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Investigating the Impact of Aorto-Ventricular Angulation on Procedural Success in Transcatheter Aortic Valve Replacements with the Lotus Valve System
Abstracts
484 Contemporary Left Ventricular Mass Assessment via 2D Echocardiography–a Comparison with Cardiac Magnetic Resonance (CMR) Imaging T. Hecker 1,∗ , R. Perry 1,2,3 , V. Chia 1 , A. King 2 , J. Selvanayagam 1,2,3 , M. Joseph 1,2 1 Flinders
Medical Centre, Adelaide, Australia University School of Medicine, Adelaide, Australia 3 Dept of Heart Health, South Australian Health and Medical Research Institute, Adelaide, Australia 2 Flinders
Background: Left ventricular (LV) wall thickness/LV hypertrophy (LVH) has been assessed by echocardiography (echo) using LV m-mode in parasternal long axis view (PLAx). LV mass (LVM) calculations can be derived from m-mode measurements or 2D in the PLAx and more recently by the area/length method from the parasternal short axis view (PSSAx). The aim was to compare LV mass derived from both the 2D PSLAx and PSSAx methods with MRI calculated LV mass as the gold standard. Method: 103 patients referred for echocardiography and CMR within a 3-month period were included. Indexed measurements for LVM from the PLAx and PSSAx views were calculated using ASE recommendations. Three-dimensional, indexed mass was calculated from the CMR images by a separate experienced CMR observer, blinded to the echo data. Results: There was good correlation between both echo derived mass calculations and MRI using Pearson’s correlation coefficient with the PSLAx r = 0.81 (p < 0.0001) and PSSAx r = 0.93 (p < 0.001). Using Bland-Altman analysis the bias (and limits of agreement) of the PSLAx was -117.74 g/m2 (-258.59 to 23.11 g/m2 ) and PSSAx was -1.18 g/m2 (-22.4 to 20.05 g/m2 ). Conclusion: Despite good correlation between echo and CMR mass, PSLAx calculated mass demonstrated a large bias. The PSSAx method is more robust but with broad limits of agreement suggesting that echo and CMR calculations of LVM are not interchangeable with echo overestimating LV mass. Given this, serial assessment of LVM should be performed by the same modality for follow-up and when using 2D echo, PSSAx is a more reliable and accurate method and hence preferable in clinical practice. http://dx.doi.org/10.1016/j.hlc.2017.06.485
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485 Correlation Between Diastolic Dysfunction and Exercise Capacity in Chronic Kidney Disease G. Gan 1,2,3,∗ , K. Kadappu 2,3 , A. Boyd 4 , N. Goonetilleke 1 , S. Eshoo 1 , L. Thomas 2,3,4,5 1 Department of Cardiology, Blacktown Hospital, Sydney, Australia 2 Department of Cardiology, Liverpool Hospital, Sydney, Australia 3 University of New South Wales, Sydney, Australia 4 Westmead Private Cardiology, Sydney, Australia 5 Department of Cardiology, Westmead Hospital, Sydney, Australia
Background: Chronic kidney disease (CKD) is a growing public health issue, associated with high rates of heart failure and diastolic impairment. Exercise capacity is an important prognostic determinant of cardiovascular outcomes. The objective of this study was to evaluate determinants of exercise capacity in CKD patients. Methods: Stage 3 CKD patients (eGFR 3059 mL/min/1.73 m2 ) (n = 95), without previous cardiac illness were prospectively recruited and underwent comprehensive transthoracic echocardiogram (TTE) and exercise stress echocardiogram. Exercise capacity was compared to age, gender and risk factor matched controls. Maximal exercise tolerance was expressed as the estimated metabolic equivalents (METs). Results: 95 patients (male 68%) were included and compared to 92 matched controls. Mean age in CKD and control group were 63 ± 9.6 years and 62 ± 9.5 years respectively. Patients with CKD had an overall lower achieved METs during exercise. Mean resting E/e’ was similar in both groups. Post exercise E/e’ was higher in the CKD group. In controls, achieved METS during exercise was inversely associated with post exercise E/e’ (p = 0.005) but not to baseline E/e’ (p = 0.07). In the CKD group, achieved METS during exercise was inversely correlated with post exercise E/e’ (p < 0.001) as well as resting E/e’ (p < 0.001). Additional independent correlates of exercise in both groups were age, male gender and body mass index. Conclusions: CKD is associated with lower achieved METS during exercise with significant inverse correlation to increase in LVEDP. http://dx.doi.org/10.1016/j.hlc.2017.06.486
Abstracts
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486 CT Coronary Angiography in a Case of Acute Coronary Syndrome: Choosing Wisely S. Wakeling, H. Brownstein ∗ , A. Al-Kaisey, N. Jones, D. Fernando Austin Health, Melbourne, Australia Case report: A 31-year-old female presented to our Emergency Department with right upper quadrant pain and nausea. Her past medical history was only significant for recurrent pericarditis. She was not on any medications and denied illicit drugs or smoking. Intravenous ondansetron was administered to help alleviate her nausea. A few seconds later, she developed central crushing chest pain with electrocardiograph findings of widespread ST depression and ST elevation in aVR. Intravenous morphine and sublingual glyceryl trinitrate were administered followed by resolution of pain and ECG changes 15 minutes later. She was admitted to the coronary care unit for observation. Further testing revealed elevated cardiac enzymes (troponin I peak of 628 ng/l) and a non-diagnostic CT abdomen. She remained clinically stable with no further episodes of chest pain. Transthoracic echocardiography showed normal left ventricular function with no pericardial effusion. CT-coronary angiography was performed demonstrating normal coronary arteries, with a calcium score of zero. The patient was diagnosed with acute coronary syndrome (ACS) likely due to ondansetron-induced coronary artery spasm. The patient was discharged on aspirin for follow up with cardiology outpatients. Discussion: Ondansetron, a 5-HT3-receptor antagonist is commonly used in the treatment of nausea and vomiting. Ondansetron induced coronary artery spasm has been described in the literature. CT coronary angiography is not generally performed in ACS however, its remains an extremely helpful test in patients with a low pre-test probability for significant obstructive epicardial coronary artery disease and without the need for invasive coronary angiography similar to our case. http://dx.doi.org/10.1016/j.hlc.2017.06.487 487 Demographics and Risk Profiles of CTCA Patients and Characteristics of CTCA Severity C. Lynch ∗ , G. Reynolds, A. Lee Wollongong Hospital, Wollongong, Australia Background: CTCA is primarily used to rule out coronary artery disease in low risk patients and aids in the reduction of invasive testing. Methods: This cohort study included 169 patients from the Illawarra region that were referred to a single, large-volume centre from October 2015 to October 2016 for CTCA for the purposes of ruling out coronary artery disease. Demographics, risk factors, results and calcium scores were collected from CTCA reports and specialist referral letters. The data was cat-
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egorised in terms of CTCA severity. Chi square analysis was used for differences between groups in terms of demographics (age, sex) and risk factors (hypertension, dyslipidaemia, smoking history, diabetes and family history). Results: Overall, 38% had normal coronary arteries, 52% had minimal to mild disease and 10 had moderate to severe disease. The average age was 60 years + - 11.8, with 50% being female. 48.5% of patients presented with chest pain, 29.6% with shortness of breath, 1.8% with palpitations, and 5.3% with syncope. A Normal CTCA result was associated with lower age (54 years, p < 0.05), Moderate/severe disease was associated with increased age (66 years, p = <0.01) and significantly higher calcium scores (1062.8 vs 485.2, p <0.01). No risk factors or clinical presentations were found to be significantly different between groups. Conclusion: The analysis showed that 90% of CTCAs performed in the Illawarra showed no or minor coronary artery disease. There was no difference in demographics and risk factors between normal and moderate/severe groups apart from age. http://dx.doi.org/10.1016/j.hlc.2017.06.488 488 Determinants of Exercise Capacity Following Acute ST-Elevation Myocardial Infarction (STEMI) H. Klimis 1,2,3,∗ , M. Altman 1 , A. Ferkh 1,2 , R. Zecchin 1 , P. Brown 1 , R. Denniss 1,2,5 , L. Thomas 1,2,4 1 Department of Cardiology, Westmead Hospital, Sydney, Australia 2 University of Sydney, Sydney, Australia 3 The George Institute for Global Health, Sydney, Australia 4 University of New South Wales, Sydney, Australia 5 Western Sydney University, Sydney, Australia
Background: Left ventricular systolic and diastolic dysfunction affect prognosis following acute ST-elevation myocardial infarction (STEMI). However, there is little information on the determinants of exercise capacity following STEMI. Aims: To determine predictors of exercise capacity following acute STEMI. Methods: Retrospective analysis was performed on consecutive STEMI patients admitted to Westmead Hospital over 12 months, who were enrolled in the cardiac rehabilitation program. A comprehensive transthoracic echocardiogram (TTE) was performed during the index presentation. Diastolic function was determined by 2 cardiologists (2016 ASE/EACVI guidelines), into normal and abnormal. Further abnormal diastolic function was grouped as impaired relaxation (n = 16), pseudonormal filling (n = 14), and restrictive filling (n = 0). Exercise capacity was determined using METS achieved during exercise stress testing. Results: 57 patients were assessed (91% male; mean age 59 years, 54% anterior infarcts). 30(53%) had diastolic dysfunction. METS achieved were lower in the abnormal diastology
484 Contemporary Left Ventricular Mass Assessment via 2D Echocardiography–a Comparison with Cardiac Magnetic Resonance (CMR) Imaging T. Hecker 1,∗ , R. Perry 1,2,3 , V. Chia 1 , A. King 2 , J. Selvanayagam 1,2,3 , M. Joseph 1,2 1 Flinders
Medical Centre, Adelaide, Australia University School of Medicine, Adelaide, Australia 3 Dept of Heart Health, South Australian Health and Medical Research Institute, Adelaide, Australia 2 Flinders
Background: Left ventricular (LV) wall thickness/LV hypertrophy (LVH) has been assessed by echocardiography (echo) using LV m-mode in parasternal long axis view (PLAx). LV mass (LVM) calculations can be derived from m-mode measurements or 2D in the PLAx and more recently by the area/length method from the parasternal short axis view (PSSAx). The aim was to compare LV mass derived from both the 2D PSLAx and PSSAx methods with MRI calculated LV mass as the gold standard. Method: 103 patients referred for echocardiography and CMR within a 3-month period were included. Indexed measurements for LVM from the PLAx and PSSAx views were calculated using ASE recommendations. Three-dimensional, indexed mass was calculated from the CMR images by a separate experienced CMR observer, blinded to the echo data. Results: There was good correlation between both echo derived mass calculations and MRI using Pearson’s correlation coefficient with the PSLAx r = 0.81 (p < 0.0001) and PSSAx r = 0.93 (p < 0.001). Using Bland-Altman analysis the bias (and limits of agreement) of the PSLAx was -117.74 g/m2 (-258.59 to 23.11 g/m2 ) and PSSAx was -1.18 g/m2 (-22.4 to 20.05 g/m2 ). Conclusion: Despite good correlation between echo and CMR mass, PSLAx calculated mass demonstrated a large bias. The PSSAx method is more robust but with broad limits of agreement suggesting that echo and CMR calculations of LVM are not interchangeable with echo overestimating LV mass. Given this, serial assessment of LVM should be performed by the same modality for follow-up and when using 2D echo, PSSAx is a more reliable and accurate method and hence preferable in clinical practice. http://dx.doi.org/10.1016/j.hlc.2017.06.485
S255
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485 Correlation Between Diastolic Dysfunction and Exercise Capacity in Chronic Kidney Disease G. Gan 1,2,3,∗ , K. Kadappu 2,3 , A. Boyd 4 , N. Goonetilleke 1 , S. Eshoo 1 , L. Thomas 2,3,4,5 1 Department of Cardiology, Blacktown Hospital, Sydney, Australia 2 Department of Cardiology, Liverpool Hospital, Sydney, Australia 3 University of New South Wales, Sydney, Australia 4 Westmead Private Cardiology, Sydney, Australia 5 Department of Cardiology, Westmead Hospital, Sydney, Australia
Background: Chronic kidney disease (CKD) is a growing public health issue, associated with high rates of heart failure and diastolic impairment. Exercise capacity is an important prognostic determinant of cardiovascular outcomes. The objective of this study was to evaluate determinants of exercise capacity in CKD patients. Methods: Stage 3 CKD patients (eGFR 3059 mL/min/1.73 m2 ) (n = 95), without previous cardiac illness were prospectively recruited and underwent comprehensive transthoracic echocardiogram (TTE) and exercise stress echocardiogram. Exercise capacity was compared to age, gender and risk factor matched controls. Maximal exercise tolerance was expressed as the estimated metabolic equivalents (METs). Results: 95 patients (male 68%) were included and compared to 92 matched controls. Mean age in CKD and control group were 63 ± 9.6 years and 62 ± 9.5 years respectively. Patients with CKD had an overall lower achieved METs during exercise. Mean resting E/e’ was similar in both groups. Post exercise E/e’ was higher in the CKD group. In controls, achieved METS during exercise was inversely associated with post exercise E/e’ (p = 0.005) but not to baseline E/e’ (p = 0.07). In the CKD group, achieved METS during exercise was inversely correlated with post exercise E/e’ (p < 0.001) as well as resting E/e’ (p < 0.001). Additional independent correlates of exercise in both groups were age, male gender and body mass index. Conclusions: CKD is associated with lower achieved METS during exercise with significant inverse correlation to increase in LVEDP. http://dx.doi.org/10.1016/j.hlc.2017.06.486
Abstracts
S256
486 CT Coronary Angiography in a Case of Acute Coronary Syndrome: Choosing Wisely S. Wakeling, H. Brownstein ∗ , A. Al-Kaisey, N. Jones, D. Fernando Austin Health, Melbourne, Australia Case report: A 31-year-old female presented to our Emergency Department with right upper quadrant pain and nausea. Her past medical history was only significant for recurrent pericarditis. She was not on any medications and denied illicit drugs or smoking. Intravenous ondansetron was administered to help alleviate her nausea. A few seconds later, she developed central crushing chest pain with electrocardiograph findings of widespread ST depression and ST elevation in aVR. Intravenous morphine and sublingual glyceryl trinitrate were administered followed by resolution of pain and ECG changes 15 minutes later. She was admitted to the coronary care unit for observation. Further testing revealed elevated cardiac enzymes (troponin I peak of 628 ng/l) and a non-diagnostic CT abdomen. She remained clinically stable with no further episodes of chest pain. Transthoracic echocardiography showed normal left ventricular function with no pericardial effusion. CT-coronary angiography was performed demonstrating normal coronary arteries, with a calcium score of zero. The patient was diagnosed with acute coronary syndrome (ACS) likely due to ondansetron-induced coronary artery spasm. The patient was discharged on aspirin for follow up with cardiology outpatients. Discussion: Ondansetron, a 5-HT3-receptor antagonist is commonly used in the treatment of nausea and vomiting. Ondansetron induced coronary artery spasm has been described in the literature. CT coronary angiography is not generally performed in ACS however, its remains an extremely helpful test in patients with a low pre-test probability for significant obstructive epicardial coronary artery disease and without the need for invasive coronary angiography similar to our case. http://dx.doi.org/10.1016/j.hlc.2017.06.487 487 Demographics and Risk Profiles of CTCA Patients and Characteristics of CTCA Severity C. Lynch ∗ , G. Reynolds, A. Lee Wollongong Hospital, Wollongong, Australia Background: CTCA is primarily used to rule out coronary artery disease in low risk patients and aids in the reduction of invasive testing. Methods: This cohort study included 169 patients from the Illawarra region that were referred to a single, large-volume centre from October 2015 to October 2016 for CTCA for the purposes of ruling out coronary artery disease. Demographics, risk factors, results and calcium scores were collected from CTCA reports and specialist referral letters. The data was cat-
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egorised in terms of CTCA severity. Chi square analysis was used for differences between groups in terms of demographics (age, sex) and risk factors (hypertension, dyslipidaemia, smoking history, diabetes and family history). Results: Overall, 38% had normal coronary arteries, 52% had minimal to mild disease and 10 had moderate to severe disease. The average age was 60 years + - 11.8, with 50% being female. 48.5% of patients presented with chest pain, 29.6% with shortness of breath, 1.8% with palpitations, and 5.3% with syncope. A Normal CTCA result was associated with lower age (54 years, p < 0.05), Moderate/severe disease was associated with increased age (66 years, p = <0.01) and significantly higher calcium scores (1062.8 vs 485.2, p <0.01). No risk factors or clinical presentations were found to be significantly different between groups. Conclusion: The analysis showed that 90% of CTCAs performed in the Illawarra showed no or minor coronary artery disease. There was no difference in demographics and risk factors between normal and moderate/severe groups apart from age. http://dx.doi.org/10.1016/j.hlc.2017.06.488 488 Determinants of Exercise Capacity Following Acute ST-Elevation Myocardial Infarction (STEMI) H. Klimis 1,2,3,∗ , M. Altman 1 , A. Ferkh 1,2 , R. Zecchin 1 , P. Brown 1 , R. Denniss 1,2,5 , L. Thomas 1,2,4 1 Department of Cardiology, Westmead Hospital, Sydney, Australia 2 University of Sydney, Sydney, Australia 3 The George Institute for Global Health, Sydney, Australia 4 University of New South Wales, Sydney, Australia 5 Western Sydney University, Sydney, Australia
Background: Left ventricular systolic and diastolic dysfunction affect prognosis following acute ST-elevation myocardial infarction (STEMI). However, there is little information on the determinants of exercise capacity following STEMI. Aims: To determine predictors of exercise capacity following acute STEMI. Methods: Retrospective analysis was performed on consecutive STEMI patients admitted to Westmead Hospital over 12 months, who were enrolled in the cardiac rehabilitation program. A comprehensive transthoracic echocardiogram (TTE) was performed during the index presentation. Diastolic function was determined by 2 cardiologists (2016 ASE/EACVI guidelines), into normal and abnormal. Further abnormal diastolic function was grouped as impaired relaxation (n = 16), pseudonormal filling (n = 14), and restrictive filling (n = 0). Exercise capacity was determined using METS achieved during exercise stress testing. Results: 57 patients were assessed (91% male; mean age 59 years, 54% anterior infarcts). 30(53%) had diastolic dysfunction. METS achieved were lower in the abnormal diastology