790 Echocardiography standard and tissue Doppler imaging: guide to electrical treatment of severe heart failure

Abstract

Introduction: CRT by biventricular PM appears to be an effective treatment in pts with severe and refractory HF. CRT improves symptoms and quality of life; reduces hospitalization rate and risk of death for CV or any other cause. The gravity of A-V, intra-ventricular and inter-ventricular dyssynchrony appears correlated to the response to CRT. However there is a proportion of 20-30% pts, who do not respond to CRT in some trials.Our survey's aim had been that to identify pts with dyssynchrony who had a very similar response to CRT. It has been used echo-standard and TDI to assess regional electromechanical activation pattern and to evaluate the regional delay in LV. Secondary end point has been that to determine the effects of CRT on clinical and Echo-parameters after 6 months. Methods: Pts have been selected by international guidelines. There had been chosen12 pts with an age between 43-75 years old. These pts have been undergone through many clinical and echocardiography assessment at baseline and 6 months further than CRT. Before CRT NYHA had been III in 8 pts and IV in 4 pts; EF < 30%; QRS duration ≥ 120 msec in 6 pts and < 120 msec in the others 6; LVEDD ≥ 55 mm. Has been evaluated IVMD and SPWMD, TDI-echo with parameters defined by Yu and by Bax. RESPONDERS to CRT are those pts who showed a 10% decrease in LVESV and an improvement in NYHA. Results: After 6 months a real evaluation has been possible for 11 pts one of them died precociously after CRT. Before CRT the mean value of LVEDV was 210 ml; the one of LVESV 159 ml; EF was 23%. 9/12 had a delay by Yu; 6/12 by BAx/3/12 by Pitzalis and 6/12 by IVMD. 11 Pts had been evaluated after 6 months. A heart had been transplanted to one of them some months later CRT due to a progress of disease. NYHA has been improved in 10 of our pts after CRT. No significant differences have been found in LVEDV and in LVEDD. There has been a remarkable decrease of mean value of LVESV (from 159 ml to 142 ml after CRT) and an increase of EF(from 23% to 30% after CRT) in all pts.Severity of MR decreased significantly (7/11).No one of the pts needed to be admitted into the hospital during the following 6 months. Conclusions:The results of this study suggest that parameter defined by YU appears the most effective to identify potential responders to CRT, even in pts with QRS duration < 120 msec.In fact CRT is able to assess intra-ventricular dyssynchrony and its extent. Although the number of our pts had been exiguous, benefits in short time have been discovered through the improvement of clinical and echo-parameters after CRT. 791The role of left ventricle isovolumic contraction and ejection phase parameters at rest and during stress echocardiography in predicting exercise tolerance in ischemic heart failure patients Background: The role of left ventricle (LV) isovolumic contraction parameters, including isovolumic acceleration, in determining exercise capacity is still unclear and under intense investigation. Aim: To assess LV isovolumic and ejection phase parameters, using tissue Dop...