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Background Subtle structural and functional changes may precede the onset of overt global left ventricular dysfunction and obvious reduction of ejection fraction (EF), especially in young diabetics. Data pertaining to tissue velocity indices (TVI) and strain imaging to assess regional myocardial function and flow mediated vasodilatation is limited in young patients with diabetes. Purpose To evaluate conventional echocardiography parameters, tissue doppler indices, global and regional strain, carotid intimal medial thickness (CIMT), endothelial dependent (FMD) and independent function (NMD) of brachial artery in young patients (age Methods Conventional echocardiography parameters, tissue velocity indices (TVI) parameters along with strain (S), and strain rate (SR) in basal and mid left ventricular (LV) lateral wall, right ventricular (RV) lateral wall and septum were measured in 50 young diabetics (age 15.16±2.95 years, mean HBA1c 8.15±1.37 gm %) and 25 controls (age 15.60±2.51 years). Flow-mediated dilatation (FMD), nitrate mediated dilatation and carotid intimal media thickness (CIMT) were also estimated. Results Conventional echocardiography parameters were similar in patients and controls however deceleration time of the mitral inflow velocity (EDT) was significantly shorter in patients when compared with controls (149.06±31.66 vs. 184.56±19.27 ms, p Strain rate in diabetic patient Conclusion Left ventricular strain indices are impaired in asymptomatic children and adolescents with type 1 DM despite absence of overt heart failure and normal ejection fraction. Early detection of subclinical regional myocardial dysfunction by deformation analysis including strain and strain rate may be useful in the asymptomatic diabetic population. In addition, evidence of endothelial dysfunction in the form of impaired flow mediated vasodilatation was observed in the diabetic children. Acknowledgement/Funding None

The patho-physiology of apical ballooning syndrome (ABS) has not been clearly defined. The aim of this study was to determine whether patients with a history of ABS are more likely to develop left ventricular (LV) mid-cavity or outflow tract obstruction, or have a greater regional LV contractile response to an adrenergic stimulus compared with normal controls. Methods and results Twenty patients who had recovered from ABS and 15 age-and sex-matched controls had dobutamine stress echo- cardiography with incremental doses up to 20 mg/kg/min. On average ABS subjects had slightly greater basal LV inter- ventricular septal (1.1+0.24 cm vs. 0.93+0.12, P ¼ 0.03) and posterior wall (1.04+0.16 vs. 0.91+0.11 cm, P ¼ 0.02) diameters compared with controls but LV end-diastolic and end-systolic volumes and LV ejection fraction were similar both at rest and after dobutamine. Regional and global LV contractility, measured with the strain rate and tissue velocity imaging were also similar during the dobutamine infusion up to 10 mg/kg/min in ABS and controls. Mid- LV or LV outflow tract obstruction was not present at rest in any subjects, but was common during peak dobutamine infusion both in the ABS (45%) and controls (53%, P ¼ 0.62). Conclusions Dynamic LV obstruction with dobutamine is common in those with and without prior ABS. However, this study did not identify a greater individual predisposition to LV obstruction, or a different regional or global LV contractile re- sponse to dobutamine in patients with a history of ABS compared with control subjects.

Aims Previous research has described differences in left ventricular (LV) systolic tissue velocity between genders. This study aimed to determine the association between LV tissue velocity and LV size in healthy controls and in those with type 2 diabetes (T2DM). Methods and results LV tissue velocities were measured in 71 controls and 222 patients with T2DM by pulsed-wave Doppler and colour-coded tissue Doppler (TDI) during systole (S’ and Sm) and diastole (early, E’ and Em, and late, A’ and Am) at the basal septum and lateral wall. Both systolic tissue velocities were higher in males than in females within controls (S’: 7.3+ 1.2 vs. 6.6+ 1.0 cm/s; P ¼ 0.017, Sm: 6.2+ 1.0 vs. 5.5+ 0.7 cm/s; P ¼ 0.002) but only by colour-coded TDI in patients with T2DM (Sm: 5.7+ 1.7 vs. 4.9+ 1.7 cm/s; P ¼ 0.025). Correction for LV length negated the difference between genders in the controls and patients with T2DM (P . 0.05 for all). In controls, LV length was the strongest predictor of S ’( b ¼ 0.393, P ¼ 0.002), whereas height was the strongest predictor of Sm (b ¼ 0.394, P ¼ 0.003). Conclusion In controls, systolic tissue velocities are significantly higher in males compared with females, which may be explained by the increased chamber size of men.

Aims To study global and regional left atrial (LA) mechanics in chronic primary mitral regurgitation (MR) with echocardiography. Methods and results LA volumes during reservoir, conduit, and contractile phases were measured in 27 MR patients and 25 controls. LA ejection fraction (EF) and ejection force were calculated. Reservoir (SR-R), conduit (SR-C), and contractile phase (SR-A) strain rates, and reservoir phase strain were obtained. LA volumes were higher in MR in all phases. In MR, ejection force was increased (21.5 vs. 12.3 kdynes, P = 0.001); reservoir phase strain (32.91 ± 14.26%), SR-R (2.65 ± 0.87), SR-C (−2.02 ± 0.58), and SR-A (−2.55 ± 1.31 s−1) were increased (23.14 ± 7.96%, 1.62 ± 0.53, −1.29 ± 0.59, −1.98 ± 0.65 s−1, in controls, respectively, P ≤ 0.004). Regional deformation correlated with corresponding volumetric parameters. Despite enhanced SR-A in MR, LA EF was unchanged (31.34 vs. 29.23%, P = ns), and LA contractile tissue velocity ( A ′) was reduced (−5.39 ± 1.95 vs. −6.91 ± 1.80 cm/s, P = 0.006). The LA contractile contribution to left ventricular filling was significantly reduced in MR. Conclusion LA deformation is increased in all phases in MR. Unchanged LA EF and reduced A ′ may reflect the reduced contractile contribution to left ventricular filling.

Aims: Movements of myocardial walls include components of high velocity and short duration calling for a high sampling rate in the acquisition of tissue velocity imaging data. This study aims at establishing the optimal sampling requirements for tissue velocity imaging measurements. Methods and Results: In 16 healthy individuals, tissue velocity imaging data were acquired at a frame rate of 141–203 frames/s for a subsequent off-line analysis using software enabling a reduction of the sampling rate to 50%, 25% and 12.5% of the initial frame rate. Different components of the myocardial velocity profile were measured at each of these frame rates. The deviation of the results from the initial values increased markedly at decreasing frame rates, producing an underestimation of peak systolic and diastolic velocities, most other measured parameters being overestimated. A cut-off point for an acceptable 10% deviation of the results corresponded to at least 70 frames/s for peak systolic and early diastolic velocity, and to at least 100 frames/s for other systolic and diastolic parameters. Conclusion: A high sampling rate is essential for a proper rendering of tissue velocity imaging signals, too low frame rates resulting in inferior accuracy of the results. This should be kept in mind while viewing reported tissue velocity imaging data.

0.66, p< 0.05). The normal group did not show a correlation between the acceleration of transmitral flow and mitral annular relaxation velocity (r=0.18, p < 0.22). Those with diastolic dysfunction also had a lower E/A ratio than the normal group (0.7 ± 0.2 vs. 1.9 ± 0.5, p < 0.001), a higher time-velocity integral of the atrial component (11.7 ± 3.2 cm vs. 5.5 ± 2.1 cm, p < 0.0001) and a lower rate of acceleration of blood across the mitral valve (549.2 ± 151.9 cm/sec2 vs. 871 ± 128.1cm/sec2 ,p