Oral Abstract session: Stress echo in clinical practice: Friday 5 December 2014, 08:30-10:00 * Location: Agora

762 Table. Age (years) ,50 50-59 60-69 ≥70 Overall N 477 713 873 901 2,968 Peak SBP (mean+SD) 137+25 130+25 131+25 133+23 132+25 Hypertensive cut-point value (mean + 2SD) 187 180 181 179 182 Hypotensive cut-point value (mean -2SD) 87 80 81 87 82 763 Contribution of dobutamine stress echocardiography to the diagnosis and prognosis of low-flow/low-gradient aortic stenosis S. Aguiar Rosa1; G. Portugal1; L. Moura Branco1; A. Galrinho1; M. Afonso Nogueira1; J. Abreu1; D. Cacela1; A. Abreu1; J. Fragata2; R. Cruz Ferreira2 Hospital de Santa Marta, Cardiology, Lisbon, Portugal; Hospital de Santa Marta, Cardiothoracic Surgery , Lisbon, Portugal Purpose: Aortic valve replacement is the treatment of choice in patients (pts) with severe symptomatic aortic stenosis (AS). Pts with depressed left ventricular function and low ejection fraction (LVEF) present as a challenge. Dobutamine Stress Echocardiography (DSE) allows distinguishing fixed Low-Flow/Low-Gradient Aortic Stenosis (LF/LG AS) from pseudo severe AS. Methods: Retrospective analysis of pts who underwent DSE for severe AS investigation, between March 2001 and October 2013. DSE was performed in 3-5 min steps until a maximum dose of 20mcg/kg/min was reached. The baseline echocardiograms, peak DSE, and one year post-op follow-up echocardiograms were analysed. The following parameters were evaluated at basal and peak dose of DSE: left ventricular (LV) end diastolic volume (EDV) and LV end systolic volume (ESV) determined by the Simpson’s biplane method, LVEF, maximum gradient (MaxG), mean gradient (MG) and aortic valve area (AVA) determined by the continuity equation. AS was considered severe if AVA at peak dose was ≤ 1 cm2. The pts were divided into 2 groups according to follow up therapy: aortic valve replacement (GI) or only medical treatment (GII). The average of follow-up period was 26+37 months. Results: 56 pts were analysed, 77% men, with a mean age of 72+7 years. Severe AS was diagnosed in 37 pts (66%). Baseline echocardiographic characteristics were: AVA 0.79+ 0.24cm2, MaxG 45.1+11.6mmHg, MG 27.5+8.5mmHg, LVEF 38.3+13.9%, EDV 155+42 ml, ESV 100+46ml. Peak DSE showed: AVA 0.87+0.36 cm2, MaxG 69.0+ 23.7mmHg, MG 41.5+14.3 mmHg, LVEF 46.2+11.9%, EDV 144.3+35.5 ml, ESV 84.4+32.8 ml. 27 pts (48%) belonged to GI: 2 intervened by transcatheter aortic valve implantation (TAVI) and the remaining 25 by surgery. In GI the mortality was significantly lower than in GII (6pts (22%) VS 20pts (68%); p=0.001). One month after intervention the mortality was null. The survival after one year of follow-up was 91.7% in intervened pts (GI) and 67.9% in non-intervened pts (GII) (p=0.04). In GI with depressed LVEF, there was a significant improvement in LVEF (30.4+5.2% to 42.4+7.0%, p=0.003). On univariate analysis, the predictors of mortality were: age (p=0.023, OR 1.09), peak DSE EDV (p=0.037,OR 1.03), peak DSE ESV (p=0.01, OR 1.07), peak DSE LVEF (p=0.006, OR 0.90) and LVEF improvement , 20% during DSE (p=0.04, OR 1.26). Conclusions: LF/LG AS has a poor prognosis without intervention. DSE permits to establish the lesion severity and define predictors of mortality. In this study age, lack of contractile reserve, peak DSE LVEF,peak DSE EDVandpeak DSE ESVwere predictors ofmortality in follow up. Abstract 760 Figure. ii138 Abstracts Eur Heart J Cardiovasc Imaging Abstracts Supplement, December 2014 by gest on F ebuary 2, 2016 D ow nladed fom 764 The quantitative assessment of the rotation and twist of the left ventricle during dobutamine stress echocardiography A. Mielczarek; JD. Kasprzak; L. Chrzanowski; M. Plewka; P. Lipiec; D. Qawoq; T. Rechcinski; K. Wierzbowska-Drabik Medical University, Lodz, Poland Background: Rotation (R) and twist (T) of the left ventricle (LV) reflects three-layer structure of myocardium and can be assessed quantitatively by speckle tracking echocardiography (STE). Although evaluated in various clinical settings at rest it is poorly validated during stress echocardiography. Aim:Ouraimwas tocalculate and compare rotation atbasalandapical levelsofLVand net twist of LV at rest (0), during peak stage (1) and at recovery (2) of dobutamine stress echocardiography (DSE) in patients without significant lesions in coronary arteries and with negative DSE test. Methods: We analyzed 44 patients with angiographically excluded coronary stenosis ≥50% in left main and ≥70% in other epicardial arteries (27 female, mean age 60+10 years, mean heart rate at baseline 70+12, at the peak 134+17 and at the recovery 92+11, p,0.0001) in whom DSE was performed. Rotation was measured at basal and apical levels of LV. We compared peak systolic rotation (RPS), rotation measured at aortic valve closure (RAVC) and twist (Tcalculated as a difference of basal and apical RAVC) using paired t-test. Results: Neither peak systolic rotation nor rotation measured at endsystole changed significantly during DSE. Similarly twist was practically constant at rest, during peak stage of DSE and at recovery, amounting 6.388, 6.738 and 6.278 respectively, see Table. Conclusions: Peak systolic and end systolic rotation as well as twist of the LV showed distinct independence from heart rate during dobutamine stress echocardiography in patients without significant coronary stenoses. This relationship was observed both at basal and apical level of LV and suggests that rotational parameters are intrinsic features of individual LV mechanics which are constant despite changing inotropic and chronotropic challenge. Abstract 764 Table. Rotation and twist parameters during DSE764 Table. Rotation and twist parameters during DSE Parameter baseline (0) peak DSE (1) recovery (2) p RPS basal segments [8] 23.52+3.17 23.51+4.03 24.15+3.39 ns RPS apical segments [8] 3.93+3.48 3.98+3.75 3.14+2.83 ns RAVC basal segments [8] 22.91+3.33 23.17+3.94 23.87+3.37 ns RAVC apical segments [8] 3.62+3.33 3.71+3.52 2.87+2.73 ns Twist [8] 6.38+4.48 6.73+5.3 6.27+4.01 ns 765 Determinants and prognostic impact of Left Ventricular Contractile Reserve in asymptomatic Aortic Stenosis J. Magne1; E. Donal2; R. Dulgheru3; L. Pierard3; P. Lancellotti3 University Hospital of Limoges, Cardiology, Limoges, France; University Hospital of Rennes Hospital Pontchaillou, Rennes, France; University of Liege Sart Tilman, Liege, Belgium Background: The management of asymptomatic patients with severe aortic stenosis (AS) is extremely controversial. This emphasizes the profound need of new echocardiographic parameters accurate to identify patients at higher risk of poor outcome. There are very few data regarding the assessment, determinants and prognostic value of left ventricular contractile reserve (LVCR) in these patients. We aimed to quantify LVCR and to evaluate its determinants and usefulness for risk stratification in asymptomatic patients with severe AS. Methods and Results: Asymptomatic patients with severe AS (n=150, aortic valve area,1cm, 70+9 years, 64% of male) and preserved left ventricular (LV) systolic function (LV ejection fraction≥55%) were prospectively referred to exercise stress echocardiography. Using 2D speckle tracking analysis, LVCR was defined as an exercise-induced changes in LV global longitudinal strain .2%. LVCR was present in 62 patients (41%) and there was no significant difference between LVCR and no LVCR groups regarding demographic, clinical and exercise data, as well as risk factors. However, patients without LVCR had significantly lower E/Ea ratio and resting LV global longitudinal strain, and higher both resting and exercise indexed left atrial (LA) area. Using multiple linear regression, after adjustment for age, sex and E/Ea ratio, the independent determinant of exercise-induced changes in LV global longitudinal strain were aortic mean pressure gradient (b=0.05+0.02, p=0.005), LV ejection fraction (b=0.06+0.03, p=0.035) and exercise indexed LA area (b=0.20+0.06, p=0.002). During a mean follow-up of 19+12 months, 76 events (51%) occurred. The absence of LVCR was associated with reduced 4-year cardiac event-free survival (26+6 vs. 53+11%, p,0.0001). By opposition, exercise-induced changes in LV ejection fraction did not predict the outcome (p=0.96). In multivariate Cox proportional hazard model, the independent predictors of events were resting brain natriuretic peptide level (p,0.0001), aortic mean pressure gradient (p=0.037), exercise cardiac output (p=0.004) and absence of LVCR (hazard ratio=1.8, 95% of confidence interval: 1.05-3.08, p=0.033). Conclusion: In asymptomatic patients with severe AS, the main determinants of LVCR, as assessed using exercise-induced changes in LV global longitudinal strain, were related to AS severity and exercise LA size. The absence of LVCR is a powerful predictor of reduced cardiac event-free survival. These results strongly support the use of exercise stress echocardiography in asymptomatic AS. Abstracts ii139 Eur Heart J Cardiovasc Imaging Abstracts Supplement, December 2014 by gest on F ebuary 2, 2016 D ow nladed fom