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Diagnostic Testing JACC February 21, 2006

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Diagnostic Testing JACC February 21, 2006 94A ABSTRACTS - Diagnostic Testing JACC February 21, 2006 POSTER SESSION 902-3 Prognostic Value of Regional Versus Global Measures 902 of Left Ventricular Function Following Myocardial Coming of Age: Echocardiography Infarction: The VALIANT Echo Study Jens Jakob Thune, Lars Kober, Marc A. Pfeffer, Hicham Skali, Nagesh Anavekar, Eric Sunday, March 12, 2006, 9:00 a.m.-12:30 p.m. J. Velazquez, Karen S. Pieper, Jalal K. Ghali, J. Malcolm O. Arnold, John J.V. McMurray, Georgia World Congress Center, Hall B1 Scott D. Solomon, Brigham and Women’s Hospital, Boston, MA, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC Presentation Hour: 9:00 a.m.-10:00 a.m. Background: Left ventricular (LV) systolic function is an important predictor of outcome 902-1 Predictors of Death in Patients With Atrial Fibrillation: following myocardial infarction (MI). It is unclear whether measures of global or regional The Role of Echocardiography systolic function are better prognostic indicators following MI. Methods: We analyzed echocardiographic studies from 507 patients with LV systolic Yoko Miyasaka, Marion E. Barnes, Stephen S. Cha, Kent R. Bailey, Walter Abhayaratna, dysfunction (SD), heart failure (HF), or both following MI, from the VALIANT trial. We Lori A. Carlson, James B. Seward, Teresa S. M. Tsang, Mayo Clinic, Rochester, MN compared the predictive value of LV ejection fraction (EF), measured by the Simpson’s-rule method, with wall motion index (WMI) based on the American Society of Echocardiography Background: Atrial fibrillation (AF) independently confers mortality risk. We sought to 16-segment model. Endpoint was all-cause death or hospitalization for HF. determine whether echocardiographic assessment of left ventricular ejection fraction and Results: The mean LVEF and WMI were 0.39 and 1.85. Both measures were significant left atrial size enhances prediction of death in patients with AF. predictors of outcome in univariable and multivariable models, adjusting for baseline Methods: All Olmsted County, MN, residents who developed first diagnosed ECG- clinical covariates. LVEF conferred no additional prognostic information in a multivariable confirmed AF over the period 1980-2000, and had echocardiographic assessment within analysis including WMI, but WMI remained a significant predictor of outcome even when 30 days of the AF diagnosis, were identified. Clinical and echocardiographic predictors of adjusting for LVEF. death were determined using Cox proportional hazards models. Conclusions: In patients with MI complicated by LVSD, HF, or both, WMI, which Results: Of a total of 4,618 subjects (mean age 73 ± 14 years; range 18 to 107 years; assesses regional myocardial function, confers greater prognostic value than LVEF, a 51% men) confirmed to have developed first AF, 1,039 subjects (mean age 71 ± 15 global measure of ventricular function. years; range 21 to 102 years; 53% men) met study criteria. Of these, 496 (48%) subjects died over a mean follow-up time of 4.7 ± 3.2 years. In a multivariable model, aside from Univariable advancing age (HR 1.07, 95% CI 1.06-1.08, P<0.0001), and male sex (HR 1.22, 95% CI Overall HR 95% CI χ2 P 1.03-1.47, P=0.047), the other predictors of death are listed in the Table below. Lower left model χ2 ventricular ejection fraction and larger left atrial dimension were independently associated LVEF (per 10 unit decrease) 2.06 1.56-2.73 25.5 <0.0001 with higher mortality risk WMI (per 0.1 increase) 1.21 1.14-1.27 43.8 <0.0001 Conclusion: In patents diagnosed with first AF, simple assessment of echocardiographic Multivariable* Diagnostic Testing left ventricular ejection fraction and left atrial size at the time of AF diagnosis were LVEF (per 10 unit decrease) 1.74 1.30-2.35 13.4 0.0002 96.6 independent of and incremental to clinical risk factors for the prediction of death. WMI (per 0.1 increase) 1.16 1.09-1.23 23.1 <0.0001 110.2 Table: Multivariable Model for Prediction of Death Multivariable* including LVEF and WMI Hazard Lower Upper LVEF (per 10 unit decrease) 1.27 0.91-1.78 2.0 0.16 109.7 Variable P-value Ratio 95% CI 95% CI WMI (per 0.1 increase) 1.14 1.06-1.22 13.8 0.0002 BMI (per kg/m2) 0.98 0.96 0.99 0.008 *Adjusted for age, creatinine, atrial fibrillation, diabetes, history of HF, previous MI, VHD 1.37 1.12 1.67 0.003 history of angina, worst Killip class during index admission, history of hypertension. HR, CHF 1.68 1.30 2.17 <0.0001 hazard ratio; CI, confidence interval. HTN 1.28 1.10 1.48 0.002 DM 1.71 1.38 2.12 <0.0001 COPD 1.67 1.37 2.05 <0.0001 902-4 Cardiac Remodeling in Professional Tennis Players Malignancy 1.18 1.06 1.31 0.002 Participating in Roland-Garros Grand Slam LVEF (per %) 0.99 0.98 0.99 <0.0001 Nicolas Mansencal, Dany-Michel Marcadet, Fabrice Martin, Bernard Montalvan, Olivier LA dimension (per mm) 1.01 1.00 1.03 0.023 Dubourg, Hôpital Ambroise Paré, AP-HP, Boulogne, France, Fédération Française de Tennis, Paris, France 902-2 Obesity Has No Effect on the Sensitivity Of NT-ProBNP Background: The practice of intensive sports may lead to cardiac changes No previous for Detection of Systolic and Diastolic Dysfunction: study has focused on tennis players. The aim of this prospective study was to analyze the Results From the ProBNP Investigation of Dyspnea in cardiac changes due to intensive tennis practice. the Emergency Department (PRIDE) Echocardiography Methods: We have systematically proposed a complete screening echocardiography Substudy to the professional tennis players participating in the 2004 Roland-Garros grand slam tournament in France. The study population consisted in 80 tennis players divided on Annabel A. Chen, Malissa J. Wood, Aaron L. Baggish, Daniel G. Krauser, Roderick Tung, 50 men (group Im) and 30 women (group Iw) and a control group matched to sex and Saif Anwaruddin, Michael H. Picard, James L. Januzzi, Massachusetts General Hospital, age (groups IIm (n=50) and IIw (n=30)). All subjects included in this study underwent Boston, MA a complete echocardiography (2D, M-mode, Doppler and TDI). All 2D/M-mode measurements were indexed by surface body area. LV mass >106 g/m² (woman) and Background: Obese patients have lower plasma levels of amino-terminal pro-B-type >111 g/m² (man)defined LVH. natriuretic peptide (NT-proBNP) than their lean counterparts. Whether the sensitivity of Results: LV mass was significantly higher in groups Im and Iw (p<0.0001). For men, 18 NT-proBNP for detection of echocardiographic abnormalities is significantly reduced in tennis players (36%) presented with LVH vs. 2 subjects in control group (p<0.0001). LV obese patients is not established. diameter and LVEF were not significantly different between groups. Right and left atrial Methods: Routine echocardiography was performed in 134 patients with dyspnea measurements were significantly higher in tennis players (p<0.003, see Figure). Significant enrolled in a study of NT-proBNP testing. The sensitivity of an NT-proBNP level > 300 pg/ correlations were observed for tennis players between age and right atrium (r=0.45, ml to detect LVEF < 50% and diastolic dysfunction was determined in patients stratified p=0.004) and between age and left atrium (r=0.35, p=0.04), but not for control groups. by body-mass index < 25, 25 to 30, and > 30 kg/m2. LVEF was determined by the modified Conclusions: Our study suggests that intensive tennis practice increases left ventricular Simpson’s method using biplane measurements of LV volumes. Diastolic dysfunction was mass and professional tennis players present a significant atrial remodeling. defined as early diastolic tissue Doppler velocity at the lateral mitral annulus (Ea) < 8 cm/ s, ratio of the early diastolic mitral inflow velocity (E) to Ea > 15, or diastolic dysfunction based on standard transmitral and pulmonary venous velocity criteria. Proportions were compared using the χ2 test.Results: There were 35, 41, and 48 patients in the 3 BMI groups. The percent of patients in each BMI group with echocardiographic abnormalities is shown in the Table. The sensitivity of an NT-proBNP level < 300 pg/ml to detect an LVEF < 50% for the 3 BMI groups was 100%, 95% and 94% (p = 0.65). When diastolic criteria were added, the sensitivity was 96%, 90% and 91% (p = 0.72). Conclusions: NT-proBNP measurement remains sensitive for the detection of systolic and diastolic dysfunction in obese patients. BMI < 25 BMI 25 to 30 BMI > 30 NT-proBNP (pg/ml) ≤ 300 >300 ≤ 300 > 300 ≤ 300 > 300 LVEF < 50% 6 40 2 44 2 31 E’ < 8 cm/s 3 46 2 27 2 23 E/E’ > 15 0 9 0 17 0 10 Diastolic dysfunction stage 1, 2 or 3 0 23 2 24 2 13 LVEF < 50% or diastolic abnormality 3 23 7 68 4 42 ACC_2006_3_DiagnosticTest A.indd 94 1/4/06 6:02:33 PM JACC February 21, 2006 ABSTRACTS - Diagnostic Testing 95A 902-5 Morphologic Ventricular Adaptations to Training 902-7 Correlation Between Acute Effect of Cardiac in Young Soccer Players and Swimmers: An Resynchronization Therapy and Mechanical Echocardiographic Study Dyssynchrony Measured by Tissue Velocity and Strain Gabriele Grippo, Valentina Di Tante, Marco Gianassi, Laura Stefani, Maria Concetta Parameters Robertina Vono, Loira Toncelli, Giorgio Galanti, Medicine Sports Centre, Florence, Italy Chinami Miyazaki, Yong-Mei Cha, Raul E. Espinosa, Barry L. Karon, Fletcher A. Miller, David L. Hayes, Robert F. Rea, Jae K. Oh, Mayo Clinic, Rochester, MN Background: Top-level training induces morphologic cardiac adaptations; the most significant change is cardiac hypertrophy.
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