Influence of cardiac sub-specialty on management after angiography of patients with coronary artery disease

A128

48th Annual

HYPERTENSION MYOCARDIAL Xandle TG. Cardioendocrine and Christchurch

Scientific

Meeting

of CSANZ

AND CARDIOVASCULAR EVENTS AFTER INFARCTION. &&& AM*. Ten RW. Td The Christchurch Research Group, Christchurch School of Medicine Hospital*, Christchurch, New Zealand.

Heart,

Lung

and Circulation

2000; 9

EARLY CLINICAL EXPERIENCE WITH PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE WITH THE AMPLATZER OCCLUDER IN ADULTS. P.C.Haves*. M.P.Fenelev. P.R.Rov, D.W.Muller. Cardiology Department, St Vincent’s Hospital, Darlinghurst, NSW.

Q&&ye: Compare neurohumoral status, ventricular remodelling and cardiovascular outcomes in hypertensive (HT) and non-hypertensive (NT) patients after myocardial infarction (MI). &.sim and Methods: Plasma neurohormones and radionuclide ventriculography were measured in 747 (282 HT, 465 NT) patients l-4 days and 3-5 months after acute MI. Adverse events were recorded over 2 years follow-up. M: Early post-MI plasma ANP (4Oi2 vs 34ilpmoVL), BNP (31&l vs 27*1pmoVL), N-terminal BNP (19212 vs 16&8pmol/L), and norepinephrine (293&l 13 vs 2598*74pmol/L), (but net epinepbrine, adrenomedullin or endothelin-1) were significantly @<0.05-~~0.01) higher in HT vs NT. Differences persisted at 3-5 mths. Early post-MI lef? ventricular diastolic (LVDV) and systolic (LVSV) volumes (15a3 vs 160+3 and 85+3 vs SW2 mls) and LVEF (47il vs 46*1 %) were similar in HT and NT, but at 3-5 months repeat ventriculography indicated significantly greater increases in LVDV (10.8il vs 5.6il %; p
OBJECTIVE: Our purpose was to evaluate the clinical utility and outcomes of percutaneous patent foramen ovale (PFO) closure in adult patients with unexplained cerebral ischaemic events. METHOD AND RESULTS: Percutaneous PFO closure with the Amplatzer occluder was performed successfully in 12 adults( 8 male) between February and December 1999. All patients had one or more cerebral ischaemic events confirmed on CT or MRI scan and negative extracranial arterial examinations. Their age was 44.6?10.8(22-58) years. All were in sinus rhythm. A hypercoagulable predisposition was found in one patient (Factor V Leiden), and simultaneous pulmonary embolism demonstrated in another. 75% were anticoagulated with warfarin pre-closure for 8.6?9.8(230) months. All patients had right-to-left or bidirectional shunt confirmed by transoesophageal contrast echocardiography, with 50% having a shunt demonstrated in the absence of Valsalva manoeuvre. Eleven 25 mm devices and one 28 mm device were positioned. The only procedural complication was transient atria1 fibrillation in one patient. Mean procedure time was 58.5?24(20-100) mins. Mean fluoroscopy time was 8.1f5.1(2.5-18.1) mins. Average post-procedural length of stay was 1.1 days. All patients received clopidogrel75 mg for 1 month and aspirin 300 mg daily for 6 months. At 36 months follow-up, only one patient had a positive contrast study during Valsalva manoeuvre. On clinical follow-up, up to one year, there were no recurrent ischaemic neurological events, or device-related complications. CONCLUSIONS: Percutaneous PFO closure in adults can be performed with minimal morbidity and may prevent recurrent cerebral ischaemia and the need for long-term anticoagulation.

LARGE ARTERY COMPLIANCE PREDICTS TIME TO ISCHEMIA DURING TREADMILL TESTING IN CORONARY ARTERY DISEASE PATIENTS. B.A. Kingwell’, T.L. Medley, T.K. Waddell, J.D. Cameron, G.L. Jennings, A.M. Dart. Alfred and Baker Medical Unit, Baker Medical Research Institute, Prahran. Victoria, Australia

INFLUENCE OF CARDIAC SUB-SPECIALTY AFTER ANGIOGRAPHY OF PATIENTS ARTERY DISEASE. Knox Private Hospital, P. Kertes*. M. Rowe;

Objective: Large artery compliance is a major determinant of pulse pressure and thus cardiac afterload and coronarv oarfusion. We hypothesised that stiffer large arteries would reduce time to exercise induced myocardial ischemia, assessed by ST segment depression of 1.5mm during a treadmill test in patients with any given degree of coronary artery disease (CAD). Design and Methods: Seventy-two patients (58 male) aged 61+9 years (mean*SD) with CAD as evidenced by Bruce protocol exercise test and angiogram were recruited. A stenosis greater than 50% on angiogram was used classify patients as having single (32), double (27) or triple (13) vessel disease. Whole body arterial compliance, aortic pulse wave velocity and aortic input and characteristic impedance were measured using carotid applanation tonometry and Doppler velocimeby of the ascending aorta, under resting conditions. Neither nitrate nor beta-blocker therapy was taken on the morning of the study. Results: The mean time to ST segment depression of 1.5 mm was 372 f 2 s with a peak blood pressure of 168/75 f 4/3 mmHg and peak heart rate of 133 f 3 bpm. In univariate analysis, time to ST segment depression of 1.5 mm correlated with whole body arterial compliance (R=0.28. P=O.O2), characteristic aortic impedance (R=-0.28, P=O.O3) and aortic pulse wave velocity (R=-0.24, P=O.O5). Consistent with these data carotid systolic (R=-0.29, P=O.Ol) and pulse pressure (R=0.27; P=O.O3) and bra&al systolic (R=-.33, P=O.O04) and pulse pressure (P=-0.31; P=O.OOS) also correlated with time to ST segment depression but degree of coronary disease as assessed by either maximum stenosis or number of diseased vessels did not. Conclusion: Large artery compliance and central blood pressure significantly influence myocardial blood demand and supply and are therefore important determinants of functional capacity in CAD.

ON MANAGEMENT WlTH CORONARY Wantima,

Victoria.

During 1999, 1278 coronary angiogramswereperformed by 8 cardiologists in a single hospital catheter lab. The findings and intended management (IM) were fully coded in 1048 cases (82%). The IM was compared between 2 groups of cardiologists, those who routinely perform angioplasty (AI’+, n-3) vs those who do not (AP-, n - 5), in patients (pts) who had either I,2 or 3 vessel disease (x-VD). Previous analyses had shown that coded IM corresponded very closely with actual treatment received. Results: The IM was coded as uncertain in 76 pts (7.3%). In p’s with l-VD (n- 274), angioplasty (PTCA) was favoured equally by both groups (63.4% and 64.0% for AP+ and AP- respectively). For p’s with 2-VD or 3-VD, the IM is shown below: 2-VD

AP+ AP-

In-

Medical

Surg&J

26% 36%

12% 20%

195)

1801

3m!

PTCA 62% * 44% * ('p-co.02)

Medica 37% 37%

Su~cal 30% 44%

PTCA 33% x 19% x ("paol)

In all pts with x-VD, surgery was a more likely IM for the AP- group (21.3%) than the AP+ group (13.2%, p