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Background/Introduction Myocardial work and work efficiency are new parameters for assessing left ventricular function. They have been shown to have value in a range of clinical settings but have not previously been applied to exercise stress echocardiography. Purpose We aim to characterize the normal myocardial work and work efficiency response to exercise in a mixed population and determine if myocardial work could be used to identify patients with inducible ischaemia. Methods Patients were retrospectively enrolled from an existing database of exercise stress echocardiography. Inclusion criteria were a clinical indication of possible ischemia and technical suitability to calculate myocardial work. Exclusion criteria were abnormal baseline left ventricular function or inadequate image quality. Echocardiograms positive for ischaemia were defined by independent visual assessment and compared with angiographic findings where available. Myocardial work and work efficiency were calculated using a proprietary algorithm. Results A total of 177 patients met inclusion criteria, 117 were excluded leaving 40 normal and 20 positive tests for analysis. During normal exercise global work increased 54% and efficiency remained at 96%. Segmental work showed a basal to apical gradient which became more prominent at peak exercise. In patients with inducible ischaemia during exercise there was a significant difference in response; work decreased by 1.9% and efficiency dropped to 87%. Receiver operating characteristic curve for myocardial work had an area under the curve of 0.94. Youden's J statistic suggested an optimum cut point of a 25% increase in work to define a normal test. Conclusion During normal exercise myocardial work increased and efficiency remained unchanged, however during exercise induced ischaemia both myocardial work and efficiency decreased. We have demonstrated that myocardial work can be applied to stress echocardiography to identify ischemia but the utility of this remains uncertain. Further research compared to an objective measure of functional ischemia is needed. Response to exercise Funding Acknowledgement Type of funding source: None

Background: Relevant aortic valvestenosis (AS) is associated with adverse prognosis. With TAVI emerging, the presented study audited management of relevant AS in Wellington. Methods: 79 patients with aortic stenosis were prospectively enrolled from February 2015-2016. Inclusion criteria were echo features demonstrating stage C or D stenosis according to ACC/AHA guidelines. Treatment outcomes included surgical valve replacement (AVR), Transcatheter Aortic Valve Replacement (TAVI), Balloon Valvuloplasty (BAV) and Medical Management. Results: 63/79 had AS indicating treatment (C2 or D). Mean age was 75.8AE10 and 37 were males. Mean followup was 193 days. In this group completed or planned treatments were: AVR 31 (49%), TAVI 4 (6.3%) and BAV 4 (6.3%). 9 (14.3%) were for medical management, the remainder were under review. There were 6 deaths: 2 post-surgery, 2 in the medical group, 2 in the review group. STS mortality scores differed between surgical and medically treated patients (1.9 AE1.5% vs 4.3AE2.7%, p<0.05). EUROSCORE was lower in surgical compared to medical groups (6.1AE1.9% vs 9.2 AE2.8%, p<0.01). Surgical patients were significantly younger compared to other groups (69.6AE8.4, p<0.05). TAVI patients were on average 15.5 years older than surgical patients (p<0.05) with a 3% higher mortality (NS). Conclusion: In this cohort 55.6% of patients with symptomatic aortic stenosis received or had planned treatment. Those for medical management were older and had higher STS and EUROSCOREs. There were a significant proportion of patients under ongoing review. TAVI patients were profoundly older and made up 6.3% of patients with indication for intervention.

Background: Patients with stage A and B heart failure can have a significant burden of fatigue and poor quality of life despite having normal left ventricular (LV) ejection fraction (EF). Global longitudinal strain (GLS) can detect early changes in LV function. This study evaluates the relationship between LV function with functional capacity and quality of life (QOL) measures in stage A and B heart failure. Methods: A cross-sectional study of patients with stage A and B heart failure (n = 431) to show the relation of echocardiographic parameters with functional capacity and quality of life measures. Functional capacity (6-min walk test (6MWT), quality of life (short form-12 (SF-12) and international measure for physical activity (IPAQ)) were measured. Echocardiogram was used to assess global longitudinal strain (GLS), Ejection fraction (EF), left ventricular mass index (LVMI), left atrial volume index (LAVI), left ventricular end diastolic volume (LVEDV) and E/e'. Results: The mean age was 65 ± 11 years, 72% were men. Mean GLS was −18.1 ± 3%. Univariate analysis showed age (−4.2 (−5.4, −3.1) P < 0.01) GLS (5.8 (1.5, 9.9) P = 0.01), LAVI (−1.5 (−2.9, −0.2) P = 0.03), and Ee' (−7.1 (−9.7,-1.1) P < 0.01) were associated with distance walked in 6 MWT. EF (0.2 (0.1, 0.3) P = 0.01) and GLS (0.5 (0.1, 0.9) P = 0.01) were both associated with higher SF 12 score. And no cardiac parameter was associated with IPAQ score. Conclusion: GLS was associated with measures of functional capacity and one in two measures of QOL in patients stage A and B heart failure.

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