Poster Session 2

Purpose: In current guidelines of resuscitation the priority of early transthoracic echo- cardiography (TTE) is emphasized. The aim of this current prospective study was to evaluate the benefit of early ( < 45min after admission) basic TTE in all patients admit- ted to our emergency department with chest pain, dyspnea, unclear syncope and ecg-changes, if performed by physicians with less than one year of TTE experience. Methods: We performed an analysis of all patients (n ¼ 21) admitted to our emergency department in a 5 months period (01.11.15 – 01.03.16) with new onset of chest pain, dyspnoea, unclear syncope and new ecg-changes, such as LBB, RBB, T-wave inversions, loss of R-waves in the precordial leads and dysrhythmia. Patients with ongoing CPR or after CPR were excluded. Furthermore patients with fever and significant elevated inflammatory markers in the point-of-care laboratory testing were excluded. Patients admitted after 8pm or at the week-end were also excluded to rule out potential bias due to limited resources. All TTEs were performed by physicians with less than one year of TTE experience. The duration of TTE examinations was analysed as well as change in initial suspected diagnosis and early prevention of a likely complicated clinical course. Furthermore the length of hospital and ICU-stay was noted, but was so far not statistically analysed. Results: 604 patients (73.6%) received a basic TTE ad admission in the emergency department. In 75 patients (12,4%) only subcostal views were obtained due to severe dyspnea or impossible positioning of the patient. The median examination time was 212 seconds (IQR, 107-317). The suspected diagnosis was changed in 143 patients (23.7%). Especially severe pulmonary embolisms, aortic valve stenoses and pro-gressed left ventricular dysfunctions could be excluded (n ¼ 92, 64.3%) or included (n ¼ 41, 28.7%). In 10 patients (7.0%) the result of the TTE led to immediate intervention in case of obvious myocardial akinesia (n ¼ 6, 4,1%), aortic dissection (Stanford Typ A, n ¼ 2; 1.4%) and pericardial effusion after surgical valve replacement (n ¼ 1; 0.7%). Conclusions: Routine transthoracic echocardiography in the emergency department – even if performed by physicians with basic experience and in a heterogenous patient collective - is a quick and effective tool for reevaluation and early change of the suspected diagnosis and has the potential to avoid fatal outcomes. ate, uncertain and inappropriate), b) referral physician’s specialty (Cardiologist or not), c) type of echo modality referred to (Trantsthoracic -TTE, Transoesophageal-TOE and stress echo) and d) the clinical scenario investigated. Results: Referrals for echocardiography are commonly based on arbritrary criteria affecting the level of quality of patients’ management and the adequacy of resources availability. Table shows that a significant number of referrals were inappropriate or of uncertain value. The worse performance of inconsistency was associated with non-cardiologists’ referrals for TTE modality. Conclusion: The first step of a high-quality echocardiography service is to satisfy appropriate patient selection in order to provide a rational and cost-effective imaging study that will lead to clinical benefit. The development of appropriateness criteria from National or International scientific Associations or Societies is considered necessary. Background: Transthoracic echocardiography is a widespread tool to assess cardiac dimensions and function. Careful scan and image-analysis are prerequisites for valid and reliable information. Quality control usually consists of double readings of the same set of images, but there is little data on the impact of different scanners on inter-observer variability. Purpose: To evaluate the impact of scanning and reading on total inter-observer vari- ability in 2D echo measures. We present results from the echo control program of the population-based STAAB cohort study (Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression). Methods: Duplicate echocardiographic recordings were performed in 43 subjects by a cardiologist and 3 trained echo technicians, respectively. Inter-observer difference (IOD), inter-scanner difference (ISD), and inter-reader difference (IRD) were assessed comparing self-readings of own scans (n ¼ 86) and cross-readings of the other observ-ers scans (n ¼ 86), respectively. Results: The table shows the 95% range of two measurements for IOD, ISD,?and?IRD of defined parameters. IOD was largest for all echo parameters. ISD?was larger than IRD for end-diastolic interventricular septum and posterior?-wall?thickness, whereas IRD was prominent in left ventricular end-diastolic diameter, late diastolic mitral inflow velocity, and the systolic gradient over the tricuspid valve. Conclusion: Trained echo technicians are able to acquire and read reliable data on cardiac dimensions and function on the population level, which can be used for epide-miological studies. To prevent underestimation of the variability of echo parameters, assessment of real inter-observer variability should be preferred to inter-reader variability as quality measure in clinical and scientific settings. Funding Acknowledgements: Federal Research. On behalf of: German Comprehensive Failure Background/Introduction: Catheter-based left atrial appendage (LAA) occlusion (LAAO) has emerged as an effective non-pharmacological strategy for stroke prevention in atrial fibrillation. Because of the complexity and variability of the LAA, incorrect sizing, incomplete seal, procedural complications, and failure are not uncommon despite careful guidance with transesophageal echocardiography (TEE) and angiogra- phy. Three-dimensional (3D) printing is a novel technology by which physical models of cardiac structures can be re-created from 3D imaging datasets for tangible appreci- ation of the anatomy and device testing. Purpose: We reported our initial experience in using 3D-printed patient-specific LAA models derived from 3D-TEE or multi-detector computed tomography (MDCT) for personalised planning of LAAO. Methods: Seventeen patients (age ¼ 70 6 12years, 10 women) undergoing catheter- based LAAO were recruited from two centres. Using dedicated software, pre-proce-dural volumetric image datasets of the LAA obtained from 3D-TEE (n ¼ 5) or MDCT (n ¼ 12) were semi-automatically segmented to create a stereolithography file for 3D printing of patient-specific silicone models. Device testing was performed on the phan- tom models to aid decision-making on device sizing and deployment strategy. Results: The average maximal LAA orifice diameter and depth on TEE were 23.1 6 4.7mm (range:11-32.5mm) and 33.6 6 7.0mm (range:23-54mm), respectively. The distribution of various LAA morphology was windsock (4[24%]), cauliflower (2[12%]), and chicken wing (11[65%]). Device testing on the 3D-printed LAA models was feasible in all 17 cases. Device-sizing discrepancy between imaging and 3D printing occurred in 9(53%) cases. Imaging could predict final device size accurately in only 8(47%) cases, as opposed to 3D printing that made accurate sizing prediction in 14(76%) out of 17 cases. In the remaining 3 cases, 3D printing also provided a closer estimation (1 size larger) than imaging alone. LAAO was performed successfully in all cases within 49 6 33minutes (range: 18-142minutes) without complications. Complete seal was achieved in all except 2 cases who had only minor peri-device flow ( < 3mm) on TEE. Conclusions: Personalised planning for catheter-based LAAO using 3D-TEE/MDCT-derived 3D-printed silicone-based physical LAA models for device testing is feasible and may enhance procedural success. Background: The metabolic syndrome (MS) has been shown to affect both structure and function of the right ventricle (RV). Central obesity (CO) has been known as a significant risk factor for cardiovascular diseases. Whether the impact of CO on RV function is independent of the MS is uncertain. Objective: To assess the impact of CO with or without MS diagnosis on right atrial dimensions and RV myocardial perform- ance index (MPI). Methods: Cross-sectional study of 100 patients (56 women) with CO defined as a waist circumference (WC) > 102 cm in men, > 88 cm in women. MS was defined by the presence of (cid:2) 3 ATP-NCEP-III criteria. All patients were subjected to conventional and tissue Doppler (TD) echocardiography. Results: MS was diag- nosed in Background: The effect of cardiac resynchronization therapy (CRT) can be relatively «early» and «late» but the relationship between time of the best effect, echocardiographic changes and long-term mortality still remains unclear. The aim: Was to analyse the relationship between time of the best effect of CRT, left ventricular functional improvement and mortality in patients with congestive heart fail- ure (CHF). Methods and results: 106 CRT patients (mean age 54.7 6 9.9 years, 83% men) with CHF (58% ischemic and 42% non-ischemic etiology) II-IV NYHA functional class were enrolled. At baseline, 1, 3 and each 6 months after implantation we evaluated clinical and echocardiographic status. In 26 patients best decrease of left ventricular end-systolic volume (LVESV) arrived in 3 months (I group – «early» effect; 1,2 6 0,9 months) and in 80 patients – later than in 3 month (II group – «late» effect; 22,2 6 14,7 months). Groups didn’t differ in clinical characteristics, NYHA functional class, QRS duration and parame- ters of mechanical dyssynchrony. In the I group LVESV (p ¼ 0.048) and left ventricular end-diastolic volume (LVEDV) (p ¼ 0.047) were significantly higher. Multiple logistic regression didn’t show significant dependency between LVESV, LVEDV and the time of the best effect. In Kaplan-Meier analysis mortality in the II group was significantly lower (26.9% vs 3.8%; p ¼ 0.001). Cox regression showed that LVESV (HR 1.014; 95% CI 1.005–1.024; P ¼ 0.002) and the time of the best eff