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Determinants of a Restrictive Filling Pattern Post Acute Myocardial Infarction
S196
Abstracts CSANZ 2012 Abstracts
ABSTRACTS
474 CT Coronary Angiography Excludes Clinically Significant Disease Even in the Presence of High Coronary Calcium C. Yu ∗ , J. Otton, D. Boshell, K. Sesel, J. McCrohon, N. Sammal, M. Feneley, L. Bester St Vincent Hospital, Sydney, Australia Background: High calcium score may limit interpretation of computed tomography coronary angiograms (CTCA) due to excessive blooming artifacts and it has been suggested that CTCA may not reliably exclude significant disease in this setting. With recent improvements in CT technology and interpretation techniques, high calcium score appears to be less of a limiting factor. Method: We retrospectively analysed all CTCAs from September 2009 to February 2012 in our centre using a 320-row detector (Toshiba AquilianOne). A threshold of 600 (Agaston) was used to define a high calcium score. The studies were classified into non-diagnostic, mild, intermediate and severe disease. Patients were followed up for up to 24 months and further investigations were performed at the discretion of treating physician. Results: Sixty-five studies with calcium score of 600 or greater were identified. The average calcium score was 1439.7 (range 605–4458). Seven (11%) studies were non diagnostic, 23 (35%) had mild or no significant disease, 16 (25%) had moderate disease and 19 (29%) has severe disease. In the moderate disease group, 10 (63%) further investigations available however in only one case (10%) were the findings suggestive of ischaemia indicating a tendency to over rather than under-call lesion severity. Conclusions: In the setting of high coronary calcium, CTCA by 320 detector row CT is seldom non-diagnostic and clinically significant lesions may be excluded. http://dx.doi.org/10.1016/j.hlc.2012.05.485 475 Delta DTI Improves Stress Echocardiography in the Real World B. Fitzgerald 1,∗ , G. Scalia 2 1 Heart 2 Heart
Care Partners, The Prince Charles Hospital, Australia Care Partners, University of Queensland, Australia
Background: Stress echocardiography (SE) is well validated in the assessment of myocardial ischaemia in high risk groups. Mitral annular Doppler Tissue Imaging (DTI) provides incremental information. This study assessed these methods in a lower risk population. Methods: 433 positive SEs (suggestive of ischaemia) were compared with age and sex matched controls (negative tests – not suggestive of ischaemia). Pulsed wave Doppler transmitral E wave and medial mitral annular DTI E wave velocities were measured before and after exercise. Results: The average age was 66 years (75.8% male, 24.2% female). Coronary angiography was available for 75.8%. In positive SEs, the E:E ratio increased from 9 to 12 (p < 0.0001). The change in ratio (Delta DTI) was +33%.
Heart, Lung and Circulation 2012;21:S143–S316
The control group Delta DTI ratio was −11% (p < 0.001), with the E:E ratio falling from 9 to 8. 186 patients had positive SE’s and coronary lesions ≥ 70% severity. The Delta DTI was +44%. By ROC analysis, a cut-off Delta DTI of ≥ +25% produced an area under the curve of 0.81 (sensitivity 89.9%, specificity 78.3%). Adding E velocity ≥ 10 cm/s with Delta DTI ≥ +25% identified 97% of anatomically positive SE (accuracy 78.8%). Delta DTI improved traditional SE accuracy from 78.9% to 83.7% (sensitivity 82.4%, specificity 86.3%). Conclusions: The addition of Delta DTI to traditional SE improves accuracy further. Using E ≥ 10 cm/s and Delta DTI ≥ +25% strongly suggests a positive SE will correlate with significant coronary disease. Delta DTI improves SE in the real world. http://dx.doi.org/10.1016/j.hlc.2012.05.486 476 Determinants of a Restrictive Filling Pattern Post Acute Myocardial Infarction X. Brennan 1,∗ , L. Hee 2 , J. Chen 1 , C. J. French 1,2 , C. Juergens 1,2 , L. Thomas 1,2,3
Allman 2 ,
1 University
of New South Wales, Australia Hospital, Australia 3 University of Sydney, Australia 2 Liverpool
Background: In this study our objective was to determine factors that contribute to the development of a restrictive filling pattern (RFP) following ST-elevation myocardial infarction (STEMI). In particular, we evaluated the time to reperfusion as a previous study demonstrated that those with longer periods of reperfusion were more likely to develop RFP. Methods and results: 100 STEMI patients having undergone primary or rescue angioplasty and a transthoracic echocardiogram within six weeks post AMI were retrospectively identified. Subjects were identified as having a restrictive filling pattern (n = 24) [DT < 160 ms, E/A > 2.0, E < 5] or non restrictive pattern (n = 76). Factors that were analysed as determinants of RFP included patient age, sex, infarct size, symptom to reperfusion time, infarct location and left ventricular systolic function. Multivariate logistic regression revealed that symptom to reperfusion time was not associated with incidence of RFP (p = 0.450). Infarcts in the proximal left anterior descending (LAD) artery territory were associated with increased rates of RFP (Odds ratio 4.920, p = 0.05). Conclusion: This study revealed that proximal LAD lesions may result in the development of RFP in STEMI patients. Further prospective studies are needed to determine factors that can contribute to the development of RFP. http://dx.doi.org/10.1016/j.hlc.2012.05.487
Abstracts CSANZ 2012 Abstracts
ABSTRACTS
474 CT Coronary Angiography Excludes Clinically Significant Disease Even in the Presence of High Coronary Calcium C. Yu ∗ , J. Otton, D. Boshell, K. Sesel, J. McCrohon, N. Sammal, M. Feneley, L. Bester St Vincent Hospital, Sydney, Australia Background: High calcium score may limit interpretation of computed tomography coronary angiograms (CTCA) due to excessive blooming artifacts and it has been suggested that CTCA may not reliably exclude significant disease in this setting. With recent improvements in CT technology and interpretation techniques, high calcium score appears to be less of a limiting factor. Method: We retrospectively analysed all CTCAs from September 2009 to February 2012 in our centre using a 320-row detector (Toshiba AquilianOne). A threshold of 600 (Agaston) was used to define a high calcium score. The studies were classified into non-diagnostic, mild, intermediate and severe disease. Patients were followed up for up to 24 months and further investigations were performed at the discretion of treating physician. Results: Sixty-five studies with calcium score of 600 or greater were identified. The average calcium score was 1439.7 (range 605–4458). Seven (11%) studies were non diagnostic, 23 (35%) had mild or no significant disease, 16 (25%) had moderate disease and 19 (29%) has severe disease. In the moderate disease group, 10 (63%) further investigations available however in only one case (10%) were the findings suggestive of ischaemia indicating a tendency to over rather than under-call lesion severity. Conclusions: In the setting of high coronary calcium, CTCA by 320 detector row CT is seldom non-diagnostic and clinically significant lesions may be excluded. http://dx.doi.org/10.1016/j.hlc.2012.05.485 475 Delta DTI Improves Stress Echocardiography in the Real World B. Fitzgerald 1,∗ , G. Scalia 2 1 Heart 2 Heart
Care Partners, The Prince Charles Hospital, Australia Care Partners, University of Queensland, Australia
Background: Stress echocardiography (SE) is well validated in the assessment of myocardial ischaemia in high risk groups. Mitral annular Doppler Tissue Imaging (DTI) provides incremental information. This study assessed these methods in a lower risk population. Methods: 433 positive SEs (suggestive of ischaemia) were compared with age and sex matched controls (negative tests – not suggestive of ischaemia). Pulsed wave Doppler transmitral E wave and medial mitral annular DTI E wave velocities were measured before and after exercise. Results: The average age was 66 years (75.8% male, 24.2% female). Coronary angiography was available for 75.8%. In positive SEs, the E:E ratio increased from 9 to 12 (p < 0.0001). The change in ratio (Delta DTI) was +33%.
Heart, Lung and Circulation 2012;21:S143–S316
The control group Delta DTI ratio was −11% (p < 0.001), with the E:E ratio falling from 9 to 8. 186 patients had positive SE’s and coronary lesions ≥ 70% severity. The Delta DTI was +44%. By ROC analysis, a cut-off Delta DTI of ≥ +25% produced an area under the curve of 0.81 (sensitivity 89.9%, specificity 78.3%). Adding E velocity ≥ 10 cm/s with Delta DTI ≥ +25% identified 97% of anatomically positive SE (accuracy 78.8%). Delta DTI improved traditional SE accuracy from 78.9% to 83.7% (sensitivity 82.4%, specificity 86.3%). Conclusions: The addition of Delta DTI to traditional SE improves accuracy further. Using E ≥ 10 cm/s and Delta DTI ≥ +25% strongly suggests a positive SE will correlate with significant coronary disease. Delta DTI improves SE in the real world. http://dx.doi.org/10.1016/j.hlc.2012.05.486 476 Determinants of a Restrictive Filling Pattern Post Acute Myocardial Infarction X. Brennan 1,∗ , L. Hee 2 , J. Chen 1 , C. J. French 1,2 , C. Juergens 1,2 , L. Thomas 1,2,3
Allman 2 ,
1 University
of New South Wales, Australia Hospital, Australia 3 University of Sydney, Australia 2 Liverpool
Background: In this study our objective was to determine factors that contribute to the development of a restrictive filling pattern (RFP) following ST-elevation myocardial infarction (STEMI). In particular, we evaluated the time to reperfusion as a previous study demonstrated that those with longer periods of reperfusion were more likely to develop RFP. Methods and results: 100 STEMI patients having undergone primary or rescue angioplasty and a transthoracic echocardiogram within six weeks post AMI were retrospectively identified. Subjects were identified as having a restrictive filling pattern (n = 24) [DT < 160 ms, E/A > 2.0, E < 5] or non restrictive pattern (n = 76). Factors that were analysed as determinants of RFP included patient age, sex, infarct size, symptom to reperfusion time, infarct location and left ventricular systolic function. Multivariate logistic regression revealed that symptom to reperfusion time was not associated with incidence of RFP (p = 0.450). Infarcts in the proximal left anterior descending (LAD) artery territory were associated with increased rates of RFP (Odds ratio 4.920, p = 0.05). Conclusion: This study revealed that proximal LAD lesions may result in the development of RFP in STEMI patients. Further prospective studies are needed to determine factors that can contribute to the development of RFP. http://dx.doi.org/10.1016/j.hlc.2012.05.487