P1357 Left atrial function decreases with age in patients with repaired tetralogy of Fallot decrease

BACKGROUND Left ventricular function has been shown to be an important prognostic indicator in patients with repaired tetralogy of Fallot (rTOF) and tends to decrease with age. In recent years, left atrial (LA) function was reported to be a useful prognostic indicator more than or equal to left ventricular function in acquired heart diseases. However, atrial function in rTOF has not yet been sufficiently examined. PURPOSE The aim of this study was to investigate the relationship between LA dysfunction and age in rTOF using strain analysis. METHODS In order to assess the relationship between LA function and age, we recruited 59 patients with rTOF ranging in age from 5-40 years. We stratified the patients into 3 groups (T1: 5-10 years, T2: 11-20 years, T3: 21-40 years) and divided 54 controls of similar age into 3 corresponding groups (N1, N2, and N3). Two-dimensional speckle tracking images (2D-STI) obtained from four- and two-chamber views were used to assess LA functions by measuring reservoir, conduit, and pump strain. Additionally, we measured the strain rate (SR) in the systole, early diastole, and late diastole. RESULTS LA reservoir strain (37.4 ± 2.2% vs. 47.9 ± 1.7%, P= 0.004), LA pump strain (8.3 ± 1.4% vs. 14.1 ± 2.7%, p <.001), atrial systolic LA-SR (1.5 ± 0.4% vs. 2.4 ± 0.6%, p <.001), and systolic LA-SR (1.5 ± 0.3% vs. 2.1 ± 0.4%, p = 0.003) were significantly decreased in T3 compared with N3. Although only LA conduit strain decreased with aging (r = -0.3204, p = 0011) in controls, all of the LA reservoir (r = -0.325, p = 0.020), conduit (r = -0.314, p = 0.025), and pump strain (r = -0.481, p < 0.001) in rTOF decreased with aging. Early diastole SR was significantly decreased in the T1 and T3 groups compared with the N1 and N3 groups (T1 vs N1, 3.00 ± 0.63% vs. 4.03 ± 0.0.80%, p <.0.001, T3 vs N3, 2.31 ± 0.57% vs.3.31 ± 0.47%, p < 0.001). Both systolic SR and late diastole SR decreased in T3 group compared with the N3 (1.54 ± 0.32% vs. 2.08 ± 0.42%, p = 0.003, 1.42 ± 0.32% vs.2.42 ± 0.61%, p < 0.001), respectively. Although only early diastole SR decreased with aging (r = -0.415, p < 0.001) in controls, all of the systole (r = -0.287, p = 0.041), early diastole (r = -0.337, p = 0.019), and late diastole SR (r = -0.407, p = 0.003) in rTOF decreased with aging. CONCLUSIONS In rTOF, most of the LA functions assessed by strain analysis decreased compared to normal controls in over 20 years old age. Furthermore, all measured functions decreased with age in rTOF while only two parameters decreased with age in normal controls. These results suggest that LA function may be an important indicator in long-term rTOF follow-up. These are new insights into LA function in patients with rTOF.

P1281 Are left atrial and left ventricular strains independent from each other?

Introduction Left atrium (LA) and ventricle (LV) share the mitral annular plane so that the motion and deformation of both chambers are coupled. Purpose To investigate the interdependence between LA and LV strain curves using strain-strain loops. Methods We included 101 patients with a wide range of pathology and selected for having sufficient image quality for both LA and LV analysis. Patients with a mobile interatrial septum and more than mild valvular regurgitation were excluded. LA and LV strains were assessed using speckle tracking in 4 and 2 chambers apical views, using the same cardiac cycle and R-R gating. Strain-strain-loops were reconstructed using LV strain data on the x-axis and corresponding, synchronized LA strain data on the y-axis (Fig .A). Linear regressions were calculated for the entire strain-strain-loop as well as for the three phases of the cardiac cycle (systole, early and late diastole) seperately. LA and LV volumes were also measured on the same images and their ratio was calculated and correlated with the slope of the regression line of the strain-strain loop (Fig. B). Results Our study population comprised normal volunteers (27), amyloidosis (8), hypertrophic cardiomyopathy (6), ischemic disease (19), non-ischemic cardiomyopathy (22), aortic stenosis (13) atrial fibrillation (6). On average, LA and LV strain curves correlated with an R2= 0.92 ± 0.04 for the entire loop, R2= 0.97 ±0.01 in systole, R2= 0.98 ± 0.02 in early diastole and R2= 0.97 ±0.03 late diastole. Further, in the individual patients, the ratio of LV/LA volumes correlated with the LA/LV strain ratio with a slope of ∼1.0 (R2 = 0.8). Conclusions LA and LV deformation are closely coupled. Strain curves have a similar shape throughout the cardiac cycle leading to a tight correlation of strain values from both chambers. The relation of LA and LV strain is dominated by the two chambers" dimensions. Abstract P1281 Figure.

P1388 LA and LV strains are closely linked in patients with diastolic dysfunction and preserved ejection fraction

Introduction Left atrial (LA) strain has been proposed as an independent parameter for the assessment left ventricular (LV) diastolic function. However, there is increasing evidence of impaired LV longitudinal function in patients with diastolic dysfunction(DD) and preserved ejection fraction (EF). Purpose To assess the relationship between LA and LV strain parameters with different grades of LV diastolic dysfunction in patients with preserved EF. Methods We included 95 patients with EF > 50% and good image quality. Patients with a mobile interatrial septum, more than mild valvular regurgitation and previous heart surgery were excluded. Standard echocardiographic measurements and the assessment of the diastolic function were performed according to current guidelines. LA and LV strains were assed using speckle tracking in 4 and 2 chambers apical views, using R-R gating. Strain values from LA and LV strain curves were derived in every phase of the cardiac cycle (peak systolic, early and late diastole strain). Results 26 patients had normal diastolic function, 23 had grade 1, 19 grade 2 and 13 grade 3 DD. Fourteen patients with indeterminate DD grade were excluded. Both peak LA and LV strain decreased significant with the degree of DD (Fig.). LA and LV early diastole strain were significantly higher in patients with normal diastolic function than any degree of DD. LA and LV late diastole strain increased in grade 1 DD. LA and LV strain parameters changes correlated significantly in systole, early and late diastole (r = 0.81,p < 0.0001; r = 0.64, p < 0.0001; r = 0.76, p < 0.0001, respectively). Other standard parameters of DD were not capable to differentiate between grades of DD. Conclusion LA and LV strain parameters show similar changes with increasing diastolic dysfunction. Diastolic dysfunction was regularly associated with reduced longitudinal strain in both LA and LV despite preserved EF. This suggest that both LA or LV strain could be used for the assessment of diastolic function. Abstract P1388 Figure. LA and LV strain parameters by DD

Abstract 10397: Higher Waist Circumference is the Start of Cardiovascular Structural and Functional Changes in Childhood Obesity

Background: Higher waist circumference (WC) is associated with cardiovascular disease, however, little is known about the association between WC and cardiovascular functional change in children. The purpose of this study is to examine the relationships between numbers of cardiovascular risk factors and left ventricular (LV) geometry and function in children. Methods: Echocardiography was performed in 311 children aged 7 to 13 years. Left atrial (LA) diameter, LV end-diastolic volume, ejection fraction, mass, mass-to-volume ratio, and carotid artery intima media-thickness (IMT) were measured. Transmitral peak flow velocities during early and late diastole and mitral annular myocardial velocities during early (Em) and late diastole (Am) were measured. LA systolic force and aortic stiffness were calculated. Lipids, uric acid, fasting glucose, insulin, high sensitive CRP, and homeostasis model assessment for insulin resistance (HOMA-IR) were also assessed. Subjects were divided into 4 groups: A group, WC within normal range; B group, increased WC; C group, increased WC plus any one of the following individual factors of hypertension, dyslipidemia (low high-density lipoprotein-cholesterol and/or high triglyceride), and raised fasting glucose; D group, metabolic syndrome. Results: Compared with the A group, LA diameter, mass/volume ratio, HOMA-IR, and uric acid were greater in the B group (p<0.05 for all). With increasing number of metabolic syndrome disorders (C and D groups), dyslipidemia, increased Hs-CRP, decreased Em/Am, enhanced LA systolic force, increased IMT, and aortic stiffening were observed (Table). Conclusions: Higher WC is associated with insulin resistance, hyperuricemia, and concentric LV hypertrophy. Cardiovascular structural and functional changes become apparent with increasing number of metabolic syndrome disorders. Our findings suggest that primary prevention programs should be initiated in children with increased WC.

Assessment Of Left Ventricular Diastolic Function By Doppler Echocardiography

Diastole is an essential part of the cardiac cycle, during which significant changes in myocardial function, ion and energy transfer, as well as coronary flow, occur. In contrast to systole, diastole consists of four phases, each of which has its distinguishing function and events. However, the four phases are inter-related with events in early diastole correlating with those in late diastole and those occurring during the isovolumic relaxation time predicting both. The complexity of diastolic phases is reflected in the ways by which diastolic function is assessed. While intra-cardiac flow velocities, into and out of the atria, are measured by pulsed-wave Doppler, those of wall motion are assessed by M-mode, myocardial Doppler velocities or, recently, speckle tracking technique. Optimum integration of various aspects of diastolic function should always be considered in order to obtain an accurate comprehensive assessment, bearing in mind factors that normally affect it, for example age.