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Contemporary Fractional Flow Reserve (FFR) Utilisation in a Large Australian Tertiary Centre
Abstracts
S260
601 This abstract has been withdrawn 602 Comparison of CoaguChek® XS INR and Laboratory INR in Patients With a Heartware® Continuous Flow Left Ventricular Assist Device Markham 1,2,∗ ,
Challa 1,2 ,
Cafaro 1 ,
R. A. J. J. Bancroft 1 , L. Wockner 3 , S. Kyranis 1,2 , K. Hyasat 1,2,3 , Y. Wong 1,2 , S. McKenzie 1,2 , W. Chan 1 , G. Javorsky 1 , D. Platts 1,2 1 Heart
& Lung Institute, The Prince Charles Hospital, Brisbane, Australia 2 University of Queensland, Brisbane, Australia 3 QIMR Berghofer Medical Research Institute, Brisbane, Australia Background: Accuracy of point-of-care testing with CoaguChek® XS (Roche) has not been well validated in patients with Continuous Flow Left ventricular assist devices (CF-LVAD). Methods: Patients with a Heartware® CF-LVAD for endstage heart failure (ESHF) between December 2013 and August 2015 as a bridge to transplant were included in the retrospective analysis. As part of standard care INR values as measured by CoaguChek® XS and the laboratory Stago’s STA-R Evolution analyser were recorded on a single spreadsheet to confirm correlation prior to discharge. Blood samples for each of the testing methods was taken within a 4 hour period of the other. Results: 230 samples were obtained from 15 CF-LVAD patients with a mean age of 40 (+/-14) years. There was a moderate correlation between laboratory and CoaguChek® XS INR values with a correlation coefficient of 0.85 (r2 =0.72, CI:0.81-0.88, p<0.0001; Fig 1a). The mean difference between the methods was 0.13 (+/-0.54) with CoaguChek® XS tending to overestimate INR (Fig 1b). When the laboratory INR was normal, CoaguChek® XS returned a normal result in 191 (91%) of occasions and 16 (94%) of the abnormal CoaguChek® XS results were an overestimation of a normal laboratory INR with only one being an underestimation of a normal laboratory INR. Conclusion: This study supports the use of point-of-care testing with CoaguChek® XS in patients with ESHF taking warfarin supported with the Heartware® CF-LVAD. However, CoaguChek® XS tended to overestimate INR in this setting. http://dx.doi.org/10.1016/j.hlc.2016.06.604
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603 Contemporary Fractional Flow Reserve (FFR) Utilisation in a Large Australian Tertiary Centre K. Lam 1 , M. Savage 1 , D. Murdoch 1,2 , C. Raffel 1,2 , D. Walters 1,2 , E. Shaw 1,3 , S. Paitry 1,∗ 1 Cardiology
Department, The Prince Charles Hospital, Brisbane, Australia 2 The University of Queensland, Brisbane, Australia 3 The University of Sydney, Brisbane, Australia Background: Fractional Flow Reserve (FFR) is the gold standard in the assessment of severity for intermediate coronary lesions. FFR provides clinical and prognostic information, ensuring treatment of physiologically significant lesions and deferring others. The aim of this study was to investigate contemporary use of FFR in a large Australian tertiary centre. Methods: 414 individual intermediate coronary lesions were assessed between July 2014 to December 2015. The cut off value for positive FFR was considered ≤0.80. Results: FFR was used in 351 of 5580 cases (6.2%). Mean FFR for all lesions was 0.83 ± 0.08. FFR-positive lesions were found in 33.82% of all lesions assessed. Lesions assessed were LAD (62.6%), RCA (14.3%), LCx (13.3%), LMCA (8.9%) and SVG (0.9%). FFR-positive lesions were more likely to be found in LAD (45.6%) when compared to non-LAD lesions (14.2%) (p=<0.001). Of the 140 FFR-positive lesions, 61 (43.6%) were treated with percutaneous coronary intervention (PCI), 59 (42.1%) with coronary artery bypass grafting (CABG) and 20 (14.3%) medical management in the first instance. Of the 20 patients treated with medical management, 19 (95%) of FFR values were between 0.76-0.8 (mean FFR 0.784). 3 patients with FFR-negative lesions underwent subsequent PCI (mean FFR 0.82). In the FFR-negative cohort, subsequent PCI was performed on non-FFR assessed lesions in 40 (14.6%) of cases. Conclusion: LAD lesions are the most commonly assessed intermediate lesions, and are more likely to be positive when compared to all other lesions. http://dx.doi.org/10.1016/j.hlc.2016.06.605 604 Design of Interactive Algorithm to Analyse Physiological Variations in Cardiac Output-Derived Haemodynamic Variables J. Boland 1,∗ , G. Gazibarich 1 , L. Wang 1,2 , D. Muller 1,2 1 St.
Vincent’s Hospital, Sydney, Australia Vincent’s Clinical School, UNSW, Sydney, Australia
2 St.
Background: Variations in accuracy and precision of cardiac output (CO) determinations can affect the calculation and interpretation of CO-derived haemodynamic variables.
S260
601 This abstract has been withdrawn 602 Comparison of CoaguChek® XS INR and Laboratory INR in Patients With a Heartware® Continuous Flow Left Ventricular Assist Device Markham 1,2,∗ ,
Challa 1,2 ,
Cafaro 1 ,
R. A. J. J. Bancroft 1 , L. Wockner 3 , S. Kyranis 1,2 , K. Hyasat 1,2,3 , Y. Wong 1,2 , S. McKenzie 1,2 , W. Chan 1 , G. Javorsky 1 , D. Platts 1,2 1 Heart
& Lung Institute, The Prince Charles Hospital, Brisbane, Australia 2 University of Queensland, Brisbane, Australia 3 QIMR Berghofer Medical Research Institute, Brisbane, Australia Background: Accuracy of point-of-care testing with CoaguChek® XS (Roche) has not been well validated in patients with Continuous Flow Left ventricular assist devices (CF-LVAD). Methods: Patients with a Heartware® CF-LVAD for endstage heart failure (ESHF) between December 2013 and August 2015 as a bridge to transplant were included in the retrospective analysis. As part of standard care INR values as measured by CoaguChek® XS and the laboratory Stago’s STA-R Evolution analyser were recorded on a single spreadsheet to confirm correlation prior to discharge. Blood samples for each of the testing methods was taken within a 4 hour period of the other. Results: 230 samples were obtained from 15 CF-LVAD patients with a mean age of 40 (+/-14) years. There was a moderate correlation between laboratory and CoaguChek® XS INR values with a correlation coefficient of 0.85 (r2 =0.72, CI:0.81-0.88, p<0.0001; Fig 1a). The mean difference between the methods was 0.13 (+/-0.54) with CoaguChek® XS tending to overestimate INR (Fig 1b). When the laboratory INR was normal, CoaguChek® XS returned a normal result in 191 (91%) of occasions and 16 (94%) of the abnormal CoaguChek® XS results were an overestimation of a normal laboratory INR with only one being an underestimation of a normal laboratory INR. Conclusion: This study supports the use of point-of-care testing with CoaguChek® XS in patients with ESHF taking warfarin supported with the Heartware® CF-LVAD. However, CoaguChek® XS tended to overestimate INR in this setting. http://dx.doi.org/10.1016/j.hlc.2016.06.604
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603 Contemporary Fractional Flow Reserve (FFR) Utilisation in a Large Australian Tertiary Centre K. Lam 1 , M. Savage 1 , D. Murdoch 1,2 , C. Raffel 1,2 , D. Walters 1,2 , E. Shaw 1,3 , S. Paitry 1,∗ 1 Cardiology
Department, The Prince Charles Hospital, Brisbane, Australia 2 The University of Queensland, Brisbane, Australia 3 The University of Sydney, Brisbane, Australia Background: Fractional Flow Reserve (FFR) is the gold standard in the assessment of severity for intermediate coronary lesions. FFR provides clinical and prognostic information, ensuring treatment of physiologically significant lesions and deferring others. The aim of this study was to investigate contemporary use of FFR in a large Australian tertiary centre. Methods: 414 individual intermediate coronary lesions were assessed between July 2014 to December 2015. The cut off value for positive FFR was considered ≤0.80. Results: FFR was used in 351 of 5580 cases (6.2%). Mean FFR for all lesions was 0.83 ± 0.08. FFR-positive lesions were found in 33.82% of all lesions assessed. Lesions assessed were LAD (62.6%), RCA (14.3%), LCx (13.3%), LMCA (8.9%) and SVG (0.9%). FFR-positive lesions were more likely to be found in LAD (45.6%) when compared to non-LAD lesions (14.2%) (p=<0.001). Of the 140 FFR-positive lesions, 61 (43.6%) were treated with percutaneous coronary intervention (PCI), 59 (42.1%) with coronary artery bypass grafting (CABG) and 20 (14.3%) medical management in the first instance. Of the 20 patients treated with medical management, 19 (95%) of FFR values were between 0.76-0.8 (mean FFR 0.784). 3 patients with FFR-negative lesions underwent subsequent PCI (mean FFR 0.82). In the FFR-negative cohort, subsequent PCI was performed on non-FFR assessed lesions in 40 (14.6%) of cases. Conclusion: LAD lesions are the most commonly assessed intermediate lesions, and are more likely to be positive when compared to all other lesions. http://dx.doi.org/10.1016/j.hlc.2016.06.605 604 Design of Interactive Algorithm to Analyse Physiological Variations in Cardiac Output-Derived Haemodynamic Variables J. Boland 1,∗ , G. Gazibarich 1 , L. Wang 1,2 , D. Muller 1,2 1 St.
Vincent’s Hospital, Sydney, Australia Vincent’s Clinical School, UNSW, Sydney, Australia
2 St.
Background: Variations in accuracy and precision of cardiac output (CO) determinations can affect the calculation and interpretation of CO-derived haemodynamic variables.