S194 Abstracts Eur J Echocardiography Abstracts Supplement, December 2006 techniques is still limited. This information is increasingly important because rising costs in the healthcare sector cause healthcare budgets to become more and more constraint. Outcomes of an economic evaluation are com- monly expressed as incremental cost-effectiveness ratios: the difference in costs between two alternatives divided by the difference in effectiveness, where effectiveness can be expressed as quality adjusted life years (QALYs). Methods: We carried out a systematic review of the literature in order to gain insight in the cost-effectiveness of echocardiography for the detection of CAD compared to ECG, SPECT and coronary angiography. Databases searched included Medline and the NHS EED database for economic evalu- ations. Sixteen articles were included in the review. Five of these were mod- elling studies and eleven were empirical studies. Results: Comparing diagnostic strategies including echocardiography to strategies including stress electrocardiography resulted in incremental costs per QALY below $10,000. Diagnostic strategies including SPECT showed better outcomes than those including echocardiography but at high costs. The incremental costs-effectiveness ratios ranged from $62,800 per QALY to $150,000 per QALY. The cost-effectiveness of coronary angiography com- pared to echocardiography was found to depend strongly on the preva- lence of CAD. In low-prevalence populations the incremental cost-effective- ness ratios ranged from $75,333 to $584,500 per QALY. In high-prevalence populations this ranged from cost-saving to $36,400 per QALY. Conclusion: Echocardiography as a diagnostic technique tended to be cost-effective when compared to ECG and SPECT. In patients at low risk of CAD, echocardiography stratifying patients before angiography was also found to be cost-effective compared to angiography alone. In patients at high risk, angiography without prior testing was the most cost-effective diagnostic strategy. In general, the studies lacked information regarding the economic parameters. Perspective, price year and justification of meth- odological assumptions were often not provided and most studies did not include the costs of treatment following the diagnostic tests. There is a need for better information about the cost-effectiveness of diagnostic strat- egies for the detection of CAD. 1111 Assessment of left ventricular systolic dysfunction by tissue Doppler imaging and measurement of plasma type-B natriuretic peptide levels in patients with Emery-Dreifuss muscular dystrophy M. Marchel 1 ; A. Madej 2 ; V. Stepien 1 ; J. Kochanowski 1 ; R. Steckiewicz 1 ;  K.J. Filipiak 1 ; I. Hausmanowa-Petrusewicz 2 ; G. Opolski 1 1 Medical University Of Warsaw, 1St Dept Of Cardiology, Warsaw, Poland; 2 Polish Academy of Sciences, Warsaw, Poland Background: Emery-Dreifuss muscular dystrophy (EDMD) is characterized by musculoskeletal abnormalities, quite frequently accompanied by cardiac defects (conduction disturbances and dilated cardiomyopathy). The aim of the study was an analysis of left ventricular systolic dysfunction in EDMD patients (pts) with the use of tissue Doppler imaging (TDI) and plasma natri- uretic peptides measurements. Material and methods: In the present study we included 19 pts with ge- netically confirmed EDMD (16 pts with an X-linked inheritance [defect in the STA gene] and 3 pts with an autosomal dominant form [defect in LMNA]) as well as 10 healthy volunteers. Conventional echocardiography and TDI were performed and natriuretic peptides levels (BNP and NT-proBNP) were measured in EDMD pts and in 10 control subjects. For each wall, the peak strain (%) and strain rate - SR (s(-1)) were assessed in basal and mid seg- ments. Results: The mean left ventricular ejection fraction (LVEF) was 52.4+/-9.3% and 66.4+/-4.8 for EDMD pts and for controls respectively (p=0.0001). The mean plasma levels of BNP were 24.1+/-22.7 pg/ml and 6.4+/-2, while of NT-proBNP they were 146+/-119 pg/ml and 21.8+/-8.4 (p=0.003) for EDMD and controls (p=0.02) respectively. We identified two subgroups of EDMD patients: 1 - LVEF<=45% (n=7) and 2 - LVEF >45% (n=12) accompanied by group 3 (controls, n=10). In group 1 we observed lower SR as compared to group 3 (2.1+/-1.3 vs 4.9+/-2.1; p=0.007), but also pts with persistent LVEF (group 2) had lower SR than controls (3.2+/-1.7 vs 4.9+/-2.1; p=0.05). Similar differences were observed with the peak strain. Conclusions: Subclinical cardiac dysfunction is common in EDMD pts. Natriuretic peptides measurements and TDI technique may be useful tools for the assessment of systolic dysfunction. The quantitative assessment of myocardial strain and strain rate can be helpful in the early detection of regional systolic alterations in EDMD pts with normal LVEF. 1112 Correlation of echo measurements and quality of life in patients before and 6 months after pacemaker implantation R. Mlynarski 1 ; A. Drzewiecka 1 ; E. Pilat 1 ; W. Kargul 1 1 Medical University of Silesia, Electrocardiology Dept., Katowice, Poland The popularity of pacemaker implantation is increasing year by year. The role of echocardiography was confirmed both before and directly after im- plantation in e.g. adjusting AV-delay. However, there is no research answer- ing the question - do echo measurements correlate with quality of live (QoL) in the follow-up period? Purpose of study: Was to correlate echo measurements with QoL in pa- tients directly before pacemaker implantation and after 6 months. Methods: Agreement of bioethical committee NN-6501-23/05 was obtained. 120 patients (median age 71.2) with AV blocks, SND (sinus node dysfunc- tion) syndrome and optimal pharmacological treatment of existing heart disease were included in the study. Excluded were patients with other se- rious illness which can interfere with the results of QoL. In all patients DDD(R) pacemakers were implanted (Sigma SD 303 or Vita 2) with bipolar elec- trodes. None of the special functions for the pacemaker model was acti- vated. All echo exams were performed by an experienced doctor on Vivid 7 ultrasound system (GE Healthcare). Reference echo examination was per- formed 1-2 days before implantation. Three days after implantation AV de- lay optimalisation was done. These parameters of echo were analyzed: all cave diameters, EF (Simpson), TAPSE, all valve regurgitations, cardiac output (CO) and cardiac index (CI) measured in the rest. QoL was mea- sured using the SF-36 scale on the first day of hospitalization, before pace- maker implantation. After 6 months (±2 weeks) a follow-up echo was done on all patients and QoL was repeated with full checking of parameters of the pacemaker. Results: High correlation was found between QoL after a 6-month follow-up and such echo parameters measured before implantation as: EF (r=0,71), area of the RV (r=0,91) and area of the LV (r=0,62). An insignificant rise of degree of tricuspid regurgitation was observed (p=0,12). Patients 6 months after implantation have a higher value of TAPSE (24,2±6 mm before vs 29±7 mm after; p<0,05) and CI (2,4±0,6 L/min/m 2 vs 2,7±0,5 L/min/m 2 ; p<0,05). Especially interesting was the correlation between CI measured before im- plantation with high improvement of QoL in follow-up (r=0,86). Conclusion: 1. Improvement of QoL at 6-month follow-up correlates with echo measurements before implantation. 2. Cardiac Index (CI) measured before implantation at rest can be a predictive factor of strong improvement of QoL and in our opinion should be evaluated in each patient before pace- maker implantation. 1113 Gender differences in carotid intimal-medial thickness in patients with suspected coronary artery disease A.T. Timoteo 1 ; R.S. Santos 2 ; S. Lima 2 ; A. Mamede 2 ; S. Ranhada 2 ;  R. Ferreira 2 ; J. Quininha 2 1 Lisboa, Portugal; 2 Santa Marta Hospital, Radiology Dept., Lisbon, Portugal Background: The selection of patients for coronary angiography by sus- pected coronary artery disease represent an important challenge, due to its frequent atypical clinical presentation and false positive rate of non-invasive tests, particularly in women. Objectives: To evaluate if there is a difference between genders in risk fac- tors for coronary artery disease and in carotid intimal-medial thickness (IMT) for the prediction of coronary artery disease. Methods: Prospective study of 270 consecutive patients with stable angina submitted to elective coronary angiography, with a mean age of 65±10 years, 35% female. All patients had a carotid ultrasound study. We compared de- mographic and risk factors for coronary artery disease. The presence of significant coronary artery disease was defined by a stenosis >=70%. Ca- rotid IMT was measured in the common carotid artery bilaterally and we considered the highest value between both sides. Results: Women were elderly, with higher body mass index (BMI) and were less smokers. There were no differences in other risk factors. The preva- lence of coronary artery disease, as well as carotid IMT was higher in males. By analysis of ROC curves, the best carotid IMT cut-off for detection of sig- nificant coronary artery disease was 1.35 mm (AUC 0.66, 95% CI 0.59-0.73, p<0.001), with a low sensibility (13%) but high specificity (92%). By logistic regression, in women, carotid IMT was associated with coronary disease (OR 8.87, 95% CI 1.71-41.0, p=0.009), as well as in men (OR 3.07, 95% CI 0.99-9.58, p=0.05). Conclusions: Women with stable angina had a lower carotid IMT compared with men, as well as lower coronary artery disease prevalence. Carotid IMT can predict coronary artery disease in both genders. Table 1 Females (n=95) Males (n=175) p BMI (Kg/m 2 ) 30.2±5.3 27.8±3.7 <0.001 Coronary disease (%) 48 76 <0.001 Carotid IMT (mm) 0.90±0.35 0.99±0.35 0.05 1114 Short - time pacing seems to have no acute effects on ventricular functions: A pulsed-Doppler tissue echocardiograpy and brain natriuretic peptide study O. Gulmez 1 ; I. Atar 1 ; E. Sade 1 ; C. Ertan 1 ; V. Simsek 1 ; A. Yildirir 1 ;  H. Muderrisoglu 1 ; B. Ozin 1 1 Baskent University Faculty Of Medicine, Cardiology Dept., Ankara, Turkey Background: The unfavorable effects of right ventricular pacing on left ven- tricular performance have been extensively studied. Tissue Doppler echocardiography (TDE) has been recently reported to be useful for the by guest on December 31, 2011 http://ejechocard.oxfordjournals.org/ Downloaded from