(1.3-1.9) 1.7฀(1.2-2.2) 1.8฀(1.1-2.9) 1.5฀(1.3-1.7) 1.2฀(0.9-1.3) 1.5฀(1.2-1.8) 1.4฀(0.9-2.1) 45-54฀years 55-64฀years ≥65฀years US฀Male Br฀Male US฀Female Br฀Female 3.2฀(2.7-3.6) 1.9฀(1.5-2.3) 1.8฀(1.3-2.3) 1.3฀(0.7-2.3) 8.1฀(6.8-9.5) 3.7฀(2.9-4.8) 4.2฀(3.1-5.6) 3.3฀(1.7-6.1) 23.6฀(17.1-32.6) 6.3฀(4.2-9.2) 10.2฀(7.4-14.10) 7.0฀(3.5-14.1) 1.7฀(1.4-1.9) 1.3฀(1.1-1.6) 1.4฀(1.2-1.7) 1.1฀(0.6-1.4) 1.3฀(1.1-1.5) 2.1฀(1.4-2.8) 1.2฀(1.0-1.6) 3.7฀(1.9-7.2) *Reference฀age฀<45฀years 1026-83฀ Metabolic฀Syndrome฀Provides฀Risk฀Stratification฀ In฀Asymptomatic฀Men฀Considered฀Low฀Risk฀By฀ Framingham฀Risk฀Estimation Raul฀D.฀Santos,฀Khurram฀Nasir,฀Peter฀Johnston,฀Jose฀AM฀Carvalho,฀Joel฀B.฀Braunstein,฀ Roger฀S.฀Blumenthal,฀Johns฀Hopkins฀Medical฀Institutions,฀Baltimore,฀MD,฀Lipid฀Clinic฀ Heart฀Institute฀(InCor)฀University,฀Sao฀Paulo,฀Brazil Background:฀ Individuals฀ with฀ metabolic฀ syndrome฀ are฀ at฀ increased฀ risk฀ for฀ atherosclerosis.฀However฀it฀is฀unknown฀whether฀MS฀provides฀incremental฀risk฀information฀ to฀the฀traditional฀risk฀factors฀ of฀the฀Framingham฀algorithm฀for฀identifying฀coronary฀artery฀ calcification฀(CAC)฀in฀asymptomatic฀men. Methods:฀ We฀ studied฀ 559฀ consecutive฀ asymptomatic฀ men฀ (46±7฀ yrs)฀ who฀ presented฀ for฀ electron-beam฀ tomography฀ in฀ San฀ Paolo,฀ Brazil.฀ Participants฀ were฀ classified฀ as฀ low฀ risk฀ (<10%฀ risk,฀ n=259),฀ intermediate฀ risk฀ (10-20%,฀ n=163)฀ and฀ high฀ risk฀ (≥20%฀ risk,฀ n=42)฀based฀on฀Framingham฀risk฀estimation฀(FRE).฀MS฀was฀defined฀according฀the฀ATP฀III฀ criteria.฀MS฀was฀present฀in฀27%฀(n=125)฀of฀the฀study฀population. Results:฀ Compared฀ it฀ individuals฀ with฀ low฀ risk,฀ the฀ odds฀ for฀ any฀ CAC฀ were฀ higher฀ with฀ intermediate฀ risk฀ (OR=3.6,฀ 95%CI=2.4-5.3,฀ p<0.0001)฀ and฀ high฀ risk฀ (5.6,฀ 3.3-9.4,฀ p<0.0001)฀respectively.฀Prevalence฀of฀CAC฀was฀significantly฀higher฀in฀individuals฀with฀MS฀ than฀without฀it฀(52%฀vs.฀37%,฀p=0.002).฀Presence฀vs.฀absence฀of฀MS฀was฀associated฀with฀ higher฀prevalence฀of฀CAC฀in฀low฀risk฀men฀(p=0.04,฀table),฀whereas฀the฀difference฀was฀nonsignificant฀on฀those฀with฀intermediate฀(p=0.4)฀and฀high-risk฀(p=0.9).฀The฀likelihood฀ratio฀ 2 ฀statistics฀showed฀that฀the฀addition฀of฀MS฀to฀FRE฀contributed฀significantly฀in฀identifying฀ CAC฀only฀among฀low฀risk฀men฀(p<0.001).฀ JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging Conclusions:฀Our฀study฀findings฀suggest฀that฀MS฀provides฀additional฀risk฀stratification฀ among฀low-risk฀individuals.฀Further฀studies฀are฀needed฀to฀confirm฀our฀findings. Prevalence฀of฀CAC฀(%)฀according฀to฀presence฀of฀MS฀in฀categories฀of฀FRE Low-risk MS No฀MS P฀value Low-risk 36% 23% 0.04 Intermediate-risk 56% 56% 0.9 High-risk 73% 73% 0.4 1026-84฀ Gender฀Differences฀in฀Risk฀Factors฀for฀Subclinical฀ Coronary฀Atherosclerosis:฀Evaluation฀by฀Electron฀Beam฀ Tomography Harvey฀S.฀Hecht,฀Eyad฀AlHaj,฀TJ฀Matarazzo,฀Patricia฀Freidmann,฀Beth฀Israel฀Medical฀ Center,฀New฀York,฀NY Background:฀Gender฀differences฀may฀affect฀the฀contribution฀of฀conventional฀risk฀factors฀ to฀subclinical฀coronary฀atherosclerosis. Methods:฀ 3912฀ consecutive฀ asymptomatic฀ patients,฀ 2692฀ men฀ (mean฀ age฀ 52.1+11.4฀ years)฀ and฀ 1220฀ women฀ (mean฀ age฀ 55.5+11.3฀ years),฀ who฀ underwent฀ electron฀ beam฀ tomography฀coronary฀artery฀calcium฀(CAC)฀plaque฀imaging฀were฀analyzed. Results:฀ CAC฀(scores>0)฀was฀present฀in฀55.3%฀of฀the฀men฀and฀35.7%฀of฀the฀women฀ (p<0.0001).฀The฀presence฀of฀CAC฀in฀relation฀to฀each฀risk฀factor฀is฀shown฀in฀the฀Table. Hypertension Diabetes Men 69.5% Women 46.8% 83.2% 51.7% Increased฀ Cholesterol 65.2% 47.9% BMI>25 BMI>30 Smoking 54.6% 39.7% 55.9% 40.1% 60.9% 36.9% Family฀ History 55.6% 45.9% 1026-85฀ Smoking฀Does฀Not฀Contribute฀to฀Subclinical฀Coronary฀ Atherosclerosis฀in฀Middle฀Aged฀Asymptomatic฀Women Eyad฀AlHaj,฀Patricia฀Friedmann,฀TJ฀Matarazzo,฀Harvey฀S.฀Hecht,฀Beth฀Israel฀Medical฀ Center,฀New฀York,฀NY Background:฀The฀ relative฀ importance฀ of฀ risk฀ factors฀ may฀ be฀ gender฀ related.฀ Smoking฀ within฀the฀past฀30฀days฀is฀considered฀a฀major฀risk฀factor฀in฀the฀Framingham฀Risk฀Score฀ irrespective฀of฀gender. Methods:฀ To฀ investigate฀ the฀ contribution฀ of฀ cigarette฀ smoking฀ in฀ women฀ to฀ the฀ development฀ of฀ subclinical฀ coronary฀ atherosclerosis,฀ 1427฀ consecutive฀ asymptomatic฀ women฀(mean฀age฀55.5+11.3฀years)฀who฀underwent฀electron฀beam฀tomography฀calcified฀ coronary฀plaque฀imaging฀were฀evaluated.฀Smoking฀categories฀were:฀never฀smoked฀(N),฀ current฀smokers฀(C),฀former฀smokers฀(F),฀and฀ever฀smoked฀(F+C). Results:฀Coronary฀calcium฀(calcium฀score฀>0)฀was฀present฀in฀35฀%฀of฀N,฀32%฀of฀C,฀39฀%฀ of฀F,฀and฀37%฀of฀F+C฀(p=NS).฀Stratification฀of฀the฀coronary฀calcium฀scores฀according฀to฀ smoking฀categories฀is฀shown฀in฀the฀Table,฀and฀demonstrates฀the฀absence฀of฀a฀relationship฀ between฀smoking฀categories฀and฀the฀calcified฀plaque฀burden. Smoking฀and฀Calcified฀Coronary฀Plaque฀ Calcium฀Scores N F C F+C 0 1-9 10-100 101-400 >400 n 919 127 224 169 85 1097 231 99 230 65.0% 61.0% 67.7% 63.0% 7.8% 5.6% 9.1% 6.7% 13.4% 15.2% 6.1% 12.4% 8.8% 14.7% 13.1% 14.2% 5.0% 3.5% 4.0% 3.6% In฀ a฀ multivariate฀ analysis฀ of฀ smoking,฀ age,฀ family฀ history,฀ hypertension,฀ BMI,฀ diabetes฀ and฀cholesterol฀disorders,฀smoking฀did฀not฀independently฀contribute฀to฀the฀presence฀of฀ coronary฀calcium. Conclusions:฀ 1)฀ Smoking฀ did฀ not฀ contribute฀ to฀ subclinical฀ atherosclerosis฀ in฀ asymptomatic฀middle฀aged฀women;฀2)฀Further฀evaluation฀of฀the฀gender฀specific฀effects฀of฀ smoking฀as฀a฀major฀risk฀factor฀may฀be฀indicated. 1026-86฀ Correlation฀Between฀Coronary฀Calcification฀and฀ Endothelial฀Dysfunction฀in฀Asymptomatic฀Subjects฀at฀ Risk฀of฀Coronary฀Artery฀Disease Rosario฀Rossi,฀Vincenzo฀Turco,฀Carlo฀Ratti,฀Guido฀Ligabue,฀Renato฀Romagnoli,฀Maria฀G.฀ Modena,฀University฀of฀Modena฀and฀Reggio฀Emilia,฀Modena,฀Italy Background:฀ The฀ amount฀ of฀ calcium฀ in฀ the฀ coronary฀ arteries฀ correlates฀ with฀ the฀ extent฀ of฀ atherosclerosis.฀ Endothelial฀ dysfunction฀ is฀ recognized฀ to฀ be฀ an฀ early฀ event฀ in฀ atherogenesis. Aim:฀We฀sought฀to฀evaluate฀the฀correlation฀between฀endothelial฀function฀and฀the฀presence฀ and฀extent฀of฀coronary฀artery฀calcium฀(CAC). Methods:฀The฀study฀was฀performed฀in฀213฀asymptomatic,฀middle-aged฀(45฀to฀60฀years฀ old;฀ mean฀ age:฀ 53฀ ±฀ 6)฀ subjects฀ (25.3%฀ men),฀ who฀ were฀ referred฀ at฀ our฀ institution฀ for฀ CAC฀screening.฀All฀enrolled฀individuals฀were฀considered฀to฀be฀at฀above-average฀risk฀for฀ coronary฀disease฀because฀of฀the฀presence฀of฀coronary฀risk฀factors.฀Multislice฀computed฀ tomography฀ was฀ used฀ to฀ detect฀ and฀ quantify฀ CAC,฀ and฀ high฀ resolution฀ ultrasound฀ to฀ measure฀flow-mediated฀vasodilation฀(FMD)฀in฀the฀brachial฀artery.฀Subjects฀were฀divided฀ into฀three฀groups฀according฀to฀FMD฀tertiles. Results:฀Hypertension฀and฀hypercholesterolemia฀were฀present฀in฀the฀50.7%฀and฀46.0%฀of฀ the฀population,฀respectively;฀41.3%฀of฀the฀individuals฀were฀current฀smokers฀and฀11.7%฀had฀ diabetes.฀CAC฀was฀detected฀(CAC฀score฀>฀0)฀in฀151฀subjects฀(70.9%฀of฀the฀entire฀population);฀ the฀mean฀CAC฀score฀resulted฀135฀±฀385.฀Mean฀FMD฀was฀5.1฀±฀4.5%.฀There฀was฀a฀significant฀ correlation฀between฀CAC฀score฀and฀FMD฀(฀r฀=฀-0.54;฀p<0.0001).฀CAC฀score฀increased฀in฀a฀ graded฀fashion฀with฀decreasing฀FMD฀(422฀±฀398฀in฀subjects฀located฀in฀the฀lowest฀tertile฀[FMD฀ <฀or฀=฀4.3%];฀133฀±฀344฀in฀the฀intermediate฀tertile฀[FMD฀from฀4.4฀to฀5.5%],฀and฀77฀±฀299฀in฀ the฀higher฀tertile฀[FMD฀>฀or฀=฀5.6];฀p<0.0001฀for฀trend).฀There฀were฀no฀significant฀differences฀ between฀groups฀regarding฀age฀and฀presence฀of฀coronary฀risk฀factors. Conclusions:฀In฀this฀population฀of฀middle-aged,฀asymptomatic฀subjects,฀elevated฀CAC฀ score฀correlated฀with฀impaired฀endothelial฀function.฀These฀data฀confirm฀a฀significant฀role฀ for฀endothelial฀dysfunction฀in฀the฀coronary฀atherogenetic฀process. POSTER฀SESSION 1027฀฀ Cardiovascular฀Magnetic฀Resonance:฀ New฀Applications฀of฀Phase฀Velocity฀ Imaging฀and฀Congenital฀Heart฀Disease Sunday,฀March฀06,฀2005,฀9:00฀a.m.-12:30฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀9:00฀a.m.-10:00฀a.m. 1027-71฀ Phase฀Contrast฀Magnetic฀Resonance฀Imaging฀of฀ the฀Pulmonary฀Artery฀Predicts฀Invasive฀Pulmonary฀ Hemodynamic฀Measurements Javier฀Sanz,฀Roxana฀Sulica,฀Santo฀Dellegrottaglie,฀Martin฀Goyenechea,฀Paola฀Kuschnir,฀ Juan฀F฀Viles-Gonzalez,฀Teresa฀Rius,฀Valentin฀Fuster,฀Sanjay฀Rajagopalan,฀Michael฀ Poon,฀The฀Zena฀and฀Michael฀A฀Wiener฀Cardiovascular฀Institute,฀Mount฀Sinai฀School฀of฀ Medicine,฀New฀York,฀NY Background:฀Right฀heart฀catheterization฀(RHC)฀is฀the฀gold฀standard฀for฀the฀diagnosis฀of฀ pulmonary฀arterial฀hypertension฀(PAH).฀Phase-contrast฀magnetic฀resonance฀imaging฀(PCMRI)฀allows฀for฀the฀noninvasive฀characterization฀of฀arterial฀flow฀profiles.฀We฀hypothesized฀ that฀pulmonary฀artery฀(PA)฀flow฀measurements฀obtained฀with฀PC-MRI฀correlate฀with฀RHC฀ parameters.฀ Methods:฀In฀55฀patients฀with฀known฀or฀suspected฀PAH฀(age฀47±14฀years)฀PC-MRI฀and฀ RHC฀(mean฀interval฀2.2±4.1฀days)฀were฀performed.฀PC-MRI฀measurements฀were฀obtained฀ perpendicular฀to฀the฀PA฀trunk฀using฀a฀retrospectively฀ECG-gated,฀breath-hold,฀velocityencoded฀sequence฀in฀a฀1.5T฀system.฀PA฀mean฀area฀(cm2),฀acceleration฀time฀(msec)฀and฀ peak฀ and฀ mean฀ velocities฀ (cm/sec)฀ were฀ measured฀ from฀ PC-MRI.฀ Mean฀ PA฀ pressure฀ (mmHg)฀and฀pulmonary฀vascular฀resistance฀(Wood฀units)฀were฀obtained฀from฀RHC.฀ Results:฀PAH฀(mean฀pulmonary฀pressure฀at฀rest฀>25฀mmHg)฀was฀confirmed฀in฀39฀(71%)฀ patients.฀ Correlation฀ coefficients฀ between฀ RHC฀ and฀ PC-MRI฀ variables฀ are฀ shown฀ in฀ table.฀Receiver-operator฀curve฀analysis฀of฀mean฀PA฀velocity฀in฀predicting฀PAH฀revealed฀a฀ sensitivity฀of฀95%฀and฀specificity฀of฀81%฀for฀the฀detection฀of฀PAH฀using฀a฀best฀cut-off฀value฀ of฀12.2฀cm/sec฀(area฀under฀the฀curve฀0.92,฀p<0.001).฀ Conclusion:฀Pulmonary฀PC-MRI฀measurements฀correlate฀with฀RHC-derived฀hemodynamic฀ parameters.฀PA฀mean฀velocity฀can฀reliably฀detect฀the฀presence฀of฀PAH.Thus,฀PC-MRI฀may฀ be฀a฀useful฀non-invasive฀imaging฀technique฀for฀the฀early฀diagnosis฀of฀PAH. Correlations฀between฀phase฀contrast฀and฀right฀heart฀catheterization฀measurements฀ Mean฀velocity Mean฀pulmonary฀ pressure Pulmonary฀vascular฀ resistance 1027-72฀ Peak฀velocity Mean฀area Acceleration฀time r=-0.73฀(p<0.0001) r=-0.35฀(฀p=0.008) r=0.66฀(p<0.0001) r=-0.37฀(p=0.005) r=-0.75฀(p<0.0001) r=-0.45฀(p=0.001) r=0.56฀(p<0.0001) r=-0.40฀(p=0.002) MRI฀Assessment฀of฀Myocardial฀Elasticity฀Using฀ Displacement฀Imaging฀and฀Phase-Contrast฀Velocity฀ Mapping Han฀Wen,฀Eric฀Bennett,฀Jonathan฀F.฀Plehn,฀National฀Heart,฀Lung฀and฀Blood฀Institute,฀ National฀Institutes฀of฀Health,฀Bethesda,฀MD Background:฀ Approximately฀ half฀ of฀ patients฀ experiencing฀ congestive฀ heart฀ failure฀ present฀with฀a฀normal฀left฀ventricular฀ejection฀fraction.฀Perturbations฀in฀material฀properties฀ affecting฀ ventricular฀ pressure/volume฀ relationships฀ are฀ likely฀ responsible฀ for฀ this฀ “stiff฀ heart฀syndrome”฀yet฀noninvasive฀tools฀permitting฀the฀accurate฀assessment฀of฀myocardial฀ elasticity฀are฀extremely฀limited. Methods฀and฀Results:฀We฀developed฀an฀MRI-based฀technique฀to฀examine฀regional฀left฀ ventricular฀stress/strain฀relationships฀by฀incorporating฀displacement฀encoding฀with฀stimulated฀ echoes฀(DENSE)฀and฀phase฀velocity฀mapping฀and฀compared฀regional฀elastic฀moduli฀(EM)฀ Noninvasive Imaging All฀but฀BMI,฀smoking฀in฀women฀and฀family฀history฀in฀men฀were฀associated฀with฀significantly฀ higher฀CAC฀than฀patients฀without฀the฀risk฀factor. Multivariate฀ analysis฀ revealed฀ the฀ independent฀ predictors฀ of฀ CAC฀ in฀ men฀ were:฀ age/10฀ years฀ (OR฀ 2.75,฀ p<0.0001),฀ ↑cholesterol฀ (OR฀ 1.63,฀ p<0.0001),฀ diabetes฀ (OR฀ 2.91,฀ p=0.0003,฀↑BP฀(OR฀1.39,฀p=0.0086)฀and฀premature฀family฀history฀(OR฀1.42,฀p=0.0034).฀ In฀women,฀independent฀predictors฀were:฀age/10฀years฀(OR฀2.66,฀p<0.0001),฀↑cholesterol฀ (OR฀1.88,฀p<0.0001),฀Premature฀family฀history฀(OR฀1.88,฀p<0.0001),฀and฀BMI฀>฀25฀(OR฀ 1.36,฀p=0.02). Conclusions:฀ 1)฀ Age,฀ cholesterol฀ and฀ premature฀ family฀ history฀ were฀ independent฀ predictors฀ of฀ subclinical฀ atherosclerosis฀ in฀ both฀ men฀ and฀ women.฀ 2)฀ Hypertension฀ and฀ diabetes฀were฀independently฀predictive฀only฀in฀men฀and฀BMI>25฀was฀predictive฀only฀in฀ women;฀smoking฀was฀not฀predictive฀in฀either฀group.฀3)฀Modifications฀of฀risk฀stratification฀ that฀incorporate฀gender฀differences฀in฀risk฀factor฀importance฀should฀be฀considered. 259A 260A ABSTRACTS - Noninvasive Imaging February 1, 2005 and฀viscous฀delay฀time฀constants฀(VDTCs)฀with฀immediate฀post-mortem฀direct฀strain฀gauge฀ measurements฀ in฀ 17฀ normal฀ dogs฀ and฀ two฀ dogs฀ 4฀ weeks฀ following฀ anterior฀ myocardial฀ infarction.฀We฀also฀assessed฀technique฀feasibility฀in฀two฀normal฀humans.฀Consistent฀with฀ known฀regional฀anisotropic฀properties,฀EMs฀by฀MRI฀were฀significantly฀greater฀in฀papillary฀ muscle฀columns฀than฀lateral฀wall฀and฀septal฀locations฀(7.59+1.65฀versus฀3.40+0.87฀versus฀ 2.55+0.93฀kPa,฀p<0.0001)฀and฀were฀similar฀in฀lateral฀and฀septal฀locations฀to฀direct฀strain฀ gauge฀measurements฀(3.78+0.93฀and฀2.96+0.88฀kPa,฀respectively฀for฀strain฀gauge,฀p=ns฀ for฀both฀versus฀MRI).฀MRI-determined฀VDTCs฀were฀similar฀in฀the฀three฀regions฀(VDTC=1.2+12.4฀versus฀3.0+7.3฀versus฀4.2+5.8฀ms,฀p=ns)฀and฀did฀not฀differ฀from฀lateral฀and฀septal฀ wall฀ strain฀ gauge฀ measurements฀ (VDTC=3.1+0.4฀ and฀ 4.6+1.9฀ ms,฀ p=ns฀ for฀ both฀ versus฀ MRI).฀In฀the฀two฀dogs฀at฀4฀weeks฀post฀infarction,฀affected฀regions฀maintained฀their฀thickness฀ but฀displayed฀markedly฀increased฀stiffness฀(EM฀8฀to฀20฀kPa)฀compared฀to฀normal฀regions฀ (EMs฀less฀then฀1.5฀kPa).฀Stress/strain฀measurements฀obtained฀in฀two฀normal฀volunteers฀ demonstrated฀similar฀regional฀distribution฀and฀progressive฀increases฀in฀EM฀and฀reductions฀ in฀VDTC฀ from฀ early฀ to฀ mid฀ diastole฀ (EM=0.65+0.29฀ to฀ 2.21+1.35฀ kPa฀ from฀ early฀ to฀ mid฀ diastole,฀VDTC=10.6+1.3฀to฀3.8+7.8฀ms). Conclusions:฀ Noninvasive,฀ regional฀ assessment฀ of฀ myocardial฀ stiffness฀ using฀ MRIbased฀DENSE฀and฀phase฀velocity฀mapping฀techniques฀is฀accurate฀in฀a฀canine฀model฀and฀ appears฀to฀be฀feasible฀in฀humans. Methods:฀ 95฀ patients฀ aged฀ from฀ 13฀ to฀ 70yrs฀ (mean฀ 48yrs,฀ 59%฀ male)฀ with฀ cerebral฀ ischemia฀ and฀ PFO฀ in฀ transesophageal฀ echocardiography฀ were฀ examined฀ by฀ contrast฀ enhanced฀ CMRI฀ (1.5฀ T฀ Intera฀ CV,฀ Philips)฀ before฀ percutaneous฀ closure฀ of฀ the฀ PFO.฀ Infarction-like฀myocardial฀late-enhancement฀was฀seen฀in฀9฀patients฀(9,5%).฀Only฀one฀of฀ those฀had฀coronary฀artery฀disease฀(CAD)฀in฀coronary฀angiography,฀so฀we฀suggest฀that฀ in฀8฀patients฀(mean฀51yrs,฀63%฀male)฀coronary฀embolism฀was฀the฀reason฀for฀myocardial฀ infarction.฀ Infarction฀ size฀ varied฀ from฀ small฀ subendocardial฀ lesions฀ to฀ large฀ defects฀ of฀ transmural฀extent.฀Only฀3฀patients฀had฀a฀history฀of฀acute฀chest฀pain,฀and฀only฀2฀of฀them฀ showed฀infarction-like฀changes฀in฀ECG. The฀ejection฀fraction฀of฀the฀left฀ventricle฀was฀significantly฀lower฀in฀patients฀with฀myocardial฀ scars฀(mean฀60,8%฀vs.฀69,6%,฀p=0,03). Conclusion:฀CMRI฀is฀a฀powerful฀non-invasive฀tool฀in฀the฀assessment฀of฀myocardial฀infarction฀ in฀patients฀with฀PFO฀due฀to฀coronary฀embolism฀that฀remains฀undiscovered฀in฀63%. 1027-73฀ Background:฀ Longitudinal฀ myocardial฀ velocities฀ can฀ assess฀ regional฀ function฀ and฀ viability.฀Phase-contrast฀Magnetic฀Resonance฀Imaging฀(PC-MRI)฀can฀provide฀quantifiable฀ velocities฀ but฀ has฀ not฀ been฀ correlated฀ with฀Tissue฀ Doppler฀ Imaging฀ (TDI)฀ velocities฀ by฀ echocardiography.฀The฀ purpose฀ of฀ this฀ study฀ is฀ to฀ validate฀ longitudinal฀ myocardial฀ and฀ transmitral฀velocities฀by฀PC-MRI฀with฀TDI. Method:฀We฀recruited฀17฀patients฀with฀myocardial฀infarction฀(MI)฀and฀9฀volunteers.฀MRI฀ and฀ echo฀ were฀ done฀ within฀ 12฀ hours฀ of฀ each฀ other.฀ Basal฀ myocardial฀ and฀ transmitral฀ velocities฀were฀measured฀by฀PC-MRI฀(temporal฀resolution฀28฀msecs).฀TDI฀of฀myocardial฀ systolic฀ (S’),฀ early฀ (E’)฀ and฀ late฀ diastolic฀ (A’),฀ and฀ transmitral฀ E฀ and฀ A฀ were฀ measured.฀ Results฀are฀mean+SD. Results:฀Mean฀age฀was฀62+11.฀Ejection฀fraction฀was฀significantly฀different฀between฀the฀ normal฀and฀MI฀groups฀(60+4฀vs.฀43+7,฀p<0.001).฀MRI฀velocities฀ranged฀from฀112฀to฀-15฀ cms/s.฀It฀showed฀strong฀linear฀correlation฀with฀echo฀velocities฀(R=฀0.98,฀p<0.001).฀BlandAltman฀analysis฀showed฀that฀MRI฀overestimated฀longitudinal฀velocities฀by฀0.5+3฀cm/s฀in฀ all฀subjects,฀by฀0.2+2฀cms/s฀in฀MI฀patients,฀and฀by฀1+4฀cm/s฀in฀normal฀volunteers฀.฀MRI฀ underestimated฀trans-mitral฀flow฀by฀10.3+10฀cm/s. Conclusions:฀ High฀ temporal฀ resolution฀ PC-MRI฀ is฀ feasible.฀ Myocardial฀ and฀ transmitral฀ velocities฀obtained฀by฀PC฀MRI฀strongly฀correlates฀with฀velocities฀by฀echo฀Doppler. Fig.฀Longitudinal฀myocardial฀velocity฀by฀PC-MRI฀(left)฀and฀TDI฀(right)฀in฀the฀inferoseptum฀of฀a฀normal฀volunteer฀ Magnetic฀Resonance฀Delayed฀Enhancement฀for฀the฀ Detection฀of฀Fibrous฀Tissue฀in฀Postoperative฀Pediatric฀ Patients฀With฀Various฀Forms฀of฀Congenital฀Heart฀ Disease Matthew฀A.฀Harris,฀Susan฀Ghods,฀Paul฀M.฀Weinberg,฀Mark฀A.฀Fogel,฀The฀Children’s฀ Hospital฀of฀Philadelphia,฀Philadelphia,฀PA Noninvasive Imaging JACC Background:฀ Because฀ endothelialization฀ occurs฀ on฀ conduits฀ and฀ patches,฀ we฀ hypothesized฀ that฀ delayed฀ enhancement฀ magnetic฀ resonance฀ (MR)฀ imaging฀ should฀ identify฀these฀areas฀and฀other฀fibrous฀tissue฀such฀as฀valve฀leaflets฀and฀their฀annuli. Methods:฀We฀retrospectively฀reviewed฀myocardial฀viability฀studies.฀Ages฀ranged฀from฀4฀ months฀ to฀ 19฀ years.฀ Studies฀ were฀ reviewed฀ for฀ the฀ presence฀ of฀ delayed฀ enhancement฀ involving฀ conduits,฀ ventricular฀ septal฀ defect฀ (VSD)฀ patches,฀ valve฀ leaflets฀ and฀ their฀ annuli.฀ Group฀ 1฀ (n=14)฀ diagnoses฀ included฀ tetralogy฀ of฀ Fallot,฀ transposition฀ with฀VSD,฀ truncus฀arteriosus,฀and฀atrioventricular฀canal.฀Group฀2฀patients฀who฀had฀never฀undergone฀ surgery-involving฀placement฀of฀conduits฀or฀VSD฀patches฀were฀used฀as฀controls฀(n=12). Results:฀In฀Group฀1,฀delayed฀enhancement฀of฀the฀conduit฀occurred฀in฀11/14฀patients฀(79%),฀ VSD฀patch฀in฀7/14฀patients฀(50%),฀and฀involvement฀of฀the฀valve฀leaflets฀or฀annuli฀in฀11/14฀ patients฀ (79%).฀ 2/14฀ patients฀ (14%)฀ did฀ not฀ have฀ any฀ delayed฀ enhancement.฀ In฀ Group฀ 2฀ there฀was฀no฀evidence฀of฀delayed฀enhancement฀in฀the฀region฀of฀the฀outflow฀tracts,฀and฀3/12฀ (25%)฀patients฀experienced฀delayed฀enhancement฀involving฀the฀tricuspid฀valve. Conclusion:฀MR฀delayed฀enhancement฀can฀identify฀regions฀of฀fibrous฀tissue฀formation฀ on฀ conduits฀ and฀VSD฀ patches฀ in฀ postoperative฀ pediatric฀ patients฀ with฀ various฀ forms฀ of฀ congenital฀heart฀disease.฀This฀information฀may฀be฀helpful฀for฀understanding฀and฀tracking฀ the฀development฀of฀fibrous฀tissue฀in฀surgically฀reconstructed฀hearts.฀ 1027-75฀ Longitudinal฀Myocardial฀and฀Transmitral฀Velocities฀by฀ Phase-Contrast฀Cardiac฀Magnetic฀Resonance฀Imaging:฀ Correlation฀with฀Doppler฀Echocardiography Sriram฀Padmanabhan,฀Vandana฀Sachdev,฀Li-Yueh฀Hsu,฀Sidenko฀Stanislav,฀Andrew฀E.฀ Arai,฀National฀Institutes฀of฀Health/NHLBI/LCE,฀Bethesda,฀MD 1027-76฀ Validation฀of฀the฀Relationship฀Between฀Pulse฀Wave฀ Velocity฀and฀Arterial฀Stiffness฀in฀End฀Stage฀Renal฀ Failure฀Using฀Cardiovascular฀Magnetic฀Resonance฀ Imaging Patrick฀B.฀Mark,฀Gang฀Gao,฀John฀E.฀Foster,฀Kevin฀G.฀Blyth,฀Henry฀J.฀Dargie,฀Alan฀G.฀ Jardine,฀Western฀Infirmary,฀Glasgow,฀United฀Kingdom 1027-74฀ Myocardial฀Infarction฀Due฀To฀Coronary฀Embolism฀In฀ Patients฀With฀Patent฀Foramen฀Ovale฀Assessed฀By฀ Cardiac฀Magnetic฀Resonance฀Imaging Nico฀Merkle,฀Thorsten฀Nusser,฀Jochen฀Wöhrle,฀Matthias฀Kochs,฀Vinzenz฀Hombach,฀Olaf฀ Grebe,฀Universitätsklinik฀Ulm,฀Innere฀Medizin฀II,฀Ulm,฀Germany Paradoxical฀embolism฀in฀patients฀with฀Patent฀foramen฀ovale฀(PFO)฀is฀supposed฀to฀be฀a฀ possible฀cause฀for฀stroke฀when฀there฀is฀no฀other฀obvious฀reason.฀It฀is฀not฀clear฀to฀what฀ extent฀there฀is฀a฀relation฀to฀myocardial฀infarction฀but฀there฀is฀some฀data฀suggesting฀that฀ coronary฀arteries฀are฀affected฀in฀about฀5-10%฀of฀all฀paradoxical฀embolism.฀The฀advantage฀ of฀cardiac฀magnetic฀resonance฀imaging฀(CMRI)฀is฀the฀non-invasive฀assessment฀of฀even฀ small฀myocardial฀infarction฀presenting฀as฀pathological฀late-enhancement. Background฀Pulse฀wave฀velocity฀(PWV),฀measured฀by฀Doppler,฀is฀an฀indirect฀measure฀ of฀arterial฀stiffness,฀and฀is฀a฀marker฀of฀poor฀cardiovascular฀outcome฀in฀end฀stage฀renal฀ failure฀(ESRF).฀We฀studied฀the฀relationship฀between฀PWV,฀measured฀by฀cardiovascular฀ magnetic฀ resonance฀ imaging฀ (CMR),฀ aortic฀ distensibilty฀ (a฀ direct฀ measure฀ of฀ arterial฀ stiffness)฀and฀LV฀dimensions฀in฀patients฀with฀ESRF. Methods฀25฀patients฀(16฀male;฀median฀age฀53,฀range฀34-62)฀with฀ESRF฀underwent฀CMR฀ (1.5T฀Siemens฀Sonata).฀LV฀and฀aortic฀dimensions฀were฀assessed฀from฀cine฀loops.฀Aortic฀ blood฀flow฀was฀measured฀using฀a฀flow฀sensitive฀fast฀low฀angle฀shot฀sequence.฀PWV฀was฀ calculated฀from฀distance฀and฀time฀delay฀in฀flow฀between฀2฀points฀along฀the฀aorta฀using฀in฀ house฀software฀(CardioWarp)฀to฀detect฀aortic฀contours฀(figure฀below).฀Ascending฀aortic฀ distensibilty฀was฀calculated฀from฀change฀in฀cross฀sectional฀aortic฀area฀and฀brachial฀pulse฀ pressure. Results฀Mean฀aortic฀distensibilty฀was฀2.8฀x฀10-3฀±฀0.13฀x฀10-3Hg-1฀and฀PWV฀was฀6.6฀±฀2.0฀ m/s.฀There฀was฀a฀significant,฀age฀independant,฀negative฀correlation฀between฀ascending฀ aortic฀distensibilty฀and฀PWV฀(R=฀-0.58,฀p<0.01)฀but฀no฀correlation฀between฀either฀aortic฀ distensibilty฀or฀PWV฀and฀LV฀dimensions.฀There฀was฀a฀non฀significant฀correlation฀between฀ age฀and฀PWV฀(R=฀0.355,฀p=0.08). Conclusions฀ PWV฀ does฀ inversely฀ correlate฀ with฀ aortic฀ distensibilty฀ and฀ therefore฀ represents฀a฀useful฀indirect฀measure฀of฀arterial฀stiffness.฀The฀prognostic฀value฀of฀CMR฀ derived฀PWV฀in฀patients฀with฀ESRF฀merits฀further฀study. JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging 261A POSTER฀SESSION 1028฀฀ MIBG฀Imaging฀of฀Cardiac฀Sympathetic฀ Nervous฀Activity Sunday,฀March฀06,฀2005,฀9:00฀a.m.-12:30฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀9:00฀a.m.-10:00฀a.m. 1028-67฀ Angiotensin฀Converting฀Enzyme฀Inhibitors฀Improves฀ Myocardial฀Adrenergic฀Innervation฀Disturbances฀in฀ Normotensive฀Patients฀With฀Diabetes฀Type฀II Mary฀E.฀Marketou,฀Evangelos฀A.฀Zacharis,฀Emmanuella฀Papadaki,฀Maria฀I.฀Stathaki,฀ George฀E.฀Kochiadakis,฀Emmanuel฀S.฀Skalidis,฀Nikolaos฀S.฀Karkavitsas,฀Panos฀E.฀ Vardas,฀Heraklion฀University฀Hospital,฀Heraklion,฀Greece 1027-77฀ Relationship฀Between฀Resting฀Heart฀Rate฀and฀Aortic฀ Wave฀Velocity฀in฀Apparently฀Healthy฀Individuals Ross฀Arena,฀James฀Arrowood,฀Ding-Yu฀Fei,฀Kenneth฀Kraft,฀Virginia฀Commonwealth฀ University,฀Richmond,฀VA 1027-78฀ Tissue฀MR฀Imaging฀of฀Subacute฀Myocardial฀Infarction:฀ Correlation฀With฀B-Type฀Natriuretic฀Peptide฀and฀Tissue฀ Doppler฀Imaging Bernard฀P.฀Paelinck,฀Christiaan฀J.฀Vrints,฀Jeroen฀J.฀Bax,฀Bharati฀Shivalkar,฀Rob฀J.฀van฀der฀ Geest,฀Albert฀de฀Roos,฀Hildo฀J.฀Lamb,฀University฀Hospital฀Antwerp,฀Edegem,฀Belgium,฀ Leiden฀University฀Medical฀Center,฀Leiden,฀The฀Netherlands Background:฀ B-type฀ natriuretic฀ peptide฀ (BNP)฀ is฀ an฀ amino฀ acid฀ protein฀ released฀ from฀ the฀ cardiac฀ ventricles฀ in฀ response฀ to฀ myocyte฀ stretch.฀ BNP฀ has฀ been฀ correlated฀ to฀ left฀ ventricular฀ (LV)฀ filling฀ pressures฀ in฀ patients฀ with฀ LV฀ dysfunction฀ and฀ has฀ been฀ used฀ to฀ improve฀management฀of฀these฀patients.฀Combining฀Doppler฀assessed฀early฀diastolic฀mitral฀ flow฀velocity฀(E)฀with฀early฀diastolic฀mitral฀annular฀velocity฀(Ea)฀has฀been฀correlated฀with฀ both฀ LV฀ pressures฀ and฀ BNP.฀ Phase-contrast฀ magnetic฀ resonance฀ (MR)฀ imaging฀ allows฀ velocity฀encoding฀of฀both฀moving฀structures฀(tissue฀MR฀Imaging)฀and฀blood.฀Therefore,฀ the฀purpose฀of฀the฀present฀study฀was฀to฀study฀whether฀tissue฀MR฀Imaging฀assessed฀E/Ea฀ correlates฀with฀BNP. Methods:฀ 14฀ patients฀ in฀ the฀ subacute฀ phase฀ (5.9฀ ±฀ 2.7฀ days)฀ of฀ Q-wave฀ myocardial฀ infarction฀(mass฀index:฀83฀±฀14฀g/m2,฀ejection฀fraction:฀44฀±฀12฀%)฀underwent฀consecutive฀ measurement฀ of฀ mitral฀ inflow฀ and฀ mitral฀ annular฀ velocities฀ with฀ Doppler฀ and฀ phasecontrast฀MR฀imaging.฀The฀data฀were฀correlated฀with฀BNP. Results:฀There฀was฀a฀strong฀relation฀between฀MR฀(12.5฀±฀6.3)฀and฀Doppler฀(12.6฀±฀5.6)฀ assessed฀E/Ea฀(r=0.89,฀P<0.0001)฀and฀between฀MR฀(1.8฀±฀0.8)฀and฀Doppler฀(1.5฀±฀0.8)฀ assessed฀ E/A฀ (r=฀ 0.92,฀ P<0.0001).฀ BNP฀ ranged฀ from฀ 39.5฀ to฀ 2380฀ pg/ml.฀ E/A฀ related฀ strongly฀to฀BNP฀(MR:฀r=0.72,฀P=0.004฀and฀Doppler:฀r=0.66,฀P=0.014).฀Best฀relation฀was฀ found฀between฀E/Ea฀and฀BNP฀(MR:฀r=0.74,฀P=0.002฀and฀Doppler:฀r=0.88,฀P<0.0001). Conclusions:฀Tissue฀MR฀Imaging฀has฀the฀ability฀to฀measure฀E/Ea.฀Tissue฀MR฀Imaging฀ assessed฀E/Ea฀correlates฀with฀BNP฀in฀patients฀with฀subacute฀myocardial฀infarction. ฀ ฀ 1028-68฀ Myocardial฀Iodine-123-Metaiodobenzylguanidine฀ Scintigraphy฀Can฀Predict฀Left฀Ventricular฀Functional฀ Reserve฀in฀Patients฀With฀Nonobstructive฀Hypertrophic฀ Cardiomyopathy Satoshi฀Isobe,฀Hideo฀Izawa,฀Mitsunori฀Iwase,฀Satoru฀Ohshima,฀Kiyoyasu฀Yamada,฀ Mamoru฀Nanasato,฀Toshihisa฀Hirai,฀Akitada฀Ando,฀Kohzo฀Nagata,฀Katsuhiko฀Kato,฀ Toyoaki฀Murohara,฀Mitsuhiro฀Yokota,฀Nagoya฀University฀Graduate฀School฀of฀Medicine,฀ Nagoya,฀Japan OBJECTIVES:฀We฀investigated฀whether฀an฀assessment฀of฀cardiac฀sympathetic฀nervous฀ activity฀by฀ 123I-metaiodobenzylguanidine฀(MIBG)฀myocardial฀scintigraphy฀might฀provide฀a฀ sign฀of฀abnormal฀left฀ventricular฀(LV)฀functional฀reserve฀in฀response฀to฀exercise-induced฀ ß-adrenergic฀ stimulation฀ in฀ patients฀ with฀ nonobstructive฀ hypertrophic฀ cardiomyopathy฀ (HCM). BACKGROUND:฀Little฀is฀known฀regarding฀the฀relation฀between฀LV฀functional฀reserve฀in฀ response฀to฀exercise฀and฀cardiac฀sympathetic฀nervous฀activity฀in฀patients฀with฀HCM. METHODS:฀Thirty฀ HCM฀ patients฀ underwent฀ MIBG฀ scintigraphy฀ and฀ echocardiography฀ at฀rest฀and฀subsequent฀biventricular฀cardiac฀catheterization฀at฀rest฀and฀during฀dynamic฀ exercise.฀LV฀pressures฀were฀measured฀using฀a฀micromanometer-tipped฀catheter฀system.฀ Early฀and฀delayed฀MIBG฀images฀were฀quantified฀as฀a฀heart-to-mediastinum฀ratio฀(HMR)฀ and฀ washout฀ rate.฀ Patients฀ were฀ divided฀ into฀ 2฀ groups฀ according฀ to฀ the฀ delayed฀ MIBG฀ HMR:฀ group฀ I฀ consisted฀ of฀ 12฀ patients฀ with฀ a฀ delayed฀ HMR฀ <=฀ 1.8฀ and฀ group฀ II฀ had฀ 18฀ patients฀ with฀ a฀ delayed฀ HMR฀ >฀ 1.8.฀ Plasma฀ levels฀ of฀ brain฀ natriuretic฀ peptide฀ and฀ norepinephrine฀were฀also฀measured. RESULTS:฀ Both฀ the฀ percent฀ (%)฀ increase฀ from฀ rest฀ to฀ exercise฀ in฀ LV฀ isovolumic฀ contraction฀(LV฀dP/dtmax)฀and฀the฀%฀shortening฀of฀LV฀pressure฀half-time฀(T1/2)฀as฀an฀index฀ of฀ isovolumic฀ relaxation฀ were฀ significantly฀ less฀ in฀ group฀ I฀ than฀ in฀ group฀ II฀ (p฀ <฀ 0.005,฀ respectively).฀ Significant฀ linear฀ correlation฀ was฀ observed฀ between฀ MIBG฀ parameters฀ (early฀ HMR,฀ delayed฀ HMR,฀ and฀ washout฀ rate)฀ and฀ the฀ %฀ increase฀ in฀ LV฀ dP/dtmax฀ (p฀ <฀ 0.05,฀respectively).฀Significant฀linear฀correlation฀was฀observed฀between฀MIBG฀parameters฀ and฀the฀%฀shortening฀in฀T1/2฀(p฀<฀0.05,฀respectively).฀Plasma฀norepinephrine฀levels฀were฀ significantly฀higher฀in฀group฀I฀than฀in฀group฀II฀(p฀<฀0.01),฀whereas฀plasma฀brain฀natriuretic฀ peptide฀levels฀were฀comparable฀in฀the฀2฀HCM฀groups. CONCLUSIONS:฀ß-Adrenergic฀enhancement฀of฀LV฀function฀during฀exercise฀may฀depend฀ on฀ the฀ extent฀ of฀ cardiac฀ sympathetic฀ nervous฀ innervation฀ in฀ HCM฀ patients.฀ Resting฀ myocardial฀ MIBG฀ scintigraphy฀ can฀ noninvasively฀ evaluate฀ the฀ LV฀ functional฀ reserve฀ in฀ response฀to฀exercise฀in฀patients฀with฀nonobstructive฀HCM. Noninvasive Imaging Background:฀ Resting฀ heart฀ rate฀ (RHR)฀ has฀ demonstrated฀ diagnostic฀ and฀ prognostic฀ value฀ in฀ a฀ number฀ of฀ previous฀ investigations.฀ Amongst฀ the฀ diagnostic฀ relationships,฀ several฀ studies฀ have฀ reported฀ a฀ significant฀ association฀ between฀ various฀ measures฀ of฀ arterial฀stiffness฀and฀RHR.฀The฀purpose฀of฀the฀present฀investigation฀was฀to฀assess฀the฀ relationship฀between฀RHR฀and฀a฀newly฀developed฀measure฀of฀aortic฀wave฀velocity฀(AWV)฀ via฀magnetic฀resonance฀imaging. Methods:฀Two฀hundred฀and฀fourteen฀apparently฀healthy฀subjects฀(114฀male/฀100฀female)฀ participated฀in฀this฀study.฀Mean฀age฀of฀the฀group฀was฀48.5฀(±14.9)฀years.฀Resting฀heart฀rate,฀ in฀beats฀per฀minute฀(BPM),฀was฀obtained฀in฀the฀seated฀position฀via฀electrocardiography.฀ Aortic฀wave฀velocity,฀in฀meters฀per฀second฀(m/s),฀was฀assessed฀in฀the฀descending฀thoracic฀ aorta฀using฀a฀magnetic฀resonance฀imaging฀technique฀developed฀by฀our฀group.฀We฀used฀a฀ Pearson฀Product฀Moment฀Correlation฀to฀evaluate฀the฀relationship฀between฀RHR฀and฀AWV฀ in฀ the฀ overall฀ group.฀ After฀ partitioning฀ subjects฀ into฀ RHR฀ subgroups,฀ (<60,฀ 60-74,฀ >74฀ BPM),฀we฀used฀one-way฀analysis฀of฀variance฀and฀Tukey’s฀honestly฀significant฀difference฀ to฀assess฀differences฀in฀age฀and฀AWV. Results:฀Mean฀RHR฀and฀AWV฀were฀64.5฀(±11.7)฀BPM฀and฀5.8฀(±1.9)฀m/s,฀respectively.฀ These฀two฀variables฀were฀significantly฀correlated฀with฀one฀another฀(r฀=฀0.22,฀p฀=฀0.001).฀ The฀ number฀ of฀ subjects฀ in฀ the฀ <60,฀ 60-74฀ and฀ >74฀ RHR฀ subgroups฀ were฀ 76,฀ 97฀ and฀ 41฀respectively.฀Mean฀age฀amongst฀the฀three฀subgroups฀[<60:฀48.4฀(±13.7),฀60-74:฀50.0฀ (±15.6),฀>74:฀45.4฀(±15.3)]฀was฀not฀significantly฀different.฀Mean฀AWV฀in฀the฀<60,฀60-74,฀ and฀ >74฀ RHR฀ subgroups฀ was฀ 5.2฀ (±1.6),฀ 6.1฀ (±2.0),฀ and฀ 6.3฀ (±1.9)฀ m/s,฀ respectively.฀ Aortic฀wave฀velocity฀in฀the฀<60฀RHR฀subgroup฀was฀significantly฀lower฀than฀that฀in฀both฀the฀ 60-74฀and฀>74฀RHR฀subgroups฀(p฀=฀0.01). Conclusion:฀ The฀ results฀ of฀ the฀ present฀ study฀ are฀ consistent฀ with฀ previous฀ reports฀ demonstrating฀a฀relationship฀between฀arterial฀stiffness฀and฀RHR,฀helping฀to฀validate฀our฀newly฀ developed฀AWV฀measurement฀via฀magnetic฀resonance฀imaging.฀Additionally,฀these฀results฀ further฀illustrate฀the฀value฀of฀RHR฀in฀reflecting฀other฀markers฀of฀cardiovascular฀health. Background:฀Myocardial฀sympathetic฀dysinnervation฀is฀frequently฀observed฀in฀patients฀ (pts)฀with฀diabetes฀mellitus฀even฀in฀the฀absence฀of฀any฀heart฀disease.฀Cardiac฀scintigraphy฀ with฀ I฀ 123฀ -Meta-iodobenzylguanidine฀ (I฀ 123฀ -MIBG)฀ was฀ used฀ to฀ assess฀ the฀ effect฀ of฀ perindopril฀ -฀ an฀ angiotensin฀ converting฀ enzyme฀ (ACE-฀ I)฀ -฀ on฀ myocardial฀ adrenergic฀ innervation฀in฀normotensive฀pts฀with฀diabetes฀type฀II. Methods:฀We฀studied฀40฀normotensive฀pts฀(22฀women,฀aged฀57฀±฀8฀years,)฀with฀diabetes฀ type฀II,฀a฀normal฀echocardiogram฀and฀a฀Thallium201฀myocardial฀perfusion฀study.฀None฀had฀ any฀other฀disease฀that฀may฀have฀affected฀myocardial฀adrenergic฀innervation.฀Perindopril฀ was฀ given฀ to฀ 20฀ pts฀ (4฀ mg/day)฀ for฀ 6฀ months,฀ while฀ the฀ rest฀ received฀ placebo.฀ Before฀ entering฀the฀study฀and฀at฀6฀months฀under฀perindopril฀therapy,฀all฀pts฀underwent฀planar฀and฀ SPECT฀myocardial฀imaging฀of฀the฀heart฀after฀intravenous฀infusion฀of฀5mCi฀I฀123-MIBG.฀ Heart฀ to฀ mediastinum฀ ratio฀ (H/M)฀ was฀ used฀ for฀ quantitative฀ assessment฀ of฀ adrenergic฀ innervation,฀ 10฀ minutes฀ and฀ 4฀ hours฀ after฀ drug฀ infusion,฀ while฀ SPECT฀ scintigraphy฀ evaluated฀the฀regional฀distribution฀of฀adrenergic฀activity. Results:฀ At฀ baseline,฀ the฀ H/M฀ ratio฀ at฀ 10฀ min฀ and฀ 4฀ hours฀ was฀ 1.62฀ ±฀ 0.3฀ and฀ 1.5฀ ±฀ 0.2฀respectively;฀which฀significantly฀improved฀after฀the฀6-month฀treatment฀with฀perindopril฀ (1,88฀±฀0.4฀and฀1.8฀±฀0.2฀respectively,฀p<0.05฀for฀both).฀During฀SPECT฀scintigraphy,฀12฀ pts฀ (80%)฀ revealed฀ severe฀ regional฀ myocardial฀ adrenergic฀ innervation฀ defects.฀ All฀ had฀ defects฀in฀the฀inferior฀and฀lateral฀wall,฀8฀had฀additional฀defects฀in฀the฀anterior฀wall฀and฀6฀ in฀the฀septal฀wall.฀There฀was฀a฀marked฀improvement฀in฀myocardial฀adrenergic฀innervation฀ after฀6฀months฀of฀therapy,฀mostly฀in฀the฀anterior฀and฀septal฀walls.฀No฀significant฀changes฀ were฀observed฀in฀the฀control฀group.฀Systolic฀blood฀pressure฀remained฀unchanged฀before฀ and฀after฀treatment. Conclusions:฀The฀administration฀of฀ACE-฀I฀in฀normotensive฀pts฀with฀diabetes฀type฀II฀results฀ in฀a฀significant฀improvement฀of฀the฀left฀ventricular฀adrenergic฀innervation฀abnormalities,฀ independently฀of฀its฀blood฀pressure฀effect.฀Further฀studies฀are฀required฀to฀establish฀the฀ preventative฀value฀of฀ACE-฀I฀in฀cardiovascular฀complications฀of฀diabetes. 262A 1028-69฀ ABSTRACTS - Noninvasive Imaging 123 Relationship฀Between฀Myocardial฀ I-MIBG฀Findings฀ and฀Myocardial฀Contractile฀Reserve฀in฀Patients฀With฀ Mild฀to฀Moderate฀Dilated฀Cardiomyopathy Satoru฀Ohshima,฀Satoshi฀Isobe,฀Hideo฀Izawa,฀Kiyoyasu฀Yamada,฀Akitada฀Ando,฀ Katsuhiro฀Kato,฀Kohzo฀Nagata,฀Toyoaki฀Murohara,฀Mitsuhiro฀Yokota,฀Nagoya฀University฀ Graduate฀School฀of฀Medicine,฀Nagoya,฀Japan Background:฀ The฀ relationship฀ between฀ cardiac฀ sympathetic฀ nervous฀ activity฀ and฀ myocardial฀contractile฀reserve฀in฀patients฀with฀dilated฀cardiomyopathy฀(DCM)฀still฀remains฀ to฀be฀elucidated. Objectives:฀We฀aimed฀to฀clarify฀the฀relationship฀between฀iodine-123-metaiodobenzylguanidine฀ (MIBG)฀findings฀and฀myocardial฀contractile฀reserve฀in฀response฀to฀atrial฀pacing฀stimulation฀ in฀mild฀to฀moderate฀DCM. Methods:฀Twenty-four฀DCM฀patients฀(mean฀LVEF฀41฀±฀7%)฀with฀sinus฀rhythm฀underwent฀ echocardiography,฀biventricular฀cardiac฀catheterization,฀and฀myocardial฀MIBG฀scintigraphy.฀ In฀ cardiac฀ catheterization,฀ left฀ ventricular฀ (LV)฀ pressures฀ were฀ measured฀ using฀ a฀ micromanometer-tipped฀ catheter.฀ The฀ myocardial฀ contractile฀ function฀ [LV฀ isovolumic฀ contraction฀(LV฀dP/dt฀max)]฀was฀determined฀at฀rest฀and฀during฀atrial฀pacing.฀Myocardial฀ MIBG฀accumulation฀was฀quantified฀as฀a฀heart-to-mediastinum฀ratio฀(HMR). Results:฀ A฀ significant฀ correlation฀ was฀ observed฀ between฀ the฀ delayed฀ MIBG฀ HMR฀ and฀ the฀percent฀change฀in฀LV฀dP/dt฀max฀from฀baseline฀to฀the฀maximum฀or฀critical฀heart฀rate฀ (r฀=฀0.64,฀p฀<฀0.001).฀The฀biphasic฀or฀flat฀pattern฀of฀change฀in฀LV฀dP/dt฀max฀(a฀worsening฀ change)฀was฀more฀frequently฀observed฀in฀DCM฀patients฀who฀showed฀a฀delayed฀HMR฀of฀ <฀1.7฀(group฀A:฀10฀patients)฀than฀in฀those฀who฀showed฀one฀of฀≥฀1.7฀(group฀B:฀14฀patients)฀ [8/10฀patients฀(80%)฀vs.฀2/14฀patients฀(14%),฀p฀<฀0.001].฀Plasma฀norepinephrine฀levels฀ were฀significantly฀higher฀in฀group฀A฀than฀in฀group฀B฀(p฀<฀0.05). Conclusions:฀ Abnormal฀ myocardial฀ 123I-MIBG฀ accumulation฀ is฀ related฀ to฀ a฀ reduced฀ myocardial฀ contractile฀ reserve฀ in฀ response฀ to฀ atrial฀ pacing฀ stimulation฀ in฀ patients฀ with฀ mild฀ to฀ moderate฀ DCM.฀ Myocardial฀ MIBG฀ scintigraphy฀ may฀ be฀ useful฀ in฀ noninvasively฀ evaluating฀ the฀ degree฀ of฀ impaired฀ myocardial฀ function฀ and฀ clinical฀ outcome฀ in฀ patients฀ with฀mild฀to฀moderate฀DCM. 1028-70฀ Differences฀in฀Cardiac฀Sympathetic฀Nerve฀Dysfunction฀ in฀the฀Dilated฀Phase฀of฀Hypertrophic฀Cardiomyopathy฀ versus฀Idiopathic฀Dilated฀Cardiomyopathy Noninvasive Imaging Hidenobu฀Terai,฀Masami฀Shimizu,฀Hidekazu฀Ino,฀Masato฀Yamaguchi,฀Noboru฀Fujino,฀ Kenji฀Sakata,฀Masaru฀Inoue,฀Kenichi฀Nakajima,฀Junishi฀Taki,฀Hiroshi฀Mabuchi,฀Kanazawa฀ University,฀Kanazawa,฀Japan Background:฀Left฀ventricular฀(LV)฀systolic฀dysfunction฀and฀dilatation,฀with฀development฀ of฀ treatment-resistant฀ heart฀ failure,฀ occur฀ both฀ in฀ the฀ dilated฀ phase฀ of฀ hypertrophic฀ cardiomyopathy฀ (DHCM)฀ and฀ in฀ idiopathic฀ dilated฀ cardiomyopathy฀ (DCM).฀ However,฀ it฀ is฀ unknown฀ whether฀ cardiac฀ sympathetic฀ nerve฀ function฀ differs฀ between฀ DHCM฀ and฀ DCM.The฀ aim฀ of฀ the฀ study฀ was฀ to฀ evaluate฀ global฀ and฀ regional฀ differences฀ in฀ I-123฀ metaiodobenzylguanidine฀ (MIBG)฀ myocardial฀ scintigraphy฀ in฀ patients฀ with฀ DHCM฀ and฀ DCM. Methods:฀ We฀ performed฀ I-123฀ MIBG฀ scintigraphy฀ in฀ 21฀ patients฀ with฀ LV฀ systolic฀ dysfunction฀and฀dilatation฀(9฀patients฀with฀DHCM฀and฀12฀patients฀with฀DCM)฀and฀in฀13฀ age-matched฀controls.฀Regional฀uptake฀and฀washout฀rates฀were฀calculated฀from฀single฀ photon฀emission฀computed฀tomographic฀imagings฀divided฀into฀20฀segments. Results:฀ No฀ significant฀ differences฀ existed฀ with฀ respect฀ to฀ gender,฀ age฀ and฀ echocardiographic฀ findings฀ between฀ DHCM฀ and฀ DCM.฀ The฀ global฀ washout฀ rate฀ was฀ higher฀in฀DHCM฀than฀DCM฀(29.6±4.1%฀vs.฀21.1±4.1%,฀p<0.01).฀In฀DHCM,฀regional฀early฀ uptake฀was฀reduced฀significantly฀in฀the฀anteroseptal฀and฀posterolateral฀walls.฀In฀contrast,฀ in฀ DCM฀ regional฀ early฀ uptake฀ was฀ significantly฀ reduced฀ in฀ the฀ posterolateral฀ wall฀ but฀ not฀ in฀ the฀ anteroseptal฀ wall.฀ Regional฀ washout฀ rate฀ increased฀ heterogeneously฀ in฀ the฀ apex฀and฀lateral฀wall฀predominantly฀in฀DHCM.฀In฀contrast,฀a฀heterogeneous฀increase฀in฀ regional฀washout฀rate฀was฀not฀found฀in฀DCM.Conclusions:฀These฀results฀suggest฀that฀ cardiac฀sympathetic฀nerve฀abnormalities฀may฀differ฀between฀DHCM฀and฀DCM.฀Cardiac฀ sympathetic฀nerve฀hyperactivity฀appears฀to฀be฀distributed฀heterogeneously฀in฀patients฀with฀ DHCM,฀as฀compared฀with฀a฀more฀homogeneous฀distribution฀is฀the฀patients฀with฀DCM. POSTER฀SESSION JACC Methods:฀ We฀ studied฀ 10฀ healthy฀ volunteers฀ (7฀ men,฀ mean฀ age;฀ 30.4±2.6฀ years).฀ All฀ subjects฀ underwent฀ serial฀ transthoracic฀ echocardiography฀ (HDI฀ 5000,฀ P12฀ probe,฀ Philips)฀to฀evaluate฀coronary฀diameter฀and฀flow฀velocity฀at฀7฀AM,฀1฀PM฀and฀7฀PM.฀In฀each฀ different฀occasion,฀we฀measured฀coronary฀diameter฀and฀flow฀velocity฀in฀the฀left฀anterior฀ descending฀artery. Results:฀Coronary฀diameter฀was฀smallest฀at฀7฀AM฀and฀the฀largest฀at฀1PM฀[0.15±0.05cm฀ at฀7฀AM,฀0.20±0.04cm฀at฀1฀PM,฀and฀0.19±0.04cm฀at฀7฀PM,฀(p<0.01:฀7฀AM฀vs.฀1฀PM,฀7฀AM฀ vs.฀7฀PM)].฀Coronary฀flow฀velocity฀was฀17.9±5.3cm/s฀at฀7฀AM,฀13.3±3.4cm/s฀at฀1฀PM,฀and฀ 15.4±6.1cm/s฀at฀PM฀(p<0.05:฀7฀AM฀vs.฀1฀PM,฀7฀AM฀vs.฀7฀PM).฀ Conclusions:฀We฀showed฀the฀circadian฀variation฀of฀coronary฀artery฀diameter฀and฀flow฀ velocity฀in฀healthy฀volunteers.฀Coronary฀diameter฀was฀smallest,฀and฀coronary฀flow฀velocity฀ was฀highest฀in฀the฀morning.฀ 1052-64฀ Coronary฀Artery฀Disease:฀฀ Role฀of฀Cardiovascular฀Ultrasound Sunday,฀March฀06,฀2005,฀1:30฀p.m.-5:00฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀1:30฀p.m.-2:30฀p.m. 1052-63฀ Circadian฀Variation฀Of฀Coronary฀Diameter฀And฀ Coronary฀Flow฀In฀Healthy฀Volunteer฀:฀High฀Frequency฀ Transthoracic฀Echocardiographic฀Study Nozomi฀Wada,฀Takashi฀Akasaki,฀Noriko฀Okahashi,฀Yuji฀Koyama,฀Nozomi฀Watanabe,฀ Takahiro฀Kawamoto,฀Kiyoshi฀Yoshida,฀Kawsaki฀Medical฀School,฀Kurashiki,฀Japan Background:฀ It฀ has฀ not฀ been฀ investigated฀ whether฀ there฀ is฀ a฀ circadian฀ variation฀ in฀ coronary฀ flow฀ and฀ coronary฀ diameter.฀ Recently,฀ coronary฀ diameter฀ and฀ coronary฀ flow฀ velocity฀ can฀ be฀ measured฀ by฀ transthoracic฀ echocardiography฀ noninvasively฀ in฀ humans฀ (Wada฀N฀et.al.฀J฀Am฀Coll฀Cardiol.฀43:฀372A฀[abstract]).฀We฀sought฀to฀evaluate฀circadian฀ variation฀in฀coronary฀diameter฀and฀coronary฀flow฀velocity฀with฀high฀frequency฀transthoracic฀ echocardiography. Non-Invasive฀Assessment฀of฀Coronary฀Flow฀Velocity฀ Pattern฀With฀Transthoracic฀Doppler฀Echocardiography฀ After฀Primary฀Angioplasty฀for฀Acute฀Myocardial฀ Infarction:฀An฀Early฀Predictor฀of฀Persistent฀Left฀ Ventricular฀Dysfunction Aliocha฀Scheuble,฀Eric฀Brochet,฀Marc฀Faraggi,฀Dominique฀Himbert,฀Jean-Michel฀Juliard,฀ Dominique฀Le฀Guludec,฀Ph.฀Gabriel฀Steg,฀Alec฀Vahanian,฀Laurent฀J.฀Feldman,฀Bichat฀ University฀Hospital,฀Paris,฀France Background:฀Intracoronary฀Doppler฀guidewire฀studies฀have฀shown฀that฀patients฀with฀an฀ early฀systolic฀retrograde฀flow฀(ESRF)฀and฀a฀short฀diastolic฀deceleration฀time฀(DDT)฀after฀ primary฀angioplasty฀for฀acute฀myocardial฀infarction฀have฀severely฀impaired฀microcirculatory฀ perfusion,฀resulting฀in฀poor฀recovery฀of฀left฀ventricular฀(LV)฀function.฀Transthoracic฀Doppler฀ echocardiography฀(TDE)฀allows฀non-invasive฀assessment฀of฀coronary฀flow฀velocity฀in฀the฀ left฀anterior฀descending฀coronary฀artery.฀We฀studied฀the฀relationship฀between฀LV฀function฀ recovery฀ and฀ coronary฀ flow฀ velocity฀ parameters฀ obtained฀ with฀TDE฀ early฀ after฀ primary฀ angioplasty฀for฀acute฀myocardial฀infarction. Methods:฀24฀consecutive฀patients฀who฀underwent฀successful฀primary฀coronary฀stenting฀ for฀≤฀12-hour฀anterior฀myocardial฀infarction฀were฀studied.฀Coronary฀flow฀velocity฀pattern฀ and฀adenosine-induced฀(140฀microgram/kg/min,฀5฀min฀iv฀perfusion)฀coronary฀flow฀velocity฀ reserve฀(CVR)฀were฀measured฀using฀a฀high฀frequency฀TDE฀probe฀(7MHz,฀7V3C฀Acuson/ Siemens)฀24฀hours฀and฀3฀days฀after฀primary฀angioplasty,฀respectively.฀LV฀function฀recovery฀ was฀defined฀as฀>20%฀improvement฀of฀the฀indexed฀wall฀motion฀score฀in฀the฀infarct฀area฀ between฀2฀echocardiograms฀performed฀24฀hours฀and฀8฀weeks฀after฀myocardial฀infarction.฀ Patients฀were฀divided฀into฀group฀A฀(11฀patients฀with฀LV฀function฀recovery)฀and฀group฀B฀(13฀ patients฀without฀LV฀function฀recovery).฀Radionuclide฀LV฀ejection฀fraction฀was฀measured฀ at฀8฀weeks. Results:฀Patients฀in฀group฀B฀had฀a฀lower฀LV฀ejection฀fraction฀at฀8฀weeks฀(39฀±9%฀vs฀52฀ ±11%,฀p=0.003),฀a฀higher฀incidence฀of฀ESRF฀(77%฀vs฀23%,฀p=0.045)฀and฀a฀shorter฀DDT฀ (341฀±365฀ms฀vs฀942฀±611฀ms,฀p=0.007)฀at฀24฀hours,฀and฀a฀marginally฀lower฀CVR฀(2.1฀ ±0.6฀vs฀1.8฀±0.5,฀p=NS)฀at฀day฀3,฀than฀patients฀in฀group฀A.฀The฀presence฀of฀an฀ESRF฀or฀ a฀DDT฀≤฀600ms฀24฀hours฀after฀myocardial฀infarction฀had฀a฀sensitivity฀of฀77%,฀a฀specificity฀ of฀ 63%,฀ a฀ positive฀ predictive฀ value฀ of฀ 71%,฀ a฀ negative฀ predictive฀ value฀ of฀ 70%฀ and฀ an฀ accuracy฀of฀71%฀to฀predict฀the฀absence฀of฀LV฀function฀recovery฀at฀8฀weeks. Conclusion:฀ Assessment฀ of฀ coronary฀ flow฀ velocity฀ pattern฀ at฀ the฀ bedside฀ with฀ TDE฀ allows฀early฀identification฀of฀patients฀with฀poor฀LV฀function฀recovery฀after฀acute฀myocardial฀ infarction. 1052-65฀ 1052฀฀ February 1, 2005 Differential฀Diagnosis฀of฀Ischemic-฀and฀Non-ischemic฀ Cardiomyopathy฀Using฀Coronary฀Flow฀Velocity฀ Measurements฀of฀the฀Left฀Anterior฀Descending฀ Coronary฀Artery฀by฀Transthoracic฀Doppler฀ Echocardiography Hiroyuki฀Okura,฀Takara฀Tsumori,฀Yasushi฀Kondo,฀Tomoichiro฀Kubo,฀Shin฀Mizoguchi,฀ Haruyuki฀Taguchi,฀Kentaro฀Yamamoto,฀Iku฀Toda,฀Junichi฀Yoshikawa,฀Bell฀Land฀General฀ Hospital,฀Sakai,฀Japan,฀Osaka฀City฀University฀School฀of฀Medicine,฀Osaka,฀Japan Background:฀ Ischemic฀ cardiomyopathy฀ (ICM)฀ and฀ non-ICM฀ have฀ similar฀ twodimensional฀echocardiographic฀features,฀left฀ventricular฀dilatation฀and฀diffuse฀wall฀motion฀ abnormalities. Purpose:฀ The฀ purpose฀ of฀ this฀ study฀ was฀ to฀ test฀ whether฀ transthoracic฀ Doppler฀ echocardiography฀(TTDE)฀can฀detect฀significant฀left฀anterior฀descending฀(LAD)฀coronary฀ artery฀stenosis฀and฀differentiate฀ICM฀from฀non-ICM. Methods:฀ TTDE฀ was฀ performed฀ in฀ 32฀ consecutive฀ patients฀ (pts)฀ with฀ left฀ ventricular฀ dilatation฀and฀diffuse฀wall฀motion฀abnormalities฀of฀unknown฀etiology.฀Peak฀and฀averaged฀ systolic฀and฀diastolic฀flow฀velocities฀of฀the฀distal฀LAD฀flow฀were฀recorded฀and฀measured.฀ Peak฀ diastolic฀ /฀ systolic฀ velocity฀ ratio฀ (pDSVR)฀ and฀ mean฀ DSVR฀ (mDSVR)฀ were฀ calculated. JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging Results:฀ (see฀ table)฀ LAD฀ flow฀ measurements฀ could฀ be฀ performed฀ in฀ 28฀ (88฀ %)฀ of฀ 32฀ pts.฀ By฀ coronary฀ angiogram,฀ 8฀ pts฀ were฀ diagnosed฀ as฀ ICM฀ and฀ 20฀ as฀ non-ICM.฀ Left฀ ventricular฀end-diastolic฀(LVEDV)฀and฀end-systolic฀volumes฀(LVESV)฀as฀well฀as฀ejection฀ fraction฀(LVEF)฀were฀similar฀between฀ICM฀and฀non-ICM.฀Doppler฀derived฀diastolic฀indices฀ (E/A,฀ deceleration฀ time:DcT)฀ were฀ also฀ similar฀ between฀ the฀ two฀ groups.฀ On฀ the฀ other฀ hand,฀pDSVR฀and฀mDSVR฀were฀significantly฀lower฀in฀patients฀with฀ICM฀than฀non-ICM.฀ A฀pDSVR฀<2.0฀or฀mDSVR฀<2.0฀had฀a฀sensitivity฀of฀100฀%฀and฀a฀specificity฀of฀70฀%฀for฀ detecting฀the฀presence฀of฀severe฀LAD฀stenosis฀and฀therefore฀the฀diagnosis฀of฀ICM. Conclusion:฀TTDE฀is฀a฀useful฀non-invasive฀method฀to฀differentiate฀ICM฀from฀non-ICM. Age฀(yrs) Male฀(%) LVEDV฀(ml) LVESV฀(ml) LVEF฀(%) E/A DcT฀(msec) pDSVR mDSVR 1052-66฀ ICM(n=8) NonICM(n=20) p฀value 64฀±15 63฀% 153±52 100±46 36±11 1.2±0.5 173±65 1.37±0.39 1.27±0.38 62±12 75฀% 161±61 101±46 38±10 1.5±0.6 165±79 2.48±0.76 2.40±0.67 NS NS NS NS NS NS NS 0.0006 0.0002 Acute฀and฀Long-term฀Effect฀of฀Cardiac฀ Resynchronization฀Therapy฀on฀Mitral฀Regurgitation฀in฀ Patients฀with฀Severe฀Chronic฀Heart฀Failure Barbara฀Vidal,฀Marta฀Sitges,฀Alba฀Marigliano,฀Lluís฀Mont,฀Manel฀Azqueta,฀Ernesto฀DíazInfante,฀David฀Noguera,฀Josep฀Brugada,฀Carles฀Paré,฀Hospital฀Clínic,฀Barcelona,฀Spain LVEDV=LV฀end-diastolic฀volume;฀LVESV=LV฀฀ end-systolic฀volume;฀*฀p<0,05฀vs.฀OFF฀ ROA฀(mm2) RV฀(ml/beat) LVEDV฀(ml) LVESV฀(ml) LV฀EF฀(%) OFF ON 6฀months 12฀months 1052-67฀ 35±฀17 21±฀14* 24±฀18* 16±฀10* 48±฀21 35±฀26* 32±฀21* 28±฀22* 245±฀91 248±฀94 252±฀82 235±฀72 192±฀81 197±฀85 188±฀70 167±฀57* 21±฀6 22±฀6 25±฀5* 27±฀7* The฀Impact฀of฀Echocardiography฀and฀Carotid฀ Ultrasonography฀in฀Cardiovascular฀Risk฀Stratification Francesca฀Sale,฀Pietro฀Sanna,฀Giuseppe฀Talanas,฀Chetti฀Ros,฀Laura฀Sanna,฀Pier฀Sergio฀ Saba,฀Davide฀Pittalis,฀Antonello฀Ganau,฀University฀of฀Sassari,฀Sassari,฀Italy BACKGROUND.฀Both฀cardiac฀and฀carotid฀ultrasonography฀(US)฀are฀useful฀in฀detecting฀ cardiac฀ and฀ vascular฀ preclinical฀ disease฀ in฀ subjects฀ exposed฀ to฀ cardiovascular฀ (CV)฀ risk฀ factors.฀The฀ aim฀ of฀ the฀ study฀ was฀ to฀ assess฀ the฀ potential฀ addictive฀ value฀ of฀ echocardiography฀and฀carotid฀US฀in฀CV฀risk฀stratification. METHODS.฀ We฀ studied฀ 532฀ patients฀ (mean฀ age฀ 56±16฀ years;฀ 42%฀ male)฀ referred฀ to฀ our฀outpatient฀clinic฀for฀the฀presence฀of฀CV฀risk฀factors,฀in฀whom฀both฀echocardiography฀ and฀carotid฀US฀were฀available.฀No฀patient฀had฀history฀or฀clinical฀evidence฀of฀CV฀disease.฀ Diabetes฀was฀present฀in฀19%฀of฀cases,฀hypertension฀in฀51%,฀hypercholesterolemia฀in฀46%.฀ The฀global฀CV฀risk฀was฀calculated฀by฀the฀Framingham฀formula฀and฀subjects฀were฀divided฀ in฀four฀classes฀of฀risk฀(low฀<=10%,฀medium฀10-20%,฀high฀20-40%,฀and฀very฀high฀>40%).฀ The฀individual฀global฀risk฀of฀subjects฀with฀US฀evidence฀of฀left฀ventricular฀hypertrophy฀(LVH),฀ carotid฀intima-media฀thickening฀(IMT)฀or฀plaque฀was฀multiplied฀by฀coefficients฀of฀attributable฀ relative฀ risk,฀ derived฀ from฀ literature฀ (coefficient฀ were฀ 2.3฀ for฀ LVH,฀ 1.57฀ to฀ 3.86฀ for฀ IMT,฀ and฀ 1.33฀ to฀ 2.45฀ for฀ plaque฀ score).฀ If฀ case฀ of฀ multiple฀ abnormalities,฀ the฀ highest฀ single฀ coefficient฀was฀used.฀For฀each฀class฀of฀risk,฀the฀global฀number฀of฀CV฀events฀predicted฀by฀the฀ Framingham฀method฀was฀redistributed,฀so฀that฀a฀proportionally฀larger฀number฀of฀events฀was฀ attributed฀to฀the฀group฀with฀US฀evidence฀of฀preclinical฀disease,฀while฀the฀remaining฀events฀ was฀used฀to฀reassess฀the฀risk฀of฀the฀group฀without฀cardiac฀and฀carotid฀abnormalities. RESULTS.฀ According฀ to฀ the฀ Framingham฀ stratification,฀ 64%฀ of฀ subjects฀ were฀ at฀ low฀ risk,฀23%฀at฀medium฀risk,฀11%฀at฀high฀risk฀and฀2%฀at฀very฀high฀risk.฀After฀cardiac฀and฀ carotid฀US,฀the฀class฀of฀risk฀increased฀in฀40%฀and฀decreased฀in฀13%฀of฀subjects,฀while฀the฀ proportion฀of฀patients฀at฀high฀or฀very฀high฀risk฀increased฀to฀14%฀and฀13%,฀respectively. CONCLUSIONS.฀In฀a฀sample฀of฀patients฀mostly฀at฀low-medium฀risk,฀the฀US฀investigation฀ of฀both฀cardiac฀and฀carotid฀preclinical฀disease฀modify฀the฀profile฀of฀risk฀in฀more฀than฀half฀ of฀subjects,฀doubling฀the฀proportion฀of฀those฀at฀high฀or฀very฀high฀risk. Hypoechoic฀Areas฀on฀Ultrasound฀Images฀of฀Atheroma฀ Are฀Not฀Always฀Diagnostic฀of฀Fatty฀Plaque Ghasan฀M.฀Tabel,฀Jaroslaw฀Hepel,฀Peter฀Whittaker,฀P.฀Anthony฀Chandraratna,฀Long฀ Beach฀VA฀Medical฀Center,฀Long฀Beach,฀CA,฀University฀of฀California,฀Irvine,฀Irvine,฀CA Background:฀Atherosclerotic฀plaques฀on฀surface฀ultrasound฀images฀and฀on฀intravascular฀ images฀ may฀ have฀ bright฀ areas฀ with฀ shadowing฀ indicative฀ of฀ calcification,฀ bright฀ areas฀ with฀no฀shadowing฀suggestive฀of฀fibrous฀plaque,฀and฀hypoechoic฀areas฀which฀are฀often฀ interpreted฀as฀fatty฀plaque.฀We฀previously฀showed฀that฀on฀ultrasound฀images฀of฀myocardial฀ fibrosis฀obtained฀with฀a฀600฀MHz฀transducer,฀fibrous฀tissue฀consisting฀of฀predominantly฀ thick฀ collagen฀ fibers฀ was฀ hyperechoic,฀ and฀ fibrous฀ tissue฀ composed฀ of฀ thin฀ fibers฀ was฀ normoechoic฀or฀hypoechoic.฀The฀current฀study฀was฀designed฀to฀test฀the฀hypothesis฀that฀ fibrous฀tissue฀in฀atherosclerotic฀plaques฀will฀be฀hyperechoic฀or฀hypoechoic฀depending฀on฀ collagen฀fiber฀morphology. Methods:฀Twelve฀ segments฀ of฀ aortic฀ arch฀ containing฀ atherosclerotic฀ plaques฀ obtained฀ from฀cadavers฀were฀suspended฀in฀a฀water฀bath฀and฀imaged฀with฀an฀8฀MHz฀ultrasound฀ transducer฀interfaced฀with฀a฀Philips฀Sonos฀5500฀ultrasound฀machine.฀The฀gain฀settings฀ and฀the฀distance฀of฀the฀transducer฀from฀the฀specimen฀were฀constant฀for฀all฀studies.฀The฀ images฀were฀recorded฀on฀videotape.฀The฀site฀of฀imaging฀was฀marked฀and฀the฀specimens฀ were฀sectioned฀at฀that฀spot,฀stained฀with฀picrosirius฀red฀and฀examined฀with฀polarized฀light฀ microscopy฀(PLM).฀Thick฀collagen฀fibers฀appear฀orange฀or฀red฀and฀thin฀fibers฀appear฀green฀ or฀yellow฀on฀PLM.฀The฀ultrasound฀images฀were฀interpreted฀by฀an฀observer฀blinded฀to฀the฀ PLM฀data฀and฀were฀graded฀as฀normoechoic,฀hyperechoic฀with฀shadowing,฀hyperechoic฀ without฀shadowing,฀hypoechoic,฀or฀anechoic. Results:฀All฀plaques฀had฀heterogeneous฀echo฀texture.฀There฀were฀12฀bright฀areas฀without฀ shadowing,฀all฀of฀which฀contained฀predominantly฀thick฀collagen฀fibers฀(orange/red).฀Two฀ areas฀ were฀ anechoic฀ with฀ predominantly฀ thin฀ collagen฀ fibers฀ (green).฀ There฀ were฀ 11฀ hypoechoic฀areas;฀6฀of฀these฀contained฀thin฀fibers฀and฀5฀contained฀no฀collagen฀on฀PLM฀ suggesting฀fat฀or฀thrombus. Conclusion:฀ Fibrous฀ aortic฀ plaques฀ consisting฀ of฀ predominantly฀ thin฀ fibers฀ appear฀ hypoechoic฀ or฀ anechoic฀ on฀ ultrasound฀ images฀ and฀ therefore฀ may฀ be฀ indistinguishable฀ from฀ fatty฀ plaques.฀These฀ findings฀ suggest฀ that฀ a฀ cautious฀ interpretation฀ of฀ ultrasound฀ images฀of฀atherosclerotic฀plaques฀is฀warranted. 1052-69฀ Early฀Noninvasive฀Assessment฀of฀Myocardial฀ Viability฀After฀Primary฀Angioplasty฀for฀Acute฀ Myocardial฀Infarction฀Using฀Transthoracic฀Doppler฀ Echocardiography Aliocha฀Scheuble,฀Marc฀Faraggi,฀Eric฀Brochet,฀Dominique฀Himbert,฀Jean-Michel฀Juliard,฀ Dominique฀Le฀Guludec,฀Ph.฀Gabriel฀Steg,฀Alec฀Vahanian,฀Laurent฀J.฀Feldman,฀Bichat฀ University฀Hospital,฀Paris,฀France Background:฀ High-frequency฀ transthoracic฀ Doppler฀ echocardiography฀ (TDE)฀ allows฀ non-invasive฀assessment฀of฀coronary฀flow฀velocity฀pattern฀in฀the฀left฀anterior฀descending฀ coronary฀ artery.฀ We฀ hypothesized฀ that฀ microcirculatory฀ dysfunction฀ assessed฀ by฀ TDE฀ early฀after฀primary฀angioplasty฀for฀anterior฀acute฀myocardial฀infarction฀is฀associated฀with฀ poor฀myocardial฀viability. Methods:฀ We฀ studied฀ 24฀ consecutive฀ patients฀ with฀ TIMI฀ 3฀ flow฀ after฀ primary฀ coronary฀ stenting฀ of฀ the฀ left฀ anterior฀ descending฀ coronary฀ artery฀ for฀ ≤฀ 12-hour฀ anterior฀ acute฀ myocardial฀ infarction.฀ Coronary฀ flow฀ velocity฀ pattern฀ and฀ adenosine-induced฀ (140฀ microgram/kg/min,฀5฀min฀iv฀perfusion)฀coronary฀flow฀velocity฀reserve฀(CVR)฀were฀measured฀ using฀a฀high฀frequency฀TDE฀probe฀(7MHz,฀7V3C฀Acuson/Siemens)฀24฀hours฀and฀3฀days฀ after฀primary฀angioplasty,฀respectively.฀At฀8฀weeks,฀blinded฀interpretation฀of฀rest฀201Tl฀singlephoton฀emission฀computed฀tomography฀(Tl-SPECT)฀was฀performed฀with฀a฀16-segment฀grid.฀ Thallium฀uptake฀in฀each฀segment฀was฀scored฀from฀1฀(normal)฀to฀4฀(no฀uptake).฀Absence฀of฀ myocardial฀viability฀was฀defined฀by฀an฀average฀thallium฀score฀(TS)฀>฀2฀in฀the฀infarct฀area. Results:฀Patients฀with฀an฀early฀systolic฀retrograde฀flow฀(ESRF)฀had฀a฀larger฀myocardial฀ infarction฀ than฀ patients฀ without฀ ESRF฀ (TS=2.66฀ ±0.79฀ vs฀ 1.32฀ ±0.38,฀ p<0.0001).฀ The฀ diastolic฀deceleration฀time฀(DDT)฀negatively฀correlated฀with฀TS฀(r=-0.75,฀p<0.0001).฀CVR฀ also฀negatively฀correlated,฀but฀to฀a฀lower฀extent,฀with฀TS฀(r=-0.43,฀p=0.04).฀The฀presence฀ of฀an฀ESRF฀or฀a฀DDT≤฀600ms฀24฀hours฀after฀acute฀anterior฀myocardial฀infarction฀predicted฀ the฀absence฀of฀myocardial฀viability฀with฀a฀sensitivity฀of฀91%,฀a฀specificity฀of฀69%,฀a฀positive฀ predictive฀value฀of฀71%,฀a฀negative฀predictive฀value฀of฀90%฀and฀an฀accuracy฀of฀79฀%. Conclusion:฀Evaluation฀of฀coronary฀flow฀velocity฀pattern฀by฀TDE฀reliably฀identifies฀patients฀ without฀evidence฀of฀myocardial฀viability,฀as฀early฀as฀24฀hours฀after฀primary฀angioplasty฀for฀ anterior฀acute฀myocardial฀infarction. 1052-70฀ Prediction฀of฀Myocardial฀Tissue฀Viability฀in฀Patients฀ With฀TIMI฀3฀Flow:฀Analysis฀Using฀Transthoracic฀Color฀ Doppler฀Echocardiography Minako฀Katayama,฀Atsushi฀Yamamuro,฀Koichi฀Tamita,฀Toshikazu฀Yagi,฀Shuichiro฀Kaji,฀ Tomoko฀Tani,฀Kazuaki฀Tanabe,฀Shigefumi฀Morioka,฀Kobe฀General฀Hospital,฀Kobe,฀Japan,฀ Institute฀of฀Biomedical฀Research฀and฀Innovation,฀Kobe,฀Japan Background:฀ The฀ Thrombolysis฀ In฀ Myocardial฀ Infarction฀ (TIMI)฀ grading฀ scale฀ after฀ coronary฀ reperfusion฀ yields฀ important฀ prognostic฀ information฀ in฀ patients฀ with฀ acute฀ myocardial฀infarction.฀The฀re-establishment฀of฀coronary฀blood฀flow฀to฀the฀infarcted฀region฀ is฀ thought฀ to฀ preserve฀ myocardial฀ viability.฀ However,฀ many฀ patients฀ with฀ angiographic฀ TIMI3฀flow฀have฀persistent,฀severe฀abnormalities฀of฀tissue฀perfusion.฀Our฀recent฀studies฀ have฀shown฀that฀coronary฀flow฀velocity฀pattern฀(CFVP)฀with฀a฀rapid฀diastolic฀deceleration฀ (DDT)฀ implies฀ the฀ advanced฀ microvascular฀ damage.฀The฀ purpose฀ of฀ this฀ study฀ was฀ to฀ investigate฀ whether฀ CFVP฀ obtained฀ by฀ transthoracic฀ color฀ Doppler฀ echocardiography฀ (TTCDE)฀can฀predict฀myocardial฀viability฀in฀patients฀who฀achieved฀TIMI3฀flow. Methods:฀The฀study฀population฀consisted฀of฀53฀consecutive฀patients฀with฀a฀first฀anterior฀ acute฀myocardial฀infarction฀successfully฀treated฀with฀percutaneous฀coronary฀intervention฀ (angiographically฀coronary฀stenosis≤50%฀with฀TIMI3฀flow).฀Using฀TTCDE,฀we฀evaluated฀ CFVP฀in฀the฀left฀anterior฀descending฀artery฀12฀to฀48฀hours฀after฀the฀intervention.฀Patients฀ Noninvasive Imaging Background:฀Acute฀reduction฀of฀mitral฀regurgitation฀(MR)฀with฀cardiac฀resynchronization฀ therapy฀(CRT)฀has฀been฀shown฀in฀patients฀(p)฀with฀left฀ventricular฀(LV)฀dysfunction฀and฀ LBBB.฀Few฀studies฀have฀assessed฀the฀quantitative฀impact฀of฀CRT฀on฀MR฀over฀time.฀We฀ sought฀ to฀ analyze฀ if฀ the฀ acute฀ effect฀ of฀ CRT฀ on฀ MR฀ persists฀ over฀ time฀ using฀ validated฀ quantitative฀echocardiographic฀methods. Methods:฀Sixty-nine฀p฀with฀heart฀failure,฀LV฀ejection฀fraction฀(EF)฀<฀35฀%฀and฀LBBB฀were฀ studied฀with฀color-Doppler฀echo฀before,฀immediately฀after,฀and฀at฀6฀and฀12-month฀follow-up฀ after฀CRT.฀MR฀was฀quantified฀according฀to฀the฀flow฀convergence฀method฀with฀a฀hemispherical฀ assumption,฀ determining฀ regurgitant฀ orifice฀ area฀ (ROA)฀ and฀ regurgitant฀ volume฀ (RV).฀ LV฀ volumes฀and฀EF฀(by฀the฀biplane฀Simpson’s฀method)฀were฀also฀determined. Results:฀There฀were฀31฀p฀(45%)฀with฀non-trivial฀MR฀(RV฀>฀10฀ml/beat);฀25฀p฀(36%)฀had฀ trivial฀MR฀(RV฀<฀10฀ml/beat)฀and฀13฀p฀(18%)฀had฀no฀MR.฀Table฀shows฀quantitative฀data฀of฀ MR฀and฀LV฀volumes฀without฀pacing฀(OFF),฀immediately฀after฀CRT฀(ON),฀and฀at฀6฀and฀12฀ month฀follow-up฀with฀CRT.฀Conclusions:฀1-฀CRT฀acutely฀reduces฀MR฀in฀patients฀with฀LV฀ systolic฀dysfunction,฀LBBB฀and฀significant฀MR;฀this฀effect฀persists฀over฀a฀12฀month฀followup฀ period.฀ 2-฀ Although฀ the฀ decrease฀ in฀ MR฀ may฀ be฀ a฀ consequence฀ of฀ LV฀ remodelling,฀ more฀studies฀are฀warranted฀to฀analyse฀the฀mechanisms฀leading฀to฀this฀effect฀. 1052-68฀ 263A 264A ABSTRACTS - Noninvasive Imaging were฀ divided฀ into฀ two฀ groups฀ based฀ on฀ myocardial฀ viability฀ assessed฀ by฀ thallium-201฀ single-photon฀ emission฀ computed฀ tomographic฀ (SPECT)฀ imaging฀ 6฀ months฀ after฀ the฀ infarction.฀ Redistribution฀ patterns฀ or฀ residual฀ maximal฀ myocardial฀ activity>50%฀ are฀ indices฀of฀tissue฀viability. Results:฀Coronary฀flow฀velocity฀measurement฀was฀possible฀in฀48฀of฀53฀patients฀(฀91%)฀ by฀TTCDE฀and฀44฀patients฀underwent฀thallium-201฀SPECT฀6฀months฀after฀the฀infarction;฀ 33฀patients฀with฀viable฀myocardium฀and฀11฀patients฀with฀nonviable฀myocardium.฀Coronary฀ flow฀velocity฀variables฀showed฀significantly฀longer฀DDT฀(886±269ms฀versus฀442±336ms;฀ p<0.0005)฀ in฀ viable฀ myocardium฀ group฀ compared฀ with฀ nonviable฀ myocardial฀ group.฀ On฀ the฀basis฀of฀ROC฀curve฀analysis,฀optimal฀cut฀off฀values฀of฀600ms฀for฀DDT฀was฀chosen฀to฀ predict฀viable฀myocardium฀(sensitivity=0.94,฀specificity=0.73). Conclusion:฀ Noninvasive฀ assessment฀ of฀ CFVP฀ is฀ useful฀ to฀ predict฀ myocardial฀ viability฀ in฀ patients฀ with฀ acute฀ myocardial฀ infarction.฀ Patients฀ with฀ a฀ DDT≤600ms฀ show฀ poor฀ myocardial฀viability฀even฀they฀have฀achieved฀TIMI3฀flow. POSTER฀SESSION 1053฀฀ 3-D฀Echo฀Assessment฀of฀the฀Ventricles Sunday,฀March฀06,฀2005,฀1:30฀p.m.-5:00฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀1:30฀p.m.-2:30฀p.m. 1053-71฀ Application฀of฀Colour฀Coded฀Tissue฀Doppler฀ Imaging฀and฀Real฀Time฀3D฀Echocardiography฀in฀ the฀quantification฀of฀Mechanical฀Intraventricular฀ Dysynchrony:a฀correlation฀study Noninvasive Imaging Emmanouil฀Liodakis,฀Osama฀Al฀Sharef,฀David฀Dawson,฀Petros฀Nihoyannopoulos,฀ National฀Heart฀Lung฀Institute,฀Imperial฀College฀University฀of฀London฀London,฀London,฀ United฀Kingdom Background:฀Mechanical฀asynchrony฀(MA)฀is฀a฀major฀observation฀in฀patients฀with฀heart฀ failure.฀ Colour฀ coded฀ tissue฀ doppler฀ imaging฀ (TDI)฀ has฀ been฀ used฀ to฀ quantify฀ MA฀ by฀ measuring฀the฀standard฀deviation฀of฀the฀time฀from฀Q฀wave฀to฀peak฀systolic฀velocity฀for฀12฀ segments฀(Ts-SD).฀Real฀time฀3D฀Echocardiography฀(RT3DE)฀is฀a฀novel฀technique฀which฀ provides฀qualitative฀and฀quantitative฀assessment฀of฀MA฀by฀measuring฀the฀Dysynchrony฀ Index฀ (DI),฀ which฀ is฀ defined฀ as฀ the฀ standard฀ deviation฀ of฀ the฀ time฀ for฀ the฀ 16฀ segments฀ to฀ reach฀ their฀ minimum฀ volumes.฀ In฀ this฀ study฀ we฀ sought฀ to฀ determine฀ the฀ correlation฀ between฀these฀two฀methods. Methods:฀ 10฀ patients฀ (61±10฀ years)฀ were฀ assessed฀ using฀TDI฀ and฀ RT3DE.฀Ts-SD฀ was฀ measured฀offline฀using฀TDI฀(Qlab).RT3DE฀images฀were฀acquired฀using฀Sonos฀7500฀and฀ analyzed฀offline฀with฀Tomtec฀software฀to฀derive฀ejection฀fraction฀(EF)฀and฀DI฀(fig). Results:฀ A฀ significant฀ negative฀ correlation฀ was฀ found฀ between฀ EF฀ and฀ both฀Ts-SD฀ and฀ DI฀ (r=-0.6฀ p<0.03,฀ r=-0.7฀ p<0.01฀ respectively).฀ A฀ strong฀ positive฀ correlation฀ was฀ also฀ documented฀between฀DI฀and฀Ts-SD฀(r=0.6฀p<0.02,฀fig).฀There฀was฀significant฀interobserver฀ agreement฀both฀in฀Ts-SD฀and฀DI฀(r=0.7฀p<0.01,฀r=0.9฀p<0.01฀respectively).฀The฀correlation฀ between฀measurements฀was฀superior฀for฀RT3DE฀compared฀with฀TDI(Z=-1.22) Conclusion:฀MA฀can฀be฀efficiently฀and฀accurately฀assessed฀using฀both฀TDI฀and฀RT3DE฀ techniques.However฀RT3DE฀provides฀a฀more฀comprehensive฀quantification฀by฀including฀ 16฀segments฀with฀lower฀interobserver฀variability฀compared฀to฀TDI.฀ 1053-72฀ Real-Time฀Three-Dimensional฀Echocardiographic฀Index฀ of฀Ventricular฀Dyssynchrony฀Identifies฀Long-Term฀ Responders฀to฀Cardiac฀Resynchronization฀Therapy Thomas฀E.฀Hong,฀Lissa฀Sugeng,฀Lynn฀Weinert,฀Victor฀Mor-Avi,฀Aseem฀D.฀Desai,฀Martin฀ C.฀Burke,฀Roberto฀M.฀Lang,฀Bradley฀P.฀Knight,฀University฀of฀Chicago,฀Chicago,฀IL Real-time฀ three-dimensional฀ echocardiography฀ (RT3DE)฀ can฀ quantify฀ left฀ ventricular฀ dyssynchrony฀and฀evaluate฀the฀effects฀of฀cardiac฀resynchronization฀therapy฀(CRT).฀Our฀ goal฀was฀to฀determine฀whether฀the฀magnitude฀of฀baseline฀LV฀dyssynchrony฀or฀the฀acute฀ change฀in฀synchrony฀in฀response฀to฀CRT฀predicts฀long-term฀benefit฀from฀CRT.฀ Methods.฀We฀studied฀9฀pts฀(6M,฀3F;฀66±14฀yrs)฀with฀refractory฀heart฀failure฀(4฀ischemic;฀ 5฀non-ischemic)฀and฀an฀IVCD฀(QRS฀duration฀=฀186±25ms)฀who฀were฀treated฀with฀CRT.฀ Patients฀ underwent฀ RT3DE฀ imaging฀ (Philips฀ 7500,฀ X4฀ probe)฀ with฀ and฀ without฀ CRT฀ 1.4±1.4฀ months฀ after฀ CRT฀ device฀ implantation.฀ Imaging฀ was฀ repeated฀ 6.2±2.4฀ months฀ after฀the฀initial฀study.฀Data฀were฀analyzed฀(TomTec)฀to฀obtain฀LVEF฀and฀regional฀volume฀ over฀time฀curves฀for฀16฀LV฀segments฀(6฀basal,฀6฀mid,฀and฀4฀apical).฀The฀time฀from฀the฀ onset฀ to฀ end฀ of฀ ejection฀ relative฀ to฀ the฀ cardiac฀ cycle฀ length฀ was฀ calculated฀ for฀ each฀ segment,฀and฀an฀index฀of฀dyssynchrony฀(DI)฀was฀defined฀as฀the฀standard฀deviation฀of฀the฀ mean฀ejection฀time฀of฀all฀segments.฀Responders฀to฀CRT฀were฀defined฀as฀patients฀with฀an฀ absolute฀improvement฀in฀LVEF฀of฀at฀least฀5%฀after฀6฀months฀of฀CRT.฀ Results.฀ 4/9฀ patients฀ were฀ identified฀ as฀ responders฀ to฀ CRT.฀ Baseline฀ LVEF฀ and฀ LV฀ dimensions฀ did฀ not฀ identify฀ responders฀ to฀ CRT.฀ However,฀ responders฀ to฀ CRT฀ tended฀ JACC February 1, 2005 to฀have฀more฀overall฀ventricular฀dyssynchrony฀at฀baseline฀compared฀to฀nonresponders฀ (DIoverall฀=฀22±5%฀vs.฀14±5%;฀p฀=฀0.06),฀and฀had฀significantly฀more฀ventricular฀dyssynchrony฀ when฀the฀apical฀segments฀were฀excluded฀from฀the฀analysis฀(DIBasalMid฀=฀21±4%฀vs.฀12±1%,฀ p฀=฀0.004).฀No฀patient฀with฀a฀baseline฀DIBasalMid฀<฀15฀was฀identified฀as฀a฀responder฀to฀CRT.฀ In฀ addition,฀ the฀ acute฀ improvement฀ in฀ overall฀ ventricular฀ dyssynchrony฀ was฀ greater฀ in฀ responders฀(DIoverall฀ =฀21±5%฀to฀12±4%;฀p฀=฀0.02)฀compared฀to฀nonresponders฀(DIoverall฀=฀ 14±5%฀to฀16±11%;฀p฀=฀NS).฀ Conclusions.฀ Baseline฀ ventricular฀ dyssynchrony฀ and฀ the฀ acute฀ improvement฀ in฀ ventricular฀dyssynchrony฀with฀CRT฀as฀measured฀by฀RT3DE฀can฀be฀used฀to฀identify฀longterm฀responders฀to฀CRT.฀Dyssynchrony฀of฀the฀basal฀and฀mid฀segments฀of฀the฀LV฀appears฀ to฀ be฀ a฀ better฀ predictor฀ of฀ the฀ response฀ to฀ CRT฀ than฀ overall฀ LV฀ dyssynchrony.฀ Larger฀ studies฀are฀needed฀to฀confirm฀these฀findings. 1053-73฀ Serial฀Follow-up฀of฀Left฀Ventricular฀Parameters฀ Using฀Real-time฀3D฀Echo฀is฀Comparable฀to฀Magnetic฀ Resonance฀Imaging฀and฀Superior฀to฀2D฀Echo Carly฀Jenkins,฀Lizelle฀Hanekom,฀Jonathan฀Chan,฀Thomas฀H.฀Marwick,฀University฀of฀ Queensland,฀Brisbane,฀Australia Background:฀The฀use฀of฀echo฀for฀serial฀follow-up฀could฀guide฀management฀decisions฀ but฀has฀been฀difficult฀because฀of฀test-retest฀variation฀with฀2D฀echo฀(2DE).฀Real-time฀3D฀ echo฀(RT3D)฀is฀now฀feasible฀as฀a฀standard฀clinical฀tool,฀and฀has฀superior฀accuracy฀to฀2DE฀ in฀cross-sectional฀studies.฀We฀sought฀to฀assess฀its฀reproducibility฀for฀serial฀follow-up฀of฀LV฀ measurements฀in฀patients฀undergoing฀follow-up฀MRI. Methods:฀Patients฀selected฀for฀serial฀follow-up฀for฀evaluation฀of฀LV฀parameters฀(n=17,฀ 14฀men,฀age฀63+11)฀were฀studied฀with฀2DE,฀RT3D฀and฀MRI.฀All฀images฀were฀obtained฀ during฀breath-hold฀and฀measurements฀were฀made฀off-line.฀MRI฀images฀were฀taken฀within฀ 14฀days฀of฀the฀echos฀and฀the฀average฀interval฀between฀the฀two฀MRI’s฀was฀329+65฀days,฀ 3D฀echo฀was฀347+68฀and฀2D฀echo฀was฀341+66. Results:฀ MRI฀ showed฀ EDV฀ to฀ fall฀ from฀ 183+46฀ to฀ 176+62,฀ ESV฀ to฀ fall฀ from฀ 104+50฀ to฀ 91+57฀ and฀ EF฀ to฀ increase฀ from฀ 44+13฀ to฀ 51+12฀ over฀ 1฀ year฀ follow-up.฀ 3D฀ echo฀ measurements฀of฀EDV฀and฀EF฀had฀a฀closer฀correlation฀to฀MRI฀than฀2D฀echo฀(see฀Table),฀ and฀ analysis฀ of฀ F฀ values฀ showed฀ 3DE฀ to฀ demonstrate฀ less฀ variation฀ than฀ 2DE.฀ The฀ correspondence฀between฀2DE฀and฀3DE฀and฀MRI฀measurements฀of฀change฀in฀volumes฀ and฀EF฀between฀visits฀is฀illustrated฀in฀Table฀1. Conclusions:฀There฀were฀no฀significant฀differences฀between฀MRI฀and฀3DE฀measurement฀ of฀ change฀ of฀ volumes฀ and฀ EF.฀ In฀ contrast,฀ 2DE฀ overestimated฀ change฀ in฀ EDV,฀ and฀ demonstrated฀greater฀variability. Table฀1฀ MRI ΔEDV฀ (mls) -7+39 2D฀Echo -33+25 3D฀Echo -9+52 1053-74฀ R฀(echo฀ F฀(echo฀ ΔESV฀ vs฀MRI) vs฀MRI) (mls) -13+17 -0.24 0.41 -17+20 P=0.02 P=0.04 0.74 1.78 -17+24 P=0.37 P=0.12 R฀(echo฀ F฀(echo฀ R฀(echo฀ ΔEF฀(%) vs฀MRI) vs฀MRI) vs฀MRI) 6+7.0 0.21 0.94 0.19 -3+14 P=0.25 P=0.45 P=0.01 0.59 1.39 0.57 9+8.0 P=0.2 P=0.26 P=0.07 F฀(echo฀ vs฀MRI) 4.7 P<0.01 1.4 P=0.25 Does฀Qualitative฀and฀Quantitative฀Analysis฀of฀Contrast฀ Enhanced฀Real-time฀3D฀Echo฀provide฀Incremental฀ Information฀in฀Stress฀Echocardiography? Stamatis฀Kapetanakis,฀Penelope฀Giannakopoulou,฀George฀Amin,฀Mark฀John฀Monaghan,฀ King’s฀College฀Hospital,฀London,฀United฀Kingdom Background:฀ Real-Time฀ 3D฀ echocardiography฀ (RT3DE)฀ provides฀ swift฀ acquisitions฀ independently฀ of฀ axis฀ of฀ acquisition,฀ which฀ may฀ be฀ of฀ value฀ in฀ stress฀ echo.฀ Moreover,฀ global฀ and฀ regional฀ volumetric฀ quantification฀ of฀ RT3DE฀ during฀ pharmacological฀ stress฀ may฀provide฀incremental฀diagnostic฀information. Methods:฀ 22฀ patients฀ underwent฀ simultaneous฀ contrast฀ enhanced฀ 2D฀ and฀ RT3D฀ echo฀ at฀ baseline฀ and฀ peak฀ dobutamine฀ stress฀ and฀ the฀ wall฀ motion฀ score฀ index฀ (WMSI)฀ was฀ calculated฀by฀both฀modalities.฀Global฀and฀regional฀volumetric฀quantification฀was฀performed฀ by฀RT3DE฀at฀both฀stages.฀A฀systolic฀dyssynchrony฀index฀(SDI)฀was฀based฀on฀dispersion฀of฀ times฀to฀minimum฀volume฀for฀the฀16฀segments.฀Time-volume฀curves฀were฀derived฀for฀each฀ major฀arterial฀territory฀by฀creating฀3฀subvolumes. Results:฀ There฀ was฀ excellent฀ correlation฀ between฀ WMSI฀ by฀ 2D฀ and฀ RT3D฀ echo฀ at฀ baseline฀ (R฀ =฀ 0.96,฀ p฀ <฀ 0.0001)฀ and฀ peak฀ stress฀ (R=฀ 0.92,฀ p฀ <฀ 0.0001).฀The฀ SDI฀ was฀ similar฀in฀patients฀with฀and฀without฀evidence฀of฀IHD฀at฀baseline฀(6.9±4.1฀vs.฀5.2±2%,฀p฀=฀ 0.25).฀At฀peak฀stress,฀patients฀with฀IHD฀had฀higher฀SDI฀(12.2±6฀vs.฀4.6±2.5%,฀p฀=฀0.05).฀ Regional฀volumetric฀analysis฀identified฀the฀correct฀ischaemic฀territory฀in฀73.8%.฀A฀regional฀ EF฀for฀the฀LAD฀territory฀identified฀100%฀of฀abnormal฀echoes฀at฀peak฀stress. Conclusions:฀Qualitative฀analysis฀of฀RT3DE฀shows฀excellent฀correlation฀with฀established฀ methods.฀Additionally,฀volumetric฀analysis฀provides฀quantification฀of฀regional฀function฀and฀ segmental฀coordination,฀which฀may฀be฀of฀value฀in฀stress฀echo.฀ JACC 1053-75฀ February 1, 2005 Comprehensive฀Analysis฀of฀Shape-Based฀Regional฀ Myocardial฀Strain฀From฀3-D฀Echocardiography ABSTRACTS - Noninvasive Imaging 1053-77฀ 265A The฀Efficacy฀of฀Real฀Time฀3-Dimensional฀ Echocardiography฀for฀Right฀Ventricular฀biopsy Gaby฀Weissman,฀Donna฀R.฀Dione,฀Xenophon฀Papademetris,฀Donald฀P.฀Dione,฀David฀ Meoli,฀James฀S.฀Duncan,฀Albert฀J.฀Sinusas,฀Yale฀University,฀New฀Haven,฀CT Monica฀Aggarwal,฀Cinthia฀Drachenberg,฀Layna฀Douglass,฀Christopher฀deFilippi,฀ University฀of฀Maryland,฀Baltimore,฀MD Background:฀ Reliable฀ quantitative฀ approaches฀ for฀ analysis฀ of฀ regional฀ myocardial฀ function฀ from฀ echocardiographic฀ (ECHO)฀ images฀ are฀ still฀ needed.฀ We฀ evaluated฀ a฀ comprehensive฀shape-based฀approach฀for฀the฀quantification฀of฀regional฀myocardial฀strain฀ from฀3-D฀ECHO฀images. Methods:฀ 3-D฀ ECHO฀ images฀ were฀ acquired฀ in฀ open-chest฀ dogs฀ (n=5)฀ both฀ before฀ and฀ after฀the฀creation฀of฀regional฀myocardial฀dysfunction฀by฀intracoronary฀infusion฀of฀lidocaine฀ (LIDO,฀8mg/min)฀into฀the฀proximal฀LAD.฀Endocardial฀and฀epicardial฀surfaces฀were฀defined฀ using฀ a฀ semiautomated฀ algorithm.฀The฀ shape฀ of฀ the฀ surfaces฀ was฀ used฀ to฀ track฀ the฀ 3-D฀ trajectories฀of฀myocardial฀regions฀over฀the฀cardiac฀cycle.฀Shape-based฀displacements฀were฀ integrated฀with฀a฀continuous฀biomechanics฀model฀to฀estimate฀transmural฀cardiac-specific฀ strains฀(Radial-RS;฀Circumferential-CS;฀Longitudinal-LS)฀for฀32฀myocardial฀regions. Results:฀ At฀ baseline,฀ RS฀ was฀ fairly฀ uniform฀ across฀ all฀ myocardial฀ segments.฀ However,฀ there฀was฀a฀slight฀increase฀in฀CS฀and฀LS฀in฀anterior฀segments฀relative฀to฀the฀lateral฀wall.฀ LIDO฀infusion฀in฀the฀LAD฀led฀to฀a฀significant฀decrease฀in฀RS฀in฀only฀the฀septal-anterior฀ segment฀(p฀<0.05),฀while฀there฀was฀a฀significant฀(p<0.05)฀decline฀in฀CS฀in฀all฀anterior฀wall฀ segments.฀ Analysis฀ of฀ CS฀ provided฀ a฀ better฀ index฀ of฀ the฀ extent฀ of฀ regional฀ dysfunction฀ than฀RS.฀(see฀figure) Conclusion:฀Shaped-based฀analysis฀of฀3-D฀ECHO฀provides฀a฀novel฀and฀comprehensive฀ quantitative฀approach฀for฀assessment฀of฀regional฀myocardial฀cardiac-specific฀strain. Background:฀Repetitive฀right฀ventricular฀(RV)฀biopsies฀can฀result฀in฀decreased฀sample฀ quality฀ by฀ inducing฀ fibrosis฀ with฀ over฀ sampling฀ specific฀ locations.฀ Three-dimensional฀ echocardiography฀(3D)฀has฀been฀shown฀to฀precisely฀locate฀the฀bioptome฀within฀the฀RV฀ compared฀to฀fluoroscopy฀(Fl).฀We฀sought฀to฀determine฀if฀a฀real฀time฀3D฀(RT3D)฀guided฀ approach฀results฀in฀differences฀in฀biopsy฀quality฀compared฀to฀Fl. Methods:฀ Thirty฀ RV฀ biopsy฀ procedures฀ were฀ performed฀ equally฀ with฀ RT3D฀ or฀ Fl฀ in฀ 14฀ transplant฀patients.฀RT3D฀was฀performed฀with฀a฀Philips฀7500฀from฀the฀apical฀4-chamber฀ position.฀Fl฀was฀performed฀with฀biplane฀images.฀With฀both฀RT3D฀and฀Fl,฀attempts฀were฀ made฀ to฀ vary฀ position฀ with฀ each฀ sample฀ to฀ avoid฀ repetitive฀ samples฀ at฀ a฀ fibrotic฀ site.฀ Fibrosis฀was฀graded฀by฀a฀pathologist฀with฀>50%฀considered฀uninterpretable. Results:฀RT3D฀provided฀excellent฀visualization฀of฀the฀distal฀end฀of฀the฀bioptome฀within฀ the฀ right฀ atrium฀ and฀ RV฀ allowing฀ rapid฀ placement฀ on฀ the฀ RV฀ septum฀ (figure).฀ A฀ mean฀ of฀ 4.3฀ ±฀ 1.0฀ biopsies฀ were฀ collected฀ per฀ procedure.฀ Of฀ 60฀ samples฀ obtained฀ by฀ Fl,฀ 13฀ (22%)฀ contained฀ fibrosis฀ and฀ 2฀ of฀ 14฀ procedures฀ had฀ >75%฀ uninterpretable฀ samples.฀ Of฀ 68฀ samples฀ obtained฀ by฀ RT3D,฀ 10฀ (15%)฀ contained฀ fibrosis฀ and฀ no฀ samples฀ were฀ uninterpretable.฀Differences฀in฀sample฀quality฀were฀not฀significant฀between฀techniques. Conclusions:฀RT3D฀echocardiography฀is฀a฀new฀method฀to฀facilitate฀rapid฀placement฀and฀ accurate฀localization฀of฀the฀bioptome฀in฀transplant฀patients฀providing฀comparable฀quality฀ RV฀biopsies฀to฀biplane฀Fl. Right฀Ventricular฀Remodeling฀in฀Chronic฀Pressure฀ Overload:฀Observations฀Using฀Real-Time฀3D฀ Echocardiography Lissa฀Sugeng,฀Nagendra฀Chouhan,฀Pankaj฀Gupta,฀Lynn฀Weinert,฀Patrick฀D.฀Coon,฀H.฀ Joachim฀Nesser,฀Roberto฀M.฀Lang,฀Ravi฀Kasliwal,฀University฀of฀Chicago,฀Chicago,฀IL,฀ Escorts฀Heart฀Institute,฀New฀Delhi,฀India The฀ complex฀ shape฀ of฀ the฀ right฀ ventricle฀ (RV)฀ restricts฀ the฀ 2D฀ echocardiographic฀ (2DE)฀ analysis.฀ Real-time฀ 3D฀ echocardiography฀ (RT3DE)฀ is฀ independent฀ of฀ geometric฀ assumptions฀allowing฀accurate฀RV฀volume฀measurements.฀We฀used฀RT3DE฀to฀study฀the฀ adaptation฀of฀the฀RV฀to฀chronic฀pressure฀overload.฀Methods.฀20฀pts฀were฀studied:฀10฀with฀ moderate฀ to฀ severe฀ pulmonary฀ hypertension฀ (PHTN;฀ PA฀ pressure:฀ 67±30฀ mmHg)฀ and฀ 10฀ normal฀ subjects฀ (25±8mmHg).฀ 2DE฀ and฀ ECG฀ gated,฀ wide-angled฀ RT3DE฀ datasets฀ of฀ the฀ RV฀ were฀ acquired฀ from฀ apical฀ windows฀ (Philips฀ 7500,฀ X4฀ probe)฀ and฀ analyzed฀ off-line฀ (Echo-View,฀TomTec).฀ From฀ 2DE,฀ diastolic฀ RV฀ major,฀ minor฀ and฀ tricuspid฀ valve฀ (TV)฀annular฀dimensions฀were฀measured฀(fig฀1).฀From฀RT3DE,฀diastolic฀RV฀areas฀were฀ measured฀ at฀ the฀TV฀ annulus,฀ at฀ 1/3฀ and฀ 2/3s฀ of฀ the฀ RV฀ major฀ diameter฀ (figs฀ 2,3).฀ RV฀ volumes฀ were฀ measured฀ at฀ end-systole฀ and฀ end-diastole฀ (RVVes,฀ RVVed)฀ using฀ disc฀ summation.฀ Results.฀ RT3DE฀ analysis฀ of฀ the฀ RV฀ was฀ feasible฀ in฀ all฀ pts.฀ Compared฀ to฀ normals,฀pts฀with฀PHTN฀had฀larger฀RV฀area฀at฀1/3฀(22±18฀vs.฀14±7cm²,฀p<0.05)฀and฀2/3฀ (11±10฀vs฀7.6±6฀cm²,฀p<0.05)฀of฀the฀RV฀major฀diameter,฀resulting฀in฀greater฀RVVes฀(38±46฀ vs18±16฀ ml/m²,฀ p<0.05).฀ and฀ RVVed฀ (63±62฀ vs39±30฀ ml/m²,฀ p<0.05).฀ No฀ intergroup฀ differences฀ were฀ noted฀ in฀TV฀ annular฀ areas฀ or฀ 2DE฀ data.฀ Conclusion.฀ In฀ response฀ to฀ chronic฀pressure฀overload,฀the฀RV฀remodels฀at฀the฀apical฀and฀mid-ventricular฀levels฀while฀ preserving฀TV฀annular฀geometry.฀RT3DE฀allows฀complete฀assessment฀of฀RV฀geometry฀ and฀provides฀new฀insight฀into฀its฀physiology. ฀ ฀ 1053-78฀ Three-Dimensional฀Echocardiography฀in฀ Arrhythmogenic฀Right฀Ventricular฀Dysplasia Kalpana฀R.฀Prakasa,฀Chandra฀Bomma,฀Darshan฀Dalal,฀Harikrishna฀Tandri,฀Jianwen฀ Wang,฀Crystal฀Tichnell,฀Cindy฀James,฀Mary฀Corretti,฀David฀Bluemki,฀Hugh฀Calkins,฀ Theodore฀Abraham,฀Johns฀Hopkins฀University,฀Baltimore,฀MD Background:฀ Arrhythmogenic฀ right฀ ventricular฀ dysplasia฀ (ARVD)฀ is฀ characterized฀ by฀ progressive฀ complex฀ right฀ ventricular฀ (RV)฀ remodeling฀ and฀ dysfunction.฀ We฀ evaluated฀ whether฀ transthoracic,฀ real-time,฀ three-dimensional฀ echocardiography฀ (3DE)฀ can฀ adequately฀assess฀RV฀morphology฀and฀function฀in฀ARVD.฀3DE฀was฀compared฀to฀cardiac฀ magnetic฀resonance฀imaging฀(CMR),฀the฀current฀gold฀standard. Methods:฀We฀prospectively฀performed฀3DE฀and฀CMR฀in฀20฀consecutive฀patients฀(5฀ARVD,฀ 10฀ first฀ degree฀ relatives฀ with฀ no฀ ARVD,฀ 5฀ RV฀ outflow฀ tract฀ tachycardia฀ with฀ no฀ ARVD).฀ ARVD฀was฀diagnosed฀using฀Task฀Force฀criteria.฀3DE฀(Tom฀Tec฀software)฀and฀CMR฀(MASS฀ software)฀data฀were฀analyzed฀off-line฀by฀two฀blinded,฀independent฀observers. Results:฀Mean฀age฀of฀the฀study฀group฀was฀34±12฀years฀and฀11฀were฀men.฀There฀was฀a฀ close฀correlation฀between฀3DE฀and฀CMR฀for฀RV฀end฀systolic฀volume฀(r=0.58,฀p=0.01),฀RV฀ end฀diastolic฀volume฀(r=0.67,฀p=0.002)฀and฀RV฀ejection฀fraction฀(r=0.99,฀p=0.001).฀3DE฀ systematically฀underestimated฀RV฀end฀systolic฀(-6.9±8.1฀ml,฀p=0.001)฀and฀end฀diastolic฀ volumes฀(-14.7±14.9฀ml,฀p=0.0003).฀Intra฀(r=0.95)฀and฀inter-observer฀(r=0.66)฀correlation฀ was฀good. Conclusions:฀3DE฀measurements฀of฀RV฀volumes฀and฀ejection฀fraction฀closely฀correlate฀ with฀CMR.฀High฀intra฀and฀inter-observer฀correlation฀suggest฀that฀3DE฀may฀be฀useful฀in฀ follow-up฀of฀ARVD฀patients. The฀ following฀ graph฀ shows฀ the฀ correlation฀ between฀ 3DE฀ and฀ CMR฀ for฀ RV฀ ejection฀ fraction. Noninvasive Imaging 1053-76฀ 266A ABSTRACTS - Noninvasive Imaging JACC February 1, 2005 Methods:฀ From฀ December฀ 2002฀ to฀ December฀ 2003,฀ we฀ prospectively฀ studied฀ 135฀ consecutive฀patients฀(pts)฀in฀sinus฀rythm฀who฀had฀undergone฀left฀main฀(61.5฀%)฀or฀ostial฀ (38.5฀%)฀coronary฀artery฀percutaneous฀transluminal฀angioplasty฀with฀stent฀implantation.฀ ECG-gated฀MSCT฀angiography฀was฀performed฀with฀a฀16-slice฀MSCT฀scanner฀(Sensation฀ 16,฀Siemens฀;฀0.42-s฀rotation฀time,฀12*฀0.75-mm฀slice฀thickness)฀24฀hours,฀and฀six฀months฀ after฀angioplasty.฀The฀left฀main฀or฀ostial฀coronary฀stents฀were฀analyzed฀by฀MSCT฀and฀instent฀restenosis฀was฀graded฀on฀a฀four฀point฀scale฀:฀1-none฀;฀2-฀mid-grade฀(<฀50฀%฀in-stent฀ lumen฀diameter฀narrowing)฀;฀3-฀high-grade฀(>฀or฀=฀50฀%)฀;฀4-฀occlusion.฀The฀analysis฀was฀ independently฀performed฀by฀double฀blinded฀observers,฀with฀the฀use฀of฀a฀computer-assisted฀ system.฀ Results฀ were฀ compared฀ with฀ conventional฀ quantitative฀ coronary฀ angiography฀ (QCA).฀122฀of฀the฀135฀pts฀(90.37฀%)฀had฀received฀beta-blocker฀treatment฀(average฀heart฀ rate฀:฀72฀+/-฀5฀min-1).After฀intravenous฀injection฀of฀a฀non฀ionic฀contrast฀medium฀with฀high฀ iodine฀content,฀the฀entire฀heart฀was฀scanned฀within฀a฀single฀breath-hold. Results:฀The฀MSCT฀investigation฀was฀completed฀successfully฀without฀any฀complications฀ in฀ all฀ pts.฀ Of฀ 135฀ stents,฀ 116฀ (85.92฀ %)฀ were฀ determined฀ assessable฀ 6฀ months฀ after฀ stenting.฀All฀pts฀were฀controlled฀by฀quantitative฀coronary฀angiography฀and฀MSCT฀scanner฀ after฀ a฀ six฀ month฀ follow-up.The฀ sensitivity,฀ specificity,฀ positive฀ and฀ negative฀ predictive฀ values฀to฀identify฀high-grade฀in-stent฀restenosis฀(>฀or฀=฀50฀%)฀were฀71฀%,฀92฀%,฀74฀%฀ and฀94฀%฀respectively. Conclusion:฀The฀results฀suggest฀that฀the฀new฀generation฀MSCT฀scanner฀is฀an฀effective฀ non฀invasive฀technology฀for฀the฀visualisation฀of฀in-stent฀restenosis฀of฀proximal฀coronary฀ arteries,฀and฀may฀also฀become฀the฀choice฀procedure฀to฀control฀these฀cardiovascular฀highrisk฀pts. 1054-81฀ POSTER฀SESSION 1054฀฀ Techniques฀in฀Computed฀Tomography฀ Coronary฀Angiography Sunday,฀March฀06,฀2005,฀1:30฀p.m.-5:00฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀1:30฀p.m.-2:30฀p.m. Noninvasive Imaging 1054-79฀ Diagnostic฀Accuracy฀of฀16-slice฀Multidetector฀ Spiral฀Computed฀Tomography฀for฀Detection฀and฀ Characterization฀of฀Congenital฀Anomalies฀of฀the฀ Coronary฀Arteries Maros฀Ferencik,฀Ricardo฀C.฀Cury,฀Stephan฀Achenbach,฀Udo฀Hoffmann,฀Thomas฀J.฀Brady,฀ Richard฀R.฀Liberthson,฀Suhny฀Abbara,฀Massachusetts฀General฀Hospital฀and฀Harvard฀ Medical฀School,฀Boston,฀MA,฀University฀of฀Erlangen,฀Erlangen,฀Germany Background:฀ Contrast-enhanced฀ multidetector฀ spiral฀ computed฀ tomography฀ (MDCT)฀ permits฀reliable฀imaging฀of฀coronary฀arteries.฀We฀investigated฀the฀performance฀of฀MDCT฀ for฀detection฀and฀characterization฀of฀congenital฀anomalies฀of฀the฀coronary฀arteries. Methods:฀ 35฀ subjects฀ (15฀ with฀ coronary฀ anomalies฀ detected฀ by฀ invasive฀ angiography฀ and฀ 20฀ with฀ angiographically฀ proven฀ normal฀ coronary฀ anatomy฀ recruited฀ for฀ other฀ scientific฀studies)฀were฀scanned฀with฀16-slice฀MDCT฀(Siemens฀Sensation฀16;฀16x0.75mm฀ collimation,฀rotation฀420ms,฀120kV,฀550mAs,฀80mL฀of฀iodixanol-320฀at฀4mL/s).฀Axial฀images฀ were฀ reconstructed฀ (thickness฀ 1.0mm,฀ 0.5mm฀ increment,฀ ECG-gated฀ reconstruction).฀ Two฀independent฀blinded฀readers฀evaluated฀MDCT฀(multiplanar฀reformats,฀max.฀intensity฀ projections฀and฀3D฀images)฀of฀patients฀with฀coronary฀anomalies฀randomly฀mixed฀among฀ the฀cases฀with฀normal฀coronary฀anatomy฀for฀the฀presence,฀origin,฀exact฀course,฀proximal฀ vessel฀caliber฀and฀compromise฀of฀anomalous฀coronary฀vessels. Results:฀Both฀observers฀correctly฀detected฀all฀15฀individuals฀with฀coronary฀anomalies฀(8฀ men,฀age฀14-75฀years)฀and฀all฀20฀subjects฀with฀normal฀coronary฀anatomy.฀As฀compared฀ to฀invasive฀angiography,฀both฀observers฀correctly฀classified฀the฀origin฀and฀course฀of฀all฀ anomalous฀ coronary฀ vessels฀ (LM฀ n=2;฀ LAD฀ n=2;฀ LCX฀ n=4;฀ RCA฀ n=9).฀The฀ anomalous฀ RCA฀had฀an฀origin฀from฀the฀left฀sinus฀of฀Valsalva฀in฀4฀subjects฀and฀above฀the฀sinotubular฀ junction฀ in฀ 5฀ subjects.฀ In฀ 7฀ subjects,฀ the฀ proximal฀ course฀ of฀ the฀ anomalous฀ RCA฀ was฀ between฀ the฀ right฀ ventricular฀ outflow฀ tract฀ (RVOT)฀ and฀ aortic฀ root.฀ In฀ subjects฀ with฀ an฀ anomalous฀LM,฀the฀proximal฀segment฀of฀the฀artery฀was฀located฀anterior฀to฀the฀pulmonary฀ artery฀ in฀ 1฀ case฀ and฀ between฀ the฀ RVOT฀ and฀ aortic฀ root฀ in฀ 1฀ other฀ case.฀ In฀ 2฀ subjects฀ with฀an฀anomalous฀LAD,฀the฀artery฀was฀located฀between฀the฀RVOT฀and฀aortic฀root.฀All฀4฀ anomalous฀LCX฀arteries฀took฀a฀course฀posterior฀and฀inferior฀to฀the฀aortic฀root.฀Among฀10฀ subjects฀with฀the฀anomalous฀artery฀crossing฀between฀the฀RVOT฀and฀aortic฀root,฀proximal฀ vessel฀compromise฀was฀detected฀in฀5฀subjects. Conclusion:฀MDCT฀coronary฀angiography฀is฀a฀reliable฀and฀accurate฀tool฀for฀the฀detection฀ and฀characterization฀of฀congenital฀anomalies฀of฀the฀coronary฀arteries. 1054-80฀ Detectability฀of฀in-Stent฀Restenosis฀after฀Left฀Main฀or฀ Ostial฀Coronary฀Stenting฀using฀16-Slice฀Computed฀ Tomography. Eric฀Maupas,฀Meyer฀Elbaz,฀Valérie฀Chabbert,฀Mehdi฀Bennaceur,฀Valérie฀CancesLauwers,฀Hervé฀Rousseau,฀Jacques฀Puel,฀Francis฀Joffre,฀Didier฀Carrié,฀Cardiology฀B,฀ Rangueil฀Hospital,฀Toulouse,฀France,฀(2)฀Radiology,฀Rangueil฀Hospital,฀Toulouse,฀France Background:฀ Multislice฀ spiral฀ CT฀ with฀ retrospectively฀ ECG฀ gating฀ is฀ a฀ new฀ approach฀ for฀non฀invasive฀coronary฀artery฀imaging.฀We฀investigated฀the฀method’s฀ability฀to฀detect฀ in-stent฀restenosis฀after฀coronary฀percutaneous฀angioplasty฀with฀stent฀implantation฀(left฀ main฀or฀ostial฀coronary฀artery). The฀Extent฀of฀Calcification฀may฀Lead฀to฀Overdiagnosis฀ of฀Coronary฀Artery฀Stenoses฀in฀Multidetector฀Spiral฀ Computed฀Tomography Ryoji฀Ishiki,฀Mitsunori฀Iwase,฀Nobutake฀Kurebayashi,฀Daiji฀Yoshikawa,฀Atsushi฀Takamura,฀ Nobuyuki฀Yasuda,฀Yasushi฀Takeichi,฀Haruo฀Inagaki,฀Toyota฀Memorial฀Hospital,฀Toyota,฀ Japan Background:฀ Multidetector฀ spiral฀ CT฀ (MDCT)฀ with฀ retrospective฀ ECG฀ gating฀ is฀ a฀ new฀ approach฀for฀non-invasive฀coronary฀artery฀imaging.฀MDCT฀coronary฀angiography฀(CTA)฀ permits฀ detection฀ of฀ coronary฀ artery฀ stenoses฀ with฀ reasonable฀ accuracy.฀ However,฀ coronary฀ arteries฀ with฀ severe฀ calcifications฀ have฀ been฀ classified฀ as฀ unevaluable฀ in฀ previous฀ studies.฀ Accordingly,฀ we฀ examined฀ the฀ accuracy฀ of฀ CTA฀ to฀ evaluate฀ coronary฀ artery฀stenotic฀lesions฀with฀calcified฀plaques. Methods:฀Fifty-three฀patients฀aged฀62.5±8.8฀years฀(74%฀male)฀with฀known฀or฀suspected฀ coronary฀artery฀disease฀underwent฀CTA฀using฀a฀16-slice฀scanner฀with฀0.5mm฀collimation.฀ The฀ scans฀ were฀ performed฀ twice,฀ before฀ and฀ after฀ intravenous฀ injection฀ of฀ a฀ non-ionic฀ contrast฀medium,฀in฀every฀patient.฀Data฀sets฀of฀precontrast฀scan฀were฀reconstructed฀and฀ cross฀ sectional฀ images฀ of฀ coronary฀ arteries฀ were฀ created.฀The฀ cross฀ sectional฀ area,฀ of฀ which฀CT฀density฀was฀more฀than฀130HU,฀was฀automatically฀calculated.฀We฀defined฀this฀ area฀as฀calcified฀cross฀sectional฀area฀(C-CSA)฀of฀coronary฀plaque.฀Data฀sets฀of฀contrast฀ scan฀ were฀ reconstructed฀ and฀ curved฀ multiplanar฀ reconstruction฀ images฀ were฀ used฀ to฀ detect฀ lesions฀ with฀ a฀ diameter฀ reduction฀ of฀ 50%฀ or฀ more.฀Within฀ one฀ month฀ after฀ CTA,฀ conventional฀coronary฀angiographies฀(CAG)฀were฀performed. Results:฀ Among฀ 589฀ non-stenting฀ coronary฀ segments฀ with฀ a฀ diameter฀ >=2mm,฀ 94฀ segments฀ were฀ classified฀ as฀ mildly฀ calcified฀ lesions฀ (C-CSA<3mm2),฀ 70฀ as฀ severely฀ calcified฀ lesions฀ (C-CSA>=3mm2).฀ For฀ all฀ segments,฀ the฀ sensitivity฀ of฀ CTA฀ to฀ detect฀ significant฀stenoses฀was฀84%฀and฀its฀specificity฀was฀85%.฀Importantly,฀23฀of฀70฀severely฀ calcified฀segments฀had฀no฀significant฀stenoses฀by฀CAG฀and฀16฀of฀23฀were฀overestimated฀ by฀CTA.฀The฀specificity฀for฀these฀severely฀calcified฀segments฀was฀only฀30%,฀although฀that฀ for฀non-฀or฀mildly฀calcified฀lesions฀was฀91%฀(p<0.001).฀On฀the฀other฀hand,฀the฀sensitivity฀ had฀no฀relations฀with฀the฀extent฀of฀calcification฀(91%฀in฀non฀or฀mild฀calcified฀segments,฀ 89%฀in฀severely฀calcified฀segments). Conclusion:฀ Although฀ CTA฀ is฀ an฀ effective฀ noninvasive฀ technology฀ to฀ detect฀ coronary฀ artery฀ stenoses฀ even฀ in฀ calcified฀ lesions,฀ CTA฀ has฀ a฀ substantial฀ false฀ positive฀ rate฀ in฀ severely฀calcified฀lesions. 1054-82฀ The฀Invisible฀Stent฀-฀Imaging฀of฀a฀Self-Degradable฀ Magnesium฀Alloy฀Stent฀with฀Multislice฀Spiral฀Computed฀ Tomography Alexander฀Y.฀Lind,฀Holger฀Eggebrecht,฀Jörg฀Rodermann,฀Axel฀Schmermund,฀Michael฀ Haude,฀Hilmar฀Kühl,฀Raimund฀Erbel,฀University฀of฀Duisburg-Essen,฀Essen,฀Germany Background:฀ Currently฀ noninvasive฀ imaging฀ of฀ coronary฀ arteries฀ by฀ multi-slice฀ spiral฀ computed฀ tomography฀ (MSCT)฀ after฀ stent฀ implantation฀ is฀ limited฀ due฀ to฀ partial฀ volume฀ and฀hardening฀effects.฀Absorbable฀magnesium฀alloy฀metal฀stents฀(AMS)฀may฀overcome฀ these฀ limitations.฀ We฀ report฀ the฀ results฀ of฀ a฀ noninvasive฀ coronary฀ angiography฀ after฀ implantation฀of฀AMS. Methods:฀In฀de฀novo฀lesions฀absorbable฀magnesium฀alloy฀stents฀(BIOTRONIK,฀Bulach,฀ Switzerland)฀ were฀ implanted฀ in฀ 5฀ patients฀ in฀ July฀ 2004.฀ The฀ positioning฀ of฀ the฀ stents฀ had฀ to฀ be฀ controlled฀ by฀ intravascular฀ ultrasound฀ (IVUS),฀ because฀ AMS฀ stents฀ consist฀ of฀ more฀ than฀ 90%฀ magnesium฀ and฀ are฀ not฀ imaged฀ by฀ x-ray.฀ After฀ stent฀ placement฀ a฀ contrast฀enhanced฀MSCT฀(Somatom฀Sensation฀16,฀Siemens,฀Forchheim,฀Germany)฀scan฀ was฀ performed฀ using฀ a฀ 500-ms฀ rotation฀ time฀ and฀ 1,5mm฀ slice฀ thickness฀ during฀ a฀ 35sbreathhold฀at฀day฀3-5฀after฀implantation. Results:฀ The฀ MSCT฀ demonstrated฀ adequate฀ perfusion฀ throughout฀ the฀ whole฀ arteries฀ without฀signs฀of฀stenosis฀in฀the฀stented฀area.฀The฀stent฀itself฀could฀not฀be฀visualized฀in฀all฀ 5฀patients.฀(Fig.฀A฀and฀B) Conclusion:฀The฀ AMS฀ does฀ not฀ interfere฀ with฀ CT฀ imaging.฀ It฀ therefore฀ overcomes฀ the฀ imaging฀problems฀of฀non-absorbable฀metallic฀stents฀(Fig.฀C)฀and฀enables฀reliable฀direct฀ visualization฀of฀coronary฀arteries.฀Thus฀noninvasive฀follow-up฀of฀these฀patients฀by฀MSCT฀ is฀feasible฀for฀the฀first฀time฀due฀to฀adequate฀differentiation฀between฀stent฀patency,฀stentclosure,฀and฀in-stent-stenosis.฀ JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging 267A Conclusion:฀The฀mean฀effective฀dose฀for฀MSCT฀coronary฀angiography฀was฀significantly฀ higher฀than฀that฀for฀conventional฀angiography.฀Calcium฀scoring฀alone฀is฀a฀relatively฀low฀ dose฀ technique,฀ particularly฀ if฀ ECG-controlled฀ tube฀ current฀ modulation฀ is฀ used.฀ These฀ results฀ suggest฀ that฀ coronary฀ MSCT฀ is฀ a฀ high฀ radiation฀ dose฀ examination.฀ Further฀ evaluation฀and฀optimisation฀of฀patient฀dose฀in฀the฀clinical฀setting฀is฀needed. 1054-85฀ Evaluation฀of฀Stenotic฀Coronary฀Artery฀Stents฀in฀16Slice฀Multislice฀Computed฀Tomography Tsunekazu฀Kakuta,฀Osamu฀Kuboyama,฀Shigeki฀Kimura,฀Taishi฀Yonetsu,฀Tomoyuki฀ Umemoto,฀Hideomi฀Fujiwara,฀Mitsuaki฀Isobe,฀Tsuchiura฀Kyodo฀General฀Hospital,฀ Tsuchiura,฀Japan,฀Tokyo฀Medical฀&฀Dental฀University,฀Tokyo,฀Japan 1054-83฀ Non-invasive฀64-slice฀Multi-detector฀Ct฀Coronary฀ Angiography฀Of฀The฀Entire฀Coronary฀Tree฀In฀Patients฀ With฀Stable฀Angina฀Pectoris฀Or฀An฀Acute฀Coronary฀ Syndrome Nico฀R.฀Mollet,฀Filippo฀Cademartiri,฀Carlos฀van฀Mieghem,฀Giuseppe฀Runza,฀Timo฀Baks,฀ Eugene฀P.฀McFadden,฀Gabriel฀P.฀Krestin,฀Pim฀J.฀de฀Feyter,฀Erasmus฀Medical฀Center,฀ Rotterdam,฀The฀Netherlands 1054-84฀ Effective฀Dose฀From฀Multislice฀CT฀Calcium฀Scoring฀and฀ Coronary฀Angiography฀Compared฀With฀Conventional฀ Diagnostic฀Coronary฀Angiography Duncan฀R.฀Coles,฀Mary฀Smail,฀Ian฀Negus,฀Peter฀Wilde,฀Martin฀Oberhoff,฀Karl฀Karsch,฀ Andreas฀Baumbach,฀Bristol฀Royal฀Infirmary,฀Bristol,฀United฀Kingdom Background:฀ Developments฀ in฀ technology฀ have฀ made฀ multislice฀ CT฀ (MSCT)฀ a฀ viable฀ modality฀ for฀ cardiac฀ imaging.฀ We฀ compare฀ the฀ effective฀ dose฀ from฀ MSCT฀ coronary฀ angiography฀with฀that฀from฀conventional฀diagnostic฀angiography.฀The฀effective฀dose฀from฀ calcium฀scoring฀scans฀is฀also฀estimated,฀together฀with฀the฀effect฀of฀ECG-controlled฀tube฀ current฀modulation฀for฀radiation฀dose฀reduction.฀MSCT฀is฀a฀potentially฀high฀dose฀imaging฀ technique฀and฀the฀relative฀radiation฀risk฀should฀be฀understood฀before฀incorporating฀it฀into฀ clinical฀protocols. Methods:฀ In฀ a฀ prospective฀ study฀ 94฀ patients฀ with฀ suspected฀ coronary฀ artery฀ disease฀ underwent฀ both฀ Coronary฀ MSCT฀ (Siemens฀ Sensation฀ 16)฀ and฀ conventional฀ coronary฀ angiography฀ (Siemens฀ Axiom฀ Artis฀ FC/BC).฀ CT฀ exposure฀ data฀ was฀ collected฀ for฀ the฀ complete฀ coronary฀ MSCT฀ protocol฀ including฀ calcium฀ scoring฀ (12x1.5mm฀ collimation)฀ without฀ (Group฀ 1:฀ n=52)฀ and฀ with฀ ECG-controlled฀ tube฀ current฀ modulation฀ (Group฀ 2:฀ n=42).฀MSCT฀coronary฀angiography,฀including฀test฀bolus฀scans,฀used฀either฀12x0.75mm฀ collimation฀ (Group฀ 1)฀ or฀ 16x0.75mm฀ collimation฀ (Group฀ 2).฀ Effective฀ doses฀ were฀ estimated฀using฀the฀NRPB/ImPACT฀CT฀dosimetry฀calculator.฀Exposure฀data฀was฀collected฀ for฀conventional฀angiography฀using฀a฀single฀or฀bi-plane฀system฀and฀effective฀doses฀were฀ estimated฀using฀PCXMC. Results:฀The฀mean฀effective฀dose฀for฀MSCT฀coronary฀angiography฀including฀test฀bolus฀ was฀14.5฀mSv;s.d฀2.3฀for฀12฀detectors฀(Group฀1)฀and฀15.5฀mSv;s.d.฀3.3฀for฀16฀detectors฀ (Group฀ 2),฀ while฀ that฀ for฀ conventional฀ angiography฀ was฀ 5.7mSv;s.d.฀ 3.7฀ (Group฀ 1)฀ and฀ 5.3mSv;s.d.฀3.3.฀(Group฀2).฀The฀mean฀effective฀dose฀for฀calcium฀scoring฀was฀4.0฀mSv;s. d.฀ 0.3;฀ and฀ with฀ ECG-controlled฀ tube฀ current฀ modulation฀ prospectively฀ applied฀ mean฀ effective฀dose฀was฀reduced฀by฀35%฀to฀2.6mSv;s.d.฀0.3. 1054-86฀ Comparison฀of฀Multislice฀Computed฀Tomography฀with฀ Conventional฀Coronary฀Angiography฀for฀the฀Detection฀ of฀In-stent฀Restenosis฀in฀the฀Left฀Main฀Coronary฀Artery Carlos฀Van฀Mieghem,฀Erasmus฀Medical฀Center,฀Rotterdam,฀The฀Netherlands Background:฀Multislice฀computed฀tomography฀(MSCT)฀is฀a฀promising฀technique฀for฀noninvasive฀evaluation฀of฀the฀coronary฀arteries.฀We฀evaluated฀the฀diagnostic฀performance฀of฀ MSCT฀to฀non-invasively฀detect฀in-stent฀restenosis฀after฀stenting฀of฀the฀left฀main฀coronary฀ artery. Methods:฀At฀our฀institution฀all฀patients฀who฀underwent฀stenting฀of฀the฀left฀main฀coronary฀ artery฀(LMCA)฀are฀systematically฀being฀evaluated฀with฀MSCT฀in฀addition฀to฀a฀conventional฀ coronary฀ angiogram฀ from฀ March฀ 2004฀ on.฀ So฀ far฀ we฀ performed฀ MSCT฀ coronary฀ angiography฀in฀41฀patients฀(34฀men,฀62฀±฀10฀years)฀scheduled฀for฀conventional฀coronary฀ angiography฀6฀months฀after฀stenting฀of฀the฀LMCA.฀All฀scans฀were฀performed฀using฀a฀16-฀or฀ 64-slice฀CT฀scanner฀equipped฀with฀a฀high฀X-ray฀tube฀rotation฀time฀(375฀ms฀and฀330฀ms,฀ respectively).฀Only฀patients฀with฀a฀regular฀heart฀rhythm,฀able฀to฀breath฀hold฀for฀at฀least฀ 20฀seconds,฀and฀without฀contraindications฀to฀administer฀iodinated฀contrast฀material฀(e.g.฀ known฀allergy,฀impaired฀renal฀function,฀thyroid฀disorders)฀were฀included.฀A฀beta-blocker฀ was฀administered฀in฀case฀the฀patient’s฀heart฀rate฀was฀above฀65฀beats฀per฀minute.฀The฀ angiographic฀and฀MSCT฀analyses฀were฀performed฀independently฀from฀each฀other฀by฀one,฀ respectively฀ two฀ observers.฀ In-stent฀ restenosis฀ was฀ defined฀ angiographically฀ as฀ ≥50%฀ diameter฀stenosis฀at฀follow-up.฀The฀stent(s)฀in฀the฀LMCA฀were฀analyzed฀by฀MSCT฀using฀ following฀criteria:฀0-normal฀lumen;฀1-restenosis;฀2-฀occlusion. Results:฀All฀scans฀were฀performed฀within฀1฀week฀of฀the฀conventional฀coronary฀angiogram.฀ Mean฀ heart฀ rate฀ during฀ the฀ scan฀ was฀ 56+/-6฀ beats/minute.฀ Total฀ scan฀ time฀ was฀ 18.2฀ (16-slice)฀ and฀ 13.1฀ seconds฀ (64-slice).฀ Image฀ quality฀ of฀ MSCT-scans฀ was฀ sufficient฀ for฀ analysis฀in฀38฀of฀the฀41฀(93%)฀patients.฀The฀sensitivity,฀specificity,฀positive฀and฀negative฀ predictive฀value฀of฀MSCT฀to฀identify฀in-stent฀restenosis฀was฀100%,฀77%,฀27%฀and฀100%฀ respectively. Conclusions:฀Current฀MSCT฀technology,฀in฀combination฀with฀optimal฀heart฀rate฀control,฀ allows฀to฀reliably฀exclude฀in-stent฀restenosis฀within฀the฀left฀main฀coronary฀artery.฀In฀this฀ particular฀ group฀ of฀ patients,฀ an฀ initial฀ non-invasive฀ evaluation฀ of฀ the฀ coronary฀ tree฀ thus฀ seems฀possible.฀ Noninvasive Imaging Background:฀The฀new฀64-slice฀Multi-detector฀Computed฀Tomography฀(MDCT)scanner฀is฀ equipped฀with฀higher฀spatial฀resolution฀(0.4฀mm฀in฀every฀dimension)฀and฀a฀faster฀rotation฀ time฀ (330฀ ms)฀ when฀ compared฀ to฀ previous฀ scanner฀ generations.฀ We฀ compared฀ the฀ diagnostic฀value฀of฀non-invasive฀64-slice฀MDCT฀coronary฀angiography฀to฀detect฀significant฀ stenoses฀(≥50%฀lumen฀diameter฀reduction)฀with฀that฀of฀invasive฀coronary฀angiography.฀ Methods:฀ We฀ studied฀ 30฀ patients฀ (18฀ men,฀ mean฀ age฀ 57.5±6.7฀ years)฀ with฀ stable฀ angina฀or฀an฀acute฀coronary฀syndrome฀prior฀to฀diagnostic฀conventional฀angiography.฀Only฀ patients฀in฀sinus฀rhythm,฀who฀had฀never฀undergone฀angioplasty฀or฀bypass฀surgery฀and฀ were฀able฀to฀breath-hold฀for฀15฀seconds,฀were฀included.฀Patients฀in฀whom฀administration฀of฀ intravenous฀iodinated฀contrast฀material฀was฀contraindicated฀(e.g.฀known฀allergy,฀impaired฀ renal฀ function,฀ or฀ thyroid฀ disorders)฀ were฀ excluded.฀ Patients฀ with฀ pre-scan฀ heart฀ rates฀ ≥70฀ beats/minute฀ received฀ oral฀ β-blockade.฀ The฀ heart฀ was฀ scanned฀ after฀ intravenous฀ injection฀of฀100฀ml฀contrast.฀The฀MSCT-scans฀were฀analysed฀by฀2฀observers฀unaware฀of฀ the฀results฀of฀invasive฀angiography฀and฀all฀main฀coronary฀arteries฀and฀≥1.5฀mm฀branches฀ were฀included฀for฀comparison฀with฀quantitative฀coronary฀angiography. Results:฀Eighty-seven฀percent฀of฀the฀included฀patients฀received฀a฀β-blocker.฀The฀mean฀ heart฀ rate฀ was฀ 57.7±7.0฀ beats/minute฀ and฀ the฀ total฀ scan-time฀ was฀ 13.1±1.1฀ seconds.฀ Invasive฀coronary฀angiography฀demonstrated฀no฀significant฀stenosis฀in฀20%฀(6/30),฀singlevessel฀disease฀in฀23%฀(7/30),฀and฀multi-vessel฀disease฀in฀57%฀(17/30)฀of฀patients.฀There฀ were฀ 47฀ significantly฀ obstructed฀ vessels.฀ Sensitivity,฀ specificity,฀ positive฀ and฀ negative฀ predictive฀value฀for฀detection฀of฀significantly฀obstructed฀vessels฀were฀96%฀(47/49,฀95%฀CI฀ 86-97),฀89%฀(63/71,฀95%฀CI฀79-95),฀85%฀(47/55,฀95%฀CI฀73-95),฀and฀97%฀(63/65,฀95%฀ CI฀89-99)฀respectively. Conclusions:฀64-slice฀MDCT฀coronary฀angiography฀reliably฀detects฀significant฀coronary฀ stenoses฀in฀patients฀with฀stable฀angina฀pectoris฀or฀an฀acute฀coronary฀syndrome. Background:฀The฀aim฀of฀this฀study฀was฀to฀evaluate฀the฀ability฀to฀assess฀the฀coronary฀instent฀lumen฀in฀the฀presence฀of฀significant฀stenosis฀in฀multislice฀CT฀(MSCT) Methods:฀Thirty-nine฀coronary฀artery฀stents฀in฀32฀patients฀with฀angiographically฀significant฀ stenosis฀were฀examined฀with฀both฀16-slice฀MSCT฀and฀intracoronary฀ultrasound฀(ICUS).฀ MIP,฀MPR,฀and฀cross-sectional฀images฀were฀assessed฀for฀MSCT฀image฀analysis฀with฀the฀ use฀of฀a฀medium฀edge฀enhancement฀kernel฀B41f.฀Images฀were฀analyzed฀regarding฀lumen฀ visibility,฀in-stent฀CT฀density,฀and฀quantification฀of฀minimum฀in-stent฀lumen฀area฀(MLA),฀ plaque฀ area฀ (PA),฀ and฀ stent฀ area฀ (SA).฀ Data฀ at฀ the฀ most฀ stenotic฀ cross-sections฀ were฀ used฀for฀the฀analysis.฀SA,฀MLA,฀and฀PA฀were฀obtained฀by฀visual฀assessment฀in฀the฀crosssectional฀images฀of฀MSCT฀using฀digital฀caliper,฀and฀compared฀with฀ICUS฀findings.฀MSCT฀ quantification฀of฀SA,฀MLA,฀and฀PA฀was฀evaluated฀by฀the฀use฀of฀linear฀regression฀analysis฀ and฀the฀Bland-Altman฀analysis฀with฀ICUS฀as฀a฀reference฀standard. Results:฀Five฀stents฀were฀unevaluable฀due฀to฀severe฀calcification฀and/or฀motion฀artifacts.฀ Mean฀angiographic฀%฀stenosis฀in฀34฀evaluable฀stents฀was฀67.2฀%.฀Mean฀artificial฀lumen฀ narrowings฀were฀46฀%฀in฀2.5mm฀stents,฀32฀%฀in฀3mm฀stents,฀27฀%฀in฀3.5mm฀stents,฀and฀ 22฀%฀in฀4mm฀stents,฀respectively฀(p<0.01).฀Lowest฀in-stent฀lumen฀CT฀density฀(HU)฀was฀ 155฀ ±฀ 71,฀ whereas฀ mean฀ patent฀ in-stent฀ attenuation฀ value฀ (HU)฀ and฀ mean฀ CT฀ density฀ at฀the฀reference฀native฀segment฀were฀382฀±฀66,฀and฀329฀±฀53,฀respectively.฀In฀thin฀strut฀ stents,฀significantly฀less฀artificial฀lumen฀narrowing฀and฀lower฀in-stent฀lumen฀CT฀density฀ were฀observed฀(Multilink฀PlusTM฀:฀23฀±฀8฀%,฀128฀±฀69฀HU฀;฀Multilink฀TristarTM฀:฀34฀±฀10%,฀ 156฀ ±฀ 73฀ HU,฀ p<0.05).฀ SA฀ in฀ MSCT฀ correlated฀ closely฀ to฀ ICUS฀ findings฀ (r฀ =฀ 0.94,฀ p฀ <฀ 0.001),฀although฀systematical฀underestimation฀was฀observed฀in฀MSCT.฀Both฀MLA฀and฀PA฀ in฀MSCT฀also฀significantly฀correlated฀to฀ICUS฀findings฀(r฀=฀0.78,฀r฀=฀0.92,฀respectively). Conclusion:฀MSCT฀evaluation฀of฀stenotic฀coronary฀stents฀is฀feasible฀and฀correct฀when฀ using฀ ICUS฀ as฀ a฀ standard฀ of฀ reference.฀ These฀ data฀ may฀ provide฀ the฀ information฀ of฀ applying฀MSCT฀for฀assessing฀in-stent฀lumen฀stenosis฀and฀justify฀the฀efforts฀to฀develop฀the฀ stents฀with฀regard฀to฀artifacts. 268A ABSTRACTS - Noninvasive Imaging POSTER฀SESSION 1055฀฀ Positron฀Emission฀Tomography฀ and฀Novel฀Single-Photon฀Emission฀ Computed฀Tomography฀Approaches Sunday,฀March฀06,฀2005,฀1:30฀p.m.-5:00฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀1:30฀p.m.-2:30฀p.m. 1055-87฀ Impact฀of฀Biventricular฀Pacing฀in฀Heart฀Failure฀on฀ Myocardial฀Blood฀Flow฀at฀Exercise Noninvasive Imaging Pascal฀Koepfli,฀Patrick฀T.฀Siegrist,฀Corinna฀Brunckhorst,฀Christoph฀Scharf,฀Michael฀ Klainguti,฀Mehdi฀Namdar,฀Christoph฀A.฀Wyss,฀Philipp฀A.฀Kaufmann,฀University฀Hospital,฀ Zurich,฀Switzerland Background:฀Biventricular฀pacing฀(bivPM)฀improves฀left฀ventricular฀(LV)฀performance฀by฀ electromechanical฀resynchronization.฀However,฀it฀remains฀unclear฀whether฀the฀optimized฀ LV฀function฀is฀due฀to฀increased฀myocardial฀contractility,฀requiring฀an฀increase฀in฀oxygen฀ consumption.฀ This฀ could฀ be฀ potentially฀ hazardous฀ in฀ patients฀ who฀ cannot฀ meet฀ the฀ increased฀oxygen฀demand฀due฀to฀reduced฀myocardial฀perfusion฀reserve. Aim:฀To฀ assess฀ the฀ impact฀ of฀ optimal฀ biventricular฀ pacing฀ on฀ LV฀ myocardial฀ blood฀ flow฀ (MBF)฀pattern. Methods:฀ MBF฀ was฀ assessed฀ by฀ positron฀ emission฀ tomography฀ (PET)฀ and฀ 15O-labeled฀ water฀in฀4฀patients฀(age฀68±4฀years)฀with฀chronic฀severe฀congestive฀heart฀failure฀at฀rest,฀during฀ standard฀adenosine฀stress฀and฀immediately฀after฀bicycle฀exercise฀(45±10฀watts)฀in฀the฀PET฀ scanner.฀All฀MBF฀measurements฀were฀performed฀with฀bivPM฀off฀and฀repeated฀with฀bivPM฀on฀ (identical฀exercise฀workload).฀Pacing฀was฀programmed฀to฀atrial฀sensing฀followed฀by฀ventricular฀ pacing฀in฀order฀to฀allow฀a฀physiological฀heart฀rate฀response฀during฀exercise.฀Coronary฀flow฀ reserve฀was฀calculated฀as฀hyperemic฀(adenosine฀and฀bicycle฀stress)฀/฀resting฀MBF. Results:฀Global฀MBF฀(ml/g/min)฀was฀not฀affected฀by฀bivPM:฀0.88±0.09฀(bivPM฀off)฀vs.฀ 0.98±0.12฀ (bivPM฀ on)฀ at฀ rest,฀ 1.45±0.43฀ (bivPM฀ off)฀ vs.฀ 1.47±0.49฀ (bivPM฀ on)฀ during฀ adenosine฀and฀1.23±0.13฀(bivPM฀off)฀vs.฀1.23±0.10฀(bivPM฀on)฀after฀bicycle฀stress฀(all฀ p-values฀=฀ns).฀Also฀regional฀MBF,฀coronary฀flow฀reserve฀and฀rate฀pressure฀product฀did฀ not฀differ฀with฀PM฀off฀and฀on. Conclusion:฀Although฀biventricular฀pacing฀improves฀LV฀performance฀it฀is฀not฀associated฀ with฀ an฀ increase฀ in฀ MBF฀ neither฀ at฀ rest฀ nor฀ at฀ pharmacological฀ or฀ physical฀ exercise฀ stress.฀ Our฀ findings฀ suggest,฀ that฀ biventricular฀ pacing฀ improves฀ LV฀ function฀ mainly฀ by฀ resynchronization฀rather฀than฀by฀increasing฀myocardial฀contractility,฀supporting฀its฀use฀in฀ patients฀with฀impaired฀flow฀reserve. 1055-88฀ Impaired฀Microvascular฀Function฀Within฀NoninfarctRelated฀Area฀May฀Relate฀to฀Left฀Ventricular฀Remodeling฀ After฀Myocardial฀Infarction Tohru฀Geshi,฀Jong-Dae฀Lee,฀Akira฀Nakano,฀Hiroyasu฀Uzui,฀Reiko฀Nakaya,฀Kiyohiro฀ Toyoda,฀Naoki฀Amaya,฀Haruhisa฀Shirasaki,฀Toshihiro฀Mizuguchi,฀Takanori฀Ueda,฀ Hidehiko฀Okazawa,฀Yoshiharu฀Yonekura,฀University฀of฀Fukui,฀Fukui,฀Japan Background/Aim:฀ Several฀ studies฀ have฀ shown฀ that฀ impaired฀ myocardial฀ flow฀ reserve฀ (MFR)฀within฀non-infarct-related฀area฀(NIRA)฀early฀after฀the฀onset฀of฀myocardial฀infarction฀ (MI)฀ persists฀ over฀ 6฀ months฀ period.฀ However,฀ the฀ relationship฀ between฀ the฀ extent฀ of฀ microvascular฀impairment฀within฀NIRA฀and฀left฀ventricular฀(LV)฀remodeling฀is฀still฀unknown.฀ The฀aim฀of฀this฀study฀was฀to฀elucidate฀whether฀the฀impaired฀microvascular฀function฀within฀ NIRA฀relates฀to฀LV฀remodeling฀after฀MI.฀ Methods:฀ We฀ prospectively฀ studied฀ 15฀ patients฀ (9฀ men,฀ mean฀ 69฀ yrs)฀ with฀ first฀ MI฀ who฀ underwent฀ successful฀ coronary฀ angioplasty฀ within฀ 12฀ hours฀ after฀ the฀ onset.฀ All฀ patients฀ had฀ single฀ vessel฀ disease฀ and฀ showed฀ no฀ restenosis฀ in฀ infarct-related฀ artery฀ during฀ observation฀ period.฀ The฀ MFR฀ within฀ NIRA฀ and฀ infarct-related฀ area฀ (IRA)฀ was฀ assessed฀using฀ 13N฀ammonia฀positron฀emission฀tomography฀at฀2฀weeks฀after฀the฀onset.฀ Peak฀creatinine฀phosphokinase฀(CPK)฀and฀defect฀score฀in฀ 99mTc-tetrofosmin฀myocardial฀ perfusion฀ imaging฀ (TF)฀ were฀ used฀ for฀ defining฀ as฀ the฀ severity฀ of฀ myocardial฀ infarction.฀ LV฀ end-diastolic฀ volume฀ index฀ (LVEDVI)฀ and฀ the฀ change฀ in฀ LVEDVI฀ (ΔLVEDVI)฀ were฀ measured฀using฀left฀ventriculography฀at฀the฀onset฀and฀1฀month฀later.฀ Results:฀The฀MFR฀within฀NIRA฀was฀2.02฀±฀1.67,฀which฀was฀lower฀than฀normal฀values฀as฀ previously฀ reported.฀When฀ patients฀ were฀ re-classified฀ into฀ group฀ S฀ (severely฀ impaired,฀ MFR฀<฀2.0)฀and฀group฀M฀(mildly฀impaired,฀MFR฀≥฀2.0),฀the฀peak฀CPK฀(8971฀±฀5158฀IU/l฀vs.฀ 2575฀±฀2193฀IU/l,฀p฀=฀0.014),฀the฀defect฀score฀in฀TF฀(19.0฀±฀2.6฀vs.฀8.8฀±฀7.3,฀p฀=฀0.047),฀ LVEDVI฀at฀1฀month฀(150.1฀±฀9.0฀ml/m2฀vs.฀80.6฀±฀19.6฀ml/m2,฀p฀=฀0.003),฀and฀ΔLVEDVI฀ (30.5฀±฀2.4฀ml/m2฀vs.฀-10.7฀±฀8.9฀ml/m2,฀p฀=฀0.0004)฀were฀significantly฀greater฀in฀group฀S฀ than฀group฀M.฀The฀MFR฀within฀NIRA฀was฀inversely฀correlated฀with฀the฀LVEDVI฀at฀1฀month฀ (r฀=฀-0.734,฀p฀=฀0.01)฀as฀the฀MFR฀within฀IRA฀(r฀=฀-0.898,฀p฀=฀0.00017)฀was.฀ Conclusion:฀Data฀indicated฀that฀microvascular฀impairment฀within฀NIRA฀was฀related฀to฀the฀ severity฀of฀myocardial฀infarction,฀and฀might฀contribute฀to฀LV฀remodeling฀after฀MI. 1055-89฀ Calcium฀Antagonists฀did฀not฀improve฀BMIPP฀Cardiac฀ Scintigraphy฀in฀Patients฀With฀Pure฀Coronary฀Spastic฀ Angina Shozo฀Sueda,฀Yousuke฀Izoe,฀Hiroshi฀Fukuda,฀Saiseikai฀Saijo฀Hospital,฀Saijo,฀Japan Background:฀Medical฀therapy฀including฀a฀calcium฀antagonist฀(Ca)฀has฀been฀effective฀to฀ reduce฀angina฀attacks฀in฀pts฀with฀variant฀angina.฀However,฀there฀are฀no฀reports฀regarding฀ the฀effectiveness฀of฀Ca฀on฀myocardial฀BMIPP฀images฀in฀pts฀with฀pure฀coronary฀spastic฀ angina฀(CSA).This฀study฀sought฀to฀examine฀the฀correlation฀between฀BMIPP฀scintigraphy฀ and฀the฀effectiveness฀of฀Ca฀administration฀in฀pts฀with฀pure฀CSA. JACC February 1, 2005 Methods:฀This฀study฀included฀35฀consecutive฀pts฀(28฀men,฀mean฀age฀of฀66±10฀years)฀with฀ angiographically฀confirmed฀CSA฀and฀no฀fixed฀stenosis.฀Long฀acting฀Ca฀was฀administered฀ in฀all฀35฀pts.฀Isosorbide฀dinitrate฀/฀nicorandil฀/฀another฀Ca฀/฀beta-bloker฀was฀administered฀ when฀chest฀pain฀was฀not฀controlled.฀Using฀an฀iodinated฀fatty฀acid฀analogue,฀15-(p-[iodine123]฀iodophenyl)-3-(R,S)฀methylpentadecanoic฀acid฀(BMIPP),฀cardiac฀scintigraphies฀with฀ intravenous฀adenosin฀triphosphate฀infusion฀were฀performed฀before฀cardiac฀catheterization฀ 12฀mo฀and฀24฀mo฀after฀medical฀therapy.฀According฀to฀the฀control฀states,฀these฀35฀pts฀were฀ classified฀ into฀ 3฀ groups;฀ good฀ (disappearance฀ of฀ angina฀ attacks,฀ 11฀ pts,฀ 60±11฀ years),฀ moderate฀(angina฀attacks฀<฀4/mo,฀12฀pts,฀67±10฀years),฀and฀poor฀control฀(angina฀attacks฀ >฀4/mo,฀12฀pts,฀71±6฀years). Results:฀Reduced฀BMIPP฀uptake฀was฀observed฀in฀24฀(69%)฀of฀35฀pts฀before฀the฀treatment.฀ Reduced฀BMIPP฀uptake฀was฀also฀found฀in฀16฀pts฀(46%)฀after฀12฀mo,฀and฀in฀17฀pts฀(49%)฀ after฀24฀mo.฀Normal฀BMIPP฀uptake฀after฀24฀mo฀therapy฀was฀observed฀in฀about฀half฀of฀ pts฀ among฀ the฀ 3฀ groups.฀There฀ was฀ no฀ difference฀ regarding฀ the฀ value฀ of฀ washout฀ rate฀ among฀the฀3฀groups.฀The฀defect฀scores฀of฀BMIPP(DS)฀in฀the฀good฀and฀moderate฀control฀ groups฀were฀not฀different฀during฀the฀two฀years฀medical฀therapy,฀while฀DS฀in฀the฀poor฀group฀ was฀significantly฀decreased฀in฀12฀mo฀and฀24฀mo฀(10.3±6.3฀(before)฀vs.฀6.8±5.7฀(12฀mo),฀ 6.4±7.0฀(24฀mo),฀p<0.05).The฀administration฀of฀Ca฀and฀isosorbide฀dinitrate/nicorandil฀and฀ 2฀Ca฀were฀significantly฀higher฀in฀the฀poor฀than฀in฀the฀good฀control฀pts. Conclusion:฀Medical฀therapy฀including฀a฀long฀acting฀Ca฀did฀not฀improve฀myocardial฀fatty฀ acid฀metabolic฀images฀in฀pts฀with฀pure฀CSA.฀It฀may฀be฀concerned฀silent฀ischemia฀due฀to฀ coronary฀vasospasm,฀irrespective฀of฀the฀disappearance฀of฀anginal฀attacks. 1055-90฀ Myocardial฀Salvage฀in฀Acute฀Myocardial฀Infarction:฀ Thrombectomy฀Versus฀Addition฀of฀a฀Distal฀Embolic฀ Protection฀Device฀to฀Primary฀Angioplasty Noriaki฀Ito,฀Takakazu฀Morozumi,฀Shinsuke฀Nanto,฀Masaaki฀Uematsu,฀Jun-ichi฀Kotani,฀ Masaki฀Awata,฀Toshinari฀Onishi,฀Osamu฀Iida,฀Fusako฀Oshima,฀Hitoshi฀Minamiguchi,฀ Seiki฀Nagata,฀Kansai฀Rosai฀Hospital,฀Amagasaki,฀Japan Background:฀ Thrombectomy฀ prior฀ to฀ primary฀ angioplasty฀ as฀ well฀ as฀ distal฀ embolic฀ protection฀ assisted฀ angioplasty฀ has฀ recently฀ been฀ attempted฀ in฀ patients฀ with฀ acute฀ myocardial฀infarction฀(AMI).฀However,฀whether฀the฀combination฀of฀distal฀protection฀further฀ salvage฀ myocardium฀ at฀ risk฀ remains฀ unclear.฀ Methods:฀ We฀ studied฀ 61฀ consecutive฀ patients฀with฀AMI฀(51฀males,฀age฀ranged฀38-86฀years)฀between฀April฀1999฀and฀August฀ 2003.฀Twenty-one฀patients฀received฀extensive฀thrombectomy฀prior฀to฀angioplasty฀and฀9฀ patients฀were฀treated฀with฀a฀balloon฀type฀distal฀protection฀after฀thrombectomy,฀whereas฀ 31฀ patients฀ received฀ neither฀ thrombectomy฀ nor฀ distal฀ protection.฀ Myocardial฀ salvage฀ was฀ quantified฀ by฀ myocardial฀ perfusion฀ SPECT฀ performed฀ before฀ and฀ two฀ weeks฀ after฀ the฀procedure.฀The฀defect฀extent฀score฀(ES)฀and฀the฀severity฀score฀(SS)฀were฀analyzed.฀ Myocardial฀salvage฀was฀evaluated฀by฀%฀change฀in฀ES:฀[฀(preES-postES)/preESx100]฀and฀ that฀in฀SS:฀[฀(preSS-postSS)/preSSx100].฀Results:฀Patients’฀demographics;฀pre-procedural฀ TIMI฀flow฀grades;฀elapsed฀time฀from฀the฀onset฀to฀angioplasty;฀ES฀and฀SS฀on฀admission;฀ peak฀ CPK฀ and฀ peak฀ CK-MB;฀ final฀ TIMI฀ flow฀ grades;฀ ES฀ and฀ SS฀ after฀ the฀ procedure฀ were฀ all฀ similar฀ among฀ the฀ groups.฀ Nonetheless,฀ changes฀ in฀ ES฀ and฀ SS฀ indicated฀ the฀ beneficial฀effect฀of฀thrombectomy฀(Figure).฀Conclusion:฀Thrombectomy฀prior฀to฀primary฀ angioplasty฀improved฀myocardial฀salvage฀in฀AMI.฀Addition฀of฀the฀distal฀embolic฀protection฀ to฀thombectomy฀could฀not฀further฀salvage฀the฀myocardium฀at฀risk.฀ 1055-91฀ Myocardial฀Efficiency฀Reserve฀Predicts฀the฀ Deterioration฀in฀Exercise฀Capacity฀Over฀Time฀in฀Patients฀ with฀Heart฀Failure Keiichiro฀Yoshinaga,฀Heikki฀Ukkonen,฀Ian฀Burwash,฀Robert฀deKemp,฀William฀Dafoe,฀ Ross฀A.฀Davies,฀Haissam฀Haddad,฀Terrence฀D.฀Ruddy,฀Jean฀N.฀DaSilva,฀Rob฀Beanlands,฀ University฀of฀Ottawa฀Heart฀Institute,฀Ottawa,฀ON,฀Canada Backgrounds:฀ Myocardial฀ efficiency฀ (ME)฀ and฀ ME฀ reserve฀ (MER)฀ can฀ be฀ estimated฀ non-invasively฀ using฀ C-11฀ acetate฀ PET฀ measurement฀ of฀ oxidative฀ metabolism฀ and฀ echocardiographic฀ measurement฀ of฀ stroke฀ volume฀ (SV)฀ at฀ rest฀ and฀ during฀ dobutamine฀ infusion.฀In฀patients฀with฀heart฀failure฀(HF),฀ME฀have฀been฀shown฀to฀be฀a฀strong฀predictor฀ of฀survival.฀However,฀the฀potential฀utility฀of฀ME฀or฀MER฀for฀predicting฀the฀functional฀capacity฀ of฀HF฀patients฀in฀follow-up฀has฀not฀been฀defined.฀We฀investigated฀whether฀ME฀and฀MER฀ could฀provide฀prognostic฀information฀on฀the฀exercise฀(Ex)฀capacity฀of฀HF฀patients฀over฀time.฀ Methods:฀25฀patients฀with฀HF฀were฀prospectively฀studied฀[age=66+8฀yrs,฀LVEF=31+8%,฀ ischemic฀(n=18)].฀ME฀was฀estimated฀by฀the฀Work-Metabolic฀Index฀(WMI฀=฀SV฀index฀(SVI)฀ x฀HR฀x฀systolic฀BP/฀k-mono,฀where฀k-mono฀is฀the฀monoexponential฀fit฀of฀the฀myocardial฀ C-11฀acetate฀PET฀time-activity฀curve).฀MER฀was฀derived฀from฀the฀%฀change฀of฀WMI฀at฀ rest฀and฀during฀dobutamine฀infusion฀(10฀µg/kg/min).฀Ex฀capacity฀[maximal฀oxygen฀uptake฀ (Peak฀VO2)]฀was฀measured฀at฀baseline฀and฀at฀6฀months฀follow฀up฀in฀all฀patients.฀Worsening฀ Ex฀capacity฀was฀defined฀as฀>฀10%฀decrease฀in฀peak฀VO2.฀ JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging ฀ Results:฀At฀the฀baseline฀study,฀dobutamine฀infusion฀resulted฀in฀an฀increase฀in฀SVI฀(35+9 to฀40+9฀ml/m2,฀p<0.001),฀k-mono฀(0.047+0.009฀ to฀0.061+0.013/min,฀p<0.001)฀and฀WMI฀ (6.1+1.7X104฀ to฀ 7.9+1.8X104,฀ p<0.001).฀ MER฀ was฀ 32+26%.฀ From฀ baseline฀ to฀ 6-month฀ follow-up,฀Ex฀workload฀and฀peakVO2฀decreased฀from฀4.8+1.4฀to฀4.3+1.1METS฀(p<0.03),฀ and฀16.7+4.8฀to฀15.2+3.8฀ml/kg/min฀(p=0.057),฀respectively.฀Among฀rest฀and฀dobutamine฀ parameters,฀ only฀ MER฀ correlated฀ with฀ the฀ change฀ in฀ Ex฀ capacity฀ over฀ time฀ (r=0.56,฀ p<0.005).฀ An฀ MER฀ <฀ 35%฀ predicted฀ a฀ worsening฀ exercise฀ capacity฀ with฀ a฀ sensitivity,฀ specificity,฀PPV฀and฀NPV฀of฀79%,฀82%,฀85%,฀and฀75%,฀respectively.฀ Conclusions:฀ Myocardial฀ efficiency฀ reserve฀ correlates฀ with฀ the฀ change฀ in฀ exercise฀ capacity฀ over฀ time฀ in฀ patients฀ with฀ HF.฀ A฀ myocardial฀ efficiency฀ reserve฀ <฀ 35%฀ predicts฀ functional฀deterioration฀with฀good฀accuracy.฀The฀myocardial฀efficiency฀reserve฀may฀be฀a฀ useful฀clinical฀prognostic฀parameter฀in฀heart฀failure฀patients. 1055-92฀ Association฀Between฀Lung฀Heart฀Ratio฀and฀Body฀Mass฀ Index฀on฀stress฀99m฀Tc฀Sestamibi฀SPECT฀Perfusion฀ Imaging Hitender฀Jain,฀Raymond฀Russell,฀Frans฀J.฀Th.฀Wackers,฀Yale฀University฀Hospital,฀New฀Haven,฀CT 1055-93฀ Myocardial฀Perfusion฀Imaging฀and฀Cardiac฀Troponin฀ T฀Provide฀Complementary฀Information฀for฀Identifying฀ Patients฀with฀Acute฀Coronary฀Syndrome฀in฀the฀ Emergency฀Department Taku฀Sakai,฀Yasunori฀Ueda,฀Yuji฀Okuyama,฀Yuzuru฀Takano,฀Sei฀Komatsu,฀Isamu฀Mizote,฀ Atsushi฀Hirayama,฀Kazuhisa฀Kodama,฀Osaka฀Police฀Hospital,฀Osaka,฀Japan Background:฀ Definite฀ identification฀ of฀ patients฀ with฀ acute฀ coronary฀ syndrome฀ (ACS)฀ among฀those฀who฀admitted฀to฀emergency฀department฀with฀possible฀myocardial฀ischemia฀ is฀ difficult.฀ Myocardial฀ perfusion฀ imaging฀ with฀ technetium-99m฀ and฀ cardiac฀ troponin฀ T฀ (cTnT)฀both฀can฀identify฀patients฀with฀acute฀coronary฀syndrome. Objectives:฀The฀purpose฀of฀this฀study฀was฀to฀compare฀the฀ability฀of฀myocardial฀perfusion฀ imaging฀and฀cTnT฀assessment฀to฀identify฀patients฀with฀ACS,฀and฀to฀evaluate฀the฀efficacy฀ to฀determine฀early฀invasive฀strategy฀in฀patients฀presenting฀to฀the฀emergency฀department฀ with฀chest฀pain. Methods:฀Patients฀considered฀ACS฀underwent฀technetium-99m฀tetrofosmin฀single฀photon฀ emission฀ computed฀ tomography฀ (SPECT)฀ and฀ measurements฀ of฀ cTnT฀ on฀ admission.฀ Positive฀myocardial฀perfusion฀imageing฀was฀defined฀as฀a฀perfusion฀defect฀with฀associated฀ abnormalities฀in฀echocardiographic฀wall฀motion.฀cTnT≥0.1µg/l฀was฀considered฀abnomal. Results:฀ Among฀ the฀ 190฀ patients฀ studied,฀ 140฀ patients฀ were฀ diagnosed฀ as฀ ACS.฀ Of฀ these฀ACS฀patients,฀113฀(59.5%)฀underwent฀revasculization฀therapy฀.฀Perfusion฀imaging,฀ cTnT฀were฀positive฀in฀144฀(75.8%),฀97฀(48.7%)฀patients฀respectively;฀of฀those฀patients,฀ 123฀ (64.7%),฀ 85฀ (44.7%)฀ patients฀ were฀ diagnosed฀ ACS.฀ Among฀ 55฀ ACS฀ patients฀ with฀ negative฀cTnT฀value,฀41฀(74.5%)฀patients฀had฀positive฀perfusion฀imaging,฀and฀underwent฀ revasculization฀in฀39฀(70.9%)฀patients.฀Sensitivity฀of฀ACS฀for฀perfusion฀imaging฀was฀higher฀ (87.9%)฀ than฀ for฀ cTnT฀ (60.7%),฀ and฀ specificity฀ of฀ ACS฀ was฀ not฀ significantly฀ different฀ between฀ perfusion฀ imaging฀ (58%)฀ and฀ cTnT฀ (60%).฀ Sensitivity฀ and฀ specificity฀ of฀ ACS฀ presenting฀positive฀perfusion฀defects฀with฀elevated฀cTnT฀were฀58.6%,฀80%. Conclusion:฀ Compared฀ with฀ cTnT,฀ sensitivity฀ of฀ perfusion฀ imaging฀ for฀ predicting฀ ACS฀ was฀ higher,฀ especially฀ for฀ patients฀ who฀ underwent฀ revasculization.฀ Positive฀ perfusion฀ imaging฀ with฀ elevated฀ cTnT฀ showed฀ higher฀ specificity฀ of฀ ACS฀ than฀ either฀ positive฀ perfusion฀ imaging฀ or฀ elevated฀ cTnT฀ alone.฀ Emergent฀ perfusion฀ imaging฀ and฀ cTnT฀ can฀ demonstrate฀complementary฀information฀for฀identifying฀patients฀with฀ACS,฀and฀useful฀for฀ deciding฀early฀invasive฀therapy. The฀Effect฀of฀Verapamil฀on฀Restoration฀of฀Myocardial฀ Perfusion฀and฀Functional฀Recovery฀in฀Patients฀with฀ Angiographic฀No-Reflow฀After฀Primary฀Percutaneous฀ Coronary฀Intervention Shigeo฀Umemura,฀Seishi฀Nakamura,฀Tetsuro฀Sugiura,฀Yoshiaki฀Tsuka,฀Tetsuya฀Kitamura,฀ Susumu฀Yoshida,฀Masato฀Baden,฀Toshiji฀Iwasaka,฀Kansai฀Medical฀University,฀Moriguchi,฀ Japan,฀Kochi฀Medical฀School,฀Kochi,฀Japan Background;฀Angiographic฀Thrombolysis฀in฀Myocardial฀Infarction฀(TIMI)฀flow฀grade฀<=2฀ after฀ primary฀ percutaneous฀ coronary฀ intervention฀ (PCI),฀ defined฀ as฀ angiographic฀ noreflow,฀predicts฀poor฀left฀ventricular฀functional฀recovery฀in฀patients฀with฀acute฀myocardial฀ infarction฀(MI). Methods;฀To฀ investigate฀ the฀ effect฀ of฀ verapamil฀ on฀ restoration฀ of฀ myocardial฀ perfusion฀ and฀ functional฀ recovery฀ in฀ patients฀ with฀ angiographic฀ no-reflow฀ after฀ PCI,฀ technetium99m฀ (99mTc)฀ tetrofosmin฀ single-photon฀ emission฀ tomographic฀ (SPET)฀ imagings฀ were฀ performed฀(before,฀immediately฀after฀and฀1฀month฀after฀PCI)฀in฀124฀consecutive฀patients฀ with฀acute฀MI.฀Defect฀score฀was฀calculated฀as฀the฀sum฀of฀perfusion฀defect฀in฀13-segment฀ model฀(scores฀of฀3,฀complete฀defect฀to฀0,฀normal฀perfusion).฀Asynergic฀score฀were฀serially฀ assessed฀by฀echocardiography฀before฀and฀1฀month฀later. Results;฀Of฀124฀patients,฀35฀patients฀(28%)฀had฀angiographic฀no-reflow฀and฀were฀divided฀ into฀two฀groups:฀23฀patients฀with฀verapamil฀(Group฀1)฀and฀12฀patients฀without฀verapamil฀ (Group฀2).฀Eighty-nine฀patients฀had฀TIMI฀grade฀3฀reflow฀after฀PCI฀(Group฀3).฀The฀change฀ in฀defect฀score฀at฀1฀month฀after฀PCI฀in฀Group฀1฀was฀significantly฀larger฀than฀that฀in฀Group฀ 2฀(12.8±5.3฀to฀7.6±4.8฀vs.฀15.3±4.7฀to฀12.0±5.8;฀p=0.02).฀Asynergic฀score฀improved฀more฀ at฀ 1฀ month฀ in฀ Group฀ 1฀ compared฀ to฀ that฀ in฀ Group฀ 2฀ (3.9±1.8฀ to฀ 1.3±1.4฀ vs.฀ 4.5±2.0฀ to฀ 3.0±2.5;฀p=0.03).฀Moreover,฀these฀improvements฀in฀Group฀1฀was฀identical฀to฀that฀in฀Group฀ 3฀(defect฀score:฀13.7±4.5฀to฀6.1±4.2,฀asynergic฀score:฀3.1±1.7฀to฀0.9±1.4). Conclusion;฀Thus,฀intracoronary฀verapamil฀restored฀myocardial฀perfusion฀in฀patients฀with฀ angiographic฀no-reflow฀after฀PCI฀and฀lead฀to฀better฀functional฀recovery฀after฀acute฀MI. POSTER฀SESSION 1081฀฀ Diagnostic฀and฀Prognostic฀Issues฀in฀ Stress฀Echocardiography Monday,฀March฀07,฀2005,฀9:00฀a.m.-12:30฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀11:00฀a.m.-Noon 1081-87฀ Impact฀of฀Coronary฀Artery฀Collaterals฀on฀Transient฀ Ischemic฀Left฀Ventricular฀Dilatation฀on฀Stress฀ Echocardiography Sripal฀Bangalore,฀Siu-Sun฀Yao,฀Devi฀Gopinath,฀Utpal฀Patel,฀Ajay฀Shah,฀Nilo฀Ayuyao,฀Asif฀ Malik,฀Farooq฀A.฀Chaudhry,฀St฀Luke’s-Roosevelt฀Hospital฀Center,฀New฀York,฀NY Background:฀The฀role฀of฀coronary฀artery฀collaterals฀in฀transient฀ischemic฀left฀ventricular฀ dilatation฀(TID)฀during฀stress฀echocardiogram฀is฀not฀well฀defined. Methods:฀We฀evaluated฀212฀consecutive฀patients฀(57฀±฀16฀years,฀70%฀male)฀who฀had฀ coronary฀angiography฀and฀stress฀echocardiography฀within฀a฀3-month฀period.฀This฀cohort฀ of฀patients฀were฀divided฀into฀3-groups฀based฀on฀type฀of฀collaterals:฀group฀A:฀no฀collaterals;฀ group฀B:฀collaterals฀supplied฀by฀vessels฀without฀flow฀limiting฀stenosis฀(good฀collaterals);฀ group฀C:฀collaterals฀supplied฀by฀vessels฀with฀flow฀limiting฀stenosis฀(bad฀collaterals).฀In฀all฀ patients,฀angiographic฀jeopardy฀score฀(AJS),฀ejection฀fraction฀(EF)฀and฀wall฀motion฀score฀ index฀ (WMSI)฀ at฀ rest฀ and฀ during฀ stress฀ were฀ evaluated.฀TID฀ was฀ defined฀ as฀ transient฀ increase฀in฀the฀end฀systolic฀dimensions฀from฀rest฀to฀peak฀stress. Results:฀TID฀was฀present฀in฀42฀(20%)฀patients.฀Patients฀with฀TID฀had฀a฀lower฀EF฀(37฀±฀18฀ vs.฀47฀±฀18,฀p฀=฀0.004),฀higher฀AJS฀(5.1฀±฀4.2฀vs.฀3.4฀±฀3.8,฀p฀=฀0.02),฀greater฀number฀of฀ ischemic฀segments฀(7.2฀±฀4.2฀vs.฀2.9฀±฀3.2,฀p฀<0.0001)฀and฀higher฀peak฀WMSI฀(2.6฀±฀0.7฀ vs.฀1.8฀±฀0.8,฀p฀<฀0.0001).฀Patients฀with฀TID฀had฀greater฀percentage฀of฀multivessel฀disease,฀ greater฀ percentage฀ of฀ group฀ A฀ (no฀ collaterals)฀ and฀ group฀ C฀ collaterals฀ (jeopardized฀ collaterals)฀than฀group฀B฀collaterals฀(graph). Conclusion:฀TID฀ on฀ stress฀ echo฀ is฀ a฀ marker฀ for฀ extensive฀ and฀ severe฀ CAD฀ and฀ may฀ represent฀ patients฀ with฀ angiographically฀ absent฀ collaterals฀ or฀ those฀ with฀ jeopardized฀ coronary฀collaterals฀(bad฀collaterals). Noninvasive Imaging Increased฀lung฀heart฀ratio฀(LHR)฀on฀stress฀99m฀Tc฀sestamibi฀SPECT฀perfusion฀imaging฀ is฀recognized฀as฀a฀marker฀of฀poor฀outcome.฀Even฀though฀initial฀studies฀have฀shown฀an฀ association฀between฀LHR฀and฀body฀weight,฀the฀exact฀impact฀of฀body฀weight฀on฀LHR฀has฀ not฀been฀investigated฀thoroughly. Methods฀and฀results:฀We฀retrospectively฀analyzed฀data฀from฀2569฀patients฀undergoing฀ 99m฀Tc฀sestamibi฀SPECT฀perfusion฀studies.฀On฀multiple฀regression฀analysis฀two฀factors฀ correlated฀significantly฀with฀LHR:฀stress฀ejection฀fraction฀(EF)฀and฀body฀mass฀index฀(BMI)฀ (p=0.04฀and฀0.001฀respectively).฀When฀patients฀were฀divided฀in฀to฀four฀groups฀based฀on฀ BMI฀criteria฀for฀obesity฀(Normal฀=฀<25,฀overweight฀=฀25-29.9,฀Obese฀=฀30-39.9,฀morbid฀ obesity฀=฀≥40),฀a฀gradual฀increase฀in฀LHR฀was฀seen฀with฀statistically฀significant฀difference฀ between฀groups฀(฀p<0.0001). As฀reported฀in฀previous฀studies฀a฀high฀LHR฀was฀found฀to฀have฀a฀significant฀association฀ with฀abnormal฀EF฀at฀stress฀and฀rest,฀quantified฀size฀of฀the฀stress฀perfusion฀defect฀and฀ degree฀of฀defect฀reversibility฀based฀on฀linear฀regression฀analysis.฀However,฀on฀multiple฀ regression฀analysis฀a฀high฀LHR฀(n=164)฀was฀most฀strongly฀associated฀with฀BMI฀(p=0.004)฀ followed฀by฀stress฀perfusion฀defect฀score฀(p=0.014)฀when฀compared฀to฀other฀factors฀such฀ as฀stress฀EF,฀size฀of฀rest฀perfusion฀defect,฀age฀and฀sex.฀In฀patients฀with฀high฀LHR,฀89฀%฀ had฀a฀high฀BMI,฀26.3฀%฀had฀a฀low฀EF฀and฀59.4฀%฀patients฀had฀a฀perfusion฀defect฀with฀ exercise. Conclusion:฀BMI฀plays฀an฀important฀role฀in฀determining฀LHR฀with฀obese฀patients฀tending฀ to฀have฀significantly฀higher฀LHR.฀This฀may฀be฀due฀in฀part฀to฀differential฀attenuation฀due฀to฀ differing฀amounts฀and฀distribution฀of฀adipose฀tissue.฀A฀high฀BMI฀may฀explain฀why฀some฀ patients฀with฀no฀perfusion฀defects฀have฀a฀high฀LHR. 1055-94฀ 269A 270A 1081-88฀ ABSTRACTS - Noninvasive Imaging Incremental฀Prognostic฀Significance฀of฀Myocardial฀ Ischemia฀in฀Patients฀With฀Heart฀Failure Abdou฀Elhendy,฀Fabiola฀B.฀Sozzi,฀Jeroen฀J.฀Bax,฀Ron฀T.฀van฀Domburg,฀Arend฀F.฀Schinkel,฀ Don฀Poldermans,฀Thoraxcenter,฀Rotterdam,฀The฀Netherlands,฀University฀of฀Nebraska฀ Medical฀Center,฀Omaha,฀NE Noninvasive Imaging Background.฀ Aim฀ of฀ the฀ study฀ was฀ to฀ assess฀ the฀ impact฀ of฀ ischemia฀ during฀ dobutamine฀ stress฀echocardiography฀(DSE)฀on฀cardiac฀mortality฀in฀patients฀(pts)฀with฀heart฀failure฀(HF). Methods.฀ We฀ studied฀ 528฀ pts฀ (age฀ =฀ 62฀ ±฀ 11฀ year,฀ 402฀ men)฀ with฀ HF฀ and฀ a฀ history฀ of฀myocardial฀infarction฀or฀coronary฀artery฀disease,฀who฀underwent฀DSE.฀Ischemia฀was฀ defined฀as฀new฀or฀worsening฀wall฀motion฀abnormalities฀or฀a฀biphasic฀response. Results.฀Mean฀ejection฀fraction฀was฀35฀±฀12%.฀Ischemia฀was฀detected฀in฀407฀(77%)฀pts.฀ During฀a฀follow฀up฀of฀3.2฀±฀2.4฀years,฀cardiac฀death฀occurred฀in฀150฀(28%)฀pts.฀Myocardial฀ revascularization฀ was฀ performed฀ within฀ 4฀ months฀ in฀ 117฀ (29%)฀ pts฀ with฀ ischemia.฀The฀ annual฀cardiac฀death฀rate฀was฀4.8%฀in฀pts฀without฀ischemia,฀5.5%฀in฀pts฀with฀ischemia฀ who฀ underwent฀ revascularization฀ within฀ 4฀ months฀ and฀ 11.8%฀ in฀ pts฀ with฀ ischemia฀ who฀ were฀not฀revascularized฀(p<0.005)฀(figure).฀In฀a฀multivariate฀analysis฀model,฀predictors฀of฀ cardiac฀death฀were฀diabetes฀(risk฀ratio฀[RR]฀=฀2,฀95%฀CI฀1.4-2.9),฀male฀sex฀(RR฀1.7,฀CI฀ 1.2-3.1),฀low฀dose฀wall฀motion฀score฀index฀(RR฀1.4,฀CI฀1.2-2.6)฀and฀ischemia฀(RR฀1.9,฀CI฀ 1.3-3.2).฀Angina฀was฀not฀predictive.฀In฀pts฀with฀ischemia,฀revascularization฀within฀4฀months฀ of฀DSE฀was฀associated฀with฀reduced฀risk฀of฀cardiac฀death฀(RR฀=฀0.4,฀CI฀0.3-0.8). Conclusion.฀Myocardial฀ischemia฀detected฀by฀DSE฀is฀associated฀with฀increased฀risk฀of฀cardiac฀ death฀among฀pts฀with฀HF,฀after฀adjustment฀for฀left฀ventricular฀function.฀Revascularization฀within฀ 4฀months฀is฀associated฀with฀a฀better฀outcome฀in฀pts฀with฀ischemia.฀ JACC 1081-90฀ Brain฀Natriuretic฀Peptide฀Predicts฀Ischemic฀Response฀ During฀Dobutamine฀Stress฀Echocardiogram Shrikanth฀P.฀Upadya,฀Sripal฀Bangalore,฀Asif฀Malik,฀Lubna฀Rashid,฀Amandeep฀Kalra,฀ Deborah฀Cantales,฀Ranju฀Soni,฀Tariqshah฀Syed,฀Veerana฀Merla,฀Joseph฀Schappert,฀ Farooq฀A.฀Chaudhry,฀St.฀Luke’s-฀Roosevelt฀Hospital,฀New฀York,฀NY,฀Yalle฀University฀ School฀of฀Medicine(฀Bridgeport),฀Bridgeport,฀NY Background:฀ Elevated฀ Brain฀ Natriuretic฀ Peptide฀ (BNP)฀ in฀ the฀ setting฀ of฀ acute฀ coronary฀ syndrome฀ has฀ important฀ prognostic฀ information.฀ Patients฀ referred฀ for฀ dobutamine฀ stress฀ echocardiogram฀(DSE)฀may฀have฀resting฀ischemia฀which฀could฀mean฀elevated฀BNP฀levels. Methods:฀ We฀ measured฀ BNP,฀ pre฀ stress฀ in฀ 142฀ unselected฀ patients฀ referred฀ for฀ dobutamine฀stress฀echocardiogram฀(DSE).฀Ischemia฀was฀defined฀as฀any฀new฀reversible฀ wall฀motion฀abnormality฀and/or฀biphasic฀response.฀Echocardiogram฀readings฀were฀blinded฀ to฀BNP฀levels.฀Receiver฀operating฀characteristics฀(ROC)฀curves฀were฀obtained฀to฀predict฀ the฀BNP฀value฀with฀maximum฀accuracy.฀BNP฀was฀analyzed฀independently฀at฀Biosite฀Inc. Results:฀ Results฀ are฀ as฀ detailed฀ in฀ the฀Table฀ with฀ the฀ BNP฀ level฀ divided฀ into฀ tertiles.ROC฀ curve฀showed฀that฀at฀the฀best฀possible฀cut-off฀level฀of฀>50฀pg/mL,฀pre฀stress฀BNP฀level฀has฀a฀ sensitivity฀of฀60.9%,฀specificity฀of฀79.2%฀and฀positive฀likelihood฀ratio฀of฀2.92฀to฀predict฀ischemia฀ on฀ DSE.฀ The฀ area฀ under฀ the฀ curve฀ was฀ 0.736฀ (p<0.001).฀ Multivariate฀ logistic฀ regression฀ analysis฀showed฀that฀pre฀stress฀BNP฀levels฀was฀a฀significant฀predictor฀of฀ischemia฀on฀DSE฀(p฀ =0.006)฀after฀controlling฀for฀age฀(p=0.004)฀and฀diabetes฀mellitus฀(p฀=฀0.001). Conclusions:฀In฀an฀unselcted฀cohort,฀pre฀stress฀BNP฀>฀50฀pg/mL฀predicts฀ischemia฀on฀ DSE.฀In฀patients฀unable฀to฀exercise,฀an฀elevated฀BNP฀in฀the฀absence฀of฀heart฀failure฀can฀ further฀risk฀stratify฀patients฀undergoing฀DSE. Age Men Hypertension Angina Diabetes฀Mellitus History฀of฀myocardial฀infarction Body฀Mass฀Index B-฀blocker฀use ACE-฀inhibitor฀use Digoxin฀use LV฀ejection฀fraction฀(%) Ischemia฀on฀DSE฀(%) Relative฀Risk฀Ratio฀to฀predict฀ ischemia 1081-89฀ Application฀of฀a฀Scoring฀System฀to฀Screen฀ Diabetic฀Patients฀for฀Coronary฀Artery฀Disease฀and฀ Cardiovascular฀Events฀with฀Exercise฀Echocardiography Dhrubo฀Rakhit,฀Melodie฀Downey,฀Stuart฀Moir,฀John฀Prins,฀Thomas฀Marwick,฀University฀of฀ Queensland,฀Brisbane,฀Australia Background:฀Stress฀echo฀(SE)฀can฀predict฀mortality฀in฀pts฀with฀diabetes฀mellitus฀(DM),฀ but฀ its฀ use฀ in฀ screening฀ for฀ coronary฀ artery฀ disease฀ (CAD)฀ is฀ limited฀ by฀ low฀ disease฀ probability฀in฀asymptomatic฀DM.฀We฀compared฀3฀scoring฀systems฀to฀identify฀a฀high-risk฀ (HR)฀ group฀ with฀ a฀ greater฀ probability฀ of฀ CAD฀ and฀ cardiac฀ events฀ (CE),฀ to฀ reduce฀ the฀ number฀of฀screening฀studies. Method:In฀199฀DM฀(57฀y,฀110฀men,฀DM฀duration฀10฀y),฀we฀compared฀i)฀Framingham฀risk฀ score฀(FS),฀ii)฀Risk฀Factor฀Score฀(RFS),฀based฀on฀number฀of฀risk฀factors฀(DM,฀smoking,฀ LDL>150mg/dl,฀ HDL<35mg/dl,฀ GFR<90mls/min,฀ hypertension,฀ family฀ history)฀ and฀ iii)฀ Diabetic฀ Cardiac฀ Risk฀ Score฀ [DCRS]฀ (Machecourt,฀ Circulation฀ 2003;108:IV-332).฀ HR฀ groups฀were฀defined฀by฀a฀FS>1%฀per฀yr,฀a฀RFS≥3฀(DM฀plus฀2฀risk฀factors)฀or฀a฀DCRS>25.฀ All฀pts฀had฀ExE;฀23฀out฀of฀27฀pts฀with฀positive฀ExE฀had฀coronary฀angiography฀(CA). Results:High-risk฀ was฀ identified฀ in฀ 27%฀ with฀ the฀ DCRS,฀ fewer฀ than฀ with฀ RFS฀ (41%,฀ p<0.01)฀ and฀ the฀ Framingham฀ score฀ (66%,฀ p<0.001).฀ Using฀ the฀ DCRS,฀ the฀ majority฀ of฀ pts฀with฀CE฀or฀CAD฀were฀in฀the฀HR฀group,฀but฀the฀FS฀and฀RFS฀were฀less฀discriminatory฀ (table).฀There฀were฀9฀CE฀and฀no฀deaths฀in฀189฀pts฀followed฀over฀1.1฀yrs.฀In฀HR฀pts,฀12%฀ had฀CE฀using฀the฀DCRS,฀compared฀to฀6%฀with฀the฀FS฀and฀RFS.฀ CAD฀by฀ExE CAD฀by฀CA Event No฀event Framingham High฀risk฀ Low฀risk฀ p (n=131) (n=68) 18 9 0.92 10/14 1/9 0.005 7 2 0.43 117 63 Risk฀Factor฀Score High฀risk฀ Low฀risk฀ (n=81) (n=118) 14 13 6/11 5/12 5 4 74 106 p 0.21 0.54 0.39 Diabetic฀Cardiac฀Risk฀Score High฀risk฀ Low฀risk฀ p (n=54) (n=145) 16 11 <0.001 9/13 2/10 0.02 6 3 0.007 46 134 Conclusion:฀DCRS฀identified฀pts฀with฀a฀higher฀likelihood฀of฀positive฀ExE฀and฀CE,฀and฀was฀ superior฀to฀the฀FS฀and฀RFS.฀Combining฀SE฀with฀the฀DCRS฀optimizes฀detection฀of฀CAD฀ and฀prediction฀of฀future฀CE฀in฀asymptomatic฀pts,฀while฀minimizing฀the฀numbers฀of฀required฀ SE฀and฀minimizing฀false฀positive฀SE. February 1, 2005 1081-91฀ Tertile฀1 (0-7.9฀pg/ml)฀ N฀=฀48 59฀±฀12 20฀(42%) 27฀(56%) 2฀(4%) 22฀(46%) 6฀(12%) 32฀±฀10 20฀(41%) 17฀(35%) 1฀(2%) 57฀±฀4 17 Tertile฀2 (8.5-50.7฀pg/ml)฀ N฀=฀49 62฀±฀13 26฀(53%) 37฀(75%) 2฀(4%) 11฀(22%) 6฀(12%) 33฀±฀11 19฀(39%) 11฀(22%) 3฀(6%) 57฀±฀7 24 Tertile฀3 (54.4-1756.7฀pg/ml)฀ N฀=฀45 69฀±฀10 19฀(42%) 38฀(84%) 3฀(7%) 26฀(58%) 13฀(29%) 28฀±฀6 23฀(51%) 20฀(44%) 2฀(4%) 46฀±฀17 56 1.0 1.6฀(0.6-4.4)฀p=0.341 4.2฀(1.7-10.2)฀p=0.001 P฀value <0.0001 0.45 0.008 0.90 0.002 0.056 0.036 0.45 0.076 0.61 <0.0001 0.001 Prediction฀of฀Long-Term฀Prognosis฀in฀Patients฀With฀ Ischemic฀Cardiomyopathy฀Undergone฀Coronary฀ Revascularization:฀The฀Role฀of฀Contractile฀Reserve฀and฀ Ischemia Vittoria฀Rizzello,฀Don฀Poldermans,฀Elena฀Biagini,฀Arend฀FL฀Schinkel,฀Eric฀Boersma,฀ Eleni฀C.฀Vourvouri,฀Gian฀Federico฀Possati,฀Jos฀RTC฀Roelandt,฀Jeroen฀J.฀Bax,฀The฀Thorax฀ Center฀Erasmus฀MC,฀Rotterdam,฀The฀Netherlands,฀The฀Catholic฀University฀of฀The฀ Sacred฀Heart,฀Rome,฀Italy Background.฀ In฀ patients฀ with฀ ischemic฀ cardiomyopathy,฀ the฀ presence฀ of฀ myocardial฀ viability฀ is฀ associated฀ with฀ favourable฀ prognosis฀ after฀ coronary฀ revascularization.฀ Contractile฀reserve฀(CR)฀and฀ischemia฀represent฀different฀features฀of฀myocardial฀viability.฀ Aim฀ of฀ the฀ present฀ study฀ was฀ to฀ evaluate฀ the฀ relative฀ role฀ of฀ CR฀ and฀ ischemia฀ in฀ the฀ prediction฀of฀long-term฀prognosis฀after฀revascularization. Methods.฀ Low-high฀ dose฀ dobutamine฀ stress฀ echocardiography฀ (DSE)฀ was฀ performed฀ before฀ coronary฀ revascularization฀ in฀ 128฀ consecutive฀ patients฀ with฀ ischemic฀ cardiomyopathy฀ (mean฀ left฀ ventricular฀ ejection฀ fraction฀ (LVEF)฀ 31±฀ 8%)฀ and฀ symptoms฀ of฀ heart฀ failure฀ (NYHA฀ class฀ 2.6±฀ 1.1).฀ Improvement฀ of฀ the฀ contractile฀ function฀ during฀ dobutamine฀infusion฀in฀dysfunctional฀segments฀defined฀the฀presence฀of฀CR.฀Deterioration฀ of฀ contractile฀ function,฀ with฀ and฀ without฀ initial฀ improvement,฀ defined฀ the฀ presence฀ of฀ ischemia.฀ Cardiac฀ death฀ was฀ evaluated฀ during฀ long-term฀ follow-up฀ (up฀ to฀ 5฀ years).฀ Clinical,฀ angiographic฀ and฀ echocardiographic฀ data฀ were฀ analysed฀ to฀ identify฀ predictors฀ of฀cardiac฀death. Results.฀ During฀ the฀ 5-year฀ follow-up฀ period,฀ cardiac฀ death฀ occurred฀ in฀ 27฀ patients.฀ Univariable฀predictors฀of฀cardiac฀death฀were฀the฀presence฀of฀multi-vessel฀diseases฀(HR฀ 0.21,฀P<0.001),฀baseline฀LVEF฀(HR฀0.90,฀P<0.0001),฀the฀wall฀motion฀score฀index฀(WMSI)฀ at฀ rest฀ (HR฀ 4.02,฀ P=0.0006),฀ low-dose฀ (HR฀ 7.01,฀ P<0.0001)฀ and฀ peak฀ DSE฀ (HR฀ 4.62,฀ P<0.0001),฀ the฀ extent฀ of฀ scar฀ tissue฀ (HR฀ 1.39,฀ P<0.0001)฀ and฀ the฀ presence฀ of฀ ≥฀ 25%฀ of฀segments฀with฀CR฀(HR฀0.34,฀P=0.02).฀The฀best฀multivariable฀model฀to฀predict฀cardiac฀ death฀ included฀ the฀ presence฀ of฀ multi-vessel฀ disease,฀ the฀WMSI฀ at฀ low-dose฀ DSE฀ and฀ the฀presence฀of฀CR฀in฀≥฀25%฀of฀the฀severely฀dysfunctional฀segments฀(Chi-square฀43.96,฀ HR฀ 9.62฀ CI฀ 3.99-23.14,฀ P<0.0001).฀ Inclusion฀ of฀ ischemia฀ to฀ the฀ model฀ did฀ not฀ provide฀ additional฀predictive฀value.฀Conclusion.฀The฀findings฀in฀the฀present฀study฀demonstrate฀ that฀ in฀ patients฀ with฀ ischemic฀ cardiomyopathy,฀ the฀ extent฀ of฀ CR฀ is฀ a฀ strong฀ predictor฀ of฀ long-term.฀ Ischemia฀ did฀ not฀ add฀ significantly฀ in฀ the฀ prediction฀ of฀ cardiac฀ death฀ after฀ revascularization. JACC 1081-92฀ February 1, 2005 Superior฀Risk฀Stratification฀by฀Stress฀Echocardiography฀ Compared฀to฀Exercise฀ECG:฀A฀Prospective฀Randomized฀ Study฀in฀Patients฀Presenting฀the฀Hospital฀With฀Acute฀ Chest฀Pain฀and฀Negative฀Troponin Paramjit฀Jeetley,฀Leah฀Burden,฀Roxy฀Senior,฀Northwick฀Park฀Hospital,฀Harrow,฀United฀ Kingdom Background:฀Patients฀with฀coronary฀risk฀factors฀presenting฀to฀hospital฀with฀acute฀chest฀ pain,฀ non-diagnostic฀ ECG’s฀ and฀ negative฀ troponin฀ currently฀ undergo฀ exercise฀ ECG฀ (ExECG)฀for฀further฀risk฀stratification.฀Stress฀echocardiography฀(SE)฀has฀better฀accuracy฀ than฀ExECG฀and฀is฀well฀established฀for฀the฀diagnosis฀of฀coronary฀artery฀disease฀(CAD).฀ We฀hypothesised฀that฀SE฀is฀superior฀to฀ExECG฀in฀the฀risk฀stratification฀of฀such฀patients฀ presenting฀to฀hospital฀with฀acute฀chest฀pain. Methods:฀ Patients฀ presenting฀ wtih฀ acute฀ chest฀ pain฀ were฀ randomised฀ to฀ ExECG฀ or฀ SE.฀ The฀ test฀ was฀ performed฀ within฀ 24฀ hours฀ of฀ admission.฀ Patients฀ with฀ a฀ low฀ posttest฀ likelihood฀ of฀ CAD฀ were฀ discharged;฀ those฀ with฀ a฀ high฀ post-test฀ probability฀ were฀ considered฀ for฀ coronary฀ angiography.฀ All฀ others฀ were฀ managed฀ according฀ to฀ standard฀ hospital฀protocols. Results:A฀ total฀ of฀ 433฀ patients฀ underwent฀ either฀ ExECG฀ (n=218)฀ or฀ SE฀ (n=215).฀ SE฀ identified฀significantly฀more฀patients฀with฀a฀low฀post-test฀probability฀of฀CAD฀(77%฀v฀33%,฀ p<0.0001)฀ and฀ signficantly฀ fewer฀ patients฀ with฀ an฀ intermediate฀ post-test฀ likelihood฀ of฀ CAD฀compared฀to฀ExECG฀(3%฀v฀44%;฀p<0.0001).฀Significantly฀more฀patients฀undergoing฀ ExECG฀were฀referred฀for฀further฀tests฀for฀risk฀stratification฀compared฀to฀SE฀(52%฀vs฀19%;฀ p<0.0001).฀In฀total,฀64(15%)฀had฀flow฀limiting฀CAD฀demonstrated฀by฀coronary฀angiography฀ of฀which฀46(11%)฀underwent฀a฀revascularisation฀procedure.฀Significant฀CAD฀was฀seen฀in฀ fewer฀patients฀with฀a฀positive฀ExECG฀(64%)฀than฀with฀a฀positive฀SE฀(81%)(p=ns).฀Those฀ patients฀discharged฀with฀a฀low฀post-test฀probability฀had฀low฀event฀rates฀(death,฀non-fatal฀ myocardial฀infarction฀or฀revascularisation)฀for฀both฀ExECG฀and฀SE฀(3%฀vs฀4%฀at฀mean฀FU฀ of฀7.8฀and฀7.0฀months฀respectively). Conclusion:฀ SE฀ is฀ more฀ accurate฀ than฀ ExECG฀ in฀ the฀ risk฀ stratification฀ of฀ patients฀ presenting฀to฀hospital฀with฀acute฀chest฀pain,฀non-diagnostic฀ECG฀and฀a฀negative฀troponin.฀ This฀implies฀that฀SE฀may฀be฀more฀cost-effective฀than฀ExECG฀for฀risk฀stratification฀in฀such฀ patients. 1081-93฀ Hemodynamic฀Response฀During฀Dobutamine-atropine฀ Stress฀Echocardiography฀Is฀Influenced฀By฀Type฀Of฀ Concomitant฀Beta-blocker฀Therapy Background:฀ Cardioselective฀ (CS)฀ beta-blockers฀ (BBLs)฀ block฀ beta1-receptors,฀ while฀ non-CS฀ BBLs฀ block฀ both฀ beta1-฀ and฀ beta2฀ receptors.฀ Dobutamine฀ is฀ a฀ partial฀ beta1agonist฀but฀also฀has฀action฀on฀beta2-receptors.฀The฀aim฀of฀this฀study฀was฀to฀compare฀the฀ hemodynamic฀effects฀of฀dobutamine฀during฀dobutamine-atropine฀stress฀echocardiography฀ (DSE)฀after฀treatment฀with฀CS฀BBLs฀and฀non-CS฀BBLs,฀including฀differences฀in฀long-term฀ prognostic฀value. Methods:฀ 3,800฀ patients฀ were฀ evaluated฀ for฀ hemodynamic฀ response,฀ test฀ results,฀ and฀ long-term฀cardiac฀events฀(cardiac฀death฀and฀myocardial฀infarction).฀Patients฀were฀followed฀ for฀6±4฀years;฀those฀who฀underwent฀revascularization฀within฀3฀months฀(n=฀217),฀were฀lostto-follow-up฀(n=50)฀or฀were฀not฀using฀BBLs฀were฀excluded. Results:฀1161฀and฀307฀patients฀were฀using฀CS฀and฀non-CS฀BBLs,฀respectively.฀The฀heart฀ rate฀response฀was฀greater฀in฀patients฀using฀CS฀BBLs฀at฀peak฀dose฀dobutamine฀(106฀vs฀ 100฀/min,฀p<0.002).฀This฀difference฀was฀absent฀after฀atropine฀infusion.฀However,฀systolic฀ and฀diastolic฀blood฀pressure฀were฀higher฀in฀patients฀using฀non-CS฀BBls฀(140฀vs฀131฀and฀ 75฀vs฀69฀mm฀Hg,฀respectively).฀This฀difference฀persisted฀after฀atropine฀addition.฀The฀6year฀cardiac฀event฀rate฀was฀similar฀for฀both฀groups฀(20%). Conclusion:฀The฀hemodynamic฀response฀to฀dobutamine฀during฀DSE฀is฀influence฀by฀the฀ type฀of฀concomitant฀beta-blocker฀therapy.฀Non-CS฀BBL฀therapy฀was฀associated฀with฀an฀ inhibition฀in฀increase฀in฀heart฀rate,฀but฀an฀increase฀in฀systolic฀and฀diastolic฀blood฀pressure.฀ However,฀no฀differences฀in฀cardiac฀outcome฀were฀observed. 1081-94฀ Functional฀Improvement฀of฀Infarcted฀Segments฀During฀ Exercise฀is฀Related฀to฀the฀Degree฀of฀Infarct฀Thickness Se-Joong฀Rim,฀Sungha฀Park,฀Byoung฀Wook฀Choi,฀Young-Guk฀Ko,฀Seok-Min฀Kang,฀JongWon฀Ha,฀Yangsoo฀Jang,฀NamSik฀Chung,฀Won-Heum฀Shim,฀Kyu-Ok฀Choe,฀Seung-Yun฀ Cho,฀Yonsei฀University฀College฀of฀Medicine฀Cardiovascular฀Center,฀Seoul,฀South฀Korea Background:฀ Viable฀ myocardium฀ in฀ the฀ outer฀ myocardial฀ layers฀ may฀ contribute฀ to฀ enhanced฀ systolic฀ performance฀ during฀ exercise.฀ However,฀ studies฀ regarding฀ the฀ relationship฀ between฀ the฀ degree฀ of฀ transmural฀ infarct฀ thickness฀ and฀ systolic฀ functional฀ improvement฀in฀dysfunctional฀segments฀during฀exercise฀have฀yet฀to฀be฀investigated.฀We฀ sought฀to฀demonstrate฀the฀relationship฀between฀transmural฀hyperenhancement฀by฀Cardiac฀ MRI(CMR)฀and฀functional฀improvement฀during฀exercise,฀demonstrated฀by฀exercise฀stress฀ echocardiography,฀in฀patients฀with฀previous฀myocardial฀infarctions Method:฀Fifteen฀patients฀undergoing฀primary฀angioplasty฀and฀stent฀implantation฀for฀AMI฀ who฀demonstrated฀resting฀wall฀motion฀abnormality(akinesia฀to฀severe฀hypokinesia)฀of฀the฀ infarct฀ territory฀ as฀ assessed฀ by฀ 2D฀ echocardiography฀ at฀ least฀ 6฀ months฀ after฀ the฀ initial฀ PCI฀were฀studied.฀There฀were฀7฀cases฀of฀inferior฀MI,฀7฀cases฀of฀anterior฀MI฀and฀1฀case฀of฀ posterolateral฀MI.฀All฀the฀patients฀had฀undergone฀cardiac฀MRI฀3-16฀days฀after฀the฀initial฀ event.฀Symptom฀limited฀supine฀bicycle฀exercise฀stress฀echocardiography฀was฀performed฀ at฀least฀6฀months฀after฀the฀initial฀event฀to฀assess฀functional฀recovery฀of฀the฀dysfunctional฀ infarct฀segments฀at฀followup.฀For฀the฀MRI฀segmental฀analysis,฀the฀most฀basal฀and฀distal฀ slices฀were฀excluded฀and฀each฀short฀axis฀slices฀were฀divided฀into฀6฀segments฀according฀ to฀ the฀ coronary฀ territory.฀ The฀ degree฀ of฀ transmural฀ infarct฀ thickness฀ in฀ dysfunctional฀ segments฀were฀evaluated฀with฀CMR.฀ 271A Results:฀ A฀ total฀ of฀ 150฀ segments฀ of฀ CMR฀ imaging฀ corresponding฀ to฀ the฀ infarct฀ related฀ dysfunctional฀ segments฀ were฀ analyzed.฀ Segments฀ with฀ 0%,฀ 1-25%,฀ 26-50%,฀ 5175%,฀ 76-100%฀ hyperenhancement฀ showed฀ functional฀ improvement฀ in฀ 15/15(100%),฀ 16/20(80.0%),฀3/39(7.7%),฀2/26(7.7%),฀and฀4/50(8.0%),฀respectively,฀in฀the฀corresponding฀ territory.฀Hyperenhancement฀of฀less฀than฀25%฀was฀associated฀with฀sensitivity,฀specificity,฀ positive฀predictive฀value,฀negative฀predictive฀value฀of฀77.5%,฀96.4%,฀88.6%,฀and฀92.2%,฀ respectively.฀ Conclusion:฀ In฀ patients฀ with฀ reperfused฀ STEMI,฀ Functional฀ improvement฀ of฀ dysfunctional฀infarct฀related฀segments฀during฀exercise฀may฀be฀predicted฀by฀CMR฀delayed฀ hyperenhancement฀imaging. POSTER฀SESSION 1082฀฀ Contrast฀Echocardiography:฀฀ Special฀Uses฀and฀Special฀Patients Monday,฀March฀07,฀2005,฀9:00฀a.m.-12:30฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀11:00฀a.m.-Noon 1082-79฀ Ultrasound-mediated฀Transfection฀Of฀Intravenous฀ VEGF165฀Plasmid-bearing฀Microbubbles฀Improves฀ Microvascular฀Perfusion฀In฀Chronic฀Ischemic฀Skeletal฀ Muscle Howard฀Leong-Poi,฀Michael฀A.฀Kuliszewski,฀Michael฀Lekas,฀Alexander฀L.฀Klibanov,฀ Duncan฀J.฀Stewart,฀Jonathan฀R.฀Lindner,฀St.฀Michael’s฀Hospital,฀Toronto,฀ON,฀Canada,฀ University฀of฀Virginia,฀Charlottesville,฀VA Background:฀Ultrasound฀targeted฀microbubble฀destruction฀can฀potentially฀provide฀a฀safe฀ and฀effective฀non-viral฀method฀of฀plasmid฀gene฀delivery.฀We฀hypothesized฀that฀VEGF165฀ delivery฀ by฀ ultrasound-mediated฀ destruction฀ of฀ plasmid-bearing฀ microbubbles฀ would฀ improve฀microvascular฀perfusion฀in฀the฀presence฀of฀chronic฀ischemia. Methods:฀ The฀ human฀ VEGF165฀ cDNA฀ was฀ sub-cloned฀ into฀ a฀ vector฀ for฀ co-translation฀ of฀both฀VEGF165฀and฀EGFP฀(enhanced฀green฀fluorescent฀protein)฀from฀a฀single฀mRNA.฀ Chronic฀unilateral฀hindlimb฀ischemia฀was฀produced฀by฀ligation฀of฀the฀common฀iliac฀artery฀ in฀ 10฀ rats.฀ Microvascular฀ blood฀ volume฀ (MBV)฀ and฀ blood฀ flow฀ (MBF)฀ in฀ the฀ proximal฀ hindlimb฀muscles฀were฀assessed฀by฀contrast-enhanced฀ultrasound฀(CEU)฀at฀day฀14,฀to฀ allow฀for฀completion฀of฀endogenous฀angiogenesis.฀At฀day฀14฀post-ligation฀in฀6฀rats,฀the฀ proximal฀ ischemic฀ hindlimb฀ was฀ exposed฀ to฀ intermittent฀ high-power฀ ultrasound฀ during฀ intravenous฀ administration฀ of฀ VEGF-165฀ plasmid-bearing฀ microbubbles฀ (500฀ µg฀ cDNA฀ coupled฀ to฀ 1x109฀ cationic฀ microbubbles)฀ over฀ 20฀ minutes.฀ Repeat฀ CEU฀ assessment฀ of฀ MBV฀and฀MBF฀in฀the฀proximal฀hindlimb฀muscles฀was฀performed฀at฀day฀28.฀Transfection฀ was฀assessed฀by฀the฀extent฀of฀GFP/VEGF165฀positive฀cells฀on฀confocal฀microscopy฀of฀the฀ hindlimb฀adductor฀muscles. Results:฀Prior฀to฀VEGF165฀delivery,฀the฀normalized฀MBV฀and฀MBF฀for฀the฀ischemic฀muscle฀ were฀similarly฀reduced฀in฀both฀VEGF165-treated฀and฀control฀non-treated฀animals.฀By฀day฀28,฀ VEGF165-treated฀ischemic฀muscles฀had฀significantly฀greater฀normalized฀MBV฀(1.00±0.17฀ vs฀ 0.70±0.20,฀ p<0.05)฀ and฀ MBF฀ (1.02±0.17฀ vs฀ 0.56±0.13,฀ p<0.005),฀ while฀ non-treated฀ ischemic฀muscles฀remained฀unchanged.฀Fluorescent฀confocal฀microscopy฀demonstrated฀ a฀robust฀EGFP฀signal฀predominantly฀within฀the฀vascular฀endothelium฀in฀treated฀ischemic฀ muscles,฀with฀little฀signal฀from฀non-ischemic฀muscles,฀or฀control฀animals. Conclusions:฀ We฀ conclude฀ that฀ VEGF165฀ delivery฀ by฀ ultrasound-mediated฀ destruction฀ of฀ plasmid-bearing฀ microbubbles฀ is฀ effective,฀ and฀ results฀ in฀ improved฀ microvascular฀ perfusion฀in฀the฀setting฀of฀chronic฀ischemic฀limb฀disease. 1082-80฀ Modifications฀of฀Lipid฀Microbubble฀Shell฀Composition฀ Affect฀Intravascular฀Kinetics Sevgi฀Kilic,฀Erxiong฀Lu,฀Eric฀Tom,฀Joan฀Gretton,฀William฀R.฀Wagner,฀Flordeliza฀S.฀ Villanueva,฀University฀of฀Pittsburgh฀School฀of฀Medicine,฀Pittsburgh,฀PA Background:฀ Ultrasound฀ contrast฀ microbubbles฀ (µb)฀ are฀ increasingly฀ used฀ for฀ diverse฀ purposes฀ requiring฀ application-specific฀ manipulation฀ of฀ µb฀ features฀ to฀ optimize฀ performance.฀ For฀ example,฀ for฀ targeted฀ imaging,฀ greater฀ µb฀ persistence฀ could฀ advantageously฀increase฀µb฀accumulation฀on฀the฀target฀with฀time.฀We฀thus฀hypothesized฀ that฀µb฀formulation฀affects฀µb฀behavior฀in฀vivo. Methods:฀The฀pharmacokinetics฀of฀4฀lipid-based฀perfluorocarbon฀gas-filled฀acoustically฀ active฀ µb฀ were฀ tested฀ by฀ intravital฀ microscopy฀ of฀ rat฀ cremaster฀ microcirculation฀ (n=5฀ rats/µb฀ type).฀ The฀ basic฀ fluorescent-labeled฀ µb฀ (A,฀ 3.2±0.1฀ µm)฀ comprised฀ distearoyl฀ phospho฀ (DSP)-choline,฀ DSP-ethanolamine-PEG-biotin฀ and฀ PEGylated฀ surfactant฀ with฀ 1฀ fatty฀ acid฀ chain.฀ µb฀ B,฀ C,฀ and฀ D฀ were฀ single฀ variations฀ of฀ µb฀ A:฀ µb฀ B฀ (3.0±0.2฀ µm)฀ used฀2฀fatty-acid฀chain฀PEGylated฀surfactant;฀µb฀C฀(2.5±0.1฀µm)฀added฀propylene฀glycol฀ (PG);฀µb฀D฀(2.4±0.2um)฀added฀PG฀+฀glycerin.฀Fluorescein-labeled฀Optison฀was฀used฀as฀a฀ comparator.฀Rats฀received฀1x108฀µb฀i.v.฀bolus.฀The฀number฀of฀µb฀crossing฀an฀index฀venule฀ vs.฀time฀was฀fit฀to฀an฀exponential฀model.฀Half-life฀(t½,฀min)฀and฀area฀under฀the฀curve฀(AUC)฀ were฀derived.฀Pulmonary฀µb฀trapping฀was฀histologically฀measured฀post-mortem. Results:฀t½฀and฀AUC฀differed฀among฀µb฀(ANOVA฀p<0.03):฀t½฀of฀the฀basic฀µb฀(µb฀A)฀was฀ 1.1±0.1฀ (p=0.86฀ vs.฀ Optison).฀ Using฀ 2-฀ rather฀ than฀ 1-฀ fatty฀ acid฀ chain฀ surfactant฀ (µb฀ B)฀ prolonged฀t½฀(1.7±0.4,฀p<0.01)฀and฀PG฀(µb฀C)฀similarly฀prolonged฀t½฀(1.6±0.1,฀p<0.001).฀ PG฀+฀glycerin฀(µb฀D)฀did฀not฀change฀t½฀(1.1±0.1,฀p=0.77).฀Despite฀similar฀t½฀of฀µb฀B฀and฀ C,฀µb฀C฀had฀the฀highest฀AUC฀(p<0.05),฀indicating฀more฀total฀circulating฀µb฀due฀to฀longer฀ persistence฀ during฀ the฀ pharmacokinetic฀ elimination฀ phase.฀This฀ finding฀ was฀ consistent฀ with฀the฀least฀lung฀retention฀of฀µb฀C฀seen฀on฀histology. Noninvasive Imaging Boudewijn฀J.฀Krenning,฀Jeroen฀J.฀Bax,฀Elena฀Biagini,฀Vittoria฀Rizzello,฀Arend฀F.L.฀ Schinkel,฀Ron฀T.฀van฀Domburg,฀Miklos฀D.฀Kertai,฀Olaf฀Schouten,฀Maarten฀L.฀Simoons,฀ Don฀Poldermans,฀Thoraxcenter,฀Rotterdam,฀The฀Netherlands ABSTRACTS - Noninvasive Imaging 272A ABSTRACTS - Noninvasive Imaging Conclusion:฀PG฀or฀a฀2-fatty฀acid฀chain฀within฀a฀lipid฀µb฀shell฀increases฀t½,฀possibly฀by฀ creating฀secondary฀forces฀between฀lipid฀components฀that฀enhance฀in฀vivo฀stability.฀Despite฀ the฀subcapillary฀size฀of฀all฀µb฀types฀tested,฀lung฀entrapment฀differentially฀varies฀with฀shell฀ composition฀and฀hence฀affects฀total฀µb฀availability.฀These฀findings฀have฀implications฀for฀the฀ design฀of฀ultrasound฀µb฀for฀differing฀applications. 1082-81฀ Gene-Loading฀of฀Targeted฀Microbubbles฀Does฀Not฀ Adversely฀Influence฀Binding฀Efficacy Shivam฀Champeneri,฀Sarah฀Taylor,฀Alexander฀Klibanov,฀Jonathan฀R.฀Lindner,฀University฀ of฀Virginia,฀Charlottesville,฀VA Background:฀Ultrasound-mediated฀destruction฀of฀microbubble฀vehicles฀has฀been฀used฀to฀ augment฀gene฀transfection฀and฀oligonucleotide฀delivery.฀Molecular฀targeting฀of฀microbubbles฀ could฀improve฀the฀efficacy฀of฀gene฀delivery฀by฀increasing฀their฀local฀concentration,฀and฀by฀ reulting฀in฀direct฀apposition฀of฀microbubbles฀against฀the฀vessel฀wall.฀We฀hypothesized฀that฀ gene-loading฀of฀microbubbles฀would฀not฀interfere฀with฀microbubble฀targeting. Methods:฀ Cationic฀ and฀ neutral฀ lipid฀ microbubbles,฀ both฀ with฀ and฀ without฀ a฀ PEG-biotin฀ arm฀ were฀ prepared.฀ Coupling฀ of฀ plasmid฀ to฀ microbubbles฀ was฀ quantified฀ by฀ YOYO-1฀ gene-labeling฀ and฀ fluorometry.฀ Microbubble฀ adhesion฀ efficiency฀ to฀ plated฀ streptavidin฀ was฀evaluated฀in฀a฀flow฀chamber฀at฀shear฀stresses฀of฀0.6฀and฀1.5฀dynes/cm2.฀For฀all฀4฀ preparations,฀adhesion฀was฀tested฀with฀or฀without฀incubation฀with฀plasmid.฀Adhesion฀in฀ vivo฀ was฀ assessed฀ by฀ intravital฀ microscopy฀ of฀TNF-alpha-treated฀ cremaster฀ muscle฀ of฀ mice฀after฀IV฀injection฀of฀fluorescently-labeled฀ICAM-1-targeted฀or฀non-targeted฀cationic฀ microbubbles,฀each฀with฀or฀without฀plasmid. Results:฀ An฀ average฀ of฀ 0.04฀ pg฀ of฀ plasmid฀ (4,800฀ plasmids)฀ was฀ charge-coupled฀ to฀ each฀ cationic฀ microbubble,฀ and฀ was฀ not฀ affected฀ by฀ the฀ presence฀ of฀ PEG-biotin.฀ Neutral฀ microbubbles฀ contained฀ little฀ plasmid฀ (<0.002฀ pg).฀ For฀ flow-chamber฀ studies,฀ only฀ microbubbles฀ containing฀ PEG-biotin฀ attached฀ to฀ plated฀ streptavidin.฀ At฀ all฀ shear฀ rates,฀attachment฀of฀plasmid-loaded฀cationic฀microbubbles฀was฀similar฀to฀that฀of฀neutral฀ microbubbles.฀ In฀ the฀ absence฀ of฀ plasmid,฀ cationic฀ microbubble฀ binding฀ was฀ reduced฀ by฀ approximately฀ half,฀ probably฀ reflecting฀ interaction฀ between฀ biotin฀ and฀ the฀ cationic฀ shell.฀ In฀ vivo฀ attachment฀ of฀ ICAM-1-targeted฀ cationic฀ microbubbles฀ to฀ inflamed฀ venular฀ endothelium฀was฀similar฀for฀microbubbles฀with฀and฀without฀plasmid฀(14±8฀vs฀13±9฀µm-2).฀ Attachment฀of฀non-targeted฀control฀microbubbles฀to฀the฀endothelium฀was฀not฀observed. Conclusions:฀Coupling฀of฀plasmid฀DNA฀to฀the฀microbubble฀surface฀does฀not฀interfere฀with฀ the฀ ability฀ to฀ target฀ microbubbles฀ to฀ disease-related฀ molecules.฀The฀ strategy฀ of฀ targeting฀ cationic฀microbubbles฀may฀be฀useful฀for฀further฀augmenting฀gene฀delivery฀with฀ultrasound. Noninvasive Imaging 1082-82฀ Stability฀of฀Echogenic฀Immunoliposomes฀Under฀ Physiological฀Conditions Kameswari฀Maganti,฀Kyle฀Buchanan,฀Shao-Ling฀Huang,฀Susan฀D.฀Tiukinhoy,฀Robert฀C.฀ MacDonald,฀David฀D.฀McPherson,฀Northwestern฀University,฀Chicago฀and฀Evanston,฀IL Background:฀ Echogenic฀ immunoliposomes฀ (ELIP)฀ have฀ great฀ potential฀ for฀ targeted฀ ultrasonic฀ enhancement฀ of฀ atheroma/vascular฀ endothelium.฀ These฀ agents฀ also฀ have฀ potential฀for฀regional฀drug฀and฀gene฀delivery.฀For฀clinical฀use,฀formulations฀having฀optimal฀ activity฀under฀physiologic฀conditions฀need฀to฀be฀established. Methods:฀ ELIP฀ (phosphatidylcholine,฀ phosphatidylethanolamine,฀ phosphatidylglycerol,฀ and฀cholesterol฀in฀a฀69:8:8:15฀mol฀%฀ratio)฀were฀made฀by฀lyophilization฀in฀the฀presence฀ of฀ mannitol.฀ Stability฀ (echogenicity฀ as฀ a฀ function฀ of฀ time)฀ was฀ assessed฀ in฀ phosphate฀ buffered฀ saline฀ and฀ human฀ serum฀ (50%),฀ as฀ well฀ as฀ in฀ the฀ presence฀ of฀ bovine฀ serum฀ albumin฀(BSA)฀at฀5฀g/ml,฀and฀human฀IgG฀(10฀mg/ml)฀(all฀at฀room฀temperature฀and฀37°C).฀ Ultrasound฀ reflectivity฀ was฀ measured฀ with฀ a฀ 20-MHz฀ intravascular฀ ultrasound฀ catheter฀ and฀quantified฀by฀computer-assisted฀videodensitometry. Results:฀ Protein฀ had฀ a฀ marked฀ effect฀ on฀ stability;฀ the฀ activity฀ (after฀ 3฀ hrs,฀ room฀ temperature)฀of฀liposomes฀exposed฀to฀serum,฀albumin,฀globulin,฀and฀no฀protein,฀was฀90,฀ 60,฀30฀and฀10%฀respectively.฀Stability฀at฀37º฀C฀was฀lower,฀but฀in฀the฀presence฀of฀serum,฀ stability฀was฀quite฀good฀(75%)฀for฀up฀to฀an฀hour. Conclusions:฀These฀ data฀ demonstrate฀ that฀ ELIP฀ provide฀ sufficient฀ time฀ for฀ diagnostic฀ imaging฀ under฀ physiologic฀ conditions.฀ Their฀ ability฀ to฀ target฀ molecular฀ structures฀ and฀ potential฀ to฀ enhance฀ drug฀ and฀ gene฀ delivery฀ expands฀ our฀ diagnostic฀ and฀ therapeutic฀ approach฀to฀atherosclerotic฀cardiovascular฀disease.฀ 1082-83฀ Transmural฀Extent฀of฀Myocardial฀Necrosis฀Affects฀ Accuracy฀of฀Myocardial฀Contrast฀Echocardiography฀in฀ Patients฀After฀Reperfused฀Acute฀Myocardial฀Infarction Roberta฀Montisci,฀Massimo฀Ruscazio,฀Cristiano฀Sarais,฀Luisa฀Cacciavillani,฀Francesco฀ Corbetti,฀Anna฀Portale,฀Sara฀Pontarollo,฀Martina฀Perazzolo฀Marra,฀Enrico฀Bacchiega,฀ Andrea฀Pavei,฀Luigi฀Meloni,฀Sabino฀Iliceto,฀University฀of฀Cagliari,฀Cagliari,฀Italy,฀ University฀of฀Padua,฀Padua,฀Italy Background:฀ Myocardial฀ contrast฀ echocardiography฀ (MCE)฀ can฀ assess฀ myocardial฀ perfusion.฀ In฀ humans,฀ no฀ data฀ exist฀ on฀ the฀ impact฀ of฀ different฀ myocardial฀ alterations฀ detectable฀ after฀ myocardial฀ infarction฀ (AMI)฀ (transmurality฀ extent฀ and฀ microvascular฀ obstruction)฀on฀MCE฀accuracy฀in฀identifying฀infarcted฀myocardial฀segments.฀We฀investigate฀ JACC February 1, 2005 the฀relationship฀between฀intravenous฀MCE฀and฀different฀myocardial฀structural฀alterations,฀ as฀assessed฀by฀Gadolium-DTPA฀contrast฀enhanced฀cardiovascular฀magnetic฀resonance฀ (GE-MRI)฀in฀patients฀with฀AMI. Methods:฀ Fifty-six฀ consecutive฀ patients฀ (mean฀ age฀ 60.6±10.5)฀ with฀ AMI฀ underwent฀ intravenous฀MCE฀study฀using฀real฀time฀mode฀during฀Sonovue฀injection฀or฀trigger฀mode฀ during฀ Levovist฀ injection฀ and฀ GE-MRI฀ 5±3฀ days฀ after฀ primary฀ percutaneous฀ coronary฀ angioplasty.฀A฀17-segment฀model฀of฀the฀left฀ventricle฀was฀used฀to฀analyze฀both฀MCE฀and฀ GE-MRI.฀At฀GE-MRI฀we฀evaluated฀the฀extension฀of฀hyperenhancement฀(HE)฀to฀define฀the฀ entity฀of฀myocardial฀necrosis฀trasmurality฀and฀of฀hypoenhancement,฀inside฀of฀HE฀zone,฀to฀ detect฀microvascular฀obstruction. Results.฀837/935฀(90%)฀myocardial฀segments฀were฀available฀for฀analysis฀after฀exclusion฀ of฀ segments฀ with฀ artifacts฀ or฀ attenuation.฀ Among฀ the฀ 546฀ segments฀ showing฀ normal฀ perfusion฀at฀GE-MRI฀475฀(87%)฀had฀normal฀perfusion฀at฀MCE.A฀MCE฀perfusion฀defect฀ was฀present฀in฀96/144฀(67%)฀segments฀with฀trasmural฀necrosis฀detected฀by฀GE-MRI฀(HE฀≥฀ 75%฀of฀the฀thickness฀of฀the฀myocardial฀segment),฀and฀in฀only฀50฀/128฀(39%)฀segments฀with฀ non฀transmural฀necrosis.MCE฀perfusion฀defect฀were฀detected฀in฀46/69฀(67%)myocardial฀ segments฀ with฀ microvascular฀ obstruction฀ at฀ GE-MRI.฀ At฀ logistic฀ regression฀ analysis฀ transmural฀ extent฀ of฀ myocardial฀ necrosis฀ was฀ better฀ associated฀ with฀ abnormal฀ MCE฀ pattern฀ (OR฀ 7.1,฀ 95%฀ CI฀ 4.76-11.1;฀ p<0.0001฀ )฀ than฀ microvascular฀ obstruction฀ pattern฀ (OR฀2.38,95%฀CI1.28-4.34,p=0.006). Conclusion:฀ MCE฀ capability฀ in฀ identifying฀ myocardial฀ necrosis฀ after฀ AMI฀ is฀ strongly฀ influenced฀ by฀ its฀ trasmural฀ extent,฀ being฀ non฀ trasmural฀ necrosis฀ rarely฀ detected.The฀ relationship฀among฀MCE฀findings฀and฀myocardial฀structural฀abnormalities฀must฀be฀taken฀ in฀to฀account฀in฀patients฀with฀reperfused฀AMI. 1082-84฀ The฀Impact฀of฀Coronary฀Artery฀Stenosis฀Severity฀on฀the฀ Induction฀of฀Wall฀Motion฀and฀Perfusion฀Abnormalities฀ During฀Dobutamine฀Stress฀Myocardial฀Contrast฀ Echocardiography Abdou฀Elhendy,฀Thomas฀R.฀Porter,฀Feng฀Xie,฀Edward฀O’Leary,฀University฀of฀Nebraska฀ Medical฀Center,฀Omaha,฀NE Aim฀ of฀ the฀ study.฀ To฀ assess฀ the฀ impact฀ of฀ coronary฀ artery฀ stenosis฀ (CAS)฀ severity฀ on฀ the฀ induction฀ of฀ myocardial฀ perfusion฀ and฀ wall฀ motion฀ abnormalities฀ (WMA)฀ during฀ dobutamine฀stress฀echocardiography. Methods.฀ We฀ studied฀ 170฀ patients฀ (age฀ 60฀ ±฀ 12฀ years,฀ 71women),฀ who฀ underwent฀ dobutamine฀ (up฀ to฀ 50฀ µg/kg/min)-atropine฀ stress฀ test฀ and฀ quantitative฀ coronary฀ angiography.฀ Wall฀ motion฀ analysis฀ and฀ myocardial฀ contrast฀ echocardiography฀ (MCE)฀ using฀repeated฀boluses฀of฀Optison฀or฀Definity,฀were฀performed฀at฀rest฀and฀at฀peak฀stress.฀ Receiver-operating-characteristics฀ (ROC)฀ curves฀ and฀ areas฀ under฀ the฀ curves฀ were฀ calculated฀to฀determine฀the฀cutoff฀percentage฀for฀CAS฀which฀optimized฀its฀performance฀ as฀an฀indicator฀of฀the฀presence฀of฀a฀reversible฀perfusion฀or฀WMA. Results.฀Percentage฀luminal฀diameter฀CAS฀was฀50-69%฀in฀108฀and฀≥70%฀in฀159฀arteries.฀ ROC฀ curves฀ showed฀ that฀ stenosis฀ severity฀ ≥65%฀ was฀ the฀ best฀ cut-off฀ that฀ determined฀ the฀ occurrence฀ of฀ WMA,฀ with฀ an฀ area฀ under฀ the฀ curve฀ of฀ 0.85.฀ WMA฀ had฀ a฀ positive฀ predictive฀value฀of฀75%฀and฀negative฀predictive฀value฀of฀80%฀for฀detecting฀stenosis฀≥65%.฀ A฀stenosis฀severity฀≥55%฀was฀the฀best฀cutoff฀that฀determined฀the฀occurrence฀of฀perfusion฀ abnormality.฀The฀area฀under฀the฀curve฀was฀0.84.฀MCE฀had฀a฀positive฀predictive฀value฀of฀ 78%฀and฀negative฀predictive฀value฀of฀80%฀for฀detecting฀stenosis฀≥55%. Conclusions.฀ Perfusion฀ abnormalities฀ occur฀ with฀ less฀ severe฀ CAS฀ compared฀ to฀WMA฀ during฀dobutamine฀stress.฀Therefore,฀MCE฀is฀particularly฀more฀sensitive฀than฀wall฀motion฀ analysis฀for฀the฀diagnosis฀of฀intermediate฀CAS. 1082-85฀ Myocardial฀Perfusion฀Assessed฀by฀Real฀Time฀Contrast฀ Echocardiography฀in฀Patients฀With฀Obstructive฀ Hypertrophic฀Cardiomyopathy฀Referred฀for฀ Percutaneous฀Transluminal฀Septal฀Myocardial฀Ablation Chiara฀Pedone,฀Elena฀Biagini,฀Chris฀van฀der฀Lee,฀Wim฀B.฀Vletter,฀Folkert฀J.฀ten฀ Cate,฀Bellaria฀Hospital,฀Bologna,฀Italy,฀Thoraxcenter฀Erasmus฀MC,฀Rotterdam,฀The฀ Netherlands Background:฀ Microvascular฀ dysfunction฀ is฀ a฀ recognised฀ feature฀ of฀ hypertrophic฀ cardiomyopathy฀depending฀on฀a฀complex฀interplay฀of฀functional฀and฀anatomic฀mechanisms.฀ In฀the฀present฀study฀we฀used฀myocardial฀contrast฀echocardiography฀(MCE)฀in฀patients฀with฀ obstructive฀hypertrophic฀cardiomyopathy฀(HOCM)฀referred฀for฀percutaneous฀transluminal฀ septal฀myocardial฀ablation฀(PTSMA)฀in฀order฀to฀assess฀myocardial฀perfusion฀pattern฀and฀ its฀changes฀after฀the฀procedure. Methods:฀ Sixteen฀ patients฀ with฀ HOCM฀ (mean฀ age฀ 49±15฀ years,฀ 69%฀ males)฀ referred฀ for฀PTSMA฀underwent฀myocardial฀contrast฀echocardiography฀(MCE)฀before฀and฀3.8±3.7฀ months฀after฀the฀procedure.฀MCE฀was฀performed฀using฀real฀time฀imaging฀during฀intravenous฀ slow฀injection฀of฀SonoVue®.฀Myocardial฀blood฀velocity฀(β)฀and฀semiquantitative฀measure฀ of฀blood฀volume฀(homogenous,฀reduced฀or฀“patchy”฀and฀absent฀myocardial฀opacification)฀ were฀assessed.฀The฀results฀were฀compared฀to฀eleven฀controls. Results:฀In฀patients฀with฀HOCM฀myocardial฀blood฀velocity฀was฀significantly฀lower฀either฀ before฀ (0.17±0.04฀ vs.฀ 0.50±0.34,฀ p=0.006)฀ or฀ after฀ PTSMA฀ (0.23±0.07฀ vs.฀ 0.50±0.34,฀ p=0.02)฀compared฀to฀control฀group.฀A฀partial฀(“patchy”)฀perfusion฀was฀present฀in฀all฀the฀ HOCM฀patients฀and฀in฀none฀control.฀After฀PTSMA฀left฀outflow฀tract฀decreased฀from฀86±19฀ to฀18±21฀(p<0.0001)฀and฀a฀significant฀symptomatic฀improvement฀was฀obtained฀consisting฀ in฀ reduction฀ of฀ NYHA฀ class฀ (2.5±1.1฀ to฀ 1.1±0.3;฀ p<0.0001)฀ and฀ resolution฀ of฀ angina.฀ Myocardial฀ blood฀ velocity฀ (β)฀ increased฀ significantly฀ after฀ procedure฀ (0.17±0.04฀ vs.฀ 0.23±0.07฀p=0.004);฀amount฀of฀change฀was฀not฀correlated฀with฀decrease฀of฀the฀gradient.฀ Perfusion฀remained฀patchy฀after฀procedure฀in฀all฀the฀patients. Conclusions:฀ In฀ patients฀ with฀ HOCM฀ underwent฀ PTSMA฀ myocardial฀ flow฀ velocity,฀ as฀ assessed฀ by฀ MCE,฀ was฀ significantly฀ slower฀ compared฀ to฀ controls฀ but฀ it฀ significantly฀ increased฀after฀a฀successful฀procedure.฀Myocardial฀blood฀flow฀may฀represent฀an฀additional฀ parameter฀to฀be฀used฀in฀the฀evaluation฀of฀PTSMA฀results. JACC February 1, 2005 1082-86฀ ABSTRACTS - Noninvasive Imaging Feasibility฀and฀Perioperative฀Prognosis฀of฀Stress฀ Echocardiography฀in฀Morbidly฀Obese฀Patients฀ Undergoing฀Bariatric฀Surgery 1083-72฀ 273A Effect฀of฀Left฀Ventricular฀Geometry฀on฀Systolic฀ Myocardial฀Velocity฀Gradient฀in฀Patients฀with฀ Hypertension Delia฀Cotiga,฀Dan฀Musat,฀Andrei฀Dobrescu,฀Louis฀Flancbaum,฀Siu-Sun฀Yao,฀Binoy฀Singh,฀ Farooq฀A.฀Chaudhry,฀St.Luke’s-Roosevelt฀Hospital฀Center฀and฀Columbia฀University฀ College฀of฀Physicians฀and฀Surgeons,฀New฀York,฀NY Hirotsugu฀Yamada,฀Eriko฀Kimura,฀Hideji฀Tanaka,฀Kenji฀Harada,฀Masahiro฀Nomura,฀ Susumu฀Ito,฀Tomotsugu฀Tabata,฀The฀University฀of฀Tokushima,฀Graduate฀School฀of฀ Medicine,฀Tokushima,฀Japan Background:฀Morbid฀obesity฀(BMI฀≥฀35kg/m2)฀is฀a฀well-recognized฀major฀perioperative฀ risk฀factor฀for฀cardiovascular฀morbidity฀and฀mortality.฀The฀role฀of฀stress฀echocardiography฀ in฀perioperative฀risk฀stratification฀in฀the฀general฀population฀is฀well฀established.฀However,฀ the฀ role฀ of฀ stress฀ echoes฀ in฀ evaluating฀ high-risk฀ morbidly฀ obese฀ patients฀ with฀ higher฀ incidence฀of฀poor฀acoustic฀window฀is฀not฀known. Methods:฀We฀studied฀196฀morbidly฀obese฀patients฀(weight฀345฀±฀97฀lbs,฀mean฀BMI฀53฀±฀ 11kg/m2)฀who฀underwent฀stress฀echocardiogram฀(SE)฀and฀subsequently฀gastric฀bypass฀ surgery฀(average฀30.5฀days฀after฀SE).฀Dobutamine฀SE฀and฀exercise฀SE฀were฀performed฀ using฀a฀standard฀protocol฀and฀wall฀motion฀analysis฀was฀performed฀using฀a฀16฀segments฀ model.฀Optison,฀Definity฀or฀Imagent฀were฀used฀for฀endocardial฀border฀definition฀in฀patients฀ with฀poor฀acoustic฀windows฀(<13/16฀segments฀visualized). Results:฀Population฀consisted฀of฀78%฀women,฀with฀mean฀age฀44฀±฀10฀years,฀diabetes฀ mellitus฀ was฀ present฀ in฀ 48%,฀ hyperlipidemia฀ in฀ 58%,฀ hypertension฀ in฀ 52%,฀ obstructive฀ sleep฀apnea฀in฀37%฀and฀pulmonary฀hypertension฀in฀12%.฀Dobutamine฀SE฀was฀performed฀ in฀155(79%)฀patients฀and฀exercise฀SE฀in฀41฀(21%).฀Mean฀EF฀was฀60±฀2.4%. A฀satisfactory฀echocardiographic฀window฀(>13/16฀segments)฀was฀observed฀in฀66(34%)฀ patients.฀ 130(66%)฀ patients฀ had฀ poor฀ acoustic฀ window.฀ Contrast฀ was฀ used฀ in฀ 100฀ patients฀with฀poor฀acoustic฀window฀(Optison฀28,฀Definity฀63,฀Imagent฀5),฀which฀improved฀ the฀ number฀ of฀ SE฀ with฀ poor฀ to฀ good฀ window฀ to฀ 83%(conversion).฀ SE฀ was฀ normal฀ in฀ 185(94.4%)฀and฀abnormal฀in฀11(5.6%)฀patients. No฀cardiac฀event฀(myocardial฀infarction฀or฀cardiac฀death)฀was฀observed฀in฀the฀follow฀up฀ period฀of฀843฀±฀246฀days฀after฀the฀surgical฀procedure.฀Negative฀predictive฀value฀of฀the฀ SE฀was฀100%. Conclusion:฀In฀the฀morbidly฀obese฀patients฀the฀incidence฀of฀poor฀acoustic฀window฀is฀high.฀ Using฀contrast฀the฀conversion฀rate฀to฀satisfactory฀window฀is฀high.฀Stress฀echocardiography฀ is฀feasible฀in฀morbidly฀obese฀patients.฀A฀normal฀stress฀echocardiogram฀portends฀a฀benign฀ prognosis฀for฀perioperative฀cardiac฀events฀in฀high-risk฀morbidly฀obese฀patients. Background:฀The฀left฀ventricular฀(LV)฀function฀in฀hypertensive฀heart฀has฀been฀evaluated฀ by฀ classifying฀ LV฀ geometry฀ referring฀ relative฀ wall฀ thickness฀ (RWT)฀ and฀ LV฀ mass฀ index฀ (LVMI).฀However,฀the฀relationship฀between฀LV฀geometry฀and฀myocardial฀contractility฀has฀ not฀been฀clearly฀elucidated. Purpose:฀To฀ evaluate฀ relationship฀ between฀ LV฀ geometry฀ and฀ peak฀ systolic฀ myocardial฀ velocity฀gradient฀(Gmax). Methods:฀Ninety-three฀patients฀with฀essential฀hypertension฀were฀classified฀into฀4฀groups:฀ normal฀ geometry฀ (N),฀ concentric฀ remodeling฀ (CR),฀ eccentric฀ hypertrophy฀ (EH)฀ and฀ concentric฀ hypertrophy฀ (CH).฀ Gmax฀ was฀ calculated฀ as฀ the฀ slope฀ of฀ regression฀ line฀ of฀ myocardial฀velocity฀profile฀between฀endcardium฀and฀epicardium฀of฀the฀LV฀posterior฀wall฀ obtained฀by฀tissue฀Doppler฀imaging฀technique. Results:฀The฀Gmax฀showed฀negative฀relationship฀with฀LV฀end-diastolic฀dimension฀(LVd)฀(r=0.61,฀p<0.0001).฀Multiple฀regression฀analysis฀demonstrated฀that฀the฀LVd฀was฀an฀independent฀ factor฀for฀predicting฀Gmax.฀The฀LVd฀in฀CH฀and฀EH฀groups฀was฀significantly฀greater฀than฀that฀in฀ N฀and฀CR฀groups฀(p฀<฀0.001).฀The฀LVMI฀was฀significantly฀greater฀in฀CH฀and฀EH฀groups฀than฀ in฀the฀other฀groups฀(p฀<฀0.001).฀The฀Gmax฀was฀significantly฀smaller฀in฀CH฀group฀than฀in฀CR฀ group฀(p฀<฀0.05),฀although฀there฀was฀no฀difference฀in฀RWT฀between฀two฀groups. LVd฀(cm) RWT LVMI฀(g/m2) Gmax฀(s-1) POSTER฀SESSION Monday,฀March฀07,฀2005,฀9:00฀a.m.-12:30฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀11:00฀a.m.-Noon 1083-71฀ Acute฀Improvement฀in฀Myocardial฀Function฀Assessed฀ by฀Strain฀and฀Strain฀Rate฀Echocardiography฀After฀ Aortic฀Valve฀Replacement฀for฀Aortic฀Stenosis Noriaki฀Iwahashi,฀Satoshi฀Nakatani,฀Hideaki฀Kanzaki,฀Kazuaki฀Wakami,฀Haruhiko฀Abe,฀ Takuya฀Hasegawa,฀Masakazu฀Yamagishi,฀Masafumi฀Kitakaze,฀Kunio฀Miyatake,฀National฀ Cardiovascular฀Center,฀Suita,฀Japan We฀ investigated฀ if฀ strain฀ and฀ strain฀ rate฀ could฀ be฀ useful฀ to฀ detect฀ changes฀ in฀ regional฀ myocardial฀function฀in฀patients฀with฀aortic฀stenosis฀(AS)฀after฀aortic฀valve฀replacement฀(AVR). METHODS:฀ We฀ studied฀ consecutive฀ 26฀ patients฀ (70±10฀ years)฀ with฀ severe฀ AS฀ 13฀ of฀ whom฀ underwent฀ AVR.฀ Peak฀ strain,฀ strain฀ rate฀ (systole,฀ Ssr;฀ early฀ diastole,฀ Esr;฀ late฀ diastole,฀Asr),฀time฀to฀peak฀strain฀(TS),฀time฀to฀peak฀systolic฀strain฀rate฀(TSsr)฀and฀time฀to฀ peak฀early฀diastolic฀strain฀rate฀(TEsr)฀of฀basal฀and฀mid฀segments฀in฀the฀apical฀4-,฀3-฀and฀ 2-chamber฀views฀were฀measured฀and฀averaged฀before฀and฀2weeks฀after฀AVR. RESULTS:฀ Peak฀ strain฀ and฀ Ssr฀ showed฀ the฀ best฀ correlation฀ with฀ left฀ ventricular฀ (LV)฀ ejection฀ fraction฀ (EF)฀ (r=0.78,฀ r=0.71,฀ respectively,฀ both฀ p<0.0001).฀ Esr฀ and฀ Asr฀ showed฀ significant฀ correlations฀ with฀ LV฀ mass฀ index฀ (r=0.51,฀ p<0.01,฀ r=0.70,฀ p<0.0001,฀ respectively),฀and฀TS,฀TSsr฀and฀TEsr฀with฀aortic฀pressure฀gradient฀(r=0.54,฀r=0.47,฀r=0.46,฀ respectively,฀all฀p<0.01)฀before฀AVR.฀Although฀LV฀mass฀index฀and฀LV฀systolic฀function฀did฀ not฀change฀significantly฀after฀2฀weeks฀(LV฀mass฀index,฀137±54฀vs.฀125±36฀g/m2;฀LVEF,฀60฀ vs.฀58%,฀both฀p=ns),฀peak฀strain,฀and฀strain฀rates฀increased฀(p<0.001)฀and฀time฀to฀peak฀ strain฀and฀strain฀rate฀shortened฀after฀AVR฀(p<0.001). CONCLUSIONS:฀ Strain฀ and฀ strain฀ rate฀ parameters฀ seemed฀ to฀ relate฀ LV฀ function฀ and฀ AS฀ severity.฀ Strain฀ and฀ strain฀ rate฀ imaging฀ could฀ sensitively฀ detect฀ early฀ changes฀ in฀ myocardial฀function฀after฀AVR฀before฀LV฀mass฀and฀LV฀function฀showed฀improvement.฀ Strain(%) Ssr(s-1) Esr(s-1) Asr(s-1) Pre฀AVR Post฀AVR Ts/(sec/√RR) TSsr฀(sec/√RR) TEsr฀(sec/√RR) Peak฀PG฀(mmHg) -12.6±2.6 -0.7±0.1 0.7±0.2 0.9±0.2 418.8±41.1 -15.3±2.5 -1.0±0.2 1.2±0.2 1.2±0.2 343±36.3 RR=R-R฀interval฀on฀ECG 251.6±45.3 173.8±48.8 513.6±26.5 461±34 100.9±35.1 23.0±8.2 EH CH 4.2฀±฀0.4 0.56฀±฀0.10 122฀±฀17 2.8฀±฀0.9 5.7฀±฀0.7 0.38฀±฀0.06 182฀±฀39 1.8฀±฀1.0 4.9฀±฀0.7 0.56฀±฀0.09 196฀±฀53 1.8฀±฀0.8 Effects฀of฀Weight฀Loss฀Following฀Gastric฀Bypass฀ Surgery฀on฀Right฀and฀Left฀Ventricular฀Systolic฀and฀ Diastolic฀Function Howard฀J.฀Willens,฀Simon฀C.฀Chakko,฀Patricia฀Byers,฀Eugenio฀Labrador,฀Juan฀C.฀ Castrillon,฀Maureen฀H.฀Lowery,฀University฀of฀Miami฀School฀of฀Medicine,฀Miami,฀FL,฀ Veterans฀Administration฀Medical฀Center,฀Miami,฀FL Background:฀The฀effect฀of฀weight฀loss฀on฀cardiac฀function฀in฀obese฀patients฀has฀not฀been฀ defined.฀This฀study฀evaluates฀the฀effects฀of฀significant฀weight฀loss฀following฀gastric฀bypass฀ on฀ right฀ and฀ left฀ ventricular฀ systolic฀ and฀ diastolic฀ function฀ using฀ conventional฀ Doppler฀ echocardiography฀(DE)฀and฀tissue฀Doppler฀imaging. Methods:฀We฀ performed฀ DE฀ and฀ tissue฀ Doppler฀ imaging฀ on฀ 14฀ patients฀ (8฀ females),฀ age฀ 44+10฀years,฀body฀mass฀index฀56+12฀kg/m2,฀before฀and฀3-15฀months฀after฀gastric฀bypass.฀DE฀ parameters฀of฀interest฀included฀left฀ventricular฀end-diastolic฀diameter,฀fractional฀shortening,฀ early฀(E)฀and฀late฀(A)฀mitral฀inflow฀velocities฀and฀(E/A)฀ratio.฀Peak฀systolic฀(S’)฀and฀early฀(E’)฀ and฀late฀(A’)฀diastolic฀tissue฀velocities฀were฀measured฀from฀the฀lateral฀and฀septal฀corners฀of฀ the฀mitral฀annulus฀and฀lateral฀tricuspid฀annulus฀in฀the฀apical฀4-chamber฀view. Results:฀Patients฀lost฀an฀average฀of฀39฀kg฀(range฀19-53).฀No฀significant฀changes฀in฀left฀ ventricular฀ end-diastolic฀ diameter฀ or฀ fractional฀ shortening฀ were฀ noted.฀ Pre฀ and฀ postsurgical฀values฀compared฀using฀a฀paired฀t฀test฀are฀shown฀in฀the฀table.฀Although฀E฀and฀A฀ decreased฀following฀surgery,฀E/A฀ratio฀increased.฀S’฀did฀not฀change฀in฀the฀left฀ventricle.฀E’฀ at฀the฀lateral฀mitral฀annulus฀but฀not฀the฀septum฀increased.฀S’and฀E’฀at฀the฀tricuspid฀annulus฀ increased฀significantly฀following฀surgery. Conclusions:฀ Substantial฀ weight฀ loss฀ achieved฀ with฀ gastric฀ bypass฀ improves฀ right฀ ventricular฀systolic฀and฀diastolic฀function฀and฀left฀ventricular฀diastolic฀function. ฀ Pre฀and฀post-surgical฀values฀for฀selected฀variables฀฀ compared฀using฀paired฀t฀test฀ variable S’฀tricuspid฀annulus฀(cm/s) E’฀tricuspid฀annulus฀(cm/s) E’฀lateral฀mitral฀annulus฀(cm/s) E’฀septal฀mitral฀annulus฀(cm/s) mitral฀E฀(cm/s) mitral฀A฀(cm/s) mitral฀E/A 1083-74฀ pre-surgery 8.7฀+฀2.6 7.1฀+฀3.0 7.4฀+฀1.6 6.3฀+฀1.6 97฀+฀23 76฀+฀14 1.2฀+฀0.2 post-surgery 10.4฀+฀2.3 10.8฀+฀2.3 8.8฀+฀2.3 7.5฀+฀1.8 88฀+฀18 60฀+฀18 1.6฀+฀0.5 p฀value 0.04 0.001 0.046 0.067 0.026 0.018 0.01 Impaired฀Myocardial฀Contractility฀in฀Aortic฀Stenosis฀ Demonstrated฀by฀Transmural฀Myocardial฀Strain฀Profile Takatoshi฀Goto,฀Satoshi฀Nakatani,฀Takeshi฀Maruo,฀Kazuaki฀Wakami,฀Takuya฀Hasegawa,฀ Hideaki฀Kanzaki,฀National฀Cardiovascular฀Center,฀Suita,฀Japan Background:฀Myocardial฀dysfunction฀has฀been฀suggested฀in฀patients฀with฀aortic฀stenosis฀ (AS)฀even฀with฀preserved฀left฀ventricular฀(LV)฀function. Methods:฀To฀ assess฀ changes฀ in฀ myocardial฀ function฀ induced฀ by฀ reduction฀ in฀ pressure฀ overload,฀ we฀ evaluated฀ transmural฀ myocardial฀ strain฀ profile฀ (TMSP)฀ using฀ tissue฀ strain฀ M-mode฀ imaging฀ (Toshiba,฀ TDI-Q)฀ in฀ 16฀ patients฀ with฀ AS฀ undergoing฀ aortic฀ valve฀ replacement฀ (AVR)฀ and฀ 12฀ normals.฀ Peak฀ myocardial฀ strain,฀ its฀ location฀ (%distance฀ of฀ the฀wall฀thickness฀from฀the฀endocardium),฀and฀endocardial฀and฀epicardial-half฀strain฀were฀ measured฀from฀systolic฀TMSP฀obtained฀at฀the฀short-axis฀LV฀posterior฀wall. Noninvasive Imaging Clinical฀Applications฀of฀Tissue฀Velocity฀ and฀Strain CR 4.8฀±฀0.5 0.39฀±฀0.05 109฀±฀25 3.1฀±฀1.2 Conclusion:฀In฀patients฀with฀essential฀hypertension,฀the฀Gmax฀worsened฀corresponding฀ to฀increase฀in฀LV฀dimension฀even฀with฀similar฀wall฀thickness. 1083-73฀ 1083฀฀ N 274A ABSTRACTS - Noninvasive Imaging JACC February 1, 2005 Results:฀ LV฀ fractional฀ shortening฀ was฀ higher฀ in฀ AS฀ than฀ in฀ normals฀ (43±4฀ vs.฀ 37±5%,฀ p<0.05).฀ Peak฀ (67±24฀ vs.฀ 111±10%,฀ p<0.0001),฀ endocardial-half฀ (46±14฀ vs.฀ 99±10%,฀ p<0.0001)฀and฀epicardial-half฀strain฀(27±16฀vs.฀49±14%,฀p<0.05)฀were฀significantly฀lower฀ and฀the฀location฀of฀peak฀strain฀was฀closer฀to฀the฀epicardium฀(33±14฀vs.฀14±8%,฀p<0.05)฀ in฀AS฀than฀in฀normals.฀Endocardial-half฀strain฀and฀aortic฀peak฀pressure฀gradient฀showed฀ a฀significant฀negative฀correlation฀(r=-0.89฀p<0.0001).฀After฀12±3฀days฀of฀AVR,฀peak฀strain฀ increased฀ significantly฀ (88±29%,฀ p<0.01)฀ and฀ its฀ location฀ shifted฀ to฀ the฀ endocardium฀ (20±12%,฀p<0.05).฀Endocardial-half฀strain฀improved฀(66±25%฀p<0.01)฀but฀epicardial-half฀ strain฀did฀not฀change฀substantially฀(23±18%,฀p=ns). Conclusions:฀In฀AS,฀reduced฀myocardial฀contractility฀was฀mainly฀found฀in฀the฀endocardial฀ side฀that฀was฀improved฀by฀AVR. 1083-77฀ 1083-75฀ Tissue฀Doppler฀Guided฀Optimization฀of฀A-V฀and฀V-V฀ Delay฀of฀Biventricular฀Pacemaker฀Improves฀Response฀ to฀Cardiac฀Resynchronization฀Therapy฀in฀Heart฀Failure฀ Patients. Noninvasive Imaging Michael฀C.฀Chan,฀Mohsen฀Gaballa,฀Randy฀Willliams,฀Soori฀Sivakumaran,฀Ken฀O’Reilly,฀ Jan฀van฀der฀Linden,฀Lars-Ake฀Brodin,฀William฀Hui,฀Royal฀Alexandra฀Hospital,฀Edmonton,฀ AB,฀Canada,฀Huddinge฀University,฀Stockholm,฀Sweden Background:฀ Only฀ a฀ proportion฀ of฀ heart฀ failure฀ patients฀ respond฀ to฀ Cardiac฀ Resynchronization฀ Therapy฀ (CRT).฀ The฀ optimal฀ atrio-ventricular฀ delay฀ (A-V฀ delay)฀ and฀ right฀to฀left฀ventricular฀delay฀(V-V฀delay)฀is฀unknown.฀We฀evaluated฀the฀impact฀of฀A-V฀delay฀ as฀well฀V-V฀delay฀on฀left฀ventricular฀(LV)฀myocardial฀performance฀as฀assessed฀by฀Tissue฀ Doppler฀ Imaging฀ (TDI).฀ We฀ also฀ assessed฀ if฀ optimization฀ of฀ different฀ pacing฀ modalities฀ might฀decrease฀the฀number฀of฀non-responder฀heart฀failure฀patients฀to฀CRT. Methods:฀฀Forty฀five฀patients฀with฀class฀3฀and฀4฀ischemic฀heart฀failure฀and฀left฀bundle฀branch฀ block,฀who฀received฀biventricular฀pacemaker฀(Medtronic)฀for฀>3฀months,฀were฀deemed฀to฀ be฀non-responders฀by฀quality฀of฀life฀(QoL)฀scoring,฀conventional฀echocardiography฀as฀well฀ as฀6฀minute฀walk฀test. TDI฀was฀acquired฀in฀these฀patients฀by฀Vivid-7฀echo฀machine฀(General฀Electric฀Medical)฀ at฀ different฀ pacing฀ modalities฀ in฀ apical฀ 2-,฀ 3-฀ and฀ 4-chamber฀ views.฀ Myocardial฀ systolic฀ velocity฀ (S),฀ atrioventricular฀ displacement฀ (AV-disp.),฀ ejection฀ fraction฀ (EF),฀ strain฀ (str.),฀ time฀ to฀ peak฀ velocity,฀ time฀ to฀ peak฀ velocity฀ imaging฀ (TSI),฀ curved฀ M-Mode฀ of฀ tissue฀ tracking฀(C-TRACK)฀were฀obtained฀in฀LV฀walls฀simultaneously. Different฀A-V฀delays฀(100,฀130,฀150,฀170฀msec)฀were฀chosen฀to฀minimize฀dyssynchrony฀ in฀LV฀walls.฀At฀the฀optimal฀A-V฀delay,฀V-V฀delay฀was฀then฀tested฀at฀4฀msec,฀then฀increased฀ stepwise฀to฀maximum฀52฀msec.฀Data฀were฀further฀analyzed฀off-line. Results:฀The฀most฀favorable฀A-V฀delay฀for฀these฀patients฀to฀obtain฀the฀highest฀value฀for฀ S,฀ str,฀ AV฀ disp.฀ was฀ 130-150฀ msec(p<฀ 0.001).฀ At฀ this฀ A-V฀ delay,฀ better฀ synchrony฀ was฀ obtained฀as฀shown฀by฀C-TRACK.฀The฀common฀optimal฀V-V฀delay฀was฀24-28฀msec.฀Thirty฀ eight฀(85%)฀patients฀improved฀significantly฀after฀optimization฀of฀CRT,฀as฀shown฀by฀QoL฀ (p<0.01),฀and฀EF฀(p<฀0.01). Conclusion:฀฀Tissue฀Doppler฀Imaging฀may฀play฀an฀important฀role฀in฀optimization฀of฀CRT.฀ An฀A-V฀delay฀of฀130-150฀msec,฀as฀well฀as฀V-V฀delay฀of฀24-฀28฀msec฀may฀generally฀be฀ used฀to฀improve฀LV฀performance฀and฀decrease฀the฀number฀of฀non-responder฀patients. 1083-76฀ Quantitative฀and฀Direct฀Assessment฀of฀the฀Left฀Atrial฀ Reservoir฀Function฀Using฀Tissue฀Strain฀Imaging Tomotsugu฀Tabata,฀Hideji฀Tanaka,฀Hirotsugu฀Yamada,฀Yoo฀Saito,฀Kenji฀Harada,฀Masahiro฀ Nomura,฀Susumu฀Ito,฀The฀University฀of฀Tokuashima฀Graduate฀School฀of฀Medicine,฀ Tokushima,฀Japan Background:฀The฀ evaluation฀ of฀ the฀ left฀ atrial฀ (LA)฀ reservoir฀ function฀ using฀ pulmonary฀ venous฀flow฀(PVF)฀velocities฀was฀influenced฀by฀the฀loading฀conditions.฀The฀tissue฀strain฀ imaging฀ (TSI)฀ could฀ potentially฀ evaluate฀ LA฀ reservoir฀ function฀ directory฀ by฀ measuring฀ systolic฀strain฀(S)฀and฀strain฀rate฀(SR). Purpose:฀To฀assess฀LA฀reservoir฀function฀in฀the฀normal฀hearts฀using฀TSI. Methods:฀Transesophageal฀echocardiography฀was฀performed฀in฀18฀normal฀volunteers฀(32฀ ±฀5yrs).฀From฀the฀recording฀of฀Doppler฀PVF฀profiles,฀we฀measured฀systolic฀(PVSvti)฀and฀ diastolic฀(PVDvti)฀velocity฀time฀integrals฀and฀their฀systolic฀fraction฀[PVSvti/(PVDvti+PVSvti)].฀ The฀ color฀ tissue฀ Doppler฀ image฀ including฀ LA฀ lateral฀ wall฀ was฀ acquired,฀ and฀ the฀ peak฀ systolic฀ S฀ and฀ SR฀ were฀ analyzed฀ off-line฀ (TDI-Q,฀ Toshiba,฀ Japan).฀ The฀ preload฀ was฀ increased฀by฀the฀lower฀body฀positive฀presser฀device฀(LBPP). Results:฀1)฀LA฀strain฀and฀strain฀rate฀profiles฀at฀rest฀were฀obtained฀as฀shown฀in฀the฀figure.฀ 2)฀The฀LA฀area,฀PVSvti฀(10.2฀vs฀15.7cm),฀PVDvti฀(6.8฀vs฀8.0cm)฀and฀systolic฀fraction฀(0.53฀ vs฀0.66)฀significantly฀increased฀reflecting฀preload฀increase฀by฀LBPP.฀3)฀Corresponding฀to฀ those฀changes,฀the฀peak฀systolic฀S฀(0.80฀vs฀1.01,฀p฀<฀0.001)฀and฀SR฀(3.5฀vs฀5.6s-1,฀p฀<฀ 0.01)฀significantly฀increased. Conclusions:฀The฀peak฀systolic฀S฀and฀SR฀increased฀corresponding฀to฀the฀increase฀in฀LA฀ preload฀as฀evidenced฀by฀changes฀in฀the฀PVF฀velocities.฀The฀parameters฀obtained฀from฀ TSI฀can฀be฀potentially฀applied฀for฀quantitative฀and฀direct฀assessment฀of฀the฀LA฀reservoir฀ function. Atrioventricular฀Conduction฀Time-Interval฀Measurement฀ by฀Tissue฀Velocity฀Doppler:฀Validation฀of฀a฀Novel฀ Technique฀and฀Correlation฀With฀ECG฀and฀Doppler฀Flow฀ Measurements. Masaki฀Nii,฀Mikiko฀Shimizu,฀Kevin฀S.฀Roman,฀Igor฀Konstantinov,฀Jia฀Li,฀Andrew฀ Redington,฀Edgar฀T.฀Jaeggi,฀The฀Hospital฀for฀Sick฀Children,฀Toronto,฀ON,฀Canada Background:฀ Accurate฀ analysis฀ of฀ atrioventricular฀ (AV)฀ conduction฀ time฀ is฀ crucial฀ to฀ detect฀evolving฀fetal฀AV฀block฀at฀an฀early฀stage.฀In฀the฀absence฀of฀real-time฀fetal฀ECG,฀ pulsed฀Doppler฀(PD)฀interrogation฀of฀the฀LV฀in/outflow฀has฀become฀an฀established฀method฀ of฀measuring฀fetal฀AV฀conduction฀time.฀Major฀drawbacks฀are฀its฀dependency฀on฀loading฀ condition฀ and฀ fusion฀ of฀ E฀ and฀ A฀ at฀ faster฀ heart฀ rates.฀ Longitudinal฀ myocardial฀ tissue฀ velocity฀imaging฀(TVI)฀might฀be฀more฀useful฀in฀this฀regard. Objectives:฀To฀study฀the฀relationship฀between฀electrical,฀hemodynamic฀and฀mechanical฀ AV฀conduction฀time฀using฀surface฀ECG,฀PD฀and฀TVI฀at฀a฀physiological฀heart฀rate฀range฀ of฀a฀human฀fetus. Methods:฀In฀15฀open-chest฀pigs,฀incremental฀epicardial฀right฀atrial฀pacing฀was฀obtained฀ at฀ 100,฀ 120,฀ 140,฀ 160,฀ 180฀ and฀ 200฀ bpm.฀ For฀ each฀ heart฀ rate,฀ surface฀ ECG฀ and฀ echo฀ measurements฀were฀obtained.฀Myocardial฀velocities฀were฀determined฀at฀the฀AV฀groove฀ of฀ the฀ right฀ (RV),฀ left฀ (LV)฀ ventricular฀ free฀ walls฀ and฀ the฀ ventricular฀ septum฀ (IVS)฀ using฀ color-coded฀TVI.฀AV฀conduction฀times฀were฀measured฀by฀TVI฀(as฀interval฀between฀onset฀ of฀A฀wave฀and฀isovolumic฀contraction฀spike);฀LV฀in/outflow฀PD฀(interval฀between฀onset฀of฀ A฀wave฀and฀LVOT฀forward฀flow);฀and฀PR฀interval฀on฀surface฀ECG.฀We฀analyzed฀correlation฀ between฀TVI,฀PD฀time฀intervals฀and฀PR฀intervals฀at฀different฀heart฀rates. Conclusion:฀Although฀TVI฀derived฀AV฀conduction฀time฀underestimates฀PR฀interval,฀it฀has฀ better฀correlation฀than฀PD฀method฀and฀is฀more฀applicable฀at฀higher฀heart฀rates. Results:฀Correlation฀to฀PR฀interval฀and฀maximal฀HR฀ Modality Correlation฀to฀PR฀interval Bias TVI-RV฀(N=53) TVI-IVS฀(N=59) TVI-LV฀(N=62) LV฀PD฀(N=43) R=0.79฀(P<0.0001) R=0.84฀(P<0.0001) R=0.75฀(P<0.0001) R=0.32฀(P=0.005) Maximum฀HR฀(bpm)฀ (range;฀median) 100-176.5;฀140 10.35 27.75 25.65 -21.15 P฀value฀ (TVI฀vs฀PD) 0.02 TVI-IVS 120-176.5;฀140 0.0005 TVI-LV 120.0-162.2;฀140 0.01 LV฀PD 93.8-142.9;฀120 Modality TVI-RV 1083-78฀ 95%฀of฀limit฀of฀ agreement -26.00-46.71 -14.29-69.78 -11.94-63.24 -69.11-26.80 Strain฀Imaging฀Is฀Useful฀for฀Assessing฀Acute฀ Hemodynamic฀Response฀to฀Cardiac฀Resynchronization฀ Therapy฀in฀Nonischemic฀Dilated฀Cardiomyopathy Takahide฀Ito,฀Michihiro฀Suwa,฀Yasuhiko฀Sakai,฀Yasunobu฀Tokaji,฀Satoshi฀Yamamoto,฀ Yasushi฀Kitaura,฀Osaka฀Medical฀College,฀Takatsuki,฀Japan Background:฀ Evidence฀ has฀ shown฀ that฀ cardiac฀ resynchronization฀ therapy฀ (CRT)฀ induces฀ clinical฀ and฀ hemodynamic฀ improvement฀ in฀ end-stage฀ heart฀ failure฀ patients,฀ although฀noninvasive฀method฀for฀assessing฀the฀efficacy฀of฀CRT฀remains฀to฀be฀validated.฀ We฀ performed฀ newly฀ developed฀ echo-Doppler฀ technique฀ strain฀ imaging฀ simultaneously฀ with฀ hemodynamic฀ study฀ in฀ patients฀ with฀ nonischemic฀ dilated฀ cardiomyopathy฀ and฀ intraventricular฀conduction฀delay฀(QRS฀duration>140฀ms).฀ Methods:฀ Strain฀ imaging฀ was฀ performed฀ on฀ 14฀ patients฀ (10฀ men,฀ mean฀ age฀ 67±15)฀ during฀ 2฀ different฀ pacing฀ modes฀ (right฀ ventricular฀ pacing฀ [RV]฀ and฀ biventricular฀ pacing฀ [CRT])฀with฀the฀pacing฀rate฀fixed฀at฀80฀beats/min.฀The฀time฀to฀peak฀negative฀strain฀was฀ measured฀from฀16฀regions฀of฀interest฀in฀apical฀2-,฀4-chamber,฀and฀long฀axis฀views,฀and฀ the฀standard฀deviation฀of฀this฀time-interval฀was฀calculated฀as฀an฀index฀of฀intraventricular฀ asynchrony.฀The฀left฀ventricular฀(LV)฀+dp/dt฀was฀measured฀noninvasively฀with฀continuous฀ wave฀Doppler.฀ Results:฀With฀the฀pacing฀mode฀changed฀from฀RV฀to฀CRT,฀the฀asynchrony฀index฀(from฀ 95±27฀ to฀ 63±16,฀ p<0.01)฀ and฀ QRS฀ duration฀ (from฀ 186±22฀ ms฀ to฀ 135±27,฀ p<0.01)฀ decreased฀significantly.฀This฀finding฀was฀associated฀with฀significant฀changes฀in฀pulmonary฀ wedge฀pressure฀(from฀15±7฀mmHg฀to฀12±8,฀p<0.05),฀LV฀+dp/dt฀(from฀732±211฀mmHg/ ms฀ to฀ 957±285,฀ p<0.01),฀ and฀ LV฀ ejection฀ fraction฀ (from฀ 31±7%฀ to฀ 35±7,฀ p<0.01).฀The฀ JACC February 1, 2005 asynchrony฀ index฀ correlated฀ significantly฀ with฀ LV฀ +dp/dt฀ (r=-0.52,฀ p<0.01),฀ LV฀ ejection฀ fraction฀ (r=-0.42,฀ p<0.05),฀ and฀ cardiac฀ index฀ (r=-0.41,฀ p<0.05).฀ Conclusions:฀ Strain฀ imaging฀is฀useful฀for฀assessing฀intraventricular฀asynchrony฀and฀hemodynamic฀response฀ for฀patients฀undergoing฀CRT. POSTER฀SESSION 1084฀฀ Cardiac฀Magnetic฀Resonance฀Imaging:฀ Clinical฀Studies Monday,฀March฀07,฀2005,฀9:00฀a.m.-12:30฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀11:00฀a.m.-Noon 1084-63฀ Detection฀of฀Procedural฀Myocardial฀Necrosis฀After฀ Surgical฀or฀Percutaneous฀Revascularization฀Using฀ Contrast-Enhanced฀Magnetic฀Resonance฀Imaging Olga฀Bondarenko,฀Aernout฀M.฀Beek,฀Mark฀B.M.฀Hofman,฀Cees฀A.฀Visser,฀Albert฀C.฀van฀ Rossum,฀VU฀University฀Medical฀Center,฀Amsterdam,฀The฀Netherlands 1084-64฀ Magnetic฀Resonance฀Imaging฀T2฀Measurements฀Of฀ Iron฀Overload฀In฀Beta-thalassemia฀Major:฀Relation฀To฀ Exercise฀Capacity฀And฀Cardiac฀Function. Athanasios฀Trikas,฀George฀Latsios,฀Costas฀Tentolouris,฀Gregory฀Kotoulas,฀Eugene฀ Vgonza,฀Dimitris฀Tousoulis,฀Christos฀Pitsavos,฀Christodoulos฀Stefanadis,฀University฀of฀ Athens,฀Athens,฀Greece Background:฀ Previous฀ studies฀ have฀ shown฀ that฀ in฀ beta-thalassemia฀ major฀ (ΤΜ)฀ the฀ assessment฀ of฀ left฀ ventricular฀ (LV)฀ function฀ with฀ echocardiography฀ alone฀ does฀ not฀ accurately฀reflect฀the฀patient’s฀cardiac฀iron฀overload฀(CIO)฀and฀clinical฀status.฀To฀compare฀ exercise฀ capacity฀ (EC)฀ with฀ common฀ echocardiographic-Doppler฀ (ED)฀ indices฀ of฀ LV฀ systolic฀ and฀ diastolic฀ function,฀ and฀ CIO฀ in฀ TM,฀ we฀ studied฀ 40฀ pts฀ (19฀ women฀ and฀ 21฀ men,฀ mean฀ age฀ 29.6±5.3฀ years),฀ who฀ were฀ in฀ stable฀ condition฀ while฀ receiving฀ regular฀ transfusions.฀Of฀the฀40฀pts,฀23฀were฀asymptomatic฀and฀17฀in฀functional฀class฀NYHA฀II-III. Methods:฀ Each฀ subject฀ underwent,฀ 3฀ days฀ after฀ transfusion,฀ a฀ complete฀ ED฀ study฀ followed฀by฀a฀cardiopulmonary฀exercise฀testing฀and฀magnetic฀resonance฀imaging฀(MRI)฀ examination.฀ T2฀ proton฀ relaxation฀ time฀ measurements฀ were฀ obtained฀ in฀ the฀ LV฀ of฀ pts฀ using฀a฀dual฀echo฀Turbo฀Spin฀Echo฀(TSE)฀sequence฀(Philips฀ACS-NT฀1.5T,฀TR=2000ms,฀ TE1=฀8ms,฀TE2=40ms).฀LV฀dimensions฀and฀walls,฀as฀well฀as฀ejection฀fraction฀(EF)฀were฀ measured฀ from฀ ED฀ study.฀ Peak฀ velocities฀ of฀ early฀ and฀ late฀ diastolic฀ filling฀ of฀ LV฀ were฀ measured฀ from฀ Doppler฀ transmitral฀ flow฀ and฀ their฀ E/A฀ ratio฀ was฀ calculated.฀ EC฀ was฀ assessed฀ by฀ peak฀ oxygen฀ consumption฀ (VO2max,฀ ml/kg/min)฀ and฀ anaerobic฀ threshold฀ (AT,฀ml/kg/min). Results:฀The฀following฀were฀observed:฀1)฀symptomatic฀pts฀had฀lower฀VO2max฀and฀AT฀than฀ did฀asymptomatic฀(18.7±1.8฀vs฀26.2±3.2฀-฀p<0.001฀and฀12.4±2.0฀vs฀15.9±1.8฀-฀p<0.001,฀ respectively),฀2)฀no฀significant฀correlation฀was฀found฀between฀LV฀T2฀measurements฀and฀ LV฀dimensions฀and฀walls฀or฀EF฀and฀E/A฀ratio,฀and฀3)฀a฀statistically฀strong฀significant฀linear฀ correlation฀ was฀ observed฀ between฀ LV฀T2฀ and฀VO2max฀ and฀ AT฀ measurements฀ (r=0.80฀ -฀p<0.01฀and฀r=0.82฀-฀p<0.01,฀respectively). Conclusions:฀In฀patients฀with฀beta-thalassemia฀major฀LV฀T2฀measurements,฀an฀index฀of฀ iron฀overload฀determined฀through฀MRI,฀is฀closely฀related฀to฀exercise฀capacity฀and฀not฀to฀ echocardiographic฀parameters.฀Conventional฀indices฀of฀cardiac฀function฀can฀only฀detect฀ advanced฀ disease,฀ while฀ exercise฀ capacity฀ parameters฀ seem฀ to฀ be฀ better฀ markers฀ for฀ predicting฀disease฀progression฀due฀to฀myocardial฀iron฀overload. 1084-65฀ 275A Delayed฀Hyperenhancement฀Magnetic฀Resonance฀ Imaging฀Is฀Useful฀in฀Predicting฀Functional฀Recovery฀of฀ Nonischemic฀LV฀Systolic฀Dysfunction Sungha฀Park,฀Se-Joong฀Rim,฀Byoung฀Wook฀Choi,฀Young-Guk฀Ko,฀Seok-Min฀Kang,฀JongWon฀Ha,฀Yangsoo฀Jang,฀NamSik฀Chung,฀Won-Heum฀Shim,฀Kyu-Ok฀Choe,฀Seung-Yun฀Cho,฀ Yonsei฀University฀College฀of฀Medicine฀Yonsei฀Cardiovascular฀Center,฀Seoul,฀South฀Korea Background:฀About฀1/4฀of฀the฀patients฀with฀recent฀onset,฀non฀ischemic฀Left฀Ventricular(LV)฀ systolic฀ dysfunction฀ improve฀ spontaneously฀ with฀ medical฀ treatment.฀ However฀ the฀ predictors฀for฀the฀future฀improvement฀in฀LV฀function฀are฀not฀yet฀known.฀Recently,฀cardiac฀ MRI(CMR)฀has฀been฀suggested฀to฀reflect฀myocardial฀fibrosis฀in฀dilated฀cardiomyopathy.฀ We฀hypothesized฀that฀the฀presence฀of฀myocardial฀fibrosis,฀assessed฀by฀CMR,฀may฀predict฀ the฀reversibility฀of฀non฀ischemic฀LV฀systolic฀dysfunction.฀ Methods:฀CMR฀was฀performed฀on฀37฀patients฀with฀new฀onset฀of฀non฀ischemic฀systolic฀ heart฀failure.฀Seventeen฀patients฀showed฀absence฀of฀delayed฀hyperenhancement(Group฀ 1,฀age:฀53.2±14.6,฀M:F=9:8)฀while฀20฀patients฀demonstrated฀delayed฀hyperenhancement฀ on฀ CMR฀ imaging(group2,฀ age:฀ 59.0±13.6,฀ M:F=15:5)฀ The฀ two฀ study฀ groups฀ were฀ compared฀in฀terms฀of฀the฀functional฀recovery฀of฀LV฀systolic฀function฀to฀at฀least฀preserved฀ status(LVEF฀>฀45%)฀at฀followup.฀ Results:฀ There฀ was฀ no฀ significant฀ difference฀ in฀ the฀ duration฀ until฀ follow-up฀ echocardiography.(group฀ 1:฀ 7.3±3.2฀ months฀ group฀ 2:฀ 9.1±5.6฀ months)฀ Thirteen฀ out฀ of฀ 17฀ patients(76.5%)฀ in฀ group฀ 1฀ demonstrated฀ functional฀ recovery฀ whereas฀ only฀ 2฀ out฀ of฀ 20฀ patients(10.0%)฀ in฀ group฀ 2฀ demonstrated฀ functional฀ recovery.฀ Absence฀ of฀ hyperenhancement฀ predicted฀ functional฀ recovery฀ with฀ sensitivity,฀ specificity,฀ positive฀ predictive฀ value,฀ negative฀ predictive฀ value฀ of฀ 86.7%,฀ 81.8%,฀ 76.5%,฀ and฀ 90.5%,฀ respectively.฀There฀were฀no฀significant฀difference฀between฀group฀1฀and฀group฀2฀for฀the฀ initial฀LV฀end฀diastolic฀dimension(LVEDD)[64.2±6.2mm฀vs฀66.9±9.2mm],฀LV฀end฀systolic฀ dimension(LVESD)[55.8±6.6mm฀ vs฀ 58.9±9.3mm],฀ LVEF(28.5±7.4%฀ vs฀ 24.9±8.1%)฀ and฀ followup฀ LV฀ end฀ diastolic฀ dimension(LVEDD)[56.0±7.5mm฀ vs฀ 61.9±13.0mm,฀ p=0.102],฀ but฀ there฀ were฀ significant฀ differences฀ for฀ follow-up฀ LVESD(43.3±9.8mm฀ vs฀ 52.0±13.9,฀ p=0.038)฀and฀LVEF(45.9±12.8%฀vs฀33.1±13.1%,฀p=0.005).฀ Conclusion:฀ Delayed฀ hyperenhancement,฀ assessed฀ by฀ CMR,฀ is฀ associated฀ with฀ functional฀recovery฀in฀non-ischemic฀LV฀systolic฀dysfunction.฀CMR฀may฀be฀clinically฀useful฀ in฀predicting฀functional฀recovery฀of฀non-ischemic฀LV฀systolic฀dysfunction. 1084-66฀ Myocardial฀Structural฀Correlates฀of฀Late฀Persistence฀ of฀ST-Segment฀Elevation฀in฀the฀Subacute฀Stage฀of฀ Myocardial฀Infarction Massimo฀Napodano,฀Luisa฀Cacciavillani,฀Francesco฀Corbetti,฀Angelo฀Ramondo,฀ Giuseppe฀Tarantini,฀Renato฀Razzolini,฀Elisabetta฀Grolla,฀Sabino฀Iliceto,฀University฀of฀ Padova,฀Padova,฀Italy Background.฀The฀persistence฀of฀ST-segment฀elevation฀(STE)฀lasting฀for฀a฀long฀time฀after฀ acute฀myocardial฀infarction฀(AMI)฀has฀been฀typically฀ascribed฀to฀left฀ventricular฀aneurysm฀ formation.฀ However฀ this฀ conclusion฀ is฀ controversial,฀ and฀ the฀ pathological฀ basis฀ of฀ late฀ persistent฀ STE฀ is฀ still฀ lack.฀ Contrast-enhanced฀ magnetic฀ resonance฀ imaging฀ (CMR)฀ allows฀ precise฀ delineation฀ of฀ transmural฀ and฀ spatial฀ extent฀ of฀ myocardial฀ necrosis฀ and฀ microvascular฀ obstruction.฀ The฀ purpose฀ of฀ this฀ study฀ was฀ to฀ evaluate฀ the฀ myocardial฀ structural฀ abnormalities฀ underlying฀ late฀ persistence฀ of฀ STE,฀ using฀ contrast฀ cardiac฀ magnetic฀resonance.฀ Methods:฀72฀patients฀who฀underwent฀direct฀percutaneous฀coronary฀intervention฀for฀their฀ first฀AMI฀were฀studied฀by฀CMR.฀The฀late฀STE฀was฀defined฀by฀the฀persistence฀of฀at฀least฀ 2฀ mm฀ in฀ two฀ or฀ more฀ leads฀ on฀ pre-discharge฀ ECG.฀ In฀ each฀ patient,฀ the฀ presence฀ and฀ extent฀ of฀ myocardial฀ necrosis฀ (late฀ hyperenhancement)฀ and฀ microvascular฀ obstruction฀ (hypoenhancement)฀ were฀ assessed฀ on฀ a฀ 17-segment฀ model.฀ For฀ each฀ segment,฀ the฀ transmural฀extent฀of฀hyperenhancement฀and฀hypoenhancement฀were฀scored฀from฀0฀to฀4,฀ and฀the฀total฀amount฀of฀hyperenhancement฀and฀hypoenhancement฀was฀expressed฀as฀the฀ sum฀of฀score฀in฀each฀segment฀divided฀by฀the฀number฀of฀segments฀assessed. Results:฀Overall฀72฀patients,฀27฀(37.5%)฀showed฀late฀persistence฀of฀STE฀and฀45฀(62.5%)฀ did฀ not.฀ Patients฀ with฀ late฀ persistence฀ of฀ STE฀ was฀ more฀ often฀ diabetics฀ (p=฀ 0.01),฀ had฀ more฀ anterior฀ infarction฀ (p=฀ 0.001)฀ and฀ had฀ longer฀ ischemic฀ time฀ (p=฀ 0.001).฀ At฀ CMR฀ patients฀ with฀ late฀ STE฀ had฀ higher฀ number฀ of฀ segments฀ exhibiting฀ hyperenhancement฀ (p<0.0001),฀higher฀hyperenhancement฀score฀(p<0.0001).฀Likewise,฀STE฀group฀had฀higher฀ number฀ of฀ hypoenhanced฀ segments฀ (p<฀ 0.0001),฀ higher฀ hypoenhancement฀ score฀ (p<฀ 0.0001).฀ In฀ a฀ multivariate฀ model฀ the฀ extent฀ of฀ hypoenhancement,฀ but฀ not฀ the฀ extent฀ of฀ hyperenhancement,฀was฀an฀independent฀predictor฀of฀late฀persistence฀STE. Conclusions:฀ Late฀ persistence฀ of฀ ST฀ segment฀ elevation฀ after฀ myocardial฀ infarction฀ is฀ related฀ with฀ a฀ larger฀ extent฀ of฀ necrosis฀ and฀ microvascular฀ obstruction฀ as฀ assessed฀ by฀ CMR.฀The฀ microvascular฀ obstruction฀ is฀ an฀ independent฀ predictor฀ of฀ late฀ persistence฀ of฀ ST฀segment฀elevation. 1084-67฀ Heterogeneity฀in฀Anatomical฀and฀Functional฀behavior฀ of฀Reperfused฀Myocardium฀after฀Primary฀Angioplasty฀ for฀Acute฀Myocardial฀Infarction;฀a฀contrast-enhanced฀ Magnetic฀Resonance฀Imaging฀study Timo฀Baks,฀Robbert-Jan฀van฀Geuns,฀Elena฀Biagini,฀Piotr฀Wielopolski,฀Nico฀Mollet,฀ Filippo฀Cademartiri,฀Willem฀van฀der฀Giessen,฀Gabriel฀Krestin,฀Dirk฀Duncker,฀Pim฀de฀ Feyter,฀Erasmus฀Medical฀Center,฀Rotterdam,฀The฀Netherlands Background:฀Early฀restoration฀of฀coronary฀blood฀flow฀in฀patients฀with฀acute฀myocardial฀ infarction฀(AMI)฀reduces฀infarct฀size฀and฀preserves฀left฀ventricular฀function,฀but฀the฀effect฀ of฀early฀reperfusion฀on฀ischemic฀myocardium฀and฀eventually฀infarct฀resorption฀is฀not฀well฀ understood.฀ Therefore,฀ we฀ performed฀ serial฀ contrast-enhanced฀ Magnetic฀ Resonance฀ Imaging฀(ce-MRI)฀in฀patients฀who฀underwent฀successful฀primary฀angioplasty฀for฀first฀AMI. Methods:฀In฀22฀patients,฀cine-MRI,฀first-pass฀perfusion฀and฀delayed฀enhancement฀(DE)฀ imaging฀was฀performed฀at฀5฀days฀and฀5฀month฀after฀primary฀angioplasty฀for฀first฀AMI.฀End฀ Noninvasive Imaging Background:฀Delayed฀contrast-enhanced฀(DCE)฀MRI฀may฀be฀more฀accurate฀in฀evaluating฀ the฀incidence฀of฀procedural฀myocardial฀infarction฀in฀patients฀undergoing฀revascularization฀ than฀cardiac฀enzymes฀and฀electrocardiographic฀criteria. Methods:฀Thirty-two฀patients฀with฀chronic฀ischemic฀left฀ventricular฀dysfunction฀underwent฀ cine฀MRI฀for฀assessment฀of฀global฀left฀ventricular฀function฀and฀DCE฀MRI฀for฀assessment฀ of฀ total฀ myocardial฀ scar฀ tissue฀ mass฀ 1฀ month฀ before฀ and฀ 3฀ months฀ after฀ surgical฀ or฀ percutaneous฀revascularization. Results:฀ None฀ of฀ the฀ patients฀ had฀ electocardiographic฀ evidence฀ of฀ procedure฀ related฀ myocardial฀infarction.฀CK-MB฀measurements฀were฀obtained฀peri-operatively฀in฀24฀patients.฀ In฀11฀of฀them฀there฀was฀biochemical฀evidence฀of฀myocardial฀infarction฀(CK-MB฀elevation฀ >฀3฀times฀upper฀limit฀of฀normal),฀whereas฀11฀patients฀showed฀no฀significant฀release฀of฀ cardiac฀enzymes.฀In฀both฀groups฀new฀scar฀tissue฀was฀detected฀by฀DCE฀MRI฀at฀follow-up:฀ 2.4±4.4฀ g฀ in฀ patients฀ with฀ infarction฀ vs.฀ 1.9±2.8฀ g฀ in฀ patients฀ without฀ infarction฀ (p=NS). The฀mean฀scar฀tissue฀mass฀for฀the฀entire฀patient฀group฀increased฀at฀follow-up฀to฀18±14฀g฀ vs.฀16±12฀g฀at฀baseline฀(p=0.005).฀The฀mean฀EF฀did฀not฀improve฀after฀revascularization:฀ 39±12%฀ vs.฀ 39±12%฀ before฀ revascularization.฀ There฀ was฀ a฀ moderate฀ but฀ significant฀ inverse฀relation฀between฀the฀change฀in฀the฀total฀scar฀tissue฀mass฀and฀the฀EF฀change฀after฀ the฀revascularization฀(r=0.47,฀p=0.007). Conclusion:฀ DCE฀MRI฀is฀superior฀to฀ECG฀and฀CK-MB฀measurements฀for฀detection฀of฀ revascularization฀procedure฀related฀myocardial฀necrosis. ABSTRACTS - Noninvasive Imaging 276A ABSTRACTS - Noninvasive Imaging diastolic฀wall฀thickness฀(EDWT)฀and฀segmental฀wall฀thickening฀(SWT)฀was฀quantified฀in฀16฀ segments฀per฀patient.฀Infarct฀size฀was฀quantified฀on฀DE฀images฀and฀myocardial฀perfusion฀ was฀evaluated฀qualitatively฀and฀scored฀on฀a฀3-points฀scale. Results:฀Myocardial฀infarct฀size฀decreased฀with฀31%฀from฀a฀mean฀of฀35±21฀gram฀to฀24±17฀ gram฀ (26%฀ to฀ 20%฀ of฀ left฀ ventricular฀ mass;฀ p<0.001).฀ Infarct฀ size฀ at฀ 5฀ days฀ was฀ a฀ good฀ predictor฀for฀infarct฀size฀at฀5฀month฀post฀AMI฀(r=0.92;฀p<0.001).฀At฀5฀days฀post฀AMI,฀EDWT฀ was฀increased฀in฀dysfunctional฀myocardial฀segments฀with฀a฀normal฀(restored)฀microvascular฀ perfusion฀(8.7±1.8mm;SWT=21±15%)฀as฀compared฀to฀remote฀(non-ischemic)฀myocardium฀ (8.3±1.7mm;฀p=0.026;฀SWT=80±28%).฀EDWT฀in฀myocardium฀with฀a฀severe฀perfusion฀defect฀ was฀ not฀ significantly฀ increased฀ (8.5±1.6mm;p=NS;฀ SWT=11±12%).฀ At฀ 5฀ months,฀ EDWT฀ became฀comparable฀for฀all฀segments฀but฀decreased฀in฀segments฀with฀a฀severe฀perfusion฀ defect฀(8.5±1.6mm฀to฀6.4±1.3mm;p<0.001;SWT=17±20%). Conclusions:฀Infarct฀size฀decreased฀with฀31%฀between฀5฀days฀and฀5฀month฀after฀AMI.฀ Increased฀EDWT฀early฀after฀AMI฀suggests฀restored฀perfusion฀of฀the฀myocardium. 1084-68฀ Delayed฀Enhancement฀is฀a฀Better฀Predictor฀than฀ Perfusion฀Imaging฀of฀left฀Ventricular฀Function฀at฀5฀ Months฀After฀Primary฀Angioplasty฀for฀Acute฀Myocardial฀ Infarction:a฀contrast-enhanced฀Magnetic฀Resonance฀ Imaging฀study Noninvasive Imaging Timo฀Baks,฀Robbert-Jan฀van฀Geuns,฀Piotr฀Wielopolski,฀Willem฀van฀der฀Giessen,฀Nico฀ Mollet,฀Filippo฀Cademartiri,฀Gabriel฀Krestin,฀Patrick฀Serruys,฀Dirk฀Duncker,฀Pim฀de฀ Feyter,฀Erasmus฀Medical฀Center,฀Rotterdam,฀The฀Netherlands Background:฀ We฀ investigated฀ whether฀ myocardial฀ perfusion฀ or฀ delayed฀ enhancement฀ (DE)฀imaging฀with฀contrast-enhanced฀Magnetic฀Resonance฀Imaging฀(ce-MRI)฀performed฀ 5฀ days฀ after฀ successful฀ angioplasty฀ for฀ acute฀ myocardial฀ infarction฀ (AMI)฀ is฀ a฀ better฀ predictor฀ of฀ segmental฀ wall฀ thickening฀ (SWT),฀ ejection฀ fraction฀ (EF),฀ and฀ end฀ systolic฀ volume฀(ESV)฀at฀5฀months฀post฀AMI.฀Myocardial฀perfusion฀and฀DE฀imaging฀have฀not฀yet฀ been฀evaluated฀in฀a฀well-defined฀homogenous฀group฀of฀patients฀with฀successful฀primary฀ angioplasty฀for฀AMI฀. Methods:฀Twenty-two฀patients฀underwent฀cine-MRI,฀first-pass฀perfusion฀and฀DE฀imaging฀ 5฀ days฀ after฀ placement฀ of฀ a฀ drug-eluting฀ stent฀ in฀ the฀ infarct฀ related฀ coronary฀ artery.฀ Regional฀myocardial฀perfusion฀was฀scored฀on฀a฀3฀points฀scale฀and฀the฀transmural฀extent฀ of฀DE฀on฀a฀5฀points฀scale฀in฀16฀segments฀per฀patient.฀A฀per฀patient฀perfusion฀score฀was฀ calculated฀and฀consisted฀of฀a฀summation฀of฀all฀segmental฀scores.฀Myocardial฀infarct฀mass฀ was฀ quantified฀ by฀ measuring฀ the฀ volume฀ of฀ DE.฀ At฀ 5฀ months฀ after฀ AMI,฀ cine-MRI฀ was฀ performed฀and฀SWT,฀EF฀and฀ESV฀were฀quantified. Results:฀The฀segmental฀DE฀scores฀correlated฀better฀than฀the฀segmental฀perfusion฀scores฀ with฀quantified฀SWT฀at฀5฀months฀post฀AMI฀(r=0.51;฀p<0.001฀versus฀r=0.37;฀p฀<฀0.001).฀ The฀acute฀myocardial฀infarct฀mass฀correlated฀better฀than฀the฀calculated฀perfusion฀score฀ with฀EF฀(r=0.80;฀p<0.001฀versus฀r=0.48;฀p=0.02)฀and฀ESV฀(r=0.88;฀p<0.001฀versus฀r=0.37;฀ p=0.09)฀at฀5฀months.฀ Conclusions:฀DE฀imaging฀with฀ce-MRI฀in฀patients฀5฀days฀after฀reperfused฀AMI฀is฀a฀better฀ predictor฀of฀SWT,฀EF฀and฀ESV฀at฀5฀months฀after฀AMI฀than฀perfusion฀imaging. 1084-69฀ Cardiac฀Magnetic฀Resonance฀Imaging฀for฀the฀Detection฀ and฀Quantification฀of฀Symptomatic฀CAD Johannes฀Rieber,฀Armin฀Huber,฀Isabelle฀Erhard,฀Thomas฀M.฀Schiele,฀Maximilian฀Reiser,฀ Volker฀Klauss,฀Medizinische฀Klinik,฀Ludwig-Maximilians-University,฀Munich,฀Germany,฀ Institute฀for฀Clinical฀Radiology,฀Ludwig-Maximilians-University,฀Munich,฀Germany Cardiac฀ magnetic฀ resonance฀ imaging฀ (CMRI)฀ is฀ a฀ rapid฀ envolving฀ method฀ for฀ the฀ noninvasive฀ assessment฀ of฀ symptomatic฀ coronary฀ artery฀ disease฀ (CAD).฀ Beneath฀ morphological฀ assessement฀ by฀ quantitative฀ coronary฀ angiography฀ (QCA)฀ the฀ pressure฀ derived฀ fractional฀ flow฀ reserve฀ (FFR)฀ is฀ the฀ well฀ established฀ new฀ gold฀ standard฀ to฀ invasively฀evaluate฀the฀functional฀severity฀of฀coronary฀lesions.฀The฀aim฀of฀our฀study฀was฀ to฀assess฀the฀ability฀of฀CMRI฀to฀detect฀flow฀limiting฀coronary฀stenoses฀compared฀to฀the฀ invasive฀reference฀standards฀QCA฀and฀FFR. Methods:฀43฀Patients฀with฀suspected฀CAD฀received฀a฀CMRI฀(Siemens฀Sonata,฀Erlangen,฀ GE;฀IPAT)฀within฀one฀week฀of฀the฀scheduled฀CA.฀Signal฀intensity฀curves฀of฀the฀first฀pass฀ of฀ a฀ Gadolineum-DTPA฀ bolus฀ at฀ rest฀ and฀ during฀ hyperemia฀ (Adenosine฀ 140µg/kg/min฀ i.v.)฀were฀investigated฀and฀input฀function฀corrected฀signal฀intensitiy฀curve´s฀upslope฀(US)฀ was฀ determined฀ for฀ each฀ myocardial฀ perfusion฀ area฀ using฀ an฀ 18฀ segment฀ model.฀The฀ myocardial฀ perfusion฀ reserve฀ (MPR)฀ was฀ calculated฀ as฀ US฀ stress฀ and฀ US฀ rest฀ ratio.฀ A฀ coronary฀artery฀with฀lesions฀<฀50%฀diameter฀reduction฀as฀assessed฀by฀standardized฀QCA฀ was฀ stated฀ as฀ normal฀ (n=42).฀ A฀ coronary฀ lesion฀ >฀ 50%฀ and฀ FFR฀ (PressureWire,฀ Radi,฀ SE)฀>฀0.75฀was฀called฀intermediate฀(n=64).฀If฀a฀diameter฀reduction฀>50%฀and฀FFR฀<฀0.75฀ was฀present,฀the฀lesion฀was฀defined฀as฀severe฀(n=23).฀A฀ROC฀analysis฀was฀carried฀out฀to฀ evaluate฀the฀best฀cut฀off฀value. Results:฀ 129฀ perfusion฀ areas฀ (43฀ LAD;฀ 43฀ LCx฀ and฀ 43RCA)฀ were฀ evaluated.฀ Mean฀ MPR฀was฀1,7฀(range฀1.0-3.5).฀Mean฀MPR฀was฀significantly฀different฀between฀the฀regions฀ supplied฀ by฀ a฀ normal฀ coronary฀ vessel฀ (2.08±0.55)฀ or฀ a฀ vessel฀ with฀ an฀ intermediate฀ (1,65±0.55)฀ or฀ severe฀ stenosis฀ (1.3±0.60)฀ (p<.001).฀ However,฀ a฀ large฀ overlap฀ between฀ these฀groups฀was฀observed.฀ROC฀analysis฀revealed฀a฀MPR฀of฀1.58฀for฀best฀discrimination฀ between฀severe฀and฀normal฀to฀intermediate฀stenosed฀coronary฀arteries.฀At฀this฀threshold฀ sensitivity฀reached฀68%฀and฀specificity฀78%. Conclusion:฀ In฀ this฀ study฀ CMRI฀ could฀ demonstrate฀ its฀ ability฀ to฀ non฀ invasively฀ identify฀ significant฀ coronary฀ lesions฀ at฀ a฀ reasonable฀ sensitivity฀ and฀ specificity.฀ ROC฀ analysis฀ identified฀a฀MPR฀value฀of฀1.58฀for฀best฀accuracy. JACC 1084-70฀ February 1, 2005 Serum฀Brain฀Natriuretic฀Peptide฀Is฀a฀Marker฀of฀ Myocardial฀Fibrosis฀in฀End฀Stage฀Renal฀Failure฀as฀ Demonstrated฀by฀Cardiac฀Magnetic฀Resonance฀Imaging Patrick฀B.฀Mark,฀Nicola฀Johnston,฀Kevin฀G.฀Blyth,฀Thomas฀E.฀Martin,฀John฀E.฀Foster,฀ Henry฀J.฀Dargie,฀Alan฀G.฀Jardine,฀Western฀Infirmary,฀Glasgow,฀United฀Kingdom Background.฀ Patients฀ with฀ end฀ stage฀ renal฀ failure฀ (ESRF)฀ have฀ an฀ increased฀ cardiovascular฀ mortality฀ with฀ left฀ ventricular฀ (LV)฀ disorders฀ being฀ a฀ marker฀ of฀ poor฀ outcome.฀ Contrast฀ enhanced฀ cardiac฀ magnetic฀ resonance฀ imaging฀ (CMR)฀ assesses฀ LV฀dimensions฀and฀non-invasively฀identifies฀myocardial฀fibrosis.฀Serum฀brain฀natriuretic฀ peptide฀(BNP)฀has฀been฀shown฀to฀correlate฀with฀LV฀mass฀and฀patient฀survival฀in฀ESRF.฀ We฀studied฀the฀relationship฀between฀BNP,฀LV฀dimensions฀and฀the฀presence฀of฀myocardial฀ fibrosis฀as฀assessed฀by฀CMR. Methods฀84฀ESRF฀patients฀from฀the฀renal฀transplant฀list฀(54฀men,฀median฀age฀54,฀range฀ 27-72)฀underwent฀CMR฀(1.5T฀scanner,฀Siemens฀Sonata)฀with฀LV฀dimensions฀assessed฀ by฀ cine฀ stack.฀ Further฀ images฀ were฀ acquired฀ following฀ i.v.฀ gadolinium-DTPA฀ using฀ an฀ inversion฀recovery฀fast฀low฀angle฀shot฀sequence,฀with฀images฀assessed฀for฀the฀presence฀ and฀extent฀of฀late฀gadolinium฀enhancement฀(LGE)฀indicating฀myocardial฀fibrosis.฀Serum฀ was฀taken฀for฀BNP฀(Shionoria)฀pre-scan. Results฀There฀was฀an฀overall฀correlation฀between฀serum฀BNP฀and฀LV฀mass/Body฀Surface฀ Area฀(r=0.24,฀p<0.05),฀and฀end฀systolic฀volume/Body฀Surface฀Area฀(r=0.35,฀p<0.01)฀but฀ not฀ejection฀fraction฀(r=-0.19,฀p=0.09).฀25฀(29.8%)฀of฀patients฀had฀evidence฀of฀myocardial฀ fibrosis฀ indicated฀ by฀ positive฀ LGE.฀ Serum฀ BNP฀ correlated฀ with฀ mass฀ of฀ myocardial฀ fibrosis฀indicated฀by฀LGE฀(r=0.33,฀p<0.01).฀In฀the฀sub฀group฀of฀patients฀with฀LGE฀there฀ was฀stronger฀correlation฀between฀serum฀BNP฀and฀LV฀mass/Body฀Surface฀Area฀(r=0.56,฀ p<0.01),฀end฀systolic฀volume/Body฀Surface฀Area฀(r=0.41,฀p<0.05)฀and฀negative฀correlation฀ with฀ejection฀fraction฀(r=-0.42,฀p<0.05).฀There฀was฀no฀relationship฀between฀BNP฀and฀LV฀ dimensions฀in฀the฀sub฀group฀of฀patients฀without฀LGE.฀The฀range฀for฀BNP฀in฀ESRF฀was฀ wide฀(LGE฀positive฀-฀0-1089pg/ml;฀negative฀-฀0-2085pg/ml)฀. Conclusions฀Myocardial฀damage฀indicated฀by฀LGE฀is฀common฀in฀ESRF.฀The฀relationship฀ between฀ BNP฀ and฀ myocardial฀ dimensions฀ in฀ ESRF฀ is฀ dependant฀ on฀ the฀ presence฀ of฀ myocardial฀damage฀and฀suggests฀that฀BNP฀may฀be฀raised฀either฀in฀response฀to,฀or฀as฀ a฀ marker฀ of฀ myocardial฀ fibrosis฀ in฀ ESRF.฀The฀ wide฀ range฀ of฀ serum฀ BNP฀ also฀ suggests฀ impaired฀BNP฀clearance. ORAL฀CONTRIBUTIONS 805฀฀ Contrast฀Echocardiography:฀New฀Tools฀ and฀Comparisons฀to฀Other฀Techniques Monday,฀March฀07,฀2005,฀9:15฀a.m.-10:30฀a.m. Orange฀County฀Convention฀Center,฀Room฀230B 9:15฀a.m. 805-3฀ Relative฀Myocardial฀Blood฀Volume:฀A฀Variable฀for฀the฀in฀ Vivo฀Distinction฀Between฀Physiologic฀and฀Pathologic฀ Left฀Ventricular฀Hypertrophy฀in฀Humans Andreas฀Indermuehle,฀Rolf฀Vogel,฀Pascal฀Meier,฀Christoph฀Staehli,฀Christian฀Seiler,฀ University฀Hospital,฀Bern,฀Switzerland Background:฀Left฀ventricular฀hypertrophy฀(LVH)฀in฀hypertensive฀heart฀disease฀(HHD)฀is฀ a฀pathologic฀adaptation฀to฀increased฀wall฀stress.฀Vascular฀density฀in฀myocardial฀biopsies฀is฀ reduced฀due฀to฀extracellular฀and฀periarteriolar฀collagen฀deposition.฀However,฀it฀is฀unknown฀ whether฀vascular฀density฀keeps฀pace฀with฀LVH฀in฀athlete’s฀heart฀(AH),฀which฀is฀supposed฀ to฀be฀a฀physiologic฀adaptation. Methods:฀Four฀groups฀were฀studied.฀14฀endurance฀athletes฀with฀AH฀(mean฀age฀32±9฀ years)฀were฀matched฀for฀age฀and฀gender฀to฀14฀patients฀with฀HHD฀(32±9฀years).฀As฀control฀ groups฀ 11฀ healthy฀ volunteers฀ (32±3฀ years)฀ and฀ 11฀ professional฀ football฀ players฀ (27±4฀ years)฀without฀LVH฀were฀examined.฀LVH฀was฀defined฀as฀ventricular฀wall฀thickness฀greater฀ than฀12฀millimetres.฀Myocardial฀contrast฀echocardiography฀was฀performed฀by฀means฀of฀ a฀ continuous฀ venous฀ ultrasound฀ contrast฀ agent฀ infusion.฀Vascular฀ density,฀ i.e.,฀ relative฀ myocardial฀ blood฀ volume฀ (rMBV,฀ ml/ml),฀ its฀ exchange฀ rate฀ (ER,฀ 1/min)฀ and฀ absolute฀ perfusion฀ (AP=rMBVxER/1.05g/ml,฀ ml/min/g)฀ at฀ rest฀ and฀ during฀ adenosine฀ stress฀ were฀ derived฀ from฀ ultrasound฀ contrast฀ agent฀ refill฀ curves฀ following฀ its฀ ultrasound-induced฀ destruction.฀The฀ratio฀of฀AP(stress)/AP(rest)฀yielded฀coronary฀flow฀reserve. Results:฀Left฀ventricular฀mass฀index฀was฀not฀significantly฀different฀in฀AH฀and฀HHD฀130฀(17)฀ and฀140฀(31)฀g/m^2,฀respectively.฀RMBV฀at฀rest฀in฀AH฀(0.141฀(±0.019))฀was฀significantly฀ higher฀ than฀ in฀ HHD฀ (0.090฀ (±0.016)฀ p<0.0001)฀ and฀ controls฀ (0.128฀ (±0.029)฀ p<0.026)฀ but฀ no฀ significant฀ difference฀ was฀ found฀ compared฀ to฀ football฀ players฀ (0.131฀ (±0.027)฀ p<0.096).฀An฀rMBV฀≥0.11฀distinguished฀between฀AH฀and฀HHD฀with฀a฀sensitivity฀of฀95%฀ and฀ a฀ specificity฀ of฀ 97%.฀ Coronary฀ flow฀ reserve฀ was฀ significantly฀ higher฀ in฀ endurance฀ athletes฀(5.2฀(±1.7))฀than฀in฀HHD฀(2.8฀(±0.8)฀p<0.0001),฀in฀controls฀(3.6฀(±0.9)฀p<0.0001)฀ and฀in฀football฀players฀(4.2฀(±1.5)฀p<0.0028). Conclusions:฀ Vascular฀ density฀ as฀ obtained฀ by฀ rMBV฀ using฀ myocardial฀ contrast฀ echocardiography฀is฀significantly฀higher฀in฀AH฀than฀in฀HHD฀demonstrating฀the฀physiologic฀ nature฀ of฀ LVH฀ in฀ AH.฀ For฀ the฀ first฀ time,฀ it฀ was฀ possible฀ to฀ measure฀ in฀ vivo฀ the฀ relative฀ fraction฀of฀vascular฀volume. JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging 9:30฀a.m. 805-4฀ Novel฀Imaging฀Method฀for฀Myocardial฀Contrast฀ Echocardiography฀Using฀Intravenous฀Contrast฀Agent,฀ LevovistTM฀:฀Usefulness฀of฀Myocardial฀Blood฀Volume฀ Map฀In฀Patients฀With฀Ischemic฀Heart฀Disease Eiichi฀Nagashima,฀Takahiro฀Ota,฀Keiko฀Maeda,฀Hitomi฀Kawano,฀Kenji฀Shimeno,฀Keiji฀ Nagae,฀Shiro฀Yanagi,฀Kazuyoshi฀Hirota,฀Junichi฀Yoshikawa,฀Fuchu฀Hospital,฀Izumi,฀ Japan,฀Osaka฀City฀University฀School฀of฀Medicine,฀Osaka,฀Japan Background:฀ Myocardial฀ contrast฀ echocardiography฀ using฀ iv.฀ contrast฀ agent฀ provides฀ increasing฀ diagnostic฀ value฀ for฀ noninvasively฀ detecting฀ myocardial฀ perfusion.฀ A฀ 1.5฀ harmonic฀imaging฀has฀been฀reported฀to฀minimize฀tissue฀signal฀of฀the฀background,฀enabling฀ clear฀visualization฀of฀myocardial฀perfusion.฀Novel฀quantitative฀method฀of฀myocardial฀blood฀ volume฀map฀(VoluMap®)฀was฀designed฀to฀evaluate฀myocardial฀perfusion,฀expressing฀the฀ contrast฀intensity฀as฀color฀coded฀map.฀We฀tested฀the฀usefulness฀of฀VoluMap฀to฀evaluate฀ myocardial฀ perfusion฀ in฀ patients฀ (pts)฀ with฀ old฀ myocardial฀ infarction฀ (OMI)฀ and฀ angina฀ pectoris(AP)฀using฀Levovist®(LEV)฀and฀compared฀to฀Tl฀SPECT. Method:฀We฀examined฀20฀pts;฀13฀OMI฀and฀7฀suspected฀AP฀(age฀65.8±4.1฀yrs,฀15฀males).฀ A฀ 1.7/2.5MHz฀ transducer฀ equipped฀ with฀ SSA-770A฀ (Toshiba฀ Ltd.)฀ was฀ used฀ to฀ image฀ myocardial฀ performance฀ of฀ LV฀ during฀ MCE฀ with฀ injection฀ of฀ LEV.฀ Series฀ of฀ intermittent฀ images฀(1:1,฀1:6)฀were฀recorded฀to฀assess฀myocardial฀enhancement฀during฀iv.฀infusion฀ (3.0฀ ml/min)฀ of฀ LEV.฀ New฀ calibration฀ method฀ to฀ quantitate฀ myocardial฀ volume฀ such฀ as฀ relative฀myocardial฀contrast฀score฀(RMS,฀dB)฀was฀calculated฀as฀the฀difference฀of฀contrast฀ intensity฀of฀myocardium฀minus฀that฀of฀adjacent฀LV฀cavity฀by฀VoluMap.฀RMS฀less฀than฀-18dB฀ indicating฀poor฀perfusion฀assigned฀as฀cold฀color฀mapping.฀Based฀on฀the฀VoluMap฀image,฀ myocardial฀ enhancement฀ was฀ scored฀ as฀ good฀ (3)฀ to฀ none฀ (0)฀ in฀ each฀ segment(seg).฀ SPECT฀was฀performed฀in฀all฀pts฀and฀scored฀visually฀and฀compared฀with฀RMS. Result:฀ A฀ 236/240฀ segs฀ (98%)฀ were฀ scored฀ in฀ SPECT฀ and฀ 210/240฀ segs฀ (88%)฀ were฀ analyzed฀and฀color฀mapped฀successfully.฀In฀pts฀with฀OMI,฀40/40฀(100%)฀infarct฀segs฀were฀ scored฀poor฀perfusion฀in฀SPECT฀and฀38/40฀segs฀in฀VoluMap. Mean฀ contrast฀ score฀ correlated฀ well฀ with฀ SPECT฀ score฀ in฀ OMI฀ (1.8±0.7฀ vs.฀ 2.2±0.8฀ r=0.752).฀In฀pts฀with฀AP฀(n=4),฀46/48฀segs฀(95%)฀by฀SPECT฀and฀40/48฀segs฀by฀VoluMap฀ was฀successfully฀identified฀as฀myocardial฀ischemia. Conclusion:฀VoluMap฀provides฀a฀coded฀color฀map฀image฀in฀the฀myocardium฀based฀on฀ the฀calibrated฀contrast฀intensity฀which฀estimates฀the฀myocardial฀volume.฀Our฀experience฀ indicates฀that฀calibrated,฀parametric฀color฀image฀with฀iv.฀contrast฀has฀a฀great฀promise฀to฀ identify฀ischemic฀seg฀correctly. 9:45฀a.m. The฀Integrated฀Backscatter฀Signal฀is฀From฀Blood฀Within฀ the฀Myocardium Antonio฀Micari,฀Marco฀Pascotto,฀Thanjavur฀Bragadeesh,฀Craig฀Norman฀Goodman,฀Sanjiv฀ Kaul,฀University฀of฀Virginia,฀Charlottesville,฀VA Background:฀ It฀ is฀ generally฀ thought฀ that฀ the฀ myocardial฀ integrated฀ backscatter฀ signal฀ (IBS)฀is฀from฀myocardial฀elastic฀and฀other฀elements฀and฀that฀the฀IBS฀cyclic฀variation฀during฀ the฀ cardiac฀ cycle฀ is฀ due฀ to฀ geometric฀ alterations฀ in฀ these฀ elements.฀ We฀ hypothesized฀ that฀the฀signal฀is฀from฀the฀blood฀present฀within฀the฀myocardium-generally฀referred฀to฀as฀ myocardial฀blood฀volume฀(MBV).฀It฀is฀well฀known฀that฀MBV฀undergoes฀phasic฀changes฀ during฀the฀cardiac฀cycle. Methods฀and฀results:฀To฀test฀our฀hypothesis,฀we฀altered฀MBV฀without฀altering฀myocardial฀ contractility฀in฀2฀groups฀of฀dogs.฀In฀group฀1฀(n-7)฀we฀placed฀a฀non-critical฀stenosis฀(mean฀ gradient฀27±4)฀on฀the฀left฀anterior฀descending฀coronary฀artery฀(LAD).฀In฀group฀2฀(n=6),฀ we฀ performed฀ a฀ selective฀ LAD฀ infusion฀ of฀ intracoronary฀ adenosine฀ (5-7฀ µg/kg/min)฀ that฀ caused฀ no฀ systemic฀ effects.฀ Wall฀ thickening฀ remained฀ unchanged฀ in฀ both฀ groups฀ before฀ and฀ after฀ the฀ intervention฀ (32±0.6%฀ vs.฀ 33%±0.8,฀ p=0.80฀ and฀ 32.1±0.7%฀ vs฀ 31.9±0.6%,฀ p=0.4).฀ Resting฀ IBS฀ measurements฀ and฀ MBV฀ estimated฀ using฀ myocardial฀ contrast฀echocardiography฀(MCE)฀tracked฀each฀during฀the฀cardiac฀cycle.฀After฀stenosis฀ placement,฀ the฀ end-diastolic฀ IBS฀ value฀ increased฀ without฀ a฀ change฀ in฀ the฀ end-systolic฀ value฀ (-26.6±7.7฀ vs฀ -25.1±6.8฀ p=0.01฀ and฀ -30.3±7.46฀ vs.฀ 30.0±7.7,฀ p=0.50).฀ The฀ IBS฀ cyclic฀ variation฀ increased฀ (3.7±1.1฀ vs.5.0±1.0,฀ p=0.02).฀The฀ LAD฀ flow฀ increased฀ 3-fold฀ after฀adenosine฀infusion฀in฀the฀group฀2฀dogs.฀Again,฀the฀end-diastolic฀IBS฀value฀increased฀ and฀ the฀ end-systolic฀ value฀ remained฀ unchanged฀ (-20.2±7.3฀ vs.฀ -18.7±6.7,฀ p=0.005฀ and฀-23.4±6.9฀vs.฀-23.1±6.7,฀p=0.25).฀Cyclic฀change฀in฀IBS฀also฀increased฀significantly฀ (3.47±1.1฀vs.฀4.37±1,฀p=0.04).฀The฀control฀left฀circumflex฀artery฀bed฀showed฀no฀change฀ sin฀IBS฀in฀either฀group฀of฀dogs. Conclusion:฀ In฀ these฀ experiments฀ we฀ increased฀ MBV฀ without฀ changing฀ myocardial฀ contractility.฀We฀found฀that฀there฀was฀close฀tracking฀of฀cyclic฀changes฀in฀IBS฀and฀MBV.฀ We฀also฀found฀that฀IBS฀values฀increased฀in฀diastole฀where฀MBV฀also฀is฀known฀to฀increase฀ with฀the฀2฀interventions฀used.฀These฀results฀imply฀that฀the฀principal฀mechanism฀underlying฀ IBS฀signal฀is฀MBV.฀These฀results฀also฀imply฀that฀non-critical฀stenosis฀could฀be฀detected฀ at฀rest฀using฀IBS. 10:00฀a.m. 805-6฀ Comparison฀of฀Real฀Time฀Perfusion฀Utilizing฀ Continuous฀Infusions฀of฀Ultrasound฀Contrast฀During฀ Vasodilator฀Stress฀With฀Radionuclide฀Uptake฀and฀ Quantitative฀Angiography Feng฀Xie,฀Jeane฀M.฀Tsutsui,฀Anna฀McGrain,฀Edward฀L.฀O’Leary,฀Jordan฀Hankins,฀Heidi฀ Mahrous,฀Thomas฀R.฀Porter,฀University฀of฀Nebraska฀Medical฀Center,฀Omaha,฀NE Background.฀By฀examining฀both฀myocardial฀contrast฀replenishment฀(MCR)฀and฀plateau฀ intensity฀ (PI)฀ within฀ the฀ capillary฀ bed฀ during฀ vasodilator฀ stress,฀ intravenous฀ continuous฀ infusions฀ of฀ ultrasound฀ contrast฀ can฀ visually฀ quantify฀ myocardial฀ blood฀ flow฀ (MBF)฀ changes฀using฀real฀time฀pulse฀sequence฀schemes฀(RTP).฀This฀may฀be฀more฀sensitive฀than฀ myocardial฀ blood฀ volume฀ techniques฀ (radionuclide฀ uptake)฀ in฀ detecting฀ physiologically฀ significant฀coronary฀stenoses฀(CAD).฀ Methods.฀In฀36฀patients฀with฀normal฀resting฀ejection฀fraction,฀a฀continuous฀infusion฀of฀3฀%฀ Definity฀(Bristol฀Myers฀Squibb)฀was฀performed฀while฀imaging฀with฀RTP฀(Siemens฀Acuson฀or฀ Philips฀Agilent).฀The฀vasodilator฀stress฀was฀adenosine฀in฀18฀and฀dipyridamole฀in฀18.฀Both฀a฀ delay฀in฀the฀rate฀of฀MCR฀following฀a฀brief฀high฀mechanical฀index฀impulse฀and฀a฀reduction฀in฀ PI฀were฀examined,฀and฀compared฀with฀radionuclide฀uptake฀(SPECT)฀in฀all฀patients.฀Twelve฀ (33%)฀subsequently฀underwent฀quantitative฀angiography฀(QCA).฀The฀agreement฀between฀ techniques฀was฀measured฀on฀a฀coronary฀artery฀territory฀(CAT)฀basis. Results.฀The฀Table฀demonstrates฀that฀of฀the฀108฀CATs฀analyzed,฀there฀were฀22฀abnormal฀ by฀ RTP,฀ and฀ 31฀ abnormal฀ by฀ SPECT.฀ Agreement฀ between฀ SPECT฀ and฀ RTP฀ was฀ 86%฀ (kappa=0.63).฀In฀the฀patients฀that฀underwent฀QCA,฀CAT฀agreement฀with฀SPECT฀was฀75%฀ (kappa=0.44),฀while฀agreement฀with฀RTP฀was฀89%฀(kappa=0.72).฀ Conclusions.฀These฀data฀indicate฀that฀RTP฀using฀quantitative฀analyses฀of฀both฀MCR฀and฀ PI฀may฀be฀superior฀to฀SPECT฀in฀detecting฀signficant฀CAD. Agreement฀between฀Three฀Imaging฀Techniques฀ Comparison Sensitivity Specificity Agreement Kappa RTP฀vs฀SPECT 61% 96% 86% 0.63 RTP฀vs฀QCA 89% 89% 89% 0.72 SPECT฀vs฀QCA 78% 74% 75% 0.43 10:15฀a.m. 805-7฀ Reliable฀Analysis฀of฀Regional฀Left฀Ventricular฀Function:฀ A฀Multicenter฀Study฀With฀Multimodality฀In-patient฀ Comparison. Rainer฀Hoffmann,฀Stephan฀von฀Bardeleben,฀Adrian฀C฀Borges,฀Jaroslaw฀Kasprzak,฀ Christian฀Firschke,฀Stephane฀Lafitte,฀Nidal฀Al-Saadi,฀Folkert฀ten฀Cate,฀Stefanie฀KuntzHehner,฀Marc฀Engelhardt,฀Jean฀Louis฀Vanoverschelde,฀Harald฀Becher,฀University฀ Aachen,฀Aachen,฀Germany Background:฀ Detection฀ of฀ regional฀ wall฀ motion฀ abnormalities฀ (RWMA)฀ is฀ an฀ integral฀ part฀ in฀ the฀ evaluation฀ of฀ left฀ ventricular฀ function.฀This฀ study฀ evaluated฀ interobserver฀ for฀ unenhanced฀ echo฀ (UE),฀ contrast฀ enhanced฀ echo฀ (CE)฀ and฀ cineventriculography฀ (Cine)฀ and฀intermethod฀agreement฀to฀cardiac฀Magnetic฀Resonance฀Tomography฀(cMRT). Methods:฀120฀pts฀with฀evenly฀distributed฀ejection฀fraction฀groups฀based฀on฀biplane฀Cine฀ (>55%,฀ 35-55%,฀ <35%)฀ UE฀ and฀ CE฀ (Sonos฀ 5500,฀ [Philips],฀ SonoVue฀ infusion฀ [Bracco,฀ Milan])฀were฀performed.฀56฀pts฀underwent฀additional฀cMRI฀at฀1.5฀T฀using฀a฀steady฀state฀ free฀precession฀sequence.฀For฀UE,฀CE฀and฀cMRI,฀RWMA฀were฀assessed฀in฀4CV,฀2CV฀ and฀3CV฀projections฀referring฀to฀a฀16฀segment฀model฀(segM).฀CINE฀was฀evaluated฀on฀a฀ standard฀7฀segM..฀Hypokinesia฀in฀at฀least฀1฀seg฀defined฀presence฀of฀RWMA.฀Interobserver฀ variability฀(IOV)฀between฀two฀independent฀readers฀(R)฀was฀determined฀within฀UE,฀CE฀and฀ CINE฀ for฀ all฀ patients.฀ For฀ the฀ cMRT฀ subgroup,฀ Intermethod฀ agreement฀ (IMA)฀ between฀ reader฀1฀of฀UE,฀CE฀and฀CINE฀and฀cMRT฀results฀was฀determined.฀To฀define฀a฀standard฀ of฀ truth฀ for฀ the฀ presence฀ of฀ RWMA฀ an฀ independent฀ expert-panel฀ decision฀ (EPD)฀ was฀ obtained฀for฀each฀patient฀based฀on฀clinical฀data,฀ECG,฀coronary฀angiography฀and฀blinded฀ information฀from฀the฀imaging฀modalities.฀ Results:฀77patients฀(64%)฀were฀found฀to฀have฀a฀RWMA฀by฀EPD.฀ IOV฀between฀R1฀and฀R2฀within฀each฀UE,฀CE฀and฀CINE: Kappa฀was฀0.51฀(CI฀0.34฀-฀0.69)฀for฀UE,฀0.55฀(CI฀0.39-0.71)฀for฀CINE฀and฀0.86฀(CI฀0.760.96)฀for฀CE.฀ IMA฀based฀on฀R1฀between฀UE฀,CE฀and฀CINE฀compared฀to฀cMRI: Kappa฀was฀0.35฀for฀CINE,฀0.63฀for฀UE฀and฀0.78฀for฀CE.฀ Accuracy฀to฀detect฀RWMA฀related฀on฀the฀EPD:฀Sensitivity฀and฀specificity฀of฀reader฀1฀of฀ each฀modality฀to฀detect฀RWMA฀was฀high฀for฀CE฀(94%฀and฀99%,฀respectively)฀and฀cMRT฀ (97%฀and฀91%)฀and฀lower฀for฀UE฀(94%฀and฀80%)฀and฀Cine฀(97%฀and฀70%).฀ Conclusion:฀CE฀significantly฀improves฀IOV฀compared฀to฀UE฀and฀CINE฀and฀shows฀the฀ closest฀agreement฀to฀cMRI฀in฀detection฀of฀RWMA.฀CE฀has฀also฀highest฀accuracy฀in฀the฀ detection฀of฀RWMA฀defined฀by฀an฀independent฀EPD. ฀ Noninvasive Imaging 805-5฀ 277A 278A ABSTRACTS - Noninvasive Imaging JACC ORAL฀CONTRIBUTIONS 809฀฀ Advances฀in฀Single-Photon฀Emission฀ Computed฀Tomography/Positron฀ Emission฀Tomography฀for฀Risk฀ Stratification Monday,฀March฀07,฀2005,฀11:00฀a.m.-12:15฀p.m. Orange฀County฀Convention฀Center,฀Room฀414A 809-3฀ Risk฀Stratification฀with฀Vasodilator฀Stress฀Gated฀SPECT฀ Tc-99m฀Tetrofosmin฀Imaging:฀Results฀of฀a฀Multicenter฀ Registry Robert฀C.฀Hendel,฀Jamshid฀Maddahi,฀Manuel฀D.฀Cerqueira,฀Naomi฀Alazraki,฀Salvatore฀ Borges฀Neto,฀Leslee฀Shaw,฀Midwest฀Heart฀Foundation,฀Fox฀River฀Grove,฀IL Background:฀Although฀substantial฀data฀exist฀regarding฀the฀utility฀of฀pharmacologic฀stress฀ testing฀with฀thallium-201฀and฀Tc-99m฀sestamibi฀in฀the฀prediction฀of฀cardiac฀events,฀limited฀ data฀are฀available฀for฀adenosine฀and฀dipyridamole฀Tc-99m฀tetrofosmin฀SPECT฀imaging฀ (TETRO).฀ Furthermore,฀ differences฀ in฀ tracer฀ kinetics฀ have฀ raised฀ questions฀ regarding฀ sensitivity฀and฀the฀ability฀of฀vasodilator฀TETRO฀to฀predict฀cardiac฀events. Methods:฀ Images฀ were฀ interpreted฀ locally฀ using฀ a฀ 20฀ segment,฀ 5-point฀ system฀ and฀ grouped฀by฀summed฀stress฀score:฀normal฀(0-3),฀mildly฀abnormal฀(abn;฀4-8),฀moderately฀ abn฀(9-13),฀and฀severely฀abn฀(>13).฀Time฀to฀cardiac฀events฀was฀calculated฀using฀a฀riskadjusted฀Cox฀proportional฀hazards฀model. Results:฀A฀total฀of฀3,772฀pts฀were฀enrolled฀in฀this฀5฀site฀study฀of฀dipyridamole฀(24%)฀and฀ adenosine฀ (76%)฀ TETRO.฀ A฀ normal฀ vasodilator฀ TETRO฀ had฀ an฀ annualized฀ event฀ rate฀ for฀ death฀ and฀ death/MI฀ of฀ 0.8%฀ and฀ 1.7%,฀ respectively.฀ An฀ abn฀ SPECT฀ demonstrated฀ increasing฀annual฀mortality,฀with฀mild,฀moderate,฀or฀severely฀abn฀summed฀stress฀scores,฀ 2.8%,฀ 3.4%,฀ 7.3%,฀ respectively.฀ The฀ risk-adjusted฀ relative฀ risk฀ for฀ events฀ increased฀ progressively฀ for฀ mild,฀ moderately,฀ or฀ severely฀ abn฀ SPECT฀ studies,฀ 2,7,฀ 3.1฀ and฀ 4.4,฀ respectively฀ (p<0.0001).฀ Incremental฀ prognostic฀ value฀ was฀ present฀ when฀ stratified฀ by฀ LVEF฀(Figure). Noninvasive Imaging Conclusions:฀ 1)฀The฀negative฀predictive฀value฀of฀a฀normal฀Tc-99m฀tetrofosmin฀stress฀test฀was฀equally฀ high฀in฀both฀Asian฀females฀and฀males. 2)฀Proportionately฀more฀males฀had฀abnormal฀SPECT฀studies. 3)฀ There฀ was฀ no฀ gender฀ bias฀ with฀ regards฀ to฀ referral฀ to฀ angiography฀ after฀ abnormal฀ SPECT฀studies฀in฀this฀large฀Asian฀cohort. 11:30฀a.m. 809-5฀ 11:00฀a.m. February 1, 2005 Positron฀Emission฀Tomography฀Myocardial฀Perfusion฀ Imaging฀Abnormalities฀Predict฀Increased฀Mortality฀in฀ Chronic฀Kidney฀Disease฀Patients Mark฀A.฀Stankewicz,฀Amar฀D.฀Patel,฀Mikhael฀F.฀El-Chami,฀Steven฀R.฀Sigman,฀Arlene฀ Chapman,฀Robert฀L.฀Eisner,฀Randolph฀E.฀Patterson,฀Carlyle฀Fraser฀Heart฀Center,฀ Emory-Crawford฀Long฀Hospital,฀Atlanta,฀GA,฀Emory฀University฀School฀of฀Medicine,฀ Atlanta,฀GA Background:฀ Coronary฀ artery฀ disease฀ (CAD)฀ is฀ prevalent฀ in฀ patients฀ with฀ chronic฀ kidney฀ disease฀ (CKD)฀ and฀ is฀ responsible฀ for฀ the฀ majority฀ of฀ morbidity฀ and฀ mortality฀ in฀ this฀population.฀Detection฀of฀CAD฀with฀myocardial฀perfusion฀imaging฀(MPI)฀single฀photon฀ emission฀computed฀tomography฀(SPECT)฀is฀reported฀to฀be฀less฀accurate฀in฀patients฀with฀ CKD.฀ Rubidium-82฀ positron฀ emission฀ tomographic฀ (PET)฀ MPI฀ is฀ more฀ accurate฀ than฀ SPECT,฀but฀its฀value฀to฀predict฀prognosis฀in฀CKD฀is฀unknown. Methods:฀Demographic,฀clinical฀and฀PET฀results฀were฀recorded฀in฀all฀CKD฀patients฀who฀were฀ evaluated฀with฀PET-MPI฀from฀1999-2003.฀Mortality฀due฀all฀causes฀was฀determined฀using฀ the฀Social฀Security฀database฀and฀hospital฀records.฀Continuous฀variables฀were฀compared฀ using฀the฀student฀t-test฀and฀categorical฀variables฀were฀compared฀with฀chi-squared฀(Yates)฀ analysis฀(SPSS).฀Multiple฀regression฀analysis฀was฀used฀to฀identify฀independent฀predictors฀ of฀mortality.฀A฀p-value฀of฀<0.05฀was฀defined฀as฀statistically฀significant. Results:฀431฀CKD฀patients฀with฀a฀mean฀creatinine฀of฀7.44฀mg/dL฀had฀PET-MPI฀during฀ the฀48฀month฀study฀period.฀Over฀an฀average฀follow-up฀period฀of฀24.2฀months,฀the฀average฀ mortality฀ rate฀ was฀ 29%.฀There฀ were฀ 259฀ women฀ (60%),฀ 348฀ African-Americans฀ (81%),฀ and฀ mean฀ age฀ was฀ 60.2฀ years฀ (29-91฀ years).฀ Patients฀ had฀ the฀ following฀ risk฀ factors:฀ hypertension฀ (89%),฀ diabetes฀ (49%),฀ tobacco฀ use฀ (27%),฀ hypercholesterolemia฀ (40%)฀ and฀family฀history฀of฀CAD฀(36%).฀Patients฀with฀abnormal฀versus฀normal฀PET-MPI฀were฀ similar฀in฀age฀(61.8฀vs฀59.6฀p=ns)฀and฀body฀mass฀index฀(27.7฀vs฀26.8,฀p=ns),฀but฀were฀ more฀often฀diabetic฀(62%฀vs฀42%,฀p<0.001).฀PET-MPI฀was฀abnormal฀in฀34%฀of฀patients,฀ and฀mortality฀was฀higher฀if฀PET-MPI฀was฀abnormal฀vs฀normal฀(46%฀vs.฀28%,฀p<0.001).฀ In฀ a฀ multivariable฀ analysis,฀ abnormal฀ PET-MPI฀ predicted฀ higher฀ all-cause฀ mortality฀ when฀ controlled฀ for฀ age,฀ race,฀ hypertension,฀ diabetes,฀ creatinine,฀ tobacco฀ use฀ and฀ hypercholesterolemia฀(p=0.002).฀ Conclusions:฀ Abnormal฀ PET-MPI฀ predicts฀ increased฀ mortality฀ in฀ patients฀ with฀ CKD,฀ independent฀of฀other฀cardiovascular฀risk฀factors. 11:45฀a.m. 809-6฀ Conclusions:฀ These฀ results฀ provide฀ evidence฀ for฀ the฀ prognostic฀ value฀ of฀ TETRO฀ in฀ association฀with฀adenosine/diypridamole฀and฀in฀a฀similar฀manner฀to฀SPECT฀data฀obtained฀ with฀other฀tracers. 11:15฀a.m. 809-4฀ Normal฀Tc-Tetrofosmin฀Myocardial฀Perfusion฀SPECT฀ studies฀in฀Asian฀Women฀Predict฀Good฀Cardiac฀Outcome Raymond฀Cc฀Wong,฀Kheng฀Thye฀Ho,฀National฀University฀Hospital,฀Singapore,฀Singapore Background:฀The฀prognostic฀utility฀of฀normal฀Tc-99m฀tetrofosmin฀SPECT฀studies฀have฀ been฀ reported฀ in฀ Caucasians.฀ It฀ is฀ unclear฀ if฀ the฀ low฀ event-rate฀ is฀ equally฀ applicable฀ to฀ Asians,฀ and฀ to฀ Asian฀ women฀ as฀ to฀ men.฀The฀ issue฀ of฀ possible฀ gender฀ bias฀ in฀ referral฀ onwards฀ to฀ angiography฀ in฀ Asian฀ women฀ with฀ abnormal฀ studies฀ has฀ also฀ not฀ been฀ examined. Methods:฀6091฀consecutive฀Asian฀patients฀underwent฀Tc-99m฀tetrofosmin฀stress฀studies฀ at฀a฀single฀center฀in฀Singapore฀between฀28th฀April฀1999฀and฀30th฀April฀2003.฀4502฀(74%)฀ had฀normal฀stress฀studies฀defined฀as฀a฀score฀of฀0฀-2฀using฀a฀20฀segment/5฀point฀visual฀ scale.฀1589฀patients฀(26%)฀had฀abnormal฀studies.฀Uniform฀methods฀of฀data฀collection฀and฀ standardized฀epidemiologic฀methods฀for฀follow-up฀were฀applied.฀Follow-up฀was฀complete฀ with฀a฀duration฀of฀24±5฀months฀in฀93%฀of฀patients. The฀mean฀age฀was฀61±12฀years฀(females)฀and฀57±12฀years฀(males).฀2641฀(41%)฀were฀ females.฀The฀racial฀distribution฀was฀4215฀(69%)฀Chinese,฀784฀(13%)฀Malay,฀816฀(13%)฀ Indian,฀ 276฀ (5%)฀ others.฀ 1761฀ (29%)฀ had฀ SPECT฀ imaging฀ for฀ evaluation฀ of฀ chest฀ pain฀ and/or฀dyspnea. Results:฀1084฀(18%)฀patients฀had฀diabetes฀mellitus,฀2159฀(35%)฀hypertension฀and฀681฀ (11฀ %)฀ prior฀ history฀ of฀ coronary฀ disease.฀ 2913฀ (48%)฀ had฀ exercise฀ testing,฀ while฀ 3178฀ (52%)฀had฀pharmacologic฀stress.฀In฀all,฀2236฀(65%)฀males฀and฀2266฀(86%)฀females฀had฀ normal฀studies. At฀24฀months฀of฀follow-up,฀0.8฀%฀of฀females฀with฀normal฀studies฀experienced฀myocardial฀ infarction฀ or฀ cardiac฀ death,฀ yielding฀ an฀ annualized฀ event฀ rate฀ of฀ 0.4%.฀ The฀ figures฀ for฀ males฀were฀0.9%฀and฀0.45%฀respectively฀(p=0.4). Of฀ patients฀ with฀ abnormal฀ studies,฀ significantly฀ less฀ females฀ (10%)฀ than฀ males฀ (13%)฀ underwent฀ angiography฀ within฀ 3฀ months฀ of฀ the฀ index฀ study฀ (p<0.01).฀This฀ difference฀ in฀ angiography฀rates฀was฀maintained฀up฀to฀2฀years.฀However,฀multiple฀regression฀analysis฀ controlling฀for฀age฀and฀diabetes฀did฀not฀reveal฀a฀significant฀gender฀bias. Myocardial฀Perfusion฀Imaging฀Risk฀Stratifies฀Women฀ with฀Intermediate฀or฀High฀Duke฀Treadmill฀Score Justin฀B.฀Lundbye,฀Fawad฀A.฀Kazi,฀Scott฀Werden,฀Gavin฀L.฀Noble,฀Allison฀Whalen,฀ Deborah฀Katten,฀Alan฀Ahlberg,฀David฀O’Sullivan,฀William฀E.฀Boden,฀Gary฀V.฀Heller,฀ Hartford฀Hospital,฀Hartford,฀CT Background:฀ACC/AHA฀guidelines฀recommend฀exercise฀tolerance฀test฀(ETT)฀in฀women฀ with฀ intermediate฀ or฀ high฀ pretest฀ probability฀ for฀ coronary฀ artery฀ disease฀ (CAD).฀ The฀ purpose฀ of฀ this฀ study฀ was฀ to฀ determine฀ whether฀ SPECT฀ myocardial฀ perfusion฀ imaging฀ (MPI)฀further฀risk฀stratifies฀women฀beyond฀Duke฀Treadmill฀Score฀(DTS). Methods:฀Women฀ with฀ intermediate฀ or฀ high฀ pretest฀ likelihood฀ of฀ CAD฀ who฀ underwent฀ ETT฀Tc99฀Sestamibi฀MPI฀(n=1,020)฀were฀categorized฀as฀low,฀moderate฀or฀high฀DTS.฀MPI฀ was฀ categorized฀ as฀ normal฀ or฀ abnormal.฀ Mean฀ follow-up฀ was฀ 2.38±1.49฀ years฀ for฀ allcause฀mortality,฀revascularization฀(>60฀days),฀and฀non-fatal฀myocardial฀infarction. Results:฀ Women฀ with฀ a฀ moderate฀ DTS฀ (-10฀ to฀ 4)฀ had฀ an฀ overall฀ annual฀ event฀ rate฀ of฀ 3.3%.฀Abnormal฀MPI฀identified฀patients฀at฀risk฀of฀adverse฀events฀within฀this฀group฀(1.8%฀ vs.฀16.8%;฀p<0.0001).฀Patients฀with฀a฀high฀DTS฀(<-11)฀had฀an฀overall฀annual฀event฀rate฀ of฀12.2%.฀Likewise,฀these฀patients฀could฀be฀further฀stratified฀based฀on฀MPI฀results฀(3.8%฀ vs.฀28.2%;฀p<0.03).฀(Chart)฀Adverse฀events฀were:฀revascularization฀(71.5%),฀non-cardiac฀ death฀(13%),฀non-fatal฀MI฀(10.5%)฀and฀cardiac฀death฀(5%).฀Patients฀with฀low฀DTS฀had฀low฀ event฀rate฀regardless฀of฀MPI฀(1.10%). Conclusion:฀ SPECT฀ myocardial฀ perfusion฀ imaging฀ reclassifies฀ women฀ with฀ moderate฀ or฀high฀Duke฀Treadmill฀Score฀to฀more฀accurately฀identify฀those฀at฀risk฀for฀adverse฀events.฀ SPECT฀myocardial฀perfusion฀imaging฀should฀be฀performed฀in฀addition฀to฀ETT฀in฀women฀ with฀intermediate฀to฀high฀pretest฀probability฀for฀CAD. ฀ JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging Noon 809-7฀ Prevalence฀and฀Prognosis฀of฀Left฀Ventricular฀Systolic฀ Dysfunction฀in฀Asymptomatic฀Diabetics฀Without฀Known฀ Coronary฀Artery฀Disease Panithaya฀Chareonthaitawee,฀Paul฀Sorajja,฀Todd฀D.฀Miller,฀Navin฀Rajagopalan,฀David฀O.฀ Hodge,฀Robert฀L.฀Frye,฀Raymond฀J.฀Gibbons,฀Mayo฀Clinic฀and฀Mayo฀Clinic฀College฀of฀ Medicine,฀Rochester,฀MN Background:฀The฀prevalence฀and฀prognosis฀of฀left฀ventricular฀(LV)฀systolic฀dysfunction฀ in฀asymptomatic฀diabetic฀patients฀without฀known฀coronary฀artery฀disease฀(CAD)฀are฀not฀ known.฀ Methods:฀ From฀ 1986฀ to฀ 2000,฀ 1046฀ diabetics฀ (age฀ 60±13฀ yrs,฀ 69%฀ male)฀ without฀ cardiovascular฀ symptoms฀ and฀ with฀ no฀ known฀ CAD฀ underwent฀ stress฀ single฀ photon฀ emission฀computed฀tomography฀(SPECT)฀and฀assessment฀of฀LV฀systolic฀function฀(EF).฀ SPECT฀images฀were฀classified฀as฀low,฀intermediate,฀or฀high฀risk฀based฀on฀the฀summed฀ stress฀score฀(SSS).฀The฀mean฀follow-up฀was฀5.3±3.3฀yrs.฀ Results:฀ The฀ prevalence฀ of฀ LV฀ systolic฀ dysfunction฀ (LVEF<50%)฀ was฀ 16.7%฀ (n฀ =฀ 175;฀ mean฀LVEF฀=฀40.0±7.7%).฀This฀group฀was฀older฀(63±11฀vs.฀59±14฀yrs;฀p฀=฀0.005),฀had฀ more฀peripheral฀arterial฀disease฀(45%฀vs.฀29%;฀p<0.001),฀a฀higher฀proportion฀with฀ECG฀ Q฀ waves฀ (21%฀ vs.฀ 9%;฀ p<0.001),฀ and฀ more฀ intermediate/high฀ risk฀ SSS฀ (74%฀ vs.฀ 38%;฀ p<0.001)฀than฀the฀group฀without฀dysfunction.฀Mean฀SSS฀(44.8±9.8฀vs.฀51.7±6.3;฀p<0.001),฀ summed฀ reversibility฀ (4.7±5.0฀ vs.฀ 2.9±4.5;฀ p<0.001)฀ and฀ rest฀ scores฀ (49.4±7.2฀ vs.฀ 54.6±3.1;฀p<0.001)฀were฀significantly฀more฀abnormal฀in฀the฀dysfunctional฀group.฀Survival฀ was฀markedly฀impaired฀in฀patients฀with฀LV฀dysfunction฀(p<0.0001฀vs.฀LVEF≥50%).฀ 279A correlation฀between฀Doppler฀and฀invasive฀methods฀(y฀=฀0.84x฀+฀5.5,฀r=0.94,฀p<0.0001). Conclusion:฀ High-frequency฀ echocardiography฀ is฀ worthy฀ for฀ accurate฀ quantitative฀ evaluation฀ of฀ PH฀ in฀ rats.฀This฀ method฀ can฀ be฀ utilized฀ at฀ developing฀ a฀ new฀ therapeutic฀ method฀of฀PH. 1109-88฀ Inflammation฀Is฀Correlated฀With฀Diastolic฀Dysfunction฀in฀ Women William฀Merhi,฀Asma฀Aouthmany,฀Cristine฀Z.฀Dickinson,฀Irina฀Valk,฀Pamela฀Gray,฀Elaine฀ Kish,฀Pamela฀M.฀Marcovitz,฀William฀Beaumont฀Hospital,฀Royal฀Oak,฀MI BACKGROUND:฀Diastolic฀dysfunction฀(DD)฀is฀associated฀with฀myocardial฀stiffening,฀and฀ is฀a฀major฀cause฀of฀CHF฀in฀women.฀Prior฀studies,฀mostly฀in฀men,฀show฀an฀association฀ between฀DD,฀hypertension฀(HTN)฀and฀increased฀ventricular฀wall฀thickness฀(IVS).฀Recent฀ reports฀suggest฀a฀role฀for฀obesity฀and฀insulin฀resistance฀in฀the฀pathogenesis฀of฀DD. Hypothesis:฀We฀postulate฀that฀inflammation฀as฀measured฀by฀hs-CRP฀and฀aortic฀sclerosis,฀ may฀play฀a฀role฀in฀the฀pathogenesis฀of฀DD. METHODS:฀ We฀ examined฀ clinical฀ and฀ echo฀ parameters฀ in฀ 449฀ patients฀ (93%฀ female,฀ age฀56+15)฀undergoing฀evaluation฀of฀suspected฀CAD.฀Echo฀parameters฀included฀ejection฀ fraction฀(EF),฀IVS฀thickness฀(mm),฀aortic฀sclerosis฀(ASC)฀and฀E:E’฀(TDI)฀as฀a฀measure฀of฀ diastolic฀function.฀DD฀was฀classified฀as฀normal฀if฀E:E’<8,฀and฀abnormal฀if฀E:E’>8.฀Clinical฀ variables฀(BMI,฀HTN,฀HbgA1C,฀and฀hs-CRP)฀were฀included. RESULTS:฀Mean฀EF฀was฀.56+฀8฀for฀the฀entire฀group.฀Age,฀hs-CRP,฀ASC,฀HTN,฀HgbA1C,฀ BMI,฀ and฀ IVS฀ thickness฀ correlated฀ in฀ the฀ univariate฀ analysis฀ with฀ DD฀ (see฀ table).฀ In฀ a฀ multivariate฀ analysis,฀ age฀ (p=<0.001),฀ BMI฀ (0.0006)฀ and฀ hs-CRP฀ (p=0.016)฀ remained฀ predictive฀of฀DD. E:E<8 N=193 E:E>8 N=256 P Age CRP IVS(mm) HgbA1C HTN ASC 48+15 2.5+2.3 27+6 9.3+17 5.6+.7 30% 28% 62+13 3.7+3.4 30+7 11+21 6.0+1 54% 68% .0009 <.0001 <.0001 <0.0001 0.002 BMI <0.0001 <0.0001 CONCLUSION:฀Markers฀of฀glucose฀intolerance฀(฀BMI,฀HgbA1C)฀and฀inflammation฀(hsCRP฀and฀aortic฀sclerosis)฀are฀associated฀with฀DD฀in฀this฀study.฀In฀a฀multivariate฀model,฀ BMI฀ ,฀ CRP฀ and฀ age฀ remained฀ as฀ predictors.฀These฀ findings฀ suggest฀ that฀ inflammation฀ plays฀ a฀ role฀ in฀ the฀ pathogenesis฀ of฀ DD฀ in฀ women,฀ likely฀ through฀ vascular฀ dysfunction.฀ Further฀studies฀are฀needed฀to฀clarify฀the฀mechanism. 1109-89฀ John฀A.฀Sallach,฀W.฀H.฀Wilson฀Tang,฀Tama฀Porter,฀Allen฀G.฀Borowski,฀Osmosalewa฀ Lalude,฀Maureen฀Martin,฀Richard฀W.฀Troughton,฀Sanjeev฀Bhavnani,฀Allan฀L.฀Klein,฀ Cleveland฀Clinic฀Foundation,฀Cleveland,฀OH,฀Saint฀Louis฀University,฀Saint฀Louis,฀MO Conclusion:฀In฀this฀population฀of฀asymptomatic฀diabetics฀without฀known฀CAD฀referred฀for฀ stress฀SPECT,฀LV฀systolic฀dysfunction฀was฀highly฀prevalent,฀occurring฀in฀1฀of฀6฀patients.฀ The฀ majority฀ have฀ intermediate/high฀ risk฀ SPECT฀ scans.฀ Survival฀ of฀ these฀ patients฀ is฀ reduced฀with฀an฀annual฀mortality฀of฀7%. POSTER฀SESSION 1109฀฀ Cardiovascular฀Ultrasound:฀Potpourri Monday,฀March฀07,฀2005,฀1:30฀p.m.-5:00฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀3:30฀p.m.-4:30฀p.m. 1109-87฀ Quantitative฀Assessment฀of฀Pulmonary฀Hypertension฀in฀ Rats฀by฀High-Frequency฀Echocardiography Ryoko฀Azakami,฀Fuminobu฀Ishikura,฀Kohei฀Okuda,฀Takashiro฀Hirano,฀Toshihiko฀ Asanuma,฀Shintaro฀Beppu,฀Osaka฀University฀Graduate฀School฀of฀Medicine,฀Suita,฀Japan Background:฀A฀pulmonary฀hypertensive฀(PH)฀rat฀model฀induced฀by฀monocrotaline฀(MCT)฀ is฀commonly฀used฀at฀developing฀a฀new฀therapeutic฀method.฀However,฀there฀have฀been฀ few฀studies฀to฀declare฀the฀efficacy฀of฀echocardiography฀to฀assess฀PH฀in฀small฀animals฀ as฀rats. Purpose:฀The฀aim฀of฀this฀study฀was฀to฀examine฀the฀accuracy฀of฀quantitative฀assessment฀ of฀the฀echocardiographic฀findings฀of฀PH฀in฀rats.฀ Method:฀Fourteen฀rats฀were฀examined.฀MCT฀(5mg/kg)฀was฀injected฀into฀the฀subcutaneum฀ in฀7฀rats฀(PH฀rats)฀for฀15days.฀After฀3฀weeks,฀SONOS5500฀(Philips)฀with฀high-frequency฀ transducer฀ (s12฀ probe)฀ was฀ applied.฀The฀ right฀ ventricular฀ (RV)฀ and฀ left฀ ventricular฀ (LV)฀ end-diastolic฀areas฀(EDA)฀were฀measured฀in฀the฀short฀ axis฀view.฀Maximal฀flow฀velocity฀ (Vmax),฀ejection฀time฀(ET)฀and฀acceleration฀time฀(AT)฀of฀the฀pulmonary฀artery฀flow฀were฀ measured.฀The฀peak฀velocity฀of฀tricuspid฀regurgitant฀flow฀was฀measured฀to฀calculate฀the฀ pressure฀gradient,฀which฀was฀compared฀with฀the฀direct฀measurement฀of฀the฀RV฀systolic฀ pressure.฀Age-matched฀7฀normal฀rats฀were฀also฀examined฀as฀control. Results:฀ RV-EDA฀ in฀ the฀ PH฀ rats฀ was฀ significantly฀ larger฀ than฀ that฀ in฀ the฀ normal฀ rats฀ (0.23±0.07฀ vs.฀ 0.06±0.02฀ cm2,฀ p<0.05),฀ while฀ LV-EDA฀ in฀ the฀ PH฀ rats฀ was฀ significantly฀ smaller฀ than฀ that฀ in฀ the฀ normal฀ rats฀ (0.16±0.06฀ vs.฀ 0.24±0.02฀ cm2,฀ p<0.05).฀The฀Vmax฀ and฀AT/ET฀in฀the฀PH฀rats฀were฀significantly฀smaller฀than฀those฀in฀the฀normal฀rats฀(Vmax:฀ 65.2±11.6฀vs.฀86.5±8.6฀cm/s,฀AT/ET:฀0.19±0.05฀vs.฀0.37±0.07฀p<0.05).฀The฀peak฀pressure฀ gradient฀ between฀ RV฀ and฀ RA฀ was฀ 79.6±14.1mmHg฀ in฀ the฀ PH฀ rats.฀There฀ was฀ a฀ good฀ Background:฀Although฀left฀atrial฀volume฀is฀a฀known฀marker฀of฀left฀ventricular฀(LV)฀systolic฀ dysfunction฀severity,฀similar฀associations฀between฀the฀right฀atrium฀(RA)฀and฀right฀ventricle฀ (RV)฀ have฀ not฀ been฀ examined.฀ We฀ sought฀ to฀ determine฀ the฀ relationship฀ between฀ RA฀ volume฀and฀RV฀systolic฀function. Methods:฀ The฀ ADEPT฀ (Assessment฀ of฀ Doppler฀ Echocardiography฀ for฀ Prognosis฀ and฀ Therapy)฀ Trial฀ enrolled฀ 183฀ patients฀ (mean฀ age฀ 57฀ ±฀ 14฀ yrs)฀ with฀ LV฀ ejection฀ fraction฀ <฀ 35%.฀ On฀ transthoracic฀ echocardiogram,฀ RA฀ volume฀ was฀ calculated฀ by฀ Simpson’s฀ method฀ and฀ indexed฀ to฀ body฀ surface฀ area฀ (RAVI).฀ RV฀ systolic฀ function฀ was฀ graded฀ as฀ normal฀(30%),฀mild฀hypokinesis฀(HK)฀(24.5%),฀moderate฀HK฀(18.5%),฀moderate/severe฀ HK฀(16%)฀and฀severe฀HK฀(11%).฀Echocardiographic฀variables฀were฀compared฀between฀ these฀groups฀using฀ANOVA. Results:฀ Mean฀ RAVI฀ was฀ 29฀ ±฀ 17฀ ml/m²฀ in฀ the฀ study฀ population.฀ RAVI฀ was฀ correlated฀ positively฀ with฀ left฀ atrial฀ volume,฀ LV฀ end-diastolic฀ volume,฀ RV฀ systolic฀ function,฀ and฀ negatively฀ with฀ LV฀ ejection฀ fraction,฀ hepatic฀ vein฀ S฀ wave฀ velocity฀ and฀ tricuspid฀ annular฀ tissue฀Doppler฀S’฀and฀A’฀velocities฀(all฀p฀<฀0.001).฀As฀RV฀systolic฀dysfunction฀worsened,฀ RAVI฀ increased฀ significantly฀ (p<0.0001)฀ (Figure฀ 1).฀ RAVI฀ was฀ strongly฀ associated฀ with฀ severity฀of฀RV฀systolic฀dysfunction. Conclusions:฀ In฀ patients฀ with฀ significantly฀ depressed฀ LV฀ systolic฀ function,฀ RAVI฀ expressed฀ the฀ severity฀ of฀ RV฀ systolic฀ dysfunction.฀This฀ new฀ echocardiographic฀ marker฀ can฀be฀used฀to฀identify฀patients฀with฀abnormal฀RV฀systolic฀function. Noninvasive Imaging Right฀Atrial฀Volume฀Is฀a฀Marker฀of฀Right฀Ventricular฀ Systolic฀Dysfunction:฀An฀ADEPT฀Trial฀Substudy 280A 1109-90฀ ABSTRACTS - Noninvasive Imaging Echocardiographic฀Outcome฀Predictors฀in฀Surgically฀ Treated฀Patients฀with฀Infective฀Endocarditis Susan฀M.฀Sallach,฀Nick฀Dobrilovic,฀Brad฀Hirsch,฀Michelle฀Paul,฀Paul฀Pappas,฀Chris฀ Cabell,฀JM฀DiMaio,฀Michael฀A.฀Wait,฀Gail฀E.฀Peterson,฀University฀of฀Texas฀Southwestern,฀ Dallas,฀TX,฀Duke฀University,฀Durham,฀NC Background:฀ Despite฀ use฀ of฀ echocardiography฀ (echo)฀ in฀ the฀ diagnosis฀ of฀ infective฀ endocarditis฀(IE),฀few฀data฀exist฀identifying฀which฀features฀are฀associated฀with฀adverse฀ outcomes฀ in฀ surgically฀ treated฀ patients.฀We฀ sought฀ to฀ identify฀ echo฀ characteristics฀ that฀ predict฀hospital฀mortality฀in฀surgically฀treated฀patients฀with฀IE฀(and฀combined฀outcome฀of฀ mortality,฀repeat฀valve฀surgery,฀recurrent฀IE฀and฀stroke).฀ Methods:฀Patients฀with฀surgically฀treated฀IE฀were฀retrospectively฀identified฀from฀1991฀to฀ 2003.฀Data฀were฀entered฀into฀a฀standard฀case฀report฀form฀based฀on฀modified฀International฀ Collaboration฀on฀Endocarditis฀and฀STS฀databases.฀ Results:฀ We฀ identified฀ 197฀ consecutive฀ patients฀ with฀ surgically฀ treated฀ IE;฀ 95.9%฀ met฀ definite฀Duke฀Criteria.฀Average฀age฀was฀45.6฀years,฀67%฀were฀men.฀Native฀and฀prosthetic฀ valve฀IE฀occurred฀in฀144฀and฀43฀patients฀respectively.฀Echo฀findings฀included฀vegetation฀ (75%),฀ abscess฀ (22.3%),฀ valve฀ perforation฀ (13.7%),฀ fistula฀ (3%)฀ and฀ prosthetic฀ valve฀ dehiscence฀ (6%).฀ Location฀ of฀ vegetations฀ were฀ aortic฀ (39.1%)฀ mitral฀ (36%),฀ tricuspid฀ (12%),฀ pulmonary฀ (4.1%)฀ and฀ nonvalvular฀ (3.5%).฀ Of฀ these฀ findings,฀ abscess฀ was฀ the฀ only฀one฀associated฀with฀increased฀mortality฀(25%,฀p<0.01)฀while฀valve฀perforation฀was฀ associated฀with฀improved฀survival฀(0฀deaths,฀p<0.01). Conclusions:฀ In฀ a฀ large฀ group฀ of฀ patients฀ with฀ IE฀ treated฀ with฀ surgery,฀ the฀ presence฀ of฀ abscess฀ identified฀ on฀ echo฀ predicted฀ in-hospital฀ mortality.฀The฀ reasons฀ for฀ improved฀ survival฀associated฀with฀valve฀perforation฀may฀involve฀the฀relative฀ease฀of฀surgical฀repair฀ with฀this฀lesion,฀and฀warrants฀further฀investigation. 1109-91฀ Characteristics฀of฀Echocardiographic฀Analysis฀in฀the฀ Patients฀with฀Ischemic฀Mitral฀Regurgitation Noninvasive Imaging Tomoko฀Tani,฀Kazuaki฀Tanabe,฀Fumie฀Ono,฀Aki฀Kitamura,฀Minako฀Tani,฀Minako฀ Katayama,฀Makoto฀Kinoshita,฀Koichi฀Tamita,฀Shuichiro฀Kaji,฀Atsushi฀Yamamuro,฀Kunihiko฀ Nagai,฀Kenichi฀Shiratori,฀Shigefumi฀Morioka,฀Yukikatsu฀Okada,฀Kobe฀General฀Hospital,฀ Kobe,฀Japan Backgrounds:฀Ischemic฀mitral฀regurgitation฀(IMR)฀is฀usually฀associated฀with฀incomplete฀ mitral฀ leaflet฀ closure฀ defined฀ as฀ apically฀ displaced฀ coaptation฀ with฀ failure฀ of฀ the฀ mitral฀ leaflet฀ to฀ reach฀ the฀ level฀ of฀ the฀ mitral฀ annulus฀ and฀ without฀ apparent฀ intrinsic฀ cusp฀ abnormalities.฀Although฀undersized฀mitral฀ring฀annuloplasty฀is฀favorable฀in฀most฀cases฀of฀ IMR,฀the฀degree฀of฀leaflet฀tethering฀may฀affect฀residual฀or฀recurrent฀mitral฀regurgitation฀ after฀ring฀annuloplasty฀alone.฀Messas฀et฀al.฀proposed฀efficacy฀of฀chordal฀cutting฀to฀relieve฀ chronic฀ persistent฀ IMR฀ using฀ sheep฀ model.฀ We฀ performed฀ ring฀ annuloplasty฀ alone฀ or฀ chordal฀ cutting฀ with฀ a฀ ring฀ annuloplasty฀ for฀ severe฀ IMR฀ and฀ assessed฀ the฀ efficacy฀ by฀ transthoracic฀echocardiography. Objectives:฀We฀studied฀whether฀ischemic฀MR฀correlated฀with฀left฀ventricular฀(LV)฀ejection฀ fruction฀(EF),฀LV฀end-diastolic฀dimension฀(Dd)฀and฀LV฀end-systolic฀dimension฀(Ds).฀And฀ we฀investigated฀the฀characteristics฀of฀mitral฀valve฀movement.฀ Methods:฀We฀studied฀36฀patients฀with฀ischemic฀MR฀after฀myocardial฀infarction.฀7฀patients฀ underwent฀chordal฀cutting฀associated฀with฀a฀ring฀annuloplasty฀(Group฀A).฀29฀pts฀underwent฀ only฀ ring฀ annuloplasty฀ (Group฀ B).฀We฀ excluded฀ the฀ patients฀ with฀ 1)฀ aortic฀ regurgitation฀ 2)฀ atrial฀ fibrillation฀ 3)฀ apparent฀ intrinsic฀ cusp฀ disease.฀ Dd,฀ Ds฀ and฀ tenting฀ area฀ were฀ measured฀ by฀ two-dimensional฀ echocardiography.฀ EF฀ was฀ derived฀ from฀ apical฀ two-and฀ four-chamber฀views฀according฀to฀the฀modified฀Simpson฀rule.฀Results:In฀Group฀A,฀there฀ were฀no฀changes฀after฀surgery฀(Dd;฀5.9±0.7cm฀vs฀5.5±0.9cm,฀p=0.51,Ds;฀5.1±1.0cm฀vs฀ 4.8±1.3cm,฀p=0.63,EF;฀34.2±10.0%฀vs฀36.0±7.7%,฀p=0.78:฀pre฀vs฀post฀surgery).฀Tenting฀ area฀was฀significantly฀decreased฀after฀surgery฀(฀2.5±0.4cm2฀vs฀0.5±0.1cm2,฀p<0.0001).฀In฀ Group฀B,฀there฀were฀no฀changes฀of฀all฀modalities฀(Dd;฀5.6±1.0cm฀vs฀5.4±0.8cm,฀p=0.67,Ds;฀ 4.5±1.4cm฀vs฀4.4±0.9cm,฀p=0.87,EF;฀42.8±18.9%฀vs฀39.9±11.7%,฀p=0.63,Tenting฀area;฀ 2.1±0.6cm2฀vs฀2.0±0.8cm2,฀p=0.77).฀ Conclusions:฀ Chordal฀ cutting฀ associated฀ with฀ a฀ small฀ sized฀ ring฀ annuloplasty฀ can฀ effectively฀ leaflet฀ tethering.฀ This฀ procedure฀ is฀ thought฀ to฀ be฀ an฀ alternative฀ to฀ valve฀ replacement฀for฀severe฀IMR. 1109-92฀ Feasibility฀of฀Non-Contact฀Thrombolysis฀by฀High฀ Intensity฀Focused฀Ultrasound฀Alone Kana฀Fujikura,฀Ryo฀Otsuka,฀Yukio฀Abe,฀Jeffrey฀A.฀Ketterling,฀Andrew฀Kalisz,฀Robert฀ Muratore,฀Frederic฀L.฀Lizzi,฀Shunichi฀Homma,฀Columbia฀Presbyterian฀Medical฀Center,฀ New฀York,฀NY,฀Riverside฀Research฀Institute,฀New฀York,฀NY Background:฀ Catheter-based฀ invasive฀ thrombolysis฀ has฀ been฀ clinically฀ evaluated฀ as฀ an฀ efficient฀ treatment฀ of฀ acute฀ myocardial฀ infarction.฀ High฀ intensity฀ focused฀ ultrasound฀ (HIFU)฀may฀be฀a฀non-invasive฀alternative฀to฀dissolve฀a฀thrombus฀by฀externally฀focusing฀ at฀the฀occlusive฀site.฀This฀technique฀may฀also฀be฀used฀in฀treating฀heparin฀contraindicated฀ patients.฀ Previous฀ studies฀ have฀ indicated฀ the฀ feasibility฀ of฀ HIFU฀ thrombolysis฀ by฀ using฀ contrast฀ agent฀ and/or฀ a฀ thrombolytic฀ agent.฀ However,฀ a฀ method฀ of฀ thrombolysing฀ by฀ HIFU฀alone฀has฀not฀been฀well฀established.฀The฀purpose฀of฀this฀study฀was฀to฀evaluate฀the฀ efficacy฀of฀HIFU-alone฀thombolysis. Method:฀Fresh฀blood฀was฀obtained฀from฀healthy฀males฀and฀placed฀in฀1cc฀syringes.฀It฀was฀ incubated฀at฀37°C฀for฀2฀hours.฀The฀thrombi฀were฀removed฀from฀the฀syringes,฀separated฀by฀ serum฀and฀cut฀in฀half฀(n=44)(194±18฀mg).฀The฀pair฀of฀thrombi฀were฀individually฀wrapped฀ with฀polyethylene฀film,฀placed฀on฀the฀epicardial฀side฀of฀a฀block฀of฀calf฀left฀ventricle,฀and฀ then฀ placed฀ in฀ a฀ phosphate฀ buffer฀ saline฀ bath฀ of฀ 37°C.฀ One฀ thrombus฀ was฀ exposed฀ to฀ ultrasound;฀the฀other฀was฀not.฀An฀80฀mm฀diameter฀spherical-cap฀HIFU฀transducer฀with฀ a฀90฀mm฀focal฀length฀was฀connected฀to฀an฀XY฀positioning฀device฀and฀was฀moved฀at฀a฀ constant฀ speed฀ of฀ 0.3฀ mm/s.฀The฀ transducer฀ was฀ operated฀ at฀ a฀ frequency฀ of฀ 510฀ kHz฀ with฀a฀nominal฀intensity฀of฀46฀W/cm2.฀The฀HIFU฀was฀exposed฀for฀240฀s฀as฀a฀pulse฀wave฀ (pulse฀repetition฀frequency฀=฀2.0฀ms;฀duty฀cycle฀=฀1/40,฀2/40.฀3/40,฀4/40).฀The฀thrombolysis฀ rate฀was฀defined฀as฀the฀fractional฀change฀of฀the฀thrombus฀mass฀divided฀by฀the฀fractional฀ JACC February 1, 2005 change฀ of฀ the฀ control฀ mass.฀ The฀ tissue฀ damage฀ underneath฀ the฀ thrombus฀ was฀ also฀ visually฀examined. Result:฀ The฀ thrombolysis฀ rate฀ was฀ 1.33±0.49,฀ 1.73±0.39,฀ 1.71±0.43,฀ 1.61±0.14฀ for฀ duty฀cycles฀1/40฀(n=5),฀2/40฀(n=5),฀3/40฀(n=6),฀4/40฀(n=6)฀respectively.฀No฀damage฀was฀ detected฀on฀the฀myocardium. Conclusion:฀ This฀ study฀ indicates฀ that฀ pulsed฀ sinosoidal฀ waves฀ dissolve฀ thrombi฀ more฀ efficiently฀ than฀ continuous฀ waves.฀ As฀ the฀ duty฀ cycle฀ increases,฀ there฀ appears฀ to฀ be฀ a฀ single฀ point฀ at฀ which฀ the฀ pulse฀ setting฀ most฀ efficiently฀ dissolve฀ the฀ thrombus.฀ Further฀ study฀is฀required฀for฀evaluating฀the฀most฀effcient฀pulse฀setting฀to฀establish฀future฀clinical฀ application. 1109-93฀ Standard฀Anteroposterior฀Left฀Atrial฀Diameter฀ Measurement฀Misclassifies฀Twenty฀Four฀Percent฀of฀ Subjects฀with฀Regards฀to฀Atrial฀Dilatation฀Using฀Left฀ Atrial฀Volume฀as฀the฀Gold฀Standard David฀A.฀Wood,฀Jessica฀Cochrane,฀Brad฀Munt,฀University฀Of฀British฀Columbia,฀ Vancouver,฀BC,฀Canada,฀St.฀Paul’s฀Hospital,฀Vancouver,฀BC,฀Canada Background:฀Determining฀left฀atrial฀(LA)฀size฀is฀critical฀for฀managing฀both฀valvular฀and฀ arrythmogenic฀cardiac฀conditions.฀Currently,฀LA฀size฀is฀measured฀using฀the฀anteroposterior฀ (AP)฀ diameter฀ in฀ most฀ echocardiographic฀ laboratories.฀ The฀ purpose฀ of฀ this฀ study฀ was฀ to฀ compare฀ standard฀ LA฀ AP฀ diameter฀ measurements฀ with฀ a฀ more฀ detailed฀ LA฀ volume฀ measurement฀to฀determine฀their฀correlation. Methods:฀Fifty฀consecutive฀patients฀with฀mild฀to฀severe฀mitral฀regurgitation฀and฀a฀native฀ mitral฀ valve฀ had฀ their฀ LA฀ AP฀ diameter฀ measured฀ conventionally฀ with฀ two-dimensional฀ transthoracic฀echocardiography.฀These฀patients฀then฀had฀their฀LA฀volume฀calculated฀as฀ the฀average฀of฀the฀volumes฀by฀the฀method฀of฀discs฀in฀the฀two฀and฀four฀chamber฀apical฀ views.฀This฀was฀taken฀as฀the฀gold฀standard. Results:฀ We฀ found฀ a฀ statistically฀ significant฀ relationship฀ between฀ measured฀ LA฀ AP฀ diameter฀and฀calculated฀LA฀volume฀(p฀<฀0.001);฀however,฀only฀42฀%฀of฀the฀LA฀volume฀ information฀was฀contained฀in฀the฀AP฀diameter.฀We฀defined฀a฀dilated฀left฀atrium฀as฀>฀95฀ %฀predicted฀for฀age฀and฀gender฀from฀the฀Framingham฀database฀for฀AP฀diameter,฀and฀>฀ 30฀ ml/m2/BSA฀ for฀ volume.฀ Only฀ 37฀ patients฀ (74฀ %)฀ are฀ correctly฀ classified.฀Ten฀ (20฀ %)฀ patients฀are฀classified฀as฀dilated฀by฀AP฀diameter฀but฀have฀a฀normal฀volume,฀while฀3฀(6฀%)฀ of฀patients฀are฀classified฀as฀normal฀by฀AP฀diameter฀but฀have฀an฀increased฀volume. Conclusions:฀Standard฀LA฀diameter฀measurements฀are฀statistically฀correlated฀with฀LA฀ volume฀but฀24฀%฀of฀patients฀are฀misclassified฀if฀LA฀volume฀is฀used฀as฀the฀gold฀standard. 1109-94฀ Assessment฀Of฀HIFU฀Lesion฀Size฀Using฀2D฀Second฀ Harmonic฀Imaging Kana฀Fujikura,฀Yukio฀Abe,฀Ryo฀Otsuka,฀Andrew฀Kalisz,฀Robert฀Muratore,฀Frederic฀L.฀ Lizzi,฀Shunichi฀Homma,฀Columbia฀Presbyterian฀Medical฀Center,฀New฀York,฀NY,฀Riverside฀ Research฀Institute,฀New฀York,฀NY Background:฀ High฀ intensity฀ focused฀ ultrasound฀ (HIFU)฀ can฀ ablate฀ tissue฀ without฀ direct฀ contact.฀We฀ have฀ demonstrated฀ the฀ ability฀ of฀ HIFU฀ to฀ create฀ focal฀ lesions฀ in฀ the฀ myocardium,฀ which฀ may฀ allow฀ future฀ non-invasive฀ clinical฀ ablation.฀ In฀ order฀ to฀ proceed฀ toward฀the฀future฀clinical฀use฀of฀HIFU,฀it฀could฀prove฀useful฀to฀evaluate฀lesions฀immediately฀ following฀ HIFU฀ exposure.฀ HIFU฀ lesions฀ can฀ be฀ observed฀ via฀ 2D฀ ultrasound฀ imaging.฀ The฀ purpose฀ of฀ this฀ study฀ was฀ to฀ assess฀ the฀ utility฀ of฀ 2D฀ second฀ harmonic฀ imaging฀ in฀ evaluating฀HIFU฀lesions. Method:฀The฀left฀ventricular฀free฀walls฀of฀calf฀hearts฀were฀cut฀into฀cuboids฀approximately฀ 3฀ ×฀ 6฀ ×฀ 3฀ cm,฀ degassed฀ and฀ heated฀ to฀ 37°C฀ in฀ degassed฀ phosphate฀ buffered฀ saline฀ (PBS).฀A฀5.25฀MHz,฀40฀mm฀diameter,฀35฀mm฀focal฀length฀spherical-cap฀transducer฀was฀ used.฀The฀spatial฀average฀intensity฀in฀the฀tissue฀was฀set฀to฀15.5฀kW/cm2.฀Lesions฀were฀ created฀approximately฀10฀mm฀below฀the฀epicardial฀surface.฀A฀series฀of฀0.2฀s฀HIFU฀pulses฀ was฀applied฀every฀4฀s,฀for฀5฀to฀20฀cycles,฀to฀create฀each฀lesion.฀Four฀lesions฀were฀created฀ in฀each฀tissue฀sample฀by฀laterally฀moving฀the฀transducer฀between฀exposures.฀In฀addition,฀ eight฀ to฀ nine฀ lesions฀ were฀ created฀ for฀ each฀ pulse฀ setting.฀ Acuson฀ Sequoia฀ Echo฀ 256฀ (Siemens,฀Malvern,฀PA;฀second฀harmonic฀1.75฀MHz฀/฀3.5฀MHz)฀was฀used฀to฀capture฀the฀ 2D฀ultrasound฀image.฀Ultrasonic฀2D฀image฀was฀taken฀immediately฀before฀and฀after฀HIFU฀ exposure;฀ the฀ lesion฀ size฀ was฀ measured฀ simultaneously.฀ Then,฀ the฀ fresh฀ (unstained)฀ tissue฀specimens฀were฀cut฀and฀shaved฀carefully฀to฀show฀the฀maximum฀longitudinal฀crosssectional฀ lesion฀ size฀ and฀ visually฀ measured.฀ These฀ two฀ measurement฀ methods฀ were฀ compared. Result:฀ All฀ 35฀ lesions฀ were฀ visibly฀ detected.฀ The฀ lesion฀ length฀ had฀ strong฀ correlation฀ between฀2D฀and฀visual฀examination฀(y฀=฀0.96x฀-฀0.37,฀r฀=฀0.72,฀p<0.001),฀whereas฀the฀ lesion฀width฀had฀significant฀correlation฀between฀those฀two฀examination฀(y฀=฀0.48x฀+฀3.10,฀ r฀=฀0.47,฀p฀=฀0.004). JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging Conclusion:฀HIFU฀created฀well฀demarcated฀lesions฀inside฀the฀myocardial฀tissue.฀Both฀ the฀length฀and฀the฀width฀of฀HIFU฀lesion฀were฀significantly฀well฀correlated฀between฀2D฀and฀ visual฀examination.฀This฀indicates฀the฀possibility฀of฀achieving฀the฀desired฀lesion฀sizes฀and฀ locations฀in฀future฀clinical฀HIFU฀ablation. POSTER฀SESSION 1110฀฀ Novel฀Applications฀of฀ThreeDimensional฀Echocardiography Monday,฀March฀07,฀2005,฀1:30฀p.m.-5:00฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀3:30฀p.m.-4:30฀p.m. 1110-79฀ Direct฀Measurement฀of฀Mitral฀Regurgitant฀Orifice฀ Area฀by฀Transthoracic฀3D-Doppler฀Echocardiography:฀ Comparison฀With฀Conventional฀Methods Katsuomi฀Iwakura,฀Hiroshi฀Ito,฀Shigeo฀Kawanp,฀Atsunori฀Okamura,฀Toshiya฀Kurotobi,฀ Motoo฀Date,฀Koichi฀Inoue,฀Yoshimune฀Hiramoto,฀Noriyuki฀Hanibuchi,฀Norihiro฀Hayashi,฀ Takahiro฀Hashimoto,฀Hiroyuki฀Nagai,฀Masao฀Takeda,฀Kenshi฀Fujii,฀Sakurabashi฀ Watanabe฀Hospital,฀Osaka,฀Japan 1110-80฀ 3D฀Geometry฀of฀Mitral฀Annulus฀in฀Mitral฀Valve฀ Prolapse฀in฀Comparison฀with฀Normal:฀Real-time฀3D฀ Echocardiography฀study Seong฀Mi฀Park,฀Jung฀Chai,฀Min฀Jae฀Jeon,฀Chang฀Kun฀Lee,฀Dae฀Hyoek฀Kim,฀Keum฀Soo฀ Park,฀Woo฀Hyung฀Lee,฀Jun฀Kwan,฀Inha฀University฀Hospital,฀Incheon,฀South฀Korea Background:฀ To฀ elucidate฀ the฀ mitral฀ annular฀ geometry฀ in฀ mitral฀ valve฀ prolapse฀ (MVP)฀ in฀ comparison฀with฀normal฀controls฀using฀a฀newly฀developed฀3D฀computer฀program฀(TomTec).฀ Methods:฀ Real-time฀ 3D฀ echocardiography฀ (RT3DE)฀ was฀ performed฀ in฀ 10฀ MVP฀ patients฀ and฀ 10฀ normal฀ controls.฀ 3D฀ shape฀ of฀ the฀ mitral฀ annulus฀ was฀ reconstructed฀ through฀ 3D฀ coordinates฀of฀annulus฀traced฀on฀16฀rotational฀apical฀planes฀during฀early฀and฀late฀systole.฀ The฀mitral฀annulus฀was฀divided฀into฀anterior฀and฀posterior฀annulus฀by฀the฀line฀connecting฀2฀ commissures.฀3D฀surface฀areas฀of฀the฀anterior฀(aMAA),฀posterior฀(pMAA)฀and฀whole฀annulus฀ (MAA)฀were฀automatically฀calculated.฀Non-planarity฀of฀annulus฀was฀estimated฀by฀non-planar฀ angle฀(NPA)฀between฀2฀vectors฀from฀two฀hinge-points฀of฀the฀annulus฀in฀the฀antero-posterior฀ plane฀to฀the฀center฀of฀the฀axis฀connecting฀two฀commissures฀in฀the฀commissure-commissure฀ plane.฀All฀MAAs฀were฀corrected฀according฀to฀their฀height฀(cMAA).฀ Results:฀NPA฀and฀MAA฀were฀significantly฀larger฀in฀MVP฀patients฀than฀in฀controls฀in฀early฀ and฀late฀systole.฀NPA฀and฀MAA฀were฀increased฀during฀late฀systole฀in฀all฀subjects฀(Table). Conclusion:฀ RT3DE,฀ with฀ a฀ newly฀ developed฀ program,฀ demonstrated฀ that฀ the฀ mitral฀ annulus฀of฀MVP฀was฀significantly฀enlarged฀and฀flattened฀compared฀to฀normal฀controls. Comparison฀of฀3D฀Geometry฀of฀Mitral฀Annulus฀between฀฀ Mitral฀Valve฀Prolapse฀and฀Normal฀ NPA฀(°) MAA(cm2) cMAA฀(cm2/m)฀ Control 142.3±4.3* 9.3±1.5 5.5±0.8* 1.7±0.3 MVP 152.5±7.9* 10.5±1.6 6.6±0.8* 1.8±0.2 Control 152.9±2.9*฀† 10.36±1.9 6.1±0.9*฀† 1.6±0.1* Late฀systole MVP 161.9±6.5*฀† 11.22±1.7 7.0±0.8*฀† 1.8±0.2* *p<0.05,฀control฀vs฀MVP,฀†P<0.05,฀Early฀systole฀vs฀Late฀systole฀in฀each฀group.฀NPA;฀ non-planar฀angle,฀MVP;฀mitral฀valve฀prolapse,฀MAA;฀mitral฀annulus฀area,฀cMAA;฀ corrected฀MAA฀by฀height,฀pMAA;฀posterior฀MAA,฀aMAA;฀anterior฀MAA. Early฀systole Jun฀Kwan,฀Seong฀Mi฀Park,฀Min฀Jae฀Jeon,฀Chang฀Kun฀Lee,฀Dae฀Hyeok฀Kim,฀Keum฀Soo฀ Park,฀Woo฀Hyung฀Lee,฀Inha฀University฀Hospital,฀Inchon,฀South฀Korea Aim:฀ To฀ explore฀ the฀ geometry฀ of฀ the฀ mitral฀ apparatus฀ including฀ the฀ degree฀ of฀ PM฀ displacement฀ in฀ functional฀ MR฀ comparing฀ with฀ normal฀ using฀ RT3DE฀ and฀ 3D฀ computer฀ software฀and฀to฀seek฀the฀main฀geometrical฀determinant฀of฀the฀MR฀severity.฀ Methods:฀Twenty฀five฀patients฀with฀functional฀MR฀(ejection฀fraction:฀24฀±฀6฀%,฀regurgitant฀ orifice฀area:฀0.23฀±฀0.19฀cm2)฀and฀12฀normal฀controls฀underwent฀RT3DE.฀Antero-posterior฀ (AP)฀ and฀ commissure-commissure฀ (CC)฀ dimensions฀ of฀ the฀ mitral฀ annulus,฀ tethering฀ angle฀ of฀ anterior฀ (Aα)฀ and฀ posterior฀ leaflet฀ (Pα)฀ and฀ mitral฀ valve฀ tenting฀ area฀ (MVTa)฀ were฀measured฀in฀two฀orthogonal฀apical฀planes฀with฀3D฀computer฀software฀(4D฀CardioView,฀TomTec,฀Co.).฀The฀mitral฀annular฀area฀(MAA)฀was฀calculated฀from฀the฀equation฀of฀ 3.14*AP*CC/4.฀For฀reliable฀estimation฀of฀the฀degree฀of฀papillary฀muscle฀(PM)฀displacement,฀ we฀specified฀a฀head฀to฀measure฀among฀multi-heads฀of฀each฀anterior฀and฀posterior฀PM,฀ which฀ distributed฀ chordae฀ only฀ to฀ the฀ anterior฀ leaflet฀ and฀ located฀ it฀ using฀ 3D฀ computer฀ software.฀Distances฀from฀the฀medial฀junction฀between฀aortic฀and฀mitral฀annulus฀(MJAM)฀ to฀each฀head฀of฀2฀PMs฀were฀measured.฀Sum฀of฀these฀two฀dimensions฀(ΣMJAMA-PM)฀was฀ then฀calculated.฀Dimension฀between฀two฀heads฀(dPM)฀was฀also฀measured.฀All฀dimesions฀ and฀areas฀were฀corrected฀(c)฀by฀the฀body฀surface฀area฀(BSA)฀of฀each฀patient.฀ Results:฀ All฀ corrected฀ measurements฀ were฀ significantly฀ larger฀ in฀ functional฀ MR฀ than฀ normal฀ (p฀ <฀ 0.01).฀ Among฀ them,฀ cMAA,฀ cMVTa,฀ Pα,฀ cΣMJAM-PM฀ and฀ cdPM฀ showed฀ significant฀correlations฀(p฀<฀0.05)฀with฀MR฀severity.฀As฀we฀explored฀the฀main฀determinants฀ using฀multivariate฀stepwise฀linear฀regression฀analysis฀with฀those฀measurements฀showing฀ significant฀correlations฀with฀MR฀severity,฀cMVTa฀was฀found฀to฀be฀the฀strongest฀determinant฀ of฀MR฀severity฀(R2฀=฀0.79,฀p฀=฀0.04).฀ Conclusions:฀ Among฀ all฀ geometric฀ measurements฀ of฀ the฀ mitral฀ apparatus,฀ corrected฀ MV฀ tenting฀ area฀ seems฀ to฀ be฀ the฀ strongest฀ geometric฀ factor฀ determining฀ the฀ severity฀ of฀ functional฀ MR.฀ RT3DE฀ with฀ 3D฀ computer฀ software,฀ providing฀ accurate฀ geometric฀ measurements฀ is฀ a฀ useful฀ tool฀ to฀ elaborate฀ the฀ geometry฀ of฀ the฀ mitral฀ apparatus฀ in฀ functional฀MR. 1110-82฀ Epicardial฀Mitral฀Annuloplasty฀in฀a฀Beating฀Heart฀for฀ Mitral฀Regurgitation฀Secondary฀to฀Left฀Ventricular฀ Dysfunction Darshak฀H.฀Karia,฀Davida฀Robinson,฀Kyung-Soon฀Hong,฀Alberto฀Milano,฀Kamal฀ Khabbaz,฀Natesa฀Pandian,฀Tufts-New฀England฀Medical฀Center,฀Boston,฀MA Background:฀Mitral฀regurgitation฀(MR)฀is฀a฀common฀complication฀of฀ischemic฀heart฀disease฀ and฀an฀independent฀risk฀factor฀for฀death.฀Mechanisms฀include฀LV฀dilation฀and฀dysfunction,฀ annular฀dilation฀and฀dysfunction,฀apical฀displacement฀of฀papillary฀muscles.฀Correction฀of฀ MR฀favorably฀affects฀remodeling,฀heart฀failure฀and฀prognosis.฀Mitral฀annuloplasty฀(MAP)฀ via฀open฀heart฀surgery฀ameliorates฀MR.฀However฀it฀needs฀cardiopulmonary฀bypass฀and฀ has฀significant฀morbidity฀and฀mortality฀in฀presence฀of฀severe฀LV฀dysfunction.฀We฀explored฀ epicardial฀MAP฀in฀a฀beating฀heart. Methods:฀ 8฀ sheep฀ were฀ anesthetized,฀ intubated,฀ and฀ ventilated.฀ Post-sternotomy,฀ epicardial฀2D฀echo฀with฀5฀MHz฀probe฀and฀3D฀echo฀imaging฀using฀a฀xMatrix฀probe฀(Philips฀ 7500฀system)฀was฀performed.฀Marginal฀branches฀of฀left฀circumflex฀coronary฀artery฀(LCX)฀ were฀ occluded.฀ Color฀ Doppler฀ verified฀ MR.฀ With฀ the฀ apex฀ lifted,฀ the฀ AV฀ groove฀ was฀ dissected,฀to฀avoid฀LCX฀or฀its฀branches.฀Multiple฀segment฀subcoronary฀plication฀sutures฀ (GoreTex)฀ were฀ placed฀ in฀ the฀ annular฀ myocardium.฀ 3D฀ echo฀ datasets฀ were฀ analyzed฀ using฀Tomtec฀ 4D฀ Cardio-ViewTM฀ RT฀ software฀ and฀ measurements฀ subjected฀ to฀ ANOVA฀ with฀Bonferroni฀test.฀Results:฀ Annuloplasty฀ (MAP) MA฀Diastolic฀Area฀(cm ) 6.5±1.4 7.40±1.0 5.7±0.5¥ 2 MA฀Systolic฀Area฀(cm ) 5.6±1.4 6.2±0.5 5.0±0.7¥ MA฀%฀Δ฀Area 13.6±6.4 15.7±6.6 11.5±5.8 MA฀Diastolic฀Circumference(cm) 9.4±1.1 10±0.6 9±0.4¥ MA฀Systolic฀Circumference฀(cm) 8.9±1.1 9.5±0.5 8.3±0.6¥ MA฀%฀Δ฀Circumference 5.79±5.1 5.19±2.9 7.2±3.9 MA฀Diastolic฀AP฀Diameter฀(cm) 2.3±0.4 2.6±0.5 2.1±0.2¥ MA฀Systolic฀AP฀Diameter฀(cm) 2.1±0.4 2.1±0.2 2.1±0.2 MA฀%฀Δ฀AP฀Diameter 9.1±5.8 17.8±10.1 1.1±8.5¥ MR฀(semi-quantitative) 0.88±0.35 1.81±0.59** 0.79±0.39 N=8 Baseline 2 Ischemia P฀value 0.005 0.049 0.26 0.017 0.041 0.66 0.021 0.84 0.001 0.0005 MA=฀Mitral฀Annulus;฀%Δ=percent฀change฀(Dias฀V/s฀Sys);฀AP=฀anteroposterior;฀¥฀Ischemia฀ v/s฀MAP;฀**฀Baseline฀v/s฀MAP Conclusion:฀Epicardial฀mitral฀annuloplasty฀in฀a฀beating฀heart฀model฀of฀ischemic฀mitral฀ regurgitation฀is฀technically฀feasible฀and฀successful฀in฀significantly฀reducing฀mitral฀annulus฀ area,฀circumference฀and฀regurgitation. 1110-83฀ pMAA/aMAA Geometry฀of฀Mitral฀Apparatus฀in฀Functional฀Mitral฀ Regurgitation:฀Real-time฀3D฀Echocardiography฀Study A฀Real-Time฀Three-Dimensional฀Digital฀Doppler฀Method฀ for฀Measurement฀of฀Flow฀Volumes฀Through฀Mitral฀Valve฀ and฀Aortic฀Valve฀in฀Children Liping฀Bu,฀Honghai฀Zhang,฀Michelle฀Disterhoft,฀Marika฀Klesic,฀Milan฀Sonka,฀Shuping฀Ge,฀ Baylor฀College฀of฀Medicine,฀Houston,฀TX,฀University฀of฀Iowa,฀Iowa฀City,฀IA One-฀ or฀ 2-dimensional฀ echo฀ Doppler฀ methods฀ for฀ measurement฀ of฀ flow฀ volumes฀ have฀ limited฀ accuracy฀ and฀ clinical฀ utility.฀ A฀ real-time฀ 3-dimensional฀ digital฀ Doppler฀ method฀ (RT3DDD)฀that฀utilizes฀the฀3D฀velocity฀profile฀is฀ideal฀for฀flow฀measurement. Methods:฀A฀total฀of฀20฀subjects฀(11.2฀±฀3.4฀years,฀10฀male/10฀female)฀were฀prospectively฀ enrolled฀ in฀ this฀ study.฀ A฀ Sonos฀ 7500฀ ultrasound฀ system฀ (Philips,฀ Andover,฀ MA)฀ with฀ a฀ X4฀matrix฀transducer฀was฀used฀to฀acquire฀the฀RT3DDD฀data฀through฀mitral฀valve฀(MV)฀ and฀aortic฀valve฀(AV).฀The฀left฀ventricular฀(LV)฀volumes฀were฀also฀obtained฀to฀determine฀ Noninvasive Imaging Background.฀Calculation฀of฀effective฀regurgitant฀orifice฀area฀(EROA)฀of฀mitral฀regurgitation฀ (MR)฀with฀the฀proximal฀isovelocity฀surface฀area฀method฀(PISA)฀method฀has฀some฀technical฀ limitations.฀We฀directly฀measured฀regurgitant฀orifice฀area฀with฀transthoracic฀3D-Doppler฀ echocardiography฀and฀compared฀its฀value฀to฀EROA฀by฀conventional฀methods. Methods.฀We฀performed฀3-D฀reconstruction฀of฀MR฀jet฀with฀Live-3D฀system฀on฀SONOS7500฀ (Philips฀Medical฀Systems)฀to฀measure฀EROA฀directly฀in฀109฀MR฀cases,฀and฀compared฀its฀ value฀to฀that฀obtained฀by฀the฀PISA฀method.฀We฀also฀determined฀MR฀regurgitant฀volume฀by฀ the฀quantitative฀2D฀echocardiographic฀method,฀and฀divided฀it฀by฀time-velocity฀integral฀of฀ MR฀jet฀to฀obtain฀EROA.฀To฀analyze฀the฀shape฀of฀regurgitant฀orifice,฀we฀calculated฀the฀ratio฀ of฀long-฀to฀short-axis฀of฀the฀orifice฀(L/S฀ratio)฀on฀the฀cropped฀3D฀images. Results.฀EROA฀measured฀with฀3D-Doppler฀method฀showed฀an฀almost฀identical฀correlation฀ with฀that฀determined฀with฀the฀quantitative฀2D-echo฀method฀(r=0.93,฀p<.0001,฀slope:0.97)฀ in฀spite฀of฀L/S฀ratio.฀The฀PISA฀method฀underestimated฀both฀EROA฀by฀the฀quantitative฀2Decho฀(slope:฀0.65)฀and฀that฀by฀3D-Doppler฀method฀(slope:฀0.61)฀in฀the฀62฀cases฀with฀L/S฀ ratio฀>1.5,฀but฀not฀in฀the฀cases฀with฀L/S฀ratio฀≤฀1.5฀(slope;฀1.17฀and฀0.89,฀respectively).฀The฀ Bland-Altman฀analysis฀revealed฀that฀there฀was฀a฀systemic฀bias฀in฀the฀cases฀with฀L/S฀ratio฀ >1.5฀between฀EROA฀by฀the฀PISA฀method฀and฀that฀by฀the฀quantitative2D-echo฀method฀or฀ that฀by฀3D฀method.฀The฀good฀correlation฀between฀EROA฀by฀the฀3D-Doppler฀method฀and฀ that฀by฀the฀quantitative฀2D-echo฀method฀was฀not฀affected฀by฀eccentricity฀of฀MR฀jet฀or฀by฀ the฀presence฀of฀atrial฀fibrillation. Conclusion.฀The฀ direct฀ measurement฀ of฀ EROA฀ of฀ MR฀ with฀ 3D-Doppler฀ is฀ a฀ promising฀ and฀quantitative฀method฀to฀overcome฀the฀limitation฀of฀the฀PISA฀method,฀especially฀in฀the฀ cases฀with฀an฀elliptic฀orifice฀shape฀of฀EROA. 1110-81฀ 281A 282A ABSTRACTS - Noninvasive Imaging JACC the฀stroke฀volume฀(SV)฀by฀real-time฀3D฀(RT3DE)฀volumetric฀measurements฀(LVSV).฀The฀ images฀ were฀ post-processed฀ offline฀ using฀ dedicated฀ software฀ (TomTec฀ 4D฀ Echo-View฀ 5.2)฀with฀two฀algorithms,฀i.e.฀the฀plane฀mode฀and฀sphere฀mode. Results:฀ There฀ were฀ no฀ statistical฀ difference฀ between฀ the฀ two฀ RT3DDD฀ algorithms.฀ Measurements฀of฀MVSV฀and฀AOSV฀were฀compared฀with฀LVSV฀using฀Pearson฀tests฀and฀ Bland-Altman฀analyses฀(Table฀1). Table฀1.฀Pearson฀and฀Bland-Altman฀Analyses:฀RT3DDD฀MVSV฀and฀AOSV฀compared฀with฀ RT3DE฀LVSV฀ r Regression฀Equation p฀Value SEE฀(ml) Mean฀Difference฀±฀SD฀(ml) MVSV 0.83 y฀=฀0.89฀x฀+11.22 AOSV 0.71 y฀=฀0.57฀x฀+฀26.09 <฀0.001 4.91 <฀0.001 5.41 6.8฀±฀4.9 8.4฀±฀6.6 Conclusions:฀It฀is฀feasible฀to฀acquire฀the฀3D฀velocity฀profile฀through฀the฀mitral฀and฀aortic฀ valve฀orifices฀by฀the฀RT3DDD฀methods.฀The฀MVSV฀measured฀by฀this฀RT3DDD฀method฀ appears฀to฀correlate฀and฀agree฀better฀with฀the฀LVSV฀by฀the฀RT3DE฀than฀the฀AOSV.฀The฀ RT3DDD฀may฀become฀a฀useful฀clinical฀tool฀to฀measure฀flow฀volumes฀and฀quantify฀flow฀ abnormalities฀in฀children฀with฀congenital฀and฀acquired฀heart฀diseases. 1110-84฀ Real-time฀Three-Dimensional฀Echocardiography:฀A฀New฀ Method฀for฀Assessing฀Left฀Atrial฀Size฀and฀Function Sunil฀T.฀Mathew,฀Aasha฀S.฀Gopal,฀Rena฀S.฀Toole,฀William฀Schapiro,฀Nathaniel฀Reichek,฀ St.฀Francis฀Hospital,฀Roslyn,฀NY,฀Stony฀Brook฀University,฀Stony฀Brook,฀NY Background:฀ 3D฀ echo฀ is฀ a฀ widely฀ available฀ method฀ that฀ permits฀ accurate฀ volumetric฀ quantification.฀But,฀its฀use฀for฀obtaining฀reliable฀measures฀of฀left฀atrial฀(LA)฀volumes฀and฀ function฀has฀not฀been฀established.฀We฀determined฀the฀number฀of฀image฀planes฀required฀ to฀preserve฀adequate฀atrial฀sampling฀in฀normal฀subjects฀while฀limiting฀the฀effort฀devoted฀ to฀ boundary฀ tracing฀ and฀ maintaining฀ accuracy฀ of฀ results฀ when฀ compared฀ to฀ cardiac฀ magnetic฀resonance฀imaging฀(CMR).฀ Methods:฀46฀normal฀subjects฀(age฀21-76฀yr,฀mean฀age฀55฀yr)฀were฀imaged฀by฀3D฀echo฀ (Philips)฀and฀by฀CMR.฀3D฀echo฀volumes฀were฀obtained฀using฀10฀rotationally฀equidistant฀ apical฀ planes,฀ manual฀ boundary฀ tracing฀ and฀ use฀ of฀ an฀ approximating฀ surface฀ model฀ (TomTec).฀ Maximum฀ LA฀ volume฀ was฀ determined฀ using฀ 2,฀ 4,฀ 6,฀ 8,฀ and฀ 10฀ planes.฀ CMR฀ volume฀was฀performed฀using฀contiguous,฀short฀axis,฀TrueFISP฀cine฀images.฀ Results:฀3D฀echo฀using฀10฀planes฀versus฀CMR:฀r฀=฀0.8;฀SEE฀=฀9฀ml;฀p<0.0001;฀RMS฀%฀ error฀=฀59฀ml;฀Bias฀=฀-5.1฀ml;฀Width฀of฀limits฀of฀agreement=฀40฀ml.฀Data฀from฀2,฀4,฀6,฀and฀ 8฀planes฀were฀then฀compared฀to฀that฀from฀10฀imaging฀planes. Noninvasive Imaging r SEE฀(ml) p RMS฀%฀Error Bias฀(ml) Width฀of฀Limits฀of฀Agreement 4-plane฀3D฀ LA฀volume 0.9 7.7 <0.0001 11 -2.5 31 6-plane฀3D฀ LA฀volume 0.92 6.2 <0.0001 10 -3.2 24 8-plane฀3D฀ LA฀volume 0.96 4.6 <0.0001 7 -1.2 18 Conclusions:฀ 1)฀ Real-time฀ 3D฀ echo฀ is฀ validated฀ as฀ an฀ accurate฀ method฀ to฀ measure฀ LA฀volume฀using฀CMR฀as฀a฀reference฀method.฀2)฀Apical฀biplane฀3D฀views฀considerably฀ underestimate฀ LA฀ volumes฀ in฀ normal฀ subjects.฀ 3)฀ Four฀ equidistant฀ image฀ planes฀ are฀ sufficient฀to฀produce฀optimal฀results฀in฀normally฀shaped฀left฀atria฀with฀high฀correlation,฀low฀ standard฀errors฀of฀the฀estimate฀and฀low฀systematic฀bias.฀Requirements฀for฀abnormal฀atria฀ remain฀to฀be฀determined. 1110-85฀ Three-Dimensional฀Echocardiography฀Is฀Useful฀in฀the฀ Evaluation฀of฀Patients฀With฀Atrioventricular฀Septal฀ Defects Anthony฀M.฀Hlavacek,฀Karen฀Chessa,฀Andrew฀M.฀Atz,฀Scott฀M.฀Bradley,฀Fred฀A.฀ Crawford,฀Girish฀S.฀Shirali,฀Medical฀University฀of฀South฀Carolina,฀Charleston,฀SC Background:฀ Recent฀ advances฀ in฀ three-dimensional฀ echocardiography฀ (3DE)฀ have฀ enhanced฀its฀practicality.฀We฀assessed฀whether฀3DE฀provided฀new฀information฀compared฀ to฀2DE฀among฀patients฀with฀atrioventricular฀septal฀defect฀(AVSD).฀ Methods:฀We฀retrospectively฀reviewed฀3DE฀datasets฀in฀52฀studies฀on฀51฀patients฀(median฀ age:฀4.6฀yrs,฀range฀0-30฀yrs;฀median฀BSA:฀0.6฀m2,฀range฀0.2-1.9฀m2)฀with฀any฀type฀of฀AVSD฀ a฀1-year฀period฀(4/03-4/04).฀3DE฀findings฀were฀compared฀to฀2DE฀and฀surgical฀reports.฀For฀ each฀study,฀AVSD฀was฀classified฀by฀2DE฀as฀one฀of฀the฀following:฀Unrepaired฀balanced฀ defect,฀Repaired฀balanced฀defect฀with฀residual฀lesions,฀Repaired฀balanced฀defect฀without฀ residual฀lesions,฀or฀Unbalanced฀defect.฀3DE฀was฀graded฀as฀1)฀Additive:฀3DE฀resulted฀in฀ a฀new฀finding฀or฀changed฀diagnosis,฀2)฀Useful:฀While฀useful,฀3DE฀did฀not฀result฀in฀new฀ findings฀or฀changed฀diagnosis,฀or฀3)฀Not฀useful.฀ Results:฀ 3DE฀ on฀ unrepaired฀ balanced฀ AVSD฀ and฀ repaired฀ AVSD฀ with฀ residual฀ lesions฀ was฀ more฀ often฀ additive/useful฀ (33/36;฀ 92%)฀ than฀ on฀ repaired฀ AVSD฀ without฀ residual฀ lesions฀or฀unbalanced฀AVSD฀(9/16฀(56%),฀p=0.009).฀3DE฀was฀additive฀or฀useful฀in฀all฀3฀ patients฀with฀unbalanced฀AVSD฀being฀considered฀for฀biventricular฀repair.฀Images฀reviewed฀ in฀ the฀ second฀ half฀ of฀ the฀ study฀ period฀ were฀ more฀ often฀ additive฀ (9/26;฀ 35%)฀ versus฀ in฀ the฀first฀half฀(4/26;฀15%)฀(p=0.2).฀Useful฀information฀obtained฀by฀3DE฀included:฀precise฀ characterization฀ of฀ mitral฀ reguritation฀ and฀ cleft฀ leaflet,฀ substrate฀ for฀ subaortic฀ stenosis,฀ valve฀anatomy,฀and฀presence฀and฀location฀of฀additional฀septal฀defects.฀ Conclusion:฀3DE฀provides฀useful฀and฀additive฀information฀in฀unrepaired฀balanced฀AVSD,฀ repaired฀AVSD฀with฀residual฀lesions,฀and฀unbalanced฀AVSD฀where฀a฀two-ventricle฀repair฀ was฀being฀considered.฀Proficiency฀in฀3DE฀entails฀a฀learning฀curve. Usefulness฀of฀Real-Time฀Three-Dimensional฀ Echocardiography฀for฀the฀Evaluation฀of฀Coronary฀Artery฀ Morphology฀in฀Kawasaki฀Disease Michio฀Miyashita,฀Nihon฀University,฀Tokyo,฀Japan Purpose:฀Usefulness฀of฀recently฀developed฀real-time฀3D฀echo฀was฀examined฀as฀to฀the฀ evaluation฀of฀coronary฀artery฀morphology฀in฀Kawasaki฀disease.฀ Subjects฀and฀Methods:฀Hundred฀patients฀were฀used฀as฀subjects,฀ranging฀from฀3฀months฀ to฀13฀years฀of฀age,฀who฀visited฀for฀Kawasaki฀disease฀follow-up.฀Coronary฀aneurysm฀was฀ detected฀in฀four฀patients฀(one฀had฀a฀giant฀aneurysm),฀and฀coronary฀dilatation฀was฀found฀ in฀five.฀Coronary฀artery฀visualization฀was฀evaluated฀and฀scored฀as฀one฀of฀four฀grades,฀zero฀ to฀three฀points,฀for฀both฀2D฀echo฀(2DE)฀and฀real-time฀3D฀echo฀(3DE)฀performed฀using฀a฀ Philips฀SONOS-7500.฀As฀for฀the฀evaluation฀criterion,฀visualization฀of฀each฀coronary฀artery฀ was฀given฀zero฀points฀when฀not฀visualized,฀one฀point฀when฀partially฀visualized,฀two฀points฀ when฀ one฀ or฀ more฀ segments,฀ which฀ were฀ defined฀ according฀ to฀ the฀ AHA฀ classification฀ of฀coronary฀angiographic฀features,฀were฀visualized,฀and฀three฀points฀when฀two฀or฀more฀ segments฀were฀visualized.฀Total฀scores฀in฀each฀patient฀and฀by฀coronary฀branches฀were฀ compared฀between฀2DE฀and฀3DE.฀ Results:฀ The฀ total฀ scores฀ of฀ coronary฀ artery฀ visualization฀ were฀ 6.93฀ ±฀ 1.48฀ and฀ 5.47฀ ±฀ 1.75฀ points฀ for฀ 3DE฀ and฀ 2DE,฀ respectively,฀ showing฀ a฀ significantly฀ higher฀ score฀ for฀ 3DE฀ than฀ for฀ 2DE฀ (p<0.01).฀ By฀ coronary฀ branches,฀ the฀ scores฀ of฀ right฀ coronary฀ artery฀ visualization฀ were฀ 2.39฀ ±฀ 0.58฀ and฀ 2.05฀ ±฀ 0.84฀ points฀ for฀ 3DE฀ and฀ 2DE,฀ respectively;฀ those฀of฀left฀anterior฀descending฀branch฀were฀2.49฀±฀0.63฀and฀2.30฀±฀0.74฀points฀for฀3DE฀ and฀2DE,฀respectively;฀and฀those฀of฀circumflex฀branch฀were฀2.04฀±฀0.68฀and฀1.11฀±฀0.69฀ points฀for฀3DE฀and฀2DE,฀respectively,฀showing฀a฀significantly฀higher฀score฀for฀3DE฀than฀ for฀2DE฀in฀circumflex฀branch฀visualization฀(p<0.01).฀A฀mural฀thrombus฀could฀be฀delineated฀ in฀the฀giant฀aneurysm.฀ Conclusion:฀3DE฀was฀determined฀to฀be฀superior฀in฀coronary฀artery฀visualization฀to฀2DE,฀ particularly฀ for฀ the฀ visualization฀ of฀ the฀ right฀ coronary฀ artery฀ and฀ circumflex฀ branches.฀ 3DE฀is฀useful฀because฀this฀system฀can฀widely฀visualize฀coronary฀arteries฀running฀threedimensionally.฀ Since฀ coronary฀ arterial฀ diameters฀ can฀ be฀ measured฀ three-dimensionally฀ when฀an฀analytical฀software฀is฀used,฀this฀system฀is฀expected฀to฀improve฀the฀screening฀of฀ coronary฀arteries฀and฀the฀throughput฀of฀the฀test. POSTER฀SESSION 1111฀฀ Comparison฀to฀10-plane฀3D฀echo฀ Biplane฀3D฀ LA฀volume 0.79 10.8 <0.0001 23 -12.6 42 1110-86฀ February 1, 2005 Cardiovascular฀Computed฀ Tomography:฀Expanding฀Applications Monday,฀March฀07,฀2005,฀1:30฀p.m.-5:00฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀3:30฀p.m.-4:30฀p.m. 1111-71฀ Multi-slice฀Computed฀Tomography฀versus฀Intracardiac฀ Echocardiography฀to฀Evaluate฀Pulmonary฀Vein฀Anatomy฀ Prior฀to฀Radiofrequency฀Catheter฀Ablation฀of฀Atrial฀ Fibrillation:฀A฀Head-to-head฀Comparison Monique฀RM฀Jongbloed,฀Jeroen฀J.฀Bax,฀Martijn฀S.฀Dirksen,฀Katja฀Zeppenfeld,฀Ernst฀ E.฀van฀der฀Wall,฀Albert฀de฀Roos,฀Martin฀J.฀Schalij,฀Leiden฀University฀Medical฀Center,฀ Leiden,฀The฀Netherlands Background:฀Radiofrequency฀catheter฀ablation฀(RFCA)฀at฀the฀site฀of฀the฀pulmonary฀veins฀ (PV)฀or฀their฀ostia฀is฀a฀potential฀curative฀treatment฀modality฀for฀atrial฀fibrillation.฀Different฀ imaging฀techniques฀have฀been฀used฀to฀visualize฀the฀PV฀in฀order฀to฀guide฀RFCA.฀In฀the฀ current฀ study,฀ a฀ head-to-head฀ comparison฀ between฀ multi-slice฀ computed฀ tomography฀ (MSCT)฀and฀intracardiac฀echocardiography฀(ICE)฀was฀performed. Methods:฀Forty-two฀patients฀(35฀men,฀age฀49±9฀years)฀admitted฀for฀RFCA฀of฀PV฀ostia฀ were฀studied.฀The฀pulmonary฀veins฀and฀their฀insertion฀in฀the฀left฀atrium฀were฀evaluated฀ and฀ measurements฀ of฀ PV฀ ostia฀ were฀ performed฀ in฀ 2฀ directions฀ (anterior-posterior฀ (AP)฀ and฀superior-inferior฀(SI)฀with฀MSCT.฀2-D฀measurements฀of฀PV฀ostia฀were฀performed฀with฀ ICE฀prior฀to฀RFCA.฀Data฀obtained฀by฀MSCT฀and฀ICE฀were฀compared. Results:฀Additional฀right฀PV฀were฀observed฀in฀12฀pts฀with฀MSCT฀and฀in฀7฀patients฀with฀ ICE.฀ One฀ additional฀ left฀ PV฀ was฀ observed฀ with฀ MSCT,฀ this฀ vein฀ was฀ not฀ noted฀ by฀ ICE.฀ Common฀ostia฀of฀left฀PV฀were฀observed฀in฀33(79%)฀with฀MSCT฀and฀in฀31(74%)฀with฀ICE.฀ Common฀ostia฀of฀right฀PV฀were฀observed฀in฀13(31%)฀and฀16(38%)฀patients฀respectively.฀ Average฀ ostial฀ diameters฀ measured฀ with฀ MSCT฀ in฀ AP฀ directions฀ were฀ similar฀ to฀ 2-D฀ measurements฀ performed฀ with฀ ICE.฀ In฀ contrast,฀ PV฀ diameters฀ measured฀ by฀ MSCT฀ in฀ SI฀ direction฀ were฀ significantly฀ larger฀ then฀ the฀ 2-D฀ ostial฀ diameters฀ measured฀ with฀ ICE.฀ Indexes฀of฀AP-and฀SI฀diameters฀measured฀by฀MSCT฀were฀0.77±0.18฀and฀0.90±0.15฀for฀ left฀and฀right฀PV฀respectively,฀indicating฀an฀oval฀shape฀especially฀left฀PV฀ostia. Conclusions:฀ Variation฀ in฀ PV฀ anatomy฀ is฀ frequently฀ observed฀ with฀ both฀ MSCT฀ and฀ ICE.฀The฀sensitivity฀for฀detection฀of฀additional฀branches฀is฀higher฀for฀MSCT.฀3-D฀imaging฀ techniques,฀such฀as฀MSCT,฀are฀required฀to฀demonstrate฀an฀oval฀shape฀of฀PV฀ostia. 1111-72฀ Multi-Detector฀Computer฀Tomography฀in฀Evaluation฀of฀ Arrhythmogenic฀Right฀Ventricular฀Dyplasia Chandra฀S.฀Bomma,฀Kalpana฀Prakasa,฀Darshan฀Dalal,฀Harikrishana฀Tandri,฀Khurram฀ Nasir,฀Crystal฀Tichnell,฀Cynthia฀James,฀Joao฀A.C.฀Lima,฀Elliot฀Fishman,฀Hugh฀Calkins,฀ David฀Bluemke,฀Johns฀Hopkins฀University฀School฀of฀Medicine,฀Baltimore,฀MD Back฀ Ground:฀ Arrhythmogenic฀ right฀ ventricular฀ dysplasia฀ (ARVD)฀ is฀ characterized฀ by฀ right฀ventricular฀(RV)฀structural฀abnormalities฀and฀ventricular฀arrhythmias.฀The฀presence฀ of฀RV฀abnormalities฀is฀one฀of฀the฀most฀important฀criteria฀for฀diagnosis฀of฀ARVD.฀Magnetic฀ JACC February 1, 2005 resonance฀imaging฀(MRI)฀has฀been฀proposed฀as฀gold฀standard฀in฀the฀diagnosis฀of฀ARVD.฀ However,฀ many฀ patients฀ with฀ suspected฀ ARVD฀ have฀ implanted฀ cardiac฀ defibrillators฀ (ICD’s),฀ which฀ preclude฀ MRI.฀The฀ purpose฀ of฀ this฀ study฀ is฀ to฀ report฀ our฀ experience฀ in฀ employing฀multi-detector฀computer฀tomography฀(MDCT)฀to฀evaluate฀known฀or฀suspected฀ ARVD. Methods:฀The฀study฀population฀included฀28฀(17฀males,฀42±12yr)฀patients฀who฀were฀reevaluated฀for฀ARVD฀at฀our฀institute.฀All฀patients฀had฀a฀comprehensive฀work฀up฀including฀ MDCT.฀Prospective฀and฀retrospective฀gated,฀contrast฀enhanced฀CT฀images฀were฀acquired฀ using฀4-detector฀and฀16-detector฀scanner฀in฀17฀and฀11฀patients฀respectively.฀Two฀patients฀ had฀both฀MDCT฀and฀MRI.฀Images฀were฀analyzed฀for฀presence฀of฀findings฀consistent฀with฀ ARVD.฀Ventricular฀ volumes฀ and฀ inlet฀ measurements฀ and฀ RV฀ outflow฀ tract฀ (RVOT)฀ area฀ were฀measured.฀Ejection฀fraction฀was฀calculated฀when฀feasible. Results:฀The฀images฀were฀free฀of฀artifact฀and฀interpretable฀in฀24฀patients.฀In฀4฀patients,฀ motion฀ artifacts฀ severely฀ degraded฀ image฀ quality฀ and/or฀ artifacts฀ from฀ ICD฀ precluded฀ detail฀interpretation.฀Of฀the฀28฀patients฀evaluated,฀16฀(57%)฀had฀a฀final฀diagnosis฀of฀ARVD฀ based฀on฀the฀Task฀Force฀criteria.฀RV฀trabeculations฀is฀present฀in฀16(100%)฀patients,฀RV฀ free฀wall฀scalloping฀and฀RV฀intra-myocardial฀fat฀in฀12(75%)฀and฀LV฀fat฀in฀5(31%)฀patients.฀ Increased฀ RV฀ volumes฀ (224ml±50ml฀ vs.168±฀ 29ml;฀ P=0.002),฀ and฀ RV฀ inlet฀ (52±11mm฀ vs.42±7mm;฀P=0.01)฀were฀seen฀ARVD฀patients.฀Ventricular฀volumes฀and฀ejection฀fraction฀ calculated฀from฀the฀MDCT฀data฀correlated฀very฀well฀with฀that฀from฀MRI฀in฀two฀patients. Conclusion:฀ The฀ results฀ of฀ our฀ study฀ demonstrate฀ that฀ MDCT฀ is฀ useful฀ to฀ identify฀ qualitative฀findings฀consistent฀with฀ARVD,฀and฀that฀it฀has฀a฀promising฀future฀in฀quantitative฀ evaluation฀ of฀ RV฀ volumes฀ and฀ function.฀ ICD฀ lead฀ and฀ motion฀ artifacts฀ occasionally฀ interfere฀with฀the฀quality฀of฀MDCT฀images. 1111-73฀ Coronary฀Stenosis฀Detection฀By฀16-slice฀Computed฀ Tomography฀In฀Heart฀Transplanted฀Patients฀:฀ Comparison฀With฀Conventional฀Coronary฀Angiography฀ And฀Impact฀On฀Clinical฀Management Guido฀Romeo,฀Lucille฀Houyel,฀Jean฀François฀Paul,฀Philippe฀Brenot,฀Jean฀Yves฀Riou,฀ Claude฀Yves฀Angel,฀Centre฀Chirurgical฀Marie฀Lannelongue,฀Le฀Plessis฀Robinson,฀France 1111-74฀ 283A ฀ 1111-75฀ Planimetry฀Of฀Aortic฀Valve฀Area฀(ava)฀In฀Aortic฀Stenosis:฀ Evaluation฀With฀16-channel฀Multislice฀Computed฀ Tomography฀(msct) Gudrun฀M.฀Feuchtner,฀Wolfgang฀Dichtl,฀Silvana฀Mueller,฀Guy฀Friedrich,฀Mathias฀Frick,฀ Hannes฀Alber,฀Dieter฀zur฀Nedden,฀Franz฀Weidinger,฀Otmar฀Pachinger,฀Innsbruck฀Medical฀ University,฀Innsbruck,฀Austria Purpose:฀ Aortic฀ valve฀ area฀ (AVA)฀ is฀ the฀ key฀ parameter฀ to฀ classify฀ severity฀ of฀ aortic฀ valve฀stenosis฀(AS).฀Purpose฀of฀this฀study฀was฀to฀evaluate฀whether฀16-channel฀multislice฀ computed฀tomography฀(MSCT)฀may฀provide฀a฀non-invasive฀imaging฀modality฀for฀planimetry฀ of฀ AVA฀ in฀ comparison฀ to฀ accepted฀ diagnostic฀ standard฀ transthoracic฀ echocardiography฀ (TTE). Material฀and฀Methods:฀22฀patients฀with฀asymptomatic,฀degenerative฀AS฀were฀examined฀ prospectively฀with฀contrast฀enhanced฀MSCT฀(Somatom฀Sensation฀16,฀Siemens,฀Germany)฀ (16฀x฀0.75฀mm;฀gantry฀rot.0.42฀s,฀TF=6.7฀mm/s;฀inc.฀0.6;฀retrospective฀ECG-gating฀at฀midlate฀systole)฀and฀TTE฀using฀continuity฀equation฀with฀doppler฀velocity฀time฀integral฀(VTI)฀ for฀ AVA฀ calculation.฀ Image฀ quality฀ was฀ graded฀ on฀ a฀ 5-point฀ scale฀ (1=excellent;5=nondiagnostic) Results:฀MSCT฀planimetry฀of฀AVA฀(mean฀AVA฀0.90฀cm²฀+/-0.24)฀shows฀a฀good฀correlation฀ to฀diagnostic฀standard฀TTE฀(r=0.86;r²=฀0.73;฀p<0.001).฀Bland-Altmann฀plot฀implies฀a฀good฀ intermodality฀agreement฀with฀narrow฀limits฀of฀agreement฀(-0.18,฀0.29)฀and฀a฀small฀bias฀ (+0.05฀ cm²).฀ Reproduciblity฀ as฀ expressed฀ by฀ interobserver฀ variability฀ was฀ good฀ (4.6%).฀ Image฀quality฀was฀1(n=13);2฀(n=6);3(n=3) Conclusio:฀MSCT฀may฀provide฀a฀non-invasive,฀accurate฀imaging฀technique฀for฀planimetry฀ of฀AVA฀in฀AS.฀MSCT฀may฀be฀implemented฀in฀clinical฀practice฀for฀simultaneous฀screening฀ of฀ asymptomatic฀ AS฀ in฀ patients฀ scheduled฀ for฀ coronary฀ MSCT฀ angiography฀ and฀ interchangeable฀for฀comprehensive฀diagnostic฀follow-up.฀ Detection฀of฀Left฀Atrial฀Appendage฀Thrombus฀by฀ Multi-slice฀Computed฀Tomography฀With฀Multiplaner฀ Reconstruction฀in฀Atrial฀Fibrillation฀Patients Hisashi฀Shimoyama,฀Kunihiko฀Hirose,฀Tamie฀Sato,฀Rie฀Futai,฀Masatake฀Hara,฀Masaru฀ Morikawa,฀Nobuyoshi฀Tomioka,฀Yutaka฀Watanabe,฀Otsu฀Red฀Cross฀Hospital,฀Otsu,฀ Japan Background:฀ Multi-slice฀ computed฀ tomography฀ (MSCT),฀ with฀ a฀ multi-detector฀ system฀ and฀thin฀slices฀enabling฀wide-range฀photographs฀to฀be฀taken฀using฀a฀short฀scanning฀time,฀ may฀be฀a฀feasible฀and฀novel฀method฀for฀studying฀atrial฀fibrillation฀(AF)฀patients.฀We฀have฀ compared฀MSCT฀with฀transesophageal฀echocardiography฀(TEE)฀for฀the฀detection฀of฀left฀ atrial฀(LA)฀appendage฀thrombus฀in฀AF฀patients. Methods:฀20฀AF฀patients฀(15฀males,฀5฀females;฀mean฀age:฀70฀years฀old)฀were฀studied฀ using฀MSCT฀and฀TEE.฀MSCT฀was฀performed฀using฀a฀16฀slice฀system฀(Toshiba฀Aquilion).฀ The฀scan฀was฀performed฀with฀collimation฀of฀0.5mm฀and฀gantry฀rotation฀of฀400ms.฀MultiPlaner฀Reconstruction฀(MPR)฀images฀along฀the฀minor฀and฀major฀axes฀of฀the฀LA฀appendage฀ were฀generated฀with฀a฀constant฀cardiac฀phase฀position฀immediately฀after฀the฀preceding฀T฀ wave,฀defined฀by฀the฀absolute฀delay฀(ms)฀in฀order฀to฀avoid฀cardiac฀motion฀artifacts.฀The฀LA฀ appendage฀thrombus฀was฀evaluated฀using฀axial฀images฀and฀MPR฀images. Results:฀ LA฀ appendage฀ thrombus฀ was฀ correctly฀ detected฀ by฀ MSCT฀ in฀ 6฀ patients฀ (sensitivity:฀100%).฀In฀12฀patients,฀MSCT฀correctly฀predicted฀the฀absence฀of฀LA฀appendage฀ thrombus,฀while฀in฀2฀patients,฀MSCT฀gave฀a฀false฀positive฀(specificity:฀86%). Conclusion:฀MSCT฀with฀axial฀MPR฀images฀has฀potential฀as฀an฀alternative฀to฀TEE฀for฀the฀ detection฀of฀LA฀appendage฀thrombus฀in฀AF฀patients. Figure:฀A฀small฀thrombus฀(arrow)฀is฀shown฀in฀an฀MSCT฀MPR฀image฀along฀the฀major฀axis฀ of฀ the฀ LA฀ appendage,฀ and฀ in฀ a฀TEE฀ view฀ of฀ the฀ LA฀ appendage฀ using฀ the฀ longitudinal฀ plane. 1111-76฀ Comparison฀of฀Stress฀Thallium฀and฀Electron฀Beam฀ Computed฀Tomography฀in฀Differentiating฀Etiology฀of฀ Dilated฀vs.฀Ischemic฀Cardiomyopathy Binu฀Jacob,฀M฀Leila฀Rasouli,฀Philip฀Tseng,฀Alex฀Chau,฀Matthew฀J.฀Budoff,฀Harbor-UCLA฀ Research฀and฀Education฀Institute,฀Harbor-UCLA,฀CA Stress฀ echocardiography฀ and฀ nuclear฀ imaging฀ have฀ both฀ been฀ utilized฀ to฀ differentiate฀ between฀dilated฀and฀ischemic฀cardiomyopathy฀(CM).฀Electron฀Beam฀tomography฀(EBT)฀ has฀recently฀been฀demonstrated฀to฀help฀a฀clinician฀distinguish฀between฀etiologies฀of฀CM.฀ A฀noninvasive฀test฀that฀is฀accurate฀in฀differentiating฀the฀cause฀of฀CM฀could฀lead฀to฀cost฀ savings฀and฀decreased฀morbidity฀in฀patients฀with฀congestive฀heart฀failure฀(CHF). Hypothesis:฀ To฀ evaluate฀ the฀ diagnostic฀ ability฀ of฀ nuclear฀ stress฀ testing฀ and฀ EBCT฀ to฀ differentiate฀ between฀ nonischemic฀ and฀ ischemic฀ CM,฀ as฀ compared฀ to฀ coronary฀ angiography. Methods:฀A฀total฀of฀56฀patients฀underwent฀technetium฀stress฀testing,฀EBT฀and฀coronary฀ angiography฀for฀the฀evaluation฀of฀CM.฀Evidence฀of฀ischemia฀as฀the฀etiology฀for฀CHF฀was฀ defined฀ as฀ >50%฀ stenosis฀ in฀ at฀ least฀ one฀ coronary฀ artery฀ by฀ angiography.฀ Evidence฀ of฀ ischemic฀ CM฀ by฀ EBT฀ was฀ considered฀ a฀ calcium฀ score฀ >0.฀ Evidence฀ of฀ ischemic฀ heart฀ disease฀ as฀ the฀ etiology฀ of฀ CHF฀ on฀ technetium-stress฀ was฀ defined฀ if฀ either฀ myocardial฀ ischemia฀(reversible฀defect)฀or฀myocardial฀infarction฀(nonreversible฀defect)฀was฀present.฀ Two฀by฀two฀contingency฀tables฀and฀Fisher’s฀Exact฀Test฀were฀applied. Results:฀Of฀the฀56฀patients,฀34฀(61%)฀had฀angiographically฀significant฀disease฀(ischemic฀ cardiomyopathy).฀Using฀the฀criteria฀of฀either฀ischemia฀(reversible฀defect)฀or฀infarct฀(fixed฀ defect),฀nuclear฀stress฀testing฀had฀sensitivity฀of฀97%฀(33฀of฀34)฀but฀a฀specificity฀of฀only฀14%฀ (3฀of฀22).฀Using฀the฀criteria฀of฀only฀reversible฀ischemia฀present,฀specificity฀of฀nuclear฀stress฀ testing฀improved฀to฀50%฀(p<0.001),฀however฀sensitivity฀decreased฀to฀56%.฀EBT฀score฀>0฀ Noninvasive Imaging Background:฀The฀aim฀of฀this฀study฀was฀to฀assess฀the฀efficiency฀of฀multi-slice฀computed฀ tomography฀(MSCT)฀coronary฀angiography฀in฀the฀detection฀of฀significant฀focal฀stenosis฀ (>50%฀ in฀ diameter)฀ using฀ 16-slice฀ computed฀ tomography฀ in฀ a฀ population฀ of฀ heart฀ transplanted฀patients. Methods:฀ Since฀ April฀ 2003,฀ 53฀ consecutive฀ heart฀ transplanted฀ patients฀ (37฀ male,฀ 13฀ female;฀ mean฀ post-transpalntation฀ time฀ 7.6฀ ±฀ 3.8,฀ range฀ 1฀ to฀ 14.5฀ years;฀ mean฀ age฀ at฀ transplantation฀ 40.6฀ ±฀ 19฀ years฀ underwent฀ 16-slice฀ CT฀ within฀ 24฀ hours฀ before฀ or฀ After฀ their฀annual฀routine฀coronary฀angiography.฀Only฀angiographic฀segments฀>1.5฀mm฀were฀ considered฀for฀analysis. Results:฀ In฀ all฀ patients฀ MSCT฀ was฀ carried฀ out฀ without฀ complications.฀ Three฀ patients฀ were฀ excluded฀ From฀ the฀ evaluation.฀ Of฀ 450฀ angiographic฀ segments,฀ 432฀ (96%)฀ were฀ judged฀ evaluable฀ by฀ MSCT.฀ Considering฀ the฀ segments฀ suitable฀ for฀ analysis฀ sensitivity฀ was฀80%,฀specificity฀99%,฀positive฀predictive฀value฀80%,฀negative฀predictive฀value฀99%,฀ and฀accuracy฀99%.฀Of฀50฀patients,฀44฀(88%)฀were฀completely฀analyzed.฀In฀20฀of฀44฀(45%)฀ patients฀ With฀ strictly฀ normal฀ MSCT,฀ no฀ stenosis฀ were฀ found฀ at฀ conventional฀ coronary฀ angiography.฀Considering฀the฀patients฀suitable฀for฀analysis,฀sensitivity,฀specificity,฀positive฀ predictive฀value,฀negative฀predictive฀value,฀were฀83%,฀95%,฀71%,฀and฀95%฀respectively;฀ accuracy฀was฀93%. Conclusion:฀ Our฀ study฀ provides฀ indications฀ about฀ the฀ potential฀ role฀ of฀ 16-slice฀ Computed฀Tomography฀coronary฀angiography฀for฀non-invasive฀follow-up฀of฀patients฀With฀ transplanted฀ heart,฀ suggesting฀That฀ patients฀ With฀ a฀ strictly฀ normal฀ MSCT฀ at฀ follow-up฀ may฀ avoid฀ subsequent฀ conventional฀ coronary฀ angiography.฀ This฀ strategy฀ is฀ currently฀ applicated฀in฀our฀institution. ABSTRACTS - Noninvasive Imaging 284A ABSTRACTS - Noninvasive Imaging had฀a฀sensitivity฀of฀97%฀(33฀of฀34)฀and฀specificity฀of฀68%฀(15/22)฀for฀defining฀ischemia.฀ Using฀a฀cutoff฀of฀100฀to฀define฀positive฀EBT฀raised฀the฀specificity฀to฀82%,฀but฀lowered฀the฀ specificity฀to฀82%฀(28฀of฀34).฀The฀mean฀calcium฀score฀by฀EBT฀for฀patients฀with฀ischemic฀ CM฀was฀significantly฀greater฀than฀non-ischemic฀patients฀(753฀vs.฀108,฀p<0.0001). This฀observational฀study฀shows฀that฀EBCT฀is฀an฀effective฀tool฀in฀assessment฀of฀ischemic฀ vs.฀dilated฀CM.฀Given฀the฀high฀sensitivity,฀this฀test฀may฀prove฀to฀be฀an฀effective฀screen฀ prior฀to฀angiography฀in฀patients฀with฀CHF฀of฀unclear฀etiology. 1111-77฀ Evaluation฀of฀Global฀Left฀Ventricular฀Myocardial฀ Function฀Using฀Retrospectively฀ECG-Gated฀16Slice฀Multi-slice฀Spiral฀Computed฀Tomography:฀ Comparison฀With฀Magnetic฀Resonance฀Imaging฀and฀ Echocardiography Noninvasive Imaging Christof฀Burgstahler,฀Martin฀Heuschmid,฀Torsten฀Beck,฀Axel฀Kuettner,฀Andreas฀F.฀Kopp,฀ Stephen฀Schroeder,฀University฀of฀Tuebingen,฀Tuebingen,฀Germany Purpose:฀ To฀ asses฀ the฀ quantitative฀ measurement฀ of฀ left฀ ventricular฀ functional฀ (LVF)parameters฀ using฀ retrospectively฀ ECG-gated฀ multi-slice฀ spiral฀ computed฀ tomography฀(MSCT)฀and฀to฀compare฀the฀results฀with฀magnetic฀resonance฀imaging฀(MRI)฀ and฀echocardiography. Materials฀ and฀ Methods:฀ 52฀ patients฀ (pts)฀ with฀ suspected฀ coronary฀ artery฀ disease฀ were฀included฀in฀the฀present฀study.฀16-slice฀MSCT฀scans฀(Sensation฀16,฀Siemens)฀were฀ performed฀ using฀ retrospective฀ ECG-gating฀ (0.75mm฀ collimation,฀ 2.8mm฀ table฀ feed/ rotation,฀ 0.42s฀ rotation฀ time).฀ Based฀ on฀ the฀ CT฀ dataset,฀ short฀ axis฀ reformations฀ of฀ the฀ left฀ ventricle฀ with฀ 8฀ mm฀ slice฀ thickness฀ were฀ performed฀ for฀ the฀ functional฀ analysis.฀ On฀ a฀ commercially฀ available฀ workstation,฀ end-diastolic฀ volume฀ (EDV),฀ end-systolic฀ volume฀ (ESV)฀and฀stroke฀volume฀(SV)฀as฀well฀as฀ejection฀fraction฀(EF)฀were฀calculated฀from฀MSCT฀ data฀ according฀ the฀ modified฀ Simpson’s฀ method.฀ In฀ 24฀ pts,฀ additional฀ echocardiography฀ was฀performed.฀The฀results฀from฀MSCT฀and฀echocardiography฀were฀compared฀with฀the฀ functional฀analysis฀of฀MR฀imaging. Results:฀In฀all฀cases,฀an฀adequate฀image฀quality฀of฀MSCT,฀echocardiography,฀and฀MR฀ images฀was฀achieved.฀Comparing฀MSCT฀with฀MRI,฀the฀results฀for฀the฀determination฀of฀ EDV,฀ESV,฀SV,฀and฀EF฀were฀as฀follows:฀EDV฀MSCT฀140.6±40.0ml฀vs.฀MRI฀125.5฀±29.4ml,฀ Pearson฀r=0.83,฀[p<0.0001],฀mean฀difference฀(MD)฀15.1±22.80;฀ESV฀MSCT฀75.0±33.7ml฀ vs.฀ MRI฀ 64.4±26.1ml,฀ r=0.90,฀ [p<0.0001],฀ MD฀ 10.6±15.5;฀ SV฀ MSCT฀ 65.6±15.3ml฀ vs.฀ MRI฀ 61.1±13.2ml,฀ r=0.66,฀ [p=0.008],฀ MD฀ 4.5±11.9ml;฀ EF฀ MSCT฀ 48.0%±9.3%฀ vs.฀ MRI฀ 49.6%±9.6%,฀ r=0.88,฀ [p=0.0072],฀ MD฀ -1.8%±4.7%.฀ In฀ comparison฀ to฀ MRI,฀ the฀ functional฀parameters฀determined฀by฀echocardiography฀were:฀EDV฀89.5±41.6ml,฀r=0.05,฀ [p=0.0012],฀MD฀36.2±48.0ml;฀ESV฀70.7±39.3ml,฀r=0.59฀[p=0.30],฀MD฀6.8±31.6ml,฀and฀EF฀ 62.5±19.2%,฀r=0.24,฀[p=0.0018],฀MD฀13.9±19.2%. Conclusion:฀Cardiac฀MSCT฀displayed฀a฀high฀correlation฀of฀LVF฀parameters฀compared฀ to฀ MRI.฀ Thus,฀ important฀ additional฀ information฀ can฀ be฀ achieved.฀ However,฀ EDV,฀ EVS฀ and฀ SV฀ were฀ overestimated฀ and฀ EF฀ underestimated฀ by฀ MSCT.฀ Compared฀ to฀ MRI,฀ the฀ echocardiographic฀results฀revealed฀a฀low฀or฀moderate฀correlation฀of฀functional฀parameters฀ with฀significant฀overestimation฀of฀EDV฀and฀EF. 1111-78฀ Myocardial฀Perfusion฀and฀Wall฀Motion฀Abnormality฀ in฀Adenosine฀5-Triphosphate฀Provocation฀Multi-Slice฀ Computed฀Tomography Akira฀Kurata,฀Yasushi฀Koyama,฀Teruhito฀Mochizuki,฀Toyoaki฀Haraikawa,฀Hiroshi฀ Higashino,฀Shigeru฀Nakata,฀Jun฀Suzuki,฀Katsuji฀Inoue,฀Tomoaki฀Ohtsuka,฀Yuji฀Hara,฀Yuji฀ Shigematsu,฀Jitsuo฀Higaki,฀Ehime฀University,฀School฀of฀Medicine,฀Ehime,฀Japan Background:฀ Along฀ with฀ coronary฀ artery฀ imaging,฀ contrast฀ enhanced฀ multi-slice฀ CT฀ (MSCT)฀can฀evaluate฀both฀wall฀motion฀and฀myocardial฀perfusion.฀We฀investigated฀whether฀ adenosine฀5-triphosphate฀(ATP)฀stress/non-stress฀MSCT฀with฀retrospective฀ECG-gating฀ acquisition฀ can฀ evaluate฀ both฀ ATP฀ induced฀ ischemia฀ and฀ transient฀ hypo-function฀ in฀ patients฀with฀coronary฀artery฀disease฀(CAD). Methods:฀Ten฀patients฀with฀CAD฀underwent฀ATP฀stress฀MSCT,฀stress฀Tl-201฀myocardial฀ perfusion฀scintigraphy฀(MPS).฀Dual-scan฀MSCT฀(ATP/non-ATP)฀was฀performed.฀First฀scan฀ for฀the฀stress฀image฀was฀as฀follows;฀70฀ml฀of฀contrast฀medium฀was฀injected฀at฀a฀rate฀of฀3฀ ml/sec฀during฀ATP฀infusion฀(0.16฀mg/kg/min฀for฀5฀minutes).฀Twenty฀minutes฀after฀the฀first฀ scan,฀nitroglycerin฀(0.6mg)฀was฀administered฀and฀the฀2nd฀scan฀for฀rest฀image฀was฀done฀ without฀ATP.฀Myocardial฀perfusion฀and฀wall฀motion฀were฀visually฀evaluated฀with฀animated฀ MSCT฀movies฀and฀compared฀with฀Tl-201฀MPS. Results:฀Perfusion฀MSCT฀grades฀in฀the฀1st฀scan฀were฀correlated฀to฀MPS฀grades฀and฀wall฀ motion฀grades.฀In฀deeper฀and฀lower฀density฀hypo-perfusion฀areas,฀wall฀motion฀and฀systolic฀ thickening฀were฀worse.฀Hypo-perfusion฀areas฀during฀the฀1st฀scan฀quickly฀turned฀normal฀ in฀the฀2nd฀scan฀in฀most฀cases.฀Hypo-perfusion/abnormal฀wall฀motion฀areas฀matched฀to฀ significant฀coronary฀artery฀stenoses. Conclusion:฀ATP฀stress/non-stress฀MSCT฀with฀retrospective฀ECG-gating฀acquisition฀can฀ evaluate฀both฀ATP฀induced฀myocardial฀ischemia฀and฀hypo-function฀in฀patients฀with฀CAD. JACC February 1, 2005 POSTER฀SESSION 1112฀฀ Prognosis฀in฀Technical฀Advances Monday,฀March฀07,฀2005,฀1:30฀p.m.-5:00฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀3:30฀p.m.-4:30฀p.m. 1112-63฀ Prognostic฀Value฀of฀Rest-Redistribution฀201-Thallium฀ Imaging฀in฀Patients฀With฀Chronic฀Coronary฀Artery฀ Disease฀and฀Left฀Ventricular฀Dysfunction Pasquale฀Perrone฀Filardi,฀Leonardo฀Pace,฀Santo฀Dellegrottaglie,฀Luigi฀Corrado,฀Maria฀ Cafiero,฀Michele฀Polimeno,฀Roberta฀Camerino,฀Annamaria฀Zarrilli,฀Antonio฀Maglione,฀ Massimo฀Chiariello,฀Institute฀of฀Cardiology,฀“Federico฀II”฀University,฀Naples,฀Italy,฀Institute฀ of฀Nuclear฀Medicine,฀“Federico฀II”฀University,฀Italy Background.฀The฀prognostic฀value฀of฀rest-redistribution฀thallium฀scintigraphy฀in฀predicting฀ major฀cardiovascular฀events,฀in฀patients฀with฀ischemic฀left฀ventricular฀dysfunction,฀has฀not฀ been฀extensively฀investigated.. Methods.฀One-hundred฀twenty-six฀patients฀with฀chronic฀coronary฀artery฀disease฀and฀mean฀ left฀ventricular฀ejection฀fraction฀39±11%฀were฀followed-up฀for฀30±17฀months฀after฀a฀restredistribution฀201-Tl฀imaging฀single฀foton฀emission฀computer฀tomography฀(SPECT).฀Cardiac฀ death฀and฀non-fatal฀myocardial฀infarction฀were฀considered฀as฀major฀cardiac฀events. Results.฀ A฀ total฀ of฀ 20฀ events฀ (11฀ deaths฀ and฀ 9฀ myocardial฀ infarctions)฀ were฀ recorded฀ during฀follow-up.฀By฀Cox฀multivariate฀analysis฀the฀number฀of฀severe฀irreversible฀SPECT฀ defects฀ was฀ the฀ only฀ variable฀ associated฀ with฀ outcome฀ (χ2=5.06,฀ p=0.024฀ for฀ death฀ +฀ myocardial฀infarction;฀and฀χ2=10.6,฀p<0.001฀for฀death฀alone).฀By฀Kaplan-Meyer฀analysis฀ mortality฀ was฀ significantly฀ different฀ among฀ patients฀ with฀ ≤3฀ (2%)฀ severe฀ defects฀ as฀ compared฀ to฀ patients฀ with฀ >3฀ severe฀ defects฀ (17%;฀ log฀ rank฀ 8.68;฀ p=0.0032).฀ Death฀ or฀ myocardial฀infarction฀occurred฀in฀62%฀of฀patients฀with฀>3฀severe฀defects฀compared฀to฀13%฀ of฀patients฀with฀≤3฀severe฀defects฀(χ2=18.04;฀p<0.0001).฀Event-free฀survival฀was฀longer฀ among฀patients฀with฀≤3฀severe฀defects฀than฀among฀patients฀with฀>3฀severe฀defects฀(58±2฀ vs฀16±3฀months;฀p฀<฀0.0001). Conclusions.฀The฀number฀of฀severe฀irreversible฀defects฀using฀rest-redistribution฀201-Tl฀ SPECT฀ is฀ a฀ powerful฀ predictor฀ of฀ major฀ cardiac฀ events฀ among฀ patients฀ with฀ moderate฀ ischemic฀left฀ventricular฀dysfunction. 1112-64฀ Concomitant฀Anti-Ischemic฀Medication฀Does฀Not฀Affect฀ the฀Prognostic฀Value฀of฀a฀Normal฀Stress฀Myocardial฀ Perfusion฀Test Antonio฀S.฀Ferreira,฀Antonio฀Ventosa,฀Victor฀Gil,฀Joao฀Calqueiro,฀Sonia฀Lima,฀Carlos฀ Aguiar,฀Rute฀Couto,฀Luis฀Raposo,฀Ricardo฀Seabra฀Gomes,฀Hospital฀Santa฀Cruz,฀ Carnaxide,฀Lisbon,฀Portugal Background:฀ Whether฀ antianginal฀ medication฀ affects฀ the฀ prognostic฀ value฀ of฀ a฀ stress฀ myocardial฀ perfusion฀ imaging฀ test฀ remains฀ a฀ controversial฀ issue.฀ Our฀ hypothesis฀ was฀ that฀ in฀ patients฀ with฀ a฀ normal฀ single฀ photon฀ emission฀ computed฀ tomography฀ (SPECT)฀ stress฀test,฀outcome฀would฀be฀worse฀in฀those฀whose฀test฀was฀performed฀on฀anti-ischemic฀ medication. Methods:฀ We฀ retrospectively฀ studied฀ 352฀ consecutive฀ patients฀ with฀ a฀ normal฀ stress฀ myocardial฀ perfusion฀ SPECT.฀ The฀ study฀ endpoint฀ was฀ time฀ to฀ a฀ major฀ cardiac฀ event฀ (cardiac฀death฀or฀non-fatal฀myocardial฀infarction). Results:฀ Previously฀ documented฀ coronary฀ artery฀ disease฀ (CAD)฀ was฀ present฀ in฀ 79฀ patients฀(22.4%).฀Stress฀consisted฀of฀an฀exercise฀treadmill฀test฀in฀233฀tests฀(66.2%).฀At฀ the฀ time฀ of฀ testing,฀ 71฀ patients฀ (20.2%)฀ were฀ on฀ beta-blocker฀ therapy,฀ 82฀ (23.3%)฀ on฀ calcium฀channel฀blockers,฀and฀57฀(16.2%)฀on฀nitrates.฀During฀a฀median฀follow-up฀of฀4.8฀ years฀(range,฀1.4฀to฀76.1฀months),฀12฀patients฀(3.4%)฀suffered฀a฀major฀cardiac฀event฀(7฀ non-fatal฀myocardial฀infarctions฀and฀5฀cardiac฀deaths).฀Time฀to฀a฀major฀cardiac฀event฀was฀ similar฀regardless฀of฀whether฀or฀not฀the฀test฀was฀performed฀under฀the฀effect฀of฀an฀antiischemic฀drug:฀event-free฀survival฀at฀last฀follow-up฀was฀100%฀vs.฀95.7%฀for฀beta-blockers,฀ 93.9%฀vs.฀97.4%฀for฀calcium฀channel฀blockers,฀and฀94.6%฀vs.฀96.9%฀for฀nitrates฀(log฀rank฀ p=ns฀ for฀ all฀ comparisons)฀ .฀ Independently฀ of฀ the฀ presence฀ or฀ absence฀ of฀ known฀ CAD,฀ performing฀the฀test฀under฀any฀anti-ischemic฀medication฀did฀not฀influence฀outcome,฀even฀ after฀adjustment฀for฀other฀variables฀(age,฀gender,฀CAD฀risk฀factors,฀presence฀of฀left฀bundle฀ branch฀block,฀and฀type฀of฀stress). Conclusion:฀A฀normal฀stress฀SPECT฀performed฀under฀anti-ischemic฀medication฀remains฀ a฀strong฀indicator฀of฀good฀prognosis. 1112-65฀ Temporal฀Progression฀of฀CAD฀in฀Patients฀with฀ Previously฀Normal฀Rest/Stress฀Tc-99m฀Myocardial฀ Perfusion฀Imaging:฀Diabetics฀vs.฀Non-Diabetics Gavin฀L.฀Noble,฀Christos฀Kasapis,฀Deb฀Katten,฀Ivette฀Leka,฀Sachin฀Navare,฀Alan฀ Ahlberg,฀Gary฀Heller,฀Hartford฀Hospital,฀Hartford,฀CT,฀University฀of฀Connecticut,฀ Farmington,฀CT Background:฀The฀progression฀of฀coronary฀artery฀disease฀(CAD)฀following฀normal฀SPECT฀ Myocardial฀ Perfusion฀ Imaging฀ (MPI),฀ particularly฀ in฀ diabetic฀ patients,฀ is฀ incompletely฀ understood.฀The฀purpose฀of฀this฀study฀was฀to฀evaluate฀serial฀testing฀in฀diabetic฀and฀nondiabetic฀populations฀for฀the฀identification฀of฀progression฀of฀CAD. Methods:฀Patients฀with฀known฀or฀suspected฀CAD฀with฀initially฀normal฀MPI฀who฀underwent฀ repeat฀ clinically฀ indicated฀ MPI฀ (Diabetics=192,฀ Non-Diabetics=486)฀ were฀ evaluated.฀ Repeat฀ MPI฀ studies฀ were฀ classified฀ as฀ normal฀ or฀ abnormal฀ (fixed฀ and฀ reversible).฀ Exclusions:฀intervening฀MI฀or฀revascularization. JACC February 1, 2005 Results:฀ Overall,฀ conversion฀ to฀ abnormal฀ was฀ significantly฀ greater฀ among฀ diabetics฀ (32.3%฀ vs.฀ 21.4%,฀ p=0.003).฀With฀ inter-test฀ intervals฀ <2฀ years,฀ conversion฀ to฀ abnormal฀ MPI฀was฀similar฀between฀groups.฀However,฀at฀an฀inter-test฀interval฀of฀2-3฀years฀diabetics฀ begin฀to฀separate,฀demonstrating฀significantly฀greater฀conversion฀to฀abnormal฀with฀intertest฀intervals฀>3฀years฀(p<0.004).฀Mean฀inter-test฀interval฀was฀similar฀between฀diabetics฀ and฀non-diabetics฀(796฀vs.฀789฀days,฀p=0.87). Conclusion:฀ Diabetic฀ patients฀ who฀ underwent฀ repeat,฀ symptom-guided฀ testing฀ are฀ at฀ significantly฀higher฀risk฀for฀progressive฀CAD฀than฀non-diabetics.฀This฀risk฀increases฀over฀ time,฀perhaps฀explaining฀higher฀cardiac฀event฀rates฀in฀diabetic฀patients฀despite฀previously฀ normal฀MPI.฀ 1112-66฀ Prognostic฀Value฀of฀Exercise฀and฀Pharmacologic฀Stress฀ Myocardial฀Perfusion฀Scintigraphy฀in฀Patients฀With฀ Complete฀Left฀Bundle฀Branch฀Block ABSTRACTS - Noninvasive Imaging 1112-68฀ 285A Impact฀of฀Percutaneous฀Coronary฀Intervention฀in฀ Patients฀With฀Myocardial฀Hibernation฀on฀Positron฀ Emission฀Tomography฀Scans Hector฀M.฀Medina,฀Hitinder฀S.฀Gurm,฀Martin฀E.฀Lascano,฀Richard฀C.฀Brunken,฀Wael฀A.฀ Jaber,฀Cleveland฀Clinic฀Foundation,฀Cleveland,฀OH Background:฀Patients฀(pts)฀with฀myocardial฀hibernation฀(MH)฀have฀an฀increased฀mortality฀ risk.฀ While฀ coronary฀ artery฀ bypass฀ grafting฀ has฀ been฀ shown฀ to฀ improve฀ survival฀ in฀ this฀ population,฀there฀is฀lack฀of฀data฀on฀the฀impact฀of฀percutaneous฀coronary฀intervention฀(PCI). Methods:฀We฀analyzed฀the฀outcome฀of฀407฀pts฀undergoing฀Rubidium/FDG฀(Fluorine-18฀ Deoxyglucose)฀Positron฀Emission฀Tomography฀(PET)฀scan฀followed฀by฀PCI฀within฀1฀year.฀ Pts฀were฀characterized฀as฀having฀MH฀if฀they฀had฀1฀or฀more฀myocardial฀segments฀with฀ FDG฀ uptake฀ with฀ a฀ corresponding฀ mismatch฀ in฀ the฀ Rubidium฀ scan.฀ Mortality฀ data฀ was฀ obtained฀using฀the฀Social฀Security฀index.฀Mean฀follow฀up฀was฀4฀years. Results:฀ At฀ least฀ 1฀ segment฀ with฀ MH฀ was฀ noted฀ in฀ 103฀ pts.฀ Pts฀ with฀ MH฀ were฀ significantly฀ more฀ likely฀ to฀ be฀ diabetic฀ (48%฀ vs.฀ 32%,฀ p=0.004),฀ more฀ likely฀ to฀ have฀ a฀ history฀of฀myocardial฀infarction฀(69%฀vs.฀43%,฀p<0.001),฀and฀had฀a฀lower฀left฀ventricular฀ ejection฀ fraction฀ (32%฀ vs.฀ 48%,฀ p<0.001),฀ compared฀ to฀ those฀ without฀ MH.฀ Complete฀ revascularization฀ was฀ achieved฀ in฀ 90%฀ of฀ the฀ pts.฀There฀ were฀ 87฀ deaths฀ on฀ follow-up.฀ There฀was฀no฀difference฀in฀mortality฀in฀pts฀with฀MH฀in฀unadjusted฀(p=0.082)฀or฀adjusted฀ analysis฀(fig)฀when฀compared฀to฀patients฀without฀MH. Conclusions:฀ In฀ this฀ series,฀ pts฀ with฀ MH฀ followed฀ by฀ PCI฀ appear฀ to฀ have฀ the฀ same฀ mortality฀risk฀of฀pts฀without฀MH,฀despite฀their฀higher฀likelihood฀of฀comorbidities฀and฀lower฀ ejection฀ fraction.฀ Given฀ the฀ historical฀ poor฀ outcome฀ in฀ this฀ group,฀ PCI฀ may฀ be฀ a฀ viable฀ revascularization฀option฀in฀carefully฀selected฀pts. Barbara฀Hesse,฀Hector฀M.฀Medina,฀Wael฀A.฀Jaber,฀Claire฀E.฀Pothier,฀Richard฀C.฀Brunken,฀ Michael฀S.฀Lauer,฀Cleveland฀Clinic฀Foundation,฀Cleveland,฀OH 1112-67฀ Prognostic฀Stratification฀of฀Elderly฀Patients฀Unable฀to฀ Perform฀Exercise฀Tests฀Using฀Dobutamine฀Stress฀99mTcTetrofosmin฀Myocardial฀Perfusion฀SPECT Arend฀F.l.฀Schinkel,฀Abdou฀Elhendy,฀Elena฀Biagini,฀Ron฀T.฀van฀Domburg,฀Roelf฀Valkema,฀ Vittoria฀Rizzello,฀Chiara฀Pedone,฀Boudewijn฀J.฀Krenning,฀Maarten฀L.฀Simoons,฀Don฀ Poldermans,฀Jeroen฀J.฀Bax,฀Thoraxcenter,฀Rotterdam,฀The฀Netherlands Background.฀Information฀on฀prognostic฀value฀of฀noninvasive฀stress฀imaging฀techniques฀ in฀the฀elderly฀is฀scarce.฀This฀study฀assesses฀the฀prognostic฀value฀of฀dobutamine฀stress฀ 99m Tc-tetrofosmin฀SPECT฀to฀predict฀of฀mortality฀and฀cardiac฀events฀in฀elderly฀patients. Methods:฀ Clinical฀ information฀ and฀ SPECT฀ results฀ were฀ analyzed฀ in฀ 272฀ consecutive฀ patients฀≥65฀years฀of฀age฀(mean฀age฀71฀±฀5฀years,฀range฀65-87฀years)฀with฀limited฀exercise฀ capacity.฀Follow-up฀was฀complete฀in฀270฀(99.3%)฀patients,฀23฀underwent฀revascularization฀ within฀60฀days฀of฀the฀scintigraphy฀and฀were฀excluded.฀An฀abnormal฀study฀was฀defined฀as฀ the฀presence฀of฀a฀fixed฀and/or฀reversible฀perfusion฀defect.฀A฀summed฀stress฀score฀(SSS)฀ was฀obtained฀to฀estimate฀the฀extent฀and฀severity฀of฀perfusion฀defects.฀The฀incremental฀ prognostic฀value฀of฀SPECT฀over฀clinical฀data฀was฀evaluated฀according฀to฀3฀multivariate฀ models,฀which฀included฀respectively฀any฀SPECT฀abnormality,฀the฀presence฀of฀a฀fixed฀or฀ reversible฀defect,฀and฀the฀SSS. Results:฀During฀the฀3.3±1.4฀year฀follow-up,฀59฀patients฀died฀(29฀cardiac฀deaths),฀16฀had฀ a฀ nonfatal฀ infarction,฀ and฀ 24฀ underwent฀ late฀ revascularization.฀ An฀ abnormal฀ scan฀ was฀ present฀in฀140฀(57%)฀patients.฀The฀annual฀event฀rates฀for฀total฀mortality,฀cardiac฀death,฀ and฀cardiac฀death฀or฀nonfatal฀infarction฀were฀respectively฀3.2%,฀0.2%฀and฀0.7%฀after฀a฀ normal฀scan฀and฀respectively฀9.5%,฀4.3%฀and฀8%฀after฀an฀abnormal฀scan฀(all฀P<0.0001).฀ Multivariate฀analysis฀showed฀that฀an฀abnormal฀scan,฀the฀presence฀of฀a฀fixed฀or฀reversible฀ defect,฀ and฀ the฀ SSS฀ provided฀ incremental฀ prognostic฀ information฀ over฀ clinical฀ data.฀ An฀ abnormal฀ scan฀ was฀ independently฀ associated฀ with฀ an฀ increased฀ risk฀ for฀ total฀ mortality,฀ cardiac฀death,฀and฀cardiac฀death฀or฀nonfatal฀infarction฀(respectively฀hazard฀ratio฀3.4฀[95%฀ CI฀1.8-6.5],฀12.1฀[95%฀CI,฀2.9-51.5]฀and฀9.0฀[95%฀CI,฀2.8-29.6]). Conclusion:฀ Dobutamine฀ stress฀ 99mTc-tetrofosmin฀ SPECT฀ provides฀ incremental฀ prognostic฀information฀for฀the฀prediction฀of฀all฀cause฀mortality฀and฀hard฀cardiac฀events฀in฀ the฀elderly.฀Elderly฀patients฀with฀a฀normal฀myocardial฀perfusion฀have฀a฀good฀prognosis,฀ and฀do฀not฀require฀further฀invasive฀evaluation฀during฀the฀3฀years฀following฀the฀study,฀if฀no฀ change฀in฀clinical฀status฀occurs. 1112-69฀ Effect฀of฀Body฀Mass฀Index฀on฀Attenuation-Corrected฀ Single-Photon฀Emission฀Computed฀Tomography฀ Imaging Neeraj฀Mehta,฀Scott฀Allison,฀Jaekyeong฀Heo,฀Ami฀E.฀Iskandrian,฀University฀of฀Alabama฀ at฀Birmingham,฀Birmingham,฀AL Background:฀ Previous฀ studies฀ show฀ that฀ attenuation,฀ scatter,฀ and฀ depth฀ resolution฀ correction฀(AC)฀improve฀the฀uniformity฀and฀diagnostic฀accuracy฀of฀single-photon฀emission฀ computed฀ tomography฀ (SPECT)฀ perfusion฀ images.฀ The฀ effect฀ of฀ body฀ mass฀ index฀ (BMI)฀on฀recovery฀of฀counts฀after฀AC฀and฀on฀non-uniformity฀is฀not฀well฀known฀and฀was฀ investigated฀in฀this฀study. Methods:฀We฀ identified฀ 120฀ patients฀ (60฀ men฀ and฀ 60฀ women)฀ who฀ had฀ normal฀ stress฀ gated฀ SPECT฀ perfusion฀ imaging฀ with฀ Tc-99m-tracer.฀ Patients฀ with฀ prior฀ myocardial฀ infarction,฀ coronary฀ revascularization,฀ left฀ bundle฀ branch฀ block,฀ and฀ non-sinus฀ rhythm฀ were฀excluded.฀The฀patients฀were฀divided฀into฀3฀groups฀based฀on฀BMI.฀Group฀I฀had฀BMI฀ <25,฀group฀II,฀25฀to฀30,฀and฀group฀III฀>30.฀The฀activity฀was฀counted฀in฀9฀segments฀per฀ patient฀ before฀ and฀ after฀ AC.฀ The฀ percent฀ increase฀ was฀ measured฀ using฀ the฀ formula:฀ (corrected฀-฀uncorrected)฀/฀uncorrected฀x฀100.฀The฀uniformity฀was฀measured฀as฀percent฀ difference฀between฀the฀highest฀and฀lowest฀segment฀counts฀both฀before฀and฀after฀AC. Results:฀There฀was฀a฀6฀to฀10฀fold฀increase฀in฀counts฀after฀AC฀(p<0.0001฀in฀each฀group).฀ The฀increase฀was฀6.9±1.0฀fold฀in฀group฀I,฀8.6±1.4฀fold฀in฀group฀II,฀and฀10.5±1.8฀fold฀in฀group฀ III฀(p<0.0001).฀The฀absolute฀counts฀after฀AC฀were฀less฀as฀BMI฀increased:฀7820±2690฀in฀ group฀I,฀6660±2690฀in฀group฀II,฀and฀6260±2310฀in฀group฀III฀(p<0.01฀between฀group฀I฀vs.฀ II฀ or฀ III).฀The฀ uniformity฀ was฀ not฀ related฀ to฀ BMI฀ as฀ the฀ maximum฀ difference฀ decreased฀ from฀29%฀before฀to฀17%฀after฀AC฀in฀group฀I,฀28%฀to฀18%฀in฀group฀II,฀and฀27%฀to฀20%฀in฀ group฀III฀(p=ns). Conclusion:฀ AC฀ results฀ in฀ marked฀ count฀ recovery฀ that฀ is฀ dependent฀ on฀ BMI฀ but฀ an฀ improvement฀in฀uniformity฀that฀is฀independent฀of฀BMI. 1112-70฀ Method฀for฀Detection฀of฀Serial฀Myocardial฀Perfusion฀ SPECT฀Changes฀by฀3D฀Volume-based฀Image฀ Registration. Piotr฀Slomka,฀Hidetaka฀Nishina,฀Cigdem฀Akincioglu,฀Aiden฀Abidov,฀Daniel฀Berman,฀John฀ Friedman,฀Guido฀Germano,฀Cedars-Sinai฀Medical฀Center,฀Los฀Angeles,฀CA Introduction:฀Current฀techniques฀for฀detection฀of฀serial฀changes฀in฀myocardial฀perfusion฀ SPECT฀(MPS)฀require฀separate฀comparisons฀to฀inter-subject฀normal฀limits฀which฀is฀not฀ optimal฀due฀to฀potential฀mis-registration,฀multiple฀count฀normalizations฀and฀inter-subject฀ variability.฀We฀ propose฀ a฀ novel฀ method฀ for฀ direct฀ estimation฀ of฀ changes฀ in฀ serial฀ MPS฀ using฀image฀registration. Noninvasive Imaging Objectives:฀To฀compare฀the฀prognostic฀value฀of฀pharmacologic฀versus฀exercise฀induced฀ myocardial฀perfusion฀SPECT฀defects฀in฀patients฀with฀LBBB. Background:฀In฀patients฀with฀LBBB,฀pharmacologic฀stress฀is฀recommended฀to฀improve฀ diagnostic฀accuracy฀of฀myocardial฀perfusion฀SPECT.฀It฀remains฀unknown฀whether฀exercise฀ affects฀the฀prognostic฀power฀of฀stress฀SPECT฀in฀this฀population. Methods:฀ 590฀ LBBB฀ patients฀ undergoing฀ pharmacologic฀ (N=283)฀ or฀ exercise฀ (N=307)฀ stress฀SPECT฀were฀followed฀for฀a฀mean฀of฀5฀years.฀Segments฀on฀SPECT฀were฀classified฀ as฀septal/non-septal,฀and฀fixed/reversible,฀and฀the฀prognostic฀value฀of฀perfusion฀defects฀ in฀these฀groups฀compared. Results:฀329฀men฀and฀261฀women฀where฀included.฀There฀were฀75฀(27%)฀deaths฀in฀the฀ pharmacological฀and฀73฀(24%)฀deaths฀in฀the฀exercise฀group.฀On฀univariate฀analysis,฀nonseptal฀defects฀predicted฀death฀in฀the฀exercise฀(fixed:฀HR฀1.10,฀95%CI฀1.03-1.17,฀p=0.007;฀ reversible:฀ HR฀ 1.13,฀ 95%CI฀ 1.00-1.27,฀ p=0.043)฀ and฀ pharmacologic฀ (fixed:฀ HR฀ 1.14,฀ 95%CI฀ 1.07-1.21,฀ p<0.0001;฀ reversible:฀ HR฀ 1.13,฀ 95%CI฀ 1.03-1.24,฀ p=0.011)฀ cohorts;฀ septal฀ defects฀ were฀ not฀ predictive.฀ After฀ adjusting฀ for฀ confounders,฀ non-septal฀ defects฀ remained฀predictive฀of฀death฀in฀the฀exercise฀(fixed:฀HR฀1.10,฀95%CI฀1.03-1.18,฀p=0.005;฀ reversible:฀HR฀1.13,฀95%CI฀1.00-1.27,฀p=0.05)฀and฀pharmacologic฀group฀(fixed:฀HR฀1.16,฀ 95%CI฀1.09-1.24,฀p<0.0001;฀reversible:฀HR฀1.11,฀95%CI฀1.01-1.21,฀p=0.029). Conclusions:฀ In฀ patients฀ with฀ LBBB฀ undergoing฀ stress฀ SPECT,฀ non-septal฀ defects,฀ but฀ not฀ septal฀ defects,฀ independently฀ predicted฀ death,฀ regardless฀ of฀ the฀ type฀ of฀ stress฀ applied.฀Exercise฀did฀not฀adversely฀affect฀the฀prognostic฀power฀of฀perfusion฀defects,฀and฀ may฀be฀a฀useful฀alternative฀to฀pharmacologic฀testing. 286A ABSTRACTS - Noninvasive Imaging JACC Methods:฀ Paired฀ serial฀ stress฀ scans฀ from฀ 166฀ patients฀ (pts)฀ forming฀ 3฀ groups฀ were฀ considered:฀1)฀scans฀of฀low-likelihood฀pts฀with฀normal฀perfusion฀(n=40)฀repeated฀within฀ 2฀years฀(NORMAL),฀2)฀abnormal฀scans฀(n=29)฀repeated฀within฀<฀1฀month฀(REPRO),฀3)฀ scans฀ repeated฀ before฀ and฀ after฀ revascularization฀ (REVASC)฀ (n=97).฀ Iterative฀ image฀ registration฀utilizing฀10-parameters฀(6฀rigid฀body,฀3฀scaling,฀1฀normalization฀factor)฀was฀ applied฀to฀serial฀scan฀pairs.฀Serial฀perfusion฀change฀(SPC)฀was฀defined฀as฀the฀ratio฀of฀ counts฀ remaining฀ after฀ normalized฀ voxel฀ count฀ subtraction฀ (100%*(study1-normalized฀ study2)/study1)฀ within฀ common฀ 3D฀ ventricular฀ boundaries.฀ For฀ comparison฀ with฀ standard฀ approach,฀ changes฀ in฀ myocardial฀ perfusion฀ were฀ estimated฀ by฀ normal-limits฀ based฀ quantification฀ (Q-%CH)฀ and฀ visual฀ scoring฀ (V-%CH).฀ Positive฀ change฀ indicated฀ improvement฀while฀negative฀change฀indicated฀worsening฀for฀Q-%CH,฀V-%CH฀and฀SPC.฀In฀ addition,฀regional฀paired-subject฀variability฀of฀perfusion฀in฀low฀likelihood฀pts฀was฀compared฀ to฀inter-subject฀variability฀in฀NORMAL฀group. Results:฀In฀NORMAL฀group,฀average฀positive฀or฀negative฀SPC฀(1.8%)฀was฀lower฀than฀Q%CH฀(2.9%)฀(p฀<฀0.01).฀In฀REPRO฀group,฀SPC฀was฀1.7%,฀lower฀than฀Q-%CH฀(3.9%)฀and฀ V-%CH฀(3.1%)฀(p฀<฀0.01).฀In฀REVASC฀group,฀the฀number฀of฀pts฀with฀positive฀SPC฀(>2.5%)฀ was฀75/97฀compared฀with฀67/97฀identified฀by฀visual฀scoring฀(p฀=NS)฀and฀51/97฀by฀standard฀ quantification฀ (p฀ <฀ 0.01)฀ (%CH฀ >2.5%).฀The฀ serial฀ count฀ variability฀ in฀ NORMAL฀ group฀ for฀lateral/anterior/septal/inferior฀regions฀was฀6.3%,฀5.9%,฀6.2%,฀and฀5.4%฀respectively,฀ lower฀than฀the฀inter-subject฀variability฀(8.2%,฀9.3%,฀9.4%,฀7.8%). Conclusion:฀ The฀ measurement฀ of฀ serial฀ MPS฀ perfusion฀ changes฀ by฀ a฀ 3D฀ registration฀ technique฀ is฀ feasible฀ and฀ is฀ more฀ reproducible฀ than฀ current฀ quantitative฀ or฀ visual฀ approaches. known.These฀measured฀during฀ dobutamine฀stress฀echocardiography฀(DSE)฀with฀tissue฀ Doppler฀imaging฀(TDI)฀could฀assess฀this฀worsening฀in฀patients฀with฀heart฀failure฀(HF). 115฀subjects฀with฀HF฀[47฀LVSD/NQRS,฀30฀LVSD/WQRS,฀38฀preserved฀LV฀function฀(PVLF)]฀ underwent฀DSE฀using฀a฀standard฀protocol฀in฀TDI฀mode฀after฀clinical฀and฀echocardiographic฀ examination.฀Standard฀views฀at฀rest฀and฀peak฀stress,฀were฀analysed฀off-line.฀The฀time฀to฀ peak฀systolic฀velocities฀from฀the฀onset฀of฀the฀QRS฀(Ts)฀were฀measured฀at฀12฀segments฀ (6฀basal,฀6฀mid)฀of฀LV.฀Each฀Ts฀were฀corrected฀for฀heart฀rate฀using฀the฀Bazett’s฀formula฀ (Tscor).฀The฀standard฀deviation฀of฀the฀12฀Ts฀(Ts-SD)฀and฀Tscor฀(Tscor฀-SD)฀and฀the฀difference฀ between฀the฀maximum฀and฀minimum฀Ts฀(Ts-diff)฀and฀Tscor฀ (Tscor฀-diff)฀were฀computed฀as฀ dyssynchrony฀indices.฀The฀paired฀t฀test฀was฀used฀to฀compare฀variables฀within฀the฀groups.฀ P<0.05฀was฀considered฀significant. With฀ stress฀Ts-diff฀ do฀ not฀ change฀ in฀ both฀ LVSD฀ groups฀ but฀ decreases฀ in฀ PLVF฀ group.฀ Tscor฀-diff,฀Ts-SD฀and฀Tscor฀-SD฀increases฀in฀both฀LVSD฀groups฀but฀not฀in฀PLVF฀group.฀The฀ differences฀attain฀higher฀significance฀on฀rate฀correction. Change฀in฀the฀dsysynchrony฀indices฀with฀stress.฀ Tsdiff Ts-SD Tscordiff Tscor฀-SD Echocardiographic฀Assessment฀of฀฀ Tissue฀Synchrony 2:00฀p.m. Noninvasive Imaging LVSD/WQRS/฀ LVSD/WQRS/฀ p฀value Rest Peak฀Stress p฀value 213฀(34) 39.1(13.7) 4.06฀(1.43) 1.40(0.51) 242฀(45) 64.5฀(40.2) 6.66฀(2.30) 2.12(0.67) <0.0001 0.10 0.14 0.07 224฀(174) 66.1฀(48.0) 10.28(8.07) 3.04(2.25) 0.71 0.001 <0.00001 <0.00001 300฀(170) 86.9฀(45.0) 13.65(7.37) 3.94(1.98) 2:30฀p.m. 815-5฀ Monday,฀March฀07,฀2005,฀2:00฀p.m.-3:30฀p.m. Orange฀County฀Convention฀Center,฀Room฀304E 815-3฀ PVLF/All/฀ PVLF/All/฀ Peak฀ Rest Stress 0.09 204฀(45) 118฀(105) 0.03 41.1฀(20.3) 35.8฀(28.4) <0.00001 6.94(6.94) 5.43(4.93) <0.0001 2.13(1.85) 1.64(1.35) LVSD/N฀ LVSD/N฀QRS/฀ p฀value QRS/฀Rest Peak฀Stress Intraventricular฀dyssynchrony฀worsens฀with฀stress฀irrespective฀of฀the฀resting฀QRS฀duration฀ in฀HF฀patients฀with฀LVSD฀but฀not฀in฀PVLF. ORAL฀CONTRIBUTIONS 815฀฀ February 1, 2005 Dyssynchrony฀Imaging,฀A฀New฀Method฀to฀Assess฀Left฀ Ventricular฀Dyssynchrony฀Based฀on฀Myocardial฀Strain:฀ Application฀to฀Dilated฀Cardiomyopathy Takuya฀Hasegawa,฀Satoshi฀Nakatani,฀Hideaki฀Kanzaki,฀Kazuaki฀Wakami,฀Haruhiko฀Abe,฀ Masakazu฀Yamagishi,฀Masafumi฀Kitakaze,฀Kunio฀Miyatake,฀National฀Cardiovascular฀ Center,฀Suita,฀Osaka,฀Japan Background:฀ Although฀ segmental฀ differences฀ in฀ time฀ to฀ peak฀ longitudinal฀ myocardial฀ velocities฀ have฀ been฀ used฀ to฀ assess฀ left฀ ventricular฀ (LV)฀ dyssynchrony,฀ they฀ are฀ sometimes฀affected฀by฀cardiac฀rotation฀and฀translation.฀A฀newly฀developed฀dyssynchrony฀ imaging฀(DI,฀Toshiba),฀based฀on฀the฀angle-corrected฀tissue฀strain฀imaging,฀can฀color-code฀ the฀difference฀in฀time฀to฀peak฀myocardial฀radial฀strain฀visualizing฀synchronous฀segments฀ as฀green฀and฀dyssynchronous฀ones฀as฀yellow฀to฀red฀irrespective฀of฀cardiac฀rotation฀and฀ translation. Methods:฀We฀applied฀DI฀to฀basal฀and฀mid฀LV฀short-axis฀images฀in฀18฀patients฀with฀dilated฀ cardiomyopathy฀ (DCM,฀ 8฀ with฀ narrow,฀ 10฀ with฀ wide฀ QRS)฀ and฀ 8฀ normals.฀The฀ time฀ to฀ peak฀myocardial฀strain฀from฀QRS฀complex฀were฀measured฀in฀the฀anteroseptal,฀anterior,฀ anterolateral,฀posterolateral฀inferior,฀inferoseptal฀segments฀at฀base฀and฀mid฀LV฀and฀the฀ maximal฀time฀difference฀between฀any฀2฀segments฀was฀obtained฀(DTmax). Results:฀ By฀ DI,฀ LV฀ showed฀ homogeneously฀ green฀ to฀ yellow฀ in฀ normals฀ but฀ regionally฀ red฀ in฀ DCM.฀ DTmax฀ was฀ significantly฀ longer฀ in฀ DCM฀ than฀ normals฀ (147±43,฀ 306±132,฀ 316±115฀ ms฀ for฀ normals,฀ DCM฀ with฀ narrow฀ QRS,฀ with฀ wide฀ QRS,฀ p<0.01฀ for฀ normals฀ vs.฀ DCM).฀ DTmax≥200฀ ms฀ predicted฀ dyssynchrony฀ in฀ 62%฀ of฀ DCM฀ assessed฀ by฀ the฀ traditional฀method฀based฀on฀longitudinal฀velocities. Conclusions:฀ DI฀ demonstrated฀ differences฀ in฀ timing฀ of฀ peak฀ myocardial฀ radial฀ strain.฀ The฀discrepancy฀between฀DI฀and฀the฀traditional฀method฀may฀reflect฀the฀effect฀of฀cardiac฀ rotation฀and฀translation฀on฀the฀latter. Evaluation฀of฀Left฀Ventricular฀Asynchrony฀Using฀ Echocardiographic฀Phase฀Imaging฀in฀Patients฀with฀ Heart฀Failure฀undergoing฀Cardiac฀Resynchronization฀ Therapy. Helmut฀Kuecherer,฀Arthur฀Filusch,฀Stefan฀Hardt,฀Alexander฀Bauer,฀Alexander฀Hansen,฀ Grigorios฀Korosoglou,฀Lei฀Sui,฀Helene฀Houle,฀Pat฀von฀Behren,฀Nelson฀B.฀Schiller,฀Hugo฀ A.฀Katus,฀University฀of฀Heidelberg,฀Heidelberg,฀Germany,฀Siemens฀Medical฀Solutions,฀ Mountain฀View,฀CA Background:฀Mechanical฀asynchrony฀relates฀to฀clinical฀outcome฀in฀patients฀with฀heart฀ failure.฀Contraction฀asynchrony฀is฀usually฀evaluated฀using฀tissue฀doppler฀imaging฀(TDI)฀ to฀measure฀timing฀of฀longitudinal฀myocardial฀contraction฀velocities.฀Automated฀objective฀ methods฀visualizing฀temporal฀sequence฀of฀cyclic฀endocardial฀motion฀are฀lacking.฀We฀tested฀ whether฀ parametric฀ echocardiographic฀ phase฀ imaging฀ (EPI,฀ Siemens)฀ of฀ endocardial฀ motion฀can฀be฀used฀to฀objectively฀quantify฀intraventricular฀contraction฀delays. Methods:฀Time฀to฀peak฀myocardial฀velocity฀was฀measured฀using฀pulsed-wave฀TDI฀in฀12฀ patients฀ (mean฀ age฀ 63±7฀ years)฀ with฀ dilated฀ (n=2)฀ or฀ ischemic฀ (n=10)฀ cardiomyopathy฀ (EF฀28±4%)฀and฀implanted฀biventricular฀pacemakers.฀Asynchrony฀was฀determined฀as฀the฀ difference฀ between฀the฀electromechanical฀coupling฀ times฀in฀the฀basal฀lateral฀and฀septal฀ segments฀with฀pacing฀modes฀set฀to฀achieve฀maximal฀delays฀between฀LV฀and฀RV฀activation.฀ Digital฀cine-loops฀of฀apical฀four฀chamber฀views฀were฀mathematically฀transformed฀using฀a฀ first฀ harmonic฀ Fourier฀ algorithm฀ displaying฀ magnitude฀ and฀ temporal฀ sequence฀ of฀ cyclic฀ endocardial฀ motion฀ in฀ a฀ color-coded฀ format.฀ Atrial฀ phase฀ was฀ used฀ as฀ a฀ reference฀ to฀ define฀end-diastole฀(phase฀angle฀0°).฀Regional฀phase฀angles฀were฀converted฀to฀time฀units฀ with฀ 360°฀ comprising฀ a฀ full฀ R฀ to฀ R฀ interval.฀ Contraction฀ delays฀ derived฀ from฀TDI฀ were฀ compared฀to฀those฀derived฀from฀EPI฀using฀linear฀regression฀and฀Bland-Altman฀statistics. Results:฀ Motion฀ asynchrony฀ was฀ easily฀ identified฀ from฀ parametric฀ images.฀ Lateral฀ to฀ septal฀contraction฀delays฀ranged฀from฀-220ms฀to฀400ms.฀EPI฀correlated฀very฀closely฀with฀ TDI฀(r฀=฀0.998,฀p<0.0001,฀SEE=0.013฀ms).฀The฀mean฀difference฀between฀TDI฀and฀EPI฀ derived฀contraction฀delays฀was฀3.2±13.6฀ms฀with฀upper฀and฀lower฀limits฀of฀agreement฀of฀ 29.7฀and฀-23.4฀ms.฀Phase฀measurements฀were฀highly฀reproducible฀with฀an฀interobserver฀ variability฀of฀3.1±25฀ms.฀ Conclusion:฀Echocardiographic฀phase฀imaging฀allows฀automated฀objective฀visualization฀ and฀quantification฀of฀intraventricular฀asynchrony฀in฀patients฀with฀biventricular฀pacemakers.฀ This฀ method฀ supports฀ the฀ analysis฀ of฀ the฀ effects฀ of฀ resynchronization฀ therapy฀ on฀ left฀ ventricular฀function. 3:15฀p.m. 815-6฀ Tasneem฀Z.฀Naqvi,฀Ahmed฀Khan,฀Asim฀Rafique,฀Charles฀Swerdlow,฀Nancy฀Taubenfeld,฀ Linda฀Arnold,฀Mary฀Vigil,฀Walter฀Kerwin,฀C.฀Thomas฀Peter,฀Cedars฀Sinai฀Medical฀Center,฀ Los฀Angeles,฀CA ฀ 2:15฀p.m. 815-4฀ Why฀Do฀Patients฀with฀Non-Ischemic฀Dilated฀ Cardiomyopathy฀Respond฀Better฀to฀Biventricular฀Pacing฀ Than฀Those฀with฀Ischemic฀Cardiomyopathy? Does฀Inta-ventricular฀Dyssynchrony฀Worsen฀With฀Stress฀ In฀Patients฀With฀Left฀Ventricular฀Systolic฀Dysfunction? Sudipta฀Chattopadhyay,฀M.฀F.฀Alamgir,฀N.฀P.฀Nikitin,฀A.฀L.฀Clark,฀J.฀G.฀Cleland,฀University฀ of฀Hull,฀Kingston฀upon฀Hull,฀United฀Kingdom Intraventricular฀ dyssynchrony฀ is฀ prevalent฀ in฀ patients฀ with฀ ischaemic฀ left฀ ventricular฀ systolic฀dysfunction฀(LVSD)฀with฀normal฀(NQRS)฀and฀increased฀QRS฀(WQRS)฀duration.฀ Whether฀the฀indices฀of฀dyssynchrony฀increase฀with฀stress฀as฀ischaemia฀worsens฀is฀not฀ Background:฀ Pts฀ with฀ non฀ ischemic฀ (NI)฀ cardiomyopathy฀ (CM)฀ respond฀ better฀ to฀ Biventricular฀ (Biv)฀ pacing฀ than฀ those฀ with฀ ischemic฀ (I)฀ CM.฀ Biv฀ pacing฀ causes฀ cardiac฀ resynchronization฀and฀shortens฀isovolumic฀contraction฀time฀IVCT.฀We฀hypothesized฀that,฀ for฀a฀comparable฀degree฀of฀LV฀dysfunction,฀pts฀with฀NICM฀have฀more฀dyssynchrony฀than฀ those฀with฀ICM.฀Methods:฀We฀evaluated฀52฀pts฀with฀ICM฀and฀30฀pts฀with฀NICM฀with฀pulsed฀ wave฀Tissue฀Doppler฀Imaging฀(TDI,฀GE฀Vivid฀7฀system).฀Dyssynchrony฀was฀evaluated฀by฀ conventional฀M-mode฀method฀and฀at฀12฀basal฀and฀mid-myocardial฀segments฀by฀pulsed฀ wave฀TDI฀using฀off฀line฀Echo฀Pac฀workstation.฀Results:฀There฀was฀no฀difference฀in฀LVEF฀ (0.32±0.1฀ vs.฀ 0.31±0.1),฀ age,฀ NYHA฀ class,฀ heart฀ rate,฀ LV฀ end฀ diastolic฀ dimension฀ or฀ volume,฀or฀mitral฀regurgitation฀severity฀in฀ICM฀vs.฀NICM฀pts.฀IVCT฀was฀more฀prolonged฀ (100±32฀vs฀61±33฀ms,฀p<0.001,฀and฀systolic฀ejection฀time฀was฀shorter฀(245±47฀vs฀284±47,฀ JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging 287A p<0.01)฀in฀NICM฀vs฀ICM฀pts.฀The฀table฀shows฀dyssynchrony฀parameters฀in฀ms.฀Data฀are฀ Mean±SD,฀λ฀p<0.001,฀γ฀p<0.03.฀Conclusion:฀For฀a฀given฀degree฀of฀LV฀dysfunction,฀pts฀with฀ NICM฀have฀more฀dyssynchrony฀and฀longer฀IVCT฀than฀pts฀with฀ICM.฀This฀may฀explain฀their฀ greater฀response฀to฀CRT฀than฀pts฀with฀ICM. Dyssynchrony฀Parameters฀in฀Patients฀with฀ICM฀and฀NICM฀ QRS฀ Duration ICM 142±40 NICM 157±66 Standard฀Deviation฀ Septoposterior฀Wall฀ of฀Time฀to฀Peak฀ Delay฀(M-mode) Contraction฀(TDI) 157±66 34±14 165±96γ 42±16γ Standard฀Deviation฀of฀ Time฀to฀Peak฀Systolic฀ Displacement฀(TDI) 62±21 87±33λ 3:00฀p.m. 815-7฀ Evaluation฀of฀Intraventricular฀Dyssynchrony฀in฀Heart฀ Failure฀Patients:฀a฀Direct฀Comparison฀between฀Pulsed฀ Wave฀and฀Color฀Tissue฀Doppler฀Imaging ORAL฀CONTRIBUTIONS 821FO฀฀ Johan฀De฀Sutter,฀Nico฀R.฀Van฀de฀Veire,฀Guy฀Van฀Camp,฀Patrizio฀Lancellotti,฀Pieter฀ Vandervoort,฀Luc฀Muyldermans,฀Tine฀De฀Backer,฀Philippe฀Unger,฀University฀Hospital,฀ Ghent,฀Belgium,฀Belgian฀Working฀Group฀on฀Echocardiography฀and฀Cardiac฀Doppler Aim:฀To฀ compare฀ Color฀ tissue฀ Doppler฀ imaging฀ (TDI)฀ &฀ Pulsed฀ wave฀TDI฀ parameters฀ for฀the฀assessment฀of฀intraventricular฀mechanical฀dyssynchrony฀(IVMD)฀in฀heart฀failure฀ (HD)฀patients. Methods:฀We฀studied฀85฀HF฀pts฀(age฀66±12฀yrs,฀LVEF฀34±14%,฀NYHA฀class฀2.35±0.8,฀ QRS฀141±44฀ms),฀referred฀for฀evaluation฀of฀IVMD.฀According฀to฀Penicka฀et฀al,฀PW฀TDI฀was฀ used฀to฀calculate฀the฀time฀to฀onset฀of฀systolic฀movement฀in฀4฀basal฀LV฀segments฀(sept,฀ lat,฀ant฀&฀inf).฀Dispersion฀(=฀longest-shortest฀time฀interval,฀DISP)฀≥60ms฀was฀defined฀as฀ significant฀IVMD.฀According฀to฀Yu฀et฀al,฀color฀TDI฀was฀used฀to฀calculate฀the฀time฀to฀peak฀ systolic฀movement฀in฀6฀basal฀and฀6฀mid฀segments฀(sept,฀lat,฀ant,฀inf,฀post฀and฀anterosept).฀ A฀standard฀deviation฀(SD)฀≥35฀ms฀was฀defined฀as฀significant฀IVMD. Results:฀Inter฀and฀intraobserver฀variability฀was฀<10%฀for฀DISP฀&฀SD฀(p=ns).฀The฀global฀ prevalence฀ of฀ IVMD฀ was฀ 32%฀ using฀ DISP฀ &฀ 42%฀ using฀ SD฀ (p=ns).฀ Both฀ DISP฀ &฀ SD฀ correlated฀ with฀ LVEF฀ (r=-0.35,฀ p<0.01฀ and฀ r=-0.31,฀ p<0.01)฀ &฀ QRS฀ duration฀ (r=0.48,฀ p<0.01฀ &฀ r=0.38,฀ p<0.01).฀ Prevalence฀ of฀ IVMD฀ increased฀ from฀ 13%฀ to฀ 46%฀ for฀ DISP฀ (p<0.05)&฀from฀27%฀to฀51%฀for฀SD฀(p<0.05)฀in฀pts฀with฀a฀QRS40%฀compared฀to฀pts฀with฀a฀ QRS≥120ms฀&฀LVEF≤40%฀(fig).฀Prevalences฀of฀IVMD฀tended฀to฀be฀lower฀in฀pts฀with฀small฀ QRS฀using฀DISP฀compared฀to฀SD. Featured฀Oral฀Session...฀ Cardiovascular฀Magnetic฀Resonance฀ Imaging:฀Emerging฀Clinical฀Trials฀and฀ Outcome฀Data Monday,฀March฀07,฀2005,฀4:00฀p.m.-5:30฀p.m. Orange฀County฀Convention฀Center,฀Hall฀F1฀ 4:15฀p.m. 821-4฀ Abdominal฀Aortic฀Plaque฀by฀Magnetic฀Resonance฀ Imaging฀Is฀Seen฀More฀Frequently฀Than฀Coronary฀Artery฀ Calcium฀in฀Young฀Women฀in฀the฀Dallas฀Heart฀Study Hao฀S.฀Lo,฀Roderick฀McColl,฀Greg฀Stanek,฀DuWayne฀Willett,฀Ronald฀M.฀Peshock,฀ University฀of฀Texas฀Southwestern฀Medical฀Center,฀Dallas,฀TX,฀Donald฀W฀Reynolds฀ Cardiovascular฀Clinical฀Research฀Center,฀Dallas,฀TX Comparison฀of฀Groups฀ Conclusion:฀IVMD฀can฀be฀reliable฀assessed฀by฀both฀PW฀&฀Color฀TDI฀in฀HF฀pts฀with฀an฀ increase฀of฀IVMD฀with฀decreasing฀LVEF฀&฀increasing฀QRS฀duration.฀About฀50%฀of฀pts฀with฀ HF,฀LVEF≤40%฀&฀QRS≥120ms฀show฀significant฀IVD฀using฀PW฀or฀Color฀TDI. 3:30฀p.m. 815-8฀ Acute฀Synchrony฀Changes฀During฀Cardiac฀ Resynchronization฀Therapy฀Predicts฀Acute฀ Hemodynamic฀Response Cynthia฀C.฀Taub,฀Dali฀Fan,฀Jagmeet฀Singh,฀Theofanie฀Mela,฀Michael฀H.฀Picard,฀ Massachusetts฀General฀Hospital,฀Boston,฀MA BACKGROUND:฀ Cardiac฀ resynchronization฀ therapy฀ (CRT)฀ improves฀ myocardial฀ performance฀ in฀ many฀ patients.฀ Early฀ identification฀ of฀ these฀ patients฀ is฀ challenging.฀The฀ aim฀of฀this฀study฀was฀to฀determine฀if฀echocardiographic฀(echo)฀parameters฀of฀improved฀LV฀ synchrony฀with฀CRT฀could฀predict฀acute฀hemodynamic฀response. METHODS:฀One฀hundred฀consecutive฀patients฀with฀heart฀failure฀meeting฀indications฀for฀ CRT฀ were฀ studied฀ shortly฀ after฀ device฀ implantation.฀ Echoes฀ were฀ performed฀ with฀ and฀ without฀CRT฀(CRT+,฀CRT-).฀Indices฀of฀LV฀function฀were฀measured฀including฀LVEF฀(biplane฀ Simpson’s),฀ wall฀ motion฀ score,฀ Tei฀ index,฀ +dP/dt฀ and฀ -dP/dt฀ (from฀ mitral฀ regurgitation฀ Doppler฀(MR)).฀LV฀synchrony฀was฀quantified฀by฀the฀Maximum฀Time฀Difference฀(MTD)฀to฀ peak฀systolic฀velocity฀between฀septal,฀inferior,฀anterior฀and฀lateral฀walls฀as฀measured฀by฀ tissue฀Doppler. RESULTS:฀In฀fifty-six฀patients,฀MR฀was฀sufficient฀to฀calculate฀+dP/dt.฀The฀magnitude฀of฀ acute฀changes฀in฀+dP/dt฀with฀CRT฀was฀not฀related฀to฀baseline฀LVEF,฀wall฀motion฀score฀ or฀ size฀ of฀ LV฀ scar฀ (%akinesis).฀ However,฀ the฀ degree฀ of฀ dyssynchrony฀ as฀ measured฀ by฀ the฀MTD฀with฀CRT฀off฀was฀related฀to฀the฀increase฀in฀+dP/dt฀(r2=0.28,฀p=0.01).฀Moreover,฀ a฀ strong฀ inverse฀ relationship฀ existed฀ between฀ the฀ percent฀ increase฀ of฀ +dp/dt฀ and฀ improvement฀in฀synchrony฀with฀CRT฀as฀expressed฀by฀the฀ratio฀of฀MTD฀with฀CRT฀on฀to฀ CRT฀off฀(see฀graph,฀r2=-0.63,฀p<0.001). CONCLUSION:฀The฀acute฀change฀in฀LV฀synchrony฀measured฀by฀tissue฀Doppler฀can฀be฀ used฀to฀identify฀hemodynamic฀improvement฀early฀after฀CRT. Variable Age฀(years) Sex฀(%฀female) Body฀Mass฀Index฀(kg/m2) Hypertension฀(%) Diabetes฀(%) Ethnicity฀(%฀black) Total฀Cholesterol฀(mg/dl) AAP+/CAC46.0 57.1 29.2 34.5 10.2 57.9 183.3 AAP-/CAC+ 51.1 36.3 31.1 51.0 20.0 61.9 183.1 p฀value <0.01 <0.01 <0.01 <0.01 <0.01 0.40 0.96 Using฀ a฀ multivariate฀ logistic฀ regression฀ model,฀ correcting฀ for฀ classic฀ cardiovascular฀ variables,฀ the฀ AAP+/CAC-฀ group฀ was฀ associated฀ with฀ female฀ sex,฀ young฀ age,฀ positive฀ family฀ history฀ of฀ myocardial฀ infarction,฀ low฀ body฀ mass฀ index฀ and฀ low฀ high-density฀ lipoprotein฀levels.฀ Conclusions:฀ In฀ the฀ DHS,฀ AAP฀ is฀ present฀ in฀ younger฀ women฀ and฀ may฀ be฀ a฀ better฀ detector฀of฀atherosclerosis฀than฀CAC฀in฀this฀population.฀Thus,฀these฀differences฀should฀ be฀considered฀when฀applying฀atherosclerosis฀detection฀techniques฀in฀future฀populationbased฀and฀intervention฀studies. 4:30฀p.m. 821-5฀ Efficacy฀of฀Gadoversetamide฀Enhanced฀MRI฀for฀the฀ Diagnosis฀and฀Assessment฀of฀Myocardial฀Infarction:฀An฀ International,฀Multicenter,฀Double-Masked,฀Randomized,฀ Phase฀2฀Trial Raymond฀J.฀Kim,฀Timothy฀SE฀Albert,฀James฀H.฀Wible,฀Jr.,฀Michael฀D.฀Elliott,฀John฀C.฀ Allen,฀Jr.,฀Jennifer฀C.฀Lee,฀Alicia฀Napoli,฀Robert฀M.฀Judd,฀Duke฀Cardiovascular฀Magnetic฀ Resonance฀Center,฀Durham,฀NC,฀Tyco฀Healthcare฀/฀Mallinckrodt,฀St.฀Louis,฀MO BACKGROUND฀The฀diagnosis฀and฀assessment฀of฀myocardial฀infarction฀(MI)฀is฀important฀ for฀ therapeutic฀ and฀ prognostic฀ purposes.฀ We฀ prospectively฀ tested฀ the฀ efficacy฀ of฀ gadoversetamide฀enhanced฀MRI฀in฀patients฀(pts)฀with฀first฀MI. METHODS฀Pts฀were฀enrolled฀in฀an฀ACUTE฀arm฀(<=16฀d฀post฀MI),฀CHRONIC฀arm฀(17฀d฀-฀6฀ mo),฀or฀both;฀then฀randomized฀to฀1฀of฀4฀doses฀of฀masked฀gadoversetamide:฀0.05,฀0.1,฀0.2,฀ or฀0.3฀mmol/kg.฀Standard฀delayed฀enhancement฀MRI฀was฀performed฀precontrast฀(control),฀ and฀ 10฀ and฀ 30฀ mins฀ postcontrast.฀ For฀ masked฀ analysis,฀ pre-฀ and฀ postcontrast฀ MRIs฀ Noninvasive Imaging Background:฀ Abdominal฀ aortic฀ plaque฀ (AAP)฀ by฀ magnetic฀ resonance฀ imaging฀ and฀ coronary฀ artery฀ calcium฀ (CAC)฀ are฀ two฀ methods฀ for฀ detection฀ of฀ atherosclerosis.฀ AAP฀ was฀compared฀to฀CAC฀in฀the฀Dallas฀Heart฀Study฀(DHS),฀a฀population-based,฀multi-ethnic฀ cohort.฀We฀ tested฀ the฀ hypothesis฀ that฀ individuals฀ with฀ AAP฀ differ฀ from฀ those฀ with฀ CAC.฀ Methods:฀AAP฀was฀compared฀to฀CAC฀in฀2514฀DHS฀participants.฀Images฀of฀the฀abdominal฀ aorta฀ at฀ 1.5T฀ were฀ obtained฀ using฀ a฀ gated,฀T2฀ weighted,฀ black฀ blood฀ sequence.฀ AAP฀ positive฀(AAP+)฀was฀defined฀as฀either฀areas฀of฀hyper-intense฀signal฀or฀luminal฀protrusion.฀ Electron฀ beam฀ computed฀ tomography฀ CAC฀ score฀ ≥฀ 10฀ Agatston฀ units฀ was฀ considered฀ positive฀(CAC+).฀ Results:฀ 912฀ individuals฀ (40.3%)฀ were฀ AAP+,฀ 466฀ (20.6%)฀ were฀ CAC+,฀ and฀ 1190฀ (52.6%)฀ were฀ negative฀ for฀ both.฀ Using฀ univariate฀ analysis,฀ the฀ AAP+/CAC-฀ group฀ was฀ associated฀with฀female฀sex,฀younger฀age,฀lower฀body฀mass฀index,฀less฀hypertension฀and฀ less฀diabetes: 288A ABSTRACTS - Noninvasive Imaging JACC were฀separated,฀randomized,฀then฀scored฀for฀hyperenhanced฀regions฀by฀3฀independent฀ readers฀not฀associated฀with฀the฀study.฀The฀infarct-related-artery฀(IRA)฀perfusion฀territory฀ was฀scored฀from฀the฀masked฀x-ray฀angios฀at฀a฀separate฀core฀lab. RESULTS฀ 514฀ pts฀ (54±11฀ yrs,฀ 76%฀ M)฀ had฀ 566฀ scans฀ performed฀ in฀ 22฀ centers฀ using฀ commercially฀available฀scanners฀from฀all฀major฀vendors.฀None฀of฀the฀scans฀were฀removed฀from฀ the฀analysis฀because฀of฀image฀quality.฀The฀MI฀detection฀rate฀was฀markedly฀higher฀(p<0.0001)฀ postcontrast฀(e.g.฀99%฀ACUTE;฀95%฀CHRONIC฀at฀0.3฀dose)฀than฀precontrast฀(<17%,฀TABLE).฀ When฀ MI฀ was฀ identified฀ postcontrast,฀ the฀ readers฀ detected฀ the฀ MI฀ in฀ the฀ correct฀ location฀ (matched฀to฀IRA)฀in฀94-100%฀of฀cases.฀Peak฀CKMB฀and฀Troponin฀levels฀correlated฀significantly฀ with฀infarct฀size฀determined฀by฀MRI฀for฀doses฀above฀0.05฀mmol/kg฀(p<0.001). CONCLUSION฀Gadoversetamide฀enhanced฀MRI฀is฀highly฀effective฀in฀the฀diagnosis฀and฀ assessment฀of฀MI฀independent฀of฀infarct฀age. Sensitivity฀(%)฀of฀Gadoversetamide฀for฀the฀Detection฀of฀MI฀ Dose฀(mmol/kg) PreContrast฀(%) PostContrast 10฀min฀(%) PostContrast 30฀min฀(%) ACUTE,฀n=282 0.05 0.1 0.2 0.3 14.4 50.7 47.3 13.2 16.9 13.7 89.3 95.6 99.1 85.3 93.0 99.6 CHRONIC,฀n=284 0.05 0.1 0.2 0.3 6.2 53.2 44.8 3.2 8.1 9.8 83.8 88.7 95.2 73.0 86.3 93.5 821-8฀ Detection฀of฀Right฀Ventricular฀Infarction฀by฀Cardiac฀ Magnetic฀Resonance฀Imaging David฀Ian฀Paterson,฀Alex฀Natanzon,฀Breno฀Pessahna,฀Andrew฀E.฀Arai,฀National฀Institutes฀ of฀Health,฀Bethesda,฀MD Cardiac฀MRI:฀Infarct฀Size฀is฀an฀Independent฀Predictor฀of฀ Mortality฀in฀Patients฀With฀Coronary฀Artery฀Disease David฀Bello,฀Rishi฀Kaushal,฀David฀Fieno,฀Michael฀Radin,฀Emanuel฀Shaoulian,฀Jagat฀ Narula,฀Jeffrey฀Goldberger,฀Alan฀Kadish,฀Kalnayam฀Shivkumar,฀University฀of฀California฀ at฀Irvine,฀Irvine,฀CA,฀Northwestern฀University,฀Chicago,฀IL Noninvasive Imaging Segments฀were฀considered฀to฀be฀viable฀if฀showing฀<฀25%฀HE.฀LV฀ejection฀fraction฀(EF)฀ was฀determined฀by฀planimetry.฀Serial฀clinical฀follow-up฀was฀obtained฀in฀all฀patients฀(mean฀ follow-up฀ 2.5±1.3฀ years)฀ regarding฀ occurence฀ of฀ cardiac฀ death,฀ death฀ attributable฀ to฀ any฀ cause,฀ myocardial฀ infarction,฀ myocardial฀ revascularization,฀ and฀ unstable฀ angina฀ or฀ congestive฀ heart฀ failure฀ requiring฀ hospitalization.฀ Patient-related฀ and฀ CMR฀ data฀ were฀ analyzed฀in฀a฀multivariate฀Cox฀regression฀model. Results:฀Among฀the฀102฀patients,฀there฀were฀11฀cardiac฀deaths฀and฀reinfarctions฀in฀the฀ follow-up฀period,฀additionally฀there฀were฀26฀patients฀with฀myocardial฀revascularization฀or฀ hospitalization฀due฀to฀unstable฀angina฀or฀congestive฀heart฀failure.฀Patients฀with฀events฀at฀ follow-up฀showed฀significantly฀lower฀EF฀(45.3±12.7฀vs.฀37.7±14.3,฀p฀=฀0.006)฀than฀patients฀ without฀events.฀In฀patients฀with฀cardiac฀deaths฀or฀reinfarction,฀the฀dysfunctional฀area฀by฀ CMR฀(0.65฀vs.฀0.48,฀p฀=฀0.08)฀and฀the฀dysfunctional฀but฀viable฀area฀by฀CMR฀(0.16฀vs.฀0.27,฀ p฀=฀0.008)฀was฀significantly฀higher฀than฀in฀patients฀without฀such฀events.฀By฀multivariate฀ analysis฀EF฀(hazard฀ratio฀0.98,฀CI฀0.95฀to฀1.0,฀p฀=฀0.03)฀and฀the฀dysfunctional฀but฀viable฀ area฀by฀CMR฀(hazard฀ratio฀1.4,฀CI฀0.9฀to฀3.0,฀p฀=฀0.04)฀were฀related฀to฀occurence฀of฀future฀ events฀independent฀of฀the฀presence฀of฀risk฀factors฀for฀coronary฀arterosclerosis. Conclusions:฀In฀patients฀after฀reperfused฀acute฀MI,฀DE-CMR฀can฀be฀used฀to฀forecast฀ major฀adverse฀cardiac฀events. 5:15฀p.m. 4:45฀p.m. 821-6฀ February 1, 2005 Background:฀ Cardiac฀ magnetic฀ resonance฀ imaging฀ (CMRI)฀ can฀ accurately฀ determine฀ infarct฀size.฀Prior฀studies฀using฀indirect฀methods฀to฀assess฀infarct฀size฀have฀shown฀that฀ patients฀with฀larger฀myocardial฀infarctions฀(MI)฀have฀a฀worse฀prognosis฀than฀those฀with฀a฀ smaller฀MI.฀This฀study฀assessed฀the฀prognostic฀significance฀of฀infarct฀size฀by฀CMRI. Methods:฀Cine฀and฀contrast฀MRI฀were฀performed฀in฀patients฀with฀coronary฀artery฀disease฀ (CAD)฀undergoing฀routine฀cardiac฀evaluation. Results:฀100฀patients฀(mean฀age฀66±11฀years,฀87%฀male,฀23%฀with฀diabetes,฀49%฀with฀ hypertension,฀62%฀with฀prior฀MI,฀mean฀ejection฀fraction฀(EF)฀34±13%)฀underwent฀CMRI.฀ Mean฀ follow-up฀ was฀ 25±18฀ months฀ after฀ MRI,฀ during฀ which฀ time฀ 15฀ patients฀ died.฀ Cox฀ regression฀was฀used฀to฀estimate฀risk฀of฀death฀associated฀with฀traditional฀risk฀factors,฀heart฀ failure฀symptoms,฀EF,฀angiographic฀severity฀of฀CAD,฀and฀extent฀of฀infarct฀size.฀Evidence฀ of฀MI฀based฀on฀CMRI฀was฀present฀in฀91%฀of฀patients.฀The฀only฀two฀significant฀univariate฀ predictors฀ of฀ death฀ (all-cause)฀ were฀ evidence฀ of฀ infarction฀ greater฀ than฀ 15%฀ of฀ left฀ ventricular฀(LV)฀mass฀and฀extent฀of฀LV฀dysfunction฀based฀on฀EF฀(p<0.05).฀On฀multivariate฀ analysis,฀presence฀of฀MI฀>15%฀of฀LV฀mass฀was฀the฀single฀best฀independent฀predictor฀of฀ death฀(p=0.01)฀with฀an฀adjusted฀relative฀risk฀of฀9.9฀(95%฀CI฀1.6-63),฀figure฀1. Conclusions:฀The฀extent฀of฀MI฀determined฀by฀CMRI฀is฀an฀independent฀predictor฀of฀death฀ in฀patients฀with฀CAD. Figure฀1:฀Survival฀curve฀for฀patients฀with฀infarct฀mass฀≤15%฀and฀>15%฀of฀LV฀mass Background:฀ Right฀ ventricular฀ (RV)฀ involvement฀ in฀ acute฀ inferior฀ wall฀ myocardial฀ infarction฀ (IMI)฀ is฀ difficult฀ to฀ diagnose฀ with฀ conventional฀ techniques.฀ However,฀ clinically฀ detected฀RV฀infarction฀has฀been฀shown฀to฀be฀associated฀with฀worse฀prognosis. Hypothesis:฀We฀hypothesized฀that฀cardiac฀MRI฀(CMR)฀will฀detect฀clinically฀unsuspected฀ right฀ventricular฀involvement฀in฀patients฀with฀acute฀IMI. Methods:฀ 45฀ consecutive฀ patients฀ (36฀ male,฀ mean฀ age฀ 60)฀ with฀ first-time฀ acute฀ IMI฀ underwent฀ CMR฀ in฀ a฀ community฀ hospital.฀ Imaging฀ consisted฀ of฀ steady฀ state฀ free฀ precession฀cine฀MRI฀(FIESTA)฀and฀contrast-enhanced฀inversion-recovery฀fast฀gradientrecalled฀ echo฀ for฀ infarct฀ detection.฀ Left฀ and฀ right฀ ventricular฀ volumes,฀ ejection฀ fractions฀ (EF)฀and฀regional฀wall฀motion฀abnormalities฀were฀specifically฀evaluated.฀Readers฀blinded฀ to฀the฀CMR฀results฀performed฀chart฀reviews฀on฀all฀patients.฀Outcomes฀measured฀included฀ in-hospital฀mortality฀and฀length฀of฀stay. Results:฀ Right฀ ventricular฀ involvement฀ was฀ detected฀ by฀ CMR฀ (RV+/CMR)฀ in฀ 10฀ of฀ 45฀ patients฀ with฀ acute฀ IMI฀ but฀ was฀ only฀ clinically฀ suspected฀ in฀ 2฀ (p=0.01).฀ RV฀ delayed฀ enhancement฀was฀present฀in฀8฀and฀RV฀wall฀motion฀abnormalities฀in฀an฀additional฀2.฀9฀of฀ these฀10฀patients฀underwent฀echocardiography฀however฀an฀RV฀abnormality฀was฀revealed฀ in฀only฀1฀case.฀Older฀age฀(p=0.03)฀and฀diabetes฀(p=.0.054)฀were฀more฀common฀in฀the฀ RV+/CMR฀ group฀ than฀ the฀ RV-/CMR฀ group.฀ Mean฀ blood฀ pressure฀ at฀ presentation,฀ peak฀ cardiac฀ enzyme฀ rise฀ and฀ the฀ presence฀ of฀ ST฀ elevation฀ were฀ similar฀ in฀ both฀ groups.฀ At฀ cardiac฀catheterization,฀the฀prevalence฀of฀significant฀stenoses฀of฀the฀proximal฀or฀mid฀right฀ coronary฀artery฀as฀well฀as฀the฀rate฀of฀angioplasty฀and฀stent฀deployment฀were฀also฀similar฀ between฀ RV+/CMR฀ and฀ RV-/CMR฀ patients.฀ CMR฀ revealed฀ similar฀ LVEF,฀ left฀ ventricular฀ volume฀and฀right฀ventricular฀volume฀but฀RVEF฀was฀significantly฀decreased฀in฀the฀RV+/ CMR฀group฀(52%฀vs.฀60%,฀p฀<฀0.001).฀Length฀of฀stay฀was฀similar฀in฀both฀groups,฀2.6฀days฀ vs.฀3฀days,฀and฀all฀patients฀survived฀to฀discharge. Conclusions:฀ RV฀ involvement฀ associated฀ with฀ acute฀ IMI฀ was฀ detected฀ 5฀ times฀ more฀ often฀by฀CMR฀than฀was฀clinically฀suspected.฀However,฀outcome฀in฀these฀subclinical฀RV฀ infarcts฀does฀not฀appear฀worse. ORAL฀CONTRIBUTIONS 823฀฀ Doppler฀Myocardial฀Imaging:฀฀ Here฀to฀Stay Monday,฀March฀07,฀2005,฀4:00฀p.m.-5:30฀p.m. Orange฀County฀Convention฀Center,฀Room฀304E 4:00฀p.m. 823-3฀ 5:00฀p.m. 821-7฀ Prognostic฀Value฀of฀Delayed฀Contrast-enhanced฀ Cardiovascular฀Magnetic฀Resonance฀in฀Patients฀with฀ Reperfused฀Acute฀Myocardial฀Infarction Matthias฀Regenfus,฀Christian฀Schlundt,฀Carolin฀Stingl,฀Johannes฀von฀Erffa,฀Robert฀ Krähner,฀Michaela฀Schmidt,฀Janice฀Hegewald,฀Werner฀Adler,฀Birgit฀Pucher,฀Werner฀G.฀ Daniel,฀FAU฀Erlangen-Nürnberg,฀Erlangen,฀Germany Background:฀ Delayed฀ contrast-enhanced฀ cardiovascular฀ magnetic฀ resonance฀ (DECMR)฀can฀be฀used฀to฀assess฀myocardial฀viability,฀its฀value฀for฀assessment฀of฀prognosis฀ after฀reperfused฀acute฀myocardial฀infarction฀(MI)฀is฀not฀known.฀We฀investigated฀whether฀ DE-CMR฀is฀able฀to฀determine฀cardiac฀prognosis฀in฀patients฀with฀reperfused฀acute฀MI. Methods:฀ 102฀ patients฀ (pts)฀ with฀ left฀ ventricular฀ (LV)฀ dysfunction฀ (EF฀ 42±8%)฀ were฀ examined฀on฀a฀1.5T฀scanner฀within฀6±3฀(4-10)฀days฀of฀an฀reperfused฀acute฀MI.฀Cine฀and฀ DE-CMR฀ (10฀ min฀ after฀ injection฀ of฀ 0.15฀ mmol/kg฀ Gd-DTPA)฀ was฀ acquired฀ and฀ scored฀ for฀regional฀wall฀thickening฀and฀contrast฀enhancement฀(HE)฀using฀a฀17-segment฀model.฀ Validation฀of฀a฀Novel฀Echocardiographic฀Method฀to฀ Assess฀Dyssynchrony Rebecca฀Andrews,฀Leo฀Polosajian,฀Eman฀Hamad,฀Anita฀Kelsey,฀Karoly฀Kazala,฀Ellison฀ Berns,฀Neal฀Lippman,฀Joseph฀Dell’Orfano,฀Richard฀Soucier,฀Saint฀Francis฀Medical฀ Center,฀Hartford,฀CT Background:฀ Cardiac฀ resynchronization฀ is฀ a฀ therapy฀ for฀ treating฀ CHF฀ in฀ patients฀ with฀ dyssynchrony.฀ QRS฀ duration฀ is฀ the฀ standard฀ marker฀ of฀ dyssynchrony.฀ A฀ significant฀ proportion฀ of฀ patients฀ with฀ conduction฀ delay฀ do฀ not฀ respond฀ to฀ this฀ therapy.฀ For฀ this฀ reason,฀ other฀ markers฀ of฀ dyssynchrony฀ have฀ been฀ proposed.฀ We฀ propose฀ a฀ simple,฀ reproducible฀ tissue฀ Doppler฀ measurement฀ (TDIm)฀ of฀ mitral฀ annular฀ motion฀ to฀ evaluate฀ ventricular฀dyssynchrony฀(VD).฀In฀normal฀hearts,฀the฀time฀to฀peak฀mitral฀annular฀velocity฀ (TMV)฀ should฀ be฀ uniform฀ across฀ the฀ annulus฀ and฀ patients฀ with฀ dyssynchrony฀ should฀ demonstrate฀non-uniform฀movement.฀We฀sought฀to฀validate฀this฀measurement฀in฀patients฀ with฀reduced฀ejection฀fraction฀(EF). Methods:฀ 46฀ patients฀ referred฀ for฀ trans-thoracic฀ echocardiography฀ underwent฀TDI฀ of฀ 4฀ separate฀points฀of฀the฀mitral฀annulus฀to฀assess฀VD.฀23฀pts฀had฀normal฀EF฀and฀23฀had฀ EF฀<฀40%.฀We฀defined฀a฀“dyssynergy฀index”฀(DI)฀representing฀the฀variation฀in฀(TMV)฀at฀ 4฀separate฀points. JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging Results:฀TDIm฀are฀shown฀below.฀Using฀a฀novel฀method฀of฀analysis,฀there฀is฀a฀significant฀ difference฀in฀VD฀in฀pts฀with฀normal,฀mean฀DI฀44฀+/-฀9,฀vs.฀abnormal฀EF,฀mean฀74฀+/-฀15,฀ (p฀value<0.001). 289A Conclusion:฀A฀new฀rapid฀and฀simple฀index฀of฀LV฀dyssynchrony฀strongly฀correlated฀with฀ multi-site฀standard฀deviation,฀previously฀shown฀to฀predict฀response฀to฀CRT฀in฀humans.฀ Color-coded฀strain฀dyssynchrony฀imaging฀has฀potential฀for฀clinical฀applications.฀ ฀ Conclusions:฀Our฀findings฀demonstrate฀a฀significant฀difference฀in฀the฀DI฀in฀normal฀patients฀ vs.฀ patients฀ with฀ reduced฀ EF.฀This฀ method฀ of฀VD฀ measurement฀ is฀ simple,฀ reproducible,฀ and฀obtained฀with฀standard฀echo฀measurements.฀This฀may฀improve฀patient฀selection฀for฀ biventricular฀pacing฀in฀patients฀with฀LV฀dysfunction฀and฀warrants฀further฀study. 4:45฀p.m. 4:15฀p.m. 823-4฀ Improvement฀of฀Left฀Ventricular฀Dyssynchrony฀ by฀Carvedilol฀Therapy฀in฀Patients฀with฀Idiopathic฀ Dilated฀Cardiomyopathy:฀Analysis฀using฀Strain฀ Echocardiography Yasuhiko฀Takemoto,฀Takeshi฀Hozumi,฀Kenichi฀Sugioka,฀Yoshiki฀Matsumura,฀Yasuhiro฀ Takagi,฀Keiji฀Ujino,฀Takashi฀Muro,฀Minoru฀Yoshiyama,฀Junichi฀Yoshikawa,฀Osaka฀City฀ University฀School฀of฀Medicine,฀Osaka,฀Japan EF฀(%) T฀peak CV฀of฀T฀peak฀(%) S฀peak CV฀of฀S฀peak฀(%) Before 1฀month 6฀months 29฀±฀7 13.6฀±฀1.4 18฀±฀5 -8.4฀±฀1.6 44฀±฀9 31฀±฀7 12.5฀±฀1.2# 15฀±฀6# -11.1฀±฀4.4# 50฀±฀24 38฀±฀11# 12.4฀±฀1.5# 14฀±฀6# -12.4฀±฀3.4# 34฀±฀17# Left฀Ventricular฀Longitudinal฀Diastolic฀Function฀And฀ Functional฀Reserve฀Are฀Reduced฀In฀Patients฀With฀End฀ Stage฀Renal฀Disease Jong-Won฀Ha,฀Shin-Wook฀Kang,฀Jin-Mi฀Kim,฀Jeong-Ah฀Ahn,฀Seok-Min฀Kang,฀Se-Joong฀ Rim,฀Namsik฀Chung,฀Yonsei฀University฀College฀of฀Medicine,฀Seoul,฀South฀Korea Abnormalities฀ of฀ the฀ left฀ ventricular฀ (LV)฀ diastolic฀ function฀ are฀ common฀ in฀ patients฀ with฀ end-stage฀ renal฀ disease฀ (ESRD).฀ In฀ patients฀ with฀ diastolic฀ dysfunction,฀ the฀ abnormal฀ relaxation฀ velocity-versus-heart฀ rate฀ relationship฀ prevents฀ augmentation฀ of฀ relaxation฀ velocity฀ as฀ heart฀ rate฀ increases฀ during฀ exercise.฀ Doppler฀ tissue฀ imaging฀ (DTI)฀ has฀ been฀ introduced฀ as฀ a฀ method฀ to฀ evaluate฀ diastolic฀ function฀ or฀ myocardial฀ relaxation฀ by฀ measuring฀ mitral฀ annulus฀ velocity฀ during฀ diastole.฀The฀ purpose฀ of฀ this฀ study฀ was฀ to฀ evaluate฀ resting฀ diastolic฀ function฀ and฀ diastolic฀ functional฀ reserve฀ during฀ exercise฀ in฀ patients฀with฀ESRD฀using฀conventional฀Doppler฀and฀DTI.฀Mitral฀inflow฀and฀septal฀mitral฀ annular฀ velocities฀ were฀ measured฀ at฀ rest฀ and฀ during฀ supine฀ bicycle฀ exercise฀ (25W,฀ 3฀ minutes฀ increments)฀ in฀ 22฀ patients฀ (15฀ male,฀ mean฀ age฀ 53฀ years)฀ with฀ ESRD฀ and฀ 29฀ patients฀(7฀male,฀mean฀age฀58฀years)฀with฀control.฀There฀were฀no฀significant฀differences฀in฀ mitral฀inflow฀velocities฀(E,฀E/A,฀DT)฀between฀the฀two฀groups฀except฀A฀velocity,฀which฀was฀ significantly฀higher฀in฀patients฀of฀ESRD.฀However,฀early฀diastolic฀mitral฀annular฀velocity฀ (E’)฀at฀rest฀and฀change฀of฀E’฀with฀exercise฀was฀significantly฀lower฀in฀patients฀with฀ESRD฀ compared฀ with฀ control.฀ In฀ conclusion,฀ unlike฀ conventional฀ mitral฀ inflow฀ parameters,฀ LV฀ longitudinal฀ resting฀ diastolic฀ function฀ and฀ diastolic฀ functional฀ reserve฀ during฀ exercise฀ assessed฀by฀DTI฀were฀significantly฀reduced฀in฀patients฀with฀ESRD.฀ 5:00฀p.m. 4:30฀p.m. 823-5฀ A฀New฀Rapid฀and฀Simple฀Index฀of฀Mechanical฀ Dyssynchrony฀by฀Color-Coded฀Strain฀Dyssynchrony฀ Imaging Kaoru฀Dohi,฀Michael฀R.฀Pinsky,฀Matthew฀S.฀Suffoletto,฀Donald฀A.฀Severyn,฀John฀Gorcsan,฀ III,฀University฀of฀Pittsburgh,฀Pittsburgh,฀PA Background:฀ Assessment฀ of฀ left฀ ventricular฀ (LV)฀ dyssynchrony฀ to฀ predict฀ response฀ to฀ cardiac฀ resynchronization฀ therapy฀ (CRT)฀ can฀ be฀ complex฀ and฀ time฀ consuming.฀ Our฀ objective฀was฀to฀test฀a฀rapid฀and฀simple฀index฀using฀the฀new฀technique฀of฀color-coded฀ strain฀dyssynchrony฀imaging. Methods:฀Ten฀open-chest฀dogs฀had฀mid-LV฀short฀axis฀views฀(Aplio฀80,฀Toshiba฀Corp)฀using฀ angle-corrected฀strain฀dyssynchrony฀imaging฀which฀color-codes฀time-to-peak฀radial฀strain฀in฀ real-time.฀Data฀were฀recorded฀during฀baseline฀and฀pacing฀at฀multiple฀sites฀to฀induce฀variable฀ degrees฀of฀dyssynchrony฀including฀the฀right฀ventricle฀to฀simulate฀left฀bundle฀branch฀block฀ (LBBB)฀ and฀ biventricular฀ (BIV)-pacing.฀The฀ new฀ dyssynchrony฀ index฀ was฀ defined฀ as฀ the฀ time฀difference฀from฀earliest฀to฀latest฀peak฀strain,฀and฀was฀compared฀to฀the฀6-site฀standard฀ deviation฀(Yu฀Index),฀previously฀shown฀to฀predict฀response฀to฀CRT฀in฀humans. Results:฀The฀LBBB฀model฀resulted฀in฀dyssynchrony฀(238±39฀ms,฀and฀36±29฀ms฀during฀ baseline)฀characterized฀by฀early฀peak฀strain฀in฀the฀anterior-septum฀and฀late฀peak฀strain฀ in฀the฀free฀wall.฀Dyssynchrony฀improved฀with฀BIV-pacing฀(49±24฀ms,฀p<0.005฀vs.฀LBBB฀ model).฀The฀ new฀ dyssynchrony฀ index฀ was฀ strongly฀ correlated฀ with฀ the฀ 6-site฀ standard฀ deviation฀(Yu฀Index),฀r=0.98. 823-7฀ Ischemia-Induced฀Increase฀in฀Myocardial฀Stiffness฀ Modulates฀Postsystolic฀Shortening Cristina฀Pislaru,฀Mayo฀Clinic฀College฀of฀Medicine,฀Rochester,฀MN Background:฀Postsystolic฀shortening฀(PSS)฀is฀a฀potential฀marker฀of฀myocardial฀viability.฀ In฀this฀study,฀we฀investigated฀the฀mechanism฀of฀the฀decrease฀in฀PSS฀during฀prolonged฀ ischemia. Methods:฀ Eight฀ pigs฀ were฀ subjected฀ to฀ 3h฀ of฀ LAD฀ occlusion฀ and฀ 2h฀ reperfusion฀ (transmural฀myocardial฀infarction).฀Segment฀length฀(SL)฀and฀LV฀chamber฀diameters฀were฀ measured฀ by฀ sonomicrometry.฀ Changes฀ in฀ myocardial฀ stiffness฀ were฀ evaluated฀ from฀ exponential฀diastolic฀stress-strain฀relationship฀by฀varying฀preload฀(caval฀constriction฀and฀ saline฀infusion)฀as฀well฀as฀by฀changes฀in฀regional฀passive฀deformation฀(late฀diastole;฀DA). Results฀ (mean±SE):฀ In฀ the฀ ischemic฀ segment,฀ PSS฀ increased฀ from฀ 2±1%฀ (baseline)฀ to฀ 16±2%฀ at฀ 5-15min฀ occlusion฀ (Fig.A);฀ thereafter,฀ it฀ gradually฀ decreased฀ (4±1%฀ at฀ 3h฀ occlusion).฀Temporal฀ changes฀ in฀ PSS฀ were฀ strongly฀ related฀ to฀ changes฀ in฀ DA(R2=0.96,฀ P<0.0001).฀ LV฀ diameters฀ and฀ DA฀ of฀ normal฀ segment฀ remained฀ constant.฀ The฀ onset฀ of฀ ischemic฀contracture฀(decrease฀in฀end-diastolic฀SL฀during฀occlusion;฀onset฀at฀40±8min;฀ full฀ effect฀ within฀ 30min)฀ accelerated฀ the฀ decline฀ in฀ PSS฀ and฀ DA฀ magnitudes฀ (Fig.A).฀ Contracture฀ and฀ edema฀ formation฀ were฀ responsible฀ for฀ leftward฀ shifts฀ in฀ stress-strain฀ relationship฀ towards฀ increased฀ myocardial฀ stiffness฀ (Fig.B).฀ Water฀ content฀ (tissue฀ samples)฀was฀higher฀in฀reperfused฀infarcts฀(p<0.0001฀vs.฀normal). Conclusions:฀Changes฀in฀PSS฀during฀prolonged฀ischemia฀reflect฀changes฀in฀myocardial฀ viscoelasticity฀brought฀by฀ischemic฀contracture฀and฀myocardial฀edema. Noninvasive Imaging Background:฀Many฀studies฀have฀reported฀beneficial฀effects฀of฀cardiac฀resynchronization฀ therapy฀using฀biventricular฀pacing฀in฀patients฀(pts)฀with฀idiopathic฀dilated฀cardiomyopathy฀ (IDC)฀and฀dyssynchronous฀wall฀motion฀abnormality.฀While฀carvedilol฀has฀been฀reported฀to฀ be฀favorable฀in฀these฀pts,฀precise฀mechanisms฀of฀its฀beneficial฀effects฀are฀still฀undefined.฀ Strain฀echocardiography฀(SE)฀accurately฀depicts฀myocardial฀mechanical฀activity฀and฀can฀ be฀used฀to฀interrogate฀segmental฀ventricular฀systolic฀function.฀The฀purpose฀of฀this฀study฀ was฀to฀evaluate฀the฀effects฀of฀carvedilol฀on฀segmental฀left฀ventricular฀(LV)฀systolic฀function฀ and฀dyssynchrony฀using฀SE฀in฀pts฀with฀IDC. Methods:฀ SE฀ (GE฀ViVid฀ 7)฀ was฀ performed฀ in฀ 12฀ pts฀ with฀ IDC฀ before,฀ 1฀ month฀ and฀ 6฀ months฀after฀administration฀of฀carvedilol.฀Regional฀myocardial฀contraction฀was฀evaluated฀ by฀measuring฀both฀value฀of฀peak฀systolic฀strain฀(S฀peak)฀and฀time฀from฀ECG฀R฀to฀peak฀ systolic฀strain฀corrected฀by฀square฀root(RR)฀(T฀peak)฀at฀mid฀and฀basal฀segments฀of฀all฀6฀ LV฀walls.฀The฀coefficient฀of฀variation฀(CV)฀of฀both฀S฀peak฀and฀T฀peak฀was฀calculated฀as฀an฀ index฀of฀dyssynchrony฀of฀LV฀contraction. Results:฀Table฀shows฀the฀results฀obtained฀from฀SE฀before,฀1฀month฀and฀6฀months฀after฀ administration฀of฀carvedilol฀(#฀p฀<฀0.05฀vs.฀Before). Conclusion:฀SE฀analyses฀showed฀that฀not฀only฀abolishing฀the฀intersegmental฀differences฀ in฀duration฀of฀systole฀but฀also฀restoration฀of฀mechanical฀segmental฀synchrony฀was฀crucial฀ for฀recovery฀of฀global฀LV฀systolic฀function฀by฀carvedilol฀therapy. 823-6฀ 290A ABSTRACTS - Noninvasive Imaging JACC February 1, 2005 Conclusions:฀Our฀results฀show฀a฀higher฀incidence฀of฀microvascular฀obstruction฀compared฀ to฀previous฀studies฀because฀we฀covered฀the฀entire฀left฀ventricle฀with฀high฀spatial฀resolution฀ immediately฀after฀contrast฀injection.฀Delayed฀measurements฀underestimate฀the฀no-reflow฀ zones,฀ because฀ the฀ extent฀ significantly฀ decreases฀ over฀ time.฀ However,฀ DE฀ imaging฀ requires฀a฀delay฀of฀at฀least฀10฀minutes. 8:45฀a.m. 834-4฀ 5:15฀p.m. 823-8฀ Abnormal฀Left฀Ventricular฀Longitudinal฀Contractile฀ Reserve฀In฀The฀Presence฀Of฀Hyperdynamic฀ Radial฀Contraction฀In฀Patients฀With฀Hypertrophic฀ Cardiomyopathy:฀Assessment฀With฀Pulsed-wave฀Tissue฀ Doppler฀Exercise฀Echocardiography Noninvasive Imaging Jong-Won฀Ha,฀Namsik฀Chung,฀Jin-Mi฀Kim,฀Jeong-Ah฀Ahn,฀Seok-Min฀Kang,฀Se-Joong฀ Rim,฀Yangsoo฀Jang,฀Won-Heum฀Shim,฀Seung-Yun฀Cho,฀Yonsei฀University฀College฀of฀ Medicine,฀Seoul,฀South฀Korea Background:฀In฀patients฀with฀hypertrophic฀cardiomyopathy฀(HCM),฀global฀left฀ventricular฀ (LV)฀systolic฀function฀appears฀normal฀or฀hyperdynamic฀when฀assessed฀with฀conventional฀ radial฀contractile฀parameters,฀such฀as฀fractional฀shortening฀or฀ejection฀fraction฀(EF).฀LV฀ longitudinal฀contraction฀results฀in฀apical฀displacement฀of฀the฀mitral฀annulus฀and฀it฀can฀be฀ quantified฀using฀pulsed฀wave฀tissue฀Doppler฀imaging.฀Since฀pathologic฀LV฀hypertrophy฀is฀ associated฀with฀myocardial฀fibrosis,฀particularly฀in฀the฀subendocardium,฀we฀hypothesized฀ that฀mitral฀annular฀systolic฀velocity฀(S’)฀at฀rest฀and฀during฀exercise฀would฀be฀abnormal฀in฀ patients฀with฀HCM.฀ Methods฀and฀Results:฀S’฀was฀measured฀at฀rest฀and฀during฀graded฀supine฀bicycle฀exercise฀ (25W,฀3฀minutes฀increments)฀in฀20฀patients฀(16฀male,฀mean฀age฀55฀years)฀with฀HCM฀and฀ 43฀ patients฀ (14฀ male,฀ mean฀ age฀ 57฀ years)฀ with฀ control.฀ LVEF฀ was฀ calculated฀ from฀ the฀ echocardiographic฀m-mode฀from฀short฀axis฀image.฀LVEF฀at฀rest฀was฀significantly฀higher฀ in฀patients฀with฀HCM฀compared฀with฀that฀of฀control฀(71±7฀vs฀66±9%,฀p=0.0098).฀Although฀ there฀was฀no฀significant฀difference฀in฀S’฀at฀rest฀between฀the฀groups฀(5.9±1.3฀vs฀6.3±1.2฀ cm/s,฀p=0.32),฀S’฀during฀exercise฀(6.4+1.5฀vs฀7.9+2.4฀cm/s฀at฀25฀W,฀p=0.005;฀7.0+1.4฀vs฀ 9.1+2.0฀cm/s฀at฀50฀W,฀p<0.0001)฀and฀change฀of฀S’฀with฀exercise฀(0.5+0.9฀vs฀1.6+1.8฀cm/s฀ from฀base฀to฀25W,฀p=0.003;฀0.9+1.2฀vs฀2.7+1.6฀cm/s฀from฀base฀to฀50W,฀p<0.0001)฀was฀ significantly฀lower฀in฀patients฀with฀HCM฀compared฀with฀control.฀In฀conclusion,฀even฀though฀ radial฀contraction฀is฀more฀vigorous฀in฀patients฀with฀HCM,฀their฀longitudinal฀contraction฀and฀ contractile฀reserve฀during฀exercise฀is฀reduced.฀The฀assessment฀of฀longitudinal฀function฀ should฀ be฀ incorporated฀ for฀ the฀ comprehensive฀ evaluation฀ of฀ LV฀ systolic฀ function฀ and฀ maybe฀the฀better฀parameter฀for฀earlier฀detection฀of฀LV฀contractile฀dysfunction. Duration฀Of฀Ischemia฀Is฀A฀Major฀Determinant฀Of฀ Transmurality฀And฀Microvascular฀Obstruction฀Assessed฀ By฀Magnetic฀Resonance฀After฀Primary฀Angioplasty Giuseppe฀Tarantini,฀Luisa฀Cacciavillani,฀Angelo฀Ramondo,฀Massimo฀Napodano,฀ Francesco฀Corbetti,฀Claudio฀Bilato,฀Martina฀Perazzolo,฀Enrico฀Bacchiega,฀Renato฀ Razzolini,฀Sabino฀Iliceto,฀University฀of฀Padova,฀Padova,฀Italy Background:฀ Late฀ reperfusion฀ results฀ in฀ less฀ myocardial฀ salvage฀ and฀ higher฀ mortality,฀ irrespective฀of฀the฀chosen฀reperfusion฀strategy.฀The฀impact฀of฀ischemic฀time฀on฀the฀extent฀ of฀ myocardial฀ and฀ microvascular฀ injury,฀ is฀ not฀ well฀ characterized.฀ Aims:฀ to฀ address฀ the฀ relationship฀between฀duration฀of฀ischemia฀and฀both฀transmural฀myocardial฀necrosis฀(TN)฀ and฀microvascular฀obstruction฀(MO),฀by฀contrast-enhanced฀magnetic฀resonance฀(CE-MR),฀ in฀patients฀with฀acute฀myocardial฀infarction฀(AMI)฀treated฀with฀primary฀angioplasty฀(PCI)฀and฀ to฀estimate฀the฀risk฀of฀TN฀and฀MO฀obstruction฀for฀each฀30-minute฀delay฀in฀treatment. Methods:฀ Sixty-four฀ patients฀ presenting฀ first฀ ST-segment฀ elevation฀ AMI,฀ within฀ 12฀ hours฀ from฀symptom฀onset,฀and฀treated฀by฀PCI฀because฀of฀TIMI฀flow฀<3฀of฀infarct฀related฀artery฀ underwent฀CE-MR฀within฀5±3฀days.฀AMI฀was฀defined฀as฀TN฀if฀CE-MR฀hyperenhancement฀ was฀ extended฀ to฀ at฀ least฀ 75%฀ of฀ the฀ wall฀ thickness฀ ≥฀ 2฀ ventricular฀ segments;฀ MO฀ was฀ identified฀as฀discrete฀areas฀of฀hypo-enhancement฀surrounded฀by฀hyper-enhanced฀regions. Results:฀Mean฀pain฀to฀balloon฀time฀was฀90±40,฀110฀±฀107,฀137฀±฀97฀minutes฀in฀patients฀ with฀ no฀ TN฀ and฀ MO,฀ with฀ only฀ TN฀ or฀ with฀ TN฀ and฀ MO,฀ respectively.฀ By฀ multivariate฀ regression฀ analysis,฀ each฀ 30-minute฀ delay฀ was฀ significantly฀ associated฀ both฀ with฀ TN฀ (odds฀ ratio฀ (OR)/30฀ minutes,฀ 1.37,฀ 95%CI฀ 1.03-1.8฀ p=0.03),฀ and฀ MO฀ (OR/30฀ minutes,฀ 1.21;฀95%CI฀1.03-1.4฀,p=0.02)฀(Figure). Conclusion:฀In฀AMI฀patients฀treated฀by฀PCI,฀every฀minute฀delay฀in฀reperfusion฀increases฀ the฀risk฀of฀TN฀and฀MO. ORAL฀CONTRIBUTIONS 834฀฀ Contrast-Enhanced฀Magnetic฀ Resonance฀Imaging:฀Assessment฀of฀ Microvascular฀Damage฀and฀Infarction 9:00฀a.m. Tuesday,฀March฀08,฀2005,฀8:30฀a.m.-10:00฀a.m. Orange฀County฀Convention฀Center,฀Room฀414A 834-5฀ 8:30฀a.m. 834-3฀ Delayed฀Contrast฀Enhancement฀and฀No-Reflow฀ Phenomenom฀in฀Acute฀Myocardial฀Infarction Oliver฀Bruder,฀Kai฀U.฀Waltering,฀Markus฀Jochims,฀Peter฀Hunold,฀Georg฀V.฀Sabin,฀Jörg฀ Barkhausen,฀University฀Hospital,฀Essen,฀Germany,฀Elisabeth฀Hospital,฀Essen,฀Germany Background:฀After฀acute฀infarction,฀microvascular฀obstruction฀detected฀by฀MRI฀predicts฀more฀ frequent฀cardiovascular฀complications.฀Aim฀of฀our฀study฀was฀to฀investigate฀the฀optimum฀timepoint฀for฀assessment฀of฀no-reflow฀zones฀and฀the฀area฀of฀delayed฀contrast฀enhancement. Method฀and฀Materials:฀41฀patients฀(31฀male,฀10฀female,฀mean฀age฀58±13฀years)฀with฀ first฀acute฀ST-elevation฀myocardial฀infarction฀(MI)฀were฀included฀into฀the฀study.฀All฀patients฀ underwent฀percutaneous฀coronary฀intervention฀resulting฀in฀TIMI฀grade฀3฀flow.฀MR฀imaging฀ was฀performed฀on฀a฀1.5T฀MR-system฀2.8±1.8฀days฀after฀MI.฀One,฀2,฀3,฀5,฀10,฀15฀and฀20฀ minutes฀after฀Gadodiamide฀injection฀(0.2฀mmol/kg฀BW,฀Omniscan,฀Amersham)฀the฀entire฀ left฀ventricle฀was฀covered฀in฀a฀single฀breath-hold฀using฀a฀single฀shot฀inversion-recovery฀ steady฀state฀free฀precession฀(IR-SSFP)฀sequence฀(TR฀2.4฀ms,฀TE฀1.1฀ms,฀FA฀50°).฀The฀ area฀of฀delayed฀enhancement฀(DE)฀and฀the฀no-reflow฀zone฀were฀measured฀by฀planimetry฀ for฀all฀different฀time฀points฀after฀contrast฀administration. Results:฀The฀ IR-SSFP฀ sequence฀ demonstrated฀ DE฀ of฀ the฀ anterior฀ wall฀ in฀ 19฀ and฀ the฀ infero-lateral฀wall฀in฀22฀patients.฀The฀mean฀infarct฀size฀defined฀as฀area฀of฀DE฀continuously฀ increased฀ within฀ the฀ first฀ 10฀ minutes฀ from฀ 13.3±13.2%฀ to฀ 18.5±14.0%฀ at฀ 10฀ min฀ post฀ contrast฀ and฀ remained฀ unchanged฀ thereafter.฀ Immediately฀ after฀ contrast฀ injection฀ noreflow฀areas฀were฀detected฀in฀26฀patients฀(63.4%)฀with฀a฀mean฀infarct฀size฀of฀24.1±14.2%฀ of฀LV฀mass.฀Only฀15฀patients฀with฀smaller฀infarct฀size฀(6.0±7.3%฀of฀LV฀mass)฀showed฀no฀ microvascular฀obstruction.฀The฀extent฀of฀the฀no-reflow฀zones฀significantly฀decreased฀over฀ time฀(11.6±8.6%฀at฀1฀min฀p.i.฀to฀4.1±5.8%฀at฀20฀min฀p.i.). Extent฀of฀Microvascular฀Obstruction฀Predicts฀Left฀ Ventricular฀Remodelling฀in฀Reperfused฀Myocardial฀ Infarction฀More฀Than฀Infarct฀Size:฀Study฀by฀Contrast฀ Magnetic฀Resonance฀Imaging. Antonella฀Lombardo,฀Luigi฀Natale,฀Francesca฀Gabrielli,฀Alessandra฀Porcelli,฀Gaetano฀ Lanza,฀Leonarda฀Galiuto,฀Vittoria฀Rizzello,฀Lorenzo฀Bonomo,฀Filippo฀Crea,฀Catholic฀ University,฀Rome,฀Italy Background:฀ left฀ ventricular฀ (LV)฀ remodelling฀ is฀ crucial฀ in฀ clinical฀ outcome฀ after฀ acute฀ myocardial฀infarction฀(AMI).฀Infarct฀size,฀microvascular฀obstruction฀(MO)฀and฀myocardial฀ viability฀are฀involved฀in฀the฀process฀of฀remodelling.฀However,฀the฀individual฀role฀of฀each฀ of฀these฀components฀is฀unknown.฀Gadolinium-enhanced฀Magnetic฀Resonance฀Imaging฀ (Gd-MRI)฀allows฀to฀detect฀tissue฀edema฀of฀the฀infarct฀zone,฀MO฀(first-pass฀and/or฀delayed฀ hypoenhancement)฀and฀infarct฀size฀(delayed฀hyperenhancement).฀Aim฀of฀this฀study฀was฀ to฀assess฀the฀role฀of฀MO฀and฀infarct฀size฀in฀the฀LV฀remodelling. Methods:฀25฀patients฀with฀AMI฀reperfused฀by฀primary฀coronary฀stenting฀(22฀with฀TIMI฀3฀and฀ 4฀with฀TIMI฀2฀flow)฀were฀studied.฀End-diastolic฀(EDV)฀and฀end-systolic฀(ESV)฀LV฀volumes฀ were฀assessed฀by฀Simpson’s฀method฀on฀echocardiography฀within฀24฀hours฀and฀at฀1-month฀ follow-up.฀A฀>20%฀increase฀of฀EDV฀and/or฀ESV฀was฀considered฀indicative฀of฀LV฀remodelling.฀ MRI฀was฀performed฀within฀3฀days฀with฀a฀1.5฀T฀scanner,฀using฀triple฀IR-prep฀fast฀spin฀echo฀ sequence฀for฀edema฀evaluation,฀steady-state฀free฀precession฀cine฀sequence฀(FIESTA)฀for฀ contractile฀function,฀fast-gradient฀echo฀train฀for฀first-pass฀perfusion฀study฀and฀IR-prep฀fast฀ gradient฀echo฀for฀delayed฀enhancement฀assessment.฀For฀first-pass฀study,฀gadolinium-DTPA฀ was฀administered฀at฀dosage฀of฀0.075฀mmol/Kg฀(3฀ml/sec)฀and฀repeated฀at฀the฀end฀of฀firstpass฀ imaging.฀ Delayed฀ enhancement฀ was฀ evaluated฀ after฀ 15฀ min.฀ Extent฀ of฀ edema,฀ MO฀ and฀hyperenhancement฀were฀evaluated฀using฀a฀score฀index฀on฀the฀basis฀of฀their฀transmural฀ extension฀(<25%,฀25-50%,฀50-75%,฀>75%)฀in฀each฀segment฀of฀a฀17-segments฀LV฀model. Results:฀ at฀ follow-up฀ 11฀ patients฀ had฀ LV฀ remodelling.฀ EDV฀ and฀ ESV฀ increased฀ from฀ 106±30฀ml฀to฀153±36฀ml฀and฀from฀60±17฀ml฀to฀91±23฀ml฀respectively฀in฀patients฀with฀LV฀ JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging remodelling.฀ MO฀ was฀ detected฀ in฀ 22฀ patients฀ (88%).฀The฀ score฀ indexes฀ for฀ edema,฀ MO฀ and฀ hyperenhancement฀ were฀ 4.0±1.6,฀ 2.4±1.1,฀ 3.3±1.6฀ respectively฀ in฀ patients฀ with฀ LV฀ remodelling฀and฀2.9±2.2฀(p:฀NS),฀1.4±0.9฀(p:฀0.04),฀2.6±1.7฀(p:฀NS)฀respectively฀in฀patients฀ without฀LV฀remodelling.฀Conclusions:฀In฀reperfused฀AMI฀Gd-MRI฀detects฀an฀high฀incidence฀ of฀MO.฀The฀effects฀of฀MO฀on฀LV฀remodelling฀are฀stronger฀than฀those฀of฀infarct฀size. 9:15฀a.m. 834-6฀ Human฀Infarct฀Scar฀Formation฀at฀7฀Months฀is฀Related฀to฀ the฀Presence฀and฀Extent฀of฀Microvacular฀Obstruction฀ Acutely.฀A฀Magnetic฀Resonance฀Imaging฀Study. Andre฀Schmidt,฀Caterina฀Silva,฀Clerio฀Azevedo,฀Sandeep฀Gupta,฀David฀A.฀Bluemke,฀Thomas฀ K.฀Foo,฀Joao฀A.C.฀Lima,฀Katherine฀C.฀Wu,฀Johns฀Hopkins฀University,฀Baltimore,฀MD Acute฀myocardial฀infarcts฀(AMI)฀by฀contrast฀enhanced฀imaging฀(ceMRI)฀shrink฀over฀time฀as฀ scar฀healing฀occurs.฀Particularly฀in฀larger฀infarcts,฀this฀shrinkage฀can฀lead฀to฀thinner฀scar฀ and฀adversely฀affect฀LV฀remodeling,฀as฀shown฀in฀animal฀studies.฀The฀presence฀or฀absence฀ of฀microvascular฀obstruction฀(MO)฀relates฀to฀thinner฀scar฀and฀adverse฀LV฀remodeling฀after฀ AMI฀because฀of฀regional฀changes฀in฀myocardial฀deformation.฀The฀relation฀between฀acute฀ MO฀extent฀and฀extent฀of฀infarct฀shrinkage฀has฀not฀been฀previously฀examined. METHODS:฀44฀patients฀underwent฀ceMRI฀3.3±2.7฀days฀after฀first฀MI฀and฀7฀months฀later.฀ MO฀extent฀was฀measured฀on฀first฀pass฀perfusion฀images฀using฀a฀hybrid฀echo-planar฀fast฀ gradient฀echo฀(FGRE)฀sequence฀after฀0.1฀mmol/kg฀Gadodiamide.฀A฀second฀0.1฀mmol/kg฀ bolus฀was฀given฀and฀on฀delayed฀enhancement฀images฀using฀inversion฀recovery฀FGRE,฀ infarct฀ size฀ (IS)฀ was฀ measured฀ using฀ custom฀ software฀ (CINE฀Tool,฀ GE)฀ .฀ Patients฀ were฀ grouped฀by฀MO฀extent฀expressed฀as฀%฀of฀total฀LV฀mass฀(Group฀I:฀no฀MO,฀n=8;฀Group฀II:฀ <15%,฀n=24;฀Group฀III:฀≥15%,฀n=12).฀ANOVA฀comparisons฀were฀used. RESULTS:฀MO฀extent฀in฀the฀3฀groups฀was฀0%,฀7.8±3.7%,฀and฀21.3±5.4%,฀respectively.฀ At฀ 7฀ months,฀ absolute฀ change฀ in฀ IS฀ mass฀ was฀ -2.7±3.0g,฀ -14.1±9.2g,฀ and฀ -26.3±16.9g,฀ respectively฀(ANOVA฀<0.0001)฀with฀significant฀between฀groups฀differences฀(p<0.05฀for฀all). CONCLUSIONS:฀ Absence฀ of฀ MO฀ predicts฀ very฀ little฀ reduction฀ of฀ IS฀ at฀ 7฀ months.฀The฀ presence฀and฀extent฀of฀MO฀correlates฀directly฀with฀IS฀shrinkage.฀ 291A 9:45฀a.m. 834-8฀ Cardiac฀Magnetic฀Resonance฀Imaging฀Detects฀Acute฀ Right฀Ventricular฀Myocardial฀Infarction Andreas฀Kumar,฀Hassan฀Abdel-Aty,฀Ilka฀Kriedemann,฀Jeanette฀Schulz-Menger,฀C.฀ Michael฀Gross,฀Rainer฀Dietz,฀Matthias฀G.฀Friedrich,฀Charite฀Franz-Volhard-Klinik,฀ Humboldt฀University,฀Berlin,฀Germany Background:฀Right฀ventricular฀infarction฀(RVI)฀is฀a฀serious฀complication฀of฀acute฀inferior฀ myocardial฀infarction.฀Delayed฀enhancement฀cardiovascular฀magnetic฀resonance฀imaging฀ (CMR)฀ accurately฀ detects฀ acute฀ left฀ ventricular฀ infarction.฀We฀ investigated฀ the฀ utility฀ of฀ delayed฀enhancement฀CMR฀for฀the฀detection฀of฀acute฀RVI. Methods:฀We฀examined฀42฀consecutive฀patients฀with฀acute฀inferior฀myocardial฀infarction฀ defined฀ by฀ ECG฀ criteria.฀ All฀ underwent฀ a฀ physical฀ examination฀ for฀ the฀ presence฀ of฀ a฀ triad฀of฀hypotension,฀clear฀lung฀sounds฀and฀jugular฀venous฀distension,฀an฀ECG฀for฀STelevation฀≥0.1mV฀in฀the฀V4r฀right฀precordial฀lead,฀and฀an฀echocardiogram฀(n=36).฀After฀ coronary฀reperfusion,฀all฀patients฀underwent฀a฀CMR฀examination฀evaluated฀by฀two฀blinded฀ observers฀for฀the฀presence฀of฀delayed฀enhancement฀in฀the฀right฀ventricular฀wall. Results:฀The฀sensitivity฀and฀negative฀predictive฀values฀of฀CMR฀for฀the฀detection฀of฀RVI,฀ compared฀to฀clinical฀triad,฀ECG฀V4r,฀and฀echocardiography฀were฀89%,฀91%,฀100%฀and฀ 95%,฀95%,฀100%,฀respectively;฀the฀specificities฀were฀61%,฀66%฀and฀55%.฀When฀the฀nonCMR฀ examinations฀ were฀ combined,฀ CMR฀ reached฀ a฀ sensitivity฀ of฀ 88%฀ and฀ specificity฀ of฀78%฀when฀the฀standard฀of฀truth฀was฀≥1฀non-CMR฀methods฀as฀positive฀for฀RVI.฀CMR฀ detected฀ all฀ patients,฀ in฀ who฀ at฀ least฀ two฀ non-CMR฀ methods฀ were฀ positive฀ for฀ RVI฀ (sensitivity฀100%). Noninvasive Imaging 9:30฀a.m. 834-7฀ Ability฀Of฀MRI฀Infarct฀Size฀To฀Identify฀Acute฀MI฀Patients฀ Who฀Will฀Have฀Persistently฀Low฀Ejection฀Fraction Caterina฀Silva,฀Andre฀Schmidt,฀Clerio฀Azevedo,฀Bernhard฀Gerber,฀Thomas฀K.฀Foo,฀David฀ A.฀Bluemke,฀Joao฀A.C฀Lima,฀Katherine฀C.฀Wu,฀Johns฀Hopkins฀University,฀Baltimore,฀MD Although฀ clinical฀ parameters฀ can฀ predict฀ prognosis฀ after฀ acute฀ myocardial฀ infarction฀ (AMI),฀none฀identifies฀patients฀who฀will฀have฀chronically฀reduced฀ejection฀fractions฀(EF).฀ This฀is฀pertinent฀in฀light฀of฀recent฀data฀supporting฀prophylactic฀implantable฀cardioverter฀ defibrillator฀(ICD)฀placement฀in฀ischemic฀cardiomyopathy฀patients.฀However,฀patients฀with฀ recent฀MI฀(<30฀days)฀usually฀are฀excluded฀from฀early฀ICD฀placement฀because฀of฀recovery฀ of฀function฀from฀myocardial฀stunning.฀We฀aimed฀to฀investigate฀whether฀MRI฀variables฀in฀ the฀acute฀setting฀identifies฀patients฀who฀will฀have฀persistent฀LV฀dysfunction. Methods:฀ 43฀ patients฀ had฀ MRI฀ 3±3฀ days฀ and฀ 10±6฀ months฀ after฀ AMI.฀ Microvascular฀ obstruction฀(MO)฀extent฀was฀measured฀on฀first฀pass฀perfusion฀images฀using฀hybrid฀echoplanar฀ fast฀ gradient฀ echo฀ (FGRE)฀ after฀ 0.1฀ mmol/kg฀ gadodiamide.฀ After฀ a฀ second฀ 0.1฀ mmol/kg฀bolus,฀infarct฀size฀(IS)฀was฀measured฀on฀delayed฀enhancement฀images฀using฀ inversion฀recovery฀FGRE.฀Patients฀were฀grouped฀by฀EF฀at฀follow-up฀[group฀I:฀EF<40%,฀ n=11฀ (mean฀ EF฀ 35+6%);฀ group฀ II:฀ EF>40%,฀ n=32฀ (mean฀ 52+8%)].฀ MO฀ and฀ IS฀ were฀ expressed฀as฀%฀total฀LV฀mass.฀Linear฀regression฀and฀ROC฀analysis฀were฀performed. Results:฀ EF฀ in฀ the฀ acute฀ and฀ chronic฀ phases฀ were฀ highly฀ correlated฀ (r=0.74,฀ p<0.05).฀ However฀44%฀(7/16)฀of฀patients฀with฀EF<40%฀acutely฀had฀functional฀recovery฀to฀EF>40%฀ at฀follow-up. IS฀ and฀ EF฀ were฀ highly฀ correlated฀ acutely฀ (r=0.72,฀ p<0.05)฀ and฀ at฀ follow-up฀ (r=0.69,฀ p<0.05).฀MO฀and฀EF฀in฀the฀acute฀phase฀were฀modestly฀correlated฀(r=0.55,฀p<0.05). Acutely,฀groups฀I฀and฀II฀had฀significantly฀different฀IS฀(35±14.5%฀vs฀20±11.0%฀p<0.05),฀but฀ only฀a฀border-line฀trend฀in฀MO฀differences฀(13±9.9%฀vs฀8±7.6%,฀p=0.08).฀IS฀at฀10฀months฀ was฀also฀different฀between฀groups฀(26±8.4%฀vs฀14±9.1%,฀p<0.05).฀From฀ROC฀analysis,฀ acute฀IS฀and฀MO฀predicted฀EF<40%฀acutely฀[for฀IS:฀sensitivity฀(Sen)฀94%,฀specificity฀(Sp)฀ 67%;฀ for฀ MO:฀ Sen฀ 81%,฀ Sp฀ 78%]฀ and฀ IS฀ also฀ predicted฀ EF<40%฀ at฀ follow-up฀ [IS:฀ Sen฀ 91%,฀Sp฀69%,฀cut-off฀26%]. Conclusion:฀MRI฀infarct฀size฀in฀the฀acute฀MI฀setting฀can฀predict฀global฀LV฀dysfunction฀ (EF<40%)฀in฀both฀acute฀and฀chronic฀phases฀post-infarct.฀This฀finding฀may฀facilitate฀early฀ risk฀stratification฀in฀such฀patients. Conclusion:฀Delayed฀enhancement฀CMR฀yields฀high฀sensitivities฀and฀negative฀predictive฀ values฀for฀the฀detection฀of฀RVI฀in฀acute฀inferior฀myocardial฀infarction.฀ POSTER฀SESSION 1138฀฀ Echocardiography:฀Not฀One฀but฀Many฀ Uses Tuesday,฀March฀08,฀2005,฀9:00฀a.m.-12:30฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀10:00฀a.m.-11:00฀a.m. 1138-87฀ Intensive฀Multiple฀Risk฀Factor฀Intervention฀Reduces฀ Progression฀of฀Aortic฀Sclerosis฀in฀Endstage฀Renal฀ Failure Leanne฀Jeffriess,฀Brian฀A.฀Haluska,฀Rodel฀Leano,฀Nicole฀Isbel,฀Thomas฀H.฀Marwick,฀ University฀of฀Queensland,฀Brisbane,฀Australia Background:฀ Pts฀ with฀ endstage฀ renal฀ failure฀ (ESRF)฀ are฀ prone฀ to฀ the฀ development฀ of฀ aortic฀sclerosis฀(AScl).฀We฀have฀recently฀validated฀an฀ultrasonic฀backscatter฀approach฀to฀ quantify฀the฀degree฀of฀sclerosis,฀and฀sought฀whether฀an฀intensive฀program฀of฀multiple฀risk฀ factor฀intervention฀could฀limit฀the฀progression฀of฀AScl. Method:฀We฀ randomized฀ 200฀ pts฀ with฀ ESRF฀ (mean฀ age฀ 56±12฀ years,฀ 27฀ men,฀ mean฀ dialysis฀duration฀1฀year)฀to฀(i)฀conventional฀cardiovascular฀prevention฀(CONV;฀according฀to฀ national฀guidelines)฀or฀ii)฀intensive฀therapy฀(INT;฀LDL-C฀<77฀mg/dl,฀homocysteine฀<2.0mg/ l,฀ blood฀ pressure฀ (<140/90),฀ anemia฀ (11.0-12.5฀ g/dl)฀ and฀ phosphate฀ <4.95฀ mg/dl).฀ In฀ a฀ subgroup฀ of฀ 43฀ pts,฀ images฀ of฀ the฀ aortic฀ valve฀ were฀ obtained฀ at฀ baseline฀ and฀ after฀ a฀ follow฀up฀of฀1.1±0.4฀yrs฀in฀the฀parasternal฀long฀axis฀view฀and฀saved฀in฀raw฀data฀format.฀ 292A ABSTRACTS - Noninvasive Imaging Six฀square-shaped฀11x11฀pixel฀regions฀of฀interest฀(ROI)฀were฀placed฀on฀the฀anterior฀and฀ posterior฀ leaflets,฀ and฀ calibrated฀ backscatter฀ values฀ were฀ obtained฀ by฀ subtracting฀ the฀ regions฀of฀interest฀in฀the฀blood฀pool฀from฀the฀averaged฀backscatter฀values฀obtained฀from฀ the฀leaflets.฀No฀patients฀had฀overt฀aortic฀stenosis฀at฀baseline฀or฀follow-up. Results:฀Significant฀improvements฀from฀baseline฀were฀achieved฀in฀the฀IT฀group฀compared฀ with฀CONV฀-฀serum฀LDL฀cholesterol฀(-31฀mg/dl฀vs.฀-13฀mg/dl;฀p=฀0.001),฀homocysteine฀ (-0.94฀vs.฀-0.09฀mg/l;฀p฀<0.001),฀systolic฀BP฀(-6.9฀vs.฀-0.2฀mm฀Hg;฀p=0.049)฀and฀diastolic฀ BP฀(-4.8฀vs.฀-1.0฀mm฀of฀Hg;฀p=0.043).฀At฀baseline,฀the฀calibrated฀backscatter฀signal฀was฀ 17.5±5.7฀in฀CONV฀and฀15.2±5.6฀in฀IT฀groups฀(p=NS),฀compared฀with฀9.8±3.3฀dB฀in฀normal฀ valves.฀ At฀ follow-up,฀ there฀ was฀ a฀ significant฀ increase฀ in฀ the฀ CONV฀ (19.8±5.1,฀ p=0.04),฀ compared฀ to฀ no฀ change฀ in฀ the฀ IT฀ group฀ (16.2±6.3,฀ p=NS).฀ Moreover,฀ the฀ backscatter฀ intensity฀was฀greater฀at฀follow-up฀in฀the฀standard฀care฀group฀(p=0.05). Conclusion:฀ Aortic฀ sclerosis฀ is฀ common฀ in฀ ESRF.฀ An฀ intensive฀ risk฀ factor฀ intervention฀ program฀may฀reduce฀the฀progression฀of฀disease.฀ 1138-88฀ Clinical฀Evaluation฀of฀Isovolumic฀and฀Systolic฀Ejection฀ Signals฀by฀Tissue฀Doppler฀Imaging฀for฀the฀Assessment฀ of฀LV฀systolic฀Function Noninvasive Imaging Ruan฀Qinyun,฀Sherif฀F.฀Nagueh,฀Baylor฀College฀of฀Medicine,฀Houston,฀TX Background:฀ Tissue฀ Doppler฀ imaging฀ (TDI)฀ is฀ a฀ valuable฀ tool฀ for฀ assessment฀ of฀ left฀ ventricular฀ (LV)฀ global฀ and฀ regional฀ function.฀ Recently,฀ animal฀ models฀ have฀ shown฀ that฀ myocardial฀ acceleration฀ (IVA)฀ during฀ isovolumic฀ contraction฀ (IVC)฀ related฀ well฀ to฀ invasive฀indices฀of฀LV฀contractility.฀However,฀there฀is฀a฀paucity฀of฀data฀on฀its฀clinical฀utility,฀ particularly฀in฀comparison฀with฀systolic฀ejection฀(Sa)฀velocities.฀ Methods:฀We฀measured฀velocities฀during฀IVC฀and฀ejection฀as฀well฀as฀IVA฀in฀70฀patients฀ (55±19฀yrs,฀33฀women),฀including฀40฀control฀subjects฀(EF:฀65±3%)฀without฀evidence฀of฀ cardiovascular฀disease฀and฀30฀pts฀with฀depressed฀EF฀(28±8%,฀p<0.001฀vs฀controls).฀TD฀ data฀were฀analyzed฀from฀mitral฀annulus฀lateral฀and฀septal฀sites.฀IVA฀was฀derived฀as฀peak฀ velocity฀during฀IVC฀divided฀by฀acceleration฀time฀from฀onset฀to฀peak฀IVC฀velocity.฀ Results:฀Pts.฀with฀depressed฀EF฀had฀a฀larger฀left฀atrial฀volume฀index฀(46±16฀vs.23±6฀ml/ m2),฀increased฀LV฀mass฀index฀(132±32฀vs81±13฀gm/m2)฀and฀lower฀early฀and฀late฀diastolic฀ velocities฀at฀both฀sites฀of฀the฀mitral฀annulus฀(all฀p<0.005).฀Likewise,฀Sa฀and฀IVC฀velocities,฀ and฀IVA฀at฀both฀sides฀of฀the฀mitral฀annulus฀were฀all฀significantly฀lower฀in฀the฀group฀with฀ depressed฀EF฀(for฀IVA฀as฀average฀of฀both฀sites:฀159±53฀vs.฀244±84฀cm/s2,฀p<0.001).฀IVA฀ had฀no฀significant฀correlation฀with฀age,฀heart฀rate฀and฀systemic฀blood฀pressure฀(p>0.1).฀ The฀best฀correlation฀with฀EF฀was฀noted฀with฀the฀average฀of฀septal฀and฀lateral฀Sa฀(r=0.65,฀ p<0.001),฀ though฀ IVC฀ signals฀ also฀ had฀ significant฀ correlations฀ (r฀ ranging฀ from฀ 0.33฀ for฀ IVC฀velocity฀at฀septal฀site฀to฀r=0.53฀for฀average฀IVA,฀both฀p<0.01).฀Using฀ROC฀curves,฀ area฀under฀ROC฀curve฀(AUC)฀was฀largest฀for฀average฀Sa฀at฀0.92,฀significantly฀(p<0.05)฀ exceeding฀IVC฀velocity฀and฀IVA฀(AUC฀ranging฀from฀0.7฀for฀septal฀IVC฀velocity฀to฀0.82฀for฀ average฀IVA).฀ Conclusions:฀While฀all฀of฀the฀investigated฀TDI฀derived฀signals฀are฀of฀value฀for฀evaluating฀ LV฀ systolic฀ function,฀ Sa฀ velocity฀ provided฀ a฀ better฀ assessment฀ of฀ EF฀ than฀ IVC฀ velocity฀ and฀ acceleration.฀ In฀ the฀ context฀ of฀ these฀ results฀ and฀ given฀ the฀ need฀ for฀ only฀ a฀ single฀ measurement฀ for฀ Sa฀ velocity฀ (versus฀ 2฀ for฀ IVA),฀ Sa฀ velocity฀ appears฀ to฀ be฀ the฀ more฀ suitable฀signal฀for฀routine฀clinical฀application. 1138-89฀ Left฀Atrial฀Diameter฀is฀independently฀predictive฀of฀ Cardiovascular฀Death฀in฀patients฀with฀Chronic฀Renal฀ Failure Mark฀Y.฀Chan,฀Hwee฀Bee฀Wong,฀Hean฀Yee฀Ong,฀Tiong฀Cheng฀Yeo,฀National฀University฀ Hospital,฀Singapore,฀Singapore,฀Clinical฀Trials฀Research฀and฀Epidemiology฀Unit,฀ Singapore,฀Singapore Background:฀Patients฀with฀chronic฀renal฀failure฀(CRF)฀have฀high฀cardiovascular฀risk.฀Left฀ atrial฀(LA)฀volume฀has฀been฀shown฀to฀predict฀cardiovascular฀events.฀It฀is฀unknown฀if฀LA฀ diameter฀has฀the฀same฀prognostic฀value฀especially฀in฀patients฀with฀CRF. Methods:฀ We฀ performed฀ echocardiography฀ and฀ SPECT฀ in฀ 200฀ patients฀ with฀ CRF฀ (creatinine฀ clearance฀ <฀ 60฀ ml/min)฀ without฀ a฀ prior฀ history฀ of฀ ischemic฀ heart฀ disease฀ or฀ pathological฀ Q฀ waves฀ on฀ electrocardiogram.฀ The฀ anterior-posterior฀ LA฀ diameter฀ was฀ measured฀by฀M-mode฀echocardiography฀and฀indexed฀to฀body฀surface฀area.฀We฀analyzed฀ clinical,฀ echocardiographic฀ and฀ SPECT฀ variables฀ to฀ assess฀ their฀ value฀ in฀ predicting฀ cardiovascular฀death. Results:฀ The฀ mean฀ age฀ of฀ the฀ study฀ population฀ was฀ 61±฀ 12฀ years,฀ mean฀ creatinine฀ clearance฀was฀17±11฀ml/min฀and฀mean฀indexed฀LA฀diameter฀was฀24฀±฀9฀mm/m2.฀During฀ a฀mean฀follow฀up฀period฀of฀3.2฀+฀1.4฀years,฀25฀patients฀(12.5%)฀reached฀the฀endpoint.฀ In฀ multivariate฀ analysis฀ adjusting฀ for฀ clinical,฀ echocardiographic฀ and฀ SPECT฀ variables,฀ indexed฀LA฀diameter฀≥฀24฀mm/m2฀was฀independently฀predictive฀of฀cardiovascular฀death฀ (Hazard฀Ratio,฀HR฀2.75,฀CI฀1.14-6.59,฀p=0.016)฀(figure1).฀Each฀mm/m2฀increase฀in฀indexed฀ LA฀diameter฀was฀associated฀with฀a฀HR฀of฀1.13฀(95%฀CI฀1.04฀-1.24,฀p=0.005). Conclusion:฀In฀patients฀with฀CRF,฀indexed฀LA฀diameter฀is฀an฀independent฀and฀powerful฀ predictor฀of฀cardiovascular฀death.฀ JACC 1138-90฀ February 1, 2005 The฀Preload฀Independence฀of฀a฀New฀Parameter฀to฀ Evaluate฀Left฀Ventricular฀Diastolic฀Function Sang-Yong฀Yoo,฀Eun-Ah฀Choi,฀Jung-Hyun฀Choi,฀Heungsoo฀Kim,฀Gyu-Tae฀Shin,฀So-Yeon฀ Choi,฀Myeong-Ho฀Yoon,฀Gyo-Seung฀Hwang,฀Seung-Jea฀Tahk,฀Joon-Han฀Shin,฀Ajou฀ University฀School฀of฀Medicine,฀Suwon,฀South฀Korea Background:฀The฀ time฀ interval฀ between฀ the฀ onsets฀ of฀ mitral฀ inflow฀ and฀ mitral฀ annulus฀ velocity฀ (TE’-E)฀ has฀ been฀ proposed฀ as฀ a฀ new฀ index฀ representing฀ left฀ ventricular฀ (LV)฀ relaxation฀and฀related฀to฀LV฀filling฀pressure.฀This฀index฀has฀been฀reported฀as฀a฀preload฀ independent฀ parameter฀ in฀ experimental฀ canine฀ model.฀ The฀ impact฀ of฀ preload฀ on฀ this฀ index,฀however,฀has฀not฀been฀studied฀in฀human. Methods:฀ Thirty-four฀ patients฀ (19฀ men,฀ mean฀ 50±14฀ years)฀ who฀ have฀ end-stage฀ renal฀ disease฀ and฀ normal฀ systolic฀ function฀ (EF฀ ≥฀ 50%)฀ underwent฀ echocardiography฀ immediately฀before฀and฀after฀hemodialysis฀(HD).฀Early฀(E)฀and฀late฀(A)฀transmitral฀inflow฀ velocity,฀ mitral฀ annulus฀ velocity฀ (E’)฀ and฀ flow฀ propagation฀ velocity฀ (Vp)฀ were฀ evaluated.฀ TE’-E฀ was฀measured฀by฀time฀interval฀of฀peak฀R฀to฀onset฀of฀E฀minus฀time฀interval฀of฀peak฀ R฀to฀onset฀of฀E’.฀Corrected฀TE’-E฀were฀calculated฀after฀correction฀by฀the฀heart฀rate฀(using฀ the฀√R-R฀interval). Results:฀The฀mean฀ejection฀fraction฀was฀68±10฀%.฀Average฀weight฀reduction฀by฀HD฀was฀ 3.0±1.3(range฀ 0.5-6.4)฀ kg.฀ The฀ dimensions฀ of฀ LV฀ end-diastole,฀ left฀ atrium฀ and฀ inferior฀ vena฀cava฀were฀reduced฀significantly฀as฀2.5±2.9,฀2.5±5.1฀,฀and฀4.5±4.2฀mm,฀respectively฀ (p<0.001).฀The฀table฀shows฀the฀changes฀of฀Doppler-Echo฀parameters฀after฀HD. Conclusion:฀A฀new฀parameter฀for฀diastolic฀function,฀time฀interval฀between฀the฀onsets฀of฀ mitral฀ inflow฀ and฀ mitral฀ annulus฀ velocity฀ appears฀ to฀ be฀ preload-independent฀ in฀ patients฀ with฀normal฀systolic฀function. ฀ E฀(cm/sec) E/A฀ratio E’฀(cm/sec) Vp฀(cm/sec) E/E’ E/Vp corrected฀TE’’-E฀(msec) 1138-91฀ Pre-HD Post-HD p 103.8±31.5 1.1±0.6 10.4±3.12 48.9±15.5 10.6±4.7 2.3±1.0 0.8±0.5 69.3±21.9 0.9±0.7 9.3±3.5 41.0±15.2 8.2±4.2 1.9±0.7 0.5±1.4 <0.001 <0.001 0.004 0.021 <0.001 0.011 NS Error฀of฀Cardiac฀Output฀Measured฀by฀Doppler฀ Ultrasound฀and฀the฀Method฀of฀Correction Tiesheng฀Cao,฀Kang฀Ding,฀Hong฀Wang,฀Lijun฀Yuan,฀Yunyou฀Duan,฀Zuojun฀Wang,฀ Department฀of฀Ultrasound฀Diagnostics,฀Tangdu฀Hospital,฀Fourth฀Military฀Medical฀ University,฀Xi’an,฀People’s฀Republic฀of฀China Background:฀ Blood฀ flow฀ velocity฀ measured฀ by฀ Doppler฀ ultrasound฀ represents฀ the฀ net฀ motion฀ of฀ the฀ blood฀ relative฀ to฀ the฀ transducer.฀ When฀ the฀ transducer฀ is฀ placed฀ on฀ the฀ apex฀and฀directed฀to฀the฀aortic฀annulus฀to฀measure฀the฀aortic฀blood฀velocity,฀the฀motion฀ of฀ the฀ annulus฀ along฀ the฀ cardiac฀ long฀ axis฀ will฀ be฀ added฀ to฀ the฀ flow฀ velocity฀ and฀ what฀ we฀measured฀is฀the฀modified฀flow฀velocity.฀However,฀what฀we฀intend฀to฀measure฀is฀the฀ velocity฀that฀is฀relative฀to฀the฀annulus.฀To฀prove฀that฀these฀two฀velocities฀are฀different฀and฀ to฀find฀a฀way฀to฀correct฀the฀error,฀we฀designed฀this฀study฀to฀have฀the฀transducer฀moved฀ synchronously฀with฀the฀aortic฀annulus฀to฀obtain฀the฀true฀flow฀velocity. Methods:฀We฀made฀a฀cardiac฀motion฀simulator฀(CMS)฀that฀can฀accurately฀simulate฀the฀ mechanical฀motion฀of฀the฀aortic฀annulus฀relative฀to฀the฀cardiac฀apex.฀Twenty-six฀normal฀ subjects฀were฀included฀in฀this฀experiment.฀M-mode฀echocardiography฀is฀used฀to฀obtain฀ the฀motion฀data฀of฀the฀aortic฀annulus฀of฀each฀individual฀and฀then฀CMS฀was฀adjusted฀to฀ simulate฀the฀motion฀amplitude฀and฀the฀duration฀according฀to฀the฀data.฀The฀transducer฀was฀ fixed฀on฀the฀arm฀of฀CMS฀that฀may฀move฀the฀transducer฀in฀the฀motion฀pattern฀of฀the฀aortic฀ annulus.฀The฀transducer฀was฀placed฀on฀the฀normal฀five-chamber-view฀window฀through฀a฀ water-balloon.฀Moving฀synchronously฀with฀the฀aortic฀annulus,฀the฀transducer฀was฀relative฀ still฀to฀the฀annulus฀and฀thus฀the฀true฀aortic฀blood฀flow฀spectrum฀was฀obtained.฀The฀velocity฀ time฀integral฀(VTI)฀of฀these฀true฀blood฀flow฀velocity฀and฀of฀the฀flow฀velocity฀from฀routine฀ method฀were฀compared. Results:฀The฀VTI฀of฀the฀true฀aortic฀flow฀velocity฀were฀about฀16.8±3.4%฀higher฀than฀that฀of฀the฀ velocity฀from฀routine฀method.฀In฀this฀study,฀we฀found฀that฀the฀Doppler฀signals฀depicting฀the฀aortic฀ annulus฀motion฀were฀also฀in฀the฀Doppler฀spectrum฀and฀may฀be฀used฀to฀correct฀the฀error. Conclusion:฀Cardiac฀output฀is฀underestimated฀due฀to฀cardiac฀motion฀opposite฀to฀the฀flow฀ direction฀and฀can฀be฀corrected฀by฀adding฀of฀the฀VTI฀of฀the฀annulus฀motion฀to฀the฀VTI฀of฀ aortic฀blood฀flow.฀We฀actually฀overestimated฀aortic฀Doppler฀flow฀routinely฀by฀measuring฀ the฀outer฀edge฀of฀the฀spectrum.฀The฀routine฀method฀seems฀to฀be฀accurate฀because฀the฀ two฀errors฀are฀in฀the฀opposite฀direction฀and฀cancel฀each฀other. 1138-92฀ Enhancement฀of฀Coronary฀Artery฀Endothelial฀Cell฀ Angiogenesis฀by฀Pulsed฀Wave฀Diagnostic฀Ultrasound฀Is฀ Frequency฀Dependant Curtiss฀Stinis,฀Faramarz฀Tehrani,฀Michael฀Jones,฀Andrzej฀Tarnawski,฀P.฀Anthony฀ Chandraratna,฀Long฀Beach฀VA฀Medical฀Center,฀Long฀Beach,฀CA,฀University฀of฀California,฀ Irvine,฀Irvine,฀CA Background:฀We฀have฀previously฀demonstrated฀that฀pulsed฀wave฀diagnostic฀ultrasound฀ enhances฀angiogenesis฀of฀human฀coronary฀endothelial฀cells฀in฀vitro฀when฀administered฀at฀ a฀frequency฀of฀1.6MHz฀for฀1฀hour.฀This฀study฀was฀designed฀to฀test฀the฀hypothesis฀that฀the฀ effect฀of฀ultrasound-induced฀enhancement฀is฀frequency฀dependant. Methods:฀ Human฀ coronary฀ artery฀ endothelial฀ cells฀ grown฀ to฀ reach฀ 80%฀ confluency฀ in฀ Clonetics฀ EGM-2MV฀ medium฀ were฀ used.฀ The฀ cells฀ were฀ incubated฀ for฀ 24฀ hours฀ in฀ serum฀ depleted฀ growth฀ medium฀ (0.1%฀ FBS)฀ containing฀ no฀ added฀ growth฀ factors,฀ then฀ trypsanized฀and฀plated฀in฀24-well฀tissue฀culture฀plates฀coated฀with฀growth฀factor-reduced฀ Matrigel.฀ The฀ cells฀ were฀ then฀ exposed฀ to฀ ultrasound฀ by฀ placing฀ the฀ plate฀ on฀ either฀ a฀ JACC February 1, 2005 1.6Mhz฀transducer฀set฀at฀a฀mechanical฀index฀of฀1.5฀for฀1฀hour฀or฀a฀8Mhz฀transducer฀at฀a฀ mechanical฀index฀of฀1.5฀for฀1฀hour.฀Paired฀control฀plates฀were฀also฀placed฀on฀a฀transducer฀ which฀was฀not฀activated.฀Experiments฀were฀repeated฀on฀6฀separate฀days.฀Endothelial฀cell฀ migration฀ and฀ formation฀ of฀ capillary-like฀ structures฀ reflected฀ in฀ vitro฀ angiogenesis.฀The฀ plated฀cells฀were฀photographed฀at฀1฀hour฀and฀6฀hours฀following฀exposure฀and฀the฀number฀ of฀capillary฀loops฀was฀counted. Results:฀ Pulsed฀ wave฀ diagnostic฀ ultrasound฀ administered฀ at฀ a฀ frequency฀ of฀ 1.6฀ Mhz฀ significantly฀stimulated฀angiogenesis฀as฀compared฀to฀cells฀exposed฀to฀ultrasound฀at฀8Mhz฀ or฀to฀unexposed฀cells.฀Cells฀exposed฀to฀1.6Mhz฀demonstrated฀a฀360%฀increase฀in฀capillary฀ loop฀formation฀at฀6hrs฀post-exposure฀as฀compared฀to฀controls฀(p=฀0.02฀),฀whereas฀cells฀ exposed฀to฀8Mhz฀demonstrated฀only฀a฀2%฀increase฀in฀capillary฀loop฀formation฀6฀hours฀ post-exposure฀as฀compared฀to฀controls฀(p=฀0.9). Conclusion:฀Enhancement฀of฀in฀vitro฀angiogenesis฀of฀human฀coronary฀artery฀endothelial฀ cells฀by฀pulsed฀wave฀diagnostic฀ultrasound฀is฀frequency฀dependant. 1138-93฀ Serum฀Interleukin-6฀And฀Interleukin-1beta฀Levels฀Are฀ Inversely฀Correlated฀With฀Coronary฀Flow฀Reserve฀In฀ Young฀Healthy฀Volunteers Li-ming฀Gan,฀Ulrika฀Hägg,฀Lennart฀Svensson,฀Regina฀Fritsche-Danielson,฀Birger฀Wandt,฀ Cardiovascular฀institute,฀Göteborg,฀Sweden 1138-94฀ POSTER฀SESSION 1139฀฀ Melissa฀Daubert,฀Jennifer฀Liu,฀Vittorio฀Palmieri,฀Lawrence฀Ong,฀Smadar฀Kort,฀David฀ Rosman,฀Rebecca฀Hahn,฀North฀Shore฀University฀Hospital,฀Manhasset,฀NY,฀Federico฀II฀ University฀Hospital,฀Naples,฀Italy Background:฀ Discrepancy฀ between฀ catheterization฀ (cath)฀ and฀ echo฀ Doppler฀ (Dop)฀ measurement฀of฀aortic฀stenosis฀(AS)฀severity฀is฀encountered฀regularly฀in฀clinical฀practice.฀ However,฀whether฀this฀difference฀can฀be฀predicted฀non-invasively฀using฀echo฀measured฀ variables฀ in฀ the฀ clinical฀ setting฀ remains฀ unclear.฀ Objective:฀ To฀ determine฀ whether฀ differences฀ between฀ cath฀ and฀ echo฀ Dop฀ measured฀ peak฀ pressure฀ gradient฀ (PG)฀ and฀ aortic฀effective฀orifice฀area฀(EOA)฀can฀be฀predicted฀by฀using฀previously฀validated฀formulas฀ for฀pressure฀recovery฀(PR)฀and฀energy฀loss฀coefficient฀(ELCo). Methods:฀ Retrospective฀ analysis฀ of฀ 69฀ patients฀ with฀ various฀ degrees฀ of฀ AS฀ who฀ underwent฀both฀echo฀and฀cath฀with฀a฀mean฀interval฀of฀22฀days฀(range฀0-197)฀between฀ the฀ two฀ tests.฀ Pressure฀ recovery฀ was฀ estimated฀ from฀ Dop฀ measured฀ peak฀ transaortic฀ gradient,฀EOA฀and฀cross฀sectional฀area฀(CSA)฀of฀the฀ascending฀aorta฀and฀compared฀with฀ observed฀differences฀between฀cath฀and฀Dop฀PG.฀Energy฀loss฀coefficient฀was฀calculated฀ from฀EOA฀(Dop)฀and฀CSA฀of฀the฀aortic฀root฀at฀the฀sinotubular฀junction. Results:฀Both฀peak฀and฀mean฀Doppler฀gradients฀(฀66฀±฀27,฀38฀±฀18฀mm฀Hg,฀respectively)฀ were฀ higher฀ than฀ cath฀ gradients฀ (฀ 41฀ ±฀ 25,฀ 34฀ ±฀ 18฀ mm฀ Hg,฀ respectively).฀ Predicted฀ difference฀between฀peak฀Dop฀and฀cath฀PG฀due฀to฀PR฀ranged฀from฀5฀to฀24฀mm฀Hg฀(mean฀ 13฀±฀4฀mm฀Hg)฀and฀correlated฀well฀with฀the฀observed฀difference฀between฀Dop฀and฀cath฀ gradients฀(r=0.58฀,฀p=฀<0.001฀).฀Corrected฀Dop฀gradient฀(peak฀Dop฀gradient฀-฀PR)฀showed฀ good฀ agreement฀ with฀ cath฀ gradients฀ (r=฀ 0.77;฀ p<0.001).฀ Calculated฀ EOA฀ (Dop)฀ (range฀ 0.3฀-฀1.7฀cm2)฀correlated฀well฀with฀EOA฀(cath)฀(range฀0.3฀-฀2.7฀cm2)฀(r฀=฀0.6;฀p<0.001)฀ but฀EOA฀(Dop)฀generally฀underestimated฀EOA฀(cath).฀Calculated฀ELCo฀(range฀0.28฀-฀2.4฀ cm2)฀showed฀similar฀correlation฀(r=฀0.61,฀p<0.001)฀with฀EOA฀(cath)฀but฀underestimation฀ was฀not฀observed. Conclusions:฀ Discrepancy฀ between฀ cath฀ and฀ Dop฀ estimates฀ of฀ AS฀ severity฀ can฀ be฀ predicted฀noninvasively฀by฀echo฀in฀the฀clinical฀setting.฀Calculation฀of฀PR฀or฀ELCo฀could฀be฀ performed฀when฀there฀is฀disagreement฀between฀cath฀and฀Dop฀estimates฀of฀AS. New฀Technology฀in฀Stress฀ Echocardiography Tuesday,฀March฀08,฀2005,฀9:00฀a.m.-12:30฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀10:00฀a.m.-11:00฀a.m. 1139-79฀ Transthoracic฀Doppler฀Echo฀Coronary฀Flow฀Reserve฀ Noninvasively฀Diagnoses฀Left฀Anterior฀Descending฀ Artery฀Patency฀In฀Left฀Bundle฀Branch฀Block. George฀Athanasopoulos,฀Evdokia฀Petropoulou,฀George฀Hatzigeorgiou,฀George฀ Karatasakis,฀Dennis฀V.฀Cokkinos,฀Onassis฀Cardiac฀Surgery฀Center,฀Athens,฀Greece INTRODUCTION:฀The฀evaluation฀of฀left฀anterior฀descending฀artery฀(LAD)฀patency฀in฀left฀ bundle฀ branch฀ block฀ (LBBB)฀ presents฀ has฀ limitations฀ with฀ either฀ scintigraphy฀ or฀ stress฀ echo.฀Non-invasive฀assessment฀of฀coronary฀flow฀reserve฀(CFR)฀by฀transthoracic฀Doppler฀ echo฀in฀the฀distal฀part฀LAD฀provides฀an฀alternative฀means.฀However฀its฀accuracy฀has฀not฀ been฀established. METHODS:฀Among฀440฀consecutive฀pts฀studied฀for฀LAD฀CFR,฀there฀were฀57฀pts฀with฀ LBBB.฀227/383฀pts฀and฀43/57฀pts฀had฀coronary฀angiography฀performed฀within฀3฀months฀ from฀ the฀ index฀ echo฀ (age฀ 61+10฀ vs฀ 62+11,฀ ejection฀ fraction฀ 49+8฀ vs฀ 36%+12).฀ LAD฀ diameter฀stenosis฀(>70%)฀was฀found฀in฀7฀(16%)฀with฀LBBB฀and฀in฀76฀(34%)฀without฀LBBB฀ pts.฀The฀LAD฀distal฀flow฀was฀investigated฀by฀a฀modified฀2฀chamber฀apical฀view฀(GE฀7฀MHz฀ transducer)฀nearby฀the฀apex.CFR฀was฀estimated฀from฀the฀diastolic฀time-velocity฀integral.฀ Adenosine฀was฀infused฀at฀140mg/kg/min฀for฀4฀min. RESULTS:฀ LBBB฀ pts฀ had฀ lower฀ diastolic฀ velocity฀ profile฀ at฀ R฀ and฀ ADEN฀ (cm:฀ 7.6+2.8฀ vs฀ 8.8+3.7,and฀ 17.4+8฀ vs฀ 20+8฀ ,฀ respectively,฀ p<0.03)฀ but฀ a฀ similar฀ CFR฀ (2.32+0.7฀ vs฀ 2.27+0.8).฀CFR฀values฀were฀similar฀irrespectively฀of฀LBBB:฀(LAD>=70%฀vs฀<70%:฀LBBB:฀ 1.42+0.4฀vs฀2.5+0.6,฀nonLBBB:฀1.24+0.5฀vs฀2.5+0.5) CFR฀had฀a฀curvilinear฀regression฀with฀%฀LAD฀stenosis฀for฀both฀LBBB฀and฀nonLBBB฀pts฀ (LBBB:฀R=0.66,฀p<0.005,฀vs฀nonLBBB:฀R=0.77,฀p<0.0001). CFR฀ could฀ reliably฀ discriminate฀ significant฀ LAD฀ stenosis฀ irrespectively฀ of฀ LBBB.฀ Using฀ ROC฀analysis,฀the฀following฀diagnostic฀performance฀was฀found฀for฀the฀respective฀CFR฀cut฀ off฀values฀(C-V):฀Non฀LBBB฀at฀C-V฀1.8/1.9/2.0:฀sensitivity฀(SN)฀0.93/0.93/0.91,฀specificity฀ (SP)฀ 0.92/0.85/0.80,฀ area฀ under฀ curve฀ (AUC)฀ 0.96.฀ With฀ LBBB฀ at฀ C-V฀ 1.8/1.9/2.0:฀ SN฀ 0.75/0.75/1,฀SP฀0.94/0.88/0.83฀and฀AUC฀0.95฀(all฀NS). Linear฀regression฀between฀CFR฀and฀SP฀was฀similar฀for฀LBBB฀and฀non฀LBBB฀pts.฀In฀contrast,฀ the฀linear฀model฀for฀CFR฀and฀SN฀had฀a฀greater฀slope฀for฀LBBB฀pts฀(SN=0.40+0.67*CFR,฀ R2=0.85฀vs฀SN=0.40+0.26*CFR,฀R2=0.75). CONCLUSION:฀ In฀ the฀ presence฀ of฀ LBBB,฀ CFR฀ evaluation฀ of฀ distal฀ LAD฀ provides฀ an฀ accurate฀ and฀ convenient฀ means฀ to฀ evaluate฀ LAD฀ patency.฀ The฀ accuracy฀ remains฀ anaffected฀in฀the฀range฀of฀CFR฀between฀1.8-2.0,฀with฀a฀greater฀SN฀for฀LBBB฀in฀the฀upper฀ limit฀of฀this฀range. 1139-80฀ Catheter/Doppler฀Discrepancies฀in฀Aortic฀Stenosis฀Can฀ Be฀Estimated฀Non-invasively:฀Practical฀Implications฀for฀ Evaluation฀of฀Aortic฀Stenosis฀in฀the฀Clinical฀Setting 293A Left฀Ventricular฀Wall฀Motion฀Abnormalities฀Induced฀by฀ Squatting:฀A฀New฀Echocardiographic฀Stress฀Test฀for฀the฀ Diagnosis฀of฀Coronary฀Artery฀Disease Rajiv฀Maraj,฀Ghasan฀M.฀Tabel,฀Arash฀Vahdat,฀Lalkrushna฀Malaviya,฀Mandeep฀Brar,฀ Shivanand฀Pole,฀P.฀Anthony฀Chandraratna,฀Long฀VA฀Medical฀Center,฀Long฀Beach,฀CA,฀ University฀of฀California,฀Irvine,฀Irvine,฀CA Background:฀This฀ study฀ was฀ designed฀ to฀ test฀ the฀ hypothesis฀ that฀ increased฀ afterload฀ induced฀by฀squatting฀will฀produce฀left฀ventricular฀wall฀motion฀(wall฀thickening)฀abnormalities฀ in฀patients฀with฀severe฀coronary฀artery฀stenoses. Methods:฀The฀study฀population฀consisted฀of฀11฀normal฀subjects฀(Group฀1)฀and฀28฀patients฀ who฀were฀scheduled฀for฀coronary฀angiography฀for฀the฀evaluation฀of฀chest฀pain฀(Group฀2).฀ The฀Heart฀rate,฀blood฀pressure,฀and฀the฀echocardiogram฀in฀standard฀views฀were฀recorded฀ in฀the฀standing฀position.฀The฀subjects฀were฀then฀asked฀to฀squat฀and฀the฀echocardiogram,฀ blood฀ pressure฀ and฀ heart฀ rate฀ were฀ repeated.฀ Echocardiography฀ was฀ repeated฀ after฀ the฀ patients฀ resumed฀ the฀ upright฀ position.฀ Regional฀ wall฀ motion฀ was฀ evaluated฀ by฀ two฀ observers฀blinded฀to฀the฀results฀of฀coronary฀angiography. Results:฀In฀Group฀1฀subjects,฀the฀heart฀rate฀(HR)฀changed฀from฀a฀baseline฀value฀of฀82฀ +/-฀16฀beats/minute฀to฀87฀+/-฀17฀beats/minute฀(P=0.054)฀and฀the฀systolic฀blood฀pressure฀ (SBP)฀ increased฀ from฀ 131฀ +/-฀ 11฀ mmHg฀ to฀ 151฀ +/-฀ 11฀ mmHg฀ (P<0.0004).฀ In฀ Group฀ 2,฀ HR฀increased฀from฀81฀+/-฀14฀beats/minute฀to฀89+/-15฀beats/minute฀(P฀=฀0.004).฀The฀SBP฀ increased฀ from฀ 125฀ +/-฀ 20฀ mm฀ Hg฀ to฀ 152฀ +/-฀ 24฀ mm฀ Hg฀ (P฀ <฀ 0.0001).฀ No฀ wall฀ motion฀ abnormalities฀ (WMA)฀ were฀ noted฀ during฀ squatting฀ in฀ Group฀ 1฀ subjects.฀ In฀ Group฀ 2,฀ 15฀ patients฀developed฀akinesis฀or฀severe฀hypokinesis฀in฀the฀anterior฀septum,฀anterolateral฀ wall฀or฀apex,฀4฀had฀WMA฀of฀the฀posterolateral฀wall,฀7฀had฀WMA฀of฀the฀inferior฀wall฀and฀2฀ had฀no฀WMA฀(1฀had฀a฀55%฀LAD฀stenosis฀and฀the฀other฀had฀a฀80%฀circumflex฀stenosis).฀All฀ WMA฀resolved฀with฀standing.฀None฀of฀these฀patients฀developed฀chest฀pain฀or฀arrhythmias.฀ Coronary฀ angiography฀ revealed฀ severe฀ stenosis฀ (>70%)฀ of฀ the฀ arteries฀ supplying฀ the฀ segments฀that฀developed฀WMA. Conclusion:฀ These฀ preliminary฀ data฀ indicate฀ that฀ squatting฀ induces฀ wall฀ motion฀ abnormalities฀in฀patients฀with฀critical฀coronary฀stenoses.฀Studies฀on฀a฀larger฀cohort฀are฀ needed฀ to฀ determine฀ the฀ sensitivity฀ and฀ specificity฀ of฀ this฀ method฀ for฀ the฀ diagnosis฀ of฀ coronary฀artery฀disease. Noninvasive Imaging Background:฀Transthoracic฀colour฀Doppler฀echocardiography฀has฀been฀used฀to฀assess฀ coronary฀flow฀velocity฀reserve฀in฀all฀the฀three฀major฀coronary฀arteries฀in฀man.฀In฀absence฀ of฀significant฀coronary฀artery฀stenosis,฀the฀adenosine-induced฀flow฀increase฀may฀at฀least฀ in฀ part฀ reflect฀ endothelial฀ function฀ in฀ the฀ coronary฀ vascular฀ bed.฀ Inflammation฀ has฀ now฀ been฀recognized฀as฀an฀important฀factor฀affecting฀on฀peripheral฀vascular฀function฀in฀man.฀ In฀the฀present฀study,฀we฀explored฀possible฀impact฀of฀inflammatory฀cytokines฀on฀coronary฀ flow฀reserve฀(CFR)฀in฀young฀healthy฀volunteers. Methods:฀Using฀the฀latest฀generation฀ultrasound฀imaging฀platform,฀resting฀and฀adenosineinduced฀(140฀µg/kg/min)฀hyperaemic฀coronary฀flows฀were฀recorded฀in฀all฀the฀three฀major฀ coronary฀arteries฀in฀19฀healthy฀volunteers฀with฀an฀average฀age฀of฀25.8±0.8฀years.฀CFR฀was฀ calculated฀as฀the฀ratio฀between฀hyperaemic฀and฀baseline฀mean฀diastolic฀flow฀velocities฀ in฀ the฀ respective฀ coronary฀ artery.฀ Mean฀ coronary฀ flow฀ reserve฀ (mCFR)฀ was฀ averaged฀ from฀the฀CFR฀values฀from฀respective฀coronary฀artery.฀Twelve฀inflammatory฀markers฀were฀ assessed฀simultaneously฀using฀Randox฀biochip฀array฀technology.฀Cholesterol,฀lipoprotein฀ fractions฀as฀well฀as฀high-sensitive฀CRP฀(hsCRP)฀were฀analysed. Results:฀ Average฀ CFR฀ values฀ were฀ similar฀ between฀ males฀ and฀ females,฀ and฀ were฀ 3.5±0.1,฀ 2.7±0.2฀ and฀ 2.7±0.1฀ in฀ the฀ left฀ anterior฀ descending,฀ left฀ circumflex฀ and฀ right฀ posterior฀ descending฀ coronary฀ arteries,฀ respectively.฀ mCFR฀ was฀ 3.0±0.1฀ in฀ the฀ study฀ population.฀ Serum฀ IL-6฀ level฀ was฀ 4.6±2.9฀ pg/ml฀ and฀ the฀ quartiles฀ of฀ IL-6฀ levels฀ were฀ inversely฀correlated฀with฀mCFR฀(p=0.009),฀independently฀of฀traditional฀risk฀factors,฀e.g.฀ cholesterol,฀ LDL,฀ apoB,฀ age,฀ CRP฀ and฀ systolic฀ blood฀ pressure.฀ mCFR฀ values฀ were฀ significantly฀lower฀in฀subjects฀with฀IL-1beta฀values฀from฀the฀upper฀median฀compared฀to฀ the฀lower฀median.฀(mCFR,฀IL-1beta฀upper฀median฀versus฀lower฀median:฀2.7±฀0.1฀versus฀ 3.1±0.1,฀p=0.026). Conclusions:Inflammatory฀ cytokines฀ are฀ independent฀ determinants฀ of฀ coronary฀ vascular฀function฀in฀young฀healthy฀volunteers.฀CFR฀seems฀to฀be฀a฀sensitive฀and฀simple฀ method฀to฀assess฀coronary฀artery฀function฀in฀man. ABSTRACTS - Noninvasive Imaging 294A 1139-81฀ ABSTRACTS - Noninvasive Imaging Feasibility฀and฀Accuracy฀of฀Dobutamine฀ Stress฀Echocardiography฀using฀Real-time฀3D฀ Echocardiography฀for฀Diagnosis฀of฀Coronary฀Artery฀ Disease Jun฀Kwan,฀Gi฀Chang฀Kim,฀Seong฀Mi฀Park,฀Min฀Jae฀Jeon,฀Dae฀Hyeok฀Kim,฀Keum฀Soo฀ Park,฀Woo฀Hyung฀Lee,฀Inha฀University฀Hospital,฀Inchon,฀South฀Korea Background:฀ Dobutamine฀ stress฀ echocardiography฀ (DSE)฀ with฀ 2D฀ echocardiography฀ (2DE)฀ is฀ one฀ of฀ time-consuming฀ procedure฀ for฀ diagnosis฀ of฀ coronary฀ artery฀ disease฀ (CAD).฀Moreover,฀accuracy฀of฀DSE฀with฀2DE฀depends฀on฀operator฀skill฀or฀bias฀during฀the฀ acquisition฀of฀the฀image฀to฀analyze.฀This฀study฀was฀done฀to฀determine฀the฀feasibility฀and฀ accuracy฀of฀DSE฀with฀real-time฀3D฀echocardiography฀(RT3DE)฀for฀diagnosis฀of฀CAD฀in฀ comparison฀with฀2DE.฀ Methods:฀ Sixty฀ two฀ patients฀ (RT3DE:฀ 35,฀ m฀ :฀ f฀ =฀ 26฀ :฀ 9,฀ age฀ =฀ 60฀ ±฀ 11฀ yrs,฀ 2DE:฀ 27,฀ m฀ :฀ f฀ =฀ 18฀ :฀ 9,฀ age฀ =฀ 60฀ ±฀ 11฀ yrs)฀ suspicious฀ of฀ angina฀ pectoris฀ underwent฀ DSE฀ and฀ coronary฀ angiography.฀ Image฀ acquisition฀ was฀ done฀ at฀ baseline,฀ followed฀ by฀ 4฀ stages฀ during฀ Dobutamine฀ infusion฀ (10,฀ 20,฀ 30,฀ 40฀ ug/kg/min,฀ for฀ 3฀ mins฀ at฀ each฀ stage)฀ and฀ finally฀at฀recovery฀stage.฀In฀all฀patients,฀the฀procedure฀time฀(from฀the฀beginning฀of฀baseline฀ to฀the฀end฀of฀peak฀dose฀stage)฀was฀recorded.฀Off-line฀regional฀wall฀motion฀analyses฀of฀ volumetric฀ images฀ acquired฀ with฀ RT3DE฀ was฀ done฀ using฀ commercially฀ available฀ 3D฀ computer฀software฀(TomTec,฀Co.).฀Digitized฀quad-screen฀images฀acquired฀with฀2DE฀were฀ analyzed฀off-line฀with฀commercially฀available฀2DE฀review฀system฀(ProSolv฀4.0).฀Images฀ were฀ analyzed฀ according฀ to฀ the฀ previously฀ described฀ 16฀ segment฀ model฀ and฀ induced฀ new฀or฀worsened฀wall฀motion฀abnormality฀in฀≥2฀contiguous฀segments฀during฀Dobutamine฀ infusion฀was฀interpreted฀as฀ischemia.฀>฀50฀%฀luminal฀diameter฀stenosis฀of฀any฀coronary฀ artery฀ on฀ coronary฀ angiography฀ was฀ defined฀ as฀ significant฀ coronary฀ artery฀ stenosis.฀ Sensitivity฀and฀specificity฀were฀compared฀between฀two฀procedures.฀ Results:฀The฀procedure฀time฀of฀DSE฀with฀RT3DE฀was฀significantly฀shorter฀than฀that฀of฀ 2DE฀(25.4฀±฀3.4฀vs฀37.2฀±฀4.3฀mins,฀p฀<฀0.01).฀DSE฀with฀RT3DE฀showed฀higher฀sensitivity฀ (79%฀ vs฀ 67%)฀ compared฀ to฀ DSE฀ with฀ 2DE.฀ There฀ was฀ no฀ significant฀ difference฀ of฀ specificity฀(94%฀vs฀94%)฀between฀those฀two฀procedures.฀ Conclusion:฀ DSE฀ with฀ RT3DE฀ seems฀ to฀ be฀ a฀ feasible฀ and฀ less฀ time฀ consuming฀ diagnostic฀ procedure฀ providing฀ better฀ sensitivity฀ for฀ the฀ detection฀ of฀ coronary฀ artery฀ stenosis฀compared฀to฀DSE฀with฀2DE. Noninvasive Imaging 1139-82฀ Feasibility฀of฀Using฀a฀Novel฀Real-Time฀ThreeDimensional฀Technique฀for฀Contrast฀Dobutamine฀Stress฀ Echocardiography Todd฀Pulerwitz,฀Kumiko฀Hirata,฀Ryo฀Otsuka,฀Susan฀Herz,฀Khady฀Fall,฀Samyra฀Ali฀Rivera,฀ Marie-Edouard฀N.฀Desvarieux,฀Margaret฀P.฀Bond,฀Marco฀R.฀Di฀Tullio,฀Shunichi฀Homma,฀ Columbia฀Presbyterian฀Hospital,฀New฀York,฀NY Background:฀Accurate฀wall฀motion฀assessment฀during฀stress฀echocardiography฀requires฀ rapid฀ acquisition฀ of฀ high฀ quality฀ echocardiographic฀ images.฀ Real-time฀ 3-dimensional฀ (RT3-D)฀ transthoracic฀ contrast฀ echocardiography฀ with฀ full฀ volume฀ acquisition฀ (Philips฀ SONOS฀ 7500)฀ offers฀ important฀ potential฀ advantages฀ over฀ standard฀ 2-dimensional฀ and฀ non-contrast฀RT3-D฀echocardiography฀when฀assessing฀left฀ventricular฀wall฀motion.฀This฀ is฀ the฀ first฀ study฀ using฀ this฀ system฀ to฀ evaluate฀ the฀ feasibility฀ of฀ RT3-D฀ imaging฀ using฀ ultrasound฀contrast฀agent฀during฀pharmacological฀stress฀testing. Methods:฀Thirteen฀patients฀undergoing฀dobutamine฀stress฀echocardiography฀(54%฀men;฀ mean฀age฀60฀±฀14.2฀years)฀were฀studied.฀Contrast฀and฀non-contrast฀apical฀full฀volume฀and฀ short฀axis฀3-dimensional฀images฀were฀obtained฀during฀rest฀and฀peak฀dose฀dobutamine฀ infusion.฀ Two฀ experienced฀ echocardiographers฀ independently฀ reviewed฀ the฀ images฀ to฀ assess฀ image฀ quality฀ (adequate฀ or฀ inadequate)฀ using฀ standard฀ 16฀ segment฀ American฀ Society฀of฀Echocardiography฀criteria. Results:฀The฀use฀of฀ultrasound฀contrast฀significantly฀increased฀the฀number฀of฀segments฀ adequately฀ visualized฀ during฀ rest฀ and฀ peak฀ dobutamine฀ infusion฀ (Table฀ 1).฀ The฀ time฀ to฀ image฀ optimization฀ and฀ acquisition฀ with฀ and฀ without฀ contrast฀ use฀ was฀ less฀ than฀ 90฀ seconds. Conclusions:฀ RT3-D฀ dobutamine฀ contrast฀ stress฀ echocardiography฀ 1)฀ is฀ feasible,฀ 2)฀ significantly฀ improves฀ image฀ quality฀ compared฀ to฀ non-contrast฀ images,฀ and฀ 3)฀ quickly฀ acquires฀full฀data฀sets. ฀ Table฀1:฀Comparison฀of฀the฀Adequacy฀of฀Contrast฀and฀Non-Contrast฀RT3-D฀Images฀During฀Dobutamine฀ Stress฀Echocardiography Apical Apical฀and฀short฀axis p-value p-value Non-Contrast Contrast Non-Contrast Contrast Rest 75% 96% 0.0001 92% 98% 0.004 Peak 75% 97% 0.0001 87% 99% 0.0001 1139-83฀ Color-Encoding฀of฀Endocardial฀Motion฀Improves฀the฀ Interpretation฀of฀Contrast-Enhanced฀Echocardiographic฀ Stress฀Tests฀by฀Less฀Experienced฀Readers Lawrence฀D.฀Jacobs,฀Lissa฀Sugeng,฀Robert฀J.฀Weiss,฀Lynn฀Weinert,฀Tina฀Bouchard,฀Kirk฀ T.฀Spencer,฀Marlon฀Everett,฀James฀Min,฀Michael฀Panutich,฀Roberto฀M.฀Lang,฀Victor฀MorAvi,฀University฀of฀Chicago,฀Chicago,฀IL,฀Androscoggin฀Cardiology฀Associates,฀Auburn,฀ME Interpretation฀ of฀ contrast฀ enhanced฀ stress฀ tests฀ in฀ pts฀ with฀ poor฀ acoustic฀ windows฀ is฀ challenging฀and฀subjective.฀We฀hypothesized฀that฀color฀encoding฀of฀endocardial฀motion฀ would฀aid฀less฀experienced฀readers฀in฀detection฀of฀wall฀motion฀abnormalities฀at฀rest฀and฀ stress฀in฀this฀population.฀ Methods.฀ We฀ studied฀ 85฀ pts฀ with฀ poorly฀ visualized฀ endocardium฀ in฀ ≥2฀ contiguous฀ segments฀in฀each฀apical฀view.฀Color-encoded฀images฀(Philips฀7500,฀color฀kinesis)฀were฀ obtained฀ at฀ rest฀ and฀ peak฀ dobutamine฀ stress฀ in฀ short฀ axis฀ and฀ 3฀ apical฀ views฀ with฀ iv฀ infusion฀ of฀ Definity฀ (Bristol-Myers฀ Squibb).฀ Two฀ cardiology฀ fellows฀ with฀ <6฀ months฀ of฀ training฀ in฀ echocardiography฀ reviewed฀ the฀ images฀ with฀ color฀ overlays฀ suppressed฀ and฀ JACC February 1, 2005 then฀ with฀ the฀ color฀ displayed฀ on฀ a฀ separate฀ day.฀ LV฀ wall฀ motion฀ in฀ each฀ segment฀ was฀ graded฀ as฀ normal,฀ abnormal฀ or฀ uninterpretable.฀ Consensus฀ grades฀ of฀ 2฀ experienced฀ readers฀served฀as฀a฀“gold฀standard”.฀The฀accuracy฀of฀the฀interpretation฀was฀calculated฀ against฀this฀“gold฀standard”฀separately฀for฀the฀3฀vascular฀territories฀(LAD,฀LCX,฀RCA)฀and฀ averaged฀for฀the฀2฀fellows.฀ Results.฀ With฀ color฀ coded฀ information฀ available:฀ 1)฀ the฀ number฀ of฀ uninterpretable฀ segments฀decreased฀by฀32%;฀2)฀both฀fellows฀reached฀higher฀levels฀of฀accuracy฀in฀all฀3฀ vascular฀territories฀both฀at฀rest฀and฀stress฀(fig.).฀ Conclusion.฀ The฀ addition฀ of฀ wall฀ motion฀ color฀ encoding฀ to฀ Definity-enhanced฀ images฀ obtained฀in฀pts฀with฀poor฀acoustic฀windows฀during฀stress฀tests฀improves฀the฀interpretation฀ of฀regional฀LV฀function฀by฀less฀experienced฀readers.฀ 1139-84฀ Effect฀of฀Perfusion฀Imaging฀During฀Dobutamine฀Stress฀ Echocardiography฀in฀Detecting฀Occult฀Coronary฀Artery฀ Disease฀in฀Patients฀With฀Advanced฀Liver฀Disease Jeane฀Mike฀Tsutsui,฀Feng฀Xie,฀Sandeep฀Mukherjee,฀Edward฀L.฀O’Leary,฀Anna฀C.฀ McGrain,฀Thomas฀R.฀Porter,฀University฀of฀Nebraska฀Medical฀Center,฀Omaha,฀NE Background:฀Patients฀(pts)฀with฀advanced฀liver฀disease฀(ALD)฀often฀have฀significant฀risk฀ factors฀for฀coronary฀artery฀disease฀(CAD).฀Dobutamine฀stress฀echocardiography฀(DSE)฀ has฀ been฀ used฀ for฀ identifying฀ CAD,฀ but฀ often฀ the฀ rate฀ pressure฀ product฀ (RPP)฀ at฀ peak฀ stress฀ in฀ these฀ pts฀ is฀ reduced฀ due฀ to฀ profound฀ vasodilation.฀ Although฀ this฀ may฀ reduce฀ the฀ sensitivity฀ of฀ wall฀ motion฀ analysis฀ (WMA),฀ perfusion฀ imaging฀ should฀ still฀ identify฀ a฀ significant฀stenosis฀in฀this฀setting.฀We฀hypothesized฀that฀real฀time฀perfusion฀(RTP)฀using฀ intravenous฀ (IV)฀ ultrasound฀ contrast฀ would฀ improve฀ the฀ detection฀ of฀ occult฀ CAD฀ in฀ pts฀ with฀ALD.฀ Methods:฀Over฀a฀four฀year฀period,฀we฀studied฀268฀pts฀(56±7฀years,฀162฀men)฀with฀ALD฀ who฀underwent฀RTP฀during฀DSE,฀and฀268฀selected฀pts฀without฀ALD฀(55±10฀years,฀146฀ men)฀ who฀ underwent฀ conventional฀ DSE฀ without฀ contrast฀ for฀ other฀ indications.฀ Both฀ groups฀ were฀ matched฀ for฀ age,฀ sex,฀ and฀ risk฀ factors฀ for฀ CAD.฀ Perfusion฀ images฀ in฀ ALD฀ pts฀ were฀ obtained฀ following฀ IV฀ injections฀ of฀ Definity฀ (n=62)฀ or฀ Optison฀ (n=206),฀ using฀ low-mechanical฀index฀RTP.฀ Results:฀ Among฀ pts฀ with฀ ALD,฀ 73฀ required฀ orthotopic฀ liver฀ transplantation฀ (OLT).฀ RPP฀ was฀significantly฀lower฀in฀ALD฀pts,฀especially฀those฀requiring฀OLT฀(Table).฀A฀total฀of฀28฀ (10%)฀pts฀with฀ALD฀had฀abnormal฀RTP,฀while฀WMA฀was฀abnormal฀in฀only฀8฀(3%)฀ALD฀pts.฀ All฀ 7฀ pts฀ that฀ had฀ >50%฀ diameter฀ stenoses฀ confirmed฀ at฀ quantitative฀ angiography฀ had฀ inducible฀perfusion฀defects,฀but฀only฀1฀had฀abnormal฀WMA.฀ Conclusion:฀RTP฀improves฀the฀detection฀of฀CAD฀during฀DSE฀in฀pts฀with฀ALD. *p<0.05฀compared฀to฀pts฀without฀ALD฀ Stages Variables Baseline Heart฀rate฀(bpm) Systolic฀blood฀ pressure฀(mm฀Hg) RPP฀(mm฀Hg/min) Peak 1139-85฀ Heart฀rate฀(bpm) Systolic฀blood฀ pressure฀(mm฀Hg) RPP฀(mm฀Hg/min) %฀Predicted฀maximal฀ heart฀rate Pts฀without฀ALD฀ ALD฀Pts฀ (n฀=฀268) (n฀=฀268) 75±14 75±13 OLT฀(n=73) 74±12 134±19 127±23* 10,032±2,228 9,579±2,371* 123±21* 9,189±2,189* 149±12 147±11 147±8 135±33 127±33* 120±31* 20,066±5,314 18,607±5,086* 17,702±5,023* 90±8 90±6 89±5 Value฀Of฀Combined฀Dobutamine฀Stress฀ Echocardiography฀And฀Myocardial฀Contrast฀ Echocardiography฀In฀Determining฀Prognosis฀Of฀Patients฀ With฀Known฀Or฀Suspected฀Coronary฀Artery฀Disease Costandina฀Aggeli,฀George฀Rousakis,฀C.฀Kokkinakis,฀Stella฀Brilli,฀George฀Latsios,฀John฀ Barbetseas,฀Christos฀Pitsavos,฀Christodoulos฀Stefanadis,฀University฀of฀Athens,฀Athens,฀ Greece Purpose:฀This฀study฀sought฀to฀determine฀whether฀the฀combination฀of฀dobutamine฀stress฀ echocardiography฀ (DSE)฀ and฀ myocardial฀ contrast฀ echo฀ (MCE)฀ can฀ be฀ used฀ to฀ predict฀ morbidity฀and฀mortality฀in฀patients฀with฀known฀or฀suspected฀coronary฀artery฀disease. Methods:฀ Follow-up฀ was฀ performed฀ on฀ 230฀ patients฀ (mean฀ age:฀ 63฀ y,฀ 188฀ men)฀ over฀ a฀ period฀ of฀ 36฀ months฀ (an฀ average฀ 25฀ months)฀ after฀ clinically฀ indicated฀ DSE.฀ The฀ JACC February 1, 2005 DSEMCE฀protocol฀included฀SonoVue฀(Bracco)฀infusion฀(at฀a฀rate฀of฀0.8฀ml/min)฀during฀ the฀baseline฀echo฀study฀and฀during฀the฀last฀stage฀of฀DSE฀using฀power฀modulation฀and฀a฀ low฀mechanical฀index฀(0.1-0.2).฀Transient฀high฀mechanical฀index฀(1.7)฀pulses฀were฀used฀ to฀destroy฀microbubbles,฀allowing฀the฀assessment฀of฀myocardial฀replenishment.฀All฀echo฀ studies฀ were฀ stratified฀ according฀ to฀ either฀ inducible฀ wall฀ motion฀ abnormalities฀ or฀ MCE฀ perfusion฀ defects฀ into฀ 4฀ responses:฀ negative฀ for฀ ischemia฀ DSE(-)฀ and฀ MCE(-),฀ positive฀ DSE(+)฀and฀negative฀MCE(-),฀negative฀DSE(-)฀and฀positive฀MCE(+)฀as฀well฀as฀positive฀ DSE(+)฀ and฀ MCE(+).฀ The฀ combined฀ end฀ points฀ of฀ cardiac฀ death฀ and/or฀ events฀ were฀ tabulated฀for฀the฀outcome. Results:฀ Cardiac฀ events฀ occurred฀ in฀ 43฀ patients฀ (19%).฀ A฀ negative฀ DSE(-)MCE(-)฀ was฀ associated฀ with฀ a฀ statistically฀ lower฀ likelihood฀ of฀ cardiac฀ event฀ compared฀ to฀ other฀ DSEMCE฀ responses฀ (p=0.003).฀ The฀ combination฀ of฀ both฀ positive฀ DSE(+)MCE(+)฀ was฀ associated฀with฀a฀higher฀likelihood฀of฀cardiac฀events฀by฀the฀multivariate฀analysis฀(p=0.01).฀ By฀ multiple฀ logistic฀ regression฀ analysis฀ of฀ DSE-MCE฀ response,฀ age,฀ and฀ cardiac฀ risk฀ factors,฀ a฀ positive฀ DSE฀ and/or฀ MCE฀ response฀ was฀ independently฀ associated฀ with฀ the฀ occurrence฀ of฀ a฀ cardiac฀ end฀ point฀ during฀ the฀ follow-up฀ period.฀ In฀ a฀ multivariate฀ Cox฀ proportional฀ hazards฀ model,฀ the฀ likelihood฀ of฀ any฀ cardiac฀ event฀ was฀ increased฀ in฀ the฀ presence฀ of฀ both฀ positive฀ DSE-MCE฀ response฀ (relative฀ risk฀ [RR]฀ 6.8,฀ 95%฀ confidence฀ interval฀[CI]฀4.09฀to฀10.4,฀p<0.01). Conclusions:฀The฀presence฀of฀positive฀response฀during฀DSE-MCE฀is฀an฀independent฀ predictor฀ of฀ cardiac฀ events฀ and฀ therefore฀ it฀ can฀ identify฀ high฀ and฀ low฀ risk฀ subsets฀ of฀ patients฀with฀known฀or฀suspected฀coronary฀artery฀disease.฀Long฀term฀follow฀up฀of฀these฀ patients฀would฀merit฀major฀consideration. 1139-86฀ ABSTRACTS - Noninvasive Imaging 295A Methods:฀30฀patients฀were฀investigated฀by฀16-slice฀CT฀(370฀or฀420฀ms฀rotation฀time,฀0.75฀ mm฀ collimation,฀ 80฀ ml฀ contrast฀ agent฀ i.v.)฀ IVUS฀ of฀ one฀ coronary฀ artery฀ was฀ performed฀ (LM+LAD:฀21,฀LM+LCX:฀4,฀LM+RCA:฀5).฀At฀238฀sites฀within฀the฀coronary฀system,฀in฀which฀ non-calcified฀ atherosclerotic฀ plaque฀ could฀ be฀ identified฀ both฀ in฀ MDCT฀ and฀ IVUS,฀ the฀ CT฀ attenuation฀ within฀ the฀ plaque฀ was฀ measured.฀The฀ measured฀ CT฀ attenuation฀ values฀ were฀correlated฀to฀the฀appearance฀of฀the฀plaque฀in฀IVUS฀(hyperechic฀in฀comparison฀to฀ adventitia฀=฀fibrous,฀hypoechoic฀=฀lipid-rich). Results:฀ The฀ mean฀ CT฀ attenuation฀ within฀ fibrous฀ plaques฀ was฀ 127±42฀ HU฀ (n฀ =฀ 69).฀ The฀ mean฀ CT฀ attenuation฀ within฀ lipid-rich฀ plaques฀ was฀ 59±43฀ HU฀ (n฀ =฀ 169,฀ p<0.001).฀ However,฀ there฀ was฀ substantial฀ overlap฀ of฀ the฀ density฀ values฀ measured฀ in฀ fibrous฀ and฀ lipid-rich฀coronary฀plaques(see฀graph) Summary:฀While฀a฀significant฀difference฀of฀the฀mean฀CT฀attenuation฀within฀fibrous฀and฀ lipid-rich฀ coronary฀ atherosclerotic฀ plaques฀ could฀ be฀ observed,฀ the฀ substantial฀ overlap฀ of฀ attenuation฀ values฀ casts฀ doubts฀ on฀ the฀ ability฀ of฀ MDCT฀ to฀ accurately฀ characterize฀ composition฀of฀single฀coronary฀plaques.฀ Combination฀Of฀Myocardial฀Contrast฀Echocardiography฀ And฀Dobutamine฀Stress฀Echo฀In฀Predicting฀Myocardial฀ Recovery฀After฀Revascularization฀In฀Patients฀With฀ Occluded฀Coronary฀Artery฀Disease Costandina฀Aggeli,฀George฀Rousakis,฀Stratis฀Tapanlis,฀Christos฀Kokkinakis,฀George฀ Latsios,฀Stella฀Brilli,฀Christos฀Pitsavos,฀Christodoulos฀Stefanadis,฀University฀of฀Athens,฀ Athens,฀Greece POSTER฀SESSION 1140฀฀ Computed฀Tomography฀for฀Disease฀ Progression:฀Atherosclerotic฀Plaque Tuesday,฀March฀08,฀2005,฀9:00฀a.m.-12:30฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀10:00฀a.m.-11:00฀a.m. 1140-71฀ Characterization฀of฀Noncalcified฀Coronary฀ Atherosclerotic฀Plaque฀by฀Multidetector฀Row฀CT:฀ Comparison฀to฀IVUS Stephan฀Achenbach,฀Dieter฀Ropers,฀Karsten฀Pohle,฀Udo฀Hoffmann,฀Maros฀Ferencik,฀ Fabian฀Moselewski,฀Ray฀Chan,฀Thomas฀J.฀Brady,฀Ik-kyung฀Jang,฀Werner฀G.฀Daniel,฀ University฀of฀Erlangen,฀Erlangen,฀Germany,฀Massachusetts฀General฀Hospital,฀Boston,฀MA Multi-detector฀ row฀ CT฀ (MDCT)฀ permits฀ visualization฀ of฀ the฀ coronary฀ arteries฀ and,฀ under฀ favourable฀ conditions,฀ detection฀ of฀ atherosclerotic฀ plaque.฀ We฀ investigated฀ the฀ CT฀ attenuation฀ of฀ non-calcified฀ plaques฀ in฀ comparison฀ to฀ their฀ characterization฀ by฀ intravascular฀ultrasound฀(IVUS).฀ 1140-72฀ Direct฀Non-invasive฀Detection฀of฀Coronary฀Remodeling฀ Using฀Multi-detector฀CT Edward฀P.฀Shapiro,฀Pamela฀Ouyang,฀Joao฀A.C.฀Lima,฀Julie฀M.฀Miller,฀Marco฀A.฀Cordeiro,฀ Irfan฀S.฀Shafique,฀David฀E.฀Bush,฀Johns฀Hopkins฀Medical฀Institutions,฀Baltimore,฀MD Introduction:฀ The฀ ability฀ to฀ detect฀ coronary฀ remodeling฀ using฀ non-invasive฀ methods฀ would฀have฀important฀implications฀for฀identifying฀and฀treating฀the฀vulnerable฀patient฀(pt).฀ Calcium฀ scores฀ provide฀ a฀ measure฀ of฀ arterial฀ disease,฀ but฀ lack฀ sensitivity฀ in฀ younger฀ individuals,฀and฀cannot฀identify฀soft฀plaque,฀the฀proximate฀cause฀of฀coronary฀events. Hypothesis:฀We฀used฀multi-detector฀CT฀(MDCT)฀to฀measure฀the฀area฀and฀density฀of฀the฀ coronary฀wall฀(including฀plaque)฀and฀lumen,฀to฀test฀the฀concept฀that฀differences฀in฀vessel฀ wall฀characteristics฀in฀pts฀with฀and฀without฀known฀CAD,฀can฀be฀detected฀non-invasively. Methods:฀Pts฀admitted฀with฀chest฀pain฀of฀uncertain฀etiology฀underwent฀MDCT฀using฀a฀ 16฀slice฀Toshiba฀scanner฀with฀400฀ms฀rotation฀time,฀acquiring฀0.5฀or฀1฀mm฀thick฀slices.฀ Coronary฀wall฀area฀(calcified฀and฀non-calcified),฀and฀lumen฀area฀were฀measured฀every฀4฀ mm฀in฀the฀left฀main฀and฀along฀the฀first฀40฀mm฀of฀the฀three฀major฀coronary฀arteries฀using฀ software฀designed฀to฀distinguish฀arterial฀components,฀guided฀by฀pre-specified฀ranges฀of฀ Hounsfield฀units.฀Vessel฀characteristics฀in฀pts฀with฀clinical฀CAD฀by฀history฀or฀in-hospital฀ testing฀vs.฀those฀without,฀were฀compared. Results:฀Twenty-six฀pts฀(77%฀male)฀aged฀55.9+10฀years,฀were฀studied.฀Thirteen฀(50%)฀ were฀found฀to฀have฀CAD.฀The฀average฀coronary฀lumen฀area฀was฀similar฀in฀pts฀with฀CAD฀ compared฀ to฀ those฀ without฀ (8.4+4฀ vs.฀ 9.2+4฀ mm2,฀ p=NS).฀ However,฀ the฀ average฀ ratio฀ of฀non-calcified฀vessel฀wall฀area฀to฀luminal฀area฀(wall/lumen)฀along฀the฀3฀major฀arteries฀ was฀greater฀in฀pts฀with฀CAD฀than฀those฀without฀(1.5+0.5฀vs.฀1.1+0.2,฀p=0.009),฀reflecting฀ coronary฀ remodeling.฀ Total฀ wall/lumen฀ including฀ calcified฀ wall฀ components,฀ was฀ also฀ greater฀in฀CAD฀vs.฀without฀(1.7+0.6฀vs.฀1.1+0.2,฀p=0.003).฀The฀average฀Hounsfield฀unit฀of฀ the฀arterial฀wall฀(83+13฀vs.฀81+16,฀p=NS)฀was฀not฀different฀in฀the฀two฀groups,฀nor฀was฀the฀ area฀of฀the฀wall฀occupied฀by฀calcium฀(1.7+2฀vs฀0.5+1฀mm2,฀p=NS). Conclusion:฀The฀average฀ratio฀of฀wall฀area฀to฀lumen฀area฀in฀the฀proximal฀coronaries,฀ a฀gauge฀of฀coronary฀remodeling,฀is฀significantly฀increased฀in฀pts฀with฀CAD.฀This฀MDCT฀ measurement฀of฀coronary฀geometry฀may฀provide฀the฀first฀practical฀non-invasive฀measure฀ of฀total฀coronary฀artery฀disease฀burden. 1140-73฀ Non-invasive฀Imaging฀of฀Coronary฀Artery฀Plaque฀ Rupture:฀Multi-slice฀Computed฀Tomographic฀ Angiographic฀Visualization฀in฀an฀Ambulatory฀Patient฀ Population Jamie฀M.฀Pelzel,฀Jana฀Lindberg,฀Scott฀W.฀Sharkey,฀Bjorn฀Flygenring,฀John฀Lesser,฀ Robert฀S.฀Schwartz,฀Minneapolis฀Heart฀Institute,฀Minneapolis,฀MN Background:฀ Coronary฀ artery฀ plaque฀ rupture฀ is฀ a฀ potentially฀ lethal฀ complication฀ of฀ atherosclerosis.฀ No฀ known฀ diagnostic฀ modality,฀ invasive฀ or฀ non-invasive,฀ is฀ known฀ to฀ detect฀its฀occurrence.฀Multi-slice฀Computed฀Tomographic฀Angiography฀(MSCTA)฀provides฀ detailed฀information฀not฀only฀about฀stenosis฀severity,฀but฀also฀about฀the฀vessel฀wall฀and฀ plaque฀ character,฀ potentially฀ enabling฀ non-invasive฀ plaque฀ characterization.฀ We฀ thus฀ evaluated฀ MSCTA฀ as฀ a฀ non-invasive฀ method฀ for฀ imaging฀ coronary฀ plaque฀ rupture฀ in฀ ambulatory฀patients. Methods:฀One฀hundred,฀seventy-six฀(176)฀consecutive฀patients฀were฀scanned฀for฀clinical฀ indications฀ (chest฀ pain,฀ elevated฀ risk฀ factors)฀ using฀ a฀ Siemens฀ Sensation฀ 16฀ MSCT฀ scanner.฀They฀ received฀ intravenous฀ contrast฀ injection฀ and฀ beta฀ blockade,฀ if฀ needed,฀ to฀ achieve฀ a฀ heart฀ rate฀ of฀ 65฀ bpm฀ or฀ less฀ (mean฀ =฀ 56).฀ Scans฀ were฀ reviewed฀ for฀ lesions฀ containing฀ contrast฀ penetrate฀ into฀ the฀ coronary฀ artery฀ wall฀ and฀ surrounded฀ by฀ plaque,฀ consistent฀with฀plaque฀rupture. Noninvasive Imaging Purpose:฀ The฀ aim฀ of฀ this฀ study฀ was฀ to฀ compare฀ the฀ ability฀ of฀ myocardial฀ contrast฀ echocardiography฀ (MCE)฀ and฀ dobutamine฀ stress฀ echocardiography฀ (DSE)฀ to฀ predict฀ recovery฀ of฀ dysfunctional฀ myocardium฀ after฀ revascularization฀ in฀ patients฀ with฀ one฀ occluded฀coronary฀artery. Methods:฀ 41฀ patients฀ (mean฀ age฀ 62±4฀ y)฀ with฀ LAD฀ disease,฀ 23฀ with฀ severe฀ stenosis฀ >70%฀(group฀A)฀and฀18฀with฀occluded฀LAD฀(group฀B)฀and฀regional฀dysfunction฀underwent฀ MCE฀ and฀ DSE฀ 2-5฀ days฀ before฀ revascularization.฀ MCE฀ was฀ performed฀ using฀ real-time฀ low฀mechanical฀index฀power฀modulation฀imaging฀during฀continuous฀infusion฀of฀SonoVue฀ (Bracco).฀Contrast฀opacification฀assessed฀at฀10฀cardiac฀cycles฀after฀bubble฀destruction฀by฀ high฀acoustic฀power฀and฀contrast฀score฀index฀(3฀grade฀scale)฀for฀the฀LAD฀supplied฀area฀ was฀calculated.฀All฀patients฀underwent฀coronary฀bypass฀grafting฀and฀follow-up฀low฀dose฀ dobutamine฀was฀repeated฀2-3฀months฀after฀revascularization. Results:฀ There฀ were฀ no฀ differences฀ in฀ age,฀ ejection฀ fraction฀ at฀ rest,฀ and฀ wall฀ motion฀ score฀index฀at฀rest฀between฀the฀two฀groups.฀Of฀243฀dysfunctional฀segments฀in฀the฀LAD฀ territory฀undergoing฀revascularization฀109฀(62฀in฀group฀A฀and฀47฀in฀group฀B)฀recovered฀ at฀followup.฀In฀group฀A,฀MCE฀and฀DSE฀exhibited฀similar฀values฀of฀sensitivity,฀specificity฀ and฀accuracy฀(87%฀vs.฀87%,฀62%฀vs.฀72%,฀73%฀vs.฀79%,฀respectively)฀whereas฀in฀group฀ B,฀MCE฀showed฀higher฀sensitivity฀and฀negative฀predictive฀value฀than฀DSE฀(81%฀vs.฀57%,฀ p<0.001฀ and฀ 80%฀ vs.฀ 68%,฀ p<0.05,฀ respectively)฀ in฀ predicting฀ segmental฀ myocardial฀ recovery.฀These฀differences฀in฀sensitivity฀and฀negative฀predictive฀value฀between฀MCE฀and฀ DSE฀were฀more฀pronounced฀in฀akinetic฀segments฀of฀group฀B฀(75%฀vs.฀35%,฀p<0.001฀and฀ 75%฀vs.฀56%,฀p<0.05).฀Significant฀correlation฀was฀observed฀between฀the฀regional฀contrast฀ score฀index฀and฀both฀the฀follow฀up฀regional฀wall฀motion฀score฀index฀(r=-0.65฀for฀group฀A฀ and฀r=-0.60฀for฀group฀B)฀and฀the฀follow฀up฀ejection฀fraction฀change฀(r=0.64฀for฀group฀A฀ and฀r=0.60฀for฀group฀B). Conclusions:฀ MCE฀ demonstrates฀ higher฀ sensitivity฀ and฀ negative฀ predictive฀ value฀ compared฀ with฀ DSE฀ in฀ predicting฀ recovery฀ of฀ dysfunctional฀ myocardium฀ supplied฀ by฀ totally฀occluded฀LAD฀after฀revascularization. 296A ABSTRACTS - Noninvasive Imaging Results:฀ A฀ ruptured฀ coronary฀ artery฀ plaque฀ was฀ found฀ in฀ 22%฀ of฀ cases฀ (39/176).฀ Statistically฀significant฀differences฀in฀patient฀groups฀with฀and฀without฀ruptured฀coronary฀ artery฀plaque฀were฀triglyceride฀level฀(230฀vs.฀149฀mg/dL)฀and฀Calcium฀Score฀(352฀vs฀147)฀ respectively.฀In฀39฀patients฀with฀ruptured฀plaque,฀only฀61%฀(24/39)฀had฀severe฀stenosis฀ in฀any฀vessel. Conclusions:฀ 1)฀ Ruptured฀ plaque฀ appears฀ detectable฀ noninvasively฀ by฀ MSCTA.฀ 2)฀ It฀ is฀ remarkably฀ prevalent฀ in฀ patients฀ presenting฀ with฀ clinical฀ indications.฀ 3)฀ Patients฀ with฀ ruptured฀ plaque฀ had฀ significantly฀ higher฀ triglyceride฀ levels฀ and฀ calcium฀ scores.฀ 4)฀ Ruptured฀plaque฀may฀be฀associated฀chest฀pain฀in฀a฀substantial฀fraction฀of฀patients฀who฀ do฀not฀have฀significant฀stenosis. 1140-74฀ Quantitative฀Assessment฀of฀Coronary฀Arteries฀by฀ Multislice฀Computed฀Tomography Noninvasive Imaging Taishi฀Yonetsu,฀Tsunekazu฀Kakuta,฀Shigeki฀Kimura,฀Osamu฀Kuboyama,฀Tomoyuki฀ Umemoto,฀Hideomi฀Fujiwara,฀Mitsuaki฀Isobe,฀Tsuchiura฀Kyodo฀General฀Hospital,฀ Tsuchiura,฀Japan,฀Tokyo฀Medical฀and฀Dental฀University,฀Tokyo,฀Japan Background:฀The฀establishment฀of฀the฀standard฀method฀for฀the฀quantitative฀measurement฀ of฀multislice฀CT฀(MSCT)฀is฀of฀paramount฀importance฀for฀its฀clinical฀use.฀We฀evaluated฀the฀ accuracy฀of฀quantitative฀assessment฀of฀MSCT฀images฀with฀the฀use฀of฀the฀full-width-halfmaximum฀ method฀ (FWHM),฀ and฀ assessed฀ if฀ this฀ method฀ would฀ be฀ affected฀ by฀ plaque฀ volume,฀vessel฀size,฀or฀CT฀density฀of฀coronary฀arteries. Methods:฀ A฀ total฀ of฀ 78฀ coronary฀ segments฀ from฀ 48฀ patients฀ were฀ assessed฀ by฀ both฀ MSCT฀ and฀ intravascular฀ ultrasound฀ (IVUS).฀ MSCT฀ cross-sectional฀ images฀ were฀ obtained฀using฀16-slice฀MSCT,฀and฀lumen฀area฀(LA)฀was฀measured฀by฀digital฀caliper฀with฀ FWHM.฀LA฀determined฀by฀IVUS฀was฀used฀for฀the฀standard฀of฀reference,฀and฀compared฀ with฀ MSCT฀ measurements.฀ All฀ 78฀ segments฀ were฀ divided฀ into฀ each฀ two฀ groups฀ by฀ the฀ medians฀of฀three฀parameters฀(%฀plaque฀area฀;฀GP฀:฀>40%฀or฀SP฀:฀≤40%,฀lumen฀area฀;฀GA฀ :฀>8.58mm2฀or฀SA฀≤฀8.58mm2,฀maximum฀CT฀density฀in฀the฀lumen฀;฀HD฀:฀>฀320HU฀or฀LD฀:฀ ≤฀320HU),฀then฀we฀evaluated฀the฀correlation฀between฀IVUS฀and฀MSCT฀measurements฀in฀ each฀groups฀and฀performed฀a฀Bland-Altman฀analysis฀to฀assess฀if฀any฀of฀the฀parameters฀ affected฀the฀agreement.฀In฀tight฀stenosis฀group฀with฀lumen฀area฀less฀than฀4.0mm2฀(N=14),฀ we฀separately฀analyzed฀the฀concordance฀between฀IVUS฀and฀MSCT฀measurements. Results:฀In฀all฀segments,฀linear฀regression฀analysis฀revealed฀a฀tight฀correlation฀between฀ MSCT฀derived฀LA฀and฀IVUS฀derived฀LA฀(r2=0.91).฀In฀each฀group,฀good฀correlation฀and฀ agreement฀between฀MSCT฀and฀IVUS฀measurements฀were฀also฀observed.฀No฀significant฀ difference฀ in฀ agreement฀ was฀ observed฀ between฀ GP฀ and฀ SP,฀ or฀ between฀ HD฀ and฀ LD.฀ However,฀weaker฀correlation฀and฀agreement฀were฀observed฀between฀MSCT฀and฀IVUS฀in฀ SA฀compared฀with฀in฀GA,฀(r2฀=0.631,฀and฀r2฀=0.783,฀respectively).฀In฀tight฀stenosis฀group,฀ we฀found฀no฀significant฀correlation฀between฀MSCT฀and฀IVUS฀measurements฀(r2=0.07). Conclusions:฀ Quantitative฀ measurements฀ of฀ MSCT฀ images฀ using฀ the฀ full-width-halfmaximum฀ method฀ showed฀ good฀ agreement฀ with฀ IVUS฀ measurements฀ irrespective฀ of฀ plaque฀volume฀or฀CT฀density.฀In฀stenotic฀segments,฀however,฀MSCT฀measurements฀using฀ FWHM฀method฀may฀not฀be฀applicable. 1140-75฀ Multislice฀CT฀Predictors฀of฀Restenosis฀After฀Stent฀ Implantation Tomoyuki฀Umemoto,฀Tsunekazu฀Kakuta,฀Shigeki฀Kimura,฀Osamu฀Kuboyama,฀Taishi฀ Yonetsu,฀Hidenori฀Fujiwara,฀Mitsuaki฀Isobe,฀Tsuchiura฀Kyodo฀Genaral฀Hospital,฀ Tsuchiura,฀Japan,฀Tokyo฀Medical฀&฀Dental฀University,฀Tokyo,฀Japan Background:฀We฀sought฀to฀assess฀whether฀multislice฀CT฀(MSCT)฀performed฀before฀PCI฀ has฀the฀predictive฀value฀of฀restenosis. Methods:฀A฀total฀of฀61฀lesions฀of฀53฀patients฀with฀angiographically฀significant฀coronary฀ artery฀disease,฀in฀whom฀pre-PCI฀16-slice฀MSCT฀with฀evaluable฀image฀quality฀was฀obtained,฀ were฀evaluated.฀For฀MSCT฀image฀analysis,฀MIP,฀VR,฀MPR,฀and฀cross-sectional฀images฀ were฀assessed฀for฀reference฀diameter฀(RD,฀mm),฀lesion฀length฀(LL,฀mm),฀minimum฀lesion฀ diameter฀(MLD,฀mm),฀lesion฀eccentricity,฀positive฀or฀negative฀remodeling,฀and฀mean฀CT฀ density฀of฀plaque฀determined฀by฀ROI฀methods฀(CT,฀HU).฀Mean฀CT฀density฀was฀determined฀ by฀calculating฀the฀mean฀of฀CT฀densities฀obtained฀from฀5฀randomly฀chosen฀ROIs฀inside฀the฀ plaque.฀Follow-up฀conventional฀coronary฀angiography฀was฀performed฀at฀6฀-฀9฀months฀after฀ PCI฀in฀all฀patients,฀and฀restenosis฀was฀defined฀by฀≥฀50%฀angiographic฀diameter฀reduction.฀ Each฀parameters฀were฀compared฀between฀restenotic฀and฀non-restenotic฀lesions. Results:฀ Stent฀ implantation฀ was฀ performed฀ in฀ 53฀ lesions.฀ Restenosis฀ occurred฀ in฀ 14฀ lesions฀(26.4%).฀RD,฀LL,฀and฀CT฀were฀significantly฀different฀between฀restenotic฀and฀nonrestenotic฀lesions฀(2.7฀±฀0.7mm฀vs฀3.1฀±฀0.6฀mm,฀11.3฀±฀3.6mm฀vs฀7.5฀±฀3.8mm;฀118฀±฀39฀ vs฀68฀±฀40฀HU,฀respectively,฀p<0.05). Conclusion:฀ RD,฀ LL,฀ and฀ CT฀ obtained฀ in฀ preprocedural฀ MSCT฀ may฀ predict฀ restenosis฀ after฀PCI.฀MSCT฀before฀PCI฀may฀help฀tailoring฀therapeutic฀approach฀including฀the฀choice฀ of฀drug฀eluting฀stent฀or฀CABG. 1140-76฀ Multislice฀Cardiac฀Computer฀Tomography฀is฀Useful฀in฀ The฀Detection฀of฀Coronary฀Artery฀Disease฀in฀Patients฀ With฀Positive฀Cardiac฀Family฀History JACC February 1, 2005 were฀ divided฀ in฀ to฀ 12฀ segments฀ similar฀ to฀ conventional฀ coronary฀ angiography฀ (CA)฀ for฀ grading฀of฀luminal฀stenosis.฀Data฀are฀given฀as฀mean฀±SD. Results:฀Ninetytwo฀of฀the฀148฀patients฀had฀a฀positive฀CACS฀(241±527),฀of฀whom฀34฀had฀ a฀PFH฀(CACS:251±593).฀Significant฀correlation฀was฀found฀between฀CACS฀and฀age,฀IMT,฀ systolic฀blood฀pressure฀and฀total฀cholesterol฀(p<0.05),฀In฀the฀subgroup฀with฀PFH฀stepwise฀ regression฀analysis฀showed฀that฀increased฀IMT฀predicted฀likelihood฀of฀CACS฀(p=฀0.01).฀ In฀ 40฀ patients฀ with฀ either฀ a฀ significant฀ CACS฀ (>400)฀ or฀ evidence฀ of฀ soft฀ plaque฀ and฀ a฀ >50%฀ stenosis฀ on฀ CTA,฀ and฀ or฀ abnormal฀ stress-MIBI,฀ CA฀ was฀ performed.฀ High฀ CACS฀ predicted฀ likelihood฀ of฀ at฀ least฀ one฀ significant฀ coronary฀ stenosis฀ on฀ CA฀ (p=0.01).฀ The฀ overall฀agreement฀for฀454฀coronary฀segments฀between฀CTA฀and฀CA฀was฀88%,฀with฀a฀very฀ good฀concordance฀(kappa฀=฀0.62).฀The฀concordance฀between฀stress฀MIBI฀and฀CA฀was฀ moderate฀at฀kappa฀=฀0.44,฀whereas฀the฀agreement฀between฀CA฀and฀the฀combined฀stress฀ MIBI-CTA฀ findings฀ was฀ excellent฀ at฀ 93%฀ (kappa฀ =0.69).฀The฀ negative฀ predictive฀ value฀ of฀ the฀ assessable฀ segments฀ with฀ CTA฀ was฀ excellent฀ at฀ 95%,฀ with฀ a฀ positive฀ predictive฀ value฀of฀65%.฀ Conclusions:฀ In฀ patients฀ with฀ a฀ low฀ FRS฀ but฀ PFH฀ a฀ strong฀ association฀ was฀ found฀ between฀CACS฀and฀IMT.฀MSCT฀is฀useful฀in฀the฀detection฀of฀CAD฀in฀patients฀with฀PFH฀and฀ reliably฀selects฀patients฀for฀further฀invasive฀assessment. 1140-77฀ Reliability฀of฀Comprehensive฀Analysis฀of฀Coronary฀ Vessel฀and฀Plaque฀in฀Patients฀with฀Acute฀Coronary฀ Syndrome฀by฀Multi-detector฀row฀CT฀with฀“Plaque฀Map”฀ System Sei฀Komatsu,฀Yosuke฀Omori,฀Atsushi฀Hirayama,฀Yasunori฀Ueda,฀Yasuo฀Fujisawa,฀ Masayoshi฀Kiyomoto,฀Toshiaki฀Higashide,฀Kazuhisa฀Kodama,฀Cardiovascular฀Division,฀ Osaka฀Police฀Hospital,฀Osaka,฀Japan,฀Department฀of฀Radiological฀Technology,฀Osaka฀ Police฀Hospital,฀Osaka,฀Japan Background.฀ We฀ examined฀ the฀ reliability฀ of฀ comprehensive฀ analysis฀ method฀ “Plaque฀ Map”฀System฀for฀any฀MDCT฀images.฀ Methods.฀102฀consecutive฀ACS฀patients฀from฀March฀2003฀to฀August฀2004฀were฀enrolled฀ (F:M=฀ 12:90;฀ 67±11฀ yrs).฀ 16-detector฀ MDCT฀ was฀ done฀ after฀ 2wks฀ after฀ PCI.฀ Coronary฀ vessel฀diameter/area,฀plaque,฀and฀positive/negative฀remodeling฀by฀“Plaque฀Map”฀images฀ were฀ analyzed฀ and฀ compared฀ with฀ IVUS฀ and฀ angioscopy.฀ Stent฀ patency฀ of฀ MDCT฀ was฀ examined฀ at฀ six฀ month฀ after฀ PCI,฀ comparing฀ follow-up฀ coronary฀ angiography฀ in฀ 28฀ patients.฀ Results.฀ Vessel฀ diameter/area฀ measured฀ by฀“Plaque฀ Map”฀ were฀ correlated฀ with฀ IVUS฀ (r2=0.93฀ and฀ r2=0.92,฀ respectively).฀ Stent฀ size฀ was฀ 3.0±0.4฀ mm฀ and฀ stent฀ length฀ was฀ 16.2±5.5฀ mm฀ (mean±SD)฀ in฀ chronic฀ stage.฀ Stent฀ occlusion฀ was฀ detected฀ by฀ “Plaque฀ Map”฀pattern฀when฀the฀diameter฀of฀stent฀was฀3.0฀mm฀or฀more.฀In฀11฀patients฀stents฀were฀ occluded฀ and฀ corresponded฀ with฀ coronary฀ angiogram.฀ The฀ sensitivity฀ and฀ specificity฀ of฀ stent฀ patency฀ detected฀ by฀ “Plaque฀ Map”฀ compared฀ with฀ coronary฀ angiogram฀ were฀ 88฀ %฀ and฀ 84%,฀ respectively.฀ Coronary฀ positive/negative฀ remodeling฀ were฀ analyzed฀ by฀ “Remodeling฀ Map”,฀ that฀ was฀ modified฀ “Plaque฀ Map”฀ focused฀ on฀ remodeling.฀ The฀ sensitivity฀ and฀ specificity฀ of฀ positive/negative฀ remodeling฀ were฀ 84%฀ and฀ 83฀ %.฀ The฀ sensitivity฀ and฀ specificity฀ of฀ detection฀ of฀ soft฀ plaque฀ by฀ MDCT฀ compared฀ with฀ yellow฀ plaque฀by฀angioscopy฀were฀77฀%฀and฀90฀%.฀ Conclusion.฀“Plaque฀Map”฀System฀for฀MDCT฀may฀analyze฀precisely฀and฀have฀a฀role฀for฀ risk฀stratification฀of฀vulnerable฀patients. ฀ 1140-78฀ Delayed-Contrast฀Vessel฀Wall฀Enhancement฀of฀Coronary฀ Atherosclerotic฀Plaques:฀An฀Ex-vivo฀Multi-Detector฀ Computed฀Tomography฀Study Bharati฀Shivalkar,฀Rodrigo฀Salgado,฀Ozkan฀Oszcharlak,฀Inge฀Goovaerts,฀Bernard฀ Paelinck,฀Paul฀Parizel,฀Christiaan฀Vrints,฀University฀Hospital฀Antwerp,฀Edegem,฀Belgium Paul฀Schoenhagen,฀Sandra฀Halliburton,฀Anuja฀Nair,฀Arthur฀Stillman,฀Michael฀Lieber,฀ Geoffrey฀Vince,฀Murat฀Tuzcu,฀Richard฀White,฀Cleveland฀Clinic฀Foundation,฀Cleveland,฀OH Background:฀ The฀ presence฀ and฀ extent฀ of฀ coronary฀ artery฀ calcification฀ is฀ indicative฀ of฀ total฀burden฀of฀calcified฀and฀noncalcified฀plaque,฀and฀may฀detect฀potentially฀vulnerable฀ lesions.฀ We฀ hypothesize฀ that฀ multislice฀ cardiac฀ computer฀ tomography฀ (MSCT)฀ may฀ be฀ useful฀to฀assess฀coronary฀artery฀disease฀(CAD)฀in฀asymptomatic฀individuals฀with฀a฀low฀ Framingham฀risk฀score฀(FRS)฀and฀positive฀family฀history฀(PFH)฀for฀cardiac฀disease. Methods:฀ One฀ hundred฀ and฀ fortyeight฀ asymptomatic฀ patients฀ including฀ 47฀ with฀ PFH฀ (male/female,฀age฀56±12฀years)฀with฀low฀to฀intermediate฀FRS฀had฀a฀MSCT฀(Siemens,฀16rows)฀for฀coronary฀artery฀calcium฀scoring฀(CACS,฀Agatston฀score)฀and฀CT฀angiography฀ (CTA),฀as฀well฀as฀a฀stress฀MIBI,฀carotid฀intima฀media฀thickness฀measurement฀(IMT),฀and฀ biochemical฀ analysis฀ (lipid,฀ fibrinogen฀ levels,฀ C-reactive฀ protein).฀The฀ coronary฀ arteries฀ Background:฀MDCT฀studies฀have฀described฀characterization฀of฀atherosclerotic฀lesions฀ based฀on฀Hounsfield฀number฀(HU).฀However,฀the฀influence฀of฀contrast-enhancement฀of฀ the฀vessel฀wall฀and฀plaque฀is฀unknown. Methods:฀ Six฀ human฀ coronary฀ arteries฀ were฀ examined฀ post-mortem฀ with฀ MDCT฀ (16฀ slice/rot,฀ 420฀ ms฀ rot฀ time,฀ 0.6฀ mm฀ slice)฀ and฀ IVUS฀ during฀ continuous฀ saline฀ perfusion.฀ MDCT฀was฀performed฀before,฀during,฀and฀after฀(10-20฀min)฀contrast฀injection.฀Eighteen฀ focal฀atherosclerotic฀lesion฀sites฀were฀identified฀and฀matched฀to฀IVUS.฀Based฀on฀IVUS,฀ plaques฀were฀identified฀as฀homogeneous฀(predominantly฀fibrous฀or฀predominantly฀soft)฀or฀ mixed฀(calcified/fibrous฀or฀calcified/soft).฀Using฀MDCT,฀multiple฀ROIs฀were฀defined฀in฀the฀ vessel฀wall฀and฀the฀mean฀HU฀of฀plaque฀burden฀was฀measured฀during฀all฀contrast฀phases.฀ JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging A฀ one-way฀ analysis฀ of฀ variance฀ was฀ performed฀ within฀ each฀ plaque฀ group,฀ comparing฀ mean฀HU฀among฀the฀three฀groups. Results:฀Contrast฀enhancement฀for฀homogeneous฀plaques,฀showed฀significant฀differences฀ relative฀to฀the฀contrast฀phase฀(p=0.005).฀The฀differences฀in฀contrast฀enhancement฀were฀ not฀significant฀for฀mixed฀plaques.฀(Table) Conclusion:฀ The฀ results฀ demonstrate฀ significant฀ contrast฀ vessel฀ wall฀ enhancement฀ of฀ coronary฀atherosclerotic฀plaques฀depending฀on฀predominant฀morphology.฀The฀contrastenhancement฀profile฀is฀likely฀a฀result฀of฀diffusion฀of฀iodine฀into฀the฀vessel฀wall฀or฀filling฀ via฀the฀vasa฀vasorum฀and฀should฀be฀considered฀in฀the฀characterization฀of฀plaques฀with฀ contrast-enhanced฀MDCT. Hounsfield฀Number฀of฀Atherosclerotic฀Plaques.฀ Plaques Homogeneous฀(N=9) Mixed฀(N=9) HU฀-฀Pre-Contrast 9฀±฀30* 74฀±฀89 HU฀-฀Contrast 61฀±฀43* 141฀±฀141 HU฀-฀Post-Contrast 46฀±฀11* 132฀±฀150 POSTER฀SESSION 1141฀฀ Magnetic฀Resonance฀Imaging฀of฀ Atherosclerosis,฀Thrombosis,฀and฀฀ New฀Techniques Tuesday,฀March฀08,฀2005,฀9:00฀a.m.-12:30฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀10:00฀a.m.-11:00฀a.m. 1141-63฀ 1141-64฀ 297A Detection฀of฀Acute฀and฀Chronic฀Arterial฀Thrombi฀in฀ vivo:฀A฀comparative฀Study฀of฀non-Contrast฀Enhanced฀ Magnetic฀Resonance฀Imaging฀(MRI)฀and฀Fibrin-Targeted฀ Contrast฀Enhancing฀MR฀Agent Marc฀Sirol,฀Valentin฀Fuster,฀Juan฀J.฀Badimon,฀Juan฀Viles-Gonzalez,฀John฀T.฀Fallon,฀Zahi฀ A.฀Fayad,฀Mount฀Sinai฀School฀of฀Medicine,฀New฀York,฀NY Background:฀ Arterial฀ thrombosis฀ plays฀ a฀ critical฀ role฀ in฀ clinical฀ manifestation฀ of฀ cardiovascular฀ diseases.฀ Thrombus฀ detection฀ by฀ MRI฀ has฀ been฀ successfully฀ reported฀ using฀either฀non-contrast฀enhanced฀MRI฀(CE-MRI)฀or฀targeted฀contrast฀agents.฀However,฀ no฀ study฀ has฀ compared฀ the฀ two฀ techniques฀ for฀ arterial฀ thrombus฀ detection.฀Therefore,฀ we฀sought฀to฀compare฀to฀non฀CE-MRI฀the฀use฀of฀a฀fibrin-targeted฀MR฀contrast฀agent฀in฀a฀ model฀of฀acute฀and฀chronic฀thrombosis. Methods:฀Carotid฀arteries฀were฀injured฀in฀14฀NZW฀rabbits.฀High-resolution฀multicontrast฀ MRI฀ (T1W,฀T2W,฀ PDW)฀ was฀ performed฀ followed฀ by฀T1W฀ images฀ after฀ EP-2104R฀ (Epix฀ Medical฀Inc.)฀injection.฀Images฀were฀acquired฀immediately,฀48฀hours฀and฀every฀week฀up฀ to฀8฀weeks฀after฀carotid฀injury. Results:฀Thrombus฀appearance฀and฀relative฀signal฀intensity฀(SI฀=฀SI฀thrombus฀/฀SI฀Muscle)฀ revealed฀characteristic฀temporal฀changes฀in฀non฀CE-MRI.฀Acute฀thrombi฀appeared฀very฀ bright฀on฀T2W฀images฀(SI฀=฀2.27฀±฀.51฀at฀1฀week).฀After฀EP-2104R฀injection,฀thrombus฀ enhancement฀was฀achieved฀in฀all฀cases.฀SI฀was฀greatly฀increased฀in฀acute฀(P฀<0.0001)฀ and฀in฀chronic฀thrombi฀(P<0.001).฀SI฀was฀significantly฀higher฀(P฀<0.01)฀after฀injection฀even฀ 6฀weeks฀after฀thrombus฀formation฀compared฀to฀non-CE-MRI฀(Figure฀1). Conclusion:฀ We฀ demonstrate฀ the฀ feasibility฀ and฀ the฀ superiority฀ of฀ fibrin-targeted฀ MR฀ contrast฀ agent฀ for฀ acute฀ and฀ chronic฀ thrombus฀ detection฀ in฀ vivo฀ compared฀ to฀ non฀ CEMRI.฀MR฀contrast-enhancement฀was฀highest฀for฀acute฀thrombi฀and฀decreased฀in฀chronic฀ organizing฀thrombi. Early฀versus฀Advanced฀Atherosclerotic฀Plaque฀in฀ vivo฀Detection฀by฀Gadofluorine-Enhanced฀Magnetic฀ Resonance฀Imaging Marc฀Sirol,฀Pedro฀Moreno,฀Valentin฀Fuster,฀Hanns฀Joachim฀Weinmann,฀Jean-Francois฀ Toussaint,฀Zahi฀A.฀Fayad,฀Mount฀Sinai฀School฀of฀Medicine,฀New฀York 1141-65฀ HDL3฀Is฀Independently฀Related฀to฀Lipid฀Core฀Volume฀in฀ Atherosclerotic฀Plaques฀Measured฀by฀High฀Resolution฀ MRI Milind฀Y.฀Desai,฀Annabelle฀Rodriguez,฀Gary฀Gerstenblith,฀Sachin฀Agarwal,฀Margene฀ Kennedy,฀David฀A.฀Bluemke,฀Joao฀AC฀Lima,฀Johns฀Hopkins฀University,฀Baltimore,฀MD Background:฀High฀density฀cholesterol฀(HDL)฀is฀known฀to฀have฀a฀cardio-protective฀role฀ believed฀ to฀ be฀ primarily฀ mediated฀ by฀ reverse฀ cholesterol฀ transport.฀ However,฀ HDL฀ is฀ a฀ heterogeneous฀ molecule฀ with฀ 2฀ major฀ sub-fractions:฀ HDL2฀ (large฀ buoyant)฀ and฀ HDL3฀ (small฀ dense)฀ and฀ controversy฀ exists฀ regarding฀ the฀ protective฀ role฀ of฀ HDL2฀ or฀ HDL3฀ in฀ atherosclerosis.฀Aim:฀To฀determine฀the฀relationship฀of฀HDL2฀and฀HDL3฀with฀lipid฀core฀(LC)฀ volume฀measured฀in฀the฀atherosclerotic฀plaque฀(AP)฀of฀the฀internal฀carotid฀artery฀(ICA)฀ imaged฀using฀magnetic฀resonance฀(MR)฀imaging.฀ Methods:฀ICA’s฀of฀28฀patients฀with฀known฀atherosclerosis฀(mean฀age฀73฀±฀4฀years,฀73%฀ males)฀ were฀ imaged฀ on฀ a฀ 1.5฀T฀ CV/i฀ GE฀ MR฀ scanner.฀ Five฀ oblique฀ slices฀ each฀ of฀ the฀ ICA฀in฀3฀different฀weightings:฀T1-weighted฀and฀T2-weighted฀(both฀pre-contrast)฀and฀T1weighted฀(after฀infusion฀of฀0.1฀mmol/kg฀of฀intravenous฀gadodiamide)฀were฀obtained฀and฀ composite฀ volume฀ of฀ LC฀ was฀ calculated฀ using฀ MASS฀ software฀ (MEDIS,฀ Netherlands).฀ HDL2฀ and฀ HDL3฀ were฀ calculated฀ from฀ plasma฀ by฀ ultracentrifugation฀ using฀ the฀ vertical฀ auto฀profile฀(VAP)฀technique฀(Atherotech,฀Inc,฀Alabama).฀Cardiac฀risk฀factors,฀low฀density฀ cholesterol฀(LDL),฀triglycerides฀(TG)฀and฀abdominal฀girth฀were฀recorded.฀ Results:฀The฀mean฀total฀HDL,฀HDL2฀and฀HDL3฀were฀48฀±฀11,฀11฀±฀5฀and฀36฀±฀7฀mg/dl,฀ respectively.฀The฀mean฀LC฀volume฀in฀AP฀was฀0.03฀±฀0.03฀mm3.฀On฀linear฀regression,฀there฀ was฀an฀inverse฀correlation฀between฀LC฀and฀HDL3฀(r฀=฀-0.57,฀p฀=฀0.003)฀which฀remained฀ significant฀ after฀ addition฀ of฀ the฀ following฀ confounding฀ variables฀ in฀ a฀ multivariate฀ model:฀ diabetes,฀ gender฀ and฀ abdominal฀ girth฀ (R2฀ =฀ 70%,฀ R2฀ adjusted฀ =฀ 63฀ %,฀ p฀ <฀ 0.001).฀ For฀ HDL2,฀ a฀ trend฀ towards฀ significance฀ (r฀ =฀ 0.35,฀ p฀ =฀ 0.08)฀ became฀ non-significant฀ after฀ multiple฀regression฀analysis฀(R2฀=฀60฀%,฀R2฀adjusted฀=฀21฀%,฀p฀=฀0.27).฀ Conclusion:฀ Plasma฀ HDL3฀ is฀ inversely฀ correlated฀ to฀ lipid฀ core฀ size฀ in฀ carotid฀ atherosclerotic฀ plaques฀ of฀ patients฀ with฀ advance฀ atherosclerosis.฀ These฀ results฀ might฀ provide฀support฀to฀the฀potential฀role฀of฀HDL3฀in฀reverse฀cholesterol฀transport฀and฀suggest฀ that฀HDL฀sub-fraction฀analysis฀may฀add฀value฀to฀blood฀lipid฀assessment฀in฀patients฀with฀ atherosclerosis.฀ Noninvasive Imaging Background:฀Our฀group฀has฀recently฀reported฀the฀use฀of฀Gadofluorine-enhanced฀MRI฀ for฀detection฀of฀lipid-rich฀plaques.฀Detection฀of฀subclinical฀atherosclerosis฀such฀as฀early฀ lesions฀could฀improve฀diagnostic฀and฀guidance฀of฀therapy.฀We฀sought฀to฀evaluate฀the฀use฀ of฀Gadofluorine฀for฀the฀assessment฀of฀early฀and฀advanced฀atherosclerotic฀plaques. Methods:฀Aortic฀denudation฀was฀performed฀in฀16฀rabbits฀fed฀with฀0.2%฀cholesterol฀diet฀ (HC)฀for฀either฀2฀months฀(early฀plaque฀group฀(Ea))฀or฀for฀8฀months฀(advanced฀group฀(Ad)).฀ Six฀animals฀were฀used฀as฀control฀(no฀HC).฀MRI฀was฀performed฀before฀and฀24฀hours฀after฀ Gadofluorine฀(Schering฀AG)฀injection฀using฀T1w,฀T2w฀and฀PDw฀imaging. Results:฀Plaque฀enhancement฀was฀successful฀after฀injection฀in฀both฀Ea฀and฀Ad฀group฀ (Figure฀1).฀Contrast-to-noise฀ratio฀(CNR)฀was฀significantly฀higher฀in฀Ad฀group฀compared฀ to฀Ea฀group฀(P<0.01).฀No฀enhancement฀was฀seen฀in฀controls.฀AHA฀classification฀revealed฀ type฀ II฀ and฀ III฀ plaque฀ in฀ Ea฀ group,฀ and฀ type฀Va฀ and฀Vc฀ plaque฀ in฀ Ad฀ group฀ (P<0.001).฀ Pre-contrast฀ MRI฀ using฀ multicontrast฀ technique฀ was฀ not฀ able฀ to฀ identify฀ atherosclerotic฀ plaques฀in฀the฀Ea฀group฀compared฀to฀the฀Ad฀group฀(P<0.001). Conclusions:฀ We฀ demonstrate฀ the฀ successful฀ use฀ of฀ Gadofluorine฀ for฀ early฀ plaque฀ detection฀compared฀to฀non-contrast฀enhanced฀MRI.฀Early฀lesions฀could฀be฀differentiated฀ from฀ advanced฀ plaque฀ according฀ to฀ CNR฀ values฀ after฀ Gadofluorine฀ injection.฀ This฀ approach฀ may฀ be฀ useful฀ in฀ the฀ assessment฀ of฀ atherosclerotic฀ burden฀ in฀ patients฀ at฀ different฀stages฀of฀the฀disease. 298A 1141-66฀ ABSTRACTS - Noninvasive Imaging Age฀and฀Smoking,฀but฀Not฀Sex฀nor฀Ethnicity,฀Are฀ Major฀Predictors฀of฀Abdominal฀Aortic฀Atherosclerosis:฀ Results฀From฀the฀Dallas฀Heart฀Study Hao฀S.฀Lo,฀Roderick฀McColl,฀Mujeeb฀Basit,฀DuWayne฀Willett,฀Ronald฀M.฀Peshock,฀ University฀of฀Texas฀Southwestern฀Medical฀Center,฀Dallas,฀TX,฀Donald฀W฀Reynolds฀ Cardiovascular฀Clinical฀Research฀Center,฀Dallas,฀TX Background:฀Atherosclerotic฀cardiovascular฀disease฀is฀the฀major฀cause฀of฀morbidity฀and฀ mortality฀in฀the฀United฀States.฀We฀used฀magnetic฀resonance฀imaging฀(MRI)฀to฀evaluate฀ the฀prevalence฀and฀extent฀of฀abdominal฀aortic฀atherosclerosis฀as฀a฀marker฀for฀subclinical฀ atherosclerotic฀disease฀in฀the฀participants฀of฀the฀Dallas฀Heart฀Study฀(DHS),฀a฀prospective฀ population-based฀cohort฀reflecting฀the฀ethnic฀composition฀of฀Dallas฀County,฀Texas. Methods:฀ High-resolution฀ imaging฀ of฀ the฀ abdominal฀ aorta฀ at฀ 1.5T฀ using฀ a฀ gated,฀ fatsuppressed,฀double-inversion฀recovery,฀T2-weighted฀sequence฀was฀performed฀in฀2,515฀ participants.฀ The฀ vessel฀ wall฀ was฀ defined.฀ Areas฀ of฀ hyper-intense฀ signal฀ and฀ luminal฀ protrusion฀were฀used฀to฀determine฀plaque฀presence฀and฀total฀aortic฀plaque฀area.฀ Results:฀ The฀ cohort฀ (age฀ 44.3+9.9,฀ 54.8%฀ female)฀ showed฀ an฀ overall฀ prevalence฀ of฀ atherosclerosis฀ by฀ MRI฀ of฀ 38.9%.฀ Age฀ and฀ smoking฀ were฀ strong฀ independent฀ predictors฀ (both฀p<0.01)฀of฀the฀presence฀of฀aortic฀plaque฀in฀a฀logistic฀regression฀model.฀Each฀10-year฀ increase฀in฀age฀was฀associated฀with฀a฀factor฀of฀1.96฀(95%฀CI฀1.77,฀2.18)฀increase฀in฀odds฀ of฀aortic฀plaque.฀Smoking฀was฀associated฀with฀a฀2.40฀(95%฀CI฀1.95,฀2.96)฀increase฀in฀odds.฀ Diabetes฀and฀systolic฀blood฀pressure฀(both฀p<0.01)฀were฀also฀positive฀predictors฀while฀highdensity฀lipoprotein฀and฀body฀mass฀index฀(both฀p<0.01)฀were฀weak฀negative฀predictors.฀Sex฀ and฀ethnicity฀were฀not฀significant฀predictors฀of฀aortic฀plaque฀presence.฀Aortic฀plaque฀extent฀ also฀increased฀with฀age฀and฀was฀associated฀with฀the฀same฀risk฀factors.฀ Conclusions:฀ Sub-clincial฀ atherosclerosis,฀ as฀ detected฀ by฀ MRI,฀ is฀ present฀ in฀ a฀ high฀ percentage฀ (38.9%)฀ of฀ participants฀ in฀ a฀ large,฀ multiethnic฀ population-based฀ sample.฀ In฀ this฀cross-sectional฀study,฀the฀prevalence฀of฀atherosclerosis฀is฀strongly฀linked฀to฀age฀and฀ smoking฀but฀not฀sex฀nor฀ethnicity. 1141-67฀ JACC February 1, 2005 balloon฀ catheter฀ into฀ the฀ LAD฀ coronary฀ artery฀ of฀ an฀ isolated฀ pig฀ heart.฀ Balanced฀ FFE฀ 19 F฀projection฀scans฀(TR=฀4ms,฀TE=฀1.5฀ms,฀matrix=฀2x2.5x70฀mm)฀were฀acquired฀on฀a฀ clinical฀1.5฀T฀Philips฀MR฀scanner฀outfitted฀with฀a฀special฀channel฀tuned฀for฀fluorine฀nuclei฀ and฀a฀13cm฀Helmholtz฀RF฀coil.฀Corresponding฀ 1H฀MRI฀scans฀of฀the฀heart฀anatomy฀were฀ used฀for฀localization฀of฀the฀19F฀image฀signal. Results:฀The฀figure฀below฀depicts฀the฀left฀coronary฀artery฀tree฀of฀this฀heart฀as฀seen฀with฀ 19 F฀MRI฀after฀injection฀of฀nanoparticles.฀This฀technique฀generated฀a฀signal฀to฀noise฀ratio฀of฀ 19.7฀from฀the฀vessel฀with฀a฀scan฀time฀of฀only฀2.8฀s฀per฀image.฀A฀series฀of฀dynamic฀images฀ acquired฀during฀injection฀allowed฀visualization฀of฀vascular฀filling. Conclusions:฀We฀have฀demonstrated฀a฀method฀for฀19F-based฀coronary฀MR฀angiography฀ that฀requires฀neither฀fat฀suppression฀nor฀other฀preparatory฀pulses฀using฀PFC฀nanoparticles.฀ Ultimately,฀ peripheral฀ injections฀ of฀ nanoparticles฀ may฀ provide฀ an฀ improved฀ method฀ for฀ noninvasive฀coronary฀MRA.฀ In฀Vitro฀Quantification฀of฀Cells฀Labeled฀with฀Magnetic฀ Nanoparticles฀Using฀Off-resonance฀Sequence Noninvasive Imaging Takayasu฀Arai,฀Charles฀H.฀Cunningham,฀Michael฀V.฀McConnell,฀Steven฀M.฀Conolly,฀Phillip฀ C.฀Yang,฀Stanford฀University,฀School฀of฀Medicine,฀Stanford,฀CA Introduction.฀In฀vivo฀monitoring฀of฀cell-based฀therapy฀is฀not฀available฀clinically.฀In฀order฀ to฀address฀this฀issue,฀we฀developed฀off-resonance฀(OR)฀magnetic฀resonance฀(MR)฀pulse฀ sequence,฀which฀exploits฀the฀magnetic฀dipole฀gradient฀to฀generate฀positive฀contrast฀from฀ super-paramagnetic฀ iron฀ oxide฀ (SPIO)฀ labeled฀ mouse฀ embryonic฀ stem฀ cells฀ (mESC).฀ Feasibility฀of฀the฀OR฀sequence฀to฀quantify฀the฀SPIO-labeled฀mESC฀in฀vitro฀was฀tested. Methods.฀ Cell฀ labeling฀ solution฀ was฀ prepared฀ by฀ incubating฀ 250µg/ml฀ of฀ ferumoxides฀ (Feridex®,฀Berlex฀Laboratories)฀with฀1µg/ml฀of฀poly-l-lysine฀for฀60minutes.฀Approximately฀ 5x105฀mESC฀were฀incubated฀with฀the฀labeling฀solution฀for฀24฀hours.฀The฀labeling฀solution฀ was฀removed฀and฀4฀samples฀of฀the฀labeled฀mESC฀were฀allowed฀to฀divide฀for฀4฀days.฀Cells฀ were฀counted฀using฀a฀hemocytometer.฀At฀days฀1,฀2,฀and฀4,฀mESC฀were฀suspended฀in฀four฀ vials฀filled฀with฀0.9%฀saline฀and฀were฀inserted฀into฀agar฀gel฀for฀susceptibility฀matching.฀ GRE฀(100ms฀TR,฀7.2ms฀TE,฀30°flip฀angle)฀and฀OR฀imaging฀(200ms฀TR,฀14ms฀TE)฀were฀ performed฀ using฀ a฀ conventional฀ 1.5T฀ Signa฀ MR฀ Scanner฀ (GE,฀ Milwaukee,฀ WI).฀ Signal฀ area฀was฀measured฀by฀computing฀the฀number฀of฀pixels฀5฀standard฀deviations฀above฀the฀ mean฀noise฀magnitude. Results.฀This฀study฀shows฀monotonic฀relationship฀between฀signal฀area฀and฀labeled฀cell฀ population฀using฀OR฀(r=0.855),฀however,฀not฀with฀GRE฀(r=0.037). Conclusion.฀The฀data฀suggests฀that฀OR฀quantifies฀the฀proliferating฀labeled฀cell฀population.฀ This฀technique฀may฀enable฀in฀vivo฀cell฀quantification. 1141-69฀ Symptomatic฀Carotid฀Plaques฀Differ฀in฀MRI฀Signal฀but฀ not฀in฀Size฀or฀Degree฀of฀Stenosis Steffen฀Bohl,฀Ralf฀Wassmuth,฀Jeanette฀Schulz-Menger,฀Michael฀Gross,฀Matthias฀ Friedrich,฀Franz฀Volhard฀Klinik,฀Berlin,฀Germany Methods:฀We฀scanned฀40฀patients฀(48-83฀years,฀26฀men)฀with฀carotid฀plaque฀in฀a฀1.5฀ T฀ MRI฀ scanner฀ with฀ a฀ bilateral฀ phased฀ array฀ coil.฀ A฀ blinded฀ neurologist฀ independently฀ classified฀8฀of฀the฀patients฀as฀symptomatic฀due฀to฀amaurosis฀fugax฀or฀a฀transient฀ischemic฀ attack฀ related฀ to฀ carotid฀ stenosis.฀We฀ acquired฀ six฀ to฀ ten฀ axial฀ 3฀ mm฀ slices฀ starting฀ in฀ the฀ common฀ carotid฀ artery฀ just฀ below฀ the฀ bifurcation฀ with฀ an฀ in-plane฀ resolution฀ of฀ 0.3฀ mm/pixel.฀Double฀inversion฀fast฀spin฀echo฀images฀were฀obtained฀in฀proton-density-฀and฀ T2-weighting.Two฀ independent฀ readers฀ measured฀ plaque฀ signal,฀ contrast฀ and฀ volume.฀ Results฀were฀compared฀to฀the฀degree฀of฀stenosis฀as฀determined฀by฀quantitative฀invasive฀ angiography฀performed฀within฀5+/-3฀days. Results:฀Symptomatic฀carotid฀plaques฀had฀a฀higher฀signal-to-noise฀(38+/-17฀vs.฀17+/-10,฀ p<0.01)฀ and฀ contrast-to-noise฀ ratio฀ (1.4+/-0,4฀ vs.฀ 1.1+/-0,2,฀ p<0.05)฀ in฀ proton-densityweighted฀images฀than฀asymptomatic฀plaques.฀The฀mean฀signal฀did฀not฀differ฀in฀T2.฀Plaque฀ volume฀was฀0.73+/-0.43฀ccm฀with฀good฀interobserver฀agreement฀(r=0.75).฀Symptomatic฀ and฀asymptomatic฀patients฀did฀not฀differ฀in฀plaque฀size฀or฀angiographic฀degree฀of฀stenosis.฀ Plaque฀volume฀by฀MRI฀did฀not฀correlate฀to฀the฀degree฀of฀stenosis฀by฀angiography.฀ Conclusion:฀ Whereas฀ carotid฀ plaques฀ in฀ symptomatic฀ patients฀ do฀ not฀ differ฀ from฀ asymptomatic฀ plaques฀ in฀ volume฀ or฀ angiographic฀ degree฀ of฀ stenosis,฀ they฀ show฀ a฀ significantly฀ higher฀ signal฀ in฀ proton-density-weighted฀ images.฀ The฀ MRI฀ pattern฀ might฀ help฀to฀characterize฀plaques฀beyond฀traditional฀parameters฀with฀special฀respect฀to฀their฀ prognostic฀relevance. 1141-70฀ Comparison฀of฀High-Resolution฀Three-Dimensional฀ Aortic฀MR฀Angiography฀and฀Vessel฀Wall฀Imaging฀With฀ Histology฀for฀Detection฀of฀Positive฀Arterial฀Remodeling฀ (PAR)฀in฀a฀Rabbit฀Model Henning฀Steen,฀Antonina฀Kolmakova,฀Subroto฀Chatterjee,฀Joao฀Augusto฀Lima,฀Matthias฀ Stuber,฀Johns฀Hopkins฀University,฀Baltimore,฀MD ฀ 1141-68฀ Magnetic฀Resonance฀Coronary฀Angiography฀฀ with฀a฀Fluorinated฀Nanoparticle฀Contrast฀Agent Anne฀M.฀Morawski,฀Shelton฀D.฀Caruthers,฀Franklin฀D.฀Hockett,฀Ralph฀W.฀Fuhrhop,฀ Gregory฀M.฀Lanza,฀Samuel฀A.฀Wickline,฀Washington฀University฀School฀of฀Medicine,฀St.฀ Louis,฀MO,฀Philips฀Medical฀Systems,฀Best,฀The฀Netherlands Background:฀We฀have฀developed฀a฀19F-based฀intravascular฀contrast฀agent฀that฀promises฀ to฀improve฀coronary฀imaging฀by฀allowing฀spatially฀matched฀detection฀of฀two฀different฀MR฀ signals,฀ 19F฀ and฀ the฀ standard฀ 1H.฀ This฀ nanoparticle฀ emulsion฀ offers฀ a฀ unique฀ spectral฀ signature฀for฀visualizing฀coronary฀artery฀anatomy฀with฀no฀background฀signal. Methods:฀ A฀ liquid฀ perfluorocarbon฀ (PFC)฀ nanoparticle฀ contrast฀ agent฀ (20%฀ v/v฀ perfluoro-15-crown-5-ether;฀ diameter฀ ~250฀ nm)฀ was฀ injected฀ through฀ a฀ 2฀ F฀ diameter฀ Background:฀Arterial฀lumen฀diameter฀changes฀and฀concomitant฀vessel฀wall฀thickening฀is฀ referred฀to฀as฀PAR฀and฀is฀associated฀more฀frequently฀with฀acute฀coronary฀syndromes.฀We฀ hypothesized฀that฀combined฀high฀resolution฀angiography฀and฀vessel฀wall฀MRI฀is฀an฀accurate฀ in-vivo฀measurement฀to฀detect฀sub-millimeter฀PAR฀in฀a฀Watanabe-(WT)-animal-model. Methods:฀ Multiple฀ sub-renal฀ 3D฀ SSFP฀ angiographies฀ (TR=7.2ms,TE=3.6ms,฀ resolu tion=0.7*0.7*1.5mm)฀ and฀ fat-sat฀ 3D฀ black฀ blood฀ Fast฀ Spin฀ Echo฀ vessel฀ wall฀ images฀ (TR=3RR,฀ TE=10.5ms,฀ in-plane฀ resolution=250µm)฀ were฀ investigated฀ in฀ 40฀ slices฀ of฀ 8฀ WT(I=3normal,II=5with฀ endothelial฀ denudation+8฀ weeks฀ high฀ cholesterol-diet)฀ on฀ a฀ 1.5T฀ MR-system฀ (Philips).฀ Animals฀ were฀ sacrificed฀ and฀ matched฀ MRI-histology฀ wall/lumen฀ dimensions฀were฀compared฀semi-automatically฀using฀a฀two-tailed฀paired฀Student´s฀t-test. Results:฀MRI฀angiography฀lumen฀diameters฀were฀similar฀in฀groups฀I฀(2.07±0.02/2.21±0.1mm)฀ and฀ II฀ (2.26±0.17/2.22±0.19mm)฀ and฀ when฀ compared฀ to฀ each฀ other฀ (Fig.B,฀ all฀ p=n.s.).฀ MRI฀ wall฀ thickness฀ was฀ similar฀ in฀ I฀ (0.39±0.02mm)฀ and฀ II฀ (0.44±0.04)฀ but฀ significantly฀ different฀when฀both฀groups฀were฀compared฀(0.39±0.02vs.0.44±0.04mm,฀Fig.A).฀Histology฀ and฀MRI฀vessel฀wall฀dimension฀measurements฀were฀in฀good฀agreement฀(r=0.74,฀Fig.C). JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging Discussion:฀Non-invasive฀high฀resolution฀angiography฀and฀vessel฀wall฀imaging฀detects฀ sub-millimeter฀ PAR฀ in฀ an฀ animal฀ model฀ on฀ a฀ commercially฀ available฀ 1.5T฀ MRI฀ system฀ correlating฀well฀with฀histology. 299A 10:45฀a.m. 840-4฀ Is฀Non-Doppler฀Based฀2D฀Strain฀Rate฀Imaging฀Capable฀ of฀Detecting฀Ascending฀and฀Descending฀Myocardial฀ Muscle฀Band฀Motion?฀An฀In฀Vitro฀Model฀Study Virginia฀N.฀Corbett,฀Evan฀Pulvers,฀Xiaokui฀Li,฀Bo฀Ren,฀Fatima฀Ghani,฀Ruolan฀Liu,฀Kaeley฀ Anderson,฀James฀Pemberton,฀David฀J.฀Sahn,฀Oregon฀Health฀&฀Science฀University,฀ Portland,฀OR Background:฀The฀ role฀ of฀ the฀ ascending฀ and฀ descending฀ myocardial฀ muscle฀ bands฀ in฀ left฀ ventricular฀ motion฀ is฀ critical฀ in฀ heart฀ function.฀ 2D฀ Strain฀ (2DS)฀ is฀ a฀ new฀ method฀ for฀ assessing฀tissue฀motion.฀We฀attempted฀to฀verify฀this฀method’s฀ability฀to฀differentiate฀the฀ two฀muscle฀band฀movements฀during฀a฀heart฀cycle฀and฀compared฀it฀with฀the฀tissue฀velocity฀ imaging฀(TDI)฀method. Methods:฀We฀created฀2฀models฀using฀fresh฀sliced฀beef฀(0.5฀cm฀and฀0.25฀cm฀thickness)฀ wrapped฀around฀a฀latex฀balloon฀connected฀to฀a฀closed฀circuit฀pulsatile฀pump.฀The฀meat฀ was฀layered฀at฀60º฀to฀each฀other฀and฀sewed฀at฀one฀end฀around฀the฀balloon.฀Five฀stroke฀ volumes฀(20-฀60฀ml/beat)฀were฀used฀at฀rates฀of฀60฀and฀75฀bpm.฀Scanning฀was฀performed฀ using฀ a฀ GE/VingMed฀Vivid฀ 7฀ (3.4฀ MHz)฀ parallel฀ to฀ either฀ inner฀ or฀ outer฀ layers.฀ Images฀ were฀analyzed฀by฀both฀2DS฀and฀EchoPac®฀TDI฀based฀strain฀software฀and฀correlated฀with฀ sonomicrometry. Results:฀SR฀derived฀by฀both฀methods฀showed฀a฀significant฀difference฀between฀the฀inner฀ and฀outer฀layers฀(TDI:฀p฀=฀0.01,฀0.03;฀2DS:฀p=0.03,฀0.04).฀There฀was฀no฀significant฀difference฀ in฀velocity฀between฀the฀outer฀and฀inner฀layers฀for฀both฀methods.฀TDI฀derived฀strain฀timing฀ showed฀a฀difference฀between฀inner฀and฀outer฀peak฀expansions฀ranging฀from฀(20-80ms฀p฀=฀ NS).฀The฀timing฀for฀2DS฀was฀limited฀by฀software.฀2DS฀measurements฀showed฀a฀moderate฀ correlation฀with฀sonomicrometry฀determined฀deformation฀(r=.86,฀p=0.06). Conclusions:฀2DS฀is฀capable฀of฀evaluating฀tissue฀motion฀in฀different฀myocardial฀muscle฀ bands฀in฀comparison฀with฀conventional฀TDI. ฀ ORAL฀CONTRIBUTIONS 840฀฀ Cardiovascular฀Ultrasound:฀Something฀ New฀and฀Something฀Old฀But฀Yet฀New Tuesday,฀March฀08,฀2005,฀10:30฀a.m.-Noon Orange฀County฀Convention฀Center,฀Room฀304A 840-3฀ 11:00฀a.m. Clinical฀Evaluation฀of฀a฀Novel฀Automatic฀Real-Time฀ Myocardial฀Tracking฀and฀Wall฀Motion฀Scoring฀Algorithm฀ for฀Echocardiography฀Introduction Alan฀S.฀Katz,฀Sriram฀Krishnan,฀Xiang฀Zhou,฀Bogdan฀Georgescu,฀Michael฀Gera,฀Dorin฀ Comaniciu,฀Jinbo฀Bi,฀Glenn฀Fung,฀Jianming฀Liang,฀Bharat฀Rao,฀Roger฀Grimson,฀ Nathaniel฀Reichek,฀Saint฀Francis฀Hospital,฀Roslyn,฀NY,฀Siemens฀Medical฀Solutions,฀ Malvern,฀PA Background:฀ Accurate฀ regional฀ wall฀ motion฀ (WM)฀ analysis฀ of฀ the฀ left฀ ventricle฀ (LV)฀ is฀ an฀ essential฀ component฀ of฀ interpreting฀ echocardiograms฀ (echoes).฀ Rapid฀ and฀ reliable฀ automated฀border฀tracking฀coupled฀with฀computer฀WM฀scoring฀would฀be฀of฀great฀value.฀ We฀ present฀ the฀ results฀ of฀ a฀ novel฀ real-time฀ automatic฀ WM฀ tracking฀ and฀ classification฀ algorithm. Methods:฀We฀ developed฀ a฀ completely฀ automated฀ and฀ robust฀ technique฀ to฀ detect฀ and฀ track฀ both฀ the฀ endocardial฀ and฀ epicardial฀ borders฀ of฀ the฀ LV.฀ No฀ human฀ interaction฀ is฀ required.฀ Motion฀ interferences฀ (probe฀ motion,฀ patient฀ movement,฀ respiration,฀ etc.)฀ are฀ compensated฀ using฀ global฀ motion฀ estimation฀ based฀ on฀ robust฀ statistics฀ outside฀ the฀ LV.฀ The฀algorithm฀was฀trained฀using฀142฀randomly฀selected฀digital฀echoes.฀Only฀the฀apical฀ four-฀ and฀ two-chamber฀ views฀ were฀ analyzed.฀The฀ septum,฀ lateral,฀ anterior฀ and฀ inferior฀ walls฀were฀divided฀into฀three฀segments฀each.฀Numerical฀feature฀vectors฀extracted฀from฀ the฀dual-contours฀tracked฀through฀time฀formed฀the฀basis฀for฀regional฀WM฀classification.฀ Using฀machine-learning฀techniques,฀individual฀WM฀models฀were฀developed฀for฀each฀of฀ the฀ twelve฀ LV฀ segments฀ analyzed฀ and฀ each฀ segment฀ was฀ classified฀ as฀ normal฀ (nl)฀ or฀ abnormal฀(abn). The฀test฀set฀consisted฀of฀sixty฀digital฀echoes,฀which฀were฀not฀used฀in฀algorithm฀training.฀ The฀twelve฀segments฀as฀described฀above฀were฀reviewed฀and฀classified฀by฀an฀experienced฀ reader฀(AK)฀blinded฀to฀the฀computer฀results.฀The฀LV฀was฀classified฀as฀abn฀if฀there฀were฀ two฀or฀more฀abn฀segments. Results:฀Of฀the฀41฀echoes฀classified฀as฀abn฀by฀the฀observer,฀34฀were฀classified฀as฀abn฀by฀ the฀computer.Of฀the฀19฀studies฀classified฀as฀nl฀by฀the฀reader,฀15฀were฀classified฀as฀nl฀by฀ the฀computer.฀Sensitivity=83%;฀Specificity=79% Conclusions:฀We฀present฀initial฀results฀of฀a฀novel฀real-time฀method฀of฀automated฀border฀ tracking฀ and฀ wall฀ motion฀ scoring.฀ The฀ method฀ is฀ robust฀ and฀ was฀ applicable฀ to฀ digital฀ studies฀of฀varying฀quality฀with฀a฀high฀sensitivity฀and฀specificity.฀Evaluation฀is฀underway฀to฀ assess฀the฀performance฀of฀the฀algorithm฀in฀classifying฀all฀LV฀segments. 840-5฀ The฀Role฀of฀A฀Narrowed฀Lumen฀of฀The฀Transmural฀฀ Small฀Coronary฀Artery฀on฀Regional฀Myocardial฀Ischemia฀ in฀Patients฀With฀Hypertrophic฀Cardiomyopathy:฀ Transthoracic฀Doppler฀Echocardiographic฀study฀vs.฀ Thallium฀Scintigaphic฀Study Shinichi฀Minagoe,฀Yutaka฀Otsuji,฀Sadatoshi฀Biro,฀Shuichi฀Hamasaki,฀Koichi฀Kihara,฀ Ryuichiro฀Anan,฀Toshinori฀Takenaka,฀Naoko฀Mizukami,฀Chuwa฀Tei,฀Kagoshima฀university,฀ Postgraduate฀school฀of฀medicine,฀Kagoshima,฀Japan Morphologic฀ abnormalities฀ of฀ transmural฀ small฀ coronary฀ arteries฀ (SCA)฀ are฀ potential฀ mechanism฀ for฀ ischemia฀ in฀ the฀ absence฀ of฀ epicardial฀ coronary฀ artery฀ stenosis฀ in฀ hypertrophic฀ cardiomyopathy฀ (HCM).฀ We฀ have฀ previously฀ reported฀ that฀ transthoaracic฀ Doppler฀ echocardiography฀ (TTDE)฀ can฀ detect฀ a฀ narrowed฀ lumen฀ of฀ the฀ SCA฀ on฀ the฀ basis฀of฀the฀acceleration฀flow฀signal฀(Acl)฀within฀the฀SCA฀(500฀to฀1000฀µm฀in฀diameter)฀in฀ patients฀with฀HCM.฀To฀investigate฀the฀role฀of฀Acl฀in฀SCA฀for฀regional฀myocardial฀ischemia,฀ we฀examined฀the฀presence฀or฀absence฀of฀Acl฀in฀the฀SCA฀using฀TTDE฀and฀compared฀it฀to฀ results฀of฀exercise฀thallium-201฀(Tl-201)฀SPECT฀in฀33฀patients฀with฀HCM฀(mean฀age฀62฀years)฀ in฀ whom฀ epicardial฀ coronary฀ artery฀ stenosis฀ was฀ neglected฀ by฀ coronary฀ angiography.฀ Acl฀signal฀within฀SCA฀was฀determined฀by฀setting฀the฀Niquist฀frequency฀to฀more฀than฀45฀ cm/sec฀to฀exclude฀the฀aliasing฀with฀low฀velocity.฀Presence฀or฀absence฀of฀Acl฀signal฀was฀ evaluated฀among฀5฀SCAs฀at฀the฀antero-septal฀area฀from฀the฀middle฀to฀the฀apex฀of฀the฀ left฀ventricular฀wall฀and฀was฀compared฀to฀the฀corresponded฀area฀by฀thallium-201SPECT฀.฀ Exercise฀induced฀ischemia฀on฀SPECT฀was฀observed฀in฀17฀of฀33฀patients฀followed฀by฀a฀ significantly฀highly฀incidence฀of฀thickened฀ventricular฀septum฀more฀than฀28฀mm฀compared฀ to฀other฀16฀patients฀without฀ischemia฀[9฀of฀17฀(53%)฀vs.฀1฀of฀16฀(6%),฀p฀<฀0.01].฀Acl฀was฀ observed฀in฀17฀of฀33฀(51%)฀patients฀with฀HCM฀and฀total฀number฀of฀Acl฀more฀than฀two฀ (Acls)฀in฀the฀same฀or฀adjacent฀SCAs฀was฀ascribed฀to฀Group฀A;฀n=15)฀and฀no฀or฀only฀one฀ Acl฀was฀assigned฀to฀Group฀B;฀n=18).฀Exercise฀induced฀ischemia฀on฀thallium-201฀SPECT฀ were฀ significantly฀ more฀ frequent฀ in฀ group฀ A฀ compared฀ with฀ that฀ in฀ group฀ B฀ [11฀ of฀ 17฀ (65%)฀vs.฀4฀of฀12฀(33%)฀respectively,฀p฀<฀0.01].฀There฀were฀no฀significant฀differences฀in฀ the฀ clinical฀ characteristics,฀ left฀ ventricular฀ size,฀ its฀ function,฀ and฀ serum฀ brain฀ natriuretic฀ peptide฀between฀groups฀A฀and฀B. Conclusions:฀1.฀Narrowed฀lumen฀in฀the฀SCA฀demonstrated฀as฀Acls฀using฀TTDE฀would฀ have฀an฀important฀role฀in฀determining฀the฀heterogeneity฀of฀myocardial฀ischemia฀in฀HCM.฀ 2.฀Noninvasive฀measurement฀of฀the฀SCA฀flow฀using฀TTDE฀is฀a฀useful฀predictor฀of฀regional฀ myocardial฀ischemia฀in฀the฀antero-septal฀area฀in฀patients฀with฀HCM. Noninvasive Imaging 10:30฀a.m. 300A ABSTRACTS - Noninvasive Imaging JACC 11:15฀a.m. 840-6฀ Echocardiographic฀and฀Biochemical฀Evidence฀of฀ Ventricular฀Dysfunction฀Following฀Prolonged฀Strenuous฀ Exercise Tom฀G.฀Neilan,฀Malissa฀Wood,฀Danita฀Yoerger,฀Michael฀Picard,฀Arthur฀Siegel,฀Kent฀ Lewandrowski,฀Elizabeth฀Lewandrowski,฀James฀Januzzi,฀Massachusetts฀General฀ Hospital,฀Boston,฀MA Background:฀Changes฀in฀echo฀indices฀of฀left฀ventricular฀function฀have฀been฀previously฀ observed฀in฀marathon฀runners.฀These฀have฀not฀however฀been฀corroborated฀with฀changes฀ in฀biochemical฀markers฀of฀ventricular฀dysfunction.฀Methods:฀Baseline฀TTE฀and฀venous฀ blood฀ testing฀ was฀ performed฀ before฀ and฀ at฀ the฀ finish฀ line฀ of฀ the฀ Boston฀ Marathon฀ in฀ 35฀ amateur฀ runners.฀ TTE฀ included฀ 2-D,฀ spectral,฀ tissue฀ Doppler฀ and฀ peak฀ ventricular฀ systolic฀strain฀and฀strain฀rate.฀Venous฀blood฀samples฀included฀a฀highly฀specific฀marker฀of฀ ventricular฀dysfunction,฀NT-proBNP฀(Elecsys฀ProBNP฀(Roche฀Diagnostics,฀Indianapolis,฀ IN).฀Results:฀85%฀of฀runners฀exhibited฀a฀significant฀increase฀in฀NT-proBNP฀(mean฀increase฀ from฀33.9±฀23.6฀to฀152.1±฀109฀(p<0.0001).฀This฀was฀associated฀with฀echo฀evidence฀of฀ diastolic฀dysfunction฀including฀a฀decrease฀in฀the฀transmitral฀E/A฀ratio(1.7±฀0.64฀to฀1.1±0.29฀ (p=0.001)฀ and฀ early฀ mitral฀ annular฀ velocities.฀ Echo฀ evidence฀ of฀ decreased฀ systolic฀ function฀ was฀ also฀ present฀ (table).฀ A฀ rise฀ in฀ NT-proBNP฀ was฀ independently฀ correlated฀ with฀a฀decrease฀in฀the฀early฀septal฀annular฀velocity฀(p=0.002).฀Conclusions:฀Marathon฀ running฀is฀associated฀with฀a฀rise฀in฀a฀biochemical฀marker฀of฀ventricular฀dysfunction.฀This฀ appears฀to฀be฀most฀closely฀associated฀with฀a฀change฀in฀diastolic฀annular฀velocities. Echo฀Parameters฀of฀Ventricular฀Function฀ Parameter Peak฀septal฀strain Peak฀lateral฀strain RVapical฀strain฀rate Ea฀Septum Pre -24฀±฀5.6 -20฀±฀5.0 -2.8±.86 -9.8±฀0.99 Post -20±฀3 -17฀±฀3 -2±฀1 -8.3฀±฀2.9 p฀value 0.05 0.04 0.01 0.07 11:30฀a.m. Noninvasive Imaging 840-7฀ The฀Presence฀Of฀Mitral฀L฀Wave฀In฀Patients฀With฀ Hypertrophic฀Cardiomyopathy฀Indicates฀Advanced฀ Diastolic฀Dysfunction Jong-Won฀Ha,฀Namsik฀Chung,฀Jeong-Ah฀Ahn,฀Seong-Hoon฀Choi,฀Seok-Min฀Kang,฀SeJoong฀Rim,฀Yangsoo฀Jang,฀Won-Heum฀Shim,฀Seung-Yun฀Cho,฀Yonsei฀University฀College฀ of฀Medicine,฀Seoul,฀South฀Korea Background:฀The฀prominent฀mid-diastolic฀filling฀wave,฀which฀has฀been฀described฀as฀an฀L฀ wave,฀is฀not฀infrequently฀encountered฀in฀patients฀with฀hypertrophic฀cardiomyopathy฀(HCM).฀ However,฀the฀significance฀of฀L฀wave฀has฀not฀been฀explored฀previously฀in฀patients฀with฀HCM.฀ The฀purpose฀of฀this฀study฀was฀to฀explore฀possible฀mechanisms฀and฀clinical฀implications฀of฀L฀ wave฀in฀patients฀with฀HCM฀using฀Doppler฀tissue฀imaging฀(DTI)฀and฀proBNP.฀ Methods฀ and฀ Results:฀ Fifty-five฀ patients฀ with฀ HCM฀ (41฀ male,฀ 14฀ female;฀ mean฀ age,฀ 57±10฀ years)฀ were฀ studied.฀ Mitral฀ L฀ wave฀ was฀ defined฀ when฀ mitral฀ flow฀ is฀ triphasic,฀ including฀mid-diastolic฀flow฀velocity฀of฀at฀least฀0.2฀m/s,฀and฀sinus฀rhythm.฀Peak฀velocity฀of฀ E,฀L,฀and฀A,฀and฀deceleration฀time฀(DT)฀of฀the฀E฀wave฀velocity฀were฀measured.฀Diastolic฀ mitral฀annular฀velocities฀were฀measured฀at฀the฀septal฀corner฀of฀the฀mitral฀annulus฀by฀DTI฀ from฀the฀apical฀4-chamber฀view.฀ProBNP฀was฀measured฀at฀the฀time฀of฀echocardiogram฀ using฀Elecsys฀proBNP,฀a฀quantitative฀electrochemiluminescence฀immunoassay.฀Patients฀ were฀classified฀into฀2฀groups:฀group฀1฀(n=16)฀included฀those฀had฀mitral฀L฀wave฀and฀group฀ 2฀(n=39)฀included฀those฀without฀mitral฀L฀wave.฀The฀heart฀rate฀was฀significantly฀lower฀in฀ patients฀ with฀ group฀ 1฀ (54฀ ±฀ 6฀ vs฀ 62฀ ±฀ 10,฀ p=.0013).฀ Group฀ 1฀ patients฀ had฀ significantly฀ higher฀E/A฀(1.6฀±฀0.1฀vs฀1.2฀±฀0.6,฀p=.03),฀and฀left฀atrial฀volume฀index฀(44฀±฀13฀vs฀32฀±฀10฀ ml/m2,฀p=.003).฀DT฀was฀significantly฀shorter฀in฀patients฀with฀group฀1฀(178±23฀vs฀214±43฀ ms,฀p=.0002).฀However,฀E/E’฀(14฀±฀5฀vs฀14฀±฀8,฀p=.86)฀and฀E’฀(4.7฀±฀1.7฀vs฀4.8฀±฀1.4฀cm/s,฀ p=.86)฀were฀not฀significantly฀differ฀between฀the฀groups.฀ProBNP฀was฀significantly฀higher฀ in฀group฀1฀(1442±361฀vs฀593฀±฀95฀pg/ml,฀p=.02).฀ Conclusion:฀ The฀ presence฀ of฀ L฀ wave฀ in฀ patients฀ with฀ HCM฀ is฀ associated฀ with฀ higher฀ E/A,฀shorter฀DT,฀elevated฀proBNP฀and฀enlarged฀left฀atrium฀indicating฀advanced฀diastolic฀ dysfunction฀with฀elevated฀filling฀pressures.฀This฀unique฀mitral฀inflow฀velocity฀pattern฀should฀ be฀helpful฀in฀identifying฀the฀patients฀with฀advanced฀diastolic฀dysfunction฀and฀increased฀LV฀ filling฀pressures฀in฀patients฀with฀HCM. 11:45฀a.m. 840-8฀ Importance฀of฀Routine฀Correction฀of฀Aortic฀Valve฀Area฀ by฀Echo฀to฀Account฀for฀Pressure฀Recovery Khalid฀Almuti,฀Garet฀Gordon,฀Daniel฀M.฀Spevack,฀Montefiore฀Medical฀Center,฀Bronx,฀NY Background:฀ ACC/AHA฀ guidelines฀ define฀ severe฀ aortic฀ stenosis฀ (AS)฀ as฀ an฀ aortic฀ valve฀ area฀ (AVA)฀ of฀ ≤1.0฀ cm2.฀ Routine฀ application฀ of฀ this฀ value฀ to฀ AVA฀ calculated฀ by฀ echo฀ (AVAEcho)฀ overestimates฀ the฀ prevalence฀ of฀ severe฀ AS.฀ Use฀ of฀ a฀ cutoff฀ for฀ AVAEcho฀ of฀ under฀ 0.75฀ cm2฀ is฀ therefore฀ commonly฀ applied.฀ Overestimation฀ of฀ AS฀ severity฀ by฀ echo฀is฀largely฀attributed฀to฀the฀phenomenon฀of฀pressure฀recovery.฀After฀the฀forward฀jet฀ loses฀ velocity฀ in฀ the฀ aortic฀ root,฀ the฀ pressure฀ increases฀ or฀ “recovers”฀ distally,฀ lowering฀ the฀effective฀trans-valvular฀gradient.฀Catheters฀used฀in฀clinical฀practice฀measure฀pressure฀ in฀ the฀ aortic฀ root,฀ downstream฀ from฀ the฀ aortic฀ valve฀ after฀ the฀ pressure฀ has฀ recovered.฀ Pressure฀recovery฀is฀less฀pronounced฀when฀the฀aortic฀root฀is฀dilated฀due฀to฀energy฀lost฀ to฀turbulence.฀Measurement฀of฀AVAEcho฀does฀not฀account฀for฀the฀aortic฀root฀size฀and฀the฀ degree฀of฀pressure฀recovery฀and฀therefore฀may฀overestimate฀the฀severity฀of฀AS฀compared฀ with฀catheter-derived฀values฀in฀patients฀with฀normal฀or฀small฀aortic฀roots. February 1, 2005 Methods:฀Reports฀were฀reviewed฀of฀217฀consecutive฀patients฀with฀AS฀and฀without฀significant฀ regurgitation,฀who฀underwent฀catheterization฀and฀echo฀for฀evaluation฀of฀AVA.฀AVAEcho฀was฀ modified฀using,฀(ARA฀*฀AVAEcho฀)฀/฀(฀ARA฀-฀AVAEcho),฀where฀ARA฀is฀aortic฀root฀cross-sectional฀ area.฀This฀equation฀has฀been฀shown฀to฀predict฀the฀AVA฀on฀catheterization฀(AVApred). Results:฀ Applying฀ ACC/AHA฀ guidelines฀ to฀ AVAEcho,฀ 181฀ patients฀ had฀ severe฀ AS,฀ 28฀ had฀ moderate฀ AS฀ (AVA฀ >1฀ and฀ <฀ 1.5)฀ and฀ 8฀ had฀ mild฀ AS.฀ Using฀ AVA฀ calculated฀ by฀ catheterization,฀143฀patients฀had฀severe฀AS,฀57฀had฀moderate฀AS฀and฀17฀had฀mild฀AS.฀ Calculation฀of฀AVApred฀yielded฀146฀patients฀with฀severe฀AS,฀54฀with฀moderate฀AS฀and฀17฀ with฀mild฀AS.฀Only฀86฀patients฀had฀AVAEcho฀under฀0.75฀cm2. Conclusion:฀ Classification฀ of฀ AS฀ severity฀ using฀ echo฀ was฀ similar฀ to฀ catheterization฀ if฀ corrected฀ for฀ the฀ effect฀ of฀ pressure฀ recovery.฀ Classification฀ of฀ severe฀ AS฀ by฀ echo฀ underestimated฀ the฀ prevalence฀ of฀ severe฀ AS฀ when฀ a฀ threshold฀ of฀ under฀ 0.75฀ cm2฀ was฀ used.฀ Routine฀ correction฀ of฀ AVA฀ by฀ echo฀ to฀ account฀ for฀ pressure฀ recovery฀ improves฀ accuracy฀of฀classification฀and฀allows฀for฀a฀more฀standardized฀definition฀of฀AS฀severity. POSTER฀SESSION 1165฀฀ Clinical฀Applications฀of฀ Transesophageal฀and฀Intracardiac฀ Echocardiography Tuesday,฀March฀08,฀2005,฀1:30฀p.m.-5:00฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀2:30฀p.m.-3:30฀p.m. 1165-87฀ Determination฀of฀Primary฀Entry฀Tear฀for฀Acute฀Aortic฀ Dissection:฀Diagnostic฀Accuracy--Comparison฀of฀ Transesophageal฀Echocardiogram฀and฀Surgical฀ Findings Alan฀X.฀Zhu,฀Richard฀Chang,฀Nan฀Wang,฀Anees฀Razzouk,฀Ramesh฀Bansal,฀Loma฀Linda฀ University฀Medical฀Center,฀Loma฀Linda,฀CA Background:฀The฀determination฀of฀primary฀entry฀tear฀(PET)฀for฀acute฀aortic฀dissection฀ (AD)฀ is฀ important฀ for฀ operative฀ strategy.฀ There฀ is฀ limited฀ information฀ on฀ the฀ use฀ of฀ Transesophageal฀Echocardiogram฀(TEE)฀to฀identify฀the฀PET.฀The฀aim฀of฀this฀study฀was฀to฀ evaluate฀the฀accuracy฀of฀TEE฀in฀identification฀of฀PET฀in฀a฀large฀series฀of฀patients฀going฀ for฀surgery. Methods:฀A฀series฀of฀130฀consecutive฀patients฀from฀1988฀to฀2004฀in฀one฀medical฀center฀ were฀reviewed.฀The฀AD฀was฀confirmed฀at฀surgery฀for฀all฀patients.฀All฀of฀these฀patients฀also฀ had฀pre-operative฀TEE.฀The฀TEE฀diagnosis฀for฀PET฀was฀compared฀with฀surgical฀report.฀ If฀ there฀ was฀ a฀ discrepancy฀ or฀ entry฀ tear฀ information฀ was฀ unavailable฀ on฀ TEE฀ report,฀ the฀ echocardiographic฀ tapes฀ were฀ reviewed฀ by฀ an฀ experienced฀ echocardiorgrapher฀ without฀ knowledge฀ of฀ surgical฀ findings฀ to฀ identify฀ the฀ site฀ and฀ the฀ possible฀ reasons฀ of฀ discrepancy. Results:฀ There฀ were฀ total฀ 130฀ patients,฀ 90฀ males฀ (69.2%)฀ and฀ 40฀ females฀ (30.8%),฀ mean฀ age฀ 58.8±14.2฀ (years).฀ By฀ DeBakey฀ classification฀ at฀ the฀ surgery,฀ there฀ were฀ 91฀ patients฀(70%)฀with฀type฀I.฀Among฀them,฀there฀were฀18฀patients฀with฀noncommunicating฀ dissection,฀ 52฀ patients฀ with฀ PET฀ in฀ ascending฀ aorta,฀ 19฀ in฀ arch฀ and฀ 2฀ in฀ descending฀ aorta.฀ There฀ were฀ 21฀ patients฀ (16.2%)฀ with฀ type฀ II.฀ Among฀ type฀ II,฀ 3฀ patients฀ had฀ noncommunicating฀dissection,฀15฀patients฀having฀PET฀in฀ascending฀aorta฀and฀3฀in฀arch.฀ For฀type฀III,฀there฀were฀18฀patients฀(13.8%).฀Of฀those,฀3฀patients฀had฀noncommunicating฀ dissection,฀ 2฀ patients฀ with฀ PET฀ in฀ distal฀ arch฀ and฀ 13฀ patients฀ in฀ descending฀ aorta.฀ For฀ communicating฀dissection,฀the฀accuracy฀of฀TEE฀in฀detection฀of฀PET฀was฀87%฀(92/106).฀ In฀noncommunicating,฀the฀accuracy฀of฀diagnosis฀was฀100%(24/24).฀The฀entry฀tear฀was฀ either฀missed฀or฀misdiagnosed฀in฀14/106฀patients฀(13.2%).฀Among฀the฀14฀misdiagnoses,฀ 7฀of฀them฀were฀due฀to฀significantly฀thrombosed฀false฀lumen,฀3฀of฀them฀being฀undetectable฀ and฀4฀patients฀being฀due฀to฀miscellaneous฀misclassifications. Conclusions:฀TEE฀had฀87%฀accuracy฀in฀the฀detection฀of฀PET฀and฀100%฀for฀intramural฀ hematoma฀in฀the฀diagnosis฀of฀acute฀aortic฀dissection.฀The฀primary฀reason฀for฀misdiagnosis฀ of฀primary฀entry฀tear฀was฀the฀significantly฀thrombosed฀false฀lumen฀with฀limited฀entry฀tear. 1165-88฀ Percutaneous฀Closure฀of฀Patent฀Foramen฀Ovale฀in฀ Divers:฀Incidence฀of฀Decompression฀Illness฀and฀ Ischemic฀Brain฀Lesions฀at฀1-Year฀Follow-Up Rainer฀Zbinden,฀Michael฀Billinger,฀Luca฀Remonda,฀Markus฀Schwerzmann,฀Rolf฀Vogel,฀ Stephan฀Windecker,฀Bernhard฀Meier,฀Christian฀Seiler,฀University฀Hospital฀Bern,฀Bern,฀ Switzerland Background:฀Patent฀foramen฀ovale฀(PFO)฀is฀related฀to฀an฀increased฀risk฀of฀decompression฀ illness฀(DCI),฀and฀is฀associated฀with฀the฀presence฀of฀ischemic฀brain฀lesions฀in฀SCUBAdivers.฀ It฀ is฀ unknown฀ whether฀ closure฀ of฀ PFO฀ reduces฀ the฀ incidence฀ of฀ DCI฀ and/or฀ of฀ ischemic฀brain฀lesions. Methods:฀ 104฀ divers฀ were฀ included฀ in฀ the฀ study฀ (mean฀ age฀ 39฀ ±฀ 7฀ years;฀ 84฀ men),฀ 65฀ with฀ a฀ PFO฀ on฀ transesophageal฀ contrast฀ echocardiography,฀ 39฀ controls.฀ PFO฀ was฀ occluded฀percutanously฀using฀an฀Amplatzer-PFO-Occluder®฀in฀26฀divers฀(PFO-occlusion฀ group).฀All฀divers฀completed฀a฀questionnaire฀to฀assess฀minor฀DCI-score฀(e.g.฀headache,฀ paresthesia,฀ joint-pain฀ etc),฀ and฀ major฀ DCI฀ (treatment฀ in฀ decompression฀ chamber)฀ at฀ inclusion฀and฀at฀follow-up.฀They฀underwent฀brain฀magnetic฀resonance฀imaging฀to฀count฀ ischemic฀lesions฀at฀inclusion฀and฀follow-up. Results:฀Mean฀follow-up฀time฀was฀374฀±฀35฀days,฀there฀were฀6326฀dives฀in฀total.฀There฀ were฀no฀significant฀differences฀in฀baseline฀characteristics฀(age,฀gender,฀mean฀number฀of฀ dives,฀mean฀diving฀depth,฀number฀of฀dives฀beyond฀40฀meters)฀between฀the฀three฀groups.฀ There฀were฀no฀procedure฀related฀complications. JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging Minor฀DCI-score฀at฀follow-up฀differed฀significantly฀between฀the฀PFO-occlusion฀group฀and฀ the฀PFO฀group฀(฀PFO-occlusion฀group:฀1.1±1.2฀minor฀DCI,฀PFO฀group:฀2.4±2.0฀minor฀DCI;฀ p=0.006).฀The฀difference฀between฀the฀control-group฀and฀the฀PFO฀group,฀and฀between฀the฀ control-group฀and฀the฀PFO-occlusion฀group฀was฀not฀significant. 3฀major฀DCI฀were฀reported:฀2฀in฀the฀PFO฀group,฀1฀in฀the฀control฀group฀and฀none฀in฀the฀ PFO-occlusion฀group฀(p=0.40). Mean฀number฀of฀ischemic฀brain฀lesions฀at฀inclusion฀was฀1.8±5.0฀lesions฀per฀person฀in฀the฀ PFO฀ group,฀ 0.9±2.2฀ lesions฀ in฀ the฀ control฀ group,฀ 0.4±0.7฀ lesions฀ in฀ the฀ PFO-occlusion฀ group,฀(p=NS฀(ANOVA฀overall).฀Only฀one฀diver฀in฀the฀PFO-occlusion฀group฀had฀three฀new฀ ischemic฀brain฀lesions฀at฀follow-up฀(p=NS) Conclusion:฀PFO฀occlusion฀reduces฀minor฀DCI฀in฀SCUBA฀divers.฀Major฀DCI฀requiring฀ treatment฀in฀a฀decompression฀chamber฀tend฀to฀be฀reduced฀with฀PFO฀occlusion. At฀1-year฀follow-up,฀there฀is฀no฀difference฀in฀the฀incidence฀of฀new฀ischemic฀brain฀lesions. 1165-89฀ Value฀of฀Transesophageal฀Echocardiographic฀Findings฀ as฀Risk฀Stratification฀for฀Embolic฀Complication฀During฀ Long-Term฀Follow-Up฀of฀Five฀Years Karlheinz฀Seidl,฀Klaus฀Dönges,฀Elke฀Fromm,฀Thorsten฀Becker,฀Thomas฀Kleemann,฀Ömer฀ Yildiz,฀Jochen฀Senges,฀Heart฀Center฀Ludwigshafen,฀Ludwigshafen,฀Germany Aim฀ of฀ the฀ study฀ was฀ to฀ evaluate฀ the฀ long-term฀ outcome฀ in฀ patients฀ (pts)฀ with฀ atrial฀ fibrillation฀(AF)฀according฀to฀the฀findings฀during฀transesophageal฀echocardiography฀(TEE)฀ performed฀before฀cardioversion฀(CV). Methods:฀TEE฀was฀performed฀in฀787฀pts฀with฀AF฀before฀CV฀at฀index฀admission.฀All฀pts฀ were฀followed-up฀(FU)฀either฀on฀an฀outpatient฀basis฀or฀by฀telephone฀survey฀for฀a฀median฀of฀ 65฀months฀(50-84฀months).฀Pts฀were฀classified฀in฀5฀groups฀according฀to฀the฀following฀TEEfindings฀ in฀ the฀ left฀ atrium฀ or฀ aorta:฀TEE฀ normal,฀ mild฀ spontaneous฀ echo฀ contrast฀ (SE),฀ moderate/severe฀SE,฀LA-thrombus,฀only฀plaques฀in฀the฀aorta.฀Furthermore฀the฀quality฀of฀ oral฀anticoagulation฀(OAC)฀was฀evaluated฀at฀the฀end฀of฀FU฀using฀the฀last฀5฀INR฀values.฀ Efffective฀OAC฀was฀defined฀if฀the฀INR฀value฀was฀in฀the฀range฀of฀2-3. Conclusion:฀1.฀SE฀at฀index฀admission฀is฀a฀risk฀indicator฀for฀mortality฀and฀thromboembolic฀ complication฀(TEC)฀during฀FU฀of฀5฀years.฀2.฀Mortality฀and฀stroke฀rate฀was฀highest฀in฀pts฀ with฀AF฀in฀whom฀LA-thrombi฀were฀detected.฀The฀risk฀for฀TEC฀during฀FU฀increased฀with฀ the฀severity฀of฀SE.฀Pts฀with฀plaques฀in฀the฀aorta฀had฀a฀similar฀risk฀for฀TEC฀than฀pts฀with฀ moderate/severe฀SE. TEE฀findings฀as฀risk฀stratification฀for฀embolic฀complications n฀(pts) 1165-90฀ 319฀pts 162฀pts 72฀pts 97฀pts 137฀pts death stroke severe฀bleeding 13.4% 17.3% 27.5% 30% 19.5% 2% 7% 9% 15.2% 9.7% 0.8% 0.3% 2% 0.7% 0.8% Initial฀Experience฀With฀A฀Left฀Atrial฀Appendage฀Filter฀ Device฀For฀Stroke฀Prevention฀In฀Atrial฀Fibrillation Arashk฀Motiei,฀David฀R.฀Holmes,฀Douglas฀L.฀Packer,฀Barugur฀S.฀Ravi,฀Pamela฀Sinning,฀ Farook฀Mookadam,฀Bijoy฀Khandheria,฀Krishnaswamy฀Chandrasekaran,฀Mayo฀Clinic,฀ Rochester,฀MN Background:฀Mechanical฀device฀occlusion฀of฀the฀left฀atrial฀appendage฀(LAA)฀may฀be฀an฀ alternate฀to฀anticoagulant฀therapy฀for฀patients฀with฀atrial฀fibrillation. Objectives:฀ To฀ study฀ the฀ safety฀ and฀ intermediate฀ term฀ efficacy฀ of฀ a฀ novel฀ LAA฀ filter฀ device฀(Watchman฀Filter฀Device) Methods:฀ Patients฀ with฀ atrial฀ fibrillation฀ at฀ risk฀ for฀ stroke฀ and฀ on฀ anticoagulation฀ were฀ enrolled.฀Transesophageal฀echocardiography฀was฀used฀to฀measure฀the฀LAA฀dimensions฀ for฀device฀size฀selection.฀The฀device฀was฀implanted฀into฀the฀LAA฀by฀percutaneous฀means.฀ Coumadin฀was฀discontinued฀after฀45฀days.฀Follow฀up฀TEE฀was฀performed฀at฀45฀days฀and฀ 6฀months. Results:฀Eight฀of฀nine฀enrolled฀patients฀(age฀range฀62-79฀years)฀underwent฀LAA฀device฀ occlusion.฀One฀patient฀with฀a฀large฀LAA฀(>30mm)฀diameter฀was฀excluded.฀The฀maximum฀ LAA฀ostial฀width฀by฀TEE฀ranged฀from฀21mm฀to฀30.1mm.฀The฀implanted฀devices฀ranged฀ from฀21฀to฀30mm฀in฀size.฀In฀5฀patients,฀the฀device฀had฀to฀be฀re-sized฀and฀re-deployed฀during฀ the฀procedure.฀This฀was฀due฀to฀complex฀anatomical฀factors฀including฀the฀asymmetry฀of฀ the฀LAA฀ostium฀and฀relationships฀of฀pectinate฀muscles,฀accessory฀LAA฀lobes฀and฀their฀ confluence฀ with฀ the฀ ostium,฀ and฀ the฀ configuration฀ of฀ the฀ left฀ superior฀ pulmonary฀ vein฀ (LSPV)฀sleeve฀adjoining฀the฀LAA.฀In฀3฀patients฀where฀LAA฀geometry฀prevented฀proper฀ device฀ placement,฀ the฀ space฀ between฀ LUPV฀ sleeve฀ and฀ the฀ LAA฀ ostium฀ was฀ used฀ to฀ deploy฀ the฀ device.฀ One฀ patient฀ required฀ the฀ utilization฀ of฀ the฀ accessory฀ lobe฀ for฀ device฀ deployment.฀The฀final฀device฀was฀deployed฀successfully฀in฀all฀8฀patients.฀There฀were฀no฀ peri-procedural฀complications.฀All฀patients฀were฀off฀coumadin฀(2฀weeks฀to฀9฀months)฀with฀ no฀embolic฀events.฀Follow฀up฀TEE฀showed฀trivial฀peri-device฀flow฀in฀4฀of฀7฀patients฀at฀45฀ days,฀and฀in฀3฀of฀5฀patients฀at฀6฀months.฀No฀device฀migration฀or฀intracardiac฀thrombi฀were฀ observed. Conclusion:฀ This฀ pilot฀ study฀ demonstrates฀ that฀ the฀ LAA฀ filter฀ device฀ can฀ be฀ safely฀ placed.฀On฀intermediate-term฀follow฀up,฀the฀device฀is฀effective฀in฀preventing฀cardiogenic฀ embolism฀in฀atrial฀fibrillation.฀TEE฀plays฀a฀valuable฀role฀in฀assessing฀the฀anatomy฀of฀the฀ LAA฀and฀guiding฀the฀device฀placement. Assesment฀of฀Interatrial฀Septum฀by฀Intracardiac฀ Echocardiography฀and฀Transcranial฀Doppler฀Following฀ Pulmonary฀Vein฀Antrum฀Isolation฀With฀Double฀ Transseptal฀Puncture฀Technique Fethi฀Kilicaslan,฀Hirosuke฀Yamaji,฀Nassir฀F฀Marrouche,฀Atul฀Verma,฀Jennifer฀E฀ Cummings,฀Oussama฀Wazni,฀Huseyin฀Bozbas,฀Dhanumjaya฀Lakkiredy,฀William฀M฀ Belden,฀Samy฀C฀Elayi,฀Luis฀C฀Saenz,฀Seil฀Oh,฀J฀David฀Burkhardt,฀Walid฀Saliba,฀Robert฀A฀ Schweikert,฀Andrea฀Natale,฀The฀Cleveland฀Clinic฀Foundation,฀Cleveland,฀OH BACKGROUND:฀For฀left฀atrial฀(LA)฀ablations,฀transseptal฀puncture฀(TP)฀is฀the฀standard฀ access฀to฀LA.฀However,฀atrial฀septal฀defect฀(ASD)฀and฀right-to-left฀shunting฀(RLS)฀related฀ to฀TP฀have฀been฀reported฀and฀may฀be฀a฀cause฀of฀paradoxical฀embolism.฀The฀incidence฀ of฀ residual฀ ASD฀ and฀ RLS฀ after฀ pulmonary฀ vein฀ antrum฀ isolation฀ (PVAI)฀ is฀ unknown.฀ OBJECTIVE:฀ We฀ sought฀ to฀ assess฀ interatrial฀ septum฀ continuity฀ and฀ to฀ determine฀ the฀ presence฀ of฀ residual฀ shunting฀ immediately฀ following฀ PVAI.฀ METHODS:฀ Thirty฀ patients฀ undergoing฀ PVAI฀ for฀ treatment฀ of฀ atrial฀ fibrillation฀ were฀ studied.฀ Patients฀ had฀ two฀ TPs฀ performed฀ routinely฀ using฀ two฀ 8-French฀ Mullins฀ transseptal฀ sheaths.฀ All฀ patients฀ had฀ a฀ baseline฀intracardiac฀echo฀(ICE)฀examination฀with฀pulse,฀continuous฀and฀color฀Doppler.฀ Transcranial฀ Doppler฀ (TCD)฀ examination฀ with฀ agitated฀ saline฀ injection฀ during฀ Valsalva฀ maneuver฀was฀also฀done฀prior฀to฀TP.฀Out฀of฀30฀patients,฀baseline฀PFO฀was฀detected฀in฀ 8฀(27%)฀and฀they฀were฀excluded.฀The฀remaining฀22฀patients฀(mean฀age฀59±8,฀4฀female)฀ were฀included.฀ICE฀was฀repeated฀and฀a฀second฀agitated฀saline฀study฀with฀Valsalva฀was฀ done฀immediately฀following฀PVAI฀after฀the฀transseptal฀sheaths฀were฀withdrawn฀from฀the฀ LA฀ into฀ the฀ right฀ atrium.฀ Air฀ microbubbles฀ in฀ the฀ LA฀ were฀ counted฀ by฀ ICE฀ and฀ cerebral฀ microembolic฀signals฀were฀monitored฀by฀TCD.฀ RESULTS:฀Mean฀EF฀and฀LA฀diameter฀were฀52±5%฀and฀4.4±0.6฀cm฀respectively.฀Mean฀ procedure฀ time฀ was฀ 182±48฀ minutes.฀ After฀ the฀ procedure,฀ a฀ small฀ residual฀ PFO฀ was฀ detected฀in฀2฀(9%)฀patients.฀ICE฀demonstrated฀microbubbles฀in฀the฀LA฀and฀TCD฀detected฀ microembolic฀signals฀during฀agitated฀saline฀study฀in฀these฀two฀patients.฀Also฀small฀ASD฀ was฀detected฀in฀4฀(18%)฀patients.฀Notably,฀in฀5฀of฀these฀6฀cases,฀transseptal฀access฀was฀ lost฀during฀manipulation฀of฀the฀ablation฀catheter฀during฀PVAI,฀and฀transseptal฀access฀had฀ to฀be฀reobtained.฀ CONCLUSIONS:฀Double฀transseptal฀puncture฀does฀not฀result฀in฀significant฀left-to-right฀ or฀right-to-left฀shunting฀in฀most฀patients.฀Rare฀cases฀of฀residue฀small฀ASD฀and฀RLS฀may฀ occur฀especially฀when฀repeated฀transseptal฀puncture฀is฀required. 1165-92฀ Use฀of฀Intracardiac฀Echocardiography฀for฀Closure฀ of฀Atrial฀Communications฀in฀Patients฀Less฀Than฀15฀ Kilograms Angira฀Patel,฀Qi-Ling฀Cao,฀Peter฀R.฀Koenig,฀Ziyad฀M.฀Hijazi,฀University฀of฀Chicago฀ Children’s฀Hospital,฀Chicago,฀IL BACKGROUND:฀ Intracardiac฀ echocardiography฀ (ICE)฀ is฀ increasingly฀ replacing฀ transesophageal฀ echocardiography฀ (TEE)฀ as฀ the฀ primary฀ imaging฀ technique฀ to฀ guide฀ device฀ closure฀ of฀ atrial฀ septal฀ defects฀ (ASD).฀ Use฀ of฀TEE฀ requires฀ general฀ anesthesia฀ due฀to฀length฀of฀the฀procedure.฀Investigators฀have฀reported฀the฀efficacy฀of฀ICE฀in฀adults฀ and฀children.฀However,฀most฀studies฀have฀shown฀its฀use฀in฀individuals฀with฀weight฀above฀ 15฀ kg.฀This฀ study฀ examines฀ the฀ use฀ of฀ ICE฀ guided฀ secundum฀ ASD฀ closure฀ in฀ children฀ less฀than฀15kg.฀ METHODS:฀17฀patients฀with฀a฀median฀age฀of฀2.8฀yrs฀(range฀1.8฀to฀4.8)฀and฀median฀weight฀ of฀13.2kg฀(range฀8.0฀to฀14.4)฀underwent฀transcatheter฀occlusion฀(Amplatzer฀occluder)฀of฀a฀ secundum฀ASD฀using฀ICE฀guidance.฀ICE฀was฀performed฀using฀an฀AcuNav®฀catheter.฀The฀ ICE฀catheter฀(10.5฀Fr)฀was฀introduced฀into฀an฀11฀Fr฀sheath฀in฀a฀contralateral฀femoral฀vein.฀ Diagnostic฀as฀well฀as฀periprocedure฀imaging฀was฀obtained. RESULTS:฀ 15฀ patients฀ had฀ single,฀ and฀ 2฀ had฀ multiple฀ defects.฀ Median฀ defect฀ size฀ as฀ measured฀by฀ICE฀was฀15mm฀(range฀2.5฀to฀25).฀The฀median฀balloon฀stretched฀diameter฀ (obtained฀ in฀ 7฀ patients)฀ was฀ 17mm฀ (range฀ 10฀ to฀ 21);฀ the฀ median฀ size฀ of฀ the฀ defect฀ for฀ these฀7฀patients฀was฀15mm฀(range฀of฀8฀to฀20).฀Both฀techniques฀for฀measuring฀the฀defect฀ correlated฀well฀with฀r=0.94.฀The฀ASD฀occluder฀size฀ranged฀from฀7฀to฀26mm฀with฀a฀median฀ of฀18mm.฀14฀patients฀experienced฀successful฀device฀placement฀with฀no฀residual฀shunt.฀ ASD฀occlusion฀was฀not฀attempted฀in฀2฀patients฀due฀to฀deficient฀rims;฀1฀attempt฀failed฀due฀to฀ left฀atrial฀disk฀prolapse฀through฀the฀ASD.฀3฀patients฀experienced฀complications฀during฀the฀ catheter฀procedure฀including฀SVT,฀sinus฀bradycardia,฀and฀complete฀heart฀block฀(resolving฀ with฀device฀removal);฀all฀had฀subsequent฀successful฀device฀placement.฀No฀complications฀ were฀attributed฀to฀the฀use฀of฀ICE฀and฀specifically,฀no฀vascular฀injury฀was฀noted. CONCLUSIONS:฀ Comparable฀ to฀ results฀ with฀ larger฀ patients,฀ ICE฀ provides฀ adequate฀ imaging฀(preprocedure฀diagnosis฀and฀periprocedure฀guidance)฀during฀device฀occlusion฀of฀ secundum฀ASD’s฀with฀no฀significant฀complications.฀Thus,฀ICE฀can฀successfully฀be฀used฀in฀ the฀closure฀of฀ASD฀in฀smaller฀patients฀(less฀than฀15฀kg)฀and฀eliminate฀the฀need฀for฀general฀ endotracheal฀anesthesia. 1165-93฀ Intracardiac฀Echocardiography฀Guidance฀During฀ Percutaneous฀Transluminal฀Septal฀Myocardial฀ Ablation฀in฀Patients฀With฀Obstructive฀Hypertrophic฀ Cardiomyopathy Chiara฀Pedone,฀Maniyal฀Vijayakumar,฀Elena฀Biagini,฀Patrick฀W.฀Serruys,฀Folkert฀J.฀ten฀ Cate,฀Bellaria฀Hospital,฀Bologna,฀Italy,฀Thoraxcenter฀Erasmus฀MC,฀Rotterdam,฀The฀ Netherlands Background:฀ Percutaneuos฀ transluminal฀ septal฀ myocardial฀ ablation฀ (PTSMA)฀ recently฀ emerged฀ as฀ an฀ alternative฀ to฀ myectomy฀ for฀ hypertrophic฀ obstructive฀ cardiomyopathy฀ (HOCM)฀ patients฀ with฀ drug-refractory฀ symptoms.฀ The฀ potential฀ role฀ of฀ intracardiac฀ echocardiography฀(ICE)฀in฀guiding฀PTSMA฀has฀never฀been฀tested. Methods:฀Nine฀consecutive฀HOCM฀patients฀(age฀range฀47฀to฀75฀yrs,฀4฀men)฀underwent฀ PTSMA฀under฀intracardiac฀echocardiography฀(ICE)฀guidance฀(AcuNav฀6-7฀MHz฀phasedarray฀transducer฀interfaced฀with฀Cypress,฀Acuson).฀The฀catheter฀tip฀was฀placed฀toward฀ Noninvasive Imaging TEE฀normal mild฀SE severe/moderate฀SE LA-thrombi Plaque฀in฀aorta OAC฀during฀ FU฀(%) 61% 71% 85% 90% 72% 1165-91฀ 301A Noninvasive Imaging 302A ABSTRACTS - Noninvasive Imaging JACC February 1, 2005 right฀ side฀ of฀ the฀ interventricular฀ septum฀ providing฀ a฀ long฀ axis฀ view฀ of฀ the฀ left฀ ventricle.฀ Images฀were฀obtained฀continuosly฀during฀the฀procedures฀and฀acquaired฀at฀baseline,฀after฀ contrast฀(Levovist,฀Schering,฀Berlin)฀and฀ethanol฀injection฀into฀the฀target฀septal฀branch.฀ Peri-procedural฀clinical฀data฀were฀collected. Results:฀PTSMA฀were฀effective฀to฀reduce฀left฀ventricle฀outflow฀tract฀gradient฀from฀75±30฀to฀ 5±9฀mmHg฀(p<0.001).฀None฀of฀the฀patients฀had฀haemodynamic฀compromise฀or฀significant฀ arrhythmias฀during฀the฀procedure;฀one฀patients฀developed฀complete฀heart฀block฀requiring฀ permanent฀dual฀chamber฀pacing.฀There฀were฀no฀ICE฀related฀complications.฀After฀contrast฀ injection฀risk฀area฀could฀be฀clearly฀visualized฀in฀all฀the฀patients฀and฀it฀guided฀the฀choice฀ of฀the฀target฀septal฀branch.฀After฀the฀ethanol฀delivery฀an฀hyperechoic,฀sharply฀demarked฀ triangular฀ area฀ appared฀ (ablated฀ area)฀ within฀ septum฀ as฀ result฀ of฀ local฀ interaction฀ of฀ contrast฀microbubble฀with฀injected฀ethanol.฀Mean฀ablated฀planimetrized฀area฀was฀1,9±0,7฀ cm2฀(0,6-2,6). Conclusions:฀ In฀ this฀ initial฀ experience฀ ICE฀ monitoring฀ during฀ PTSMA฀ was฀ safe฀ and฀ provided฀high฀quality฀and฀continuous฀imaging฀of฀the฀treated฀segment฀of฀the฀septum฀during฀ the฀whole฀procedure.฀ICE฀may฀be฀considered฀as฀complete฀guiding฀tool฀during฀PTSMA. injury฀by฀documentation฀of฀ST฀segment฀re-elevation฀shortly฀after฀R,฀and฀left฀ventricular฀ ejection฀fraction฀(LVEF),฀regional฀wall฀motion฀within฀the฀LAD฀region฀(RWM;฀SD/chord)฀and฀ left฀ventricular฀end-diastolic฀volume฀(ml)฀(LVEDV)฀on฀both฀day฀0฀and฀6months฀after฀R.฀Noreflow฀size฀(%฀risk฀area)฀was฀determined฀using฀ECG฀triggered฀1.5฀harmonic-myocardial฀ contrast฀ echocardiography฀ 2weeks฀ after฀ R.฀ Data฀ was฀ shown฀ as฀ mean(1SD),฀ *shows฀ p<0.05฀vs.฀control Results:฀On฀day฀0,฀risk฀area฀size,฀RWM,฀LVEF,฀LVEDV,฀collateral฀circulation,฀and฀time฀from฀ symptom฀onset฀to฀R฀were฀similar฀in฀4฀groups.฀However,฀frequency฀of฀reperfusion฀injury฀ (35%*,฀25%*,฀20%*,฀56%;฀GPS,฀ATP,฀GPS฀with฀ATP,฀Control฀in฀this฀order),฀documentation฀ of฀malignant฀arrhythmia฀(Vf,฀VT,฀etc.)฀(23%,฀18%*,฀13%*,฀36%),฀no-reflow฀size฀(27(24)%,฀ 15(18)%*,฀12(16)%*,฀33(27)%),฀LVEF฀at฀6monts฀(57฀(14),฀64฀(16)*,฀67฀(15)฀*,฀53฀(15)),฀ RWM฀at฀6months฀(-1.97฀(1.00),฀-1.66฀(0.72)*,฀-1.54฀(0.71)฀*,฀-2.35฀(0.75),฀and฀LVEDV฀at฀ 6months฀(90฀(29)*,฀87฀(28)*,฀84฀(28)*,฀115฀(59))฀were฀significantly฀different. Conclusions:฀Distal฀coronary฀protection฀for฀thrombus฀as฀well฀as฀plaque฀burden฀with฀ATP฀ infusion฀during฀reperfusion฀can฀significantly฀reduce฀no-reflow฀and฀improve฀left฀ventricular฀ function฀in฀AMI฀patients. 1165-94฀ 1166-80฀ Development฀of฀A฀New฀Small฀Animal฀Model฀of฀ Chronic฀Mitral฀Regurgitation฀Under฀Transesophageal฀ Echocardiographic฀Guidance Hypertriglyceridemia฀by฀Itself฀Deteriorates฀the฀ Coronary฀Circulation:฀Real-Time฀Myocardial฀Contrast฀ Echocardiographic฀Study Zhaohui฀Gao,฀Jianhua฀Li,฀William฀Davidson,฀Jr.,฀Lawrence฀Sinoway,฀Min฀Pu,฀Penn฀State฀ University,฀Hershey฀Medical฀Center,฀Hershey,฀PA Kasumi฀Masuda,฀Fuminobu฀Ishikura,฀Kohei฀Okuda,฀Kentaro฀Otani,฀Toshihiko฀Asanuma,฀ Shintaro฀Beppu,฀Osaka฀University฀Graduate฀School฀of฀Medicine,฀Suita,฀Japan Background:฀Large฀animal฀models฀(dog฀or฀sheep)฀are฀often฀used฀for฀the฀investigation฀ of฀ the฀ pathophysiology฀ of฀ chronic฀ mitral฀ regurgitation฀ (MR),฀ but฀ are฀ very฀ costly.฀ We฀ hypothesized฀ that฀ a฀ cost-effective฀ animal฀ model฀ of฀ chronic฀ MR฀ could฀ be฀ developed฀ in฀ small฀animals. Methods:฀ Twenty-two฀ male฀ rats฀ underwent฀ open฀ chest฀ surgery฀ to฀ create฀ chronic฀ MR.฀ Transesophageal฀ echocardiography฀ (TEE)฀ was฀ performed฀ using฀ an฀ intracardiac฀ echocardiography฀catheter.฀Under฀TEE฀guidance,฀a฀fine฀needle฀was฀inserted฀into฀the฀apex฀ of฀the฀left฀ventricle฀(LV)฀to฀damage฀the฀mitral฀leaflets.฀Twelve฀rats฀had฀sham฀operations฀ without฀MR฀produced.฀Color฀Doppler฀TEE฀was฀performed฀to฀assess฀the฀severity฀of฀MR.฀ Transthoracic฀ echocardiography฀ was฀ performed฀ to฀ assess฀ LV฀ remodeling฀ and฀ function.฀ LV฀end-diastolic฀diameter฀(LVEDD),฀end-systolic฀diameter฀(LVESD),฀fractional฀shortening฀ (FS)฀were฀measured฀1฀week฀prior฀to,฀and฀1,฀6,฀and฀12฀weeks฀post฀procedure.฀Rats฀were฀ followed฀ up฀ for฀ mean฀ 243฀ ±฀ 22฀ days฀ for฀ evaluation฀ of฀ all-cause฀ mortality.฀ Costs฀ were฀ calculated฀using฀a฀fee-scale฀from฀our฀animal฀facility. Results:฀Mean฀MR฀jet฀areas฀were฀17฀±฀4฀mm2฀in฀the฀MR฀group฀and฀there฀was฀no฀MR฀in฀ the฀sham฀group.฀There฀were฀no฀significant฀differences฀in฀LVEDD฀(7.5฀±฀0.5฀vs.฀7.3฀±฀0.4฀ mm,฀p>0.05),฀LVESD฀(4.0฀±฀0.4฀vs.฀4.1฀±฀0.9฀mm,฀p>0.05),฀FS฀(47฀±฀5%฀vs.฀44฀±฀10฀%,฀ p>0.05)฀between฀the฀sham฀and฀MR฀groups฀prior฀to฀introduction฀of฀MR.฀At฀the฀12th฀week฀ post฀the฀procedure฀LV฀was฀significantly฀larger฀in฀the฀MR฀group฀(LVEDD:฀11.3฀±฀1.4฀mm,฀ LVESD:฀7.0฀±฀1.2฀mm)฀than฀in฀the฀sham฀group฀(LVEDD:฀8.9฀±฀0.8฀mm,฀p<0.01,฀LVESD:฀ 4.8฀±฀0.8฀mm,฀p<0.01).฀FS฀were฀significantly฀lower฀in฀the฀MR฀group฀(39฀±฀6%)฀than฀that฀in฀ the฀sham฀group฀(47฀±฀7฀%,฀p฀<฀0.01).฀Survival฀rate฀was฀significantly฀lower฀in฀the฀MR฀group฀ than฀in฀the฀sham฀group฀(50฀%฀vs.฀100฀%฀p<฀0.01).฀The฀costs฀of฀the฀rat฀model฀of฀chronic฀ MR฀were฀40฀times฀lower฀than฀that฀of฀large฀animal฀models.฀ Conclusion:฀ Development฀ of฀ rat฀ model฀ of฀ chronic฀ MR฀ under฀TEE฀ guidance฀ is฀ feasible฀ and฀cost-effective.฀This฀new฀model฀has฀demonstrated฀a฀pathophysiology฀similar฀to฀large฀ animal฀models.฀It฀may฀be฀used฀for฀1)฀the฀study฀of฀molecular฀and฀cellular฀mechanisms฀of฀ LV฀remodeling฀and฀dysfunction฀in฀chronic฀MR฀and฀2)฀the฀assessment฀of฀potential฀medical฀ therapies฀for฀chronic฀MR. Aim:฀It฀is฀reported฀that฀hyperlipidemia฀may฀deteriorate฀the฀coronary฀circulation฀by฀itself,฀ although฀ its฀ precise฀ mechanism฀ have฀ not฀ been฀ elucidated.฀The฀ aim฀ is฀ to฀ examine฀ the฀ effect฀ of฀ acute฀ hypertriglyceridemia฀ on฀ coronary฀ circulation฀ using฀ real-time฀ myocardial฀ contrast฀echocardiography฀(MCE). Methods:฀Hypertriglyceridemia฀was฀induced฀by฀rapid฀infusion฀of฀fat฀emulsion฀(Intralipos®)฀ in฀ 9฀ normal฀ dogs.฀ Coronary฀ flow฀ volume฀ was฀ measured฀ by฀ a฀ flowmeter฀ set฀ on฀ the฀ left฀ anterior฀ descending฀ artery฀ (LAD),฀ and฀ coronary฀ flow฀ reserve฀ (CFR)฀ was฀ determined฀ by฀ adenosine฀ triphosphate฀ (ATP)฀ administration.฀ MCE฀ was฀ examined฀ using฀ SIEMENS฀ Sequoia-512฀ during฀ infusion฀ of฀ Definity®.฀ The฀ replenishment฀ curve฀ was฀ obtained฀ to฀ measure฀ “β”฀ in฀ the฀ equation฀ of฀ y=A(1-e-βt).฀ To฀ calculate฀ the฀ myocardial฀ blood฀ volume฀ (MBV),฀square฀of฀acoustic฀unit฀at฀both฀septum฀(AU2M)฀and฀its฀adjacent฀LV฀cavity฀(AU2LV)฀ were฀measured฀and฀the฀formula฀of฀100×AU2M/฀AU2LV(ml/100g)฀was฀applied. Results:฀ After฀ lipid฀ administration,฀ each฀ of฀ the฀ blood฀ viscosity,฀ LAD฀ flow฀ and฀ MBV฀ increased,฀but฀CFR฀and฀“β”฀decreased฀even฀at฀rest.฀Although฀both฀MBV฀and฀“β”฀increased฀ after฀ATP,฀their฀increasing฀rates฀decreased฀from฀1.80±0.57฀to฀1.22±0.17,฀and฀1.72±0.31฀ to฀1.57±0.42,฀respectively,฀by฀lipid฀administration. Conclusions:฀ These฀ data฀ suggested฀ that฀ dilatation฀ of฀ myocardial฀ microvessels฀ compensates฀high฀shear฀stress฀of฀viscous฀blood฀by฀hypertricglyseridemia.฀This฀should฀be฀ the฀mechanism฀of฀deterioration฀of฀the฀coronary฀circulation฀by฀hypertriglyceridemia.฀ POSTER฀SESSION 1166฀฀ Clinical฀Evaluation฀Using฀Contrast฀ Echocardiography Tuesday,฀March฀08,฀2005,฀1:30฀p.m.-5:00฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀2:30฀p.m.-3:30฀p.m. 1166-79฀ Myocardial฀Tissue฀Protection฀With฀Distal฀Coronary฀ Protection฀and฀Adenosine฀Triphosphate฀Disodium฀ Infusion฀Can฀Further฀Reduce฀No-Reflow฀in฀Acute฀ Myocardial฀Infarction Tadamichi฀Sakuma,฀Takenori฀Okada,฀Ken฀Ishibashi,฀Kentaro฀Miura,฀Toshiharu฀Oka,฀ Mamoru฀Toyofuku,฀Hidekazu฀Hirao,฀Yuuji฀Muraoka,฀Hironori฀Ueda,฀Yoshiko฀Masaoka,฀ Yasuhiko฀Hayashi,฀Shinji฀Mito,฀Tsuchiya฀General฀Hospital,฀Hiroshima,฀Japan,฀Hiroshima฀ University,฀Hiroshima,฀Japan Background:฀It฀remains฀unknown฀whether฀thrombectomy฀with฀distal฀coronary฀protection฀ and฀ appropriate฀ pharmacological฀ intervention฀ can฀ further฀ reduce฀ no-reflow฀ in฀ patients฀ with฀acute฀myocardial฀infarction฀(AMI). Methods:฀One฀hundred฀twenty-five฀consecutive฀patients฀with฀first฀anteroseptal฀AMI฀were฀ enrolled.฀In฀whom,฀culprit฀lesion฀was฀confirmed฀on฀proximal฀LAD฀with฀TIMI฀0฀or฀1,฀and฀TIMI฀ grade฀3฀recanalization(R)฀with฀less฀than฀20%฀diameter฀stenosis฀was฀achieved฀by฀primary฀ percutaneous฀ coronary฀ intervention฀ (PCI)฀ within฀ 8฀ hours฀ after฀ symptom฀ onset.฀ They฀ underwent฀PCI฀with฀GuardWire฀Plus฀System®฀(GPS;฀temporary฀occlusion฀&฀aspiration฀ system)฀(n=23)฀or฀PCI฀with฀adenosine฀triphosphate฀disodium฀(ATP)฀(n=26)฀or฀PCI฀with฀ both฀GPS฀and฀ATP฀(n=23)฀or฀PCI฀without฀any฀protections฀(n=53).฀ATP฀at฀a฀dose฀of฀150฀ µg/kg/min฀was฀intravenously฀administered฀from฀10฀min฀prior฀to฀R฀to฀50฀min฀after฀R.฀We฀ measured฀risk฀areas฀(asynergic฀region฀in฀apical฀long฀axis฀view)฀before฀R,฀and฀reperfusion฀ 1166-81฀ Myocardial฀Microcirculation฀and฀Left฀Ventricular฀ Diastolic฀Dysfunction฀in฀Obstructive฀Sleep฀Apnea฀ Syndrome Akira฀Yamada,฀Akiko฀Noda,฀Hideo฀Izawa,฀Tomoko฀Kato,฀Toyoaki฀Murohara,฀Mitsuhiro฀ Yokota,฀Nagoya฀University฀Graduate฀School฀of฀Medicine,฀Nagoya,฀Japan Background:฀ Patients฀ with฀ obstructive฀ sleep฀ apnea฀ syndrome฀ (OSAS)฀ often฀ have฀ hypertension฀ with฀ left฀ ventricular฀ (LV)฀ hypertrophy฀ (LVH).฀ We฀ investigated฀ the฀ influence฀ of฀ OSAS฀ on฀ myocardial฀ microcirculation฀ applying฀ myocardial฀ contrast฀ echocardiography฀(MCE). Methods:฀ MCE฀ was฀ performed฀ for฀ 27฀ patients฀ with฀ OSAS฀ (Group฀ OSAS;฀ 49.3±7.4฀ years),฀ 41฀ hypertensive฀ patients฀ without฀ OSAS฀ (Group฀ HT;฀ 51,3±8.1฀ years)฀ and฀ 26฀ healthy฀controls฀(Group฀C;฀47.8±6.2฀years).฀Images฀were฀obtained฀from฀the฀apical฀two-฀ and฀ four-chamber฀ views฀ at฀ pulsing฀ intervals฀ of฀ one฀ to฀ four฀ cardiac฀ cycles฀ with฀ bolus฀ infusion฀ of฀ Levovist.฀ The฀ color฀ pixel฀ intensity฀ was฀ determined฀ at฀ 8฀ different฀ regions฀ of฀ interest฀ in฀ the฀ LV฀ myocardium฀ (inferior฀ base฀ and฀ apex,฀ anterior฀ base฀ and฀ apex,฀ septal฀ base฀and฀apex,฀lateral฀base฀and฀apex)฀and฀within฀the฀chamber฀adjacent฀to฀them.฀Standard฀ polysomnography฀ was฀ performed฀ in฀ OSAS฀ patients฀ to฀ determine฀ the฀ number฀ of฀ apnea฀ and฀hypopnea฀episodes฀or฀oxygen฀desaturation฀per฀hour฀(apnea-hypopnea฀index฀(AHI),฀ oxygen฀desaturation฀index฀(ODI)). The฀ mean฀ contrast฀ intensity฀ difference฀ (ID)฀ between฀ myocardium฀ and฀ chamber฀ in฀ all฀ regions฀ was฀ significantly฀ greater฀ in฀ Group฀ OSAS฀ than฀ in฀ Group฀ C฀ (26.7±3.6฀ Versus฀ 21.0±2.1฀dB,฀p30/hr฀than฀in฀those฀with฀AHI<30/hr. Conclusions:฀ The฀ repeated฀ episodes฀ of฀ nocturnal฀ oxygen฀ desaturation,฀ sleep฀ fragmentation,฀and฀the฀consequent฀activation฀of฀the฀sympathoadrenal฀system฀in฀OSAS฀ may฀involve฀in฀myocardial฀microcirculation฀impairment฀and฀LV฀diastolic฀dysfunction. JACC February 1, 2005 1166-82฀ ABSTRACTS - Noninvasive Imaging Detection฀Of฀Left฀Anterior฀Descending฀Coronary฀ Artery฀Obstruction฀By฀Myocardial฀Flow฀Reserve฀As฀ Determined฀By฀Real-time฀Contrast฀Echocardiography.฀A฀ Head฀To฀Head฀Comparison฀With฀Transthoracic฀Doppler. Altamiro฀F.฀Osorio,฀Ingrid฀Kowatsch,฀Jeane฀M.฀Tsutsui,฀Maria฀L.฀Trindade,฀Juliana฀C.฀ Frizera,฀Marden฀L.฀Lopes,฀Jose฀L.฀Andrade,฀Jose฀F.฀Ramires,฀Wilson฀Mathias,฀Jr.,฀Heart฀ Institute฀(InCor)฀University฀of฀Sao฀Paulo฀Medical฀School,฀Sao฀Paulo,฀Brazil Background:฀ Real-time฀ myocardial฀ contrast฀ echocardiography฀ (RTMCE)฀ is฀ a฀ new฀ technique฀ that฀ allows฀ for฀ detection฀ of฀ coronary฀ artery฀ disease฀ (CAD)฀ by฀ evaluating฀ the฀ regional฀myocardial฀blood฀flow.฀Although฀the฀decrease฀in฀myocardial฀blood฀flow฀reserve฀ (MBFR)฀is฀indicative฀of฀CAD,฀a฀direct฀comparison฀with฀the฀coronary฀flow฀reserve฀(CFR)฀ obtained฀by฀transthoracic฀Doppler฀echocardiography฀(DE)฀has฀not฀been฀fully฀demonstrated.฀ In฀this฀study฀we฀sought฀to฀determine฀the฀value฀of฀MBFR฀and฀CFR฀for฀detecting฀left฀anterior฀ descending฀artery฀(LAD)฀stenosis.฀ Methods:฀We฀studied฀44฀patients฀(18฀men,฀57±13฀years)฀with฀RTMCE฀at฀rest฀and฀during฀ 140mcg/kg/min฀of฀adenosine฀infusion.฀Plateau฀intensity฀(A)฀and฀myocardial฀replenishment฀ velocity฀(B)฀were฀quantified฀with฀Q-Lab฀2.0฀(Philips),฀and฀MBFR฀calculated฀as฀the฀ratio฀of฀ AxB฀during฀adenosine/baseline.฀CFR฀was฀calculated฀as฀the฀ratio฀of฀peak฀diastolic฀velocity฀ obtained฀ by฀ DE฀ during฀ adenosine/baseline.฀ LAD฀ stenosis฀ (>50%)฀ was฀ determined฀ by฀ quantitative฀angiography฀performed฀within฀1฀week฀of฀RTMCE.฀ Results:฀MBFR฀and฀CFR฀were฀lower฀in฀the฀28฀pts฀with฀LAD฀stenosis฀than฀in฀the฀16฀pts฀ with฀normal฀LAD฀(Table).฀A฀cut-off฀value฀of฀1.75฀and฀1.90฀were฀obtained฀for฀differentiating฀ normal฀ and฀ abnormal฀ MBFR฀ and฀ CFR,฀ respectively.The฀ sensitivity,฀ specificity฀ and฀ accuracy฀for฀detecting฀LAD฀stenosis฀were฀85%,฀80%฀and฀81%฀for฀MBFR฀and฀85%,฀100%฀ and฀81%฀for฀CFR฀(p=NS).฀ Conclusion:฀Quantitative฀RTMCE฀and฀transthoracic฀DE฀had฀similar฀ability฀to฀differentiate฀ patients฀with฀and฀without฀LAD฀stenosis. *p<0.05฀compared฀to฀normal฀LAD Normal฀LAD Normal฀LAD Baseline Adenosine A฀value B฀value Myocardial฀ blood฀flow฀ (RTMCE) Peak฀Diastolic฀ Velocity฀(DE) 5.62฀±฀1.77 0.50฀±฀0.15 6.11฀±฀1.56 1.04฀±฀0.54 2.74฀±฀1.38 6.37฀±฀2.87 2.43฀±฀0.80 2.86฀±฀1.67 3.18฀±฀1.59* 1.24฀±฀0.48* 24.8฀±฀8.5 68.8฀±฀23.4 2.86฀±฀0.71 30.1฀±฀10.6 48.6฀±฀23.9* 1.57฀±฀0.38* 1166-83฀ LAD฀Stenosis LAD฀Stenosis LAD฀Stenosis Reserve฀ Baseline Adenosine (Adenosine/ Baseline 5.60฀±฀1.91 5.88฀±฀1.74 1.12฀±฀0.38 0.49฀±฀0.18 0.57฀±0.23* 1.23฀±฀0.46* Clinical฀Usefulness฀of฀Myocardial฀Contrast฀ Echocardiography฀and฀Tirofiban฀in฀Identification฀and฀ Treatment฀of฀High฀Risk฀Chest฀Pain฀Patients Duk-Hyun฀Kang,฀Duk-Woo฀Park,฀Soo-Jin฀Kang,฀Kwan-Ho฀Ko,฀Kyoung-Ha฀Park,฀JongMin฀Song,฀Kee-Jun฀Choi,฀Myeong-Ki฀Hong,฀Jae-Kwan฀Song,฀Seong-Wook฀Park,฀SeungJung฀Park,฀Asan฀Medical฀Center,฀Seoul,฀South฀Korea Background:฀Myocardial฀contrast฀echocardiography฀(MCE)฀was฀expected฀to฀be฀clinically฀ useful฀in฀diagnosing฀high฀risk฀chest฀pain฀patients.฀We฀sought฀to฀evaluate฀clinical฀efficacy฀ of฀tirofiban฀in฀acute฀coronary฀syndrome฀diagnosed฀by฀MCE. Methods:฀ Using฀ intermittent฀ power฀ doppler฀ harmonic฀ imaging฀ and฀ continuous฀ infusion฀ of฀PESDA,฀MCE฀was฀performed฀to฀assess฀myocardial฀perfusion฀in฀patients฀presenting฀to฀ emergency฀room฀with฀suspected฀ischemic฀chest฀pain฀at฀rest.฀Exclusion฀criteria฀were฀age฀ >฀75฀yrs,฀pregnancy,฀presence฀of฀Q฀wave฀or฀ST฀segment฀elevation,฀poor฀echo฀window,฀ and฀refusal฀of฀consent.฀Positive฀MCE฀was฀defined฀as฀presence฀of฀myocardial฀perfusion฀ defects฀in฀at฀least฀1฀coronary฀artery฀territory.฀A฀total฀of฀63฀patients฀(age:฀59฀±฀10฀yrs,฀51฀ men)฀with฀positive฀MCE฀were฀randomly฀assigned฀to฀either฀tirofiban฀group฀(n=32)฀or฀control฀ group฀(n=31).฀The฀primary฀end฀point฀was฀a฀composite฀of฀death฀and฀nonfatal฀myocardial฀ infarction฀(MI)฀occurring฀after฀the฀index฀event. Results:฀The฀initial฀troponin฀I฀level฀was฀elevated฀in฀22(35%)฀patients,฀and฀ST฀depression฀ was฀noted฀in฀18(29%)฀patients.฀Coronary฀angiography฀was฀performed฀in฀all฀patients,฀and฀ percutaneous฀ coronary฀ intervention฀ (PCI)฀ in฀ 44(70%)฀ patients,฀ coronary฀ artery฀ bypass฀ graft฀surgery฀(CABG)฀in฀10(16%)฀patients.฀The฀final฀diagnosis฀at฀discharge฀was฀unstable฀ angina฀in฀21(33%)฀patients,฀non฀ST฀elevation฀MI฀in฀41(65%)฀patients,฀and฀non-ischemic฀ chest฀ pain฀ in฀ 1(2%)฀ patient.฀There฀ were฀ no฀ significant฀ differences฀ between฀ two฀ groups฀ in฀terms฀of฀baseline฀characteristics,฀and฀time฀to฀PCI฀(2.9฀±฀1.2฀days฀in฀tirofiban฀group฀vs฀ 2.6฀±฀1.6฀days฀in฀control,฀p฀=฀NS).฀The฀tirofiban฀group฀had฀a฀slightly฀higher฀frequency฀of฀ PCI฀(72%฀vs.฀68%,฀p฀=฀NS)฀and฀lower฀frequency฀of฀CABG฀(13%฀vs.฀19%,฀p฀=฀NS)฀than฀ control.฀Adverse฀events฀occurred฀in฀4฀(13%)฀patients฀(2฀deaths,฀2฀MI)฀of฀control,฀compared฀ with฀no฀event฀in฀tirofiban฀group฀(p฀<฀0.05).฀The฀event-free฀survival฀rates฀were฀93฀±฀5%฀at฀ 1฀yr฀and฀82฀±฀8%฀at฀2฀yrs฀in฀control฀and฀significantly฀worse฀than฀those฀in฀tirofiban฀group฀ (p฀<฀0.05). Conclusions:฀MCE฀can฀identify฀high฀risk฀chest฀pain฀patients,฀and฀early฀use฀of฀tirofiban฀ is฀ associated฀ with฀ favorable฀ outcomes฀ in฀ these฀ patients฀ with฀ acute฀ coronary฀ syndrome฀ diagnosed฀by฀MCE. Prognostic฀Value฀of฀Myocardial฀Contrast฀ Echocardiography฀in฀Patients฀Presenting฀to฀Hospital฀ with฀Acute฀Chest฀Pain฀and฀Negative฀Troponin Paramjit฀Jeetley,฀Leah฀Burden,฀Kim฀Greaves,฀Roxy฀Senior,฀Northwick฀Park฀Hospital,฀ Harrow,฀United฀Kingdom Background:฀Myocardial฀contrast฀echocardiography฀(MCE)฀is฀a฀new฀bedside฀technique฀ that฀facilitates฀the฀diagnosis฀of฀coronary฀artery฀disease฀(CAD).฀We฀hyopthesised฀that฀MCE฀ can฀be฀used฀to฀risk฀stratify฀patients฀with฀coronary฀risk฀factors฀presenting฀to฀hospital฀with฀ acute฀chest฀pain,฀non-diagnostic฀ECGs฀and฀negative฀12฀hour-troponin. Methods:฀All฀subjects฀underwent฀standard฀clinical฀tests฀for฀risk฀stratification.฀Subsequently฀ low฀power฀MCE฀was฀performed฀using฀SonoVue฀as฀a฀continuous฀infusion฀at฀rest฀and฀following฀ vasodilator฀ stress.฀ Patients฀ were฀ recommended฀ for฀ coronary฀ angiography฀ by฀ treating฀ physicians฀on฀the฀basis฀of฀standard฀tests฀for฀risk฀stratification฀and฀blinded฀to฀MCE฀results. Results:฀ A฀ total฀ of฀ 139฀ patients฀ underwent฀ MCE฀ at฀ a฀ mean฀ time฀ of฀ 17±27฀ days฀ after฀ admission.฀At฀coronary฀angiography,฀26฀(19%)฀patients฀were฀found฀to฀have฀significant฀CAD,฀ 21(81%)฀of฀which฀were฀detected฀by฀MCE.฀At฀follow-up฀(7.3±4.1฀months),฀patients฀with฀an฀ abnormal฀ MCE฀ (n=49฀ pts)฀ had฀ higher฀ cardiac฀ event฀ rates฀ (death,฀ non-fatal฀ myocardial฀ infarction฀and฀urgent฀revascularisation)฀compared฀to฀those฀with฀normal฀MCE฀(36%฀vs฀7%;฀ p<0.0001).฀Hard฀cardiac฀event฀rates฀(death฀and฀non-fatal฀myocardial฀infarction)฀were฀low฀ (3%)฀in฀the฀patients฀with฀normal฀MCE฀(n=90฀pts). Conclusion:฀MCE฀accurately฀classified฀patients฀presenting฀to฀the฀hospital฀with฀coronary฀ risk฀factors฀but฀troponin฀negative฀chest฀pain฀into฀high฀and฀low฀risk฀groups.฀A฀normal฀MCE฀ confers฀an฀excellent฀prognosis฀in฀such฀patients. 1166-85฀ Myocardial฀Contrast฀Echocardiography฀Accurately฀ Estimate฀Trasmurality฀and฀Size฀of฀Acute฀Myocardial฀ Infarction. Maria฀L.฀Trindade,฀Altamiro฀F.฀Osorio,฀Ingrid฀Kowatsch,฀Marcia฀A.฀Caldas,฀Vitor฀Monsao,฀ Carlos฀E.฀Rochitte,฀Jose฀L.฀Andrade,฀Wilson฀Mathias,฀Jr.,฀Heart฀Institute฀(InCor),฀São฀ Paulo,฀Brazil Background:฀ In฀ acute฀ myocardial฀ infarction฀ (AMI),฀ accurate฀ of฀ it’s฀ extent฀ is฀ still฀ a฀ challenging฀ issue฀ involving฀ availability฀ of฀ technology,฀ scarcity฀ of฀ appropriate฀ clinical฀ quantitative฀ validation฀ and฀ cost.฀ Quantitative฀ myocardial฀ contrast฀ echocardiography฀ (QMCE)฀with฀parametric฀imaging฀(PI)฀and฀gray฀scale฀low฀mechanical฀index฀2฀dimensional฀ echocardiography฀(2D฀echo)฀has฀been฀promising฀in฀determining฀the฀location฀and฀severity฀ of฀ AMI.฀ We฀ sought฀ to฀ evaluate฀ the฀ correlation฀ of฀ 2D฀ echo฀ and฀ QMCE฀ with฀ magnetic฀ resonance฀imaging฀(MRI)฀in฀determining฀location,฀transmurality฀and฀size฀of฀AMI. Methods:฀ We฀ prospectively฀ evaluated฀ 20฀ patients฀ (12฀ men,฀ 64.25฀ ±฀ 13.3฀ years)฀ admitted฀for฀AMI฀from฀June฀2003฀to฀July฀2004.฀PI฀and฀2D฀echo฀were฀used฀to฀measure฀ the฀segmental฀location,฀infarct฀area฀(cm2),฀%฀infarct฀area,฀transmural฀extent฀(cm)฀and฀%฀ transmural฀extent฀using฀a฀17-segment฀model.฀Studies฀were฀performed฀with฀a฀Sonos฀5500฀ and฀quantified฀with฀a฀QLab฀software฀(Philips฀medical฀systems),฀and฀were฀compared฀with฀ MRI฀late฀enhanced฀imaging. Results:฀There฀were฀10฀AMI฀in฀anterior,฀5฀in฀inferior฀and฀5฀in฀lateral฀wall,฀and฀there฀were฀ 266฀infarcted฀segments฀by฀MRI.฀The฀echocardiographic฀correlations฀with฀that฀of฀MRI฀are฀ shown฀bellow. Conclusion:฀These฀results฀suggests฀that฀QMCE,฀in฀especial฀PI,฀correlates฀well฀with฀MRI฀ in฀detecting฀infarct฀location,฀size฀and฀transmural฀extent,฀therefore฀this฀technique฀has฀the฀ potential฀to฀be฀the฀ideal,฀first฀hand฀tool฀for฀evaluating฀the฀extent฀of฀AMI. The฀echocardiographic฀correlations฀with฀that฀of฀MRI฀ Segmental฀Location Infarct฀area฀(cm2) %฀Infarct฀area Trasmural฀extent฀(cm) %฀Trasmural฀extent 1166-86฀ MRI 2D฀ECHO PI _ 3.42฀±2.80 16.76฀±14.48 0.64฀±0.36 75.10฀±29.27 259/266(r=0.98) 3.03±฀2.77(r=0.97฀p=0.0001) 15.22฀±14.84(r=0.97฀p=0.0001) 0.60฀±฀0.37(r=0.79฀p=0.0001) 71.49฀±฀38.12(r=0.74฀p=0.0002) 263/266(r=0.99) 3.36฀±฀2.82(r=0.99฀p=0.0001) 16.46฀±฀14.41(r=0.99฀p=0.0001) 0.68±฀0.28฀(r=0.84฀p=0.0001) 78.29฀±25.11(r=0.84฀p=0.0001) Safety฀and฀Feasibility฀of฀Real฀Time฀Myocardial฀Perfusion฀ Imaging฀With฀Intravenous฀Ultrasound฀Contrast฀During฀ Dobutamine฀Stress฀Echocardiography Jeane฀Mike฀Tsutsui,฀Feng฀Xie,฀Abdou฀Elhendy,฀Anna฀C.฀McGrain,฀Brian฀Cory,฀Robert฀ Garvin,฀Thomas฀R.฀Porter,฀University฀of฀Nebraska฀Medical฀Center,฀Omaha,฀NE Background:฀ Although฀ myocardial฀ perfusion฀ analysis฀ (MPA)฀ with฀ intravenous฀ (IV)฀ ultrasound฀contrast฀(UC)฀and฀real-time฀myocardial฀contrast฀echocardiography฀(RTMCE)฀ may฀improve฀the฀sensitivity฀of฀dobutamine฀stress฀echocardiography฀(DSE),฀two฀potential฀ concerns฀ exist.฀ First,฀ ultrasound-induced฀ microbubble฀ destruction฀ has฀ been฀ reported฀ to฀ stimulate฀ arrhythmias฀ during฀ DSE.฀ Secondly,฀ the฀ feasibility฀ of฀ performing฀ MPA฀ with฀ RTMCE฀has฀not฀been฀evaluated฀in฀a฀large฀series฀of฀patients.฀ Methods:฀Accordingly,฀we฀examined฀1,487฀pts฀(60±13฀years)฀who฀underwent฀dobutamine฀ stress฀RTMCE,฀as฀well฀as฀1,012฀control฀pts฀(63±13฀years)฀who฀underwent฀DSE฀without฀ UC.฀ To฀ reduce฀ microbubble฀ destruction,฀ RTMCE฀ was฀ performed฀ with฀ low-mechanical฀ index฀ (<0.3)฀ pulse฀ sequence฀ schemes฀ following฀ IV฀ UC฀ (Optison฀ or฀ Definity).฀ Blood฀ pressure,12฀lead฀electrocardiograms,฀and฀symptoms฀were฀assessed฀during฀each฀infusion฀ stage.฀Feasibility฀was฀defined฀as฀the฀ability฀to฀perform฀MPA฀in฀at฀least฀2฀of฀3฀segments฀in฀ each฀left฀ventricular฀wall฀(septal,฀lateral,฀inferior,฀anterior,฀posterior).฀ Results:฀The฀mean฀dose฀of฀IV฀Optison฀per฀study฀was฀2.8±0.8฀ml,฀while฀it฀was฀1.0±0.3฀ ml฀for฀Definity.฀No฀myocardial฀infarction฀or฀death฀occurred฀in฀either฀group,฀and฀there฀was฀ no฀difference฀in฀any฀type฀of฀arrhythmia฀(Table).฀MPA฀was฀feasible฀in฀93%฀of฀the฀walls฀at฀ baseline฀and฀94%฀at฀peak฀stress.฀ Noninvasive Imaging Variables Normal฀LAD Reserve฀ (Adenosine/ Baseline) 1.17฀±฀0.44 2.08฀±฀0.82 1166-84฀ 303A 304A ABSTRACTS - Noninvasive Imaging JACC February 1, 2005 Conclusion:฀Dobutamine฀stress฀RTMCE฀is฀a฀safe฀and฀feasible฀test฀for฀evaluating฀patients฀ with฀known฀or฀suspected฀coronary฀artery฀disease. Adverse฀effects Premature฀ventricular฀complexes Premature฀supraventricular฀complexes Supraventricular฀tachycardia Atrial฀fibrillation Nonsustained฀ventricular฀tachycardia Sustained฀ventricular฀tachycardia Combined฀sustained฀arrhythmias Hypotension Hypertension RTMCE฀(n฀=฀1,487) 348฀(23.4%) 71฀(4.8%) 21฀(1.4%) 27฀(1.8%) 20฀(1.3%) 5฀(0.3%) 53฀(3.6%) 189฀(12.7%) 27฀(1.8%) DSE฀(n฀=฀1,012) 230฀(22.7%) 44฀(4.3%) 19฀(1.9%) 14฀(1.4%) 8฀(0.8%) 3฀(0.2%) 36฀(3.5%) 127฀(12.5%) 15฀(1.5%) POSTER฀SESSION 1167฀฀ Technical฀Advances฀in฀Tissue฀Velocity,฀ Strain,฀and฀Torsion Tuesday,฀March฀08,฀2005,฀1:30฀p.m.-5:00฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀2:30฀p.m.-3:30฀p.m. 1167-71฀ Automated฀Quantitative฀Measurement฀of฀Mitral฀Annular฀ Longitudinal฀Displacement฀Using฀Tissue฀Texture฀ Tracking฀Allows฀Ultrafast฀Assessment฀of฀LV฀Ejection฀ Fraction Noninvasive Imaging Jeanne฀M.฀DeCara,฀Eran฀Toledo,฀Ivan฀S.฀Salgo,฀Georgeanne฀Lammertin,฀Lynn฀Weinert,฀ Victor฀Mor-Avi,฀Roberto฀M.฀Lang,฀University฀of฀Chicago,฀Chicago,฀IL The฀ calculation฀ of฀ LV฀ ejection฀ fraction฀ (EF)฀ based฀ on฀ manual฀ tracing฀ of฀ endocardial฀ borders฀ is฀ time-consuming฀ and฀ relies฀ on฀ adequate฀ endocardial฀ visualization.฀ Mitral฀ annular฀displacement฀(MAD)฀has฀been฀used฀as฀a฀surrogate฀marker฀of฀LV฀systolic฀function.฀ We฀developed฀a฀technique฀for฀automated฀quantification฀of฀MAD฀and฀tested฀its฀accuracy฀for฀ ultrafast฀assessment฀of฀LV฀systolic฀function.฀Methods.฀Apical฀4-chamber฀views฀obtained฀ in฀ 68฀ patients฀ were฀ used฀ for฀ off-line฀ automated฀ tissue-texture฀ tracking฀ and฀ frame-byframe฀color-encoding฀of฀mitral฀annular฀motion฀throughout฀systole฀(Q-LAB,฀Philips).฀Colorencoded฀images฀(fig.฀A)฀were฀analyzed฀to฀quantify฀MAD฀using฀custom฀software.฀In฀46฀pts฀ (study฀group),฀MAD฀values฀were฀correlated฀with฀biplane฀EF฀(method฀of฀discs)฀to฀obtain฀a฀ regression฀formula,฀which฀was฀then฀applied฀prospectively฀to฀predict฀EF฀in฀the฀remaining฀ 22฀pts฀(test฀group).฀Results.฀Mitral฀annular฀tracking,฀color-encoding฀and฀quantification฀of฀ MAD฀was฀achieved฀in฀all฀pts฀within฀<10฀sec.฀MAD฀correlated฀highly฀with฀EF฀in฀the฀study฀ group฀and฀was฀fitted฀with฀a฀bilinear฀regression฀formula฀(fig.฀B).฀When฀tested฀prospectively฀ using฀ this฀ formula,฀ MAD฀ predicted฀ EF฀ with฀ minimal฀ inter-technique฀ differences฀ (fig.฀ C;฀ r=0.80,฀ p<0.00001).฀ Conclusions.฀ Quantification฀ of฀ MAD฀ from฀ color-encoded฀ images฀ provides฀accurate฀information฀on฀LV฀systolic฀function.฀This฀automated,฀ultrafast฀technique฀ can฀be฀used฀even฀in฀patients฀with฀poorly฀visualized฀endocardium,฀since฀the฀mitral฀annulus฀ is฀usually฀well฀visualized.฀ 1167-72฀ Radial฀and฀Longitudinal฀Myocardial฀Velocity฀Estimation฀ From฀Gray-Scale฀Conventional฀Echocardiography.฀ Validation฀Against฀Doppler฀Velocities. Maria฀Jesus฀Ledesma-Carbayo,฀Manuel฀Desco,฀Norberto฀Malpica,฀Patricia฀Mahía,฀ Esther฀Pérez฀David,฀Andres฀Santos,฀Miguel฀Angel฀García฀Fernández,฀Hospital฀General฀ Universitario฀Gregorio฀Marañón,฀Madrid,฀Spain Background:฀Measurments฀of฀myocardial฀velocity฀(V)฀using฀Tissue฀Doppler฀Imaging฀(TDI)฀ has฀the฀intrinsic฀limitation฀of฀the฀angular฀dependency.฀This฀work฀presents฀a฀new฀method฀to฀ obtain฀radial฀and฀longitudinal฀myocardial฀velocities฀from฀2D฀gray-scale฀echocardiographic฀ sequences฀and฀its฀validation฀against฀Tissue฀Doppler฀Imaging฀(TDI)฀velocities.฀ Methods:฀ TDI฀ and฀ gray฀ scale฀ sequences฀ of฀ the฀ septum฀ (apical฀ view)฀ were฀ acquired฀ simultaneously฀from฀normal฀volunteers฀with฀an฀Acuson฀Sequoia฀at฀a฀frame฀rate฀of฀110฀ fps,฀and฀analyzing฀V฀with฀both฀methods.฀The฀2D฀velocity฀vector,฀that฀enclose฀the฀radial฀ and฀longitudinal฀components,฀was฀obtained฀by฀means฀of฀an฀automatic฀motion฀detection฀ method฀based฀on฀non-rigid฀registration฀of฀consecutive฀frames.฀Linear฀regression฀analysis฀ was฀ applied฀ to฀ assess฀ the฀ relationship฀ between฀ the฀ V฀ calculated฀ with฀ the฀ proposed฀ method฀(Vr)฀and฀Doppler฀velocities฀(Vd). Results:฀Linear฀regression฀results฀showed฀a฀good฀correlation฀between฀Vr฀and฀Vd฀(slope฀ =฀0.846±0.003,฀R2=0.782).฀Figure฀shows฀an฀standard฀TDI฀image฀(A),฀the฀equivalent฀image฀ obtained฀with฀the฀proposed฀method฀(B),฀and฀the฀corresponding฀velocity฀time฀curves฀from฀ a฀ROI. Conclusions:฀ Non-rigid฀ registration฀ techniques฀ allow฀ obtaining฀ radial฀ and฀ longitudinal฀ components฀ of฀ V฀ from฀ conventional฀ gray-scale฀ imaging,฀ overcoming฀ the฀ limitations฀ of฀ Doppler฀techniques. ฀ 1167-73฀ Single฀Beat฀Determination฀of฀Regional฀Myocardial฀ Strain฀Measurements฀in฀Patients฀with฀Atrial฀Fibrillation Kaoru฀Funabiki,฀Katsuya฀Onishi,฀Masaki฀Tanabe,฀Takashi฀Yamanaka,฀Masaaki฀Ito,฀Naoki฀ Isaka,฀Takeshi฀Nakano,฀Mie฀University฀School฀of฀Medicine,฀Tsu,฀Japan Background:฀Evaluation฀of฀regional฀myocardial฀function฀is฀an฀important฀goal฀in฀clinical฀ cardiology.฀The฀clinical฀assessment฀of฀regional฀myocardial฀function฀in฀patients฀with฀atrial฀ fibrillation฀is฀unreliable฀and฀difficult฀because฀of฀beat-to-beat฀variation.฀Recent฀reports฀have฀ shown฀that฀the฀ratio฀of฀preceding฀(RR1)฀to฀prepreceding฀RR฀intervals฀(RR2),฀RR1/RR2฀ can฀ assess฀ left฀ ventricular฀ systolic฀ function.฀ Accordingly,฀ we฀ tested฀ the฀ hypothesis฀ that฀ regional฀wall฀motion฀can฀be฀estimated฀from฀single฀beat฀based฀on฀RR1/RR2฀in฀patients฀ with฀atrial฀fibrillation.฀ Methods฀and฀Results:฀Peak฀systolic฀strain฀was฀measured฀by฀tissue฀Doppler฀image฀(Vivid฀ 7,฀GE฀Medical฀Systems฀,฀USA)฀on฀apical฀4฀chamber฀view฀in฀50฀patients฀with฀atrial฀fibrillation฀ (mean฀ejection฀fraction฀0.52±0.16,฀and฀mean฀heart฀rate฀76±16฀bpm).฀Each฀left฀ventricular฀ wall฀was฀divided฀into฀base,฀middle฀and฀apex฀and฀all฀measurements฀were฀recorded฀during฀ 30±10฀cardiac฀cycles฀in฀each฀patient.฀Peak฀strain฀in฀each฀segments฀showed฀a฀positive฀ correlation฀with฀the฀RR1฀and฀RR2,฀and฀a฀significant฀positive฀correlation฀with฀the฀RR1/RR2฀ ratio.฀The฀correlation฀coefficients฀were฀significantly฀greater฀for฀the฀relationship฀between฀ the฀peak฀strain฀and฀the฀RR1/RR2฀ratio฀than฀for฀those฀between฀the฀parameter฀and฀the฀RR1฀ or฀RR2.฀Furthermoore,฀the฀peak฀strain฀at฀RR1/RR2=1฀was฀calculated฀from฀the฀equation฀of฀ linear฀regression฀line฀and฀compared฀with฀measured฀average฀value฀over฀all฀cardiac฀cycles฀ in฀each฀patient.฀The฀calculated฀value฀of฀each฀parameter฀at฀RR1=RR2฀was฀quite฀similar฀to฀ the฀average฀value฀(r=0.997฀at฀base,฀0.998฀at฀middle฀and฀0.996฀at฀apex).฀ Conclusions:฀ Regional฀ myocardial฀ strain฀ at฀ RR1/RR2=1฀ in฀ the฀ linear฀ regression฀ line฀ could฀be฀the฀representative฀of฀average฀value฀over฀all฀cardiac฀cycle฀in฀each฀patients฀with฀ atrial฀fibrillation. 1167-74฀ Relationship฀of฀Left฀Ventricular฀Apical฀Torsion฀to฀ Longitudinal฀Mechanics฀in฀Health฀and฀Disease Huy฀Trong฀Nguyen,฀Peng฀Li,฀Hirsch฀Mehta,฀Mai฀T.฀Pham-Dunong,฀Cynthia฀D.฀Dell,฀ Margaret฀L.฀Knoll,฀Gianni฀Pedrizzetti,฀Giovanni฀Tonti,฀Helene฀Houle,฀Chowdhury฀Ahsan,฀ Jagat฀Narula,฀Mani฀A.฀Vannan,฀University฀of฀California฀Irvine,฀Irvine,฀CA Background:฀LV฀torsion฀is฀a฀critical฀determinant฀of฀pump฀ejection.฀Longitudinal฀myocardial฀ velocity฀(MV),฀strain฀(S)฀and฀strain฀rate฀(SR)฀by฀TDI฀is฀an฀index฀of฀LV฀function,฀but฀TDI฀ is฀ limited฀ by฀ angle-dependency฀ to฀ assess฀ apical฀ torsion.฀ We฀ studied฀ the฀ relationship฀ between฀apical฀torsion฀and฀longitudinal฀mechanics฀in฀normal฀and฀abnormal฀LV฀using฀a฀ novel฀B-Mode,฀high฀frame฀rate฀(FR),฀angle-independent,฀automated฀myocardial฀tracking฀ algorithm฀(Diogenes). Methods:฀30฀individuals฀(10฀normals,฀10฀DCM฀and฀10฀hypertensive฀LVH)฀were฀studied.฀ High฀FR฀(~100฀Hz),฀B-Mode฀SAX฀view฀of฀LV฀apex฀and฀apical฀4C฀views฀obtained฀using฀4V2฀ TTE฀ probe฀ linked฀ to฀ Acuson฀ Sequoia™฀ (Siemens).The฀ endocardial฀ border฀ was฀ traced฀ over฀one฀arbitrary฀frame฀and฀was฀then฀automatically฀tracked฀over฀time฀(Diogenes,฀AmidItaly฀&฀Siemens,฀USA).฀MV,฀S฀and฀SR฀were฀measured฀in฀the฀basal-mid฀septum฀(septum)฀ in฀the฀A4C฀view฀and฀the฀apical฀SAX฀view. Results:฀Septal฀MV฀was฀comparable฀in฀normals฀and฀LVH฀(p=0.3)฀but฀reduced฀in฀DCM฀(฀ p=0.005).฀Septal฀S฀and฀SR฀was฀reduced฀(Vs.฀normals)฀by฀45±0.4฀%฀and฀64±0.2฀%฀in฀LVH฀ and฀by฀66±0.3฀%฀and฀75±0.1฀%฀in฀DCM,฀respectively.฀Apical฀twist฀was฀reduced฀in฀both฀LVH฀ (8.9%,฀p=0.02)฀and฀DCM฀(23.6฀%,฀p=0.0001)฀compared฀to฀normals,฀see฀figure฀below. Conclusions:฀ Longitudinal฀ myocardial฀ mechanics฀ is฀ determined฀ by฀ apical฀ torsion.฀ Disruption฀ of฀ apical฀ twist฀ disrupts฀ longitudinal฀ S฀ and฀ SR฀ although฀ MV฀ may฀ be฀ normal,฀ as฀ seen฀ in฀ LVH.฀ Diogenes฀ based฀ on฀ myocardial฀ tracking฀ affords฀ a฀ method฀ to฀ measure฀ apical฀torsion.฀ JACC 1167-75฀ February 1, 2005 Measurement฀of฀Apical฀Torsion฀in฀Mitochrondrial฀ Cardiomyopathy฀Using฀a฀Novel฀B-Mode,฀Automated฀ Tracking฀Algorithm Peng฀Li,฀Giovanni฀Tonti,฀Johan฀Verjans,฀Gianni฀Pedrizzetti,฀Hirsch฀Mehta,฀Steve฀Appleby,฀ Huy฀Trong฀Nguyen,฀Helene฀Houle,฀Jagat฀Narula,฀Douglas฀Wallace,฀Margaret฀Knoll,฀Mani฀ A.฀Vannan,฀Univeristy฀of฀California฀Irvine,฀Irvine,฀CA Background:฀ Apical฀ torsion฀ determines฀ optimal฀ pump฀ ejection.฀ Diogenes฀ is฀ a฀ novel฀ angle-independent฀ (unlike฀ TDI)฀ algorithm฀ which฀ utilizes฀ high฀ frame฀ rate฀ (FR)฀ B-mode฀ images฀ and฀ automated฀ myocardial฀ tracking฀ to฀ yield฀ velocity฀ vector฀ and฀ deformation฀ data.฀ We฀ tested฀ Diogenes฀ in฀ Wild฀Type฀ (WT)฀ and฀ Ant1฀ mutant฀ mice฀ with฀ mitchondrial฀ cardiomyopathy฀(CMP). Methods:฀14฀mice฀(7฀CMP฀and฀7฀WT)฀were฀imaged฀with฀15L8฀(8-15฀MHz)฀linear฀probe฀on฀ Acuson฀Sequoia™฀(Siemens).฀SAX฀views฀of฀the฀apex฀were฀obtained฀at฀a฀FR฀of฀~110฀Hz.฀ The฀endocardial฀border฀was฀traced฀over฀one฀arbitrary฀frame฀and฀was฀then฀automatically฀ tracked฀over฀time฀with฀Diogenes฀(Amid,฀Italy฀&฀Siemens,฀USA).฀Mice฀were฀sacrificed฀and฀ histology฀was฀done฀on฀the฀hearts. Results:฀ EF฀ was฀ 66±3฀ %฀ in฀ control฀ and฀ 36±5฀ %฀ in฀ CMP-confirmed฀ on฀ histology(p<0.001).฀ A฀ total฀ 553฀ frames฀ (14฀ mice)฀ were฀ divided฀ into฀ 6636฀ regions฀ of฀ which฀ 6166฀ regions฀(92.9%)฀were฀automatically฀tracked.฀Dyssynchrony(4.3±6฀Vs.฀47.1±9฀ms,฀controls฀ Vs.฀CMP,฀p<0.001)฀and฀decreased฀amplititude฀(1.0±0.4฀Vs.฀0.5±0.3฀cm/s,฀p<0.001)฀was฀ noted฀between฀medial฀and฀lateral฀apical฀regions฀in฀B-Mode฀vectoy฀display,฀M-mode฀maps฀ and฀3-D฀spatial฀display.฀Apical฀twist฀measured฀as฀peak฀strain฀and฀strain฀rate฀was฀-2.1±1.1฀ Vs.฀-1.3±0.7,฀and฀0.8±0.3/s฀Vs.฀0.3±0.2/s,฀p<0.001),฀see฀fig. Conclusions:฀Apical฀twist฀is฀reduced฀and฀dysnchronous฀in฀this฀transgenic฀mice฀model฀of฀ CMP.฀Apical฀torsion฀can฀be฀measured฀by฀angle-indepnedent฀Diogenes฀utilizing฀high฀FR฀ B-mode฀images฀to฀automatically฀track฀myocardium.฀ 1167-76฀ Ikuo฀Hashimoto,฀Aarti฀Hejmadi฀Bhat,฀Xiaokui฀Li,฀David฀J.฀Sahn,฀Oregon฀Health฀&฀ Science฀University,฀Portland,฀OR Background:฀The฀Torrent-Guasp฀double-helix฀heart฀muscle฀fiber฀orientation฀theory฀links฀ embryonic฀development฀to฀the฀presence฀in฀the฀left฀ventricle฀(LV)฀of฀an฀inner฀descending฀ and฀outer฀ascending฀myocardial฀band฀that฀overlap฀and฀cross฀each฀other฀in฀the฀septum฀ and฀contribute฀to฀apex฀to฀base฀shortening฀and฀the฀spiral฀components฀of฀contraction. Methods:฀ Strain฀ rate฀ (SR)฀ imaging฀ studies฀ were฀ performed฀ in฀ 8฀ open฀ chest฀ pigs฀ from฀ short฀ axis฀ and฀ apical฀ views,฀ analyzing฀ SR฀ in฀ subendocardial฀ (subendo)฀ and฀ mid฀ mural฀ (mid)฀ layers฀ of฀ the฀ septum฀ and฀ LV฀ free฀ wall.฀ Mid฀ septal฀ bright฀ stripe฀ was฀ used฀ as฀ the฀ boundary฀ between฀ the฀ subendo฀ and฀ the฀ mid฀ septal฀ zone฀ and฀ LV฀ dP/dt฀ was฀ measured฀ concurrently.฀Sampling฀was฀performed฀over฀2฀x฀2฀mm฀areas฀on฀images฀developed฀with฀ minimal฀spatial฀and฀temporal฀averaging.฀Meticulous฀tissue฀tracking฀was฀used฀to฀keep฀the฀ sample฀over฀the฀same฀area฀of฀muscle. Results:฀For฀both฀radial฀SR฀during฀isovolumic฀contraction฀(ICT)฀and฀peak฀systolic฀SR,฀ differences฀between฀phases฀were฀greater฀between฀subendo฀and฀mid฀layers฀in฀the฀septum฀ (ICT:฀septal฀difference,฀3.31฀s-1฀vs.฀free฀wall฀difference,฀1.13฀s-1฀ ±฀0.24฀s-1,฀systole:฀5.05฀ s-1฀vs.฀4.15฀s-1฀ ±฀0.19฀s-1,฀p<0.01),฀and฀there฀was฀a฀difference฀between฀subendo฀and฀mid฀ layers฀for฀peak฀longitudinal฀strain฀imaged฀from฀the฀apex,฀as฀well฀as฀a฀difference฀in฀SR฀ timing.฀Also,฀subendo฀SR฀during฀ICT฀bore฀a฀closer฀relationship฀to฀peak฀positive฀dP/dt฀(r฀ =฀0.86,฀p<0.01). Conclusions:฀Advances฀in฀SRI฀may฀verify฀aspects฀of฀the฀Torrent-Guasp฀hypothesis. 1167-77฀ Methods:฀Six฀open-chest฀pigs฀were฀studied฀during฀pacing฀studies฀to฀simulate฀arrhythmias฀ and฀EP฀procedures฀with฀the฀catheter฀running฀on฀a฀GE฀VingMed฀Vivid฀7฀system. Results:฀ High฀ frame฀ rate฀ myocardial฀ imaging฀ and฀ tissue฀ Doppler฀ strain฀ rate฀ allow฀ a฀ mechanical฀survey฀of฀the฀effects฀of฀electrical฀activation฀and฀shorten฀the฀ability฀to฀detect฀ early฀contraction฀in฀the฀area฀of฀the฀heart฀that฀moves฀first฀on฀tissue฀tracking฀for฀high฀frame฀ rate฀ strain฀ recording.฀ Transatrial฀ puncture฀ and฀ imaging฀ of฀ pulmonary฀ veins฀ is฀ likewise฀ facilitated฀by฀this฀high-resolution฀technique. Conclusions:฀The฀next฀generation฀probes฀now฀being฀fabricated฀will฀incorporate฀ablational฀ electrodes,฀isolated฀enough฀from฀the฀ultrasound฀section฀of฀the฀device฀to฀allow฀intracardiac฀ with฀imaging฀of฀ablations฀performed฀using฀the฀same฀catheter฀as฀used฀for฀the฀imaging. 1167-78฀ Tracking฀Tissue฀Torsion฀by฀Tissue฀Doppler฀Based฀Strain฀ Rate฀Imaging฀and฀a฀New฀Speckle฀Tracking฀2D฀Strain/ Motion฀Anaylsis฀Program:฀An฀In฀Vitro฀Study Muhammad฀Ashraf,฀Monica฀T.฀Young,฀Amariek฀J.฀Jensen,฀James฀Pemberton,฀David฀J.฀ Sahn,฀Oregon฀Health฀&฀Science฀University,฀Portland,฀OR Background:฀ Normal฀ LV฀ contraction฀ involves฀ a฀ twisting฀ component,฀ the฀ unwinding฀ of฀ which฀is฀an฀important฀contribution฀to฀early฀diastolic฀filling. Methods:฀We฀used฀a฀variable฀speed฀motor฀to฀rotate฀a฀thin฀plastic฀rod฀in฀a฀water฀bath.฀ A฀ continuous฀ layer฀ of฀ beef฀ was฀ wrapped฀ around฀ this฀ rod฀ as฀ a฀ twist฀ phantom.฀Tension฀ in฀ the฀ roll฀ increased฀ slightly฀ during฀ rotation.฀ Short฀ axis฀ 2D฀ and฀ tissue฀ Doppler฀ images฀ were฀ acquired฀ using฀ a฀ GE/VingMed฀ Vivid฀ 7฀ at฀ 3.5฀ MHz฀ and฀ >100frames/sec.฀ Seven฀ different฀speeds฀(20-80฀cycles/min฀of฀winding฀and฀unwinding)฀were฀studied฀at฀two฀angles฀ of฀rotation฀(45º฀&฀90º).฀Data฀was฀analyzed฀offline฀on฀EchoPac®฀for฀tissue฀Doppler฀based฀ strain฀and฀a฀new฀2D฀strain฀rate฀(2DSR)฀program฀embedded฀in฀EchoPac®. Results:฀The฀ 2DSR฀ program฀ tracked฀ torsion฀ well฀ at฀ 45°฀ (mean฀ determination฀ =฀ 49.4°฀ ±฀2.2°[SE]),฀while฀it฀underestimated฀the฀90°฀twist฀computation฀(mean฀=฀68.6°฀±฀15.5°),฀ more฀ at฀ the฀ highest฀ twist฀ rates.฀Tissue฀ Doppler฀ based฀ SRI฀ could฀ not฀ effectively฀ define฀ twist฀consistently.฀An฀inner฀to฀outer฀deformation฀gradient฀during฀twisting฀could฀be฀detected฀ by฀tissue฀Doppler฀based฀SRI฀but฀clearer,฀less฀noisy฀determinations฀for฀this฀gradient฀were฀ computed฀by฀the฀2DSR฀method. Conclusions:฀ The฀ 2DSR฀ program฀ was฀ more฀ effective฀ for฀ detecting฀ twist,฀ especially฀ because฀targets฀move฀across฀the฀sector,฀crossing฀scan฀lines฀of฀differing฀resolution฀during฀ rotational฀movement. A฀New฀Intracardiac฀Ultrasound฀Imaging฀System฀With฀ High฀Resolution,฀High฀Frame฀Rate฀Motion฀Mapping฀and฀ EP฀Recording฀Capability Aaron฀Dentinger,฀Kai฀Thomenius,฀K.฀Kirk฀Shung,฀Jonathan฀Cannata,฀Raymond฀Chia,฀ Douglas฀N.฀Stephens,฀Xunchang฀Chen,฀Matthew฀O’Donnell,฀Crispin฀H.฀Davies,฀James฀ Pemberton,฀Grant฀H.฀Burch,฀Seshadri฀Balaji,฀David฀J.฀Sahn,฀Oregon฀Health฀&฀Science฀ University,฀Portland,฀OR,฀University฀of฀Michigan,฀Ann฀Arbor,฀MI Background:฀ This฀ paper฀ reports฀ first฀ animal฀ tests฀ with฀ a฀ 9฀ French,฀ 8-13฀ MHz฀ sidelooking฀64-element฀array฀technology฀developed฀by฀our฀Biomedical฀Research฀Partnership฀ Grant.฀The฀catheters฀are฀fabricated฀by฀Irvine฀Biomedical฀and฀are฀steerable,฀much฀like฀EP฀ catheters,฀and฀enabled฀for฀EP฀recording฀with฀2฀to฀6฀electrodes. 305A ฀ ฀ Noninvasive Imaging Exaggerated฀Differences฀Between฀Subendocardial฀and฀ Mural฀Strain฀Rate฀in฀the฀Septum฀Are฀Clues฀to฀the฀Helical฀ Structure฀of฀the฀Heart ABSTRACTS - Noninvasive Imaging 306A ABSTRACTS - Noninvasive Imaging JACC POSTER฀SESSION 1168฀฀ Diagnosis฀in฀Chronic฀Coronary฀Artery฀ Disease Tuesday,฀March฀08,฀2005,฀1:30฀p.m.-5:00฀p.m. Orange฀County฀Convention฀Center,฀Hall฀E1 Presentation฀Hour:฀2:30฀p.m.-3:30฀p.m. 1168-63฀ Fragmented฀QRS฀including฀RSR�฀Complex฀Not฀Related฀ To฀Bundle฀Branch฀Block฀Strongly฀Predicts฀Abnormal฀ Myocardial฀Perfusion฀and฀Function฀by฀SPECT Bilal฀Khan,฀Mithilesh฀K.฀Das,฀Awaneesh฀Kumar,฀Sheri฀Stricker,฀Stephen฀G.฀Sawada,฀Jo฀ Mahenthiran,฀Krannert฀Institute฀of฀Cardiology,฀Indianapolis,฀IN Noninvasive Imaging Background:฀Fragmented฀QRS฀(fQRS)฀complexes,฀not฀related฀to฀typical฀bundle฀branch฀ block฀ (BBB)฀ predicts฀ abnormally฀ delayed฀ myocardial฀ depolarization฀ and฀ function.We,฀ therefore,฀ postulate฀ that฀ fQRS฀ is฀ associated฀ with฀ significant฀ perfusion฀ and฀ function฀ abnormalities฀on฀myocardial฀perfusion฀imaging฀(MPI)฀by฀gated฀SPECT. Methods:฀ Baseline฀ EKG฀ and฀ MPI฀ of฀ 248฀ patients฀ (pts)฀ were฀ studied.฀ Independent฀ observers฀blinded฀to฀clinical฀data฀evaluated฀the฀EKG฀and฀MPI.฀The฀fQRS฀was฀defined฀by฀ a฀QRS฀(duration฀<120฀ms)฀with฀more฀than฀one฀R’฀prime฀or฀other฀RSR’variants฀(figure)฀in฀ ≥฀2฀leads฀corresponding฀to฀a฀coronary฀artery฀territory.฀MPI฀perfusion,฀sum฀motion฀score฀ and฀ejection฀fraction฀was฀analyzed฀using฀a฀standard฀17-segment,฀5-point฀scale.฀MPI฀scar฀ was฀defined฀by฀a฀single฀segment฀and฀sum฀rest฀score฀≥฀3฀and฀a฀sum฀difference฀score฀≤฀3฀ corresponding฀to฀individual฀coronary฀territory. Results:฀In฀237฀pts฀(mean฀age฀58฀±฀12฀years,฀128฀[54%]฀males),฀108฀(45%)฀pts฀had฀fQRS฀ complexes฀(11฀pts฀were฀excluded฀due฀to฀BBB฀or฀paced฀rhythm).฀MPI฀findings฀summarized฀ on฀ the฀ table฀ (figure).฀There฀ was฀ significant฀ correlation฀ of฀ a฀ fQRS฀ to฀ an฀ underlying฀ MPI฀ scar฀(r=0.65,฀p<0.001)฀in฀89฀of฀108฀(82%)฀pts.On฀logistic฀regression,฀resting฀systolic฀blood฀ pressure฀(p=0.007,฀RR:฀0.95)฀and฀the฀presence฀of฀myocardial฀scar฀by฀MPI฀(p<0.001,฀RR:฀ 29.5)฀were฀significant฀predictors฀of฀fQRS฀on฀EKG. Conclusions:฀An฀fQRS฀complex฀including฀RSR’patterns,฀in฀the฀absence฀of฀typical฀BBB,฀ is฀a฀significant฀predictor฀of฀regional฀myocardial฀scar฀and฀reduced฀ejction฀fraction฀by฀MPI. February 1, 2005 Table฀1฀ Exercise Exercise฀Time฀(min) Total฀MET DTS SSS>4 SSS>8 1168-65฀ ED NO฀ED P฀value 50% 8.0 9.2 4 55% 41% 77% 10.2 11.6 9 38% 15% <0.001 <0.001 <0.001 <0.001 0.030 <0.001 Association฀Between฀Plasma฀Myeloperoxidase฀ Levels฀and฀Ischemic฀Response฀During฀Stress฀Nuclear฀ Perfusion฀Imaging Hamid฀Ghanbari,฀Bischan฀Hassunizadeh,฀Frances฀Williams,฀Denise฀Cunningham,฀ Shivani฀Agrawal,฀Christian฀Machado,฀Souheil฀Saba,฀Providence฀Hospital฀and฀Medical฀ Centers,฀Southfield,฀MI Background:฀Myeloperoxidase฀(MPO)฀is฀an฀abundant฀enzyme฀secreted฀from฀monocytes,฀ neutrophils,฀and฀tissue฀macrophages.฀Elevated฀MPO฀levels฀correlate฀with฀an฀increased฀ risk฀of฀future฀major฀cardiac฀events฀in฀patients฀with฀chest฀pain฀and฀are฀found฀in฀patients฀ with฀angiographically฀documented฀cardiovascular฀disease. Objective:฀The฀objective฀of฀this฀study฀was฀to฀determine฀if฀plasma฀MPO฀levels฀measured฀ by฀Enzyme฀Immuno฀Assay฀(EIA)฀correlate฀with฀the฀detection฀of฀myocardial฀ischemia฀in฀ patients฀undergoing฀stress฀myocardial฀perfusion฀imaging฀(MPI). Methods:฀Patients฀undergoing฀MPI฀and฀patients฀that฀had฀recent฀positive฀MPI฀referred฀for฀ cardiac฀catheterization฀were฀included฀in฀the฀study.฀Patients฀with฀evidence฀of฀inflammatory฀ disease฀ by฀ history฀ or฀ abnormal฀ differential฀ blood฀ count฀ and฀ patients฀ with฀ previous฀ myocardial฀infarction฀were฀excluded.฀Five฀milliliters฀of฀heparinized฀plasma฀was฀analyzed฀ by฀ EIA฀ (Assay฀ Designs,฀ Inc)฀ using฀ human฀ MPO฀ antibody฀ and฀ the฀ MPO฀ levels฀ were฀ determined฀photometrically. Results:฀The฀study฀comprised฀of฀83฀patients.฀Mean฀age฀was฀63฀years.฀In฀control฀group,฀ 32฀ patients฀ had฀ a฀ negative฀ MPI฀ (Group฀ 1).฀ Positive฀ MPI฀ was฀ noted฀ in฀ 29฀ patients,฀ of฀ which฀ 17฀ had฀ significant฀ stenosis฀ >70%฀ on฀ subsequent฀ coronary฀ angiogram฀ (Group฀ 2,฀ true฀positives)฀and฀the฀remaining฀12฀had฀non-critical฀CAD฀or฀normal฀coronaries฀(Group฀ 3,฀false฀positives).฀Patients฀in฀Group฀1฀had฀a฀significantly฀higher฀mean฀MPO฀level฀(215฀+฀ 22฀pM)฀compared฀to฀patients฀in฀Group฀3฀(118฀+฀20.9,฀p=0.02).฀Patients฀in฀Group฀2฀had฀ a฀significantly฀higher฀mean฀MPO฀level฀(320฀+฀62.6)฀than฀patients฀in฀Group฀3฀(p=0.006).฀ Group฀ 2฀ had฀ a฀ higher฀ MPO฀ level฀ than฀ Group฀ 1,฀ but฀ the฀ difference฀ was฀ not฀ statistically฀ significant฀(p=NS).฀Patients฀who฀were฀obese฀with฀BMI฀>฀30฀had฀a฀higher฀mean฀MPO฀level฀ (248฀+฀28.7฀pM)฀than฀patients฀with฀BMI฀<฀30฀(124฀+฀20.6฀pM,฀p=0.001). Conclusion:฀1)Patients฀with฀a฀true฀positive฀MPI฀and฀confirmed฀critical฀CAD฀on฀coronary฀ angiogram฀(Group฀2)฀have฀significantly฀higher฀MPO฀levels฀than฀patients฀who฀have฀false฀ positive฀MPI฀studies฀(Group฀3).฀MPO฀levels฀may฀help฀in฀differentiating฀true฀positive฀from฀ false฀positive฀MPI฀results. 2)Patients฀ with฀ obesity฀ (BMI฀ >฀ 30)฀ have฀ a฀ significantly฀ higher฀ level฀ of฀ MPO฀ than฀ nonobese฀patients. 1168-66฀ Significance฀of฀Changes฀in฀Left฀Ventricular฀Cavity฀ Size฀in฀Dipyridamole฀Stress฀Rubidium-82฀Myocardial฀ Perfusion฀PET Timothy฀M.฀Bateman,฀A.฀Iain฀McGhie,฀Gary฀V.฀Heller,฀Kelly฀L.฀Moutray,฀Ginger฀ Hertenstein,฀Jan฀R.฀Bryngelson,฀Kevin฀W.฀Moser,฀S.฀James฀Cullom,฀James฀A.฀Case,฀ John฀D.฀Friedman,฀Cardiovascular฀Imaging฀Technologies,฀Kansas฀City,฀MO,฀Mid฀America฀ Heart฀Institute,฀Kansas฀City,฀MO 1168-64฀ Erectile฀Dysfunction฀Predicts฀Clinically฀Significant฀ Coronary฀Artery฀Disease฀in฀Men฀Referred฀For฀ Myocardial฀Perfusion฀SPECT฀Testing James฀K.฀Min,฀Tochi฀M.฀Okwuosa,฀George฀W.฀Bell,฀Michael฀S.฀Panutich,฀Nami฀Choe,฀Kim฀ A.฀Williams,฀R.฀Parker฀Ward,฀University฀of฀Chicago฀Hospitals,฀Chicago,฀IL Background:฀ Erectile฀ dysfunction฀ (ED)฀ is฀ associated฀ with฀ coronary฀ artery฀ disease฀ (CAD)฀ risk฀ factors,฀ but฀ the฀ association฀ between฀ ED฀ and฀ CAD฀ is฀ unknown.฀ Myocardial฀ perfusion฀ SPECT฀ (MPS)฀ imaging฀ allows฀ detection฀ of฀ CAD฀ and฀ predicts฀ cardiovascular฀ (CV)฀prognosis.฀We฀hypothesized฀that฀ED฀is฀associated฀with฀CAD฀as฀determined฀by฀MPS฀ testing.฀ Methods:฀167฀male฀patients฀(pts)฀referred฀for฀MPS฀testing฀were฀prospectively฀screened฀ for฀ED.฀CV฀comorbidities฀and฀medications฀were฀recorded.฀ED฀was฀defined฀by฀a฀score฀of฀<฀ 25฀on฀the฀validated฀international฀index฀of฀erectile฀function฀(IIEF).฀CAD฀was฀defined฀as฀mild฀ [summed฀stress฀score฀(SSS)฀>4]฀or฀severe฀(SSS>8).฀ Results:฀ED฀was฀present฀in฀56%฀of฀pts.฀ED฀pts฀were฀older,฀had฀more฀diabetes฀(DM)฀,฀ hypertension฀(HTN),฀beta฀blocker฀use฀and฀other฀antihypertensive฀use.฀ED฀was฀associated฀ with฀more฀referrals฀for฀pharmacologic฀MPS฀testing,฀and฀more฀CAD฀(See฀Table฀1).฀Among฀ pts฀referred฀for฀exercise,฀ED฀was฀associated฀with฀lower฀exercise฀time฀and฀Duke฀treadmill฀ score฀(DTS).฀Multivariate฀analysis฀considering฀CV฀risk฀factors฀and฀medication฀use฀found฀ ED฀to฀be฀an฀independent฀predictor฀of฀severe฀CAD฀(OR฀3.2,฀95%฀CI฀1.4-7.1,฀p<0.01).฀ED฀ absence฀is฀associated฀with฀a฀high฀negative฀predictive฀value฀for฀severe฀CAD฀(85%).฀ Conclusions:฀ ED฀ is฀ common฀ in฀ men฀ referred฀ for฀ MPS฀ testing฀ and฀ is฀ associated฀ with฀ adverse฀prognostic฀indicators฀including฀lower฀exercise฀time,฀lower฀DTS,฀and฀more฀mild฀ and฀ severe฀ CAD.฀ Furhter฀ study฀ is฀ needed฀ to฀ determine฀ if฀ all฀ pts฀ with฀ ED฀ benefit฀ from฀ screening฀for฀CAD฀with฀MPS฀testing. ฀ Background:฀ Transient฀ ischemic฀ dilation฀ (TID)฀ of฀ the฀ left฀ ventricle฀ in฀ stress฀ SPECT฀ imaging฀correlates฀with฀extensive฀coronary฀artery฀disease฀(CAD)฀and฀a฀worse฀prognosis.฀ Dipyridamole฀ myocardial฀ perfusion฀ PET฀ scans฀ are฀ acquired฀ at฀ the฀ peak฀ of฀ hyperemia,฀ not฀post-stress฀as฀with฀SPECT.฀We฀therefore฀hypothesized฀that฀this฀non-perfusion฀marker฀ would฀carry฀greater฀diagnostic฀significance฀when฀it฀occurs฀with฀PET฀imaging. Methods:฀The฀current฀investigation฀evaluates฀TID฀in฀123฀rest-stress฀dipyridamole฀Rb-82฀ PET฀scans฀of฀patients฀who฀had฀either฀low฀likelihood฀for฀significant฀CAD฀(n=33)฀or฀who฀had฀ coronary฀angiography฀<฀60฀days฀(7฀=฀no฀CAD฀>฀50%฀stenosis,฀22฀=฀single-vessel฀(SV)฀ CAD,฀61฀=฀multivessel฀CAD).฀Images฀were฀acquired฀using฀an฀ACCEL฀(CTI,฀Knoxville,฀TN)฀ LSO฀dedicated฀PET฀scanner฀in฀2D฀mode.฀The฀presence฀or฀absence฀of฀TID฀was฀assessed฀ visually฀by฀consensus฀of฀4฀interpreters฀blinded฀to฀all฀clinical฀information.฀Quantitative฀TID฀ was฀also฀computed฀using฀a฀commercially-available฀computer฀program฀(QGS®;฀CedarsSinai,฀LA,CA). Results:฀By฀visual฀analysis,฀TID฀was฀present฀in฀0/40฀patients฀without฀CAD,฀32%฀of฀pts฀ with฀single-vessel฀CAD฀(p<0.001฀vs฀no฀CAD),฀and฀39%฀of฀pts฀with฀multivessel฀(MV)฀CAD฀ (p<0.001฀vs฀no฀CAD;฀p=ns฀vs฀SV฀CAD).฀Sensitivity฀and฀specificity฀of฀visual฀TID฀for฀any฀ CAD฀were฀37%฀and฀100%฀and฀for฀MV฀CAD฀were฀39%฀and฀85%.฀By฀quantitative฀analysis,฀ mean฀TID฀ratio฀ranged฀from฀1.1฀+/-฀0.1฀for฀pts฀without฀CAD฀to฀1.3฀+/-฀0.2฀for฀those฀with฀ MV฀CAD฀(p=0.02).฀Using฀1.2฀as฀a฀cut-off฀criteria฀for฀abnormality฀yielded฀sensitivity฀and฀ specificity฀of฀46%฀and฀73%฀for฀any฀CAD.฀The฀mean฀summed฀difference฀score฀(17฀segment฀ model,฀scores฀0฀-฀3฀per฀segment)฀was฀5.5+/-6.8฀for฀those฀without฀TID,฀versus฀11.1+/-10.4฀ for฀ those฀ with฀TID฀ (p=0.0003).฀There฀ were฀ no฀ gender฀ differences฀ for฀ any฀ comparisons.฀ Addition฀of฀TID฀to฀perfusion฀defect฀analysis฀improved฀PET฀sensitivity฀from฀84%฀to฀89%฀ (p<0.05)฀with฀no฀change฀in฀specificity฀(100%฀to฀98%). Conclusions:฀ Transient฀ ischemic฀ dilation฀ in฀ response฀ to฀ image฀ acquisition฀ during฀ dipyridamole-induced฀hyperemic฀stress฀Rb-82฀PET฀is฀a฀highly฀specific฀marker฀of฀CAD,฀is฀ frequent฀in฀both฀single฀and฀multivessel฀CAD,฀and฀modestly฀improves฀diagnostic฀sensitivity฀ above฀perfusion฀defect฀analysis฀alone. JACC February 1, 2005 1168-67฀ ABSTRACTS - Noninvasive Imaging Left฀Ventricular฀Dysfunction฀After฀Vasodilator฀Stress฀ Is฀More฀Accurate฀Than฀Perfusion฀for฀Diagnosis฀of฀ Coronary฀Artery฀Disease Regina฀S.฀Druz,฀Kenneth฀J.฀Nichols,฀Olakunle฀O.฀Akinboboye,฀Nathaniel฀Reichek,฀St.฀ Francis฀Hospital,฀Stony฀Brook฀University,฀State฀University฀of฀New฀York,฀Roslyn,฀NY,฀Long฀ Island฀Jewish฀Medical฀Center,฀New฀Hyde฀Park,฀NY Background:฀ Three-vessel฀ coronary฀ disease฀ (3VD)฀ is฀ difficult฀ to฀ detect฀ by฀ perfusion฀ imaging฀due฀to฀balanced฀ischemia.฀We฀hypothesized฀that฀post-stress฀left฀ventricular฀(LV)฀ dysfunction฀should฀more฀accurately฀identify฀3VD. Methods:฀86฀pts.฀(74±12฀y;฀58฀male)฀with฀rest฀Tl-201/adenosine฀Tc-99m฀sestamibi฀scans฀ were฀identified:฀43฀with฀known/suspected฀coronary฀stenoses฀with฀≥฀1฀segmental฀reversible฀ defect,฀and฀43฀age-฀and฀sex-matched฀controls฀with฀no฀coronary฀disease฀and฀normal฀LV฀ perfusion฀and฀function.฀Perfusion฀was฀based฀on฀a฀20-segment/5-point฀summed฀difference฀ score฀(SDS),฀with฀≥฀8฀cut-off฀for฀extensive฀defects.฀Segments฀with฀no฀tracer฀uptake฀were฀ excluded฀ to฀ lessen฀ partial฀ volume฀ effects.฀ LV฀ ejection฀ fraction฀ (EF)฀ and฀ end-systolic฀ volume฀(ESV)฀were฀quantified฀at฀rest฀and฀60฀min฀post-adenosine฀by฀QGS฀(Cedars-Sinai฀ Medical฀Center,฀Los฀Angeles,฀CA).฀A฀cut-off฀for฀EF฀decrease฀(↓)฀was฀≥฀-12%฀(=฀2฀SD฀of฀ mean฀ EF↓฀ in฀ controls:฀ -0.9±6.0%).฀ LV฀ dilation฀ ratio฀ was฀ measured฀ by฀ ESV฀ adenosine:฀ rest.฀Angiography฀was฀performed฀in฀36/43฀pts฀with฀segmental฀defects,฀and฀15/36฀pts฀had฀ 3VD.฀McNemar’s฀test฀(p<0.05)฀was฀used฀to฀compare฀SDS≥฀8฀vs.฀EF↓ ≥฀-12%. Results:฀See฀Table. Conclusion:฀ LV฀ dysfunction฀ manifested฀ as฀ stunning,฀ with฀ decrease฀ in฀ LV฀ EF฀ and฀ LV฀ dilation฀ in฀ patients฀ with฀ extensive฀ reversible฀ defects,฀ especially฀ those฀ with฀ angina.฀ A฀ decrease฀in฀EF฀was฀more฀specific฀and฀accurate฀for฀3VD฀than฀perfusion.฀Thus,฀gated฀rest฀ and฀stress฀studies฀had฀improved฀diagnostic฀yield฀over฀perfusion.฀ ESV฀adenosine:฀ EF฀↓฀for฀3฀VD rest฀ Sensitivity฀87% 6±5 1.3±0.2 Specificity฀82%‡ Accuracy฀83%‡ 10±5* 1.7±0.3† EF ↓ ≥฀-12% Angina SDS No n=33 Yes n=10 9% 44%* SDS≥8฀for฀3฀VD Sensitivity฀87% Specificity฀48% Accuracy฀62% *p<0.05฀†p<0.0001฀‡฀p<0.004฀vs.฀SDS 1168-68฀ Routine฀Myocardial฀Perfusion฀Imaging฀Post฀ Implantation฀of฀Drug฀Eluting฀Stents,฀Frequency฀of฀ Detecting฀Ischemia฀in฀Asymptomatic฀Patients Introduction:฀ Patients฀ who฀ have฀ had฀ percutaneous฀ coronary฀ intervention฀ (PCI)฀ historically฀have฀often฀been฀referred฀for฀myocardial฀perfusion฀imaging฀(MPI)฀because฀of฀ a฀relatively฀high฀prevalence฀of฀recurrent฀myocardial฀ischemia.However,฀restenosis฀occurs฀ less฀ frequently฀ after฀ drug-eluting฀ stent฀ (DES)฀ implantation,฀ and฀ it฀ is฀ not฀ clear฀ whether฀ follow-up฀algorithms฀involving฀liberal฀use฀of฀MPI฀are฀appropriate฀in฀the฀current฀era. Methods:฀We฀reviewed฀the฀findings฀on฀MPI฀in฀all฀asymptomatic฀or฀minimally฀symptomatic฀ post-DES฀patients฀at฀our฀center฀(n=168)฀who฀were฀tested฀electively฀at฀3฀-฀12฀months฀after฀ DES-PCI฀and฀compared฀the฀results฀with฀those฀of฀similar฀patients฀who฀had฀routine฀MPI฀ after฀bare฀metal฀stents฀(BMS)฀(n=681).฀Patients฀were฀not฀included฀if฀they฀had฀more฀than฀ mild฀symptoms.฀Ischemia฀was฀defined฀as฀a฀summed฀difference฀score฀>฀3฀on฀20฀segment,฀ 0-4฀grade฀scale. Results:฀The฀mean฀interval฀from฀PCI฀to฀MPI฀was฀5.1฀±฀1.8฀mo฀&฀5.8฀±฀2.7฀for฀the฀DES฀ and฀BMS฀groups฀respectively.฀Mean฀age฀(64.6฀±฀11.9฀&฀64.7฀±฀12),sex฀(69%฀&฀67%฀male),฀ and฀ diabetics฀ (20.7%฀ &฀ 19.3%)฀ were฀ similar,฀ but฀ the฀ DES฀ group฀ received฀ more฀ stents฀ (mean฀1.9±1฀vs฀1.7±1)฀(p=.02),฀more฀total฀stent฀length฀31.6±฀18฀vs฀28±฀17.2฀mm)(p=.018)฀ with฀a฀smaller฀mean฀stent฀diameter฀(2.9±฀.03฀vs฀3.3±฀.5฀mm)(p<.001),฀and฀a฀trend฀toward฀ more฀multivessel฀CAD฀(74.4฀vs฀64.6%)(p=.06)฀On฀MPI,฀some฀ischemia฀was฀common฀in฀ both฀groups,฀occurring฀in฀61.5%฀and฀63%,฀but฀was฀frequently฀mild.฀However,฀target฀vessel฀ ischemia฀more฀than฀mild฀occurred฀in฀25.2%฀and฀25.9%฀(p=ns),฀and฀significant฀ischemia฀ (summed฀difference฀score฀≥฀8฀)฀was฀seen฀in฀29.8%฀and฀30.7%)(p=ns). Conclusions:฀In฀this฀population฀of฀patients฀post฀DES฀implantation,฀MPI฀done฀for฀routine฀ follow-up฀detected฀clinically฀significant฀silent฀ischemia฀in฀30%฀of฀patients.฀Ischemia฀post฀ DES-MPI฀was฀as฀common฀as฀in฀the฀post฀BMS-PCI฀group,฀probably฀related฀to฀an฀increase฀ in฀the฀complexity฀of฀the฀coronary฀disease฀being฀treated.฀These฀data฀support฀a฀policy฀of฀ liberal฀MPI฀testing฀post฀DES-MPI,฀despite฀the฀low฀rate฀of฀restenosis฀seen฀in฀clinical฀trials. 1168-69฀ Chest฀Discomfort฀Does฀Not฀Predict฀Abnormal฀ Rubidium-82฀Positron฀Emission฀Tomography฀Results฀or฀ Mortality฀in฀Non-Diabetic฀Patients฀with฀Chronic฀Kidney฀ Disease Mark฀Anthony฀Stankewicz,฀Amar฀D.฀Patel,฀Robert฀L.฀Eisner,฀Randolph฀E.฀Patterson,฀ Carlyle฀Fraser฀Heart฀Center,฀Emory-Crawford฀Long฀Hospital,฀Atlanta,฀GA,฀Emory฀ University฀School฀of฀Medicine,฀Atlanta,฀GA Background:฀ Chest฀ discomfort฀ (CP)฀ and฀ coronary฀ artery฀ disease฀ (CAD)฀ are฀ common฀ in฀chronic฀kidney฀disease฀(CKD)฀patients,฀and฀CP฀is฀a฀common฀indication฀for฀myocardial฀ perfusion฀imaging฀(MPI).฀However,฀the฀reliability฀of฀CP฀to฀predict฀CAD฀in฀CKD฀patients฀ has฀not฀been฀studied฀in฀detail.฀We฀examined฀the฀reliability฀of฀CP฀to฀predict฀rubidium-82฀ positron฀emission฀tomography฀(PET)฀MPI฀results฀and฀mortality฀rate. Methods:฀All฀CKD฀patients฀having฀cardiac฀PET-MPI฀from฀1999-2003฀were฀identified,฀and฀ diabetics฀ were฀ excluded.฀ Patients฀ were฀ grouped฀ based฀ on฀ features฀ of฀ CP:฀ chest฀ pain฀ onset฀ with฀ exertion,฀ duration฀ of฀ 2-30฀ minutes฀ and฀ location฀ in฀ the฀ retrosternal฀ position.฀ One฀ of฀ three฀ features฀ defined฀ non-anginal฀ CP,฀ two฀ features฀ defined฀ atypical฀ angina,฀ and฀CKD฀patients฀with฀three฀features฀(classic฀angina)฀did฀not฀have฀PET-MPI.฀All฀cause฀ mortality฀ was฀ determined฀ by฀ using฀ the฀ Social฀ Security฀ database฀ and฀ hospital฀ records.฀ Continuous฀variables฀were฀compared฀using฀the฀student฀t-test฀and฀categorical฀variables฀ were฀compared฀with฀chi-squared฀(Yates)฀analysis฀(SPSS).฀A฀p-value฀of฀<0.05฀was฀defined฀ as฀statistically฀significant. Results:฀230฀CKD฀patients฀with฀a฀mean฀creatinine฀of฀7.73฀mg/dL฀had฀cardiac฀PET-MPI฀ during฀the฀48฀month฀study฀period.฀There฀were฀115฀women฀(50%),฀172฀African-Americans฀ (83%),฀ and฀ the฀ mean฀ age฀ was฀ 58.5฀ years฀ (29-89฀ years).฀ Mortality฀ was฀ 31%฀ over฀ the฀ average฀ 24.2฀ month฀ follow-up฀ period.฀ CP฀ was฀ present฀ in฀ 71%฀ of฀ patients,฀ defined฀ as฀ non-anginal฀(50%)฀or฀atypical฀anginal฀CP฀(21%฀of฀all฀patients).฀CP฀patients฀used฀tobacco฀ more฀frequently฀(59%฀vs฀39%,฀p=0.04),฀and฀were฀more฀likely฀to฀report฀a฀family฀history฀ of฀ CAD฀ (59%฀ vs฀ 18%,฀ p<0.001).฀ Abnormal฀ PET฀ results฀ occurred฀ with฀ equal฀ frequency฀ among฀patients฀with฀the฀following:฀no฀CP฀(27%),฀non-anginal฀CP฀(28%),฀or฀atypical฀angina฀ (28%,฀ p=ns).฀ Mortality฀ rates฀ were฀ also฀ similar฀ among฀ these฀ same฀ groups฀ (27%,฀ 28%,฀ 37%,฀p=ns). Conclusions:฀ CP฀ did฀ not฀ predict฀ abnormal฀ PET-MPI฀ or฀ increased฀ mortality฀ in฀ CKD฀ patients,฀even฀after฀excluding฀diabetics.฀In฀this฀study,฀CP฀history฀appears฀to฀have฀limited฀ value฀to฀predict฀ischemic฀heart฀disease฀or฀mortality฀in฀CKD฀patients. 1168-70฀ Gender฀and฀Racial฀Differences฀in฀the฀Specificity฀of฀ Exercise฀Induced฀ST฀Segment฀Depression Sabahat฀Bokhari,฀Lynne฀Johnson,฀Steven฀Robert฀Bergmann,฀Simbo฀Chiadika,฀Columbia฀ University฀Medical฀Center/฀New฀York฀Presbyterian฀Hospital,฀New฀York,฀NY Objective:฀It฀is฀not฀known฀whether฀racial฀differences฀affect฀the฀specificity฀of฀ST฀segment฀ depression฀during฀treadmill฀exercise฀stress฀testing.฀Therefore,฀we฀examined฀the฀incidence฀ of฀exercise฀induced฀ST฀segment฀depression฀among฀Caucasians(C)฀and฀African฀Americans฀ (AA)฀who฀underwent฀exercise฀treadmill฀testing฀with฀the฀standard฀Bruce฀protocol฀and฀had฀ normal฀myocardial฀perfusion฀imaging. Methods:฀We฀evaluated฀338฀patients,฀186฀C฀(97M,฀mean฀age฀60฀±฀12฀years)฀and฀152฀ AA฀(57M,฀mean฀age฀55฀±฀12฀years,฀(p฀=฀0.001).฀There฀was฀no฀significant฀difference฀in฀ 10฀year฀CAD฀risk฀using฀Framingham฀risk฀score฀among฀C฀(12฀±฀8)฀and฀AA฀(12฀±฀9)฀p฀=฀ NS.฀ Standard฀ ST฀ segment฀ depression฀ criteria฀ as฀ defined฀ by฀ the฀ ACC/AHA฀ guidelines฀ were฀used. Results:฀ Percent฀ predicted฀ maximum฀ heart฀ rate฀ was฀ higher฀ in฀ C฀ (94%฀ ±฀ 11)฀ vs฀ that฀ for฀AA฀(90%฀±฀11)฀p฀<฀0.006.฀Mean฀exercise฀time฀was฀longer฀in฀C฀(8.3฀±฀2.9฀mins)฀as฀ compared฀with฀AA฀(7.5฀±฀2.5฀mins),฀p฀=฀0.01.฀Overall,฀the฀incidence฀of฀false฀positive฀ST฀ segment฀depression฀was฀26/186฀(14%)฀among฀C,฀and฀9/152฀(6%)฀among฀AA,฀p฀=฀0.01.฀ The฀incidence฀of฀false฀positive฀ST฀segment฀depression฀was฀13/97฀(13%)฀in฀C฀males,฀and฀ 4/57฀ (7%)฀ in฀ AA฀ males,฀ p=NS.฀The฀ incidence฀ of฀ false฀ positive฀ ST฀ segment฀ depression฀ was฀13/98฀(15%)฀in฀C฀females,฀as฀compared฀with฀5/95฀(5%)฀in฀AA฀females,฀p=0.05.฀Thus฀ the฀ specificity฀ of฀ ST฀ segment฀ depression฀ was฀ 87%฀ in฀ C฀ males฀ compared฀ with฀ 93%฀ in฀ AA฀males,฀and฀85%฀in฀C฀females฀compared฀with฀95%฀in฀AA฀females.Conclusion:฀Our฀ study฀shows฀that฀there฀was฀a฀significantly฀higher฀incidence฀of฀false฀positive฀ST฀segment฀ changes฀in฀Caucasians฀females฀as฀compared฀to฀African฀Americans฀females.฀There฀may฀ be฀a฀need฀for฀race฀and฀gender฀specific฀criteria฀for฀ST฀segment฀changes฀during฀exercise฀ stress฀testing. ORAL฀CONTRIBUTIONS 855฀฀ Real-Time฀Three-Dimensional฀ Echocardiographic฀Assessment฀of฀ Chamber฀Function Tuesday,฀March฀08,฀2005,฀2:00฀p.m.-3:30฀p.m. Orange฀County฀Convention฀Center,฀Room฀232A 2:00฀p.m. 855-3฀ Partition฀Values฀for฀Normal฀Left฀and฀Right฀Ventricular฀ Volumes฀by฀Three-Dimensional฀Echocardiography Sunil฀T.฀Mathew,฀Aasha฀S.฀Gopal,฀Rupa฀R.฀Krishnaswamy,฀Rena฀S.฀Toole,฀William฀ Schapiro,฀Nathaniel฀Reichek,฀St.฀Francis฀Hospital,฀Roslyn,฀NY,฀Stony฀Brook฀University,฀ Stony฀Brook,฀NY Background:฀ Live฀ three-dimensional฀ echocardiography฀ (3D฀ echo)฀ for฀ acquisition฀ of฀ volumetric฀ data฀ utilizing฀ 4฀ ECG฀ gated฀ sequential฀ scan฀ sets฀ (Philips฀ 7500)฀ is฀ widely฀ available,฀but฀normal฀values฀for฀chamber฀volumes฀have฀not฀been฀determined.฀We฀obtained฀ left฀(LV)฀and฀right฀ventricular฀(RV)฀end-diastolic฀(EDV)฀and฀end-systolic฀(ESV)฀volumes฀by฀ 3D฀echo฀and฀cardiac฀magnetic฀resonance฀imaging฀(CMR).฀ Methods:฀31฀normal฀subjects฀(ages฀21-76฀yrs,฀mean฀56.6฀yrs,฀21฀men,฀BSA฀1.9+/-0.2฀m2฀ screened฀ by฀ history,฀ physical฀ examination฀ and฀ 2D฀ echo฀ for฀ cardiac฀ abnormalities฀ were฀ imaged฀using฀a)฀3D฀echo฀by฀an฀approximating฀surface฀model฀(TomTec)฀from฀8฀rotationally฀ equidistant฀ apical฀ slices,฀ and฀ b)฀ CMR฀ (1.5฀ T฀ Siemens)฀ using฀ contiguous,฀ short฀ axis,฀ ECG฀gated,฀breath-hold,฀TrueFISP฀cine฀images฀(146฀x฀256฀matrix,฀8฀mm฀slice฀thickness,฀ 31฀ x฀ 38฀ cm฀ FOV).฀ Echocardiographic฀ results฀ were฀ compared฀ to฀ CMR฀ using฀ Pearson’s฀ correlation,฀linear฀regression,฀and฀Bland-Altman฀analysis.฀ Noninvasive Imaging Randall฀C.฀Thompson,฀Justin฀L.฀Martin,฀Timothy฀M.฀Bateman,฀Ben฀D.฀McCallister,฀Barry฀ D.฀Rutherford,฀Mid฀America฀Heart฀Institute,฀Kansas฀City,฀MO 307A 308A ABSTRACTS - Noninvasive Imaging JACC Results:฀ Partition฀Values฀for฀Normal฀and฀Abnormal฀฀ LV฀and฀RV฀Volumes฀and฀EF฀ 3DLVEDV(ml) 3DLVEDV(ml/m2) 3DLVESV(ml) 3DLVESV(ml/m2) 3DRVEDV(ml) 3DRVEDV(ml/m2) 3DRVESV(ml) 3DRVESV(ml/m2) Mean(ml) 2SD(ml r SEE฀ (ml) Regression p Bias 128 69 54 29 112 60 59 31 6.5 3.3 5.6 3.1 16.1 8.9 11 5.7 y=0.8x+27 y=0.8x+17 y=0.7x+17 y=0.7x+10 y=0.7x+9 y=0.7x+5 y=0.7x+7 y=0.7x+5 3 1.7 1.2 0.7 -27 -14 -15 -8 42 18 24 10 58 27 38 18 0.95 0.94 0.88 0.82 0.84 0.76 0.83 0.77 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 Lower฀ limits฀ (ml) -13 -6 -12 -7 -62 -33 -40 -21 Upper฀ limits฀(ml) 19 10 14 8 8 4 10 5 Conclusions:฀1)฀3D฀echo฀LV฀EDV฀and฀ESV฀indexed฀values฀of฀86฀ml/m2฀and฀39฀ml/m2฀are฀ 2฀SD฀from฀the฀normal฀mean฀and฀should฀be฀considered฀abnormal.฀2)฀Excellent฀agreement฀ is฀noted฀between฀3D฀echo฀and฀CMR.฀3)฀RV฀volumes฀are฀underestimated฀by฀3D฀echo฀and฀ may฀be฀corrected฀by฀regression.฀3D฀echo฀RV฀EDV฀and฀ESV฀values฀of฀87฀ml/m2฀and฀49฀ ml/m2฀are฀abnormal.฀4)฀Further฀work฀is฀necessary฀to฀determine฀age฀and฀gender฀effects฀on฀ normal฀values฀and฀clinical฀utility฀must฀be฀demonstrated฀in฀abnormal฀ventricles. 2:15฀p.m. 855-4฀ Real-Time฀Three-Dimensional฀Echocardiographic฀ Quantification฀of฀Left฀Ventricular฀Volumes฀Using฀a฀Rapid฀ Tissue฀Tracking฀Algorithm Noninvasive Imaging Lawrence฀Jacobs,฀Ivan฀S.฀Salgo,฀Sascha฀Goonewardena,฀Lissa฀Sugeng,฀Lynn฀Weinert,฀ Patrick฀D.฀Coon,฀Dianna฀Bardo,฀Olivier฀Gerard,฀Eran฀Toledo,฀Cristiana฀Corsi,฀Victor฀ Mor-Avi,฀Roberto฀M.฀Lang,฀University฀of฀Chicago,฀Chicago,฀IL,฀Philips฀Medical฀Systems,฀ Andover,฀MA Determination฀ of฀ LV฀ volumes฀ and฀ ejection฀ fraction฀ (EF)฀ from฀ 2D฀ images฀ is฀ limited฀ due฀ to฀ the฀ extrapolation฀ of฀ manually฀ or฀ semi-automatically฀ traced฀ endocardial฀ borders฀ and฀ geometric฀ modeling.฀ This฀ methodology฀ is฀ subjective,฀ time-consuming฀ and฀ relatively฀ inaccurate.฀Our฀aim฀was฀to฀develop฀a฀method฀for฀rapid฀measurement฀of฀LV฀volumes฀from฀ real-time฀three-dimensional฀(RT3D)฀data฀and฀validate฀it฀against฀cardiac฀MRI.฀Methods.฀ Cardiac฀MRI฀(GE,฀1.5T฀FIESTA,฀6-10฀slices฀base฀to฀apex)฀and฀apical฀wide-angle฀RT3D฀ data฀sets฀(fig.฀A)฀were฀obtained฀in฀23฀patients฀(Philips฀7500,฀X4฀probe).฀Prototype฀software฀ (3DQ฀ Advanced)฀ was฀ used฀ for฀ analysis฀ of฀ 3D฀ data.฀ Following฀ manual฀ initialization฀ of฀ 5฀ points฀on฀2฀non-foreshortened,฀anatomically฀correct฀orthogonal฀long-axis฀views฀extracted฀ from฀the฀3D฀data฀sets฀(figs.฀B,฀C),฀endocardial฀surface฀was฀detected฀using฀a฀deformable฀ model฀by฀tracking฀tissue฀voxels฀(fig.฀D).฀End-systolic฀and฀end-diastolic฀volumes฀(ESV฀and฀ EDV)฀ were฀ computed฀ directly฀ from฀ voxel฀ counts.฀ Data฀ were฀ compared฀ with฀ MRI฀ (GE,฀ MASS฀analysis)฀using฀linear฀regression฀and฀Bland฀Altman฀analyses.฀Results.฀Generating฀ one฀LV฀volume฀from฀RT3D฀required฀<1min฀including฀initialization.฀RT3D฀measurements฀ correlated฀ highly฀ with฀ MRI฀ (r:฀ 0.93,฀ 0.94,฀ 0.83฀ for฀ EDV,฀ ESV฀ and฀ EF,฀ respectively)฀ with฀ small฀biases฀(-9฀ml,฀-4฀ml,฀-0.4%)฀and฀narrow฀limits฀of฀agreement฀(SD:฀16฀ml,฀16฀ml,฀9%).฀ Conclusions.฀Near-automated฀detection฀of฀the฀LV฀endocardial฀surface฀from฀RT3D฀data฀ allows฀rapid,฀accurate,฀direct฀measurement฀of฀LV฀volumes. February 1, 2005 3DE฀ and฀ MRI฀ (r=0.70,฀ y฀ =43.6+0.81x).฀ Mean฀ difference฀ of฀ LV฀ mass฀ between฀ 2DE฀ and฀ MRI฀ was฀ -10.7.฀With฀ the฀ RT-3DE,฀ intra-฀ and฀ inter-observer฀ variability฀ for฀ LV฀ mass฀ was฀ 7.6%฀and฀10.6฀%.฀With฀the฀2DE,฀intra-฀and฀inter-observer฀variability฀for฀LV฀mass฀was฀21.5฀ %฀and฀27.0฀%. Conclusion:฀The฀new฀RT-3DE฀system฀allows฀accurate฀measurement฀of฀LV฀mass฀in฀pts฀ with฀ LVH.฀The฀ present฀ study฀ suggests฀ that฀ greater฀ accuracy฀ and฀ reproducibility฀ of฀ 3D฀ techniques฀ by฀ new฀ RT-3DE฀ for฀ LV฀ mass฀ measurement฀ has฀ important฀ implications฀ for฀ clinical฀practice. 2:45฀p.m. 855-6฀ New฀Observations฀in฀Use฀of฀Live฀3-D฀Echo฀during฀2-D฀ Dobutamine฀Stress฀Echocardiography;฀the฀Impact฀of฀ Contrast฀Enhancement฀and฀Evaluation฀of฀the฀Extent฀of฀ Ischemia Masood฀Ahmad,฀Zening฀Jin,฀Tianrong฀Xie,฀William฀Hendrix,฀Ildiko฀Agoston,฀Meneleo฀ Dimaano,฀Frank฀Tiller,฀Jr.,฀Fen฀Wei฀Wang,฀University฀of฀Texas฀Medical฀Branch฀at฀ Galveston,฀Galveston,฀TX Background:฀We฀recently฀reported฀the฀complimentary฀role฀of฀Live฀3-D฀echocardiography฀ (3-D฀ Philips฀ Medical฀ Systems)฀ in฀ patients฀ (pts)฀ undergoing฀ 2-D฀ Dobutamine฀ stress฀ echocardiography฀(DSE).฀The฀present฀study฀extends฀our฀observations฀in฀a฀larger฀group฀of฀ pts฀and฀includes฀the฀use฀of฀contrast฀for฀LV฀visualization฀and฀the฀evaluation฀of฀the฀extent฀ of฀ischemia฀by฀3-D. Methods:฀ Two฀ hundred฀ and฀ sixty-six฀ pts,฀ age฀ range฀ 30฀ -฀ 89฀ yrs฀ were฀ studied.฀ All฀ pts฀ had฀ 2-D฀ DSE.฀ 3-D฀ bi-plane฀ and฀ full฀ volume฀ images฀ were฀ obtained฀ in฀ parasternal฀ and฀ apical฀ views฀ at฀ baseline฀ and฀ at฀ peak฀ stress฀ by฀ rapidly฀ switching฀ transducers฀ between฀ 2-D฀and฀3-D฀techniques.฀Intravenous฀contrast฀(Definity฀or฀Optison)฀was฀used฀in฀189฀pts฀ with฀suboptimal฀image฀quality฀at฀baseline.฀Cropping฀planes฀were฀applied฀on-line฀to฀slice฀ images฀for฀visualization฀of฀LV฀segments฀in฀multiple฀planes.฀LV฀wall฀motion฀was฀assessed฀ in฀3-D฀from฀serial฀short฀axis฀slices฀obtained฀from฀apex฀to฀base.฀2-D฀and฀3-D฀images฀were฀ evaluated฀by฀two฀different฀observers. Results:฀Technically฀satisfactory฀3-D฀images฀for฀comparison฀with฀2-D฀were฀obtained฀in฀ all฀266฀pts.฀Based฀on฀the฀presence฀or฀absence฀of฀normal฀or฀abnormal฀LV฀wall฀motion฀at฀ baseline฀ and฀ on฀ the฀ presence฀ or฀ absence฀ of฀ ischemia฀ at฀ peak฀ stress,฀ the฀ agreements฀ between฀2-D฀and฀3-D฀were฀95.5%฀(Kappa฀(K)฀=฀0.80)฀at฀baseline฀and฀92.5%฀(K฀=฀0.78)฀ at฀peak฀stress.฀In฀179฀pts฀with฀contrast,฀the฀agreements฀were฀95%฀(K฀=฀0.72)฀at฀baseline฀ and฀92.3%฀(K฀=฀0.77)฀at฀peak฀stress฀and฀in฀87฀pts฀without฀contrast,฀the฀agreements฀were฀ 96.6%฀(K฀=฀0.85)฀at฀baseline฀and฀93%฀(K฀=฀0.81)฀at฀peak฀stress.฀The฀mean฀LV฀wall฀motion฀ score฀at฀peak฀stress฀in฀58฀pts฀with฀ischemia฀by฀3-D฀was฀1.34฀±฀0.30฀compared฀to฀1.28฀ ±฀ 0.35฀ by฀ 2-D฀ (p฀ =฀ 0.01).฀ In฀ 89฀ pts฀ with฀ coronary฀ angiograms,฀ the฀ sensitivity฀ of฀ 3-D฀ in฀ detection฀of฀coronary฀artery฀disease฀was฀84%฀compared฀to฀69.6฀%฀by฀2-D฀(p฀<฀0.05). Conclusions:฀ Technically฀ satisfactory฀ 3-D฀ stress฀ images฀ were฀ obtained฀ in฀ all฀ pts฀ by฀ selective฀contrast฀enhancement.฀There฀was฀good฀overall฀agreement฀between฀3-D฀and฀2D฀in฀assessment฀of฀ischemia.฀3-D฀had฀higher฀sensitivity฀and฀detected฀a฀greater฀number฀of฀ ischemic฀segments฀when฀compared฀to฀2-D.฀The฀visualization฀of฀LV฀from฀multiple฀vantage฀ points฀by฀3-D฀offers฀advantages฀in฀estimating฀the฀extent฀of฀ischemia. 3:00฀p.m. 855-7฀ Can฀Quantification฀of฀Left฀Ventricular฀Mechanical฀ Dyssynchrony฀by฀Real-time฀3d฀Echo฀Predict฀Reverse฀ Left฀Ventricular฀Remodelling฀Following฀Cardiac฀ Resynchronisation฀Therapy? Stamatis฀Kapetanakis,฀Mark฀Kearney,฀Nicholas฀Gall,฀Francis฀Murgatroyd,฀Mark฀John฀ Monaghan,฀King’s฀College฀Hospital,฀London,฀United฀Kingdom ฀ 2:30฀p.m. 855-5฀ New฀Real-time฀3D฀Echocardiography฀Provides฀Accurate฀ Measurement฀of฀Left฀Ventricular฀Mass฀in฀Patients฀With฀ Left฀Ventricular฀Hypertrophy Hiroki฀Oe,฀Takeshi฀Hozumi,฀Yoshiki฀Matsumura,฀Kotaro฀Arai,฀Kazuaki฀Negishi,฀Kenichi฀ Sugioka,฀Ujino฀Keiji,฀Yasuhiko฀Takemoto,฀Yuichi฀Inoue,฀Junichi฀Yoshikawa,฀Osaka฀City฀ University฀Medical฀School,฀Osaka,฀Japan Background:฀Measurement฀of฀left฀ventricular฀(LV)฀mass฀is฀important฀for฀the฀evaluation฀ of฀LV฀hypertrophy,฀and฀provides฀prognostic฀information.฀The฀purpose฀of฀this฀study฀was฀to฀ evaluate฀whether฀LV฀mass฀assessed฀by฀the฀new฀real-time฀3D฀echocardiography฀(RT-3DE)฀ system฀corresponds฀to฀cardiac฀magnetic฀resonance฀imaging฀(MRI)฀in฀patients฀(pts)฀with฀ LV฀hypertrophy฀(LVH). Methods:฀The฀study฀population฀consisted฀of฀22฀pts฀(53฀±฀14฀years)฀who฀underwent฀MRI฀ for฀the฀evaluation฀of฀LVH.฀All฀the฀pts฀were฀examined฀by฀RT-3DE฀(Philips฀Sonos฀7500)฀and฀ two-dimensional฀echocardiography฀(2DE)฀for฀calculating฀LV฀mass.฀The฀apical฀approach฀ was฀used฀to฀acquire฀full฀volume฀volumetric฀data฀sets฀of฀the฀LV.฀LV฀mass฀was฀calculated฀ by฀the฀average฀rotation฀method฀with฀8฀apical฀cross-sectional฀images,฀using฀3D฀imaging฀ analyzer฀(Tomtec).฀In฀2DE,฀LV฀mass฀were฀calculated฀with฀the฀area-length฀methods. Results:฀In฀20฀of฀22฀pts,฀it฀was฀possible฀to฀obtain฀adequate฀3D฀data฀for฀LV฀mass฀analysis.฀ The฀ acquisition฀ time฀ of฀ the฀ 3D฀ data฀ by฀ RT-3DE฀ was฀ shorter฀ than฀ cardiac฀ MR฀ data฀ acquisition฀ (<10฀ seconds฀ vs฀ 10-15฀ minutes).฀ Regression฀ analysis฀ showed฀ LV฀ mass฀ by฀ RT-3DE฀correlated฀well฀with฀LV฀mass฀determined฀by฀MRI฀(r=0.95,฀y=28.9+0.85x).฀Mean฀ difference฀of฀LV฀mass฀between฀RT-3DE฀and฀MRI฀was฀-14.1.฀The฀correlation฀between฀LV฀ mass฀determined฀by฀2DE฀and฀MRI-derived฀LV฀mass฀was฀smaller฀than฀that฀between฀RT- Background:฀ Left฀ ventricular฀ mechanical฀ dyssynchrony฀ (LVMD)฀ has฀ emerged฀ as฀ a฀ possible฀ predictor฀ of฀ outcome฀ following฀ cardiac฀ resynchronisation฀ therapy฀ (CRT).฀ We฀ investigated฀ the฀ value฀ of฀ Real-Time฀ 3D฀ echo฀ (RT3DE)฀ in฀ quantifying฀ LVMD฀ in฀ patient฀ undergoing฀CRT. Methods:฀2D฀and฀RT3D฀echo฀was฀performed฀in฀26฀patients฀(67.5±6.1฀years,฀86%฀male)฀ pre,฀ at฀ 2±1฀ days฀ and฀ at฀ 10±1฀ months฀ post฀ CRT.฀ Biplane฀ EF,฀ SPWMD฀ and฀ myocardial฀ performance฀index฀(MPI)฀was฀calculated฀by฀2D฀and฀Doppler฀echo.฀RT3D฀data฀sets฀were฀ analysed฀ offline฀ to฀ produce฀ time-volume฀ curves฀ for฀ each฀ of฀ the฀ standard฀ 16฀ segments฀ and฀a฀Systolic฀Dyssynchrony฀Index฀(SDI)฀was฀calculated฀based฀on฀dispersion฀of฀times฀ to฀ minimum฀ regional฀ volume฀ for฀ all฀ segments.฀ Reverse฀ remodelling฀ was฀ defined฀ as฀ a฀ reduction฀in฀LV฀end-diastolic฀volume฀of฀20%฀or฀more. Results:฀16฀patients฀were฀re-investigated฀at฀10±1฀months.฀3฀patients฀(11.3%)฀reported฀ no฀ symptomatic฀ improvement฀ 2฀ months฀ post฀ CRT,฀ while฀ all฀ other฀ patients฀ reported฀ a฀ decrease฀in฀NYHA฀class.฀In฀these,฀the฀SDI฀pre฀CRT฀was฀significantly฀higher฀(13.9±5.3฀ vs.฀ 6.1±3.1,฀ p฀ =฀ 0.019)฀ and฀ was฀ the฀ only฀ predictor฀ of฀ symptomatic฀ improvement฀ in฀ multivariate฀analysis.฀At฀10±1฀months,฀reverse฀remodelling฀was฀present฀in฀9฀patients.฀SDI฀ pre฀CRT฀was฀the฀strongest฀predictor฀with฀an฀AUC฀of฀0.84฀(p฀=฀0.023).฀An฀SDI฀of฀9.2%฀had฀ a฀sensitivity฀of฀88.9%฀and฀a฀specificity฀of฀86.7%฀for฀reverse฀remodelling฀post฀CRT. Conclusion:฀ Symptomatic฀ improvement฀ post฀ CRT฀ and฀ reverse฀ LV฀ remodelling฀ was฀ predicted฀by฀RT3DE.฀This฀may฀be฀useful฀in฀patient฀selection฀for฀CRT. ฀ JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging 3:15฀p.m. 855-8฀ Electroanatomic฀(Carto)฀Mapping฀for฀Evaluating฀ Left฀Atrial฀Volume:฀Validation฀Against฀Real-Time฀3-D฀ Echocardiography Haran฀Burri,฀Hajo฀Müller,฀Henri฀Sunthorn,฀Pascale฀Gentil,฀René฀Lerch,฀Dipen฀Shah,฀ University฀Hospital,฀Geneva,฀Switzerland Background:฀Left฀atrial฀size฀may฀be฀a฀determinant฀of฀atrial฀fibrillation฀ablation฀efficacy฀and฀ embolic฀risk.฀Electro-anatomic฀(CARTO)฀mapping฀allows฀estimation฀of฀chamber฀volume,฀ but฀has฀never฀been฀validated฀for฀measuring฀left฀atrial฀size.฀The฀recent฀advent฀of฀real-time฀ 3D฀ echocardiography฀ allows฀ measurement฀ of฀ chamber฀ volumes฀ more฀ accurately฀ than฀ with฀standard฀echocardiography. Aim:฀To฀compare฀left฀atrial฀volume฀measured฀using฀CARTO฀with฀that฀measured฀by฀realtime฀3D฀echocardiography. Methods:฀ 26฀ patients฀ undergoing฀ CARTO-guided฀ radiofrequency฀ ablation฀ for฀ atrial฀ fibrillation฀or฀left฀atrial฀flutter฀were฀studied,฀and฀left฀atrial฀volume฀measured฀by฀mapping฀ 73+17฀points.฀Full-volume฀real-time฀3-D฀echocardiography฀was฀performed฀within฀24฀hours฀ in฀each฀patient,฀and฀end-systolic฀left฀atrial฀volume฀measured฀offline. Results:฀Left฀atrial฀volume฀measured฀using฀CARTO฀correlated฀very฀well฀with฀that฀using฀ 3D฀ echocardiography฀ (see฀ figure),฀ but฀ electro-anatomic฀ mapping฀ consistently฀ yielded฀ greater฀values฀(mean฀difference฀of฀30+15cc). Conclusion฀:฀Left฀atrial฀volume฀measured฀by฀CARTO฀correlates฀remarkably฀well฀with฀that฀ using฀real-time฀3D฀echocardiography,฀although฀the฀former฀technique฀consistently฀yields฀ larger฀values. 309A 4:15฀p.m. 861-4฀ Evaluation฀of฀Coronary฀Artery฀Disease฀(CAD)฀in฀ Diabetic฀Patients฀Presenting฀with฀Dyspnea฀but฀no฀ Chest฀Pain฀:฀Findings฀on฀Myocardial฀Perfusion฀Imaging฀ (SPECT)฀and฀Coronary฀Angiogram฀(CATH) Su฀Min฀Chang,฀Regina฀Chu,฀Douglas฀Russell,฀Timothy฀F.฀Christian,฀University฀of฀ Wisconsin,฀Madison,฀WI Background:฀ Diabetics฀ with฀ underlying฀ CAD฀ often฀ present฀ with฀ dyspnea฀ but฀ no฀ chest฀ pain฀(CP) Objectives:฀In฀diabetics฀with฀dyspnea฀but฀no฀CP,฀examine฀the฀prevalence฀and฀predictors฀ of฀CAD฀detected฀as฀myocardial฀perfusion฀abnormality฀(MPA)฀by฀SPECT฀and฀angiographic฀ coronary฀stenosis฀(CAS)฀(>฀50฀%฀stenosis฀in฀one฀major฀coronaries) Method:฀ 198฀ consecutive฀ SPECT฀ were฀ performed฀ in฀ diabetics฀ with฀ dyspnea฀ alone฀ for฀ suspected฀ CAD.฀ Used฀ as฀ control฀ were฀ 312฀ diabetics฀ with฀ CP฀ alone.฀ CATH฀ were฀ done฀ in฀44฀%฀and฀53฀%฀of฀pts฀respectively.฀High฀risk฀MPA฀was฀defined฀as฀>15฀%฀LV฀perfusion฀ defect฀size฀(LVPDS),฀multivessel฀or฀LAD฀distribution.฀Severe฀CAS฀defined฀as฀left฀main,฀3฀ VD฀or฀2VD฀involving฀LAD Results:฀The฀baseline฀characteristics฀between฀the฀2฀groups฀were฀similar.฀The฀prevalence฀ of฀MPA฀(60฀%฀vs฀61%฀p฀=0.8),฀high฀risk฀MPA฀(44฀%฀vs฀43฀%฀p฀=0.8)฀and฀LVPDS฀(22.7+15.6฀%฀of฀LV฀vs฀23.9฀+-฀13.1฀%฀p฀=0.6฀)฀were฀about฀equal.฀Finding฀on฀CATH฀was฀also฀ similar.฀85฀%฀of฀dyspneic฀pts฀had฀CAS฀vs฀88฀%฀of฀pts฀with฀CP฀(p฀=0.6).฀The฀prevalence฀of฀ severe฀CAS฀was฀identical฀(44฀%฀vs฀44฀%฀p฀=0.9) Univariate฀ predictors฀ of฀ MPA฀ in฀ dyspneic฀ pts฀ were฀ male,฀ h/o฀ MI,฀ abnormal฀ rest฀ ECG฀ and฀ inability฀ to฀ exercise.฀ Male฀ and฀ MPA฀ predicted฀ presence฀ of฀ CAS.(฀ p<฀ 0.05)฀ Similar฀ predictors฀were฀found฀for฀pts฀with฀CP฀alone. Independent฀predictors฀for฀severe฀CAD฀in฀both฀groups฀of฀pts฀were฀shown฀on฀table. Conclusion:฀ Diabetics฀ presenting฀ with฀ dyspnea฀ alone฀ have฀ a฀ high฀ likelihood฀ of฀ CAD,฀ similar฀to฀those฀with฀CP฀alone.฀Age฀>฀65,฀positive฀stress฀ECG฀and฀high฀risk฀MPA฀identified฀ pts฀at฀high฀risk฀for฀severe฀CAS. all฀P฀<=0.05 ฀ ORAL฀CONTRIBUTIONS Advances฀in฀Single-Photon฀Emission฀ Computed฀Tomography฀and฀Positron฀ Emission฀Tomography฀for฀Coronary฀ Artery฀Disease฀Diagnosis Tuesday,฀March฀08,฀2005,฀4:00฀p.m.-5:00฀p.m. Orange฀County฀Convention฀Center,฀Room฀230D 861-3฀ Combined฀Prone฀and฀Supine฀Quantification฀Improves฀ Diagnostic฀Value฀of฀the฀Myocardial฀Perfusion฀SPECT Hidetaka฀Nishina,฀Piotr฀J.฀Slomka,฀Aiden฀Abidov,฀Cigdem฀Akincioglu,฀Xingping฀Kang,฀ Ishac฀Cohen,฀Sean฀W.฀Hayes,฀John฀D.฀Friedman,฀Guido฀Germano,฀Daniel฀S.฀Berman,฀ Cedars-Sinai฀Medical฀Center,฀Los฀Angeles,฀CA Background:฀ Acquisition฀ in฀ the฀ prone฀ position฀ has฀ been฀ demonstrated฀ to฀ improve฀ the฀ accuracy฀of฀myocardial฀perfusion฀SPECT฀(MPS).฀However,฀the฀additional฀value฀of฀prone฀ MPS฀using฀quantitative฀analysis฀has฀not฀been฀shown. Methods:฀Separate฀prone฀and฀supine฀normal฀limits฀were฀derived฀from฀40฀males฀and฀40฀ females฀with฀a฀low฀likelihood฀(LLk)฀of฀coronary฀artery฀disease฀(CAD)฀using฀a฀2.5฀average฀ deviation฀ cut-off.฀ These฀ limits฀ were฀ applied฀ to฀ 326฀ consecutive฀ pts฀ (Group฀ 1)฀ without฀ known฀CAD฀who฀had฀coronary฀angiography฀within฀3฀months฀of฀MPS.฀Total฀perfusion฀deficit฀ (TPD),฀defined฀as฀a฀product฀of฀defect฀extent฀and฀average฀severity฀scores,฀was฀obtained฀ for฀ supine฀ (S-TPD),฀ prone฀ (P-TPD),฀ and฀ combined฀ supine-prone฀ datasets฀ (C-TPD).฀ CTPD฀was฀derived฀by฀limiting฀the฀quantification฀of฀supine฀defects฀within฀overlapping฀prone฀ defects.฀Group฀1฀was฀randomly฀divided฀into฀two฀equal฀groups฀for฀deriving฀and฀validating฀ optimal฀cut-offs.฀Normalcy฀rates฀were฀validated฀in฀three฀groups฀of฀consecutive฀LLk฀pts:฀ unselected฀pts฀(Group฀2a,฀n=105);฀female฀pts฀with฀large฀breasts฀(Group฀2b,฀n=108);฀and฀ pts฀with฀body฀mass฀index฀>30฀(Group฀2c,฀n=118). Results:฀ C-TPD฀ yielded฀ significantly฀ higher฀ specificity฀ than฀ S-TPD฀ for฀ identification฀ of฀ CAD฀≥70%,฀without฀compromising฀sensitivity.฀Normalcy฀rates฀for฀C-TPD฀were฀also฀higher฀ than฀for฀S-TPD฀in฀groups฀2b฀and฀2c.฀ Conclusions:฀ Combined฀ prone-supine฀ MPS฀ quantification฀ significantly฀ improves฀ specificity฀of฀MPS฀in฀identification฀of฀obstructive฀CAD฀compared฀to฀supine฀MPS฀alone.฀ ROC฀areas S-TPD P-TPD C-TPD 0.85±0.02 0.88±0.02 0.89±0.02* *฀p<฀0.02฀vs.฀S-TPD Sensitivity (%) 88 88 86 Specificity (%) 67 80 91* Normalcy฀Rate฀(%) Group฀2a Group฀2b 89 78 92 87 94* 97 Group฀2c 82 91 98* 2.8฀(฀1.01฀-฀7.7) 7.8฀(฀1.55฀-฀40) 3฀(1.02฀-฀9.3฀) 3.5฀(฀1.3฀-฀9.3) 3.4฀(1.4฀-฀10.8฀) 3฀(1.1฀-฀8.1฀) 4.2฀(฀1.3฀-฀13.4) Diabetics฀with฀Chest฀ Pain฀Alone Severe฀CAS฀ age>฀65 Male High฀Risk฀MPA High฀Risk฀MPA฀ h/o฀Revascularization Abnormal฀rest฀ECG >฀2฀risk฀factors Positive฀stress฀ECG Odds฀Ratio฀(95%฀CI) 4.6฀(1.8฀-11.7) 4.8฀(2.1-11) 4.7฀(฀1.8฀-12.3) 4.7฀(2.3฀-9.9) 3.4฀(1.7฀-฀6.8) 3.2฀(1.1฀-9.1) 2.9฀(1.15-7.3) 4:30฀p.m. 861-5฀ 4:00฀p.m. Odds฀Ratio฀ (95%฀CI) Attenuation฀Corrected฀Myocardial฀Perfusion฀Imaging฀ Optimizes฀Detection฀of฀Left฀Anterior฀Descending฀ Coronary฀Artery฀Stenoses฀in฀Women Regina฀S.฀Druz,฀Kenneth฀J.฀Nichols,฀Uzodinma฀R.฀Dim,฀Karen฀Ngai,฀Olakunle฀O.฀ Akinboboye,฀Nathaniel฀Reichek,฀St.฀Francis฀Hospital,฀Stony฀Brook฀University,฀State฀ University฀of฀New฀York,฀Roslyn,฀NY,฀Long฀Island฀Jewish฀Medical฀Center,฀New฀Hyde฀Park,฀NY Background:฀Perfusion฀imaging฀in฀women฀is฀affected฀by฀anterior฀wall฀attenuation฀due฀to฀ breast.฀Attenuation฀correction฀(AC)฀yields฀conflicting฀results.฀We฀investigated฀whether฀AC฀ improves฀accuracy฀and฀diagnostic฀interpretation฀over฀supine฀uncorrected฀imaging฀for฀left฀ anterior฀descending฀(LAD)฀stenosis฀in฀women. Methods:฀68฀women฀(70±12฀y)฀with฀(+)฀or฀without฀(-)฀LAD฀stenosis฀≥70%฀who฀underwent฀ rest฀ TL-201/stress฀ Tc-99m฀ sestamibi฀ with฀ (+)฀ and฀ without฀ (-)฀ AC฀ were฀ retrospectively฀ identified.฀AC฀was฀performed฀with฀a฀commercially฀available฀gadolinium฀source฀to฀generate฀ a฀transmission฀scan฀simultaneously฀with฀the฀supine฀emission฀scan.฀All฀women฀had:฀breast฀ shadow฀on฀the฀raw฀data;฀LAD฀segmental฀defects฀as฀per฀AHA/ASNC฀position฀statement;฀ no฀prior฀anterior฀infarction;฀diagnostic฀angiography฀within฀30฀days.฀Perfusion฀was฀scored฀ based฀ on฀ 5-point/17-segments฀ model,฀ and฀ percent฀ myocardium฀ in฀ the฀ LAD฀ segmental฀ perfusion฀defects฀(%฀LV)฀was฀calculated฀from฀the฀scores.฀Diagnostic฀interpretation฀was฀ scored฀as:฀1=definitely฀abnormal;฀2=probably฀abnormal;฀3=equivocal;฀4=probably฀normal;฀ 5=definitely฀ normal.฀Wilcoxon฀ signed฀ rank฀ test฀ (for฀ %LV)฀ and฀ McNemar’s฀ test฀ (p<0.05)฀ were฀used฀to฀compare฀AC฀(+)฀and฀AC฀(-)฀scans. Results:฀See฀Table. Conclusion:฀AC฀yielded฀larger฀estimates฀of฀the฀extent฀of฀segmental฀LAD฀defects,฀and฀ improved฀specificity,฀accuracy,฀and฀diagnostic฀interpretation฀with฀preserved฀sensitivity.฀This฀ data฀suggests฀a฀rationale฀for฀using฀AC฀in฀older฀women฀with฀apparent฀breast฀shadows.฀ %LV฀ %LV LAD฀(-) N=68 N=46 AC฀(-) 6% 4% AC฀(+) 8% 5% p 0.001 0.03 %LV฀ LAD฀(+) N=22 10% 12% 0.01 Definitely฀ Sensitivity Specificity Accuracy normal฀or฀ abnormal 86% 59% 67% 51% 86% 76% 79% 82% NS <0.0001 0.008 0.0002 ฀ ฀ ฀ Noninvasive Imaging 861฀฀ Diabetics฀with฀ Dyspnea฀Alone Severe฀CAS฀ age>฀65 Positive฀stress฀ECG High฀Risk฀MPA High฀Risk฀MPA฀ h/o฀MI฀ Abnormal฀rest฀ECG Inability฀to฀exercise Positive฀stress฀ECG 310A ABSTRACTS - Noninvasive Imaging JACC 4:45฀p.m. 861-6฀ Impact฀of฀Pharmacologic฀Stress฀/฀Rest฀Myocardial฀ Perfusion฀Imaging฀with฀Positron฀Emission฀Tomography฀ and฀Rubidium-82฀on฀Invasive฀Procedure฀Utilization,฀ Cost,฀and฀Outcomes฀in฀Coronary฀Disease฀Management Michael฀Merhige,฀Joseph฀Oliverio,฀Victoria฀Shelton,฀George฀Watson,฀Kimberly฀Smith,฀ Shannon฀Frank,฀Gary฀Stern,฀David฀Avino,฀Anthony฀Perna,฀State฀University฀of฀New฀York฀ at฀Buffalo,฀Buffalo,฀NY,฀The฀Heart฀Center฀of฀Niagara,฀Niagara฀Falls,฀NY Background:฀ Myocardial฀ perfusion฀ imaging฀ using฀ positron฀ emission฀ tomography,฀ i.v.฀ dipyridamole฀ and฀ Rb-82฀ (PET-MPI),฀ provides฀ more฀ accurate฀ detection฀ and฀ quantitation฀ of฀ potential฀ myocardial฀ ischemia฀ than฀ does฀ single฀ photon฀ imaging฀ (SPECT),฀ and฀ thus฀ may฀ reduce฀ the฀ demand฀ for฀ subsequent฀ diagnostic฀ coronary฀ arteriography฀ (ANGIO),฀ the฀necessary฀prerequisite฀for฀PTCI฀or฀CABG฀(REVASC).฀Accordingly,฀we฀hypothesized฀ that฀routine฀use฀of฀PET-MPI,฀compared฀with฀SPECT,฀in฀patients฀with฀suspected฀coronary฀ disease฀(CAD),฀should฀reduce฀costs฀in฀coronary฀disease฀management฀without฀worsening฀ patient฀outcomes.฀ Methods:฀We฀assessed฀downstream฀utilization฀of฀ANGIO฀and฀REVASC,฀as฀well฀as฀one฀ year฀clinical฀outcomes฀in฀2159฀patients฀studied฀with฀PET-MPI฀in฀whom฀pretest฀likelihood฀of฀ CAD฀was฀matched฀to฀two฀control฀groups฀studied฀with฀SPECT:฀an฀internal฀control฀group฀of฀ 102฀patients฀and฀the฀largest฀most฀completely฀reported฀multicenter฀trial฀of฀SPECT฀(END).฀ CAD฀ management฀ costs฀ were฀ calculated฀ using฀ these฀ estimates:฀ SPECT฀ -$1,000,฀ PET฀ -฀$1,850,฀ANGIO฀-฀$4,800,฀PTCI฀-฀$10,000,฀CABG฀-฀$40,000.฀Results:฀Table฀1. Conclusions:฀CAD฀Management฀with฀PET-MPI฀results฀in฀over฀50%฀reduction฀in฀ANGIO฀ and฀CABG,฀over฀25%฀reduction฀in฀cost,฀and฀excellent฀1฀year฀outcomes. Table฀1.฀ SPECT฀(END) SPECT PET Noninvasive Imaging Conclusions:฀Patients฀with฀statin฀therapy฀have฀a฀significantly฀lower฀progression฀of฀aortic฀ valve฀calcifications.฀C-reactive฀protein฀shows฀an฀association฀with฀the฀progression฀of฀AVC฀ that฀is฀independent฀from฀lipid-lowering฀therapy. 4:15฀p.m. 863-4฀ Aortic฀Calcification฀Predicts฀Hard฀Coronary฀Events฀and฀ is฀Incremental฀to฀Framingham฀Score Jesse฀A.฀Davila,฀Thomas฀R.฀Behrenbeck,฀Tanya฀L.฀Hoskin,฀Terri฀J.฀Vrtiska,฀C.฀Daniel฀ Johnson,฀Mayo฀Clinic,฀Rochester,฀MN Coronary฀ artery฀ calcification฀ is฀ a฀ diagnostic฀ took฀ in฀ risk฀ stratification฀ of฀ patients฀ complementing฀algorithms฀like฀the฀Framingham฀Score฀(FS),฀commonly฀used฀in฀preventive฀ cardiology.฀ We฀ studied฀ the฀ potential฀ role฀ of฀ aortic฀ vascular฀ calcification฀ (AVC)฀ in฀ risk฀ stratification฀and฀predicting฀hard฀cardiac฀events.฀AVC฀in฀467฀patients฀(mean฀age฀64฀years,฀ range฀ 34฀ -฀ 83;฀ 275฀ males)฀ was฀ prospectively฀ studied฀ using฀ low฀ dose฀ abdominal฀ and฀ pelvic฀CT.฀AVC฀scores฀were฀obtained฀from฀the฀celiac฀axis฀to฀the฀aortic฀bifurcation฀using฀ commercially฀available฀software฀(GE฀SmartScoreTM).฀AVC฀was฀present฀in฀87%฀of฀patients,฀ (mean฀score฀977,฀range฀0฀-฀22,754,฀75th฀percentile฀3558).฀Risk฀factors฀were฀measured฀ and฀entered฀into฀the฀Framingham฀calculator.฀Patients฀were฀grouped฀into฀low,฀moderate,฀ high฀risk฀according฀to฀guidelines.฀Hard฀events฀(n฀=฀9)฀were฀defined฀as฀death฀from฀cardiac฀ cause฀or฀myocardial฀infarction.฀Mean฀follow-up฀was฀3.1฀years฀(range฀0฀-฀6฀years).฀KaplanMeier฀estimates฀were฀calculated฀for฀FS฀and฀AVC,฀dividing฀the฀study฀cohort฀into฀a฀lower฀ (≤฀ 75th฀ percentile)฀ and฀ higher฀ risk฀ group฀ (>฀ 75th฀ percentile).฀ Spearman฀ rank฀ correlation฀ showed฀a฀significant฀correlation฀between฀FS฀and฀AVC.฀Cox฀proportional฀hazard฀models฀ were฀ also฀ calculated฀ with฀ FS฀ as฀ covariate.฀ For฀ all฀ groups,฀ AVC฀ added฀ additional฀ risk฀ information฀beyond฀the฀FS.฀ Variable p฀value (PET฀vs.฀either฀SPECT) n 5826 102 2159 Pretest฀CAD฀Probability ANGIO฀Rate REVASC฀Rate CABG฀Rate PTCI฀Rate Cardiac฀Mortality฀Rate (฀one฀year฀) Acute฀MI฀Rate (฀one฀year฀) CAD฀Management฀Cost฀ per฀Patient 0.39 0.34 0.13 not฀reported not฀reported 0.37 0.31 0.11 0.078 0.029 0.39 0.13 0.06 0.034 0.028 n.s. <฀0.003 <฀0.02 <฀0.0008 n.s. 0.01 0.02 0.008 >฀0.15 0.01 0.029 0.011 >฀0.15 not฀reported $5,936 $4,280 5฀year฀prob.฀of฀cardiac฀event 95%฀confidence฀interval Framingham฀Risk Low Moderate High 0 1.4% 5.7% ≤฀75th฀percentile 0.9% >฀75th฀percentile 7.2% P฀-฀value฀=฀0.004฀for฀Kaplan-Meier฀estimates 0-3.6% 1.9-18.9% Conclusion:฀1)฀Aortic฀calcification฀is฀predicts฀risk฀for฀cardiac฀events.฀2)฀It฀correlates฀with฀ the฀ Framingham฀ risk฀ score.฀ 3)฀ AVC฀ adds฀ information฀ for฀ risk฀ stratification฀ beyond฀ the฀ Framingham฀risk฀score. 4:30฀p.m. Coronary฀Calcium฀is฀Independently฀Predictive฀of฀Hard฀ CHD฀Outcomes฀in฀a฀Young,฀Unselected฀Population:฀5฀ Year฀Outcomes฀from฀the฀Prospective฀Army฀Coronary฀ Calcium฀Project ORAL฀CONTRIBUTIONS Cardiac฀Computed฀Tomography฀for฀ Risk฀Assessment Tuesday,฀March฀08,฀2005,฀4:00฀p.m.-5:00฀p.m. Orange฀County฀Convention฀Center,฀Room฀232A 4:00฀p.m. 863-3฀ 0-7.6% 0.7-14.8% Calcium฀Score 863-5฀ 863฀฀ February 1, 2005 Association฀Of฀Elevated฀C-reactive฀Protein฀Levels฀ To฀The฀Progression฀Of฀Aortic฀Valve฀Calcification฀As฀฀ Quantified฀By฀Electron฀Beam฀Tomography. Karsten฀Pohle,฀Dorette฀Raaz,฀Michael฀Schmid,฀Dieter฀Ropers,฀Christoph฀Garlichs,฀ Werner฀Günther฀Daniel,฀Stephan฀Achenbach,฀Department฀of฀Internal฀Medicine฀II,฀ Neunkirchen,฀Germany Background:฀ Aortic฀ valve฀ calcification฀ (AVC)฀ is฀ an฀ actively฀ regulated฀ process฀ with฀ pathophysiologic฀similarities฀to฀atherosclerosis.฀Electron฀beam฀tomography฀(EBT)฀allows฀ the฀ detection฀ and฀ exact฀ quantification฀ of฀ calcifications฀ in฀ the฀ aortic฀ valve.฀ The฀ aim฀ of฀ this฀ study฀ was฀ to฀ investigate฀ the฀ association฀ between฀ systemic฀ inflammation฀ and฀ the฀ progression฀of฀degenerative฀calcification฀of฀the฀aortic฀valve. Methods:฀ In฀ 89฀ patients฀ (mean฀ age:฀ 66±15฀ years,฀ 64%฀ men,฀ 59฀ with฀ statin฀ therapy)฀ with฀ aortic฀ valve฀ calcification,฀ the฀ volume฀ score฀ of฀ AVC฀ in฀ electron฀ beam฀ tomography,฀ C-reactive฀ protein฀ (high-sensitive฀ immunoassay)฀ and฀ LDL-cholesterol฀ was฀ determined.฀ EBT฀was฀repeated฀after฀a฀mean฀interval฀of฀13฀months฀(10฀to฀14฀months),฀and฀the฀relative฀ progression฀of฀AVC฀was฀calculated. Results:฀The฀mean฀volume฀score฀of฀AVC฀was฀1146.2±1699mm³฀at฀the฀initial฀EBT฀scan฀ and฀1347.7±1932mm³฀at฀follow-up฀with฀a฀mean฀relative฀annual฀progression฀of฀15.9±29%.฀ CRP฀ was฀ 2.88±2mg/dl฀ and฀ LDL฀ 148.2±38mg/dl฀ (on฀ statins:฀ 114.7±26mg/dl,฀ without฀ statins:฀ 153.2±45mg/dl).฀ Progression฀ of฀ AVC฀ was฀ significantly฀ lower฀ in฀ patients฀ with฀ as฀ compared฀ to฀ without฀ statin฀ therapy฀ (8.3±21%,฀ n฀ =฀ 59฀ vs.฀ 35.5±39%,฀ n฀ =฀ 30,฀ p<0.001).฀ Mean฀CRP฀was฀significantly฀higher฀in฀the฀upper฀tercile฀of฀AVC฀progression฀(≥33.1%)฀vs.฀ the฀lowest฀tercile฀(<7.4%)฀[3.71฀mg/dl฀vs.฀2.23฀mg/dl,฀p=0.02].฀In฀a฀multivariate฀regression฀ analysis,฀CRP฀and฀LDL-฀cholesterol฀were฀independent฀predictors฀of฀the฀progression฀of฀ AVC฀in฀the฀total฀patient฀group฀(CRP฀p=0.03,฀LDL฀p=0.04)฀and฀in฀patients฀without฀statin฀ therapy฀(CRP฀p=0.05,฀LDL฀p=0.003).฀In฀patients฀with฀statin฀therapy,฀CRP฀(p=0.01)฀but฀not฀ LDL฀cholesterol฀(n.s.)฀predicted฀AVC฀progression. Allen฀J.฀Taylor,฀Jody฀Bindeman,฀Tracy฀Perron,฀Irwin฀M.฀Feuerstein,฀Michael฀Brazaitis,฀ Patrick฀G.฀O’Malley,฀Walter฀Reed฀Army฀Medical฀Center,฀Washington,฀DC Background:฀ Controversy฀ remains฀ over฀ the฀ independent฀ predictive฀ value฀ of฀ coronary฀ artery฀calcium฀(CAC)฀detection฀in฀unselected฀populations.฀We฀examined฀the฀relationship฀ between฀coronary฀heart฀disease฀(CHD)฀outcomes฀and฀CAC฀in฀a฀long-term,฀prospective฀ study. Methods:฀ 2000฀ unselected,฀ asymptomatic,฀ healthy฀ men฀ and฀ women฀ ages฀ 40-50฀ yrs฀ (mean฀ 43)฀ were฀ evaluated฀ with฀ measured฀ risk฀ variables,฀ including฀ CAC.฀ Incident฀ CHD฀ outcomes฀were฀tracked฀via฀annual฀telephonic฀contacts.฀ Results:฀ The฀ mean฀ 10-year฀ predicted฀ CHD฀ risk฀ (Framingham)฀ was฀ 4.0±2.7%.฀ The฀ prevalence฀of฀any฀detectable฀CAC฀was฀19.4%.฀During฀5.5฀year฀actuarial฀follow-up,฀there฀ were฀8฀hard฀CHD฀events฀(definite฀ACS฀or฀CHD฀death),฀including฀7฀of฀388฀individuals฀with฀ CAC฀(1.8%)฀and฀1฀of฀1612฀without฀CAC฀(0.06%;P฀<.0001฀by฀log-rank).฀Cox฀regression฀ showed฀that฀CAC฀was฀associated฀with฀a฀22-fold฀increased฀risk฀for฀hard฀CHD฀(P฀=฀.004)฀ after฀controlling฀for฀the฀Framingham฀risk฀score. Conclusion:฀ These฀ data฀ extend฀ the฀ evidence฀ supporting฀ the฀ independent฀ predictive฀ value฀of฀CAC฀for฀CHD฀outcomes฀to฀a฀younger,฀lower฀risk฀population.฀However,฀because฀ of฀ the฀ low฀ event฀ rate฀ in฀ the฀ overall฀ population,฀ even฀ among฀ those฀ with฀ CAC,฀ avoiding฀ unnecessary฀testing฀will฀require฀criteria฀that฀can฀optimally฀select฀low-risk฀individuals฀with฀ the฀greatest฀likelihood฀of฀benefit฀from฀CAC฀screening. ฀ JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging 4:45฀p.m. 863-6฀ Underestimation฀of฀Coronary฀Risk฀by฀Measuring฀ Subclinical฀Coronary฀Atherosclerosis฀in฀Referral฀ Cohorts:฀Evidence฀From฀the฀Large฀Unselected฀Heinz฀ Nixdorf฀Recall฀Cohort Axel฀Schmermund,฀Stefan฀Mohlenkamp,฀Sina฀Berenbein,฀Heiko฀Pump,฀Susanne฀ Moebus,฀Ulla฀Roggenbuck,฀Andreas฀Stang,฀Rainer฀Seibel,฀Dietrich฀Gronemeyer,฀KarlHeinz฀Jockel,฀Raimund฀Erbel,฀Heinz฀Nixdorf฀Recall฀Study฀Investigative฀Group,฀University฀ Clinic฀Essen,฀Essen,฀Germany Coronary฀artery฀calcification฀(CAC)฀is฀determined฀for฀risk฀stratification.฀It฀is฀essential฀to฀ quantify฀CAC฀compared฀with฀reference฀data฀in฀individuals฀of฀the฀same฀age฀and฀gender.฀ However,฀the฀distribution฀of฀CAC฀scores฀in฀the฀unselected฀general฀population฀is฀not฀well฀ defined. Methods:฀ The฀ Heinz฀ Nixdorf฀ Recall฀ study฀ (HNR)฀ is฀ a฀ population-based฀ study฀ which฀ recruited฀a฀total฀of฀4,814฀participants฀aged฀45฀-฀74฀years฀in฀the฀German฀Ruhr฀area.฀CAC฀ scores฀were฀determined฀using฀electron-beam฀CT฀(EBCT)฀and฀the฀Agatston฀method,฀and฀ compared฀with฀previous฀reports฀on฀referral฀cohorts฀(Raggi฀2000,฀Hoff฀2001,฀Mitchell฀2001,฀ Nasir฀2004). Results:฀Of฀the฀4,472฀(92.9%)฀subjects฀with฀no฀history฀of฀coronary฀artery฀disease,฀CAC฀ scores฀were฀available฀in฀4,259฀(95%)฀(2,017฀men,฀2,242฀women).฀Percentile฀values฀were฀ computed฀ in฀ 5-year฀ age-groups฀ for฀ men฀ and฀ women.฀ Analysis฀ of฀ median฀ CAC฀ scores฀ demonstrated฀ significant฀ differences฀ compared฀ with฀ most฀ of฀ the฀ other฀ cohorts.฀ In฀ the฀ higher฀age-groups฀(>=฀60฀years),฀CAC฀scores฀were฀significantly฀lower฀than฀in฀3฀of฀the฀4฀ previous฀reports฀(Figure). Conclusions:฀ In฀ a฀ general,฀ unselected฀ population฀ in฀ Europe,฀ CAC฀ scores฀ were฀ lower฀ than฀ in฀ most฀ previous฀ reports฀ which฀ included฀ volunteers฀ and฀ subjects฀ referred฀ by฀ their฀ physicians.฀Classification฀of฀the฀CAC฀score฀with฀reference฀to฀the฀previous฀referral฀cohorts฀ would฀ underestimate฀ true฀ risk฀ when฀ compared฀ with฀ our฀ data฀ in฀ a฀ truly฀ unselected฀ population฀with฀no฀history฀of฀coronary฀artery฀disease.฀ 311A The฀mean฀heart฀rate฀was฀lowered฀from฀71฀±฀10฀bpm฀to฀58฀±฀9฀during฀the฀scan.฀Depending฀ on฀the฀covered฀volume฀(mean฀125฀±฀14฀mm),฀total฀breathhold฀time฀was฀between฀8.5฀and฀ 12.25฀s฀(mean฀10.3฀s).฀138฀of฀148฀coronary฀arteries฀(left฀main,฀left฀anterior฀descending,฀ left฀ circumflex฀ and฀ right฀ coronary฀ artery,฀ including฀ their฀ respective฀ side฀ branches฀ in฀ 37฀ patients)฀could฀be฀evaluated฀(93%).฀In฀evaluable฀arteries,฀27/29฀significant฀lesions฀were฀ detected฀and฀absence฀of฀occlusion฀or฀stenosis฀was฀correctly฀identified฀in฀104/109฀arteries฀ (sensitivity฀93%,฀specificity฀95%).฀Overall฀accuracy฀(including฀unevaluable฀segments)฀was฀ 89%฀(131/148). According฀ to฀ this฀ initial฀ data,฀ 64-slice฀ MDCT฀ with฀ isotropic฀ submillimeter฀ resolution,฀ increased฀ gantry฀ speed฀ and฀ consistent฀ premedication฀ with฀ beta฀ blokade฀ permits฀ diagnostic฀image฀quality฀in฀the฀majority฀of฀patients฀and฀allows฀detection฀of฀coronar฀artery฀ occlusions฀and฀significant฀stenoses฀with฀high฀sensitivity฀and฀specificity 8:45฀a.m. 865-4฀ Noninvasive฀Quantitative฀Assessment฀of฀Coronary฀Instent฀Lumen฀by฀16-slice฀Computed฀Tomography Osamu฀Kuboyama,฀Tsunekazu฀Kakuta,฀Shigeki฀Kimura,฀Taishi฀Yonetsu,฀Tomoyuki฀ Umemoto,฀Hideomi฀Fujiwara,฀Mitsuki฀Isobe,฀Tsuchiura฀Kyodo฀General฀Hospital,฀ Tsuchiura,฀Japan,฀Tokyo฀Medical฀&฀Dental฀university,฀Tokyo,฀Japan 9:00฀a.m. 865-5฀ Ralph฀Haberl,฀Barbara฀Richartz,฀Vanessa฀Weberndörfer,฀Eike฀Böhme,฀Carola฀WagnerManslau,฀Jürgen฀Buck,฀Andreas฀Czernik,฀Peter฀Steinbigler,฀Klinik฀Munich-Pasing,฀ Munich,฀Germany ORAL฀CONTRIBUTIONS 865฀฀ Advances฀in฀Computed฀Tomography฀ Coronary฀Angiography Wednesday,฀March฀09,฀2005,฀8:30฀a.m.-10:00฀a.m. Orange฀County฀Convention฀Center,฀Hall฀E2A 8:30฀a.m. 865-3฀ Multislice฀CT-Angiography฀Combined฀With฀MRI-Stress฀ Perfusion:฀Excellent฀Prediction฀of฀Intervention฀Strategy฀ in฀Symptomatic฀Patients฀With฀Coronary฀Artery฀Disease Noninvasive฀Coronary฀Angiography฀by฀Retrospectively฀ ECG-gated฀64-slice฀Spiral฀Computed฀Tomography:฀ Initial฀Clinical฀Experiences Dieter฀Ropers,฀Katharina฀Anders,฀Ulrich฀Baum,฀Werner฀Bautz,฀Werner฀Guenther฀Daniel,฀ Stephan฀Achenbach,฀University฀of฀Erlangen,฀Erlangen,฀Germany Multidetector฀computed฀tomography฀(MDCT)฀has฀been฀shown฀to฀permit฀coronary฀artery฀ imaging.฀However,฀even฀with฀acquisition฀of฀16฀slices฀per฀rotation,฀a฀rotation฀time฀of฀420฀ms฀ and฀a฀slice฀thickness฀of฀0.75฀mm,฀10฀to฀15%฀of฀the฀coronary฀segments฀are฀unevaluable.฀ We฀ analyzed฀ the฀ accuracy฀ of฀ a฀ recently฀ introduced฀ 64-slice฀ scanner฀ (Sensation฀ 64,฀ Siemens,฀Germany)฀with฀increased฀gantry฀speed฀for฀detection฀of฀coronary฀stenoses. 37฀patients฀(27฀men,฀10฀women,฀mean฀weight,฀84฀±฀14฀kg,฀mean฀age,฀59฀±฀13฀years)฀ referred฀ for฀ invasive฀ coronary฀ angiography฀ due฀ to฀ suspected฀ coronary฀ artery฀ disease฀ were฀studied฀by฀MDCT฀(64฀x฀0.6฀mm฀collimation,฀375฀ms฀tube฀rotation,฀80฀ml฀contrast฀ agent฀i.v.).฀Patients฀received฀100฀mg฀atenolol฀60฀minutes฀prior฀to฀the฀scan฀if฀heart฀rate฀was฀ above฀60฀bpm.฀If฀necessary,฀up฀to฀20฀mg฀metoprolol฀were฀given฀intravenously฀immediately฀ before฀the฀investigation.฀Recording฀of฀the฀ECG฀permitted฀retrospective฀reconstruction฀of฀ contiguous฀cross฀sections฀(slice฀thickness฀0.75฀mm฀in฀0.5-mm฀intervals).฀In฀the฀MDCT฀ images,฀all฀coronary฀artery฀segments฀with฀a฀diameter฀of฀1.5฀mm฀or฀more฀were฀assessed฀ concerning฀the฀presence฀of฀occlusions฀or฀stenoses฀exceeding฀50%฀diameter฀reduction.฀ Results฀were฀compared฀to฀quantitative฀coronary฀angiography. Background:฀Multislice฀CT-angiography฀(MSCTA)฀provides฀impressive฀images฀of฀coronary฀ morphology,฀however,฀flow฀and฀perfusion฀information฀-฀indicative฀for฀coronary฀intervention฀ -฀is฀missing.฀We฀therefore฀tested฀a฀combined฀protocol฀of฀MSCTA฀and฀adenosine฀stress฀ MRI฀perfusion฀(AS-MRI)฀for฀optimal฀noninvasive฀prediction฀of฀coronary฀intervention. Methods:฀We฀ performed฀ MSCTA฀ (Philips฀ 16-slice)฀ and฀ AS-MRI฀ (Philips฀ Intera฀ 1.5T,฀TFEPI,฀ 3฀ short฀ axis฀ slices,฀ adenosine฀ 140µg/kg/min,฀ gadolinium฀ first฀ pass)฀ and฀ invasive฀ angiography฀ (INV-A)฀ in฀ 53฀ symptomatic฀ patients฀ with฀ angina฀ (16฀ patients฀ had฀ previous฀ MI฀ and/or฀ stent฀ implantation,฀ acute฀ coronary฀ syndromes฀ excluded).฀ MSCTA฀ was฀ defined฀ abnormal฀in฀case฀of฀>50%฀stenosis,฀AS-MRI฀was฀considered฀abnormal฀in฀case฀of฀transmural฀ or฀subendocardial฀perfusion฀defect฀in฀>1฀segment฀during฀stress฀not฀present฀at฀rest. Results:฀With฀MSCTA฀92%฀of฀segments฀(AHA฀15-segment฀model)฀had฀diagnostic฀image฀ quality,฀AS-MRI฀could฀be฀evaluated฀in฀51฀of฀53฀patients. Prediction฀of฀coronary฀intervention฀ n=53 sensitivity specificity ppv npv MSCTA 92% 61% 68% 89% AS-MRI 92% 90% 88% 93% MSCTA+฀AS-MRI 84% 94% 95% 100% Normal฀MSCTA฀excluded฀stenosis฀requiring฀intervention฀with฀very฀high฀accuracy฀(92%),฀ thus฀INV-A฀and฀AS-MRI฀can฀be฀saved.฀If฀MSCTA฀identified฀stenosis,฀but฀AS-MRI฀excluded฀ perfusion฀ defect,฀ intervention฀ was฀ rarely฀ needed฀ (increase฀ of฀ specificity฀ and฀ pos.฀ predictive฀value).฀In฀case฀of฀abnormal฀MSCTA฀and฀AS-MRI,฀coronary฀intervention฀had฀to฀ be฀performed฀in฀21/22฀cases. Conclusion:฀The฀stepwise฀approach฀using฀MSCTA฀and฀AS-MRI฀allows฀a฀strong฀focus฀of฀ INV-A฀on฀intervention฀and฀also฀to฀save฀>30%฀of฀diagnostic฀catheters. Noninvasive Imaging Background:฀We฀investigated฀the฀ability฀of฀16-slice฀multislice฀CT฀(MSCT)฀to฀assess฀instent฀lumen฀by฀16-slice฀MSCT. Methods:฀ We฀ studied฀ a฀ total฀ of฀ 176฀ stents฀ from฀ 92฀ consecutive฀ patients฀ referred฀ for฀ conventional฀angiography฀(CA)฀after฀stent฀implantation.฀All฀patients฀were฀studied฀by฀both฀ 16-slice฀MSCT฀and฀CA.฀MIP,฀MPR,฀and฀cross-sectional฀images฀of฀stented฀segments฀were฀ assessed฀ with฀ the฀ use฀ of฀ a฀ medium฀ edge฀ enhancement฀ kernel฀ (B41f)฀ and฀ the฀ native฀ reference฀ segments฀ were฀ evaluated฀ with฀ the฀ convolution฀ kernel฀ of฀ B30f.฀ Images฀ were฀ analyzed฀ regarding฀ lumen฀ visibility,฀ quantification฀ of฀ in-stent฀ minimum฀ lumen฀ diameter฀ (MLD)฀ and฀ lesion฀ length฀ by฀ visual฀ assessment฀ in฀ MIP฀ and฀ cross-sectional฀ images฀ of฀ MSCT฀ using฀ digital฀ caliper,฀ and฀ the฀ values฀ were฀ compared฀ with฀ QCA฀ findings฀ .฀ MSCT฀ quantification฀of฀MLD฀and฀lesion฀length฀were฀evaluated฀by฀the฀use฀of฀linear฀regression฀ analysis฀and฀the฀Bland-Altman฀analysis฀with฀QCA฀as฀a฀reference฀standard. Results:฀ One฀ hundred฀ fifty-seven฀ stents฀ (89.2%)฀ were฀ evaluable฀ for฀ in-stent฀ lumen.฀ MSCT฀ permitted฀ the฀ detection฀ of฀ 30฀ of฀ 31฀ significant฀ (≥50%฀ lumen฀ reduction)฀ stenosis฀ (sensitivity฀96.8%),฀and฀correctly฀depicted฀the฀absence฀of฀restenosis฀in฀107฀of฀126฀stents฀ (specificity฀ 84.9%).฀These฀ values฀ correspond฀ to฀ positive฀ predictive฀ value฀ of฀ 61.2%฀ (30฀ of฀ 49),฀ negative฀ predictive฀ value฀ of฀ 99.1%฀ (107฀ of฀ 108),฀ diagnostic฀ accuracy฀ of฀ 87.3%฀ in฀ evaluable฀ stents฀ and฀ 77.8%฀ in฀ the฀ whole฀ stents.฀ In฀ 30฀ restenotic฀ stents฀ detected฀ by฀ both฀MSCT฀and฀angiography,฀mean฀MLD฀,฀reference฀diameter,฀and฀%฀diameter฀stenosis฀ by฀QCA฀and฀MSCT฀were฀0.89฀±฀0.50mm฀and฀0.82฀±฀0.43mm,฀2.71฀±฀0.60mm฀and฀2.74฀ ±฀0.68mm,฀67.0฀±฀13.9%฀and฀68.0฀±฀15.7%,฀respectively.฀Both฀MLD฀and฀lesion฀length฀in฀ MSCT฀correlated฀closely฀to฀QCA฀findings฀(r฀=฀0.89,฀r=0.95,฀p฀<฀0.001,฀respectively). Conclusion:฀MSCT฀with฀submillimeter฀collimation฀permits฀reliable฀visualization฀of฀in-stent฀ lumen฀and฀correctly฀detects฀patients฀without฀in-stent฀restenosis. 312A ABSTRACTS - Noninvasive Imaging JACC 9:15฀a.m. 865-6฀ Utility฀of฀Prototype฀256-slice฀Cone฀Beam฀Computed฀ Tomography;฀Dynamics฀of฀Cardiovascular฀Circulation฀ and฀Segmented฀Myocardial฀Perfusion฀by฀Selective฀ Intracoronary฀Contrast฀Injection฀in฀Four-Dimensional฀ Images Nobusada฀Funabashi,฀Katsuya฀Yoshida,฀Hiroyuki฀Tadokoro,฀Keiichi฀Nakagawa,฀Kenichi฀ Odaka,฀Nobuyuki฀Komiyama,฀Takanori฀Tsunoo,฀Shinichiro฀Mori,฀Masahiro฀Endo,฀Shuji฀ Tanada,฀Issei฀Komuro,฀Chiba฀University฀Graduate฀School฀of฀Medicine,฀Chiba,฀Japan,฀ National฀Institute฀of฀Radiological฀Sciences,฀Chiba,฀Japan Background:฀We฀employed฀256-slice฀cone฀beam฀computed฀tomography฀(CT)฀(Athena,฀ Sony฀Toshiba)฀ at฀ one฀ rotation฀ per฀ second฀ and฀ a฀ section฀ thickness฀ of฀ 0.5฀ mm฀ to฀ show฀ dynamics฀of฀cardiovascular฀circulation฀by฀intravenous฀contrast฀injection฀and฀segmented฀ myocardial฀perfusion฀by฀selective฀intracoronary฀contrast฀injection฀in฀4D฀films. Methods:฀Six฀domestic฀pigs฀(20฀kg฀each)฀were฀anesthetized฀with฀isoflurane.฀Distal฀tips฀ of฀catheters฀were฀positioned฀in฀the฀left฀anterior฀descending฀branch฀(LAD)฀of฀the฀coronary฀ artery฀(pigs฀1,฀2),฀left฀circumflex฀branch฀(LCx)฀(pig฀3)฀or฀inferior฀vena฀cava฀(IVC)฀(pigs฀4-6).฀ Volumetric฀scanning฀and฀contrast฀injection฀were฀started฀simultaneously฀and฀continued฀for฀ 25฀seconds,฀and฀images฀were฀reconstructed฀at฀half฀-second฀intervals.฀ Results:฀ Axial฀ source฀ images฀ 5฀ seconds฀ after฀ injection฀ revealed฀ segmented฀ left฀ ventricular฀(LV)฀myocardial฀enhancement฀of฀the฀anterior฀wall฀and฀apical฀portion฀of฀interventricular฀septum฀(IVS)฀in฀pig฀1฀and฀2,฀and฀the฀lateral฀and฀posterior฀walls฀in฀pig฀3.฀4D฀ filming฀revealed฀coronary฀arterial฀trees,฀followed฀by฀selective฀3D฀images฀of฀the฀anterior,฀ apical฀and฀IVS฀portion฀of฀the฀LV฀myocardium฀supplied฀by฀the฀LAD฀in฀pigs฀1฀and฀2,฀and฀ the฀lateral฀and฀posterior฀portion฀of฀LV฀by฀the฀LCx฀in฀pig฀3.฀In฀pigs฀4-6,฀4D฀filming฀revealed฀ dynamics฀of฀cardiovascular฀circulation฀three-dimensionally,฀first฀in฀the฀IVC฀then฀the฀right฀ ventricle฀and฀pulmonary฀artery,฀then฀the฀LV,฀left฀atrium,฀and฀pulmonary฀vein฀and฀finally,฀the฀ right฀heart฀disappeared฀and฀only฀the฀left฀heart฀and฀aorta฀remained฀visible. Conclusions:฀ Using฀ 256-slice฀ CT฀ with฀ intracoronary฀ injection,฀ selective฀ myocardial฀ perfusion฀ images฀ were฀ visualized฀ in฀ 4D.฀ Images฀ of฀ the฀ segmented฀ LV฀ myocardium฀ supplied฀by฀each฀coronary฀artery฀are฀potentially฀useful฀to฀confirm฀recovery฀of฀myocardial฀ micro-vascular฀perfusion฀after฀percutaneous฀coronary฀intervention.฀Also,฀we฀demonstrated฀ the฀cardiovascular฀circulation฀in฀4D,฀which฀could฀have฀application฀in฀the฀visualization฀of฀ cardiovascular฀circulatory฀problems.฀Furthermore,฀analyzing฀those฀data฀by฀a฀time฀density฀ profile฀three-dimensionally,฀quantitative฀evaluation฀of฀blood฀flow฀was฀measured. February 1, 2005 Methods:฀A฀phantom฀used฀by฀the฀American฀College฀of฀Radiology฀for฀the฀accreditation฀ of฀ CT฀ imaging฀ programs฀ (Gammex฀ rmi)฀ was฀ scanned฀ on฀ a฀ 16-slice฀ scanner฀ (Siemens฀ Sensation฀Cardiac;฀gantry฀rotation,฀375฀msec;฀collimation,฀0.75฀mm)฀at฀permutations฀of฀ tube฀current฀(80฀or฀120฀kVp)฀and฀of฀product฀of฀tube฀current฀multiplied฀by฀exposure฀time฀ (mAs)฀(650,฀700,฀or฀750฀mAs[eff]),฀with฀and฀without฀dose-sparing฀“ECG฀pulsing”฀(ECG-P).฀ Images฀were฀gated฀at฀10%฀(systole)฀and฀60%฀(diastole)฀of฀the฀R-R฀interval฀of฀a฀simulated฀ ECG฀tracing฀(rate,฀70฀bpm)฀and฀reconstructed฀to฀a฀slice฀thickness฀of฀1฀mm฀and฀a฀temporal฀ resolution฀of฀approximately฀97฀msec.฀“Noise”฀was฀the฀standard฀deviation฀of฀the฀average฀ CT฀number฀in฀the฀CT฀number฀uniformity฀module฀of฀phantom;฀contrast-to-noise฀ratio฀(CNR)฀ was฀ calculated฀ using฀“contrast”฀ measured฀ in฀ the฀ low฀ contrast฀ module฀ of฀ phantom.฀The฀ effective฀dose฀(E)฀was฀calculated฀from฀CT฀dose฀index฀measurements฀with฀an฀ionization฀ chamber. Reconstructions฀at฀60%฀of฀R-to-R฀interval฀ kVp 120 120 120 80 80 80 mAseff 750 650 550 750 650 550 E฀(mSv) ECG-P฀off ECG-P฀on 13 11.3 9.5 4.1 3.6 3.0 9.4 8.1 6.9 3.0 2.6 2.2 Noise CNR 13.8 15.6 17.9 27.8 30.7 31.6 0.57 0.49 0.40 0.17 0.17 0.20 Conclusions:฀ Radiation฀ dose฀ increases฀ more฀ than฀ CNR฀ with฀ changes฀ of฀ tube฀ voltage฀ or฀ mAs.฀ Studies฀ are฀ needed฀ to฀ examine฀ the฀ relationship฀ between฀ image฀ quality฀ and฀ diagnostic฀accuracy฀of฀MSCT-CA฀to฀establish฀the฀necessary฀tradeoff฀between฀diagnostic฀ accuracy฀and฀radiation฀dose. ORAL฀CONTRIBUTIONS 880฀฀ Prognostic฀Aspects฀of฀Dobutamine฀ Echocardiography Wednesday,฀March฀09,฀2005,฀10:30฀a.m.-Noon Orange฀County฀Convention฀Center,฀Room฀230B Noninvasive Imaging 9:30฀a.m. 865-7฀ Identification฀Of฀Lipid฀And฀Fibrous฀Coronary฀Plaque฀Is฀ Hampered฀By฀The฀Influence฀Of฀Contrast฀Density฀During฀ Ct฀Coronary฀Angiography Nico฀R.฀Mollet,฀Filippo฀Cademartiri,฀Timo฀Baks,฀Nico฀Bruining,฀Ronald฀Hamers,฀ Giuseppe฀Runza,฀Pamela฀Somers,฀Michiel฀Knaapen,฀Stefan฀Verheye,฀Pim฀J.฀de฀Feyter,฀ Erasmus฀Medical฀Center,฀Rotterdam,฀The฀Netherlands Background:฀CT฀coronary฀plaque฀characterization฀is฀based฀on฀absolute฀plaque฀density฀ values.฀ However,฀ the฀ effect฀ of฀ intracoronary฀ contrast฀ on฀ the฀ density฀ values฀ of฀ coronary฀ plaques฀is฀not฀yet฀defined. Methods:฀ Multislice฀ Computed฀ Tomography฀ coronary฀ angiography฀ (MSCT-CA)฀ was฀ performed฀ in฀ 7฀ ex-vivo฀ left฀ coronary฀ artery฀ specimens฀ (emerged฀ in฀ oil฀ to฀ simulate฀ epicardial฀fat)฀filled฀with฀5฀solutions฀with฀increasing฀concentrations฀of฀contrast฀material:฀ 1/0,฀1/200,฀1/80,฀1/50฀and฀1/20.฀MSCT-CA฀was฀also฀performed฀in฀12฀patients฀(males฀9;฀ mean฀age฀58.7฀±฀9.9)฀to฀evaluate฀in-vivo฀the฀effect฀of฀differences฀in฀contrast฀attenuation฀ on฀plaque฀density฀values.฀These฀patients฀underwent฀two฀subsequent฀scans฀(arterial฀and฀ delayed)฀ after฀ intravenous฀ administration฀ of฀ a฀ single฀ bolus฀ of฀ contrast฀ material฀ (100฀ ml฀ of฀Iomeprol฀400mgl/ml฀at฀4ml/s).฀The฀attenuation฀(HU)฀value฀of฀atherosclerotic฀plaques฀ was฀measured฀in฀each฀solution฀at:฀lumen,฀plaque฀(non฀calcified฀thickening฀of฀the฀vessel฀ wall),฀calcium฀and฀surrounding.฀The฀results฀were฀compared฀with฀one-way฀ANOVA-test฀and฀ correlated฀with฀Pearson’s฀test. Results:฀The฀mean฀attenuation฀of฀the฀5฀solutions฀in฀the฀lumen฀(45±38฀HU;฀85±38฀HU;฀ 121±38฀HU;฀322±104฀HU;669±151฀HU)฀and฀plaque฀(11±35฀HU;฀20±38฀HU;฀34±43฀HU;฀ 61±65฀ HU;฀ 101±72฀ HU)฀ was฀ significantly฀ different฀ (p<0.001).฀The฀ attenuation฀ of฀ lumen฀ and฀ plaque฀ of฀ coronary฀ plaques฀ showed฀ moderate฀ correlation฀ (r=0.54;฀ p<0.001).฀ The฀ mean฀attenuation฀value฀in-vivo฀arterial฀/฀delayed฀for฀lumen฀(325±70HU;฀174±46฀HU)฀and฀ non-calcified฀ plaque฀ (138±71HU;฀ 100±52HU)฀ was฀ significantly฀ different฀ (p<0.001).฀The฀ attenuation฀of฀calcium฀and฀oil฀was฀not฀effected฀by฀differences฀in฀lumen฀contrast฀both฀in฀ ex-vivo฀and฀in-vivo฀measurements. Conclusion:฀Non-calcific฀coronary฀plaque฀attenuation฀values฀are฀significantly฀modified฀ by฀differences฀in฀lumen฀contrast฀densities,฀which฀should฀be฀taken฀into฀account฀with฀CT฀ plaque฀characterization฀based฀on฀absolute฀density฀values. 9:45฀a.m. 865-8฀ Radiation฀Dose฀and฀Image฀Quality฀in฀16-Slice฀Computed฀ Tomographic฀Coronary฀Angiography:฀Effect฀of฀ Acquisition฀Technique Thomas฀C.฀Gerber,฀Brian฀P.฀Stratman,฀Ronald฀S.฀Kuzo,฀Birgit฀Kantor,฀Richard฀L.฀Morin,฀ Mayo฀Clinic฀Jacksonville,฀Jacksonville,฀FL,฀Mayo฀Clinic,฀Rochester,฀MN Background:฀ The฀ balance฀ between฀ radiation฀ dose฀ and฀ image฀ quality฀ may฀ become฀ a฀ limiting฀ factor฀ in฀ the฀ use฀ of฀ multislice฀ CT฀ coronary฀ angiography฀ (MSCT-CA).฀ We฀ hypothesized฀that฀variations฀of฀tube฀voltage฀and฀tube฀current฀affect฀radiation฀dose฀more฀ than฀image฀quality. 10:30฀a.m. 880-3฀ Aggressive฀Risk฀Factor฀Modification฀Does฀Not฀Reduce฀ New฀Ischemia฀by฀Sequential฀Dobutamine฀Stress฀ Echocardiography฀in฀Patients฀With฀End฀Stage฀Renal฀ Disease Dhrubo฀Rakhit,฀Rodel฀Leano,฀Kirsten฀Armstrong,฀Nicole฀Isbel,฀Thomas฀Marwick,฀ University฀of฀Queensland,฀Brisbane,฀Australia Background:฀Cardiac฀events฀(CE)฀are฀a฀major฀cause฀of฀morbidity฀and฀mortality฀in฀pts฀with฀ end฀stage฀renal฀disease฀(ESRD).฀We฀sought฀whether฀aggressive฀risk฀factor฀modification฀ (ARFM)฀ in฀ pts฀ with฀ ESRD฀ could฀ i)฀ reduce฀ CE฀ (cardiac฀ death฀ and฀ MI)฀ in฀ pts฀ with฀ an฀ abnormal฀dobutamine฀stress฀echo฀(DSE)฀and฀ii)฀limit฀development฀of฀new฀ischemia฀(NI). Methods:฀200฀patients฀with฀ESRD฀were฀randomized฀to฀either฀an฀ARFM฀strategy฀(focus฀ group฀-฀targeted฀treatment฀of฀hypertension,฀dyslipidaemia,฀homocysteine,฀hemoglobin฀and฀ phosphate)฀or฀usual฀care฀(standard฀group).฀An฀intention฀to฀treat฀analysis฀was฀performed฀ on฀152฀pts฀(mean฀age฀54฀yrs,฀87฀male,฀99฀dialysis-dependant)฀who฀had฀a฀baseline฀DSE฀ (including฀ 53฀ who฀ had฀ follow฀ up฀ DSE฀ at฀ 2฀ yrs).฀ Biochemical฀ parameters,฀ cardiac฀ risk฀ factors฀ and฀ investigations฀ (ECG,฀ 2D฀ echo,฀ and฀ carotid฀ intimal฀ medial฀ thickness฀ (IMT))฀ were฀ recorded฀ at฀ baseline.฀ A฀ positive฀ difference฀ in฀ the฀ peak฀ wall฀ motion฀ score฀ index฀ (WMSI)฀or฀positive฀delta฀WMSI฀between฀follow฀up฀and฀baseline฀DSE฀was฀classed฀as฀NI. Results:฀ Mean฀ follow฀ up฀ between฀ baseline฀ and฀ sequential฀ DSE฀ was฀ 2.1฀ yrs.฀ Between฀ standard฀and฀focus฀groups฀there฀was฀no฀difference฀in฀CE฀(7฀v฀10),฀development฀of฀NI฀(15฀ v฀18),฀and฀in฀pts฀with฀an฀abnormal฀baseline฀DSE฀(non-diagnostic,฀scar฀or฀ischemia)฀the฀ CE฀rate฀was฀similar฀(29%฀v฀25%).฀Predictors฀of฀NI฀are฀shown฀below฀(table) ฀ Univariate฀Analysis Multivariate฀Analysis Variable OR฀(95%฀CI) p OR฀(95%฀CI) p Age฀(yrs) Abnormal฀ECG 1.06฀(1.03-1.09) 3.72฀(1.65-8.43) 0.001 0.002 1.05฀(1.01-1.10) 3.96฀(1.43-10.98) 0.01 0.008 Duration฀Diabetes฀Mellitus฀(yrs) 1.04฀(1.00-1.08) 0.07 Ejection฀Fraction฀(%) 0.02 0.96฀(0.92-0.99) Previous฀Cardiac฀Event 2.56฀(1.16-5.66) 0.02 Diabetes฀Mellitus 2.61฀(1.15-5.90) 0.02 IMT฀(mm/10) 1.61฀(1.34-2.28) 0.007 Conclusion:฀ ARFM฀ in฀ pts฀ with฀ ESRD฀ does฀ not฀ reduce฀ CE฀ in฀ those฀ with฀ an฀ abnormal฀ DSE฀ nor฀ does฀ it฀ limit฀ the฀ development฀ of฀ NI.฀ Age฀ and฀ abnormal฀ ECG฀ at฀ baseline฀ are฀ independent฀predictors฀of฀NI฀at฀2฀years. JACC February 1, 2005 ABSTRACTS - Noninvasive Imaging 10:45฀a.m. 880-4฀ Chronotropic฀Incompetence฀is฀a฀Strong฀Prognsticator฀ In฀Diabetics฀Undergoing฀Dobutamine฀Stress฀ Echocardiography Shrikanth฀P.฀Upadya,฀Sheikh฀Mahfuzul฀Hoq,฀Siu-Sun฀Yao,฀Farooq฀A.฀Chaudhry,฀ St.฀Luke’s-฀Roosevelt฀Hospital,฀New฀York,฀NY,฀Yale฀University฀School฀of฀Medicine,฀ Bridgeport,฀CT Background:฀In฀patients฀with฀known฀or฀suspected฀coronary฀artery฀disease฀undergoing฀ exercise฀ stress฀ testing,฀ chronotropic฀ incompetence฀ (CI)฀ is฀ associated฀ with฀ poor฀ prognosis.฀ CI฀ is฀ also฀ frequently฀ seen฀ in฀ dobutamine฀ stress฀ echocardiogram฀ (DSE)฀ and฀ the฀significance฀of฀this฀is฀not฀well฀known.฀We฀examined฀the฀role฀of฀CI฀in฀diabetic฀patients฀ undergoing฀DSE. Methods:฀ We฀ examined฀ 329฀ diabetic฀ patients฀ referred฀ for฀ DSE.฀ CI฀ was฀ defined฀ as฀ an฀ inability฀in฀attaining฀85%฀of฀the฀maximum฀predicted฀heart฀rate฀for฀the฀age฀during฀DSE.฀ Wall฀motion฀analysis฀was฀performed฀using฀a฀standard฀16-segment฀model.฀Ischemia฀was฀ defined฀ as฀ new฀ reversible฀ wall฀ motion฀ abnormality฀ and/or฀ biphasic฀ response.฀ Five-year฀ follow฀up฀was฀obtained฀for฀MI฀and฀cardiac฀death฀and฀annual฀event฀rate฀was฀calculated. Results:฀CI฀was฀noted฀in฀128(39.2%)฀diabetics.฀Patients฀were฀followed฀for฀a฀mean฀duration฀ of฀2.67±฀1฀years.฀Significant฀univariates฀are฀described฀in฀the฀Table.฀By฀multivariate฀logistic฀ regression฀analysis,฀age฀(p=0.001),฀use฀of฀beta-blockers฀(0.002)฀and฀LVEF฀(p=฀0.005)฀were฀ predictors฀of฀hard฀events฀while฀ischemia฀on฀DSE฀showed฀a฀trend฀towards฀worse฀outcomes฀ (p=0.057).฀Annual฀event฀rate฀was฀5.1%฀vs.฀1.5%฀(p=0.005)฀in฀diabetics฀with฀CI฀vs.฀no฀CI. Conclusions:฀In฀diabetics,฀CI฀is฀associated฀with฀high฀incidence฀of฀ischemia฀on฀DSE฀that฀ showed฀a฀trend฀towards฀worse฀outcomes.฀CI฀was฀also฀associated฀with฀a฀high฀incidence฀of฀ B-blocker฀use,฀lower฀LVEF฀and฀lower฀age.฀CI฀in฀diabetics฀predicted฀a฀high฀hard฀event฀rate.฀ <85%฀MPHR฀on฀ DSE฀(CI) 60±11 62.5 Age Males฀(%) 113±22 145±11 Hypertension(%) High฀Cholesterol฀(%) Prior฀MI฀(%) Beta฀Blocker฀use(%) LVEF฀(%) Ischemia฀on฀DSE฀(%) Hard฀Events฀(%) 79 57 57 43 39฀±18 61.7 13.6 82 51 41 15 53±฀11 27.9 4.1 NS NS <0.001 <0.001 <0.001 <0.001 0.003 Prognostic฀Implications฀of฀Angina฀During฀Dobutamine฀ Stress฀Echocardiography฀in฀the฀Absence฀of฀Inducible฀ Wall฀Motion฀Abnormalities Abdou฀Elhendy,฀Arend฀F.฀Schinkel,฀Jeroen฀J.฀Bax,฀Ron฀T.฀van฀Domburg,฀Elena฀Biagini,฀ Don฀Poldermans,฀Thoraxcenter,฀Rotterdam,฀The฀Netherlands,฀University฀of฀Nebraska฀ Medical฀Center,฀Omaha,฀NE Rationale.฀Aim฀of฀this฀study฀was฀to฀assess฀the฀incidence,฀clinical฀correlates฀and฀prognostic฀ significance฀of฀angina฀during฀dobutamine฀stress฀echocardiography฀(DSE)฀in฀patients฀(pts)฀ without฀inducible฀wall฀motion฀abnormalities. Methods.฀We฀ studied฀ 1592฀ pts฀ (age฀ =฀ 61฀ ±฀ 13฀ years,฀ 955฀ men)฀ who฀ underwent฀ high฀ dose฀DSE฀and฀had฀no฀new฀or฀worsening฀wall฀motion฀abnormalities฀during฀DSE.฀Follow฀ up฀events฀were฀hard฀cardiac฀events฀(cardiac฀death฀or฀non-fatal฀myocardial฀infarction)฀and฀ myocardial฀revascularization. Results.฀Angina฀was฀induced฀in฀160฀(10%)฀pts฀during฀stress.฀DSE฀was฀normal฀in฀1034฀ (65%)฀pts,฀whereas฀558฀(35%)฀pts฀had฀fixed฀wall฀motion฀abnormalities.฀During฀a฀mean฀ follow฀ up฀ of฀ 4.2฀ ±฀ 3.1฀ years,฀ 115฀ pts฀ died฀ of฀ cardiac฀ causes฀ and฀ 66฀ pts฀ had฀ non฀ fatal฀ myocardial฀infarction.฀Pts฀with฀angina฀during฀DSE฀were฀more฀likely฀to฀have฀a฀prior฀history฀ of฀exertional฀angina฀(60%฀vs฀18%,฀p<0.005)฀and฀received฀larger฀doses฀of฀dobutamine฀(37฀ ±฀6฀vs฀34฀±฀9฀µg/kg/min,฀p<0.01)฀compared฀to฀pts฀without฀angina.฀The฀annual฀hard฀cardiac฀ event฀rate฀was฀2.9%฀in฀pts฀with฀dobutamine฀induced฀angina฀and฀2.7%฀in฀pts฀without฀(p฀ =฀NS).฀Myocardial฀revascularization฀was฀performed฀more฀frequently฀during฀follow฀up฀in฀ pts฀ with฀ than฀ without฀ dobutamine฀ induced฀ angina฀ (38%฀ vs฀ 11%,฀ p<0.0001).฀ In฀ a฀ Cox฀ regression฀model,฀independent฀predictors฀of฀hard฀cardiac฀events฀were฀age฀(risk฀ratio฀[RR]฀ 1.03,฀ 95%฀ confidence฀ intervals฀ [CI]฀ 1.02-1.04,฀ male฀ sex฀ (RR฀ 1.6,฀ CI฀ 1.1-2.2),฀ smoking฀ (RR฀1.5,฀CI฀1.1-2.9)฀and฀resting฀wall฀motion฀score฀index฀(RR฀2.7,฀CI฀1.8-3.8). Conclusion.฀ In฀ pts฀ without฀ ischemia฀ by฀ echocardiographic฀ criteria฀ during฀ dobutamine฀ stress,฀ inducible฀ angina฀ is฀ associated฀ with฀ a฀ high฀ incidence฀ of฀ revascularization฀ during฀ follow฀up.฀However,฀the฀hard฀cardiac฀event฀rate฀is฀not฀different฀in฀pts฀with฀compared฀to฀pts฀ without฀dobutamine฀induced฀angina. 11:15฀a.m. Ratio฀of฀Left฀Ventricular฀Peak฀E-wave฀Velocity฀to฀Flow฀ Propagation฀Velocity฀Assessed฀by฀Color฀M-mode฀ Doppler฀Echocardiography฀During฀Dobutamine฀Stress฀ Echocardiography:฀A฀Potent฀Predictor฀of฀Mortality฀After฀ Acute฀Myocardial฀Infarction Betina฀Nørager,฀Mirza฀Husic,฀Jacob฀E.฀Møller,฀Steen฀H.฀Poulsen,฀Patricia฀A.฀Pellikka,฀ Kenneth฀Egstrup,฀Svendborg฀Hospital,฀Svendborg,฀Denmark Background:฀ The฀ ratio฀ of฀ peak฀ E-wave฀ velocity฀ to฀ flow฀ propagation฀ velocity฀ (E/Vp)฀ assessed฀by฀color฀M-mode฀Doppler฀echocardiography฀is฀a฀noninvasive฀measure฀of฀left฀ 11:30฀a.m. 880-7฀ Levosimendan฀Echocardiography฀as฀a฀New฀Test฀for฀ Detecting฀Myocardial฀Viability.฀A฀Comparison฀With฀ Dobutamine฀Echocardiography Cinzia฀Cianfrocca,฀Vincenzo฀Pasceri,฀Francesco฀Pelliccia,฀Antonio฀Auriti,฀Sabina฀Ficili,฀ Christian฀Pristipino,฀Giuseppe฀Richichi,฀Massimo฀Santini,฀San฀Filippo฀Neri฀Hospital,฀ Rome,฀Italy Background:฀ Levosimendan฀ is฀ a฀ new฀ calcium-sensitizer฀ inotropic฀ agent฀ with฀ positive฀ inotropic฀ and฀ vasodilatory฀ activities฀ but฀ no฀ adrenergic฀ effects,฀ used฀ successfully฀ for฀ treatment฀of฀heart฀failure.฀Aim฀of฀this฀study฀was฀to฀assess฀the฀possible฀role฀of฀levosimendan฀ echocardiography฀for฀detection฀of฀myocardial฀viability. Methods:฀ We฀ studied฀ a฀ total฀ of฀ 21฀ patients฀ (65±10฀ years,฀ 17฀ men)฀ with฀ previous฀ myocardial฀infarction฀who฀underwent฀on฀two฀consecutive฀days฀dobutamine฀(increases฀of฀ 5฀µg/Kg/min฀every฀5฀min)฀and฀levosimendan฀(24฀µg/Kg/min฀in฀10฀min)฀echocardiography฀ before฀ revascularization฀ by฀ either฀ coronary฀ artery฀ by-pass฀ surgery฀ (n=2)฀ or฀ coronary฀ intervention฀(n=19).฀Myocardial฀viability฀was฀identified฀by฀>1฀point฀improvement฀in฀regional฀ wall฀motion฀in฀at฀least฀two฀LV฀regions฀as฀assessed฀on฀the฀standard฀16-segment฀model฀by฀ consensus฀of฀two฀independent฀readers. Results:฀ Compared฀ with฀ baseline,฀ global฀ wall฀ motion฀ score฀ index฀ (WMSI)฀ was฀ significantly฀decreased฀with฀both฀levosimendan฀(1.57±0.41฀vs.฀1.80±0.42,฀P=0.0002)฀and฀ dobutamine฀(1.61±0.41฀vs.฀1.80±0.42,฀P=0.0003).฀Similarly,฀global฀ejection฀fraction฀(EF)฀ was฀significantly฀increased฀with฀both฀levosimendan฀(52±10%฀vs.฀44±11%฀P=0.0001)฀and฀ dobutamine฀(49±11%฀vs.฀44±11%฀P=0.0002).฀Overall฀there฀was฀a฀significant฀agreement฀ between฀ the฀ two฀ tests฀ (kappa=0.62,฀ P<0.0001).฀ Incidence฀ of฀ side฀ effects฀ tended฀ to฀ be฀ lower฀ with฀ levosimendan฀ compared฀ with฀ dobutamine฀ (2฀ vs.฀ 8฀ patients,฀ P=0.04).฀ At฀ 6month฀follow-up฀after฀revascularization,฀there฀was฀a฀significant฀improvement฀of฀cardiac฀ function฀ (EF=฀ 51±13%฀ and฀ WMSI=1.57±0.38).฀ Viability฀ of฀ each฀ myocardial฀ segment฀ was฀ predicted฀ in฀ a฀ similar฀ way฀ by฀ response฀ to฀ either฀ levosimendan฀ (kappa=0.52)฀ or฀ dobutamine฀ (kappa=0.51).฀ Sensitivity฀ for฀ predicting฀ functional฀ recovery฀ tended฀ to฀ be฀ higher฀for฀levosimendan฀than฀for฀dobutamine฀echocardiography฀(72%฀vs.฀60%,฀P=0.18)฀ while฀specificity฀tended฀to฀be฀higher฀for฀dobutamine฀(89%฀vs.฀80%,฀P=0.08). Conclusion:฀ Levosimendan฀ echocardiography฀ is฀ a฀ novel฀ test฀ for฀ identification฀ of฀ myocardial฀viability฀after฀a฀MI฀and฀for฀prediction฀of฀functional฀improvement฀after฀coronary฀ revascularization฀that฀compares฀favorably฀with฀dobutamine฀echocardiography. 11:45฀a.m. 880-8฀ Relationship฀Between฀Systolic฀and฀Diastolic฀Function฀ During฀Dobutamine฀Stress฀Echo฀in฀Patients฀With฀ Coronary฀Heart฀Disease Francesca฀Innocenti,฀Vittorio฀Palmieri,฀Chiara฀Agresti,฀Francesca฀Caldi,฀Giulio฀Masotti,฀ Riccardo฀Pini,฀University฀of฀Firenze฀and฀AOU฀Careggi,฀Florence,฀Italy,฀University฀ Federico฀II,฀Naple,฀Italy Background:฀Cross-sectional฀studies฀have฀demonstrated฀that฀left฀ventricular฀(LV)฀systolic฀ and฀diastolic฀function฀are฀intercorrelated.฀The฀extent฀to฀which฀the฀change฀in฀myocardial฀ systolic฀function฀correlates฀with฀the฀parameters฀of฀LV฀diastolic฀function฀is฀unclear. Methods:฀ 48฀ patients฀ with฀ history฀ of฀ coronary฀ heart฀ disease฀ (age฀ 61±10฀ years,฀ body฀ mass฀ index฀ 26.2±4.1฀ kg/m2)฀ underwent฀ assessment฀ of฀ wall฀ motion฀ score฀ index฀ (WMSI)฀ and฀ diastolic฀ function฀ at฀ baseline฀ and฀ during฀ low฀ dose฀ dobutamine฀ stress฀ Noninvasive Imaging 11:00฀a.m. 880-6฀ ventricular฀(LV)฀diastolic฀filling฀pressure.฀We฀hypothesized฀that฀an฀increase฀in฀E/Vp฀during฀ low-dose฀ dobutamine฀ echocardiography฀ (LDDE),฀ reflecting฀ compromised฀ LV฀ diastolic฀ filling฀reserve,฀could฀provide฀additional฀prognostic฀information฀beyond฀conventional฀stress฀ echocardiographic฀data฀after฀acute฀myocardial฀infarction฀(AMI). Methods:฀ In฀ 162฀ consecutive฀ patients฀ with฀ a฀ first฀ AMI,฀ LDDE฀ (10฀ µg/kg/min)฀ was฀ performed฀16±6฀hours฀after฀hospital฀admission.฀E/Vp฀was฀measured฀at฀rest฀and฀during฀ dobutamine฀infusion.฀Primary฀endpoint฀was฀all-cause฀mortality. Results:฀ During฀ follow-up฀ of฀ 25±11฀ months,฀ 33฀ patients฀ (20%)฀ died.฀ In฀ 33฀ patients,฀ E/ Vp฀ increased฀ during฀ LDDE฀ (mean฀ percent฀ increase฀ from฀ rest฀ to฀ LDDE฀ was฀ 15±14%,฀ p<0.0001),฀ which฀ was฀ associated฀ with฀ increased฀ mortality฀ rate฀ (Figure).฀ On฀ Cox฀ regression฀analysis,฀an฀increase฀in฀E/Vp฀(hazard฀ratio฀2.36฀per฀0.01฀unit฀increase,฀95%฀ CI฀1.05-5.30,฀p฀=฀0.04)฀was฀an฀independent฀prognostic฀indicator฀after฀adjustment฀for฀age,฀ Killip฀Class,฀ejection฀fraction,฀mitral฀deceleration฀time฀≤140฀ms,฀E/Vp฀at฀rest,฀and฀infarctzone฀viability฀by฀LDDE. Conclusions:฀ An฀ increase฀ in฀ E/Vp฀ during฀ LDDE฀ after฀ AMI,฀ suggestive฀ of฀ a฀ reduced฀ diastolic฀filling฀reserve,฀provides฀independent฀prognostic฀information฀beyond฀conventional฀ resting฀and฀stress฀echocardiographic฀measures฀of฀LV฀systolic฀function.฀ >85%฀MPHR฀on฀DSE฀ P฀value (No฀CI) 63±10 0.01 41.8 <0.001 Peak฀Heart฀Rate 880-5฀ 313A 314A ABSTRACTS - Noninvasive Imaging echocardiography฀(LDDOB,฀10฀µg/kg/min฀for฀3฀minutes,฀preceded฀by฀5฀µg/kg/min฀for฀3฀ minutes).฀Of฀the฀study฀sample,฀88%฀were฀men,฀79%฀had฀previous฀myocardial฀infarction฀ (44%฀anterior,฀31%฀inferior,฀4%฀nonQ).฀Beta-blocker฀was฀taken฀by฀81%฀of฀the฀sample,฀ which฀was฀withdrawn฀24฀hour฀before฀the฀LDDOB.฀The฀peak฀velocities฀of฀the฀early฀(E)฀and฀ late฀ (A)฀ LV฀ filling฀ waves฀ and฀ E฀ wave฀ deceleration฀ time฀ (DT)฀ were฀ measured฀ according฀ to฀standard฀protocol.฀The฀E฀wave฀propagation฀rate฀(Vp)฀was฀assessed฀by฀color฀Doppler฀ M-mode฀across฀the฀mitral฀valve.฀The฀Tei฀index฀was฀calculated฀as:฀(isovolumic฀relaxation฀ time+isovolumic฀ deceleration฀ time)/ejection฀ time.฀ The฀ changes฀ during฀ LDDOB฀ were฀ calculated฀as:฀100*(value฀during฀LDDOB฀-฀value฀at฀baseline)/baseline. Results:฀ At฀ baseline,฀ WMSI฀ correlated฀ with฀ Tei฀ index฀ (r=-0.43)฀ and฀ Vp฀ (r=0.65,฀ both฀ p<0.05),฀ but฀ not฀ with฀ E/A฀ and฀ DT.฀ During฀ LDDOB,฀ WMSI฀ changed฀ by฀ -8.3±8.1%฀ (on฀ average,฀ improved)฀ and฀ RR฀ changes฀ by฀ -7±12%;฀ Tei฀ index฀ changed฀ by฀ -22±35%,฀ Vp฀ increased฀by฀38±27%,฀E/A฀by฀15±39%฀and฀DT฀by฀8±22.฀During฀LDDOB,฀WMSI฀remained฀ significantly฀correlated฀with฀Tei฀index฀(r=0.36)฀and฀Vp฀(r=-0.60),฀and฀not฀with฀E/A฀and฀DT.฀ However,฀ the฀ change฀ (%)฀ in฀WMSI฀ from฀ baseline฀ to฀ LDDOB฀ did฀ not฀ correlate฀ with฀ the฀ changes฀(%)฀in฀the฀parameters฀of฀diastolic฀function฀(with฀delta฀EA฀r=-0.10,฀with฀delta฀DT฀ r=0.08,฀with฀delta฀Vp฀r=-0.22,฀with฀delta฀Tei฀index฀r=0.02,฀all฀p=NS). Conclusions:฀ While฀ we฀ found฀ that฀ the฀ myocardial฀ systolic฀ function฀ correlated฀ with฀ preload-insensitive฀parameters฀of฀diastolic฀function฀(Tei฀index฀and฀Vp)฀both฀at฀baseline฀ and฀during฀LDDOB,฀the฀change฀in฀myocardial฀contractility฀function฀during฀LDDOB฀was฀not฀ a฀predictor฀of฀the฀changes฀in฀the฀parameters฀of฀diastolic฀function. Noninvasive Imaging ฀฀฀฀฀฀฀฀฀฀฀฀฀฀ JACC February 1, 2005