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Is computed tomography coronary angiography (CTCA) more likely than myocardial perfusion scintigraphy (MPS) to alter primary prevention therapies in patients presenting at intermediate risk of coronary artery disease
Abstract
545 Is bicuspid aortic valve phenotype heterogeneity predicting aortopathy or accelerated valve dysfunction? M. Habibian 1,∗ , A. Yedalian 1,2 , H. Raghuraman 1 , M. Zhang 1 , S. Buchholz 1,2 1 Mackay
Hospital & Health Service, Mackay QLD, Australia 2 James Cook University, College of Medicine & Dentistry, Mackay Campus QLD, Australia Background: Recent literature suggests that the valvular phenotype in bicuspid aortic valve (BAV) may result in different degrees of valve dysfunction and aortopathy due to abnormal helical aortic flow. Methods: We reviewed 4500 echocardiogram reports and selected 46 patients (76% male, age 48 +/- 16 years) with definite BAV, and defined 3 phenotypes- right and left cusp fusion (type 1; n = 30), and non-coronary cusp with either right (type 2; n = 10) or left cusp fusion (type 3; n = 6). We used a previously published calcium scoring system and current guidelines for chamber quantification, valvular disease and aortic dimensions. Results: The sinus of Valsalva was significantly larger in type 1 vs. type 2 (4.0 +/- 0.6 vs. 3.5 +/- 0.6 cm; p=0.03), however, when indexed to body surface area (BSA), this statistical difference was lost (2.0 +/- 0.4 vs 1.8 +/- 0.4 cm/m2 ; p = 0.12). Additionally, there was no difference between groups for indexed sino-tubular junction, proximal ascending aorta and transverse arch. Type 3 BAV had a significantly higher calcium score (2.7 vs. 0.8 [type 2] vs. 0.9 [type 1]; p=0.02) as well as higher average corrected transvalvular maximum pressure gradients (45 +/23 vs. 29 +/- 40 vs. 19 +/- 18 mmHg; p= 0.0056 for comparison type 3 vs. type 1). Conclusions: In our patient cohort no BSA-indexed difference in the degree of aortopathy was found. The (rare) presence of fusion of the left and non-coronary cusp may be predictive of a more ‘malignant’ BAV phenotype. http://dx.doi.org/10.1016/j.hlc.2015.06.548 546 Is computed tomography coronary angiography (CTCA) more likely than myocardial perfusion scintigraphy (MPS) to alter primary prevention therapies in patients presenting at intermediate risk of coronary artery disease I. Tsay ∗ , I. Subiakto, A. Castles, M. Asrar ul Haq, W. van Gaal Department of Cardiology, Northern Health, VIC, Australia Background: In patients at intermediate risk of coronary artery disease MPS reliably assesses functional flow limitation, whilst CTCA provides atherosclerotic burden and anatomy. Anecdotally, CTCA is used to stratify patients to pri-
S347
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mary prevention therapy such as statin therapy. We sought to evaluate which modality is more likely to alter primary prevention therapy of patients presenting with chest pain. Methods: Pre and post-imaging records were reviewed for all patients undergoing CTCA or MPS between January and December 2013. Patients with pre-existing ischaemic heart disease were excluded. Changes in the use of aspirin, statin, ACE-inhibitor or angiotensin-receptor blocker for primary prevention or revascularisation with percutaneous intervention or bypass grafting were compared between imaging modalities. Increase in primary prevention therapy was defined as commencement or dose increase of any of these drugs. The Chi-Square test was used to compare categorical variables. Results: 410 consecutive patients were identified. 196 underwent CTCA and 214 MPS. Overall, 28 CTCA and 16 MPS patients (14.2% vs. 7.4%, p=0.026) had escalation of their management. 19 CTCA and 5 MPS patients (9.6% vs. 2.3%, p=0.001) had an increase of primary prevention therapy, while 9 CTCA and 11 MPS patients received revascularisation (4.5% vs. 5.1%, p=0.796). Conclusion: In our experience, CTCA was significantly more likely than MPS to escalate primary prevention therapies. No significant difference was found in revascularisation rates. We attribute this phenomenon to direct visualisation of atheroma and consequently a lower threshold for what is considered a “positive result”. Whether this approach is beneficial remains to be proven. http://dx.doi.org/10.1016/j.hlc.2015.06.549 547 Is global longitudinal strain better than left ventricular ejection fraction for predicting infarct scar size? L. Hee 1,2,∗ , A. Chen 1 , C. Mussap 1,2 , T. Nguyen 2 , C. Juergens 1,2 , H. Dimitri 1,2 , J. French 1,2 , D. Richards 1,2 , L. Thomas 1,2 1 Liveprool
Hospital, Sydney, NSW, Australia Clinical School, UNSW, Sydney, NSW, Australia
2 SSWAH
Background: Global longitudinal strain (GLS) describes LV function with improved sensitivity compared with LVEF. We examined multi-planar GLS, and compared its predictive value with LVEF for infarct scar size. Methods: Thirty consecutive STEMI patients who underwent PCI were included. Clinical and demographic data were collected prospectively. Between days 2-7 post STEMI, all patients had an echocardiogram with 2D GLS assessment, and cardiac magnetic resonance imaging (CMRI). GLS was measured from apical 2-, 4-chamber and long-axis views, and LV multi-planar (endo-, mid-, epi-cardial) datasets were obtained, whilst scar size evaluation was evaluated by late gadolinium enhanced CMRI. Receiver operating characteristic (ROC) curve was performed to rank the predictive value between LV multilayer GLS and LVEF to determine worse scar size. Results: Patients were 56±10 years of age, risk factors were diabetes (8%), smoker (69%); hypertension
545 Is bicuspid aortic valve phenotype heterogeneity predicting aortopathy or accelerated valve dysfunction? M. Habibian 1,∗ , A. Yedalian 1,2 , H. Raghuraman 1 , M. Zhang 1 , S. Buchholz 1,2 1 Mackay
Hospital & Health Service, Mackay QLD, Australia 2 James Cook University, College of Medicine & Dentistry, Mackay Campus QLD, Australia Background: Recent literature suggests that the valvular phenotype in bicuspid aortic valve (BAV) may result in different degrees of valve dysfunction and aortopathy due to abnormal helical aortic flow. Methods: We reviewed 4500 echocardiogram reports and selected 46 patients (76% male, age 48 +/- 16 years) with definite BAV, and defined 3 phenotypes- right and left cusp fusion (type 1; n = 30), and non-coronary cusp with either right (type 2; n = 10) or left cusp fusion (type 3; n = 6). We used a previously published calcium scoring system and current guidelines for chamber quantification, valvular disease and aortic dimensions. Results: The sinus of Valsalva was significantly larger in type 1 vs. type 2 (4.0 +/- 0.6 vs. 3.5 +/- 0.6 cm; p=0.03), however, when indexed to body surface area (BSA), this statistical difference was lost (2.0 +/- 0.4 vs 1.8 +/- 0.4 cm/m2 ; p = 0.12). Additionally, there was no difference between groups for indexed sino-tubular junction, proximal ascending aorta and transverse arch. Type 3 BAV had a significantly higher calcium score (2.7 vs. 0.8 [type 2] vs. 0.9 [type 1]; p=0.02) as well as higher average corrected transvalvular maximum pressure gradients (45 +/23 vs. 29 +/- 40 vs. 19 +/- 18 mmHg; p= 0.0056 for comparison type 3 vs. type 1). Conclusions: In our patient cohort no BSA-indexed difference in the degree of aortopathy was found. The (rare) presence of fusion of the left and non-coronary cusp may be predictive of a more ‘malignant’ BAV phenotype. http://dx.doi.org/10.1016/j.hlc.2015.06.548 546 Is computed tomography coronary angiography (CTCA) more likely than myocardial perfusion scintigraphy (MPS) to alter primary prevention therapies in patients presenting at intermediate risk of coronary artery disease I. Tsay ∗ , I. Subiakto, A. Castles, M. Asrar ul Haq, W. van Gaal Department of Cardiology, Northern Health, VIC, Australia Background: In patients at intermediate risk of coronary artery disease MPS reliably assesses functional flow limitation, whilst CTCA provides atherosclerotic burden and anatomy. Anecdotally, CTCA is used to stratify patients to pri-
S347
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
mary prevention therapy such as statin therapy. We sought to evaluate which modality is more likely to alter primary prevention therapy of patients presenting with chest pain. Methods: Pre and post-imaging records were reviewed for all patients undergoing CTCA or MPS between January and December 2013. Patients with pre-existing ischaemic heart disease were excluded. Changes in the use of aspirin, statin, ACE-inhibitor or angiotensin-receptor blocker for primary prevention or revascularisation with percutaneous intervention or bypass grafting were compared between imaging modalities. Increase in primary prevention therapy was defined as commencement or dose increase of any of these drugs. The Chi-Square test was used to compare categorical variables. Results: 410 consecutive patients were identified. 196 underwent CTCA and 214 MPS. Overall, 28 CTCA and 16 MPS patients (14.2% vs. 7.4%, p=0.026) had escalation of their management. 19 CTCA and 5 MPS patients (9.6% vs. 2.3%, p=0.001) had an increase of primary prevention therapy, while 9 CTCA and 11 MPS patients received revascularisation (4.5% vs. 5.1%, p=0.796). Conclusion: In our experience, CTCA was significantly more likely than MPS to escalate primary prevention therapies. No significant difference was found in revascularisation rates. We attribute this phenomenon to direct visualisation of atheroma and consequently a lower threshold for what is considered a “positive result”. Whether this approach is beneficial remains to be proven. http://dx.doi.org/10.1016/j.hlc.2015.06.549 547 Is global longitudinal strain better than left ventricular ejection fraction for predicting infarct scar size? L. Hee 1,2,∗ , A. Chen 1 , C. Mussap 1,2 , T. Nguyen 2 , C. Juergens 1,2 , H. Dimitri 1,2 , J. French 1,2 , D. Richards 1,2 , L. Thomas 1,2 1 Liveprool
Hospital, Sydney, NSW, Australia Clinical School, UNSW, Sydney, NSW, Australia
2 SSWAH
Background: Global longitudinal strain (GLS) describes LV function with improved sensitivity compared with LVEF. We examined multi-planar GLS, and compared its predictive value with LVEF for infarct scar size. Methods: Thirty consecutive STEMI patients who underwent PCI were included. Clinical and demographic data were collected prospectively. Between days 2-7 post STEMI, all patients had an echocardiogram with 2D GLS assessment, and cardiac magnetic resonance imaging (CMRI). GLS was measured from apical 2-, 4-chamber and long-axis views, and LV multi-planar (endo-, mid-, epi-cardial) datasets were obtained, whilst scar size evaluation was evaluated by late gadolinium enhanced CMRI. Receiver operating characteristic (ROC) curve was performed to rank the predictive value between LV multilayer GLS and LVEF to determine worse scar size. Results: Patients were 56±10 years of age, risk factors were diabetes (8%), smoker (69%); hypertension