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Predictive Value of Dynamic Left Ventricular Outflow Tract Obstruction During Dobutamine Stress Echocardiography in Patients Undergoing Liver Transplant
Heart, Lung and Circulation 2013;22:S126–S266
S191 ABSTRACTS
CSANZ 2013 Abstracts
length (inferolateral + anteroseptal) showed a significant difference (p < 0.0001) between UE (46.71 ± 2.75 mm) and CE (57.74 ± 2.60). Conclusion: Despite exposure to destructive hydrodynamic forces, CE is feasible in an ovine VV ECMO model. CE results in significantly improved EDS and increased length of visualised endocardium. http://dx.doi.org/10.1016/j.hlc.2013.05.454 453 Predicting Pre-A Wave LVEDP in Biomarker Positive Acute Coronary Syndrome using Lateral E/E and Tei Index M. Dooris ∗ , L. Carr, A. Camuglia, P. Stewart, S. Prasad Royal Brisbane and Women’s Hospital, Australia Aim: This study aimed to develop models for prediction of Pre-A wave left ventricular end-diastolic pressure (PreA) using echocardiographic metrics of diastolic function in patients with acute coronary syndrome (ACS). Methods: Patients with biomarker positive (ACS) undergoing cardiac catheterisation (CC) were enrolled prospectively. Echocardiography immediately preceded CC. Noninvasive and invasive assessments were mutually blinded. Results: Twenty-three patients were identified: mean age 64 years, male 78%, mean troponin 7.2 (range 0.073, 68) ng/mL. Culprit lesions: LCA: 9, RCA: 4, vein graft: 1, indeterminate 6, stress cardiomyopathy 2. Univariate models for PreA were assessed. Variables with p < 0.1 included: mitral deceleration time, a wave duration (Ad), septal E/E , lateral E/E (EtoEpLat), isovolumic contraction time and Tei Index. Backwards stepwise regression selected the final model presented below (adjusted R2 : 0.65). A simplified EtoEpL at and Tei Index model is shown (adjusted R2 : 0.54). Estimate Std. (Intercept) Ad
Error t
Value
3.69498
8.23400
0.449
0.6605
−0.10179
0.04699
−2.166
0.0480
Pr(>|t|)
EtoEpLat
0.79690
0.29947
2.661
0.0186
TeiIndex
14.97654
5.16867
2.898
0.0117
Estimate Std.
Error t
Value
Pr(>|t|)
(Intercept)
−11.8136
4.5423
−2.601
0.02007
EtoEpLat
1.0202
0.3139
3.250
0.00538
TeiIndex
16.0348
5.7442
2.791
0.01369
The simplified model is visualised above right (mean prediction and 95% confidence interval). Prediction formula: PreA = 1.02 EtoEpLat + 16.0 TeiIndex − 11.8. Conclusions: A number of non-invasive measures of diastolic function correlated with PreA in biomarker positive ACS. Ad, EtoEpLat and TeiIndex provided the best explanatory model. EtoEpLat and TeiIndex can be used to predict PreA. http://dx.doi.org/10.1016/j.hlc.2013.05.455 454 Predictive Value of Dynamic Left Ventricular Outflow Tract Obstruction During Dobutamine Stress Echocardiography in Patients Undergoing Liver Transplant R. Rayoo 1,∗ , J. Grewal 1 , D. Patrick 1 , S. Lovibond 1 , K. Lu 1,2 , P. Calafiore 1 , P. Srivastava 1,2 1 Austin
Hospital, Australia of Melbourne, Australia
2 University
Introduction: Left ventricular outflow tract obstruction (LVOTO) on Dobutamine stress echo (DSE) has led to the denial of transplantation at certain centres as these patients have previously been thought to have a poor response to haemodynamic stress associated with liver transplantation. The assessment of LVOTO during DSE is an important component of preoperative assessment of patients undergoing liver transplant at our centre. Aims and Objectives: This study examined all liver transplant recipients from December 2009 to March 2012, with a view to look at intraoperative and postoperative hypotension, fluid and inotropic requirements, ICU length of stay and postoperative Major adverse cardiac events (MACE). Materials and Methods: The collected data was analysed using SPSS software for any statistically significant differences in outcomes in two different groups of patients with or without LVOTO. Results: A total of 103 patients underwent liver transplant during the study period. Of these 54 (52%) underwent a DSE for preoperative cardiovascular risk assessment of which 10 (18.5%) had evidence of dynamic LVOTO. There was no statistically significant difference in mean intraoperative fluid, inotropic dose, ICU length of stay or MACE. There was a trend towards increased use
S192
Heart, Lung and Circulation 2013;22:S126–S266
CSANZ 2013 Abstracts
ABSTRACTS
of postoperative fluid use within first 48 h (7.1 ± 6.2 L vs 11.3 ± 7.8 L), but this was not statistically significant. Conclusion: Dynamic LVOTO during DSE does not predict to significant differences in intraoperative or postoperative haemodynamic response or MACE in patients undergoing liver transplant surgery.
456
http://dx.doi.org/10.1016/j.hlc.2013.05.456
Cardiovascular Division, North Shore Hospital, Waitemata Health, New Zealand
455 Prevalence of Patent Foramen Ovale in Scuba Divers with Decompression Illness Referred from a Specialist Diving Medicine Clinic K. Liou 1,∗ , D. Wolfers 2 , R. Turner 2 , M. Bennett 2 , G. Cranney 1 1 Eastern
Heart Clinic, Prince of Wales Hospital, Australia
2 Australian Diving and Hyperbaric Medicine Research Group,
Prince of Wales Hospital, Australia Introduction: Presence of patent foramen ovale (PFO) is a risk factor for decompression illness (DCI). We report our experience in 75 scuba divers with DCI from a major referral centre for Diving and Hyperbaric Medicine, utilising trans-septal bubble studies to diagnose PFO. Methodology: In our centre, criteria for referral for transoesophageal echocardiogram (TOE) of divers with DCI has focused on those who developed DCI involving central nervous system, spinal cord or inner ear; or those who developed DCI in spite of obeying their decompression schedule for a particular dive profile. A retrospective review of our echocardiogram database was performed since January 2004, and results cross-tabulated and analysed. Results: Overall 4945 bubble studies have been performed at our centre as part of a TOE. Seventy-five studies (1.5%) were performed for divers with DCI, whilst 28% of studies were done to identify sources of emboli and 70.5% for other indications. Overall 13.8% of the these studies were positive for trans-septal bubble flow, including 9.7% with spontaneous trans-septal shunt without provocation. Fifty-six percent of the bubble studies performed for divers with DCI were positive, which is significantly higher than studies performed to identify sources of emboli (21%; p < 0.001) and for other indications (10%, p < 0.001). Conclusion: Inter-atrial right to left shunt demonstrated by TOE bubble studies is highly prevalent in scuba divers with decompression illness, referred from a specialist Diving Medicine Clinic. http://dx.doi.org/10.1016/j.hlc.2013.05.457
Prognostic Value of Adenosine Stress Cardiac Magnetic Resonance Imaging in Patients with Known Coronary Artery Disease M. Rigolli ∗ , A. To, C. Edwards, P. Ding, J. Christiansen
Background: Cardiac magnetic resonance (CMR) stress imaging has excellent diagnostic capability for coronary disease (CAD), and predicts subsequent cardiac events. However, prognostic studies demonstrating a near absence of events following normal CMR perfusion have included only limited numbers of patients with confirmed CAD. The prognostic importance in pre-existing CAD is unclear. Objectives: To assess the prognostic value of stress perfusion in CAD for the prediction of major adverse cardiac events (MACE), defined as: all-cause death, myocardial infarction, rehospitalisation for acute cardiac symptoms and unplanned revascularisation. Elective procedures arising from the stress CMR were not considered. Methods and Results: We retrospectively reviewed 280 patients (mean age 64.6 ± 11.7, 57% male, mean ejection fraction 59 ± 12%) who underwent stress perfusion and were followed for an average of 1.8 ± 1 years. Fifty-two percent had angiographically established CAD, of which more than one third demonstrated ischaemia on CMR. MACE were significantly more common in patients with known CAD than those without (34 vs 13 events, p < 0.05). On Kaplan–Meier survival analysis patients with CAD had a consistently worse prognosis, even if perfusion imaging was normal (p < 0.05). The presence of ischaemia predicted subsequent events in both patients with and without established CAD. Ischaemia and CAD were independent predictors of survival on Cox regression analysis. Conclusion: Inpatients with established coronary disease, normal stress perfusion CMR is not associated with a uniformly good event-free survival over an average of a nearly two-year follow-up. Clinicians should be cautious in interpreting the results of CMR stress perfusion. http://dx.doi.org/10.1016/j.hlc.2013.05.458 457 Pulmonary Embolism Impedance Tomography
Detection
with
Electrical
D. Nguyen 1,∗ , W. Chik 2 , R. Kosobrodov 1 , M. Barry 2 , J. Pouliopoulos 2 , C. Jin 1 , A. McEwan 1 , A. Thiagalingam 2 1 School of Electrical and Information Engineering, The Univer-
sity of Sydney, Australia of Cardiology, Westmead Hospital, Australia
2 Department
The diagnosis of pulmonary embolism (PE) in critically unwell patients is an important issue that currently lacks a satisfactory solution. Electrical Impedance Tomography (EIT) is a non-invasive, radiation-free, portable,
S191 ABSTRACTS
CSANZ 2013 Abstracts
length (inferolateral + anteroseptal) showed a significant difference (p < 0.0001) between UE (46.71 ± 2.75 mm) and CE (57.74 ± 2.60). Conclusion: Despite exposure to destructive hydrodynamic forces, CE is feasible in an ovine VV ECMO model. CE results in significantly improved EDS and increased length of visualised endocardium. http://dx.doi.org/10.1016/j.hlc.2013.05.454 453 Predicting Pre-A Wave LVEDP in Biomarker Positive Acute Coronary Syndrome using Lateral E/E and Tei Index M. Dooris ∗ , L. Carr, A. Camuglia, P. Stewart, S. Prasad Royal Brisbane and Women’s Hospital, Australia Aim: This study aimed to develop models for prediction of Pre-A wave left ventricular end-diastolic pressure (PreA) using echocardiographic metrics of diastolic function in patients with acute coronary syndrome (ACS). Methods: Patients with biomarker positive (ACS) undergoing cardiac catheterisation (CC) were enrolled prospectively. Echocardiography immediately preceded CC. Noninvasive and invasive assessments were mutually blinded. Results: Twenty-three patients were identified: mean age 64 years, male 78%, mean troponin 7.2 (range 0.073, 68) ng/mL. Culprit lesions: LCA: 9, RCA: 4, vein graft: 1, indeterminate 6, stress cardiomyopathy 2. Univariate models for PreA were assessed. Variables with p < 0.1 included: mitral deceleration time, a wave duration (Ad), septal E/E , lateral E/E (EtoEpLat), isovolumic contraction time and Tei Index. Backwards stepwise regression selected the final model presented below (adjusted R2 : 0.65). A simplified EtoEpL at and Tei Index model is shown (adjusted R2 : 0.54). Estimate Std. (Intercept) Ad
Error t
Value
3.69498
8.23400
0.449
0.6605
−0.10179
0.04699
−2.166
0.0480
Pr(>|t|)
EtoEpLat
0.79690
0.29947
2.661
0.0186
TeiIndex
14.97654
5.16867
2.898
0.0117
Estimate Std.
Error t
Value
Pr(>|t|)
(Intercept)
−11.8136
4.5423
−2.601
0.02007
EtoEpLat
1.0202
0.3139
3.250
0.00538
TeiIndex
16.0348
5.7442
2.791
0.01369
The simplified model is visualised above right (mean prediction and 95% confidence interval). Prediction formula: PreA = 1.02 EtoEpLat + 16.0 TeiIndex − 11.8. Conclusions: A number of non-invasive measures of diastolic function correlated with PreA in biomarker positive ACS. Ad, EtoEpLat and TeiIndex provided the best explanatory model. EtoEpLat and TeiIndex can be used to predict PreA. http://dx.doi.org/10.1016/j.hlc.2013.05.455 454 Predictive Value of Dynamic Left Ventricular Outflow Tract Obstruction During Dobutamine Stress Echocardiography in Patients Undergoing Liver Transplant R. Rayoo 1,∗ , J. Grewal 1 , D. Patrick 1 , S. Lovibond 1 , K. Lu 1,2 , P. Calafiore 1 , P. Srivastava 1,2 1 Austin
Hospital, Australia of Melbourne, Australia
2 University
Introduction: Left ventricular outflow tract obstruction (LVOTO) on Dobutamine stress echo (DSE) has led to the denial of transplantation at certain centres as these patients have previously been thought to have a poor response to haemodynamic stress associated with liver transplantation. The assessment of LVOTO during DSE is an important component of preoperative assessment of patients undergoing liver transplant at our centre. Aims and Objectives: This study examined all liver transplant recipients from December 2009 to March 2012, with a view to look at intraoperative and postoperative hypotension, fluid and inotropic requirements, ICU length of stay and postoperative Major adverse cardiac events (MACE). Materials and Methods: The collected data was analysed using SPSS software for any statistically significant differences in outcomes in two different groups of patients with or without LVOTO. Results: A total of 103 patients underwent liver transplant during the study period. Of these 54 (52%) underwent a DSE for preoperative cardiovascular risk assessment of which 10 (18.5%) had evidence of dynamic LVOTO. There was no statistically significant difference in mean intraoperative fluid, inotropic dose, ICU length of stay or MACE. There was a trend towards increased use
S192
Heart, Lung and Circulation 2013;22:S126–S266
CSANZ 2013 Abstracts
ABSTRACTS
of postoperative fluid use within first 48 h (7.1 ± 6.2 L vs 11.3 ± 7.8 L), but this was not statistically significant. Conclusion: Dynamic LVOTO during DSE does not predict to significant differences in intraoperative or postoperative haemodynamic response or MACE in patients undergoing liver transplant surgery.
456
http://dx.doi.org/10.1016/j.hlc.2013.05.456
Cardiovascular Division, North Shore Hospital, Waitemata Health, New Zealand
455 Prevalence of Patent Foramen Ovale in Scuba Divers with Decompression Illness Referred from a Specialist Diving Medicine Clinic K. Liou 1,∗ , D. Wolfers 2 , R. Turner 2 , M. Bennett 2 , G. Cranney 1 1 Eastern
Heart Clinic, Prince of Wales Hospital, Australia
2 Australian Diving and Hyperbaric Medicine Research Group,
Prince of Wales Hospital, Australia Introduction: Presence of patent foramen ovale (PFO) is a risk factor for decompression illness (DCI). We report our experience in 75 scuba divers with DCI from a major referral centre for Diving and Hyperbaric Medicine, utilising trans-septal bubble studies to diagnose PFO. Methodology: In our centre, criteria for referral for transoesophageal echocardiogram (TOE) of divers with DCI has focused on those who developed DCI involving central nervous system, spinal cord or inner ear; or those who developed DCI in spite of obeying their decompression schedule for a particular dive profile. A retrospective review of our echocardiogram database was performed since January 2004, and results cross-tabulated and analysed. Results: Overall 4945 bubble studies have been performed at our centre as part of a TOE. Seventy-five studies (1.5%) were performed for divers with DCI, whilst 28% of studies were done to identify sources of emboli and 70.5% for other indications. Overall 13.8% of the these studies were positive for trans-septal bubble flow, including 9.7% with spontaneous trans-septal shunt without provocation. Fifty-six percent of the bubble studies performed for divers with DCI were positive, which is significantly higher than studies performed to identify sources of emboli (21%; p < 0.001) and for other indications (10%, p < 0.001). Conclusion: Inter-atrial right to left shunt demonstrated by TOE bubble studies is highly prevalent in scuba divers with decompression illness, referred from a specialist Diving Medicine Clinic. http://dx.doi.org/10.1016/j.hlc.2013.05.457
Prognostic Value of Adenosine Stress Cardiac Magnetic Resonance Imaging in Patients with Known Coronary Artery Disease M. Rigolli ∗ , A. To, C. Edwards, P. Ding, J. Christiansen
Background: Cardiac magnetic resonance (CMR) stress imaging has excellent diagnostic capability for coronary disease (CAD), and predicts subsequent cardiac events. However, prognostic studies demonstrating a near absence of events following normal CMR perfusion have included only limited numbers of patients with confirmed CAD. The prognostic importance in pre-existing CAD is unclear. Objectives: To assess the prognostic value of stress perfusion in CAD for the prediction of major adverse cardiac events (MACE), defined as: all-cause death, myocardial infarction, rehospitalisation for acute cardiac symptoms and unplanned revascularisation. Elective procedures arising from the stress CMR were not considered. Methods and Results: We retrospectively reviewed 280 patients (mean age 64.6 ± 11.7, 57% male, mean ejection fraction 59 ± 12%) who underwent stress perfusion and were followed for an average of 1.8 ± 1 years. Fifty-two percent had angiographically established CAD, of which more than one third demonstrated ischaemia on CMR. MACE were significantly more common in patients with known CAD than those without (34 vs 13 events, p < 0.05). On Kaplan–Meier survival analysis patients with CAD had a consistently worse prognosis, even if perfusion imaging was normal (p < 0.05). The presence of ischaemia predicted subsequent events in both patients with and without established CAD. Ischaemia and CAD were independent predictors of survival on Cox regression analysis. Conclusion: Inpatients with established coronary disease, normal stress perfusion CMR is not associated with a uniformly good event-free survival over an average of a nearly two-year follow-up. Clinicians should be cautious in interpreting the results of CMR stress perfusion. http://dx.doi.org/10.1016/j.hlc.2013.05.458 457 Pulmonary Embolism Impedance Tomography
Detection
with
Electrical
D. Nguyen 1,∗ , W. Chik 2 , R. Kosobrodov 1 , M. Barry 2 , J. Pouliopoulos 2 , C. Jin 1 , A. McEwan 1 , A. Thiagalingam 2 1 School of Electrical and Information Engineering, The Univer-
sity of Sydney, Australia of Cardiology, Westmead Hospital, Australia
2 Department
The diagnosis of pulmonary embolism (PE) in critically unwell patients is an important issue that currently lacks a satisfactory solution. Electrical Impedance Tomography (EIT) is a non-invasive, radiation-free, portable,