P594Contrast transthoracic echocardiography as a gatekeeper for patent foramen ovale closureP595Mitral annular displacement in apical four-chamber view by speckle-tracking echocardiography as a simple index for left ventricular longitudinal systolic functionP596Impact of chronic glycemic control on left ventricular myocardial function in young patients with type 1 diabetes mellitusP597Association of left atrial function echocardiographic parametres with fibrosis assesed invasively in patients with sinus rhythm and atrial fibrillation undergoing ablation for atrial fibrillationP598Mitral annular calcification decreases diastolic tissue Doppler velocity(E') in regions affected with calcificationsP5992D longitudinal LV speckle tracking strain pattern in breast cancer survivors: sports activity vs exercise as prescription modelP600Catheter related atrial fibrillation is associated with left atrial deformation in patients with paroxsymal supraventricular tachycardia: a study of two-dimensional speckle tracking echocardiographyP601Early radiotherapy-induced ecg changes and their comparison with echocardiography in breast cancer patientsP602Renal function is a major determinant of decreased sub-epicardial longitudinal strain in hypertensionP603Evaluation of left atrial function in patients with non valvular atrial fibrillation post cardioversion: speckle tracking echocardiographyP604Myocardial dysfunction in ANCA vasculitis measured by two-dimensional speckle tracking echocardiographyP605CRT, arterial stiffness and ventricular-arterial coupling in HFrEFP606Mitral annular morphology and function in cardiac amyloidosis as assessed by three-dimensional speckle tracking echocardiographyP607Coronary plaque characterization in Egyptian metabolic syndrome patients using 64-MDCT

Background. The presence of patent foramen ovale (PFO) has been linked to many illness, including cryptogenic stroke, transient ischemic attack, migraine, platypnea-orthodeoxia syndrome and decompression sickness in scuba divers. Transesophageal echocardiography is the gold standard technique for the visualization of atrial septal anatomy, but it is a secondary level exam, not always available, with additional associated costs and not completely free from procedural risks. Standard transthoracic echocardiography (TTE) has a too low sensitivity for PFO screening. Purpose. The aim of the study was to assess the role of TTE associated with agitated saline contrast injection (contrast-TTE) as a gatekeeper for the identification of PFO in a large cohort of patients undergoing selection for percutaneous closure. Methods. A total of 200 patients undergoing a diagnostic work-up for the identification of PFO was imaged by contrast-TTE at rest and after provocative maneuvers (PM: Valsalva in all cases). Contrast TTE was graded from 0 to 4 on the bases of bubbles counting (0: no bubbles; 1: 30 bubbles; 4: complete LV opacification). PFO closure was performed after a consensual clinical decision by the cardiologist and the neurologist taking into account comprehensive imaging, clinical evaluation and thrombophilia screening. PFO closure was always monitored by intracardiac echocardiography. Results. At baseline contrast TTE was positive (≥2) in 34 patients (17%) while contrast TTE with PM was positive in 94 cases (47%). 27 out of 200 patients (14%) had an interatrial septal aneurysms. PFO closure was performed in 34 cases (17%). All of these had severe right-to-left shunting (≥3) at contrast TTE and 9 cases had also an interatrial septal aneurysms. The procedure was aborted in only 1 patient due to a complex defect anatomy. Conclusion. Contrast TTE with PM may be not only considered an accurate tool for the detection of PFO but may be also inserted in the diagnostic work- up as a primary gatekeeper for percutaneous closure. Severe shunting at contrast TTE influences final decision making in a large cohort of cases undergoing screening for PFO closure.