322 Self-Management Training For Chronic Stable Angina

S216 BACKGROUND: To evaluate the feasibility of sub-mSv CT Cor-

onary Calcium Scoring (CCS). METHODS: A prospective study enrolling 55 clinical patients, 54 ⫾ 6y, BMI 29 ⫾ 4 who had CCS using volumetric CT 240-320 x 0.5mm. An initial clinical CCS scan was performed using a weight based protocol (S1, 120kV, 87.5-140mAs), followed by one of two research CCS scans performed using tube current stratification by Average Thoracic Diameter (ATD) (S2a, 120kV, 28-105mAs), or Scout Attenuation Coefficient (SAC) (S2b, 120kV, 17.5-140mAs). The final cohort included 30 patients with ATD and 25 patients with SAC stratified protocols. All CCS images were anonymized, randomized, and post-processed by 2 readers (R1, R2) to evaluate the Agatston Score (AS). The mean value of R1 ⫹ R2 readings for AS was used for each technique. Spearman’s rank correlation coefficient was computed for the clinical and research CCS protocols. RESULTS: All images were of diagnostic quality, mean AS was 141.3 (range 0-1414) for S1 CCS protocols and 150.6 (range 0-1606) for S2 (a and b) CCS protocols. AS were increased up to 6% using research protocols. Spearman’s rank correlation coefficient showed AS between both scans was highly correlated r ⫽ 0.93 (p⬍0.001). Mean dose length product (DLP) was 152.6⫾27.3, 83.5⫾33.9, and 62.8⫾39.5mGy*cm for S1, S2a, and S2b; respectively. The average radiation dose was 2.14, 1.17, and 0.88mSv for weight, ATD, and SAC based stratified protocols, respectively. CONCLUSION: Accurate sub-mSv CCS is possible using patient stratification by the Scout Attenuation Coefficient which is easily obtained from the scout CT projections.

Canadian Journal of Cardiology Volume 28 2012 METHODS: A retrospective chart review of 147 patients who underwent heart transplantation at the University of Alberta Hospital between August 1987 to February 2006 was performed. Patients were eligible for inclusion if they were currently followed in the heart transplant clinic at the University of Alberta and had both a coronary angiogram and MIBI perfusion scintigraphy scan performed annually for at least 3 years. Hospital. RESULTS: All patients Angiograms were scored based on the accepted ISHLT criteria for graft vasculopathy prior to comparison to their MIBI results. When looking at patients who received an angiogram in year 2 in comparison to their MIBI at year 3 it became apparent that a poor correlation using Cohen’s Kappa calculation existed. However where the two diagnostic tests agreed was when the CAV (coronary allograft vasculopathy) score was 0. The same was true when comparing patients who underwent MIBI in year 4 to their angiogram in year 5. (please see tables 1, 2). CONCLUSION: When looking at the post Cardiac transplant population, correlation between MIBI and coronary angiography is modest at best, unless the patient has no evidence of coronary allograft vasculopathy. Other modalities such as Dobutamine Stress Echocardiography and PET-rubidium with flow quantification may be a better surrogate to predict graft vasculopathy.

321 THE CORRELATION BETWEEN ANGIOGRAPHY AND MIBI IN PREDICTING CARDIAC ALLOGRAFT VASCULOPATHY IN THE EARLY POST TRANSPLANT POPULATION NC Sharma, L Lalonde, G Pearson Edmonton, Alberta

Although coronary angiography remains the gold standard for screening of transplant coronary artery disease (TxCAD), other screening methods such as MIBI perfusion scintigraphy have been developed to improve on its TxCAD incidence estimation and reduce its invasiveness (Legare et al., 2001; Carroll et al., 2009). Previous single-centre studies have demonstrated similar incidence of TxCAD estimation between coronary angiography and MIBI perfusion scintigraphy; however, a poor correlation between these two methods has been observed. The current local protocol for annual assessment of patients post-heart transplantation involves coronary angiography for years 1, 2 and 5, with MIBI scans performed in years 3 and 4. The aim of this study was to evaluate the correlation between these two diagnostic modalities in screening of coronary vasculopathy in orthotopic heart transplant (OHT) patients at the University of Alberta Hospital.

BACKGROUND:

322 SELF-MANAGEMENT TRAINING FOR CHRONIC STABLE ANGINA M McGillion, J Victor, H Arthur, S Carroll, A Cook, S O’Keefe-McCarthy, T Cosman, J Watt-Watson Toronto, Ontario BACKGROUND: Cardiac pain arising from chronic stable angina (CSA) has a major negative impact on health-related quality of life (HRQL) including pain, poor general health status, psychological distress, and inability to self-manage. METHODS: We used meta-analysis to assess the effectiveness of self-management training interventions for improving stable

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Abstracts

angina symptoms, health-related quality of life (HRQL) and psychological well-being. Nine trials, involving 1,282 participants in total, were included. We used standard inverse-variance random-effects meta-analysis to combine the trials. Heterogeneity between trials was evaluated using chi-square tests for the tau-squared statistic and was quantified using the I2 statistic. RESULTS: There was a significant improvement in the frequency of angina symptoms across trials, standardized mean difference (SMD) ⫽ 0.31 (95% Confidence interval [CI], 0.15 to 0.47). Self-management training also resulted in significant reduction in the use of sublingual (SL) nitrates, SMD⫽ -0.45 (95% CI (-0.67, -0.22). A significant HRQL improvement (Seattle Angina Questionnaire) for physical limitation was also found, SMD⫽ 0.38 (95% CI, 0.20 to 0.55). Self-management training did not improve other HRQL dimensions including disease perception and treatment satisfaction. There was no significant statistical heterogeneity across trials, I2 range⫽ 0% to 17%. CONCLUSION: Self-management training interventions significantly reduce the frequency of angina symptoms and related use of SL nitrates. The inability of these interventions to impact other dimensions of HRQL may be due to the magnitude of the psychological burden imposed by chronic angina.

323 OBESITY AND CARDIAC REHABILITATION: A DIFFERENTIAL ASSOCIATION WITH REFERRAL AND ATTENDANCE IN WOMEN VERSUS MEN B Martin, T Hauer, ML Knudtson, On behalf of the APPROACH Investigators, R Arena, JA Stone, SG Aggarwal Calgary, Alberta BACKGROUND: One important treatment modality for subjects with coronary artery disease (CAD) is cardiac rehabilitation (CR). The association between obesity and CR participation has not been assessed. The objective of this study was to assess whether obesity has an influence on referral to and attendance at CR, and whether or not sex influences that referral pattern. METHODS: The Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) database was used to obtain information on all patients. Subjects with at least one vessel CAD were considered as the pool of subjects to be referred. Characteristics were compared between those who were referred and not referred, and between those who attended and those who did not attend CR. Logistic regression models were constructed to determine predictors of CR referral; subsequent models were constructed to predict attendance. Body mass index (BMI) was considered as categorical variable (BMI⬍18.5, BMI 18.5-25, BMI 25-30, BMI 30-35, BMI 3540, BMI⬎40kg/m2); subjects with BMI 18.5-25 (normal weight) were referent group for all models. Models were constructed looking at obesity alone, then adjusted for all clinical risk factors.

RESULTS: There were 24,461 subjects who underwent coronary catheterization, had at least one vessel CAD and BMI recorded. Only 8,792 (36.0%) subjects were referred for CR, 4,693(53.4%) attended. Subjects who were referred had a higher mean BMI (28.5 vs 28.0), those who attended had a lower BMI (28.4 vs 28.6) (both p⬍0.05). BMI 30-35kg/m2 and BMI 35-40 kg/m2 were associated with increased referral (OR 1.17, 95%CI 1.07, 1.28 and OR 1.20, 95%CI 1.05, 1.38, respectively), BMI⬎40kg/m2 was not. When stratified by sex, higher BMI was not associated with increased referral in women, but the association persisted in men (adjusted OR for referral: BMI 35-40 women, 1.08, 95%CI 0.84, 1.39; for men, 1.26, 95%CI 1.07, 1.48). BMI⬎40kg/m2 was associated with reduced CR attendance, more so in women than men (OR for attendance in women, 0.51, 95%CI 0.31, 0.85; OR men 0.64, 95%CI 0.45, 0.90). CONCLUSION: Obesity was associated with increased referral to CR, except among the most obese. However, this association did not exist for women. The role of BMI in CR attendance is less than that in referral, with the notable exception of the class III obese subjects, who are less likely to attend CR. The reasons for the difference in association between BMI and CR referral in women versus men are unclear.

324 WHY SHOULD RENAL FUNCTION IMPACT CHRONIC MANAGEMENT OF STROKE PREVENTION IN ATRIAL FIBRILLATION? J Grégoire, P Guerra Montréal, Québec BACKGROUND: A personal physician practice assessment of Canadian primary care physicians and specialists looked at the relationship between renal function and use of oral anticoagulant therapy to prevent stroke in patients with atrial fibrillation. METHODS/RESULTS: A Physician Practice Assessment (PPA)Stroke Prevention & Atrial Fibrillation Evaluation (SAFE)was conducted between May and August of 2011 with 42 general practitioners and 20 specialists (62 in total) from across Canada. Each physician completed a series of electronic questions upon completion of visits with approximately 15 atrial fibrillation patients - thus recording their current practice habits. In total, data from 663 unique patient visits were recorded over the course of the PPA (3 months). Study results show that 60% of physicians are concerned about how to best utilize the new oral anticoagulants in patients with renal failure. While the data revealed that 84% of the assessed patients had serum creatinine (sCr) and 94% had glomerular filtration rate (eGFR) testing within the last year, what remains unclear is how renal function guided therapeutic decisions. The data also showed that 25% of the patients with severe renal impairment (eGFR⬍30 mL/min; 3 patients out of 12) and 27% of patients with moderate renal function (eGFR 30-60 mL/min; 48 patients out of 176) were currently on dabigatran. This new oral