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PERCEPTIONS OF CARDIOVASCULAR RISK FACTORS AMONG CARDIOLOGY OUTPATIENTS
S22
Heart, Lung and Circulation 2008;17S:S1–S34
Abstracts
ABSTRACTS
Conclusion: We have developed an internally consistent picture of the descriptive epidemiology of CHD for the whole New Zealand population in 2001–2003 which has relevance to prioritization and planning of relevant health care services. doi:10.1016/j.hlc.2008.03.048 48 PROCEDURE-RELATED INFORMATION RECALLED BEFORE CORONARY ANGIOGRAPHY D Leiper, S Mann ∗ University of Otago, Wellington, New Zealand Aim: We wished to ascertain what perceptions patients held about the benefits and risks of coronary angiography and angioplasty after receiving usual information. Method: We surveyed 50 consecutive patients about to undergo coronary angiography ± angioplasty (37 acute and 13 elective). Ten were female, mean age was 65 years, 42 were of European ethnicity and 19 had had a previous angiogram. Results: Forty of 50 rated the information given by the house officer as “very useful” but only 26 of 46 were aware of the doctor’s grade Additional non-verbal information had been accessed by 32 patients, mainly from booklets (27 patients) and videos (9 patients). 29 patients had consulted people other than hospital staff for information including other patients (11) and family or friends (23). Patients recalled an average of 3.1 of 6 information points about the procedure but 5 could not explain it at all. Only 2.3 of 9 possible complications were recalled on average, 10 patients could not recall any possible complication, females and the elderly recalling fewer points. Patients who had extra information recalled more points than those who did not but specific written or audio-visual information did not improve scores. Angioplasty was ranked highest of any measure in extending life expectancy by 26 of 41 patients. Conclusions: Patients were content with information received but could not recall much detail, even when additional sources of information were used. Patients had a realistic view of the purpose of the procedure but overestimated the effectiveness of angioplasty in extending life expectancy. doi:10.1016/j.hlc.2008.03.049 49 PERCEPTIONS OF THE PROGNOSTIC BENEFIT OF STATIN THERAPY AND PERCUTANEOUS CORONARY INTERVENTION AMONG PRIMARY HEALTH CARE PROFESSIONALS S Mann University of Otago, Wellington, New Zealand Aim: To assess perception of the benefits of lipidlowering therapy and percutaneous coronary intervention (PCI) among primary health care professionals (PCPs).
Method: Interactive seminars were conducted with 222 PCPs in 8 different centres in New Zealand. An example case was given of a man recovering from myocardial infarction with moderate dyslipidaemia. Using anonymised audience response technology, perception of the prognostic benefits of statin therapy was assessed by standardised questions. Participants also estimated reduction of future cardiovascular events following PCI in a patient with stable angina. Results: 16% would initiate diet and lifestyle change first while 84% of respondents would treat the index patient with simvastatin, 37% opting for 20 mg/day with 33% starting 40 mg/day. If allowed a free choice, 67% would prefer to use atorvastatin. 48% would not attempt to quantify benefit to the patient, 34% would estimate relative risk reduction (RRR) and 14% absolute risk reduction (ARR). RRR was estimated at 20–30% by 32% of respondents and 30–50% by 25%. ARR estimates (for a 5-year period) were variable but 70% gave estimates between 5% and 20%. 18% of respondents thought that life expectancy might be increased by >1 year and 5% by >5 years. 72% of the respondents expected reduction of future cardiovascular events from PCI in stable angina, 32% estimating the RRR from this being greater than 25%. Conclusion: Although widely spread, numerical answers were grouped around realistic estimates of benefit, apart from an overestimate for life expectancy. The majority expected significant prognostic benefit from PCI in stable angina. doi:10.1016/j.hlc.2008.03.050 50 PERCEPTIONS OF CARDIOVASCULAR RISK FACTORS AMONG CARDIOLOGY OUTPATIENTS C Stirrat, S Mann ∗ University of Otago, Wellington, New Zealand Aim/methods: Using a written questionnaire, we surveyed patient knowledge and attitudes regarding cardiovascular risk factors during attendance at a Public Hospital outpatient clinic. Results: Of 104 attendees, 2 declined consent, 13 agreed but did not have time to complete the questionnaire and 6 could not complete it due to communication difficulties. Of those completing it, 58% were female and all decades from teenage to >80 years were represented. No patient self-identified as Maori, 79% were ethnically European, 13% Pacific Islanders, and 4% Asian; 26% had a tertiary qualification. Only 7% were attending primarily because of a risk factor (hypertension 6%, dyslipidaemia 1%). Specific mention, and lifestyle or medical treatment, of relevant personal risk factors was remembered from the consultation in 32%. 89% of patients were already aware of risk factors, the main sources of information being media (62%), primary care (58%), friends and relatives (39%) or previous hospital contact (19%). Risk factors recognised were: smoking (85%), high blood pressure (82%), lack of exercise (80%), high cholesterol (80%), obesity (77%) and
high fat diet (77%), stressful life (76%) and a previous heart attack (67%). 58% thought alcohol and 37% marijuana relevant. Fewer than half recognised older age, male sex, family history or diabetes as risks. In rating the importance of interventions for reducing risk, 73% thought lifestyle change very important, 68% drug therapy, 61% angioplasty and 58% bypass surgery. Conclusion: Opportunities remain to improve risk education among cardiology patients. doi:10.1016/j.hlc.2008.03.051 51 MULTIMODALITY IMAGING—ITS USE IN THE DIAGNOSIS AND TREATMENT OF BIVENTRICULAR OUTFLOW TRACT OBSTRUCTION IN A PATIENT WITH LEOPARD SYNDROME AM Moynagh 1,∗ , C O’Donnell 2 , K Finucane 2 , I Crozier 1 1 Christchurch 2 Auckland
Hospital, Christchurch, New Zealand City Hospital, Auckland, New Zealand
Background: LEOPARD syndrome is a rare autosomal dominant hereditary disorder characterised by multiple lentigines and rarely, with cardiac involvement. Methods: A 47-year-old woman was referred to clinic for evaluation of NYHA class III angina and self terminating palpitations in addition to symptoms of right heart failure. She has been previously diagnosed with LEOPARD syndrome on chromosomal analysis and has been followed up for presumed hypertrophic cardiomyopathy. Results: 2D transthoracic echocardiographic images confirmed severe left ventricular outflow tract obstruction. In addition, there was a right ventricular outflow tract gradient, which appeared to be subvalvular. The origin of the obstruction could not be defined by 2D echo. A 3D echocardiogram was able to localise the right ventricular gradient to muscle bundles in the right ventricular outflow tract, below the level of the pulmonary valve. Invasive haemodynamic testing confirmed dynamic obstructions in the right and left ventricular outflow tracts. Left ventricular and right ventricular angiograms confirmed these findings. Coronary angiography revealed normal coronary arteries. Cardiac MRI showed displacement of both ventricles into the left hemithorax with subpulmonary obstruction contributed to, both by muscle bundles and apparent compression of the right ventricle by a severe pectus abnormality. Conclusions: Multimodality imaging was required to identify the multiple causes of biventricular outflow tract obstruction in this unusual case, thus allowing the patient to proceed to definitive surgical treatment with septal myomectomy, plication of the anterior mitral valve leaflet, right ventricular outflow tract muscle resection and pectus excavatum repair. doi:10.1016/j.hlc.2008.03.052
Abstracts
S23
52 CARDIAC CT ANGIOGRAPHY FOR DETECTION OF CORONARY ARTERY DISEASE—PREVALENCE OF INCIDENTAL FINDINGS A Moynagh 1,∗ , J Lainchbury 1 , S 2 Keenan , R Troughton 1 1 Department
of Cardiology, Christchurch, New Zealand 2 Department of Radiology, Christchurch, New Zealand
MacDonald 2 , R
Christchurch
Hospital,
Christchurch
Hospital,
Background: Although the intent of cardiac CT is to accurately image the coronary structures, non-cardiac structures are also visible on the scan. Non-cardiac incidental findings are detected in between 25 and 60% of all cardiac CT scans, the majority of these being pulmonary nodules. We aimed to retrospectively assess the prevalence of non-cardiac disease and its potential clinical significance. Methods: 100 patients (age 60 ± 11 years, 64% male) with suspected coronary artery disease underwent routine diagnostic coronary angiography (DCA) followed by ECGgated 64 slice coronary CT. All CT scans were assessed by an experienced thoracic radiologist. The prevalence of coronary disease and all non-cardiac findings were reported. Results: 28 patients had non-cardiac abnormalities on CT. Of these, 50% were pulmonary nodules. These have been followed up over a one year period with no interval change. 3 patients had pulmonary emboli, one of which was certainly the cause of the presenting symptoms. The other 2 patients were asymptomatic and definitive coronary intervention was delayed until a period of anticoagulation was completed. 3 patients were diagnosed with mild asymptomatic interstitial lung disease. Other findings were hiatus hernias, enlarged thyroids and a pericardial cyst. Conclusions: Non-cardiac findings were found in 28% of all patients studied. Of these, the non-cardiac abnormality was thought to be the cause of symptoms in 1 patient. In the asymptomatic patients, non-cardiac findings seemed to have minimal clinical significance. doi:10.1016/j.hlc.2008.03.053 53 COMPARISON OF INTRATHORACIC IMPEDANCE WITH DIRECT LEFT ATRIAL PRESSURE IN CHRONIC HEART FAILURE RE Park 1,2,∗ , JLT Ritzema 2 , IC Melton 2 , IG Crozier 2 , AM Richards 2 , RW Troughton 2 1 Medtronic
Electrophysiology Fellow, Christchurch Hospital, New Zealand 2 Department of Cardiology, Christchurch Hospital, New Zealand Background: Pulmonary fluid congestion resulting from elevated left atrial (LA) and left ventricular filling pressures is a common event in heart failure decom-
ABSTRACTS
Heart, Lung and Circulation 2008;17S:S1–S34
Heart, Lung and Circulation 2008;17S:S1–S34
Abstracts
ABSTRACTS
Conclusion: We have developed an internally consistent picture of the descriptive epidemiology of CHD for the whole New Zealand population in 2001–2003 which has relevance to prioritization and planning of relevant health care services. doi:10.1016/j.hlc.2008.03.048 48 PROCEDURE-RELATED INFORMATION RECALLED BEFORE CORONARY ANGIOGRAPHY D Leiper, S Mann ∗ University of Otago, Wellington, New Zealand Aim: We wished to ascertain what perceptions patients held about the benefits and risks of coronary angiography and angioplasty after receiving usual information. Method: We surveyed 50 consecutive patients about to undergo coronary angiography ± angioplasty (37 acute and 13 elective). Ten were female, mean age was 65 years, 42 were of European ethnicity and 19 had had a previous angiogram. Results: Forty of 50 rated the information given by the house officer as “very useful” but only 26 of 46 were aware of the doctor’s grade Additional non-verbal information had been accessed by 32 patients, mainly from booklets (27 patients) and videos (9 patients). 29 patients had consulted people other than hospital staff for information including other patients (11) and family or friends (23). Patients recalled an average of 3.1 of 6 information points about the procedure but 5 could not explain it at all. Only 2.3 of 9 possible complications were recalled on average, 10 patients could not recall any possible complication, females and the elderly recalling fewer points. Patients who had extra information recalled more points than those who did not but specific written or audio-visual information did not improve scores. Angioplasty was ranked highest of any measure in extending life expectancy by 26 of 41 patients. Conclusions: Patients were content with information received but could not recall much detail, even when additional sources of information were used. Patients had a realistic view of the purpose of the procedure but overestimated the effectiveness of angioplasty in extending life expectancy. doi:10.1016/j.hlc.2008.03.049 49 PERCEPTIONS OF THE PROGNOSTIC BENEFIT OF STATIN THERAPY AND PERCUTANEOUS CORONARY INTERVENTION AMONG PRIMARY HEALTH CARE PROFESSIONALS S Mann University of Otago, Wellington, New Zealand Aim: To assess perception of the benefits of lipidlowering therapy and percutaneous coronary intervention (PCI) among primary health care professionals (PCPs).
Method: Interactive seminars were conducted with 222 PCPs in 8 different centres in New Zealand. An example case was given of a man recovering from myocardial infarction with moderate dyslipidaemia. Using anonymised audience response technology, perception of the prognostic benefits of statin therapy was assessed by standardised questions. Participants also estimated reduction of future cardiovascular events following PCI in a patient with stable angina. Results: 16% would initiate diet and lifestyle change first while 84% of respondents would treat the index patient with simvastatin, 37% opting for 20 mg/day with 33% starting 40 mg/day. If allowed a free choice, 67% would prefer to use atorvastatin. 48% would not attempt to quantify benefit to the patient, 34% would estimate relative risk reduction (RRR) and 14% absolute risk reduction (ARR). RRR was estimated at 20–30% by 32% of respondents and 30–50% by 25%. ARR estimates (for a 5-year period) were variable but 70% gave estimates between 5% and 20%. 18% of respondents thought that life expectancy might be increased by >1 year and 5% by >5 years. 72% of the respondents expected reduction of future cardiovascular events from PCI in stable angina, 32% estimating the RRR from this being greater than 25%. Conclusion: Although widely spread, numerical answers were grouped around realistic estimates of benefit, apart from an overestimate for life expectancy. The majority expected significant prognostic benefit from PCI in stable angina. doi:10.1016/j.hlc.2008.03.050 50 PERCEPTIONS OF CARDIOVASCULAR RISK FACTORS AMONG CARDIOLOGY OUTPATIENTS C Stirrat, S Mann ∗ University of Otago, Wellington, New Zealand Aim/methods: Using a written questionnaire, we surveyed patient knowledge and attitudes regarding cardiovascular risk factors during attendance at a Public Hospital outpatient clinic. Results: Of 104 attendees, 2 declined consent, 13 agreed but did not have time to complete the questionnaire and 6 could not complete it due to communication difficulties. Of those completing it, 58% were female and all decades from teenage to >80 years were represented. No patient self-identified as Maori, 79% were ethnically European, 13% Pacific Islanders, and 4% Asian; 26% had a tertiary qualification. Only 7% were attending primarily because of a risk factor (hypertension 6%, dyslipidaemia 1%). Specific mention, and lifestyle or medical treatment, of relevant personal risk factors was remembered from the consultation in 32%. 89% of patients were already aware of risk factors, the main sources of information being media (62%), primary care (58%), friends and relatives (39%) or previous hospital contact (19%). Risk factors recognised were: smoking (85%), high blood pressure (82%), lack of exercise (80%), high cholesterol (80%), obesity (77%) and
high fat diet (77%), stressful life (76%) and a previous heart attack (67%). 58% thought alcohol and 37% marijuana relevant. Fewer than half recognised older age, male sex, family history or diabetes as risks. In rating the importance of interventions for reducing risk, 73% thought lifestyle change very important, 68% drug therapy, 61% angioplasty and 58% bypass surgery. Conclusion: Opportunities remain to improve risk education among cardiology patients. doi:10.1016/j.hlc.2008.03.051 51 MULTIMODALITY IMAGING—ITS USE IN THE DIAGNOSIS AND TREATMENT OF BIVENTRICULAR OUTFLOW TRACT OBSTRUCTION IN A PATIENT WITH LEOPARD SYNDROME AM Moynagh 1,∗ , C O’Donnell 2 , K Finucane 2 , I Crozier 1 1 Christchurch 2 Auckland
Hospital, Christchurch, New Zealand City Hospital, Auckland, New Zealand
Background: LEOPARD syndrome is a rare autosomal dominant hereditary disorder characterised by multiple lentigines and rarely, with cardiac involvement. Methods: A 47-year-old woman was referred to clinic for evaluation of NYHA class III angina and self terminating palpitations in addition to symptoms of right heart failure. She has been previously diagnosed with LEOPARD syndrome on chromosomal analysis and has been followed up for presumed hypertrophic cardiomyopathy. Results: 2D transthoracic echocardiographic images confirmed severe left ventricular outflow tract obstruction. In addition, there was a right ventricular outflow tract gradient, which appeared to be subvalvular. The origin of the obstruction could not be defined by 2D echo. A 3D echocardiogram was able to localise the right ventricular gradient to muscle bundles in the right ventricular outflow tract, below the level of the pulmonary valve. Invasive haemodynamic testing confirmed dynamic obstructions in the right and left ventricular outflow tracts. Left ventricular and right ventricular angiograms confirmed these findings. Coronary angiography revealed normal coronary arteries. Cardiac MRI showed displacement of both ventricles into the left hemithorax with subpulmonary obstruction contributed to, both by muscle bundles and apparent compression of the right ventricle by a severe pectus abnormality. Conclusions: Multimodality imaging was required to identify the multiple causes of biventricular outflow tract obstruction in this unusual case, thus allowing the patient to proceed to definitive surgical treatment with septal myomectomy, plication of the anterior mitral valve leaflet, right ventricular outflow tract muscle resection and pectus excavatum repair. doi:10.1016/j.hlc.2008.03.052
Abstracts
S23
52 CARDIAC CT ANGIOGRAPHY FOR DETECTION OF CORONARY ARTERY DISEASE—PREVALENCE OF INCIDENTAL FINDINGS A Moynagh 1,∗ , J Lainchbury 1 , S 2 Keenan , R Troughton 1 1 Department
of Cardiology, Christchurch, New Zealand 2 Department of Radiology, Christchurch, New Zealand
MacDonald 2 , R
Christchurch
Hospital,
Christchurch
Hospital,
Background: Although the intent of cardiac CT is to accurately image the coronary structures, non-cardiac structures are also visible on the scan. Non-cardiac incidental findings are detected in between 25 and 60% of all cardiac CT scans, the majority of these being pulmonary nodules. We aimed to retrospectively assess the prevalence of non-cardiac disease and its potential clinical significance. Methods: 100 patients (age 60 ± 11 years, 64% male) with suspected coronary artery disease underwent routine diagnostic coronary angiography (DCA) followed by ECGgated 64 slice coronary CT. All CT scans were assessed by an experienced thoracic radiologist. The prevalence of coronary disease and all non-cardiac findings were reported. Results: 28 patients had non-cardiac abnormalities on CT. Of these, 50% were pulmonary nodules. These have been followed up over a one year period with no interval change. 3 patients had pulmonary emboli, one of which was certainly the cause of the presenting symptoms. The other 2 patients were asymptomatic and definitive coronary intervention was delayed until a period of anticoagulation was completed. 3 patients were diagnosed with mild asymptomatic interstitial lung disease. Other findings were hiatus hernias, enlarged thyroids and a pericardial cyst. Conclusions: Non-cardiac findings were found in 28% of all patients studied. Of these, the non-cardiac abnormality was thought to be the cause of symptoms in 1 patient. In the asymptomatic patients, non-cardiac findings seemed to have minimal clinical significance. doi:10.1016/j.hlc.2008.03.053 53 COMPARISON OF INTRATHORACIC IMPEDANCE WITH DIRECT LEFT ATRIAL PRESSURE IN CHRONIC HEART FAILURE RE Park 1,2,∗ , JLT Ritzema 2 , IC Melton 2 , IG Crozier 2 , AM Richards 2 , RW Troughton 2 1 Medtronic
Electrophysiology Fellow, Christchurch Hospital, New Zealand 2 Department of Cardiology, Christchurch Hospital, New Zealand Background: Pulmonary fluid congestion resulting from elevated left atrial (LA) and left ventricular filling pressures is a common event in heart failure decom-
ABSTRACTS
Heart, Lung and Circulation 2008;17S:S1–S34