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Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Real-time 3-dimensional echocardiography (RT3DE) is superior to 2D echocardiography in assessing left ventricular (LV) volumes and ejection fraction (EF), but its feasibility is limited by multibeat acquisition, which requires an optimal breath-hold and a regular heart rhythm. We sought to evaluate the accuracy and feasibility of single- and 2-beat RT3DE for LV volume and EF assessment.Sixty-six consecutive patients referred for cardiac magnetic resonance (CMR) underwent RT3DE and CMR on the same day. Of the 50 patients (age, 59±18 years; 68% men; 42% coronary artery disease; LVEF=49±14%; limits, 14% to 76%) with an adequate RT3DE image quality, accuracy for LV volumes and EF measurements of single- and 2-beat modalities were compared with the conventional 4-beat acquisition and CMR. Correlations with CMR for LV end-diastolic volume (161±59 mL, r=0.93 to 0.94) and end-systolic volume (86±56 mL, r=0.93 to 0.96) were excellent regardless of the number of cardiac cycles used. However, because of the low temporal resolution (7±2 volumes per second), single-beat underestimated LVEF (bias, -5±8%) with greater bias than 2-beat (bias, 1±6%, P<0.001) and 4-beat (bias, 3±7%, P<0.001) modalities. Interestingly, 2-beat provided accuracy similar to 4-beat for end-diastolic volume (bias, -17±21 mL versus -15±23 mL), end-systolic volume (bias, -9±16 mL versus -12±17 mL), and LVEF (bias, 1±6% versus 3±7%) measurements, but fewer stitching artifacts were observed with 2- than 4-beat modalities (3% versus 30%).Compared with conventional multibeat acquisitions, 2-beat modality provides similar accuracy in LV volume and EF measurements and should be preferred due to fewer stitching artifacts. In contrast, the temporal resolution of single-beat modality appears insufficient to provide an accurate estimation of LVEF. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study which investigated the longitudinal contractile marker relevant for clinical decision making for patients with chronic heart failure (HF). It was found that impaired longitudinal global strain of greater than nine percent is associated with increased cardiovascular events in HF patients. The findings also suggest that longitudinal global strain by speckle tracking is superior compared to strain rare (SR) and left ventricular ejection fraction (LVEF) in predicting chronic HF outcomes.

Background: Fetuin-A is an ubiquitary anti-inflammatory protein that counteracts CRP effects and has a protective effect against inflammation and myocardial ischemia. Low fetuin-A has been found to be associated with cardiovascular death in patients with end-stage renal failure disease. Low fetuin-A combined with high CRP level may be used to severe inflammatory imbalance and to predict outcome in acute coronary syndromes (ACS). Methods: We measured admission plasma fetuin-A and CRP level in 748 consecutive patients (65±13 years, sex, 389 with ST and 337 without ST elevation) included in the ACS French registry (Fast MI) and correlated these data with the outcome. Tertile was used to define low fetuin-A (tertile 1) and high CRP level (tertile 3). Results: Plasma fetuin-A and CRP concentrations at admission averaged 95±27mg/L and 11±16UI, respectively with low fetuin-A defined as <69mg/L and high CRP level as 25UI. At one year follow up (n=726, 97%), cardiovascular mortality (n=50, 7%) was 16% (18/111), 9% (21/250) and 3% (11/365) in patients with low fetuin-A/high CRP (n=111), either low fetuin or high CRP (n=250) and high fetuin-A/low CRP (n=365), respectively. By multivaritate analysis low fetuin-A/high CRP level remained independently predictive of outcome (OR=3.4 [1.6–7.3], p=0.001, Figure 1) after adjustment to ST elevation, GRACE score and medical treatment. In contrast, CRP and fetuin-A alone failed to predict outcome. Conclusions: Inflammatory imbalance assessed by combining fetuin-A and CRP values is an important predictor of cardiovascular death in ACS patients. Display Omitted [ABSTRACT FROM AUTHOR]

Background: In dysfunctional segment, contractility in delayed segments does not fully contribute to end-systolic function. This reserve of contraction (strain delay index) related to mechanical dyssynchrony is supposed to be greater in viable and ischemic segments than in infarct segments. Methods: Percutaneous coronary occlusion (circumflex) was performed in 13 anesthetized pigs to investigate changes in strain delay index during acute ischemia (after 3’ of occlusion) and after induced myocardial necrosis (>2 hours of occlusion). The strain delay index, which was defined as the difference between peak and end-systolic strain was computed from circumferential and radial strain curves obtained by speckle tracking analysis performed on short axis view. Results: In related coronary occluded segments, delayed myocardial contraction and impaired regional peak strain was observed during early ischemia for circumferential and radial strain. However, despite prolonged coronary occlusion, delayed contraction and peak circumferential and radial strain remained unchanged. In contrast, regional strain delay index showed a biphasic pattern with an increased during early ischemia and a significant decrease after a prolonged coronary occlusion. Conclusions: Delayed myocardial contraction and reduce peak strain by speckle tracking can be similarly observed during early and prolonged coronary occlusion. In contrast, regional strain delay index used to quantify contractile reserve appears to more sensitive to identify myocardial viability. Display Omitted [ABSTRACT FROM AUTHOR]

Purpose: In some patients, extensive myocardial dysfunction may be observed during acute coronary syndromes despite limited coronary lesions. Mechanism of depressed contractility during ischemia in remote segments is unclear. In the present study, we addressed the changes in myocardial deformation in remote segments during acute experimental ischemia. Methods: Acute myocardial ischemia was induced in 9 anesthetized pigs by balloon coronary occlusion (left coronary descending artery, n=6). Radial and circumferential strain by speckle tracking were computed in the 6 mid short axis segment using 2D echocardiography data acquired at 5’, 15’, 30’and 60’of induced ischemia. Results: Reduced in peak circumferential (−16%±2 vs. –6±2% p=0.04) and radial (45±5% vs. 17±6 p=0.002) strain occurred early after 5’of coronary occlusion and persisted during ischemia. Interestingly, reduced in peak radial strain (45±4% vs. 22±5% p=0.0005) was also observed in control segments (Figure) during the first stage of ischemia (5’). Compared to ischemic segments, impaired contraction in control segments was brief and recovered after 15’ of ischemia. Importantly only radial but not circumferential strain was affected in control segments. Conclusions: A brief reduction in radial motion was observed during acute myocardial ischemia in control segments. This may explain the occurrence of transient and extensive myocardial dysfunction during acute coronary syndromes despite limited lesions. Display Omitted [Copyright &y& Elsevier]

Background and aim Outcomes of AMI patients have substantially improved over the past 2 decades. Whether similar trends are observed in elderly (≥75 years of age) and younger patients has not been extensively studied. Methods We analysed one-year mortality of elderly vs younger patients in 4 nationwide French survey carried out 5 years apart from 1995 to 2010. Consecutive STEMI and NSTEMI patients (≤48 hours from onset) were recruited over one-month periods. Among 10610 patients included in the 4 surveys, 3389 (32%) were aged 75+. Results From 1995 to 2010, the proportion of 75+ remained stable in NSTEMI (1995: 36%, 2010: 38%), but decreased in STEMI patients (1995: 30%, 2010: 25.5%, P=0.006). Use of PCI ≤72 hours of admission increased from 6.0% to 54.9% in tin the past 15 years he 75+, and from 19% to 77% in the younger pts, use of new anticoagulants increased from 0 to 62% and 0 to 79%, respectively, and use of recommended secondary prevention medications from 2% to 43% and from 9% to 69% respectively. All clinical outcomes improved both in the 75+ and <75 age groups (Table). Risk of one-year death in 2010 vs 1995 was HR 0.48 (0.40-0.59) in the 75+ and HR 0.38 (0.29-0.50) in younger patients. When early use of PCI, recommended medications and new anticoagulants were added to the models, survey period was no longer significantly associated with one-year death. Conclusion In these 4 nationwide surveys of AMI pts conducted over a 15-year period, outcomes improved markedly in elderly as in younger patients. Most of the improvement in outcomes appear mediated by improved early management (use of PCI and medications). Abstract 0112 – Table: Evolution of outcomes from 1995 to 2010 across age groups <75 years (n=7.221) 1995-2000-2005-2010 ≥75 years (n=3.389) 1995-2000-2005-2010 VF 4.0 – 2.3 – 1.5 – 1.2% 4.6 – 4.9 – 2.0 – 1.0% AF 7.7 – 5.0 – 3.7 – 2.9% 21.5 – 16.8 – 9.5 – 10.1% Reinfarction NA – 2.3 – 1.5 – 0.8% NA – 2.9 – 2.4 – 1.8% Stroke NA – 0.7 – 0.7 – 0.4% NA – 1.6 – 1.4 – 0.5% Shock 4.7 – 4.4 – 4.0 – 2.7% 11.6 – 13.6 – 9.3 – 6.7% 30-day death 7.2 – 4.8 – 2.9 – 1.4% 25.0 – 16.8 – 13.0 – 8.4% One-year death 10.9 – 8.8 – 5.9 – 3.9% 36.2 – 30.0 – 26.9 – 20 0% [ABSTRACT FROM AUTHOR]

Article Full text available at: http://eurheartj.oxfordjournals.org/content/early/2015/08/28/eurheartj.ehv318 . [ABSTRACT FROM AUTHOR]

Aims To evaluate the prognostic impact of QRS width in patients with low-flow/low-gradient aortic stenosis (LF/LGAS). Methods and results Among 88 consecutive patients referred to our institution for LF/LGAS from September 1994 to March 2007, baseline demographic, clinical, echocardiographic and electrocardiographic data were collected. This population was divided in two groups according to baseline QRS duration (cutoff: QRS≥ 130ms). Follow-up data, including electrocardiographic evolution and overall mortality were analyzed. The mean follow-up duration was 3.1 (2.2-6.2) years. In the whole group, 67 patients underwent surgical aortic valve replacement. Forty-nine patients (56%) had a QRS duration≥ 130ms. Among operated patients, there was no significant change in QRS duration between baseline and latest follow-up (126±26 vs. 131±25ms; p=0.82). In addition, wider QRS was a strong independent predictor of overall mortality [HR=2.20; CI, 1.15–4.24; p=0.027]. Conclusion Significant intra-ventricular conduction disturbances are common in patients with LF/LGAS and do not recover after aortic valve replacement. QRS duration is strongly associated with mortality in this selected population. [ABSTRACT FROM AUTHOR]

Background The rational and the benefit of load expansion is controversial in acute pulmonary embolism (PE). Diuretic may reduce RV preload and improve hemodynamic status. The present study reported the safety of furosemide in normotensive acute PE with oligo-anuria. Methods and Results We prospectively included 68 consecutive normotensive patients (systolic blood pressure ≥90 mmHg) admitted for acute PE with oligoanuria and RV dilation. RV dilation was defined by a right and left ventricular diameter ratio >0.6. Overall, 29 patients were treated by a repeated bolus of furosemide (83±84 mg, range 40 to 160 mg), while 39 patients received isotonic saline solution (1.6±0.8 L, range, 0.5 to 4,0 L). Patients treated by furosemide and fluid expansion had similar severity of hypoxemia but the furosemide group had lower admission blood pressure (119±21 mmHg vs. 132±18 mmHg, P=0.007) and greater shock index defined as heart rate and blood pressure ratio (0.81±0.23 vs. 0.69±0.18, P=0.02). Despite these differences, only the furosemide group had decrease shock index (0.81±0.23 vs. 0.62±0.17, P<0.0001) with improved systolic blood pressure (119±21 mmHg vs. 133 ±18 mmHg, P<0.001), heart rate (93±19 bpm vs. 81±18 bpm, P<0.001), and creatinin level. Finally, more patients were weaned in oxygen at 24 hours (39% vs. 19%) and in-hospital survival without death and PE-related shock was similar between the two groups (93% vs. 95%). Conclusions In normotensive PE with oligoanuria and RV dilatation, diuretic can be safely delivered to improve systolic blood pressure and oxygenation. [ABSTRACT FROM AUTHOR]

Background To assess the prognostic value of right ventricular (RV) function by 2D global strain, RV fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE) in patients referred to cardiac surgery. Methods The study included 344 patients (67±13 years, LVEF= 52%±12%) referred for left side cardiac surgery (121 isolated CABG, 146 aortic valve surgery, EuroSCORE 10.5%±13). RV function before cardiac surgery assessed by RV-2D global strain by speckle tracking (6-segments model), RVFAC and TAPSE was compared to postoperative outcome defined by one-month mortality. Results RV-2D global strain was feasible in 73% of patients (n=250), while RVFAC and TAPSE were computed in all. RV-2D global strain averaged - 18±5% and moderately correlated with RVFAC (r=-0.49, P<0.0001) and TAPSE (r=-0.42, P<0.0001). RV dysfunction was more observed by 2D-strain [61% (n=152) and 47% (n=118) for RV-2D global strain>-20% and >-18%, respectively] than by TAPSE<16 mm (14%) and RVFAC<35% (6%). Univariate analysis showed that RV-2D global strain (AUC=0.72, P<0.001), TAPSE (AUC=0.65, P=0.009) and RVFAC (AUC=0.63, P=0.02) were all predictive of postoperative mortality (n=26, 7.5%) but only RV-2D global strain remained associated with outcome (OR=1.1, P=0.03) by stepwise multivariate analysis adjusted to Euroscore. Importantly, in patients with RV dysfunction (RV-2D global strain>-18%), postoperative mortality was strongly reduced (7.5% vs. 24%, P=0.02) when cardiac pulmonary bypass duration was <2 hours. Conclusions RV-2D global strain appears more sensitive and superior to conventional 2D echocardiography markers for characterizing RV dysfunction and predict postoperative outcome. In patients with impaired RV-2D global strain, postoperative mortality may be reduced by shortening cardiac pulmonary bypass duration. [ABSTRACT FROM AUTHOR]

Background Global longitudinal strain (GLS) seems accurate for detecting sub-clinical myocardial dysfunction, and may therefore be used improve risk stratification for cardiac surgery. Methods and results Longitudinal strain (by 2D-speckle tracking) was computed in 425 patients (mean age 67±13 years, 69% male, LVEF 51±13%) referred for cardiac surgery (isolated coronary artery bypass graft [CABG, n=155], aortic valve surgery [n=174], mitral surgery [n=96]). Global longitudinal strain (global-ε) was assessed for predicting postoperative death. Despite a fair correlation between LVEF and global strain (r=-0.73, p<0.0001), 40% of patients with preserved LVEF (defined as LVEF ≥50%) had abnormal global-ε (defined as global-ε >-16%): -12.8±1.7%, range -15% to -8%. In patients with preserved LVEF, NT-proBNP level (983 pg/mL vs. 541 pg/mL, P=0.03), heart failure symptoms (NYHA class, 2.2±0.9 vs. 1.9±0.9, P=0.02) and the need of prolonged (>48H) inotropic support after surgery (33.3% vs. 21.2%, P=0.03) were greater when global-ε was impaired. Importantly, despite similar EuroSCORE (9.7±12% vs. 7.7±9%, P=0.2), the rate of post-operative death was 2.4 fold (11.8% vs. 4.9%, p=0.04) in patients with preserved LVEF when global-ε was impaired. Multivariate analysis showed that global-ε is an independent predictor for postoperative mortality (OR=1.10 [1.01-1.21]) after adjustment to EuroSCORE. Conclusions Global longitudinal strain has an incremental value over LVEF for risk stratification in patients referred for cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: Diffusion weighted magnetic resonance imaging (DWI) is used to identify tissue injury area in patients admitted for stroke. Limited study has been performed to evaluate its clinical interest in patients with acute ST elevation myocardial infarction (STEMI). Methods: The study included 17 patients (14 men, 55±14years, 12 anterior) with a recent STEMI (<7days) treated by percutaneous coronary intervention. A breath free ECG gated DWI sequence with increasing b values (0, 50, 100, 150 and 200sec/mm2) was applied in attempting to image myocardial injury. Hypersignal area was automatically computed from log transformed DWI sequences. The hypersignal area was compared to baseline (n=17) and left ventricular ejection fraction (LVEF) recovery (n=11). Results: Large area of hypersignal correlated with impaired baseline LVEF whatever b value (r value range between 0.58 and 0.60, p<0.05 for all). However, only hypersignal area with b=50sec/mm2 correlated with LVEF recovery (r=−0.61, p<0.05). Importantly, apparent diffusion coefficient failed to correlate with baseline and LVEF recovery. Conclusion: In patients with acute MI, hypersignal area from diffusion weighted magnetic resonance imaging with b=50sec/mm2 seems to provide an accurate assessment of myocardial injury and may be used to predict LVEF recovery. [ABSTRACT FROM AUTHOR]

Background: The impact of antidiabetic medications on clinical outcomes in patients developing acute myocardial infarction (MI) is controversial. We sought to determine whether in-hospital outcomes in patients who were on sulfonylureas (SUs) when they developed their MIs differed from those of diabetic patients not receiving SUs, and whether clinical outcomes were related to the pancreatic cell specificity of SUs. Methods and Results: we analyzed the outcomes of the 1310 diabetic patients included in the nationwide French registry of Acute ST-elevation and non ST-elevation myocardial infarction (FAST-MI) in 2005. Medications used before the acute episode were recorded. In-hospital complications were analyzed according to prior antidiabetic treatment. Mortality was lower in patients previously treated with SUs (3.9%), versus those on other oral medications (6.4%), insulin (9.4%) or no medication (8.4%) (p=0.014). Among SU-treated patients, in-hospital mortality was lower in patients receiving pancreatic cell-specific SUs (gliclazide or glimepiride)(2.7%), compared with those on glibenclamide (7.5%) (p=0.019). Arrhythmias and ischemic complications were also less frequent in patients receiving gliclazide/glimepiride. The lower risk in patients receiving gliclazide/glimepiride versus glibenclamide persisted after multivariate adjustment (OR=0.15; 95%CI: 0.04–0.56) and in propensity score-matched cohorts. Conclusion: In this nationwide registry of patients hospitalized for acute MI, no hazard was associated with the use of SUs before the acute episode. In addition, patients who had previously received gliclazide/glimepiride had better in-hospital outcomes, compared to those on glibenclamide. [ABSTRACT FROM AUTHOR]

Objective: Increase left ventricular (LV) filling pressure strongly impacts on heart failure (HF) prognosis. Diastolic global strain rate (E''SR) by speckle tracking appears superior to tissue Doppler imaging (TDI) in assessing of LV filling pressure. However, their prognosis value in HF patients has never been compared. Methods: The study included 120 consecutive symptomatic HF patients (63±16 years, 77% male, LVEF=31±10%, 61% NYHA III–IV). LV filling pressure was assessed by the ratio of early diastolic mitral pulsed Doppler (E) over E''SR by speckle tracking computed from strain rate curves of apical views. E/E''SR was compared to E/E’TDI and the occurrence of major adverse cardiac events (MACE). Results: E/E’ averaged 18.4±11.9 by speckle tracking and correlated with the severity of NYHA functional class (11.4±3.8 vs 18.7±8.1 p=0.02 for class I and class II–IV, respectively), BNP value (r=0.27 p=0.02), LVEF (r=0.25 p=0.006) and E’/E’ by TDI (r=0.57 p<0.0001). During the follow-up period (266±177 days), MACE occurred in 47 (38%) patients (15 death, 29 recurrent HF and 4 heart transplantations). By univariable analysis, E/E''SR and E/E’TDI were associated with the occurrence of MACE. But, only E/E''SR (OR 1.43, p=0.02) and LVEF (OR 0.95, p=0.004) remained associated to outcome by multivariate analysis. Importantly, E/E''SR>18 (optimal cut-off value defined by ROC curves,) was associated with an increase of risk of MACE by 4 (Figure). Conclusion: LV filling pressure by speckle tracking is superior to TDI to predict outcome in HF patients. Display Omitted [Copyright &y& Elsevier]

Objective: To assess whether LV mechanical dyssynchrony may be used to predict response to CRT in patients with narrow QRS complex (<120ms). Methods: CRT was performed in 183 symptomatic heart failure patients (64±12 years, EF=25±8%) with narrow (n=41) and wide QRS complex (n=142). Mechanical dyssynchrony before CRT implantation was quantified by the 12 segment standard deviation of peak longitudinal strain by speckle tracking (12SD) and the strain delay index (SDI) defined as the sum of difference between end systolic and peak strain across the 16 segments. Results: Before CRT, wide and narrow QRS patients had similar 12SD (100±32ms vs. 105±35ms) and SDI (36±14% vs. 38±15%). However, in wide QRS patients, QRS duration decreased after CRT (143±35ms vs. 120±34ms, p<0.0001) and ESV reduction (mean=−21%, ESVR>15% in 66%, 92/139) correlated with SDI (r=0.41, p<0.0001) and 12SD (r=0. 21, p=0.01) before CRT. In contrast, in narrow QRS population, QRS duration increased after CRT (96±16ms vs. 108±28ms, p=0.006) and ESV reduction (Mean=−11%, ESVR>15% in 39% (25/41) failed to correlate with mechanical dyssynchrony before CRT. Importantly, increase in QRS duration after CRT in narrow QRS population was associated with adverse remodeling (r=0.43, p=0.01) and tended to correlate with an increase in SDI after CRT (r=0.32, p=0.08). Conclusion: Response to CRT does not correlate to the importance of mechanical dyssynchrony in narrow QRS population. The benefice of CRT despite a significant LV dyssynchrony appears counterbalanced by a significant QRS enlargement after CRT implantation in narrow QRS population. [ABSTRACT FROM AUTHOR]

Background: Left Ventricular Ejection Fraction (LVEF) is commonly used to identify patients at high risk of sudden cardiac death and ventricular arrhythmia. However LVEF by Simpson biplane method may be challenging in heart failure patients with severe LV deformation and abnormal wall motion. The aim of the study was to assess the additional value of global longitudinal strain by 2D speckle tracking in predicting the occurrence of ventricular arrhythmia. Methods: The study included 45 heart failure patients (86% men, 64±22 years, 60% ischemic) with left ventricular dysfunction (median=28%, range 13 to 47%) referred for Implantable Cardiac Defibrillator (ICD). LVEF and longitudinal global strain by speckle tracking before ICD implantation was compared to major cardiac outcome (MACE defined by cardiovascular death and ventricular arrhythmia). Results: Global strain averaged −7±3% (median=7%, range −3 to −13%) and correlated with LVEF (r=−0.71, p<0.0001). During the follow-up (380±272days), ventricular arrhythmia (n=17) and death (n=2) occurred in 42% patients. MACE did not differ according to LVEF (52% vs. 36%, p=0.3), and global strain median value (42% vs. 42%, p=0.9). However, in patients with LVEF<28%, MACE tended to be greater when global strain was > – 7% (100% vs. 41%, p=0.06). Conclusion: Global longitudinal strain by 2D speckle tracking may improve the identification of patients at risk of ventricular arrhythmia and death in heart failure population with severe left ventricular dysfunction. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to compare the accuracy of longitudinal diastolic velocity and strain rate (SR) obtained by tissue Doppler imaging (TDI), 2D and 3D speckle tracking in assessing left ventricular end diastolic pressure (LVEDP) Methods: LVEDP measurements were performed in 40 consecutive patients referred for coronary angiogram (mean age=60±15 years, mean EF=41±14%). A comprehensive transthoracic echocardiography (Artida, Toshiba) study was performed immediately after LVEDP measurement. Echocardiography data acquired included mitral early diastolic velocity (E) by conventional pulsed Doppler, early diastolic mitral annulus velocity by TDI (E’), and high frame rate 2 and 3D apical views. Global longitudinal SR by 2D (2DEGSR) and 3D (3DEGSR) were assessed using longitudinal strain curves from speckle tracking analysis. LV filling pressure estimated using echocardiography data (E/E’, E/2DE GSR, E/3DE GSR) were correlated to invasive LVEDP measurements. Result: On the whole, LVEDP averaged 13mmHg (5 to 32,) and best correlated with LV filling pressure assessed by 2D speckle tracking (r2 =0.65, p<0.0001). In contrast, conventional E/E’ by TDI and E/3DEGSR poorly correlated with LVEDP (see Figure). Conclusions: Longitudinal diastolic strain rate by 2D and not 3D speckle tracking appears superior to conventional E/E’ by TDI for assessing LV filling pressure. Display Omitted [ABSTRACT FROM AUTHOR]

Introduction: Central venous oxygen saturation (SvO2) provides an accurate assessment of oxygen delivery and organs consumption balance, and correlate with outcome in extra cardiac shock. Its prognosis value has never been specifically validated in heart failure patients with cardiogenic shock. Methods: SvO2 was prospectively assessed in 27 patients (60±17 years, 17 male, LVEF=25±6%) admitted for heart failure with cardiogenic shock. SvO2 before and after 24 hours (24H SvO2) of intra-venous inotropic and diuretic support in patients with cardiogenic shock was compared to control subject with compensate heart failure (n=12) and to in hospital outcome (death and heart transplant). Results: During hospitalisation period, major cardiovascular event occurred in 10 (36%) patients (6 deaths, 4 heart transplants). In patients with cardiogenic shock, admission SvO2 was lower than in patients with compensated heart failure (50±12, 66±6, 95% CI>58%) but increased after 24H of treatment (50±12, 59±8, p=0.002). Importantly, improvement in Sv02 at 24H (>58%, n=15) was associated with an excellent in hospital outcome (93%, 14/15), while a persistently low ScvO2 at 24H (< 58%) correlated with the occurrence of major cardiac adverse outcome (75%, 9/12). Furthermore, there was no difference regarding to clinical or echographical features between event free and poor outcome groups. Conclusion: Change in SvO2 under intra-venous inotropic and diuretic treatment is a strong predictor of outcome in patients with cardiogenic shock. [Copyright &y& Elsevier]

Objective: To assess the predictive value of peak global longitudinal strain (e) and e rate by speckle tracking to predict outcome in heart failure (HF) patients. Methods: The study included 112 consecutive patients admitted for HF (64±13 years, 81% male, 52% ischemia) with reduced left ventricular ejection fraction (LVEF<50%, mean =31±10%, range 10-49]. Longitudinal global-ɛ and ɛ rate by speckle tracking were curves computed from apical views and compared to the occurrence of major cardiac events (death, heart transplantation, and recurrent HF). Results: On the whole, peak systolic longitudinal global-ɛ and ɛ rate averaged -8± 3% [range -3 to -18] and -0.34±0.20s-1 [range -1.6 to -0.1], respectively. During the follow up period (208±149 days), major cardiac adverse events occurred in 40 (36%) patients (11 death, 23 recurrent HF and 4 heart transplantation). Univariable analysis using Cox model shown that global-ɛ, ɛ rate, LVEF, tricuspid annular plane systolic excursion, NYHA class and BNP level were associated with cardiac adverse event. However, only global-ɛ (OR1.2, p=0.025) and BNP level (OR1.3, p=0.024) were predictive of outcome by multivariable analysis. Conclusion: In patients admitted for heart failure with impaired LVEF, peak global strain by speckle tracking appears to be the only echocardiography predictor of adverse outcome. [Copyright &y& Elsevier]

Purpose: Post systolic shortening (PSS) and stretching motion occur early during ischemia. Delayed contraction in PSS and stretching motion does not fully contribute to left ventricular end systolic (ES) function and contribute to the left ventricular dysfunction. The wasted energy can be quantified as the difference between peak strain and end systolic strain and used to identify ischemic segments. Methods: Acute myocardial ischemia was induced in 9 anesthetized pigs by balloon coronary occlusion (left coronary descending artery, n=6). Circumferential strain by speckle tracking was computed from short axis view during ischemia at 5’, 30’and 60’. PSS was defined as peak strain occurring after ES and stretching motion as positive systolic peak strain. Results: Before induced ischemia, PSS was observed in 38% segments and stretching motion was low (0±1%), then the wasted energy was limited (1±0%). During acute (5’) and prolonged (60’) coronary occlusion, stretching motion increased (4±2% at 5’, and 8±2% at 60’) and PSS became more prevalent (54% and 54%, respectively) and delayed in ischemic segment (3% and 12% of RR interval, respectively). This result the wasted energy was greater in ischemic than non ischemic segment (5±1% vs. 1±1% at 5’, p<0.001, 9±1% vs. 2±1% at 60’ p<0.001). Importantly, using ROC curves, a wasted energy of 25% identify ischemic segment with 70% of sensitivity and 74% of specificity. Conclusions: The wasted energy related to PSS and stretching motion appears accurate to identify early ischemic segments. [Copyright &y& Elsevier]