S 106 Abstracts 1.14-0.5s-1). Two of them with the worst impairment of regional function (SR=- 0.84-0.6s-1) died in the follow-up period. LV ejection fraction was normal in all groups described. Conclusions: These results illustrate that at end-stage Fabry cardiomyopathy the patients develop LV hypertrophy and myocardial fibrosis which is associated with severe impaired regional LV function. 713 Echocardiographically guided transvenous endomyocardial biopsy: technical refinement with modern imaging techniques R.R. Brandt 1, R. Arnold 2, A. Elsaesser 2, M. Rau 2, C.W. Hamm 2. 1Kerckhoff Heart Center, Cardiology DepL, Bad Nauheim, Germany; 2Kerckhoff Heart Center, Cardiology DepL, Bad Nauheim, Germany Transvenous endomyocardial biopsy (EMB) is essential for the diagnosis of cer- tain cardiomyopathies and rejection in heart transplant patients. Traditionally, EMB is performed under fluoroscopic guidance in the catheterization laboratory. How- ever, exact anatomic positioning of the biopsy catheter system (bioptome) is not possible with fluoroscopy, which is also associated with radiation exposure both to the patient and operator. Two-dimensional echocardiography is a useful alternative imaging technique. Ten patients (8 men, 2 women) with a mean age of 454-10 years underwent EMB for suspected myocarditis (n=9) or restrictive cardiomyopathy (n=l) in the supine position. The bioptome was introduced through the right internal jugular vein, ad- vanced across the tricuspid valve, and directed against the interventricular septum under echo-guidance from the subcostal (n=8) or apical window (n=2) using har- monic imaging and high frame rates to improve endocardial border delineation, Occasional malpositioning of the bioptome in the inferior vena cava or coronary sinus were instantly detected. An average of 6.14-1.6 specimens were obtained at a procedure time of 11.2±1.8 minutes. The apical 4-chamber view allowed better visualization of the distal third of the right ventricle compared to the subcostal view, No procedure-related pericardial effusion or tricuspid regurgitation were detected, However, in several patients, small and highly mobile echogenic structures were detected at the biopsy site corresponding to small thrombi immediately after the procedure but not on the following day. 10-\ " ° , Subcostal 4-charnberview with bioptome Echo-guided transvenous endomyocardial biopsy is a safe and effective procedure without radiation exposure. Modern imaging techniques facilitate the performance and detection of complications. 714 Is QRS width sufficient in selecting patients with intraventricular asynchronism in dilated cardiomyopathy? Echocardiographical study R.O. Jurcut 1 , B.A. Popescu 2, R. Ciudin 2, M. Serban 2, I. Cojocaru 2, C. Ginghina 2. 1Institute of Cardiovascular Diseases, Cardiology, Bucharest, Romania; 21nstitute of Cardiovascular Diseases, Cardiology, Bucharest, Romania The aim of the study was to assess the correlations existing between electrocardio- graphic data (QRS width and PR length) and mechanical asynchronism in patients with dilated cardiomyopathy, in order to establish the relative place of ECG and echocardiography in the evaluation and choice of treatment (especially resynchro- nization therapy) for patients hospitalized with dilated cardiomyopathy (DCM). Material and methods: 34 patients (pts), mean age 56.94-12.1 years, hospitalized in our Department between 11/2004 - 04/2005 with a diagnosis of DCM (44% idio- pathic, 32% ischaemic, 16% ethanolic, and the rest of hypertensive etiology), with CHF class Ill-IV NYHA after optimal pharmacological treatment. Every patient had an ECG with assessment of QRS width and PR length, as well as an echocardio- graphy (performed on a GE Vivid 7 system), with evaluation of several parameters of atrioventricular, interventricular and intraventricular asynchrony. Results: We studied two groups: group 1 = 16 pts with narrow QRS (<120 ms), and group 2 = 18 pts with wide QRS (_>120 ms). The 2 groups did not differ by age, sex, DCM etiology, left ventricular global systolic function (LVEF, LV volumes, aor- tic VTI, MAPSE, dp/dt) or magnitude of mitral regurgitation. Intraventricular asyn- chreny parameters did not differ significantly between the 2 groups: pre-ejectional aortic time (1504-47 vs 1314-13 ms, p=0.06) and septal-to-posterior wall motion delay (1114-60 vs 924-41 ms, p=0.07). Pts in group 2 had more severely altered LV diastolic dysfunction (more frequent restrictive pattern and a mean ratio ENp = 2.44-1, vs 1.94-0.9, p=0.02), as well as longer intermechanical ventricular delay (49.84-36 vs 15.84-15 ms, p=0.008). Differences between the 2 groups with regard to the mechanical dispersion as measured with color tissue Doppler imaging (TDI) and pulsed wave TDI were however non-significant. 33% of pts with wide QRS did not present with mechanical asynchrony, while in group 1, 12% pts had inter- ventricular asynchrony and 31% pts had intraventricular asynchrony. In our group, QRS width had a good positive predicitive value (PPV) (91.6%) and NPV (90%) for interventricular asynchreny, and less PPV (66.6%) or NPV (60%) for intraventricu- lar asynchrony. PR interval length did not correlate with atrioventricular asynch rony (r=0.135, p=0.61). Conclusions: While QRS width helps in identifying pts with interventricular asyn- chreny, echocardiography remains the essential tool for evaluation atrio-ventricular asynchreny and intra-venticular asynchrony (especially localization of late contract- ing segments). 715 Recurrent acute pericarditis: diastolic function in long-term echocardiographic follow-up A. Moreo 1 , B. De Chiara 2, A. Brucato 3, A. Alberti 1, C. Munforti 1, G. Brambilla 3, D. Spodick 4, E Mauri 1. 1Niguarda Ca' Granda Hospital, Cardiothoracovascular Dept., Milan, Italy; 2CNR Clinical Physiology Institute, Niguarda Ca' Granda Hospital, Milan, Italy; 3 Niguarda Ca" Granda Hospital, Internal Medicine, Milan, Italy; 4 Saint Vincent Hospital, Cardiology Dept, Worcester, United States of America Background: The long-term outcome of recurrent acute pericarditis is not well known, and patients and physicians are often alarmed about the possible progres- sion in a constrictive disease. Methods: Thirty-nine patients (14 women) with recurrent acute pericarditis were followed for an average of 7.7 years (range 1-43). During this period of activity we observed a mean of 2.3 episodes per patient per year (range 0.2-8). Echocardio- graphic examination was performed at the end of follow-up in all patients; pulsed Doppler examination of mitral and pulmonary venous inflow as well as tissue Doppler imaging of the mitral annulus were evaluated in order to assess diastolic function. Patients were classified as normal, impaired, pseudonormal and restric- tive diastolic pattern. Results: At the end of follow-up all patients had normal systolic function (ejection fraction 0.624-0.04) and normal left ventricular volumes (end-diastolic 864-20 ml and end-systolic 334-10 ml). Twenty-five patents had normal diastolic function, 12 had impaired relaxation and 3 pseudonormal pattern; no patients developed re- strictive pattern. The diastolic parameters did not correlate with number of attacks, duration of pericarditis and duration of sustained remission without therapy. Conclusions: A very long-term echocardiographic follow-up showed that patients with recurrent acute pericarditis had no evidence of cardiac dysfunction, even if the clinical course was characterised by several relapses. This reassurance may be important in the global approach to these patients. 716 Colour-coded tissue Doppler echocardiography in the follow up of patients with catheter interventional therapy (TASH) of hypertrophic obstructive cardiomyopathy (HOCM): a new tool to monitor therapy? G. Beer 1 , O.A. Breithardt 2, J. Reinhardt 3, Z Lawrenz 3, C. Strunk-Mueller 3, E Lieder 3, H. Kuhn 3, C. Stellbrink 3. 1The Bielefeld Klinikum, Department of Cardiology, Bielefeld, Germany; 2University Mannheim, Department of Cardiology, Mannheim, Germany; aThe Bielefeld Klinikum, Department of Cardiology, Bielefeld, Germany In pts with HOCM, a new sign of dynamic left ventricular outflow tract (LVOT) obstruction, characterized by an abrupt mid-systolic septal deceleration notch (MSSD) in the basal septal longitudinal velocity trace, was reported using colour -coded tissue Doppler imaging (TDI). Especially in challenging cases with difficult Doppler angles and concomitant mitral regurgitation it seems to be helpful in the evaluation of pts with HOCM and TASH. Methods: We examined 24 consecutive pts with HOCM (12 men, 12 women; age 524-18 years; septal wall 234-4 mm; SAM septal contact in 21/24 pts) by transtho- racic echocardiography and bicycle Doppler echocardiography before and 1 week after TASH. In 12 pts mid-term follow up after TASH (6 months after TASH) was performed (serial echocardiographic examinations of up to 6 examinations per pt). In all pts septal longitudinal motion was assessed by colour-coded TDI (> 100 frames/s) at rest for velocity analysis of septal longitudinal function and the identi- fication of MSSD. Results: A pathological septal longitudinal motion at rest with a characteristic biphasic systolic velocity pattern with an early ($1) and a late ($2) positive ve- locity peak, interrupted by an abrupt MSSD notch was identified in all pts (100%) before TASH. After TASH peak LVOT gradient at rest (from 824-43 mmHg to 384-25 mmHg) was reduced and the LVOT area increased. In 13 pts (54%) both a gradient of > 30 mmHg at rest and a pathological longi- tudinal septal motion with MSSD persisted. In 11 pts (46%) the septal longitudi- nal velocity trace was normalized after TASH; MSSD was not present. In 10 of these 11 pts significant LVOT obstruction at rest was eliminated (< 30 mmHg). Pts with persisting MSSD after TASH, compared to those without MSSD, had a significant higher persisting LVOT gradient at rest (CW-Doppler 544-23 mmHg vs 204-10 mmHg). In 6 pts both the MSSD and LVOT gradient were eliminated after TASH and were both not demonstrable in the mid-term follow up. In 6 pts there was persistence of MSSD and LVOT gradient (> 30 mmHg) at rest in the mid-term follow up in serial echocardiographic examinations. Eur J Echocardiography Abstracts Supplement, December 2005 Downloaded from https://academic.oup.com/ehjcimaging/article/6/suppl_1/S106/2403492 by guest on 13 March 2023