Abstracts S179 Eur J Echocardiography Abstracts Supplement, December 2006 ejection fraction (EF), sphericity index (SI), the wall motion score index (WMSI).The quantitative assessment of MR was performed using echocardiography by PISA method (regurgitant volume-RV and effective regurgitant orifice area- ERO were calculated) and CMR by using velocity encoded imaging by subtracting left ventricle stroke volume and aortic flow. Results: No correlations between the mitral deformation indices, nor the global left ventricle remodeling and severity of MR expressed as ERO and RV were established in the analysis of any parameters obtained in TTE. Upon using CMR a good correlation was observed between RV and end-diastolic mitral annular area (p<0.01; r=0.73), mitral annulus diameter - anterior mitral leaflet lenght ratio (p<0.01; r=0.72), coaptation height (p<0.01; r=0.69), respectively, and a weaker correlation between RV and end-systolic mitral annular area (p<0.1; r=0.49). Upon analysing left ventricle geometry parameters the strongest corre- lation was observed between RV and EDV/BSA (p<0.1; r=0.54). Conclusions: 1. In mild and moderate MR neither mitral deformation indi- ces, nor global left ventricle remodeling, as assessed by echocardiographic method, correlated with quantitative parameters of MR. 2. CMRI appears to be a more accurate and sensitive method in assessing left ventricle remod- eling and deformation of mitral valve than echocardiography. HEART VALVE DISEASE 1057 Changes in deformation in asymptomatic patients with isolated severe mitral regurgitation detected by strain rate imaging A. Marciniak 1 ; M. Marciniak 1 ; T. Karu 1 ; A. Baltabaeva 1 ; E. Merli 1 ; B. Bijnens 1 ; M. Jahangiri 1 ; G.R. Sutherland 1 1 St. George’s Hospital, Echo Dept., London, United Kingdom Early left ventricular (LV) dysfunction in patients with mitral regurgitation (MR) is often underestimated due to the lack of a sensitive diagnostic tool to monitor systolic function. To date, there is no specific and widely used diagnostic method to detect subclinical changes in systolic function before irreversible LV dysfunction occurs in MR. Aims: To assess changes in regional LV function by strain rate (SR) imaging in patients with MR before development of clinical features. Methods: 53 individuals were studied: 30 asymptomatic patients with iso- lated severe MR (age 55±11 y) and 23 age matched controls. All patients underwent a standard echo examination with a tissue Doppler study. SR and strain (S) data were acquired from the posterior wall (LVPW) - radial deformation and from LV lateral wall and septum (longitudinal deformation). Patients were excluded if they had ischemic heart disease. Results: Radial peak systolic SR in the LVPW was significantly decreased in patients with severe MR compared to controls (2.20±0.8 vs 3.00±0.57, p<0.005). Radial SR and S were inversely correlated with LV end systolic diameter (ESD) (Fig. 1). Longitudinal SR was significantly reduced in LV lateral wall compared to controls (1.27±0.56 vs 1.60±0.24, p<0.005) as well as in septum 1.15±0.51 vs controls 1.50±0.32, (p=0.008). Conclusions: SR imaging, could be a sensitive clinical tool in detecting sub- clinical deterioration in LV function in asymptomatic patients with severe MR. 1058 Evaluation of ventricular long axis contraction in patients with asymptomatic non-ischemic mitral valve regurgitation and normal systolic function I.A. Paraskevaidis 1 ; S. Kyrzopoulos 2 ; D. Tsiapras 2 ; E.K. Iliodromitis 1 ;  J. Parissis 1 ; D. Farmakis 1 ; D.T. Kremastinos 1 1 Attiko University Hospital, 2nd University Cardiology Dept., Athens, Greece; 2 Onassis Cardiac Surgery Center, Second Department of Cardiology, Athens, Greece Purpose: Several indices have been proposed in order to evaluate left ven- tricular (LV) function in chronic mitral regurgitation (MR); however, none of them is unique. We investigated the role of ventricular long axis contraction in patients with non-ischemic asymptomatic MR. Methods: Eighty-nine patients, aged 59.9±13.5 years, with non-ischemic asymptomatic MR were studied by echocardiography, exercise radionuclide cineangiography and cardiac catheterization. Results: Fifty of 89 patients (56.2%) had a normal LV response to exercise, de- fined as a >5% increase in ejection fraction. LV end-diastolic diameter (59±5 vs 57±4 mm) and volume (214±53 vs 190±43 mL) were significantly higher in pa- tients with an impaired LV response (p<0.05). Peak systolic wave velocity and systolic wave slope both at the lateral wall and at the inter-ventricular septum were significantly lower in patients with an impaired LV response (p<0.001). Peak systolic wave velocity at the lateral wall (LatS) was the index that best predicted LV response to exercise; a cutoff value of 9.5 cm/sec predicted an impaired LV response with a sensitivity of 96% and a specificity of 100%. As defined by the width of vena contracta, MR was mild/moderate in 78% of patients with a LatS >9.5 cm/sec and severe in 69.2% of patients with a LAtS <9.5 cm/sec. Conclusion: The evaluation of LV long axis contraction at rest can unmask a subnormal LV functional status in patients with asymptomatic non-ischemic MR. 1059 TEE guided thrombolysis with or without surgery in prosthetic valve thrombosis A. Nagy 1 ; M. Lengyel 1 1 Gottsegen Hungarian Institute of Cardiology, Cardiology Dept., Budapest, Hungary In the management of prosthetic valve thrombosis (PVT) thrombolysis (T), surgery and heparin are treatment alternatives. The aim of the study was to assess the outcome of thrombolythic therapy with or without surgery in critically ill patients. Transesophageal echocardiography (TEE) was used for the diagnosis of PVT, assessment of thrombus (THR) size, location and motility, leaflet motion and treatment monitoring. Nonobstructive PVT was defined as normal leaflet motion with thrombus. Obstructive PVT (OPVT) included all cases with restricted leaflet motion, even in the absence of THR. Between 1993 and April 2006 109 episodes of PVT were found in 80 patients (24 males, 56 females; mean age 56 years; range 28-80 years). T was given in 58 episodes. In 44 cases T was com- pletely successful (75% success rate), partially successful in 10 cases and failed in 4 cases. 4 patients died in this group (7% mortality) and complica- tions of T included 4 episodes of stroke, 2 major bleedings, 2 peripheral embolic events, 2 transient ischemic events. 8 critically ill patients out of the 10 partially successful OPVT cases underwent surgery. 6 patients had mitral valve prosthesis, one patient aortic valve prosthesis, and one patient trival- vular prosthesis, out of which the mitral and the tricuspid valves were in- volved. In all these patients the valvular gradient decreased after thromboly- sis, and the hemodynamic parameters improved. In all patients TEE showed partial resolution of the obstruction, the disappearance of thrombus in 7 cases while in one patient the left atrial thrombus was unchanged. Surgery was successful in all these cases and proved pannus in 5 patients and valve thrombosis in 3 patients. In comparison 7 patients died out of the 26 pa- tients who underwent surgery for other reasons (mortality rate 27%). Conclusions: Thrombolysis can be performed in critically ill patients with PVT with high success rate, however severe complications can occur. In some patients the residual obstruction has to be resolved surgically due to pannus, or inveterated thrombus. In these cases, due to improved hemody- namics surgery can be performed safely. 1060 Factors associated with pulmonary artery pressure rise in mitral regurgitation related to valve prolapse T. Le Tourneau 1 ; A.S. Polge 2 ; C. Vanesson 1 ; S. Pouwels 1 ; J. Darchies 1 ;  A. Yameogo 1 ; C. Bauters 1 ; G. Deklunder 1 1 Hospital Cardiologique, Service Expl Fonct Du Dr Deklunder, Lille Cedex, France; 2 Cardiologic University Hospital, Lille, France Purpose: Mitral valve surgery is recommended in patients with organic mi- tral regurgitation (MR) and severe pulmonary artery pressure (PAP≥50 mm Hg) at rest. However little is known about the determinants of PAP in this setting. Therefore, we sought to evaluate the predictive factors of systolic PAP in MR due to mitral valve prolapse. Methods: One hundred forty-two patients (61±12 years, 102 males) with moderate to severe MR related to valve prolapse underwent a complete echocardiographic examination with pulmonary artery pressure measure- ment (using tricuspid regurgitation) and mitral tissue doppler imaging (TDI). Results: Mean systolic PAP was 44±13 mm Hg, ranging from 25 to 105 mm Hg. Patients with a systolic PAP≥50 mm Hg (n=33) were older and more symptomatic, had a more severe MR and a higher heart rate, a greater left atrium, a higher mitral E wave and E/A ratio, a shorter mitral deceleration time, a higher septal mitral E/Ea ratio and a lower aortic stroke volume. In univariate analysis, predictive factors of systolic PAP were age (r=0.29, p=0.0005), MR grade (r=0.29, p=0.0005), left atrial volume/m 2 (r=0.39, p=0.0002), mitral E velocity (r=0.42, p=0.0001), mitral E/A ratio (r=0.46, p<0.0001), mitral deceleration time (r=-0.22, p=0.034), septal mitral E/Ea ratio (r=0.57, p<0.0001), and aortic stroke volume (r=-0.31, p=0.006). In multivariate analysis, the strongest independent factor associated with sys- tolic PAP was septal mitral E/Ea ratio (p<0.0001); other independent factors were left atrial volume/m 2 (p=0.017) and mitral E/A ratio (p=0.017). Left ven- tricular size or ejection fraction, as well as effective regurgitant orifice or re- gurgitant volume were not predictive of systolic pulmonary artery pressure. Conclusion: In moderate to severe organic mitral regurgitation related to mitral valve prolapse, systolic PAP is not associated with left ventricular size or function, but is strongly associated with a parameter of diastolic function (septal mitral E/Ea ratio); systolic PAP is also associated with left atrial vol- ume and mitral E/A ratio. by guest on October 16, 2011 ejechocard.oxfordjournals.org Downloaded from