Background: Three-dimensional speckle-tracking echocardiography (3D-STE) is believed to be influenced by image quality, although quantitative evidence on this is limited. A previous evaluation indicated that sub-optimal image quality introduces a systematic bias in 3D-STE derived left ventricular (LV) deformation indices1, 2. Therefore, we aimed to quantify the extent of bias in proportion to impairment in image quality. Methods: This was a prospective experimental study. 18 healthy participants (age 31 ± 6 years, 83.3 % men) with good echocardiographic windows underwent 3D echocardiography (3DE). To impair the quality of the 3DE images of the LV in a reproducible and graded manner, a sheet of ultrasound-attenuating material, neoprene rubber, of three different thicknesses (2, 3 and 4 mm) was used to mimic mild, moderate and severe impairment in image quality respectively. 4 gated LV 3DE full-volume data-sets (including the optimal quality reference) were acquired per participant. All acquisitions were free of stitching artefacts and similar frame rates were maintained throughout. LV volumetric, and global and segmental LV deformation indices were measured. Mixed linear modelling was used to estimate the extent of bias. Results: There was a systematic bias in all global and segmental LV strains, and LV rotational indices. quality Conclusions: Abstract 2: First-phase ejection fraction is a powerful predictor of adverse events in asymptomatic patients with aortic stenosis preserved total ejection fraction Objectives First-phase ejection fraction (EF1), the ejection fraction up to the time of maximal ventricular contraction may be more sensitive than existing markers in detecting early systolic dysfunction. We examined the prognostic value of EF1 in patients with aortic stenosis (AS), a condition in which left ventricular dysfunction as measured by conventional indices is an indication for valve replacement. Methods Abstract 3: Improved Aortic Dimension Assessment With Specialist Echocardiography Clinics: A Quality Improvement Study. Background: Aortopathy is a common clinical problem. Guidelines recommend the use of double-oblique short axis imaging (CT/MRI) for significant aortic dilatation. Echocardiography is more readily available and cost effective. However accuracy and reproducibility is affected by operator variability. Good correlation between imaging techniques is vital for patient management, and may reduce health care expense and ionizing radiation. Objectives: We investigated the effect of dedicated specialist valve/aortopathy echocardiography clinics on accuracy of measurements and correlation with CT/MRI, compared to routine echocardiography performed outside these clinics. We hypothesized that a dedicated specialist based clinics would yield a better correlation with CT/MRI. Methods: 30 patients undergoing echocardiography in a specialist clinic for aortopathy, who also had correlative imaging with CT/MRI were retrospectively analysed. Aortic measurements were obtained using the inner edge to inner edge in end diastole method. Correlative imaging was compared for the aortic root (aortic annulus, sinus of valsalva, sinotubular junction) and ascending aortic measurements. A similar cohort of 25 patients outside specialist echocardiography clinic was used for comparison. Results: Patient Abstract 5: Introduction: BSE guidelines to assess the probability of pulmonary hypertension (PH) have been recently published. We present a contemporary dataset of patients attending a regional service for evaluation of PH. We audit BSE guidelines and highlight areas for potential development. Methods: 174 patients attending from August 2017 for PH assessment had echo and right heart catheter (RHC) data analysed from the RUH PH registry. Results: Of the 174 patients, 142 (82%) were diagnosed as having PH at RHC (mean RHC mPAP 44.4mmHg). Of those with RHC PH (n=142), 92 (65%) had high probability of PH based on echo assessment, 33 (23%) had intermediate echo probability of PH whilst 17 (12%) had low echo probability of PH (Figures 5 & 6). Only 2 patients with a high echo probability of PH (2%) had no RHC PH.

Patients with myocardial infarction (MI) are at risk of developing left ventricular systolic dysfunction (LVSD), with implications for quality of life, driving and mortality related to heart failure and sudden death. Current UK and European guidelines recommend inpatient echocardiography after MI, to identify those with severe LVSD. This guides early secondary prevention and consideration of prophylactic implantable cardioverterdefibrillator (ICD) therapy if severe LVSD is sustained after 6 weeks.