K. Wierzbowska

Tissue Doppler echocardiographic identification of ischemic etiology in patients with dilated cardiomyopathy.

Objective. To compare the left ventricular function in patients with ischemic and nonischemic cardiomyopathy using tissue Doppler echocardiography (TDE). Methods. We studied 30 patients after myocardial infarction (MI group), 30 patients with dilated cardiomyopathy (DCM group) and 60 healthy volunteers in corresponding control groups. TDE velocities, time intervals of cardiac cycle were measured and dispersion index of TDE parameters was calculated. Results. Early diastolic velocities were lower in MI group than in DCM group, with similar systolic and late diastolic velocities. The dispersion index of systolic velocities was significantly higher in MI than in DCM group and in controls (respectively 33.1±6.0% vs 12.6±3.7% vs 15.9±5.6%; p < 0.001) and differentiated ischemic from idiopathic dilated cardiomyopathy. In MI group, preejection period was shorter and isovolumic relaxation and diastasis time were longer than in DCM group, with no differences in dispersion index of time intervals between the groups. Conclusions. TDE parameters: early diastolic velocity, preejection period, isovolumic relaxation time and the dispersion index of systolic velocities differentiate ischemic and nonischemic etiology of dilated cardiomyopathy.

752 Aortic wall thickness and pulsatility - do they represent the same aspect of atherosclerosis?

diastole. Study group consisted of 38 consecutive patients referred for the routine TEE. Thoracic aorta was scanned by rotational 3-D TEE. Reformatted datasets were reviewed and the lumen-intima and media-adventitia interfaces were determined. Serial volumetric calculations of 2 cm segments at three levels of the thoracic aorta were performed. The volume of lumen of two-centimeter segments measured at three levels of the thoracic aorta (30 cm, 35 cm and 40 cm from incisors) varied from 7.3 to 17.6 cm 3 (mean 12.0±3.2, 11.5±3.1 and 10.9±2.5 cm3 respectively). The volume of intimamedia complex varied from 0.5 to 5.0 cm 3 (mean 1.8±1.0, 1.6±1.0 and 1.7±1.1 cm3 respectively). Aortic pulsation defined as the difference between the largest and the smallest lumen volume of the same aortic segment varied from 0.0 to 2.8 cm3 (mean 1.3±0.5, 1.1±0.7 and 1.1±0.6 cm3 respectively). The intima-media complex volume was correlated with the aortic lumen volume (R2=0.55, p<0.001), but not with the aortic pulsation (R2=0.02, p=NS). The differences in the measurements of aortic lumen volume, aortic pulsation and intima-media complex volume by the same observer were 0.22±0.10 cm3, 0.07±0.08 cm3 and 0.21±0.06 cm3 respectively, whereas by two observers 0.23±0.15 cm3 ,0 .14 ±0.13 cm3 and 0.17±0.03 cm3 respectively. Following risk factors were independently related to the intima-media complex volume: hypertension (p<0.001), hyperlipidemia (p=0.032) and cigarette smoking (p=0.045). Age (p<0.001), diabetes (p=0.002), masculine gender (p=0.014) and family history (p=0.014) were related to the aortic pulsation. Conclusions: Aortic intima-media complex volume and aortic pulsation represent different aspects of aortic properties and are related to different clinical risk factors of atherosclerosis.

124 Utility of new Doppler parameters connected with elevated left ventricle end-diastolic pressure for identification of mitral inflow pseudonormalization

Purpose: We compared E/Ep and E/E’ ratios and other echocardiographic parameters between patients (pts) with normal (N) and pseudonormal (PN) mitral inflow, performed ROC analysis for detection of optimal cut-off values and assessed diagnostic value of this parameters for detection of pseudonormalization. Methods: Among 120 pts with coronary artery disease and 60 healthy persons examined by transthoracic echocardiography with assessment of diastolic function we selected the subgroup with E/A ratio between 1 and 2, and divided them into N and PN mitral inflow group according to E wave deceleration time. Propagation velocity was measured by color M-mode and tissue Doppler parameters were assessed in lateral segment of mitral annulus. Than we compared 15 pts with PN (mean age 57±11, male) and 54 persons with N pattern (mean age 55±9, male). Results: In N group E/Ep and E/E’ ratios were lower than in PN group (1,7+0,4 vs 3,5±1,3 for E/Ep and 6,3±2,1 vs 9±3,7 for E/E’; p<0,001). For cut-off values of Ev/Ep above 2,3 and of E/E’ above 8,2, sensitivity, specificity, positive predictive value, negative predictive value and accuracy for detection of PN were respectively: 87, 91, 72, 96, 90% and 60, 81, 47, 88, 77%. Area under ROC curve (AUC) for Ev/Ep= 0,921 was comparable with this for left atrium (LA) diameter (0,963) and was higher than AUC for parameters of pulmonary vein flow (0,814 for atrial reversal time and 0,779 for the difference of atrial reversal time and atrial wave duration of mitral inflow). Conclusions: Both Ev/Ep and E/E’ ratios are useful for differentiation of PN and N pattern. In our group of pts diagnostic value of E/Ep ratio was highly significant, greater than E/E’ ratio, comparable with enlarged LA diameter and slightly better than value of pulmonary flow parameters.

333 Prognostic value of systolic and diastolic echocardiographic parameters in patients after myocardial infarction after 18-months follow-up

Purpose: Our aim was to assess role of wide spectrum of echocardiographic parameters in prediction of combined cardiac events (death, myocardial infarction or exacerbation of heart failure) and cardiac deaths in 18-months follow-up in 60 subjects after myocardial infarction. Methods: We assessed classic two-dimensional and Doppler parameters, pulmonary vein flow, propagation of mitral waves and mitral annulus motion by pulsed tissue Doppler. After follow-up period combined endpoints and deaths were registered and on basis of cut-off values found by ROC analysis Kaplan-Meier survival curves were compared. Results: The greatest accuracy for detection of patients with combined endpoint showed: left atrium (LA)>44 mm, area under curve (AUC) 0,909, ejection fraction (EF) below or equal 34%, AUC 0,784, left ventricle diastolic (LVd)>51 mm, AUC 0,811 and systolic dimensions (LVs)>43 mm, AUC 0,798, early wave deceleration time (Edt) below or equal 130 ms, AUC 0,798 and difference of atrial reversal and atrial wave of mitral inflow duration (delta At) >23, AUC 0,781. For all above cutoff values comparison of survival curves revealed highly significant difference with p<0,001. Relative risk and 95% confidence intervals for combined endpoint are shown in table 1. For Edt below 130 ms and delta At above 23 ms all patients experienced combined endpoint. Multivariate analysis revealed only one independent predictor of both combined endpoint and deaths: LA dimension with cutoff values above 44 mm for combined endpoint (p=0,001) and above 46 mm for deaths, (p=0,004).