The role of cardiac magnetic resonance-based feature-tracking strain analysis in the differential diagnosis and prognostic assessment of patients with left ventricular hypertrophy

Background

Cardiac magnetic resonance (CMR) examinations have an essential role in the diagnosis of myocardial diseases with left ventricular (LV) hypertrophy; however, limited data are available from CMR-based feature-tracking strain analysis in this patient population. The aim of our study was to investigate the differential diagnostic and prognostic importance of feature-tracking strain analysis in patients with LV hypertrophy caused by myocardial disease.

Methods

We investigated 404 patients who underwent CMR examination and were diagnosed with myocardial disease causing LV hypertrophy. Hypertrophic cardiomyopathy (HCM) was detected in 330 patients, cardiac amyloidosis (CA) in 46 patients, Fabry disease (FD) in 12 patients, and endomyocardial fibrosis (EMF) in 16 patients. LV strain analysis was performed with feature-tracking. Global longitudinal (GLS), circumferential (GCS) and radial (GRS) LV strain parameters were measured. Strain values for the six basal, six midventricular, and five apical segments were averaged to obtain regional longitudinal and circumferential strain values (basal LS, midventricular LS, apical LS, basal CS, midventricular CS, apical CS). The apex-to-base regional LS and CS ratios were calculated as apical LS/basal LS and apical CS/basal CS, respectively. To assess global dyssynchrony, mechanical dispersion (MD) was measured. The all-cause mortality of the patients was analyzed.

Results

In the differentiation of CA from HCM, GLS had the highest sensitivity with a cutoff of more than −23%, and basal LS and basal CS had the highest specificity with a cutoff of more than −16% and −38%, respectively (p<0.001). FD patients had the lowest longitudinal and circumferential MD values, meaning that compared to that of other patients with LV hypertrophy, global dyssynchrony is least pronounced in this patient population (p<0.01). EMF patients had impaired global and regional CS and the lowest apex-to-base CS and LS ratios. CA patients had the highest apex-to-base CS and LS ratios, suggestive of apical sparing (p<0.001). CA patients had the worst prognosis; the significant independent predictors of mortality were a diagnosis of CA, the LV stroke volume index and basal LS (p<0.01).

Conclusions

Myocardial diseases with left ventricular hypertrophy have remarkable differences in CMR-based strain characteristics which can be helpful in the differential diagnosis and provides incremental information on adverse outcomes.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Development and Innovation Fund of Hungary, Ministry for Innovation and Technology in Hungary

Hypoattenuated leaflet thickening is associated with silent brain injury

Background

The association between hypoattenuated leaflet thickening (HALT) following transcatheter aortic valve implantation (TAVI) and stroke remains contradictory. Whether HALT carries an increased risk of subclinical brain injury (SBI) has not been investigated.

Purpose

We investigated whether HALT is associated with SBI on MRI. Furthermore, we assessed whether post-TAVR SBI impacts the patients' cognition and outcome.

Methods

153 patients undergoing TAVR were prospectively enrolled. Brain MRI was performed shortly post-TAVR and 6 months (6M) later to assess the occurrence of acute silent cerebral ischaemic lesions (SCIL) and chronic white matter hyperintensities (WMH). HALT was screened by cardiac CT angiography 6M post-TAVR. Neurocognitive evaluation was performed before, shortly after and 6M following TAVR.

Results

At 6M, 115 patients had diagnostic CTA and 10 had HALT. HALT status, baseline and follow-up MRIs were available in 91 cases. At 6M, new SCIL was evident in 16%, new WMH in 66%. New WMH was more frequent (100% vs 62%; p=0.047) with higher median volume (319 vs 50 mm3; p=0.039) among HALT-patients. In uni- and multivariate analysis, HALT was associated with new WMH volume (beta: 0.72; 95% CI: 0.2–1.39; p=0.009).

The patients' cognitive trajectory from pre-TAVR to 6M showed significant association with the 6M SCIL volume (beta: −4.69; 95% CI: −9.13 to −027; p=0.038), but was not related to the presence or volume of new WMH. During a 3.1-year follow-up neither HALT, nor the related WMH burden was related with increased mortality (HALT HR: 0.86, 95% CI: 0,202–3,687; p=0.84; new WMH HR: 1.09; 95% CI: 0,701–1,680; p=0.71).

Conclusions

6M post-TAVR, HALT was linked with greater WMH burden, but did not carry an increased risk of cognitive decline or mortality over a 3.1-year follow-up.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): János Bolyai Scholarship of the Hungarian Academy of Sciences

The role of feature-tracking strain analysis in the differentiation of cardiac amyloidosis from hypertrophic cardiomyopathy

 

Cardiac magnetic resonance (CMR) examinations have an essential role in the differentiation of cardiac involvement of amyloidosis (CA) from hypertrophic cardiomyopathy (HCM). The CMR diagnosis is traditionally based on morphologic features and the pattern of late gadolinium enhancement (LGE). However, in patients contraindicated for contrast agent administration, the diagnosis can be challenging. Novel CMR techniques, including strain analysis, can help in the differentiation of these patients.

The aim of our study was to investigate the differential diagnostic and prognostic importance of feature-tracking strain analysis in patients with left ventricular hypertrophy caused by CA or HCM.

We investigated 89 HCM patients (48 males; 50±18 years) and 46 CA patients (29 males; 64±10 years) who underwent CMR examination. The left ventricular ejection fraction (LVEF), volumes (end-diastolic volume: LVEDV, end-systolic volume: LVESV, stroke volume: LVSV), mass (LVM), and the amount of LGE were quantified. Global longitudinal (GLS), circumferential (GCS) and radial (GRS) LV strain parameters, and basal, midventricular, and apical LS and CS were measured. The apex-to-base regional LS and CS ratios were calculated. The all-cause mortality of the patients was analyzed. The characteristics of groups were compared with an independent t-test or Mann-Whitney test, as appropriate. ROC curve analysis was performed to analyze the diagnostic accuracy of a parameter and to identify optimal cutoff values. The prognostic value of CMR parameters was assessed with Cox proportional hazard regression analyses. Survival probability was analyzed with Kaplan-Meier curves and compared by the log-rank test.

CA patients had significantly lower LVEF (51±11 vs. 63±8%; p<0.0001), lower LVSVi (43±12 vs. 54±12 ml/m2; p<0.0001), higher LVMi (94±24 vs. 79±24 g/m2; p<0.001), higher amount of LGE (29±15 vs. 8±8%; p<0.0001), and more impaired global and regional strain values (GRS: 55±22 vs. 93±29%; GCS: −33±10 vs. −42±8%; GLS: −18±4 vs. −25±6%; basal CS: −26±9 vs. −39±7%; basal LS: −15±4 vs. −22±6%; p<0.0001) than HCM patients. The apex-to-base CS and LS ratios were higher in CA patients, suggestive of apical sparing (1.71±0.68 vs. 1.29±0.33; p<0.0001; 1.88±0.76 vs. 1.57±0.62; p<0.05; respectively). In the differentiation of CA and HCM, LGE, basal CS, basal LS, GRS, and GLS had the highest diagnostic accuracies (AUCs: 0.911, 0.866, 0.848, 0.859, 0.849). During the mean 2.1±2.0 years of follow-up, three HCM patients (3.4%) and 29 CA patients (63%) died (p<0.0001). The significant independent predictors of mortality were a diagnosis of CA, LVSVi and basal LS.

Our results show that CMR-based strain analysis might be a useful method for differentiating cardiac involvement of amyloidosis from HCM. Furthermore, this technique provides additional information for the assessment of prognosis in this patient population.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): National Research, Development and Innovation Office of Hungary; Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging programmes of the Semmelweis University

Training- and sex related alterations of global feature-tracking strain values of highly trained athletes using cardiac magnetic resonance imaging

Introduction

Cardiac magnetic resonance imaging (CMR) is a reference method for assessing the morphological and functional parameters of the heart, and more recently, strain analysis can detect mechanical features. Based on echocardiographic data, strain parameters may help to differentiate between physiological athlete adaptation and pathological hypertrophy, however, there are still little data available among elite athletes regarding strain values using CMR.

Aims

Our aim was to study the strain characteristics of the athlete's heart using CMR imaging.

Methods

Overall, 228 (149 male, 24±5 years) highly trained adult (18–35 years), Caucasian athletes (≥10h training hours/ week) who underwent CMR examination as part of their screening were included in our study. Cine movie images in long- and short axis views were performed. Standard CMR parameters including left- and right ventricular (LV and RV) volumes, ejection fraction and muscle masses were measured. Feature-tracking strain analyses were performed, global LV longitudinal, circumferential and radial strain and RV longitudinal strain were calculated. CMR parameters of athletes were compared with healthy sex- and age matched sedentary control groups (n=105, 55 men).

Results

Athletes competed in mixed (n=99), endurance (n=99) and power (n=30) sport disciplines, and performed sport activity in quite high training hours (average: 21±5 hours/week). Regarding standard CMR parameters we found pronounced sports adaptation in both male and female athletes compared to sex- and age matched controls including lower LV and RV ejection fraction (p<0.05), elevated LV and RV volumes and masses (p<0.001). Strain analysis also revealed differences between athletes and controls: LV- GLS, GCS, GRS were lower in athletes compared to controls, regardless of their sex (p<0.05). RV-GLS was slightly lower in male athletes compared to male controls. Examining the effects of sport disciplines, we found the most marked sport adaptation in the case of endurance athletes. Training hours showed a positive correlation with LV-GLS and GCS values, and a negative correlation with GRS (p<0.001). We found that male athletes had more pronounced cardiac adaptation compared to females (p<0.001), and their LV-GLS and GRS values were lower (GLS: male athletes: −20±2% vs. female athletes: −22±2%; p<0.001), while GCS and RV-GLS showed no difference between sexes.

Conclusion

Our results suggest that in addition to standard CMR parameters, global strain values also show a small but consistent change during sport adaptation. Moreover, our results support the use of sex specific strain normal values in highly trained athletes.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The study was financed by the Research Excellence Programme of the Ministry for Innovation and Technology in Hungary within the framework of the Bioimaging Thematic Programme of Semmelweis University. LS was supported by the ÚNKP-20-3-II-SE-61 New National Excellence Program of the Ministry for Innovation and Technology from the source of the National Research, Development and Innovation Fund.

Tissue characteristics of the athlete"s heart: differentiation of physiological and pathological hypertrophy using parametric T1 and T2 mapping

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Fund of Hungary

Background

Intensive physical exercise leads to structural and functional cardiac adaptation termed athlete’s heart. Cardiac magnetic resonance (CMR) has an important role in the differentiation of physiological adaptation and pathological conditions. Beside the precise measurement of the ventricular volumes, mass, and function, it provides tissue specific information. Recently, native T1 mapping technique has been applied as a non-contrast method to detect myocardial fibrosis. Previous studies suggested that native T1 mapping can identify myocardial pathology before other CMR imaging techniques. T2 mapping values are elevated in case of myocardial edema.

Purpose

The aim of our study was to investigate the differences in CMR characteristics especially the native T1 and T2 mapping values of highly trained healthy athletes, healthy controls and patients with hypertrophic cardiomyopathy (HCM).

Methods

A total of 43 healthy athletes (water polo, swimming, football, 22 ± 8 training hours/week), 27 non-athlete healthy control and 25 HCM patients were involved in the study. Our inclusion criteria were: age >18 years,  in the athlete group >7 training hours per week . We evaluated the left ventricular (LV) end-systolic, end-diastolic (EDVi) and stroke volume (SVi) index, mass index (LVMi), ejection fraction (EF) and maximal end-diastolic wall thickness (EDWT). In a basal short axis slice the native T1 and T2 mapping values were evaluated.

Results

Athletes had significantly higher LV volumes compared to the control and HCM group (LVEDVi 114 ± 13 vs. 86 ± 11; 84 ± 15  ml/m2, LVSVi 64 ± 7 vs. 51 ± 7; 54 ± 10 ml/m2, respectively, p < 0.0001). HCM patients had the highest LVMi (72 ± 14 g/m2) and EDWT (18 ± 4 mm) compared to athletes and controls, athletes had higher LVMi (60 ± 11 vs. 42 ± 8 g/m2) and EDWT (10 ± 2 vs. 8 ± 1 mm) compared to the controls (p < 0.001). The native T1 mapping values differed significantly in the three groups, athletes had the lowest, HCM patients had the highest T1 values (athletes: 956 ± 19 ms, controls: 971 ± 20 ms, HCM patients: 993 ± 39 ms; p < 0.0001). There was no difference in the T2 mapping values between athletes and controls (44 ± 2 vs. 43 ± 2 ms), HCM patients had higher T2 values (45 ± 2 ms) compared to the other two groups (p < 0.01).

Conclusion

Intensive and regular training may lead to tissue specific changes of the myocardium. T1 and T2 mapping are potentially useful tools for differentiating between athlete"s heart and patients with hypertrophic cardiomyopathy.

Abstract Figure. T1 mapping in HCM and athlete

Left ventricular hypertrabeculation - an unanswered question

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Supported by the ÚNKP-19-3-II New National Excellence Program of the Ministry for Innovation and Technology

Left ventricular (LV) hypertrabeculation (H-TRAB) is a morphological description when the LV is highly trabeculated, but it remains below the diagnostic criterion of  noncompaction cardiomyopathy (NCMP). Although, it is a frequent finding on cardiac MRI scans its diagnostic and prognostic relevance remains controversial.  

In this cardiac MRI study, we aimed to describe the LV functional and feature-tracking strain values of healthy subjects with LV H-TRAB to decide whether it is a normal variant or an NCMP-like pattern.

We included 189 adult participants with good LV ejection fraction (EF), and without co-morbidities. 63 of them had a morphology of LV H-TRAB (H-TRAB, age: 37.1 ± 14.4 years; EF: 66.4 ± 5.1%), 63 patients were diagnosed with NCMP (age: 36.3 ± 14.0 years, EF: 65.8 ± 5.5%) and the remaining 63 people were healthy controls (38.3 ± 14.0 years, EF: 69.0 ± 4.9%). MR examinations were performed with 1,5T Philips Achieva and Siemens Aera devices. The  Medis Suite software was used for post-processing analysis, the MedCalc software for statistics, p < 0.05 was considered statistically significant. No significant differences were found between the functional parameters of the H-TRAB and NCMP groups. However, the EF was decreased, the end-diastolic (EDVi),  and end-systolic volume (ESVi), the myocardial mass (LV-massi), and trabeculated muscle mass (LV-trabi) values were increased in both groups compared to controls (H-TRAB vs. control: EF: 6.4 ± 5.4 vs. 69.0 ± 5.0%, EDVi: 74.4 ± 14.3 vs. 69.7 ± 12.8 ml/m2, ESVi: 25.1 ± 6.7 vs. 21.7 ± 5.8 ml/m2, LV-massi: 77.0 ± 15.1 vs. 71.2 ± 12.3 g/m2, LV-trabi: 25.0 ± 5.1 vs. 20.1 ± 4.0 g/m2; NCMP vs. control: EF: 65.8 ± 5.5 vs. 69.0 ± 5.0%, EDVi: 77.8 ± 15.0 vs. 69.7 ± 12.8 ml/m2, ESVi: 26.7 ± 7.9 vs. 21.7 ± 5.8 ml/m2, LV-massi: 76.8 ± 18.0 vs. 71.2 ± 12.3 g/m2, LV-trabi: 25.9 ± 7.5 vs.

20.1 ± 4.0 g/m2; p ≤ 0.05). The global circumferential strain (GCS) differed significantly between these groups: its absolute value was the lowest in the NCMP and the highest in the control group (NCMP vs. H-TRAB vs. control: -30.2% vs. -34.3% vs. -35.9%; p < 0.05). Similar results were found in the comparison of the mean segmental circumferential strain values of the apical-, mid- and basal-parts between the three groups. The absolute values of these parameters were the lowest in the NCMP patients, followed by the H-TRAB, and were the highest in the control group.

These results suggest that the LV functional and strain values of the H-TRAB population are more similar to NCMP patients than healthy controls. Further studies are necessary to determine the pathological implications and consequences of this morphology.

Temporal changes of left atrial function after orthotopic heart transplantation using cardiac magnetic resonance imaging in a single-center prospective study

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ÚNKP-19-3-I New National Excellence Program of the Ministry for Innovation and Technology; National Research, Development and Innovation Office of Hungary (NKFIA; NVKP_16-1-2016-0017 National Heart Program)

Background

The geometry and function of the left atrium (LA) change after orthotopic heart transplantation (HTX) with bicaval technique, as the LA has a recipient part around the pulmonary veins and a donor part, and these often contract separately. Because of this altered LA function, the recognition of left ventricular diastolic dysfunction can be challenging. The standard echocardiographic diastolic parameters are often in abnormal range in HTX patients despite of normal left ventricular diastolic function.

Purpose

The aim of our prospective study was to investigate the LA volumes and function and their temporal changes after HTX  using cardiac magnetic resonance (CMR).

Method

To better understand the cardiac characteristics of HTX patients, we started a prospective trial in January 2018. CMR was performed at one, three and six months after HTX. Left atrial contour detection was performed in 2- and 4-chamber views. Patients who had ≥Grade II allograft rejection before the CMR examination, were excluded (n = 6). In the remaining HTX patients (n = 37, 52 ± 12y, 29 male) and in a control group (n = 20, 49 ± 5y, 15 male) LA ejection fraction (EF), BSA-corrected maximum and minimum LA volume (Vi), stroke volume (SVi) were evaluated using bi-plane mode. LA global longitudinal strain (GLS) was defined with CMR based deformation imaging, called feature tracking.

Results

HTX patients had significantly higher LA volumes (maxLAVi 65 ± 22 vs. 46 ± 7 ml/m2, minLAVi 47 ± 21 vs. 18 ± 6 ml/m2) lower LASVi (19 ± 5 vs. 29 ± 4 ml/m2), LAEF (31 ± 10 vs. 62 ± 8%) and LA-GLS (10 ± 4 vs. 39 ± 11%) compared to the control group (p < 0.0001).  Analysing the temporal changes in HTX patients, we found an increase in the LA-GLS already at three months (10 ± 4 vs. 12 ± 3%, p < 0.05). The LAEF improved significantly at six months (29 ± 10 vs. 33 ± 10%, p < 0.05).

Conclusion

After HTX the LA volumes and function differ markedly from the normal population. The LA funcional parameters showed a moderate improvement after HTX. Better understanding the changes of left atrial function after HTX could help us to recognise  pathological conditions.

Abstract Figure. Strain analysis of the left atrium

Diagnostic and prognostic impact of cardiac magnetic resonance, including scar quantification and strain imaging in patients with malignant ventricular arrhythmias and nonobstructed coronary arteries

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Development and Innovation Fund of Hungary, National Research, Development and Innovation Office

Background

In case of malignant ventricular arrhythmias (VA) and nonobstructed coronary arteries, the differential diagnosis of the  underlying diseases is still challenging, due to the board spectrum of possible causes. Cardiac magnetic resonance (CMR) provides functional, morphological and tissue specific information, including necrotic and scar-tissue. 

Aims

  We aimed to assess the diagnostic and prognostic implications of CMR parameters including global strain values and myocardial scar in patients after ventricular fibrillation (VF) or sustained ventricular tachycardia (SVT) and nonobstructed coronary arteries.

Methods

Between 2011 and 2019, 99 patients (42 ±17 years, 54 male) presenting with VF or SVT and nonobstructed coronary arteries, who underwent CMR examination before secondary prevention implantable cardioverter defibrillator (ICD) implantation were included in our study. Post-processing included feature-tracking strain analysis and left ventricular (LV) scar quantification. Patients were followed for the combined endpoint of all-cause-mortality and appropriate ICD therapy.

Results

CMR examination proved structural myocardial disease in 72%: dilated (n = 21), arrhythmogenic (n = 11), hypertrophic cardiomyopathy (n = 7) and other cardiomyopathies (n = 3). We found LGE patterns showing chronic myocardial infarction (n = 4), suggesting chronic myocarditis (n = 4) and aspecific nonischemic scar formation (n = 14). In 7 cases aspecific structural alterations without scar formation were detected. Overall, myocardial scar was found in 52%, with an average extent of 12 ± 8% of the LV myocardium. The CMR examination changed the clinical diagnosis in 55% of the patients.  During a median follow-up at 2 years, 6 patients died and 42 experienced appropriate ICD therapy. We found an association between cardiac events and the presence of structural abnormality and myocardial scar (logrank: 4,553, p < 0.05 and 8.375, p <0.01).  On Cox proportional-hazards modell LV ejection fraction, LV stroke volume index, the presence of structural abnormality, the presence and extent of  myocardial scar, global LV strain parameters including longitudinal and circumferential strain, and a global left ventricular dssynchrony parameter (mechanical dispersion) were univariate predictors of the combined endpoint of all-cause-mortality and appropriate ICD therapy(p < 0.05). 

Conclusion

CMR performed in patients after malignant VA and nonobstructed coronary arteries not only establishes the diagnosis in a high proportion of patients, but may also provide additional prognostic factors. This may indicate that CMR could play a complementary role in the risk stratification in this patient population.

Abstract Figure.

Predictors of cerebral embolisation after percutaneous transfemoral aortic valve implantation (TAVI) in the RETORIC substudy

Purpose

To evaluate the predictors, occurrence and distribution of TAVI-related silent ischemic brain lesions using diffusion MRI.

Methods and materials

We investigated 109 consecutive patients with severe aortic stenosis from the prospective arm of the RETORIC study who underwent brain MRI one week afterpercutaneous transfemoral aortic valve implantation TAVI. To determine the occurrence and distribution of periprocedural cerebral ischemic lesions averaged diffusion-weighted images (trace) and mean diffusivity (MD) maps from the DTI dataset were used. To evaluate the aortic valve calcium score (AVCS), we assessed the preoperative prospectively ECG-triggered cardiac CT (256-slice MDCT). We also assessed the periprocedural factors such as periprocedural time, pre- and postdilatation. Multivariate linear regression analysis was performed to identify the independent predictors of TAVI-related ischemic lesions.

Results

After TAVI, a total of 918 new cerebral ischemic lesions were detected in 100/109 patients (92%). The median ischemic lesion volume was 237 μl (interquartile range 89.5–650) with a median lesion number of 6 (2–10) per patient. 759/918 lesions (83%) were supratentorial (389 left vs 370 right). Most lesions (628/918, 68%) were subcortical; the left and right MCA territories were the most affected (190. The vast majority of ischemic lesions were clinically silent (96%); 4% of patients had stroke which was proven by MRI. The median AVCS was 2769 (interquartile range 1858–4537). Balloon predilatation during TAVI procedure showed significant correlation with increased total ischemic lesion volume (p<0.001, β = 0.370) on univariate analysis, AVCS, periprocedural time, or postdilatation were not associated with ischemic load on MRI (p<0.05).

Conclusions

Periprocedural ischemic lesions are frequent (92%), most of them are clinically silent, however. Only balloon dilatation during TAVI was a predictor of increased ischemic load.

Aortic valve Ca scoring and DWI MRI

Funding Acknowledgement

Type of funding source: None

P1338 Anomalous left coronary artery from pulmonary artery syndrome diagnosed in adulthood: case of a mother of five

Funding Acknowledgements

Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary

Introduction

Bland-White-Garland syndrome or ALCAPA (anomalous left coronary artery from pulmonary artery) syndrome is a rare congenital disorder with a prevalence of 1: 300,000. This condition is one the most common causes of infant myocardial infarction. It can ultimately lead to heart failure before the age of one, however when pronounced left and right coronary artery collateralization is present, patients may remain asymptomatic until older age. Due to the development and availability of non-invasive imaging techniques, these patients diagnosed more frequently in recent years.

Case description: We present a 53-year-old patient with treated hypertension and five uncomplicated pregnancies. At the age of 40, the patient was referred to coronary angiography due to her dyspnea on exertion. The examination showed that the left main coronary artery (LMCA) originates from the pulmonary artery 7 mm above the pulmonary valve and the right coronary artery is significantly dilated. Based on the mild complaints and good left ventricle systolic function, conservative therapy was recommended by the cardiac surgery team. Since 2018 the patient has had gradually worsening complaints despite of the therapy adjusted for chronic heart failure. Q-waves were depicted on the 12-lead ECG in aVL and V1-V6 leads. Echocardiography showed dilated left ventricle (LV), LV hypertrophy, diffuse hypokinesia, decreased LV systolic function and diastolic dysfunction. At our clinic, we performed cardiac magnetic resonance imaging (CMR) which showed moderately reduced LV ejection fraction, diffuse LV hypokinesia, increased LV volume, septal LV hypertrophy. We visualized the retrograde flow on the LMCA, the shunt volume at the anomalous artery was 1,27 L/min. The CMR also showed irreversible damage of the subendocardial region of the myocardium via late gadolinium enhancement in the area supplied by the LMCA. Since we planned to reevaluate the surgical possibilities, the collateral network with tortuous and dilated left and right coronary arteries were visualized by coronary CT angiography. The surgical team at our institute decided to perform myocardial revascularization and restoration of dual coronary artery supply.

Discussion

ALCAPA is usually diagnosed in infancy however, in about 10-15% of cases the disease is only recognized in adulthood. The long-term morphological and functional characteristics of the syndrome may include reversible/irreversible ischemic damage, systolic and diastolic dysfunction, mitral regurgitation, significant collateral circulation, left-to-right shunt, dilated coronary arteries. Surgical myocardial revascularization and restoration of dual coronary artery supply is recommended even in adult patients.

Abstract P1338 Figure. CTA reconstruction and LGE CMR

P345 Temporal changes of left atrial function after orthotopic heart transplantation in a single-center prospective study

Funding Acknowledgements

Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary

The geometry and function of the left atrium (LA) change after orthotopic heart transplantation (HTX) with bicaval technique, as the LA has a recipient part around the pulmonary veins and a donor part, and these often contract separately. Because of this altered LA function, the recognition of left ventricular diastolic dysfunction can be challenging. The standard echocardiographic diastolic parameters are often in abnormal range in HTX patients despite of normal left ventricular diastolic function.

The aim of our prospective study was to investigate the LA volumes and function and their temporal changes after HTX using cardiac magnetic resonance (CMR).

To better understand the cardiac characteristics of HTX patients, we started a prospective trial in January 2018. CMR was performed at one, three and six months after HTX. Left atrial contour detection was performed in 2- and 4-chamber views. Patients who had ≥Grade II allograft rejection before the CMR examination, were excluded (n = 2). In the remaining HTX patients (n = 21) and in a control group (n = 21) LA ejection fraction (EF), BSA-corrected maximum and minimum LA volume (Vi), stroke volume (SVi) were evaluated using bi-plane mode. LA global longitudinal strain (GLS) was defined with CMR based deformation imaging, called feature tracking.

HTX patients had significantly higher LA volumes (maxLAVi 71 ± 22 vs. 47 ± 6 ml/m2, minLAVi 53 ± 22 vs. 18 ± 5 ml/m2) lower LASVi (19 ± 7 vs. 29 ± 4 ml/m2), LAEF (27 ± 10 vs. 62 ± 8%) and LA-GLS (8 ± 3 vs. 39 ± 10%) compared to the control group (p < 0.0001).

Analysing the temporal changes in HTX patients, we found an increase in the LAEF (26 ± 8 vs. 30 ± 5%) and LA-GLS (8 ± 3 vs. 11 ± 3%) at three months (p < 0.05), there was no significant difference between the LA parameters at three and six months.

Better understanding of the changes of left atrial function after HTX could help us to recognise pathological conditions.

Abstract P345 Figure. Strain analysis of the left atrium

P363 Cardiac magnetic resonance characteristics of patients in the grey zone of hypertrophy

Funding Acknowledgements

National Research, Development and Innovation Office (NKFIH) of Hungary (K 120277); Project no. NVKP_16-1-2016-0017. Supported by the ÚNKP-18-3-IV

Background

Differentiation between athlete’s heart and hypertrophic cardiomyopathy (HCM) may cause difficulties especially in patients in the grey zone of hypertrophy.

Purpose

We aimed to analyse cardiac magnetic resonance (CMR) characteristics of healthy athletes, sedentary HCM and athletic HCM patients in the grey zone of hypertrophy.

Methods

Male HCM patients with slightly elevated maximal end-diastolic wall thickness (EDWT 13-18 mm) and highly trained healthy athletes (n = 34, 20.4 ± 2.3 training hrs/week) were consecutively enrolled. HCM patient group was divided to sedentary (n = 35, <7 training hrs/week) and athletic HCM group (n = 13; >7 h/week, 13.2 ± 5.0 h training hrs/week).We determined conventional CMR parameters (left ventricular (LV) ejection fraction (EF),BSA-corrected end-diastolic (EDVi) and end-systolic volume (ESVi), mass (Mi)), derived parameters such as EDWT/LVEDVi, LVM/LVEDV and CMR based strain parameters such as global longitudinal (GLS), radial (GRS) and circumferential strain (GCS), standard deviation of peak LS, RS and CS (SD LS peak, SD RS peak, SD CS peak), standard deviation of time to peak LS, RS and CS (TTP LS, TTP RS, TTP CS) using feature tracking. Presence of late gadolinium enhancement (LGE) was determined on delayed contrast enhanced images. Inter-observer analysis for strain values was performed in a subgroup of 20 patients conducted by two blinded observer.

Results

Healthy athletes showed lower LVEF, GCS and GRS than sedentary and athletic HCM patients, respectively (57.9 ± 5.2 vs 65.3 ± 7.4, 62.7 ± 5.1; -19.7 ± 7.0 vs -24.4 ± 4.6, -22.8 ± 4.8; 61.7 ± 11.2 vs 75.4 ± 21.4, 69.3 ± 19.8). Both healthy athletes and athletes with HCM showed higher LVEDVi, LVESVi, LVSVi and LVMi than sedentary HCM patients. Although sedentary athletes showed higher SD peak strain values and more pronounced intraventricular dyssynchrony than healthy athletes (TTP LS 15.4 ± 4.9 vs 11.7 ± 4.3), none of the global strain values, SD of peak strain values or TTP strain values showed any difference between athletic HCM and healthy athletes. EDWT/LVEDVi ratio was significantly lower in healthy athletes than in sedentary and athletic HCM, respectively (0.11 ± 0.02 vs 0.19±.0.04; 0.18 ± 0.04). Inter-observer analysis showed good agreement in GLS (κ=0.77), GRS (κ=0.69) and TTP LS (κ=0.74), moderate agreement in GCS (κ=0.54), and only fair or poor agreement in SD peak strain, TTP CS and TTP RS values. None of the healthy athletes showed LGE, 62% of athletic HCM and 71% of sedentary HCM patients showed LGE in the hypertrophic segments or in the insertion points.

Conclusions

Based on our results CMR characteristics of sedentary and athletic HCM differs significantly, therefore establishing diagnostic parameters and cut-off values based on comparison between athletic HCM and healthy athletes would be essential. Presence of late gadolinium enhancement and derived parameters may have an important role in the differential diagnosis.

P364 The first prospective study of non-compaction cardiomyopathy patients with preserved ejection fraction using cardiac magnetic resonance feature tracking

Feature tracking (FT) is a new cardiac magnetic resonance (CMR) technique for strain measurement to reveal changes e.g. in noncompaction cardiomyopathy (NCMP) patients with good ejection fraction (EF).

Our aim was to describe, first in the literature, the functional and CMR-FT strain values of NCMP patients with good EF and to compare them with their previous scans taken 4 years ago.

At the Heart and Vascular Center of Semmelweis University 6743 CMR examinations were done between 2009-2015 and 232 NCMP patients were diagnosed. We followed up 27 patients, who had a previous examination at least 4 years ago, had no co-morbidities and whoes EF were above 50% (mean age: 37 ± 14.4 years, 18 males, mean follow up: 5.7 ± 1.5 years). Their parameters were compared to a matched control (C) group.

The Medis Suite software was used for analysis, the MedCalc software for statistics, (p < 0.05).

We compared the patient’s previous (PREV) and recent (REC) functional parameters but did not find significant changes. Comparing the global longitudinal and global circumferential strains (GLS, GCS) and rotation (R) no difference was found between the PREV and the REC values. The GCS showed significant difference between NCMP and C groups (-30.2 ± 5.0 vs -35.9 ± 4.5; p < 0.0001). We compared the segmental longitudinal and circumferential strain values of PREV vs. REC groups and NCMP vs C groups and found significant differences just in a few segments. The left ventricular (LV) apical part’s mean longitudinal strain value showed significant decrease on the REC scans compared to the PREV (PREV vs REC: -24.4 ± 7.7 vs -20.6 ± 5.1%; p < 0.05) and a non-significant decrease compared to the C (C vs REC: -22.8 ± 7.5 vs -20.6 ± 5.1%; p= n.s.).

The ratio of the average longitudinal strain value of the apical and basal part of the left ventricle was significantly smaller in the REC group compared to the PREV but did not differ from the C subjects ( PREV vs. REC: 1.5 ± 0.8 vs 1.0 ±0.3; C vs REC: 1.5 ± 0.3 vs 1.2 ± 0.5; p < 0.05)

We did not find worsening in the functional parameters of NCMP patients with good EF by the end of the follow up period. However, subclinical changes can be detected in the affected apical part of LV when using FT suggesting the need for follow up.

P1831 Predictors and clinical consequences of silent ischaemic brain lesions following transcatheter aortic valve implantation

Funding Acknowledgements

This study was supported by the János Bolyai Scholarship of the Hungarian Academy of Sciences

Background

A number of studies aimed to identify the predictors of periprocedural cerebral embolizations related to transcatheter aortic valve implantation (TAVI). Much less investigated is the prevalence and determinants of subacute ischaemic brain lesions that develop following TAVI.

Purpose

We sought to identify predictors of subacute clinically silent ischaemic brain lesions in patients following TAVI.

Methods

Patients were included from the Rule out Transcatheter Aortic Valve Thrombosis with Post Implantation Computed Tomography (RETORIC) prospective trial. Echocardiography and brain MRI were performed after TAVI procedure, before hospital discharge. Cardiac CT was performed 6 months later to identify subclinical leaflet thrombosis (HALT), as well as repeat brain MRI, to identify any silent ischaemic lesions that appeared since the intervention. The cognitive trajectory of patients was assessed using the Addenbrookes cognitive test (ACE), performed shortly after TAVI and at 6-month follow-up (FU). All-cause mortality data was retrieved from the National Mortality Database.

Results

79 consecutive patients were included in the present analysis. 28% had known history of atrial fibrillation (AF). 33% of the cohort was treated with oral anticoagulant, of these 56% with single and 25% with dual antiplatelet therapy (DAPT). The mean CHA2DS2VASC score was 4. From discharge to the 6-month FU, 20 patients (25%) developed new silent ischaemic brain lesions on MRI. Clinically manifest stroke did not occur. On the 6-month CT, HALT was identified in 6 patients (8%). Clinical and imaging parameters, including age, body mass index, hypertension, dyslipidaemia, diabetes, smoking, statin-, OAC- and DAPT therapy, history of AF, history of stroke, echocardiographic metrics of left ventricular (ejection fraction, stroke volume index) and atrial (left atrial strain) function as well as HALT were analysed for association with ischaemic brain lesions. Of the above, only HALT showed significant association (OR:6,58; p = 0.04) with silent brain embolizations. The cognitive trajectory from discharge till 6-month FU did not differ between patients with or without ischaemic focuses (ΔACEscore: 1.0 vs. 0.1; p = NS). Over a median FU of 553 (IQR 453 – 665) days, 8 patients died; 2 with and 6 without ischaemic lesions. Kaplan-Meyer analysis showed no difference in outcome between the two groups (p = 0.68)

Conclusion

Subclinical leaflet thrombosis was identified as a significant predictor of subacute silent ischaemic brain lesions after TAVI. These lesions did not affect the overall cognitive performance or outcome of the patients.

P1824 Feature tracking strain values of noncompaction cardiomyopathy patients: differences in the light of ejection fraction

Feature tracking (FT) is a new cardiac magnetic resonance (CMR) technique for strain measurement which may give additional information about the progression of noncompaction cardiomyopathy (NCMP).

First in the literature, we compared the strain and functional parameters of NCMP patients with reduced (R) and good (G) ejection fraction (EF) using CMR-FT.

From the total of 164 CMR proven R NCMP patients, who were examined between 2009 and 2018 at the Heart and Vascular Center of Semmelweis University, we selected 26 non-ischaemic, contrast agent-free examinations (age: 56 ± 10.6 years; EF: 32.7 ± 10.0%; male = 19). According to their EF they were divided into medium (M; EF: 35-50%; n = 10) and significantly reduced EF (SR; EF <35%; n = 16) subgroups. We searched 25 NCMP patients with good EF (age: 37 ± 14.4 years; EF: 65.9 ± 5.3%; male = 16) and 26 control persons (age: 52 ± 10.7 years; EF: 70.8 ± 5.1%; male = 16) to the above mentioned groups.

The Medis Suite program was used for analysis and the MedCalc software for statistics, (p < 0.05).

Significant differences were found between the functional parameters of R and G patients. The global longitudinal strain (GLS) and global circumferential strain (GCS) values of the R group were decreased significantly compared to G and C groups. (R vs G; GLS: -9.5 ± 4.3 vs -20.9 + 3.2%; GCS: -12.5 ± 6.1 vs -30.5 ± 5.0%, p < 0.0001; R vs C; GLS: -9.5 ± 4.3 vs -23.3 ± 4.4%; GCS: -12.5 ± 6.1 vs -35.6 ± 5.1%, p < 0.0001).

All the segmental strain values of R group were decreased compared to G and C groups, moreover this significancy was observed between the M and SR subgroups as well.

The strain values of the R group in all the basal, mid and apical part of the left ventricle (LV) were reduced equally.

The average longitudinal strain values of the apical part of the LV in the SR subgroup were significantly reduced compared to the average strains of the basal part (apical vs basal: -8.9 ± 3.0 vs -11.9 ± 4.4 %, p < 0.05). In addition, we found positive correlation in the R subgroup between the GCS and the mass of trabeculated muscle (r = 0.58, p = 0.002) .

Our study shows that the global and segmental strain values decreased significantly in proportion to the reduction of the EF which describes well the progression of heart failure in NCMP. However, the decreased strain values of the hypertrabeculated apical part might be specific to NCMP.

P3381Quantification of hypo-attenuated leaflet thickening after transcatheter aortic valve implantation - clinical relevance of HALT volume

Background

Hypo-attenuated leaflet thickening (HALT) is a recently recognized phenomenon following transcatheter aortic valve implantation (TAVI) and there is no consensus over the standardized assessment of HALT and its clinical relevance is poorly understood. We sought to determine the predictors and clinical significance of HALT volume.

Methods

Patients, who previously underwent TAVI between 2011 and 2016 were prospectively enrolled in the RETORIC (Rule out Transcatheter Aortic Valve Thrombosis with Post Implantation Computed Tomography) study, a single-center observational study. At inclusion cardiac computed tomography angiography (CTA), transthoracic echocardiography (TTE) and brain magnetic resonance imaging (MRI) was performed. HALT was volumetrically quantified on cardiac CTA images by segmenting the inner volume of the TAVI frame at the level of the leaflets and applying a threshold of −200 to 200 Hounsfield units. We evaluated the clinical predictors of HALT volume, and its association with ischemic brain MRI lesions (recent and chronic large vessel ischemic focuses, microbleed/microembolization, white matter or small vessel disease) and all-cause mortality.

Results

In total, we analyzed 111 patients with CoreValve bioprosthesis (56.7% female, mean age 80.3±7.4 years). A median of 19 [IQR: 11–29] months passed between TAVI procedure and enrollment. The mean HALT volume was 111.0±163.4 mm3. Current malignant disease, prosthesis implantation depth measured on CTA images acquired at inclusion, and aortic mean gradient and aortic valve area evaluated on TTE images at inclusion predicted HALT volume by univariate analysis (all p<0.05). After multivariate adjustment, aortic mean gradient remained a significant predictor of HALT volume (beta-coefficient: 11.5, 95% CI: 5.0–18.0; p<0.001). HALT volume was not associated with ischemic brain MRI lesions (all p>0.05) and did not predict all-cause mortality (median follow-up: 20 months [IQR: 18–23]; HR: 1.0; 95% CI: 1.0–1.0; p=0.15).

Volumetric quantification of HALT.

Conclusion

Aortic mean gradient was the only predictor independently associated with HALT volume. Our results suggest that TAVI valve function is negatively affected by HALT volume, however, we found no association of HALT volume with cerebrovascular ischemic lesions or increased risk for all-cause mortality.

P4429Cardiac magnetic resonance characteristics of professional athletes and hypertrophic cardiomyopathy patients in the grey zone of hypertrophy

Acknowledgement/Funding

National Research, Development and Innovation Office (NKFIH) of Hungary (K 120277). Project no. NVKP_16-1-2016-0017

2388Differential diagnosis of MINOCA patients: the contribution of early cardiac magnetic resonance imaging to the final diagnosis in patients with normal coronary angiography

Introduction

The diagnostic value of cardiac magnetic resonance (CMR) imaging has been suggested in determination of the cause behind Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA). According to the current STEMI Guideline CMR is considered to have the best diagnostic performance, when CMR timing is within its optimal ≤2 weeks.

Purpose

The aim of our study was to establish the prevalence of the underlying pathologies using early (1–7 days) CMR examination in patients with signs of troponin positive acute coronary syndrome (ACS) but normal coronary angiography (NCA). We also aimed to investigate how early CMR changes the provisional diagnosis, and to provide detailed information of CMR characteristics of our pts and to compare laboratory parameters and risk factors of each group.

Methods

Between 2010–2018 (n=234) consecutive pts (40.2±12.1y, 159 male) with troponin positive ACS underwent CMR examination following NCA (≤20% stenosis), in a mean length of time of 2.5 days. Cine movie, T2-weighted and late gadolinium enhanced images (LGE) were performed. Left ventricular end-diastolic and end-systolic volumes (LVESVi), ejection fraction (LVEF), mass (LVM) and myocardial necrosis were evaluated. We analysed the risk factors and laboratory values of our patients.

Results

CMR proved acute myocardial infarction (MI) in 42 pts (52% male), acute myocarditis in 138 pts (89% male), Tako-Tsubo cardiomyopathy (TTC) in 25 woman, myocardial contusion in one case, in three cases CMR raised the suspicion of sarcoidosis and in 25 pts (56% male) there was no CMR abnormality. LVEF was lower, LVESVi was elevated in TTC patients compared to MI and myocarditis (LVEF: 44±9.1 vs 56.5±7 vs 55±6.6%; LVESVi: 52.5±12.9 vs 41±16.8 vs 42.1±8.9 ml/m2 p<0.001). The most frequently affected areas of the myocardium by LGE were the basal and mid inferolateral segments in case of myocarditis (69% of pts). In MI pts the anterior wall was affected only in 16%, while the involvement of inferior wall was visible in 57% of the pts. Early CMR examination established a definitive diagnosis in 88% of the cases, in 11% there was no CMR abnormality and it remained inconclusive in only 1% of the cases. CMR changed the provisional diagnosis in 47% of the pts.

Myocarditis pts were younger (myocarditis: 32.5±10.8 vs MI 47.6±15.5 vs TTC 65.5±9.6 y; p<0.001) and lower percentage had hypercholesterinaemia (myocarditis: 18.8 vs MI: 40 vs TTC: 54.5%, p<0.01) or hypertension (myocarditis: 14.3 vs MI: 38.7 vs TTC: 55.6%, p<0.001). Laboratory values showed significant elevation of hsTroponin and CKMB of MI and myocarditis pts compared to other groups (p<0.05), but there was no difference between these two groups.

Underlying pathologies in MINOCA

Conclusion

In patients with the working diagnosis of MINOCA and normal coronary angiography early CMR established a definitive diagnosis in 88% of our patients and changed the provisional diagnosis in 47% of the pts.

Acknowledgement/Funding

Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary

P876Cardiac magnetic resonance based feature-tracking myocardial strain analysis in MINOCA patients

Acknowledgement/Funding

Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary

P1528The added value of cardiac magnetic resonance to the diagnosis of patients after aborted sudden cardiac death

Introduction

An estimated 25% of all cardiovascular deaths are due to sudden cardiac death (SCD). The primary cause of SCD is coronary artery disease, however cardiac diseases accounted for SCD differ in young vs. older individuals. In patients with normal coronary angiography (NCA) the differential diagnosis is still challenging, due to the broad spectrum of underlying cardiovascular abnormalities. Cardiac magnetic resonance (CMR) provides accurate tissue specific and functional information of the heart.

Purpose

We aimed to investigate patients after aborted sudden cardiac death but NCA using cardiac magnetic resonance imaging (CMR). Our goal was to evaluate left and right ventricular parameters, presence of late gadolinium enhancement (LGE) and to assess the diagnostic value of CMR.

Methods

We enrolled 84 consecutive patients (39±13 y; 51% male) after aborted SCD with NCA and without CMR contraindication. CMR examination including long- and short-axis cine, T2-weighted and LGE images were performed. Left and right ventricular parameters were evaluated. Presence and pattern of the oedema and LGE were also assessed.

Results

Structural myocardial abnormality was present in 57% of pts: dilated (n=13), arrhythmogenic right ventricular (n=6) and hypertrophic (n=4) cardiomyopathy (CMP), moreover acute (n=2) and chronic (n=3) myocardial infarction, acute (n=2) and chronic (n=2) myocarditis, Tako-Tsubo CMP (n=1), noncompaction CMP (n=1), endomyocardial fibrosis (n=1). In 13 cases aspecific structural alterations were detected with (n=7) and without (n=6) LGE. Only 13% of the patients showed ejection fraction lower than 35% (LVEF=52±9%), 54% showed LV dilation (LVEDVi>100 ml/m2 in males and >90 ml/m2 in females; LVEDVi=104±22 ml/m2). LGE was present in 36%, showing ischemic pattern in five cases and nonischaemic pattern in 25 cases. Eleven patients were elite athletes (28±10y, 91% male, training hours: >10 hours/week). Three of them showed ARVC based on the current Task Force criteria, another three athletes showed aspecific structural alteration with nonischaemic LGE.

The CMR examination confirmed the referral diagnosis in 22%, excluded the presence of structural myocardial alteration in 43% and changed the clinical diagnosis in 35% of the patients.

Conclusion

CMR has an important diagnostic value in patients after reanimation but NCA. More than half of these patients showed structural alteration and CMR provided a diagnosis in 42%.

Acknowledgement/Funding

Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary

P3558Cardiac magnetic resonance characteristics of the transplanted heart: first results of the prospective Heart-TIming CMR substudy

Background

In case of heart transplantation (HTX) the heart is affected by several factors e.g. ischaemia/reperfusion, denervation, immunosuppression. During the adaptation, the heart may show marked temporal changes in terms of myocardial mechanics, function and tissue characteristics. To better understand temporal characteristics after orthotopic bicaval HTX we started the prospective Heart-TIming (Transplantation Imaging) trial in January 2018 including standard 12-lead ECG, 24-hour Holter monitor, endomyocardial biopsy, transthoracic echocardiography, invasive coronary angiography with intravascular ultrasound and optical coherence tomography and cardiac magnetic resonance (CMR).

Aim

In our CMR substudy we aimed to evaluate the physiological structural and functional left and right ventricular characteristics and their temporal changes after HTX using CMR.

Methods

As part of the study HTX patients underwent CMR at 1, 3 and 6 months after HTX (n=31; 52±10.5y, 25 male). Cine images, T2-weighted, late gadolinium enhancement (LGE) and adenosine stress perfusion (at 1 month) images were acquired. In order to describe physiological characteristics of the transplanted heart we excluded pts with significant coronary artery disease, ischaemic scar, ≥Grade II allograft rejection from this present study (n=6). We assessed the left (LV) and right ventricular (RV) ejection fractions, volumes, masses (M) and LV strain. We assessed the global strain values: longitudinal, circumferential (GCS) strain and the standard deviation (SD) of the peak longitudinal strain (LS) and the left ventricular mechanical dispersion. We compared baseline volumetric and strain parameters to age matched healthy controls (n=20; 47±11.4y, 15 male), and the temporal changes between one, three and 6 months.

Results

Comparing the HTX patients' CMR parameters at one month with normal controls, HTX patients had lower LV and RV end-diastolic volumes (LVEDVi: 76.6±15.9 vs 90.6±11.6ml/m2; RVEDVi 74.5±17.5 vs 90.3±12.1ml/m2, p<0.05),stroke volumes (p<0.05) and higher LVMi (67.6±14.4 vs 57.2±11g/m2, p<0.05). CMR based strain analysis of the HTX pts showed hyperkinetic GCS (−40,5±6.3% vs −35.2±4.8%, p<0.05), increased SD of peak LS and more pronounced mechanical dispersion (p<0.001) compared to the controls. Examining temporal changes in HTX pts we found a decrease in LVMi (69.57±16.4 vs 61.7±9.8g/m2, p<0.05) already at three months, normalization of GCS (−37.7±5.5% vs −32.6±4.9%, p<0.05) and decrease in SD of peak LS (13.5±2.3 vs 11.4±2.4, p<0.05) at 6 months. Oedema was present in all pts at one month after HTX, and disappeared after three months. LGE with aspecific pattern was present in 42%.

LGE with aspecific pattern in HTX pts

Conclusions

Understanding the temporal changes of LV mechanics, function and tissue characteristics, furthermore the establishment of physiological values may help in the early, noninvasive identification of pathological changes in HTX pts.

NCT number: NCT03499197

Acknowledgement/Funding

Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary

P310Differentiation between arrhythmogenic right ventricular cardiomyopathy and athlete's heart using cardiac magnetic resonance based derived parameters and strain analysis

Acknowledgement/Funding

National Research, Development and Innovation Office (NKFIH) of Hungary (K 120277), ÚNKP-18-3-IV New National Excellence Program of Human Capacities.