S158 Abstracts Eur J Echocardiography Abstracts Supplement, December 2006 chrony Index (DI), obtained from 3D echo, has been proposed as a glo- bal, accurate and useful parameter. We sought to determine the correlation between currently used parameters of LV dyssynchrony with the DI in pa- tients with systolic dysfunction. Methods: 45 consecutive pts with a LV Ejection Fraction <40% were in- cluded. LV dyssynchrony was defined as a septal-to-posterior wall motion delay (SPWMD) >130 msec, a septal-to-lateral delay >60 msec, the pres- ence of Post-systolic contraction >50 msec of the LV ejection time or a intra- LV electromechanical delay >40 msec. From the 3D derived time-volume- curves, the DI, defined as the standard deviation of the time for all the LV segments to reach their minimum volumes was obtained. Correlation was assessed between the DI and conventional parameters of dyssynchrony. Results: Mean age was 65±13 years. The presence of LV dyssynchrony was observed in 29, 47, 32, and 82.4% of patients using the SPWMD, the septal- to-lateral delay, the presence of p ost-systolic contraction and the intra-LV electromechanical asynchrony respectively. Average DI was 8.5±4%. No cor- relation was found between parameters of LV dyssynchrony and the DI. Conclusions: The prevalence of LV dyssynchrony is variable depending on the method used. There is no correlation between the parameters of LV dyssynchrony and the DI. This variability should be considered when apply- ing specific echo-Doppler criteria in cardiac resynchronization. Table 1. DI correlations r SPWMD 0.016 Septal to lateral delay >60 ms 0.015 Post-systolic contraction 0.015 Intra LV electromechanical delay 0.016 LV: Left ventricular; SPWMD: septal-to-posterior wall motion delay 932 Feasibility and accuracy of single-beat three-dimensional tissue synchronization imaging (TSI) in comparison with two-dimensional TSI in heart failure patients L. Badano 1 ; M. Baldassi 1 ; E. Tosoratti 1 ; G. Nucifora 1 ; D. Pavoni 1 ;  P. Gianfagna 1 ; P.M. Fioretti 1 1 A. O. S Maria della Misericordia, Chief Echo.Lab., Cardiovascular Sciences Dept., Udine, Italy Left ventricular mechanical dyssynchrony (LVMD) has emerged as a thera- peutic target with the advent of cardiac resynchronization therapy (CRT). 2D tissue synchronisation imaging (TSI) is an emerging technology to assess LVMD whose ability to identify CRT reponders has been proved. However, 2D TSI requires calculation of LVMD in LV views obtained at different times and it is not feasible in patients with unstable cardiac rhythm or atrial fibrilla- tion. The aim of our study was to test whether single-beat real time 3D echo (RT3DE) TSI can be used to objectively quantify LVMD in heart failure pts in comparison to 2D TSI. We studied 79 heart failure pts (66±13 years, 70% M), LV ejection fraction =29±7%, QRS duration =152±38 ms, and NYHA III- IV=37%. 69% patients showed QRS duration >120 msec, and 53% a left bundle branch block. Apical 4-, 2-chamber and long-axis LV views were acquired from all patients with both 2D and RT3DE (Vivid 7-Dimension, GE Healthcare, Horten, Norway). Intra-ventricular synchronicity was assessed by TSI using the time to regional peak systolic velocity measured in ejection phase (Ts), and a 6-basal-6-mid-segment model of LV. RT3DTSI was fea- sible in all pts (feasibility =100%). Time spent to assess LVMD with 2D and RT3DE TSI is summarized in the Table. The standard deviation of Ts (Ts-SD) was significantly wider when calculated with RT3DE than with 2D modality (58±35 vs 48±20 msec; p=0.007). Despite a low correlation between Ts- SDs calculated using the 2 techniques (R2=0.31), they showed high con- cordance (k=0.86; p 34 msec), and the most delayed LV wall (k=0.83; p<0.0001). RT3DE TSI is feasible in heart failure pts with severe LV dysfunc- tion. The technique provided quick qualitative and quantitative assessment of LVMD in a single R-R interval, which showed high concordance with stan- dard 2D TSI. Our data may represent the basis to use RT3DE to assess LV synchronicity in patients with unstable hemodynamics, or with atrial fibrilla- tion or other cardiac arrhythmias Table 1 Echo-Modality Acquisition Measurement Overall Time (s) Time (s) Time (s) 2D - TSI 142±30 43±5 185±29 RT3DE - TSI 94±74 29±7 123±60 Comparison of time needed to assess LV synchronicity in heart failure patients using 2D and 3D Tissue Synchronization Imaging 933 Systolic dyssynchrony index at real time 3D echocardiography correlates with left ventricular ejection fraction in patients with previous myocardial infarction and in controls E. De Marco 1 ; S. De Vecchi 1 ; V. Magnano 1 ; F. Forni 1 ; D. Pappalardo 1 ;  F. Platini 1 ; F. Rametta 1 1 S.S. Pietro and Paolo Hospital, Soc Cardiology Dept., Borgosesia (Vc), Italy Background: Mechanical asynchrony (MA) is a major observation in pa- tients with heart failure and is a therapeutic target in resynchronisation therapy. Real time 3D Echocardiography (RT3DE) is a novel technique which pro- vides qualitative and quantitative assessment of MA by measuring the Sys- tolic Dyssynchrony Index (SDI), which is defined as the standard deviation of the time for the 16 segments to reach their minimum. No data exist on the relation between MA at 3D echo and EF in patients with previous myocardial infarction.  Purpose: To investigate in patients with previous myocardial infarction and in controls correlation between mechanical asynchrony expressed as SDI at Real time 3D Echocardiography and left ventricular ejection fraction (LVEF) at rest. Methods: 48 consecutive pts were recruited, 18 with previous myocardial infarction (group 1) mean age 69±10 and 30 controls with normal LV func- tion, (group 2), mean age 60±12. RT3DE scanning was performed using the Philips ie 33 and analyzed offline with QLAB to produce time-volume curves. Systolic dyssynchrony index was derived from the dispersion of time to minimum regional volume for all 16 segments. Results: Mechanical asynchrony was found to correlate negatively with LVEF. There was a negative correlation between EF and the SDI (p=0.04, r=-0.57), either in patients with previous IMA (p=0.03, r=-0.61, n=18), either in con- trols (p=0.006, r=-0.74 n=30). The SDI was significantly higher in pts with previous MI 8,1±9 vs 1,24± in controls, p<0.01. There was a significant difference in LVEF in the two groups, 36%±13 in group 1 vs 58%±4 in group 2, p=0.00. An SDI >9 identified patients with EF <35%, p<0.001. Conclusions: Our findings show the correlation between Mechanical asynchrony expressed as SDI at three dimensional echocardiography and LVEF. SDI is correlated with systolic function in all patients either in patients with LVEF dysfunction or in controls. 934 Measurement of basal ventricular asynchrony by real-time 3D long axis echocardiography R. Chung 1 ; W. Li 1 ; M.Y. Henein 1 1 Royal Brompton Hospital, Echocardiography Dept., London, United Kingdom Background: In patients with dilated left ventricular (LV) cavities and LV disease, the presence of ventricular asynchrony may be a target for re- synchronisation therapy. Current methods to assess synchronous LV func- tion have their known limitations, Doppler Tissue Imaging (DTI) requires up to 12 acquisitions and long axis M-mode requires three acquisitions. Real- time 3D (RT3D) echo assessing LV asynchrony has been proposed, but current methods require statistical evaluation of 16 cavity segments. Methods: We investigated a novel method of quantifying intersegmental LV asynchrony by measuring 3D long axis at four points on the mitral ring in a single acquisition using a Philips Sonos 7500 RT3D and Tomtec LV Analysis 1.2 software. The timing of local distance from four basal segments (septal, lateral, anterior, inferior) to the mean centre of 3D LV cavity was measured with respect to end of ejection, indicated by aortic valve closure. Seventeen patients with LV disease and dilated cavity (LVESD =5.1±1.1 cm; LVEDD =6.6±0.98 cm, FS =23±8.9%) were compared to 11 normal controls (LVESD =3.1±0.29 cm; LVEDD =4.6±4 cm; FS =33±5.4%). Results: Mean LV volumes by RT3D correlated significantly with 2D cavity measurements in patients (LVESV =129±85 ml, r²=0.766; LVEDV =188±93 ml, r²=0.615, all p=0.05). Mean LV EF correlated well with 2D EF (Teich) (3D EF =35±12%, r² =.636, p<0.05). Intersegmental LV asynchrony at four basal sites in patients versus controls was (58±55 ms vs 21±27 ms, p<0.005), suggesting a cut-off value for basal asynchrony of 75 ms. Conclusion: Basal intersegmental delay by 3D long axis may be a useful indication of significant LV asynchrony, allowing clinically relevant assessment in a single acquisition compared to existing DTI or RT3D techniques. 935 Left ventricular asynchrony in dilated cardiomyopathy patients and normal subjects with and without left bundle branch block: A three- dimensional echocardiography study C. Sonne 1 ; L. Weinert 1 ; R.W. Childers 1 ; R. Lang 1 ; L. Sugeng 1 1 University of Chicago Hospitals, Internal Medicine Dept., Chicago, United States of America Background: Cardiac resynchronization therapy (CRT) has been indicated in patients with congestive heart failure based on left ventricular function and the width of the QRS. However, patients (pts) with CHF and narrow QRS have been shown to also have LVA. Three-dimensional echocardiography (3DE) is a new method for measuring LVA of the entire LV rather than based on a segmental approach. The aim of this study was to compare the degree of LVA in pts with normal (NL) function and dilated cardiomyopathy (DCM), with and without (w/o) LBBB using real-time 3DE (RT3DE). by guest on October 22, 2012 http://ehjcimaging.oxfordjournals.org/ Downloaded from