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Poster Session 1 Monday, June 28 10:00 am - 1:00 pm Moderated Posters: 3D Echocardiography and Valvular Heart Disease - Posters P1-01 through P1-15 Posters: Contrast Echocardiography: Techniques & Applications (I) - Posters P1-16 through P1-25 Congenital Heart Disease - Posters P1-26 through P1-38 Interventional Echocardiography: TEE, Intraoperative, Intravascular - Posters P1-39 through P1-47 Ventricular & Atrial Function (I) - Posters P1-48 through P1-60 P1-01. Moderated Poster Proximal Flow Convergence Region as Assessed by Matrix-Array Real-Time 3D Echo: The Complexity of the Isovelocity Contour Chaim Yosefy, Mordehay Vaturi, Robert A Levine, Judy Hung Massachusetts General Hospital, Boston, MA Background: Calculating mitral regurgitant (MR) flow and orifice area by the proximal flow convergence region (PFCR) assumes a hemispherical contour. This may not be valid given the elliptical configuration of the mitral orifice. 2D imaging of the PFCR is limited in displaying the complete contour of the PFCR. This limitation can be improved by 3D echo. We hypothesized that the PFCR is frequently not hemispherical but rather more complex, given the hemielliptical shape of the mitral valve orifice. Methods: Twenty nine patients (20F/9M) aged 60±13 with at least moderate MR (80% functional MR; 20% mitral valve prolapse (MVP)) were evaluated by 2D and real-time 3D (Philips Sonos 7500) in standard apical windows with optimized depth and color settings. Results: The 3D PFCR was hemispherical in shape in only one patient. Seventeen patients had an elliptical PFCR contour, and 6 had a crescent shape. In 5 patients (all with MVP and eccentric MR jets), the PFRC contour was more complex, not fitting into any of the above shapes (Figure). Importantly, non-hemispheric contours persisted at all alias velocities from 10-50 cm/s. Conclusions: In patients with MR, the PFCR contour is frequently not hemispherical, especially with eccentric MR jets such as in MVP. The true 3D PFCR contour appears to be more complex, paralleling the contour of the elliptical mitral valve orifice. This complexity of the PFCR should be considered when quantifying MR severity. P1-02. Moderated Poster Improved Quantification of Left Ventricular Mass Using Real-Time Three- Dimensional Echocardiography: Comparison with Magnetic Resonance Imaging Victor Mor-Avi 1 , Lissa Sugeng 1 , Enrico G Caiani 1 , Lynn Weinert 1 , Peter MacEneaney 1 , Rick Koch 1 , Ivan Salgo 2 , Roberto M Lang 1 1 University of Chicago, Chicago, IL; 2 Philips Medical Systems, Andover, MA Background. Left ventricular (LV) mass is an important predictor of morbidity and mortality, especially in patients with systemic hypertension. However, the accuracy of LV mass measurements from 2D echocardiographic images is limited due to the difficulties with acquiring anatomically true, non-foreshortened apical views. We hypothesized that LV mass could be measured more accurately from real-time three-dimensional (RT3D) datasets, which allow off-line selection of non-foreshortened apical views. This hypothesis was tested by comparing 2D and RT3D measurements of LV mass using MRI as a “gold standard”. Methods. Echocardiographic imaging was performed (X4 matrix array probe, Philips 7500) in 19 patients (11M, 8F) referred for cardiac magnetic resonance imaging (CMRI) studies. Apical two- and four-chamber views and RT3D pyramidal datasets were acquired and analyzed off-line by 2 independent observers. The RT3D datasets were used to select two orthogonal views with the largest long axis of the left ventricle (QLab, Philips). In both 2D and RT3D images, endocardial and epicardial boundaries were traced at end diastole in the apical two- and four- chamber views, and LV mass was calculated using the bi-plane method of disks. “Gold standard” LV mass values were obtained from CMRI studies (1.5T, GE) using standard analysis techniques (MASS Analysis, GE). Both 2D and RT3D derived values of LV mass were compared against CMRI using linear regression and Bland-Altman analyses. In addition, inter-observer variability was calculated for each technique as the difference between the 2 observers’ measurements in % of their mean. Results. Identification of non-foreshortened apical views from the RT3D datasets was achieved in most patients within 20 sec. The RT3D measurements of LV mass correlated with CMRI better (r=0.90) than the 2D measurements (r=0.79). Bland-Altman analysis showed that the 2D technique consistently underestimated LV mass (bias 39%), whereas RT3D-based measurements showed only minimal bias (3%). Also, the 95% limits of agreements were significantly wider for 2D (52%) than RT3D (28%). In addition, the RT3D-based technique reduced the inter-observer variability from 36% to only 7% of the measured LV mass values. Conclusion. RT3D imaging provides the basis for accurate measurement of LV mass. P1-03. Moderated Poster Determinants of Ischemic Mitral Regurgitation in Patients with Anterior Myocardial Infarction: A Real-Time Three-Dimensional Echocardiography Study Jong-Min Song, Takahiro Shiota, Jian Xin Qin, Deborah A Agler, Vorachai Kongsaerepong, Nicholas G Smedira, Patrick M McCarthy, A. Marc Gillinov, Delos M Cosgrove, James D Thomas Cleveland Clinic Foundation, Cleveland, OH Background: The aim of this study was to elucidate the mechanism of the development of ischemic mitral regurgitation (IMR) in patients with anterior myocardial infarction (MI) with/without inferoposterior MI using real-time 3- dimensional echocardiography (RT3DE). Methods: A total of 34 patients with chronic anterior wall MI (age: 61±12 yrs, 8 females) underwent RT3DE, including 16 patients with anterior MI only (Group A), and 18 patients with both anterior and inferoposterior MI (Group B). The regurgitant orifice area (ROA) of the mitral valve was determined with a proximal isovelocity surface area method and the left ventricular spherical index was defined as the short-axis/long-axis dimension ratio in the end-diastolic apical 4-chamber view. With the RT3DE software, the mitral valvular commissure-commissure plane and 3 anteroposterior planes (medial, central, and lateral) that were perpendicular to it were generated. The systolic tenting area of mitral valve (MVTa) and the angles between the annular plane and leaflets (anterior, A ; posterior, P ) from the anteroposterior planes were measured. The left ventricular end-systolic (ESV) and end-diastolic volume (EDV), and systolic (SA) and diastolic mitral annulus area (DA) were obtained by RT3DE. Results: ROA was significantly smaller in Group A than Group B (0.08±0.09 vs. 0.20±0.18 cm 2 , p<0.05). Only 1 patient (6.3%) in Group A and 9 patients (50%) in Group B showed significant IMR (ROA 2.0 cm 2 ) (p<0.01). In the total 34 patients, ROA was correlated significantly with ESV (r=0.67), EDV (r=0.70), ejection fraction (r=-0.44), spherical index (r=0.51), SA (r=0.79), DA (r=0.66) and MVTas of medial (r=0.85), central (r=0.80) and lateral planes (r=0.81). The medial MVTa (p<0.001), SA (p<0.05) and the spherical index (p<0.05) were three independent determinants of ROA by multiple stepwise regression analysis. SA was the only independent determinant of ROA in Group A although the severity of IMR was not significant in most patients of this group. The medial MVTa was the only independent determinant in Group B. No significant difference in MVTa, A , or P was found between medial and lateral planes in Group A, while P (p<0.05) and MVTa (p=0.06) tended to be larger in medial than those in lateral side in Group B. Conclusion: The geometry of mitral valve apparatus was more important in determining IMR than left ventricular volume or ejection fraction in patients with anterior MI with/without inferoposterior MI. The posteromedial side tethering could play an important role in causing significant IMR when the inferoposterior MI coexists with anterior MI. Journal of the American Society of Echocardiography Volume 17 Number 5 Abstracts 497
