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Pulmonary vascular remodeling is common among patients with advanced heart failure. Right heart catheterization is the gold standard to assess pulmonary hypertension, but is limited by indirect measurement assumptions, a steady-flow view, load-dependency, and interpretation variability. We aimed to assess pulmonary vascular remodeling with intravascular optical coherence tomography (OCT) and to study its correlation with hemodynamic data.This observational, prospective, multicenter study recruited 100 patients with advanced heart failure referred for heart transplant evaluation. All patients underwent right heart catheterization together with OCT evaluation of a subsegmentary pulmonary artery.OCT could be performed and properly analyzed in 90 patients. Median age was 57.50 [interquartile range, 48.75-63.25] years and 71 (78.88%) were men. The most frequent underlying heart condition was nonischemic dilated cardiomyopathy (33 patients [36.66%]). Vascular wall thickness significantly correlated with mean pulmonary artery pressure, pulmonary vascular resistance, and transpulmonary gradient (R coefficient=0.42, 0.27 and 0.32 respectively). Noninvasive estimation of pulmonary artery systolic pressure, acceleration time, and right ventricle-pulmonary artery coupling also correlated with wall thickness (R coefficient of 0.42, 0.27 and 0.49, respectively). Patients with a wall thickness over 0.25mm had significantly higher mean pulmonary pressures (37.00 vs 25.00mmHg; P=.004) and pulmonary vascular resistance (3.44 vs 2.08 WU; P=.017).Direct morphological assessment of pulmonary vascular remodeling with OCT is feasible and is significantly associated with classic hemodynamic parameters. This weak association suggests that structural remodeling does not fully explain pulmonary hypertension.

Background Paravalvular aortic regurgitation after transcatheter aortic valve implantation is associated with a hemodynamic deterioration and a poor outcome. We aim to determine the early hemodynamic effect of paravalvular aortic regurgitation in relation with the change in the left ventricle filling pattern and to assess their clinical outcome. Material and methods Eighty-two consecutive patients referred for transcatheter aortic valve implantation were included. Patients were classified according to the change in the left ventricular filling pattern, and significant paravalvular aortic regurgitation (grade ≥ 2) was reported. Follow-up and incidence of death and hospitalization for heart failure were reported. Results Sixteen patients (19·5%) presented a worsening of left ventricular filling pattern. The incidence of significant paravalvular aortic regurgitation was higher in the group with a worsening of left ventricular filling pattern (56·3% vs. 19·7%; P = 0·009). In the multivariate analysis, the only variable significantly associated with the worsening of left ventricular filling pattern was the significant paravalvular aortic regurgitation (OR 4·84; 95% CI 1·23 – 19·1; P = 0·024). During the follow-up (642·5 days), there was a higher incidence of the endpoint of death or hospitalization for heart failure in the group with a worsening of left ventricular filling pattern (62·5% vs. 31·8%; P = 0·042) and a lower event-free survival rate (long rank test = 0·013). Conclusions The presence of a significant paravalvular aortic regurgitation is associated with a worsening in parameters of diastolic function. This finding should alert the cardiologist as patients with a worsening of left ventricular filling pattern present a higher incidence of paravalvular aortic regurgitation and a less favourable outcome.

Cardiac allograft vasculopathy (CAV) is a major impediment to long-term graft survival after heart transplantation. Intravascular ultrasound (IVUS) is more sensitive than coronary angiography for diagnosis, but the identification of specific plaque components or plaque composition is limited. In addition, there is an evident need for other noninvasive tools for diagnosing CAV. The aim of this study was to assess the utility of 2 new techniques for evaluating CAV: optical coherence tomography (OCT), and new high-sensitivity troponin T (hsTnT) assays. In 21 heart transplantation patients, coronary arteriography with IVUS and OCT were performed. Maximal intimal thickness (MIT) and luminal area at the most severe site were measured using the 2 techniques. Immediately before cardiac catheterization, blood samples were obtained and hsTnT levels measured. The evaluation of CAV by OCT showed a good correlation with IVUS measurements, with a mean difference in MIT of 0.0033 (95% confidence interval -0.049 to 0.043), taking advantage of lower interobserver variability (r = 0.94 for OCT vs r = 0.78 for IVUS) and better plaque characterization. When independent predictors of MIT were assessed in a multiple linear regression model, time after transplantation (β = 0.488, p = 0.004) and hsTnT (β = 0.392, p = 0.011) were the only independent predictors of MIT (R(2) = 0.591). In conclusion, this study is the first to evaluate 2 new techniques, OCT and hsTnT, in the challenging setting of CAV. The findings suggest that OCT provides lower interobserver variability and better plaque characterization than IVUS. Also, hsTnT could become a useful tool for ruling out CAV.

Introduction: According to current practice guidelines, coronary bypass surgery is the standard care option for unprotected left main (ULM) stenosis. However, a group of high surgical risk patients who are not eligible for coronary bypass surgery could benefit from percutaneous coronary intervention (PCI). Severe calcification hampers PCI in this setting, and rotational atherectomy (RA) could be of great help. Methods: We retrospectively analyzed a cohort of 40 patients with severely calcified ULM stenosis, not eligible for coronary artery bypass grafting, who underwent RA in our center. Results: Forty patients (mean age, 73 ± 8 years; 26 males) with ULM stenosis were treated with RA. Twenty-seven (67%) had distal stenosis. The mean number of treated vessels was 2.38 ± 0.74, with a mean lesion length of 30 ± 18 mm. Abciximab was used in 12 (30%) cases and an intra-aortic balloon pump in three cases. One patient died during the procedure and another two patients died in the first 24 hr after the procedure. The major events registered after the procedure included one significant branch loss, and two minor and one major case of bleeding (the latter requiring transfusion) at the puncture point. After a median of 24.7 (IQR 19.6–34.3) months of follow-up, 12 cardiac deaths were recorded. Survival free of cardiac death was 71 ± 7% and clinical guided target vessel revascularization 19.3 ± 7% at 2 years. Conclusion: In a group of high surgical risk patients, RA on severely calcified left main stenosis is feasible and, in spite of high mortality rates, could pose the only possible effective treatment. © 2012 Wiley Periodicals, Inc.

70 Paravalvular aortic regurgitation after autoexpandibles aortic protheses. Comparison between Edwards-Sapien protheses and Perceval sutureless aortic valve. {#article-title-2} Purpose: The transcatheter aortic valve implantation (TAVI) has proved to be an alternative treatment for severe aortic stenosis in high risk patients. New surgical techniques with autoexpandibles suturless aortic valve protheses have shown good results with a less invasive surgical approach and a reduction in surgical time. The purpose of the study was to compare initial echocardiographic results after aortic valve implantation by both techniques. Methods: We studied 142 consecutive patients submitted to TAVI and 33 patients submitted to aortic valve replacement (AVR) with autoexpandibles sutureless Perceval valves. Clinical and demographic variables were registered and a transthoracic echocardiography study was performed before the implantation and after the procedure or surgery. Maximum and mean aortic gradients were registered as well as the paravalvular aortic regurgitation (AR). The latter was classified in two grades: I= null o mild; II= moderate or severe. Results: The 142 patients submitted to TAVI were diagnosed of symptomatic severe aortic stenosis with a high surgical risk (Logistic EuroSCORE 10,4 ± 7,8), and higher age than the ones submitted to surgery (81,8 vs. 79,8; p=0,005). From the 33 patients submitted to AVR with Perceval protheses, 5 of them (15%) were also performed a coronary artery bypass graft. The incidence of paravalvular AR was grade I (null o mild) in 25 patients (86%), and grade II (moderate or severe) in 4 (14%). In patients with TAVI, 94 of them (69,1%) presented null or minimum paravalvular AR, while in the 42 remaining patients (30,9%) it was grade II, with statistically significant differences between the 2 types of protheses ( p=0,046). Both protheses presented similar aortic gradients in the study after the implantation, without statistically significant differences between TAVI and Perceval protheses in maximum Doppler gradient (20,98 vs. 23,87 mmHg; p= 0.152) and mean gradient (11,16 vs. 13,31 mmHg; p=0.063). The relation between time-velocity integral of the LV outflow tract and aortic valve after the implantation was also similar between both groups (median 0,55 vs. 0,53; p= 0,228). Conclusions: The early echocardiographic study after the implantation of autoexpandible aortic protheses shows comparable results between both types of protheses in terms of gradients, with a higher incidence of paravalvular aortic regurgitation in the group of TAVI. # 71 Exercise echocardiographic determinants of BNP changes during follow-up in asymptomatic patients with aortic stenosis and preserved left ventricular function {#article-title-3} Purpose: B-type natriuretic peptide (BNP) level may be a useful prognostic marker in asymptomatic patients with severe aortic stenosis (AS). Recently updated European Society of Cardiology guidelines recommend its measurement and the use of exercise stress echocardiography to optimize risk stratification in these patients. The goal of this study was to correlate exercise echocardiographic data and BNP changes during follow-up in asymptomatic patients with AS and preserved left ventricular (LV) function. Methods: We studied 61 asymptomatic patients (age: 70±13 years; 64% of males) with ≥ moderate AS (aortic valve area: 0.98±0.25cm2) and preserved LV ejection fraction (69±6%) who underwent resting and exercise Doppler echocardiography with concomitant BNP level measurement at baseline. None of the patients developed symptoms during test. BNP measurement was repeated after at least 6-months follow-up (22±12.5 months; median: 20; range: 7-47 months) and then each 6- or 12-month, according to the individual management. Results: From baseline to the last BNP measurement during follow-up, the distribution of BNP changes was: 65.5±129.5pg/mL; median: 29; range: -104-+675pg/mL. Patients were divided into 2 groups according to the median of serial BNP changes. There were no significant differences regarding clinical characteristics (all p

To assess the prognostic value of exercise echocardiography in subjects who had diabetes, we studied 214 patients who had 28 hard cardiac events (cardiac death in 15, myocardial infarction in 13) during a follow-up of 44 +/- 16 months. Independent risk factors for predicting cardiac events were insulin therapy (odds ratio 2.313), peak left ventricular ejection fraction (odds ratio 0.973), and ischemia detected by exercise echocardiography (odds ratio 2.513).

The relations between left ventricular (LV) function and global tissue Doppler velocity, strain rate, and strain were assessed in 99 studies. Significant correlations were found between the LV ejection fraction and global tissue Doppler velocity, strain, and strain rate (r = 0.50, r = 0.63, and r = 0.46, respectively, all p

A 27-year-old male was transferred to the Emergency Department after blunt chest trauma caused by motor cycle accident. Initial electrocardiogram showed a right bundle branch block (RBBB). On physical examination, the patient had non-severe facial injuries and anterior chest wall pain. Transthoracic echocardiography demonstrated mild anterior hypokinesia with …