A98 ABSTRACTS - Imaging and Diagnostic Testing JACC March 11, 2008 ACC.E-POSTER CONTRIBUTIONS 9:00 a.m. 901 901-252 Severe Diastolic Dysfunction in Non-Hospitalized E-Poster Session 901 Patients Is Associated With Unexpectedly High Sunday, March 30, 2008, 9:00 a.m.-10:00 a.m. Mortality McCormick Place, South Hall Kofo O. Ogunyankin, Jasdeep Saluja, Andrew G. Day, Queen’s University, Kingston, ON, Canada 9:00 a.m. Background: The long-term prognosis associated with severe diastolic dysfunction (SDD) in the absence of clinical heart failure remains unresolved. 901-250 LEFT VENTRICULAR RESTRICTIVE FILLING AS Methods: The vital status of patients (n=238, females = 112) who had clinically indicated A PREDICTOR OF OUTCOME IN PATIENTS WITH outpatient echocardiograms in 2003, was determined by an observer blinded to CARDIAC RESYNCHRONIZATION THERAPY echocardiographic data. Consecutive echocardiograms on which a previously validated algorithm using lateral annulus Tissue Doppler, mitral and pulmonary vein Doppler, color Xuedong Shen, Mark J. Holmberg, Aryan N. Mooss, Tom Hee, Stephanie Maciejewski, M-mode, LV mass and ejection fraction (LVEF) data were applicable, are included. Each Dennis J. Esterbrooks, The Cardiac Center of Creighton University, Omaha, NE patient was classified into normal n=122, abnormal relaxation (AR) n=60, or SDD n= 56 We hypothesized that left ventricular restrictive filling (LVRF) is a predictor on responses diastolic function (DF) groups. Kaplan-Meier survival plots with log-rank trend test were to cardiac resynchronization therapy (CRT), mortality and regression of left ventricular calculated on the whole cohort and on a subset with LV ejection fraction ≥40%. The Cox mechanical dyssynchrony (LVMD). Method: We studied 100 consecutive patients on proportional hazards model was used to estimate hazard ratios. CRT (male 73, female 27, age 69.9± 9.6 years). Patients with atrial fibrillation and mitral Results:A history of angiography or revascularization was obtained in 139 (58%), valve stenosis were excluded. Patients were divided into normal or relaxation abnormality of which 51 (21%) had coronary disease proximate to echo study. Mean age (yrs) in (Group I), pseudonormalization (Group II) and restrictive filling (Group III), according to SDD, AR and normal groups were 70; 66; 58 respectively p< 0.001). Figure shows a the pattern of mitral flow and annulus motion by pulsed wave (PW) and tissue Doppler 4-yr survival of 65%, 91% and 89% respectively. SDD was associated with hazard ratios of 4.5 (C.I= 2.4-8.7; p<0001) unadjusted, and 2.5 ( 1.2-5.4; p=0.02) after adjustment for (TDI). The time difference (TPW-TDI) between QRS onset to the end of LV ejection by PW and QRS onset to the end of the systolic wave in basal segment with greatest delay by TDI age, sex and LVEF compared to normal+AR. In those with LVEF≥40%, SDD remained a strong predictor of death. was measured before CRT and 14.4 ± 10.5 months after CRT. TPW-TDI > 50ms was defined as LVMD. Positive response to CRT was defined as left ventricular end systolic volume Conclusions: In non-hospitalized patients, SDD is a prognostic marker for increased decrease of ≥15% after CRT. Results: Group I, II and III before and after CRT consisted mortality. of 29, 38 and 33 patients and 46, 28 and 26 patients. The percentage of CRT responders in Group III was lower than in Group I (p< 0.05). TPW-TDI in Group III did not reduced after CRT (p= 0.46, Table). Patients with LVRF either before or after CRT predicted a higher mortality compared to Group I (7% vs 33%, p= 0.03 and 4% vs 42%, p< 0.001) during follow-up of 17.0± 10.6 months. Conclusion: Patients with LVRF predicted a lower rate of positive response to CRT and a higher mortality after CRT. p (Group I p (Group II Group I Group II Group III vs III) vs III) Baseline 20.9±7 19.8±7 20.7±6.1 0.92 0.56 Imaging and Diagnostic Testing After 28.2±14.8 24.3±11.4 25.5±10.6 0.39 0.65 LVEF (%) CRT p 0.02 0.04 0.03 62% 37% 33% 9:00 a.m. Responders (%) < 0.05 0.95 (18/29) (14/38) (11/33) Baseline 90.1±53 72.5±42.1 63.6±49.3 0.05 0.41 901-253 Abnormal Arterial-Ventricular Function in Early Chronic After 44.9±23 44.9±29.5 55.4±39.2 0.21 0.2 Kidney Disease: a Pattern Resembling Heart Failure TPW-TDI (ms) CRT with Preserved Ejection Fraction p < 0.001 0.001 0.46 Nicola C. Edwards, Charles J. Ferro, Richard P. Steeds, John N. Townend, University 9:00 a.m. of Birmingham, Birmingham, United Kingdom, University Hospital Birmingham, Birmingham, United Kingdom 901-251 Sensitivity and Predictive Value of Transthoracic Background: Patients with early chronic kidney disease are more likely to die from Echocardiographic Findings in Patients with Suspected cardiovascular disease than to progress to end stage renal failure but vascular and Endocarditis ventricular function in this high risk group is poorly defined. We measured arterial and ventricular elastance (stiffness) in early CKD and healthy controls and examined their Arnold B. Meshkov, Haile Jones, Francis Burt, Behnam Bozorgnia, Peter Axelrod, relationship (arterio-ventricular coupling ratio). Temple University School of Medicine, Philadelphia, PA Methods: 107 patients with stage 2 (eGFR 60-89 ml/min/1.73m2) or stage 3 (eGFR 30-59 Background: Diagnosis of Infectious Endocarditis (IE) is often uses modified Duke ml/min/1.73m2) non-diabetic CKD were compared with 40 age and sex matched controls. Criteria (mDC) to define 3 categories: DefiniteD ( ), Possible (P), and Rejected (R). In All subjects were normotensive (24hr ABPM 125 ± 1 / 76 ± 1mmHg) and had no history patients with P IE, other criteria must be utilized to determine a diagnosis. Transthoracic of cardiovascular disease. Ventricular function and arterial-ventricular elastance were echo (TTE) findings other than vegetation (V) may be helpful in these patients. assessed by transthoracic echocardiography. Hypothesis: mDC results in a high % of P diagnoses. The presence of valvular Results: Arterial (Ea), LV end-systolic (Ees), LV end-diastolic (Eed) elastances were all regurgitation (Rg) and/ or thickening (T) has a high sensitivity (S) and negative predictive greater in CKD than controls (p<0.05) and were inversely correlated with eGFR (p<0.05). value (NPV) for the presence of V on transesophageal echo. Indexes of systolic function were preserved in CKD but diastolic function and LV relaxation Study Protocol: 167 patients were referred for evaluation of IE. All underwent TTE and were abnormal. Table 1. TEE within 7 days. mDC were used: D ( 2 major, 1 major and 3 minor, or 5 minor); P( 1 Conclusion: Early stage CKD is characterized by abnormal diastolic function and major and I minor, or 3 minor); or R. The presence or absence of Rg and/or T of the aortic, increases in arterial, ventricular systolic and diastolic stiffness but the arterio-ventricular mitral and tricuspid valves was noted by TTE. S of Rg and/or T for the presence of V on coupling ratio is preserved. This pattern of patho-physiological abnormalities closely TEE, and NPV of the absence of either were calculated. resembles that seen in heart failure with preserved ejection fraction and may contribute to Results: 45/167 (27%) of patients had neither Rg or T. The incidence of V on TEE in this the high levels of cardiovascular morbidity and mortality seen in patients with CKD. group was 4/45 (9%) (3 V found in D IE group, and 1 tricuspid valve V in the P IE group). Ventricular and Vascular function (†<0.05; ††<0.01 vs controls) 9/39 (23%) in D group had no V on TEE. CKD Stage CKD Stage Controls(n=40) # of patients Sensitivity NPV 2(n=27) 3(n=80) Arterial Elastance (Ea) (mmHg) 1.40±0.25 1.65±0.40† 1.74±0.48†† Definite 39 (23%) 27/30 (90%) 2/5 (40%) Arterial Elastance Index (EaI) 0.77±0.17 0.93±0.30† 0.93±0.29†† Possible 70 (42%) 7/8 (88%) 18/19 (95%) (mmHg ml/m2) End-systolic elastance 1.93±0.46 2.43±0.83† 2.43±0.78†† Rejected 58 (35%) 2/2 (100%) 21/21 (100%) (Ees)(mmHg/ml) Total 167 36/40 (90%) 41/45 (91%) End-diastolic elastance (Eed) 0.07±0.04 0.11±0.04†† 0.12±0.04†† Arterial-ventricular coupling ratio 0.73±0.16 0.71±0.16 0.75±0.19 Conclusion: mDC results in a high % of patients with P IE. The presence of valvular (Ea/Ees) Rg and/or T has a high S for V on TEE, and the absence of R and/or T a high NPV. In Ejection Fraction (%) 65.4±5.6 63.3±4.7 62.7±6.8 the absence of Rg or T, TEE added no diagnostic information in the R group. In the P IE Lateral annular TDI Sm (cm/s) 8.8±1.5 8.4±2.4 7.9±1.9 group, V on TEE is rarely found without significant Rg or T on TTE. These TTE findings E/Em 5.6±1.1 7.4±1.8†† 8.0±2.4†† can decrease the number of P diagnoses of IE by current mDC. LA volumes(ml/BSA) 19.7±4.9 25.7 ±5.4† 27.4 ±6.3†† JACC March 11, 2008 ABSTRACTS - Imaging and Diagnostic Testing A99 9:00 a.m.