P857Analysis of left ventricular remodelling in patients after myocardial infarction: comparison of post-infarction drug therapy with valsartane or ace inhibitors using native and contrast echocardiography

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The aim of the study was to determine the effect valsartane (ARB) instead of ACE inhibitors (ACEI) after acute myocardial infarction on left ventricular (LV) remodelling using native echocardiography (NE) and LV opacification (LVO) by contrast echocardiography (CE).Methods: In group I (n=13pts) ARB and in group II (n=13pts) ACEI were given. All pts were investigated after interventional therapy at hospital pre-discharge and at follow-up 6 month later. Standardized 2D transthoracic NE and CE were performed in all pts using Vivid 7 system. The results of LV end-diastolic volume (LVEDV) and ejection fraction (EF) in NE were compared with the results of LVO imaging for analysis in the mono-, bi-, and triplane data sets using the Simpson's rule.Results: The assessment of LVEDV and EF was feasible with all methods. No significant differences were found between the apical mono-, bi-, and triplane approach (Mann-Whitney Rank; p≥0.05). Standard deviations of the triplane approach were significantly lower than the mono- and biplane approach. Variances of the results were increased in NE compared to CE. The comparison of LVEDV and EF shows significant increases using CE (Mann-Whitney Rank; T-test p≤0.05). Due to reduced image quality 6 pts could not be analysed without CE. The evaluation of LV remodelling with respect to ARB or ACEI therapy did not show any significant changes (Mann-Whitney Rank; p≥0.05).Conclusion: LVO imaging with CE significantly improves the determination of LVEDV and EF in a clinical scenario. With respect to image quality and standardization the triplane approach with CE seems to be actually the best method. In most of the contrast applications multiplane imaging was possible (n=22; Fig.1). Remodelling does not significantly differ between the cohorts treated with ARB or ACEI.

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