- Email: [email protected]
PS252 Predictors of Radiation Dose in Patients Undergoing Cardiac Computed Tomography Angiography (CCTA)
CAD (-) N[34
Age (yrs)
6511
6111
Male (%)
74 (57)
15 (44)
P¼0.054 P¼0.246
T-Chol (mg/dL)
18445
17943
P¼0.565
HDL-Chol (mg/dL)
4413
5117
P¼0.008
LDL-Chol (mg/dL)
11938
10742
P¼0.125
TG (mg/dL)
12666
137115
P¼0.458
Lp (a) (mg/dL)
18.418
1410
P¼0.405
Apo-A (mg/dL)
12826
15043
P¼0.040
Apo-B (mg/dL)
7920
6825
P¼0.121
IMT (mm)
0.720.16
0.620.09
P¼0.0001
Plaque Number
2 (0-9)
0 (0-5)
P¼0.005*
*Mann-Whitney U test
maximum trans-aortic speed. Subsequently gated simple tomography was performed, with prospective acquisition of the best diastolic phase in a 256 cuts equipment (Definition Flash, Siemens Medical Systems, Forcheim, Germany), to quantify AVC in Agatston units. Results: A total of 111 patients, 6112 years, 53% male, 91% with aortic stenosis (rest with sclerosis) were included. The AVC average was 3,694 2,804 UA. Moderate correlations between AVC and aortic speed, maximum, and average gradient were observed (r ¼ 0.43, 0.5, 0.47 respectively, all P <0.05). Analizing by gender, significant difference were observed in the median left ventricular ejection fraction (M: 59% vs F: 63%, p <0.05) and AVC (M: 4,411 vs F: 2,205 UA, p <0.05), the latter also with a significant difference ammong degrees of aortic stenosis severity. AVC quantification was able to predict the presence of severe stenosis in men (cutoff of 2,829 UA, AUC¼ 0.82, 95%CI 0.65,0.98) and women (cutoff of 831 AU, AUC ¼ 0.9, 95%CI 0.89, 1.0). Conclusion: In patients with suspected aortic stenosis, tomography AVC quantification correlates with the aortic stenosis severity, with significant differences ammong genders. The cutoff of AVC to predict severe aortic stenosis were 831 in women and 2,829 UA in men. Disclosure of Interest: None Declared PS252
PS249 Incidence of New Wall Motion Abnormalities on Transthoracic Echocardiogram in Non ST Elevation Myocardial Infarction and its Role in the Likelihood of Revascularization 1
1
1
2
A. Sharma* , D. Jacob , H. Atluri , A. Nanda 1 Internal Medicine, 2UMKC school of medicine, kansas city, United States Introduction: Patient with non ST elevation myocardial infarction (NSTEMI) comprise a largest percentage of the acute coronary syndrome spectrum. Transthoracic echocardiogram (TTE) is a non-invasive imaging modality frequently used in the management of NSTEMI to evaluate for regional wall motion abnormalities (RWMA). Many studies have evaluated the utility of echocardiogram in evaluation of patients presenting with chest pain in emergency department. Objectives: In this study we identify the incidence of new RWMA in patients with NSTEMI who underwent cardiac catheterization. Within the same subset of patient population, we further evaluate the role of transthoracic echocardiogram in predicting the likelihood of revascularization. Methods: In this retrospective study at a tertiary care center, we evaluated all patients who presented with NSTEMI and subsequently underwent cardiac catheterization from January 1, 2011 to December 31, 2014. Patients who had a transthoracic echocardiogram performed prior to or upto 48 hours after cardiac catheterization were included. They were further classified based on the presence of new RWMA and if they underwent revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Results: A total of 503 patients presented with NSTEMI of which 425 patients had TTE performed within the specified criteria. The incidence of new RWMA is 62.8% (n¼267). Those with new RWMA are statistically more likely to undergo revascularization compared to subjects without new RWMA (58.4% vs 47.5%; p¼0.03). Among the subset of patients without previous coronary artery disease, the incidence of new RWMA is 60%. Similarly, in this subset, revascularization was statistically more likely to occur in patients with new RWMA (59.1% vs 38.4%; p¼0.002). Conclusion: We conclude that there is a high incidence of new regional wall motion abnormalities in patients presenting with NSTEMI. Those with new RWMA found on transthoracic echocardiogram are statistically more likely to undergo revascularization. Disclosure of Interest: None Declared PS251 Gender Differences in Aortic Valve Calcification and the Severity of Aortic Stenosis with MDCT S. Trevethan-Cravioto1, E. A. Berríos-Bárcenas*2, M. Juarez-Contreras1, J. Cossio-Aranda1, E. Kimura3, S. Criales3, J. Fritche-Salazar1 1 Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, 2Cardiology, Hospital Español de México, 3Radiology, Instituto Nacional de Cardiología Ignacio Chávez, México D.F., Mexico Introduction: The number of patients referred to our institution due to aortic stenosis has increased significantly in the last two decades. Calcification of the valve is common in this pathology and its etiology has been widely discussed. Multislice tomography scanner has demonstrated to quantify the amount of calcium in these structures by Agatston units. Currently, some reports showed a correlation between aortic valve calcification (AVC) and the severity of aortic stenosis. Furthermore, it has been observed differences in the amount of AVC by gender in general population, however, it is unclear whether this difference impacts the severity of aortic stenosis. Objectives: To determine whether there is a correlation between the presence of AVC and the aortic stenosis severity, ammong genders. Methods: We performed a prospective study that included patients between 18 and 85 years, with clinical suspicion of aortic stenosis, who underwent Doppler echocardiography to measure the valve area, maximum instantaneous gradient, mean gradient and
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
Predictors of Radiation Dose in Patients Undergoing Cardiac Computed Tomography Angiography (CCTA) Y. L. Cham*1, N. H. Mohd Amin1, N. Z. Khiew1, A. Said2, A. Y. Fong1, T. K. Ong1 1 Cardiology, Sarawak General Hospital Heart Center, 2Universiti Malaysia Sarawak, Kota Samarahan, Malaysia Introduction: CCTA is increasingly utilised to exclude coronary artery disease in patients at low to intermediate cardiovascular risk. Despite dose reduction advances, the effects of ionizing radiation exposure remain a concern. In the local population, factors that predict radiation dose in patients undergoing CCTA have yet to be determined. Objectives: To identify factors that affect radiation dose in patients undergoing CCTA in routine clinical practice. Methods: Consecutive patients undergoing CCTA in our center in 2012 were included in this observational study. All were scanned using Siemens SOMATOM Definition Flash scanner. Graft angiography, concomitant left ventricular function assessment, high coronary calcium scores contradicting performance of CCTA and non-diagnostic studies were exclusion criteria. Results: 234 patients were analysed. The mean age was 53.5+10.1 years. 65.7% were male. The mean weight, height and body mass index(BMI) were 68.9+13.3 kilogrammes, 161.5+8.3 centimetres and 26.4+4.4 respectively. 15.0% had diabetes mellitus, and 59.2% hypertension. During scanning, the mean heart rate(HR) was 64.8+12.4 beats per minute and 95.3% had stable sinus rhythm(SSR). The mean radiation dose was 3.56+3.0 millisieverts. Tube voltages of 80kV(16.3%), 100kV(31.3%) and 120kV(54.5%) were used. Scanning techniques included Flash(16.3%), sequential(80.7%) and spiral(3.0%) based on physician’s discretion. Sinogram affirmed iterative reconstruction(SAFIRE TM ) was used in all patients(22.3%) when it became available in our center. In the univariate analysis, weight, BMI, HR, heart rhythm, tube voltage, scanning technique and SAFIRE TM use significantly affected radiation dose. In the multivariate analysis, a SSR(p<0.01), Flash scanning technique(p<0.01) and tube voltage of 80kV(p<0.01) independently predicted lower radiation dose. In contrast, spiral scanning technique(p<0.01) and tube voltage of 120kV(p<0.01) independantly predicted higher radiation dose. Conclusion: In our local cohort of patients undergoing CCTA, a SSR, Flash scan and 80kV tube voltage independently predicted a lower radiation dose while spiral scan and 120kV tube voltage independently predicted a higher radiation dose. With the advent of new scanners that continously push the limits with the ability to scan at faster heart rates and non-stable heart rhythms, judicious patient selection remains of utmost importance. Disclosure of Interest: None Declared PS253 Cardiac Tumors: 16 Years of Experience in the National Institute of Cardiology Ignacio Chavez M. Naranjo*1 1 Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico Introduction: Cardiac neoplasms are rare with an extremely low incidence. The differential diagnosis includes vegetations, thrombus and tumors; The benign tumors represent 80% of the primary cardiac neoplasms and myxomas are the most prevalent type. Angiosarcoma is the most frequent malignant neoplasm. There is no much information about this rare disease in latino population. Objectives: We report our experience with a cohort study in a tertiary care hospital in Mexico city since 1998 to 2014, and asses the non invasive imagenologic behavior of cardiac masses on cardiac magnetic resonance and its clinical and histological correlation. Methods: We retrospectively analyzed 99 patients diagnosed at our institution with a cardiac tumor since January-1998 to December-2014. The diagnosis was established with
e55
POSTER ABSTRACTS
CAD (+) N[130
Age (yrs)
6511
6111
Male (%)
74 (57)
15 (44)
P¼0.054 P¼0.246
T-Chol (mg/dL)
18445
17943
P¼0.565
HDL-Chol (mg/dL)
4413
5117
P¼0.008
LDL-Chol (mg/dL)
11938
10742
P¼0.125
TG (mg/dL)
12666
137115
P¼0.458
Lp (a) (mg/dL)
18.418
1410
P¼0.405
Apo-A (mg/dL)
12826
15043
P¼0.040
Apo-B (mg/dL)
7920
6825
P¼0.121
IMT (mm)
0.720.16
0.620.09
P¼0.0001
Plaque Number
2 (0-9)
0 (0-5)
P¼0.005*
*Mann-Whitney U test
maximum trans-aortic speed. Subsequently gated simple tomography was performed, with prospective acquisition of the best diastolic phase in a 256 cuts equipment (Definition Flash, Siemens Medical Systems, Forcheim, Germany), to quantify AVC in Agatston units. Results: A total of 111 patients, 6112 years, 53% male, 91% with aortic stenosis (rest with sclerosis) were included. The AVC average was 3,694 2,804 UA. Moderate correlations between AVC and aortic speed, maximum, and average gradient were observed (r ¼ 0.43, 0.5, 0.47 respectively, all P <0.05). Analizing by gender, significant difference were observed in the median left ventricular ejection fraction (M: 59% vs F: 63%, p <0.05) and AVC (M: 4,411 vs F: 2,205 UA, p <0.05), the latter also with a significant difference ammong degrees of aortic stenosis severity. AVC quantification was able to predict the presence of severe stenosis in men (cutoff of 2,829 UA, AUC¼ 0.82, 95%CI 0.65,0.98) and women (cutoff of 831 AU, AUC ¼ 0.9, 95%CI 0.89, 1.0). Conclusion: In patients with suspected aortic stenosis, tomography AVC quantification correlates with the aortic stenosis severity, with significant differences ammong genders. The cutoff of AVC to predict severe aortic stenosis were 831 in women and 2,829 UA in men. Disclosure of Interest: None Declared PS252
PS249 Incidence of New Wall Motion Abnormalities on Transthoracic Echocardiogram in Non ST Elevation Myocardial Infarction and its Role in the Likelihood of Revascularization 1
1
1
2
A. Sharma* , D. Jacob , H. Atluri , A. Nanda 1 Internal Medicine, 2UMKC school of medicine, kansas city, United States Introduction: Patient with non ST elevation myocardial infarction (NSTEMI) comprise a largest percentage of the acute coronary syndrome spectrum. Transthoracic echocardiogram (TTE) is a non-invasive imaging modality frequently used in the management of NSTEMI to evaluate for regional wall motion abnormalities (RWMA). Many studies have evaluated the utility of echocardiogram in evaluation of patients presenting with chest pain in emergency department. Objectives: In this study we identify the incidence of new RWMA in patients with NSTEMI who underwent cardiac catheterization. Within the same subset of patient population, we further evaluate the role of transthoracic echocardiogram in predicting the likelihood of revascularization. Methods: In this retrospective study at a tertiary care center, we evaluated all patients who presented with NSTEMI and subsequently underwent cardiac catheterization from January 1, 2011 to December 31, 2014. Patients who had a transthoracic echocardiogram performed prior to or upto 48 hours after cardiac catheterization were included. They were further classified based on the presence of new RWMA and if they underwent revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Results: A total of 503 patients presented with NSTEMI of which 425 patients had TTE performed within the specified criteria. The incidence of new RWMA is 62.8% (n¼267). Those with new RWMA are statistically more likely to undergo revascularization compared to subjects without new RWMA (58.4% vs 47.5%; p¼0.03). Among the subset of patients without previous coronary artery disease, the incidence of new RWMA is 60%. Similarly, in this subset, revascularization was statistically more likely to occur in patients with new RWMA (59.1% vs 38.4%; p¼0.002). Conclusion: We conclude that there is a high incidence of new regional wall motion abnormalities in patients presenting with NSTEMI. Those with new RWMA found on transthoracic echocardiogram are statistically more likely to undergo revascularization. Disclosure of Interest: None Declared PS251 Gender Differences in Aortic Valve Calcification and the Severity of Aortic Stenosis with MDCT S. Trevethan-Cravioto1, E. A. Berríos-Bárcenas*2, M. Juarez-Contreras1, J. Cossio-Aranda1, E. Kimura3, S. Criales3, J. Fritche-Salazar1 1 Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, 2Cardiology, Hospital Español de México, 3Radiology, Instituto Nacional de Cardiología Ignacio Chávez, México D.F., Mexico Introduction: The number of patients referred to our institution due to aortic stenosis has increased significantly in the last two decades. Calcification of the valve is common in this pathology and its etiology has been widely discussed. Multislice tomography scanner has demonstrated to quantify the amount of calcium in these structures by Agatston units. Currently, some reports showed a correlation between aortic valve calcification (AVC) and the severity of aortic stenosis. Furthermore, it has been observed differences in the amount of AVC by gender in general population, however, it is unclear whether this difference impacts the severity of aortic stenosis. Objectives: To determine whether there is a correlation between the presence of AVC and the aortic stenosis severity, ammong genders. Methods: We performed a prospective study that included patients between 18 and 85 years, with clinical suspicion of aortic stenosis, who underwent Doppler echocardiography to measure the valve area, maximum instantaneous gradient, mean gradient and
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
Predictors of Radiation Dose in Patients Undergoing Cardiac Computed Tomography Angiography (CCTA) Y. L. Cham*1, N. H. Mohd Amin1, N. Z. Khiew1, A. Said2, A. Y. Fong1, T. K. Ong1 1 Cardiology, Sarawak General Hospital Heart Center, 2Universiti Malaysia Sarawak, Kota Samarahan, Malaysia Introduction: CCTA is increasingly utilised to exclude coronary artery disease in patients at low to intermediate cardiovascular risk. Despite dose reduction advances, the effects of ionizing radiation exposure remain a concern. In the local population, factors that predict radiation dose in patients undergoing CCTA have yet to be determined. Objectives: To identify factors that affect radiation dose in patients undergoing CCTA in routine clinical practice. Methods: Consecutive patients undergoing CCTA in our center in 2012 were included in this observational study. All were scanned using Siemens SOMATOM Definition Flash scanner. Graft angiography, concomitant left ventricular function assessment, high coronary calcium scores contradicting performance of CCTA and non-diagnostic studies were exclusion criteria. Results: 234 patients were analysed. The mean age was 53.5+10.1 years. 65.7% were male. The mean weight, height and body mass index(BMI) were 68.9+13.3 kilogrammes, 161.5+8.3 centimetres and 26.4+4.4 respectively. 15.0% had diabetes mellitus, and 59.2% hypertension. During scanning, the mean heart rate(HR) was 64.8+12.4 beats per minute and 95.3% had stable sinus rhythm(SSR). The mean radiation dose was 3.56+3.0 millisieverts. Tube voltages of 80kV(16.3%), 100kV(31.3%) and 120kV(54.5%) were used. Scanning techniques included Flash(16.3%), sequential(80.7%) and spiral(3.0%) based on physician’s discretion. Sinogram affirmed iterative reconstruction(SAFIRE TM ) was used in all patients(22.3%) when it became available in our center. In the univariate analysis, weight, BMI, HR, heart rhythm, tube voltage, scanning technique and SAFIRE TM use significantly affected radiation dose. In the multivariate analysis, a SSR(p<0.01), Flash scanning technique(p<0.01) and tube voltage of 80kV(p<0.01) independently predicted lower radiation dose. In contrast, spiral scanning technique(p<0.01) and tube voltage of 120kV(p<0.01) independantly predicted higher radiation dose. Conclusion: In our local cohort of patients undergoing CCTA, a SSR, Flash scan and 80kV tube voltage independently predicted a lower radiation dose while spiral scan and 120kV tube voltage independently predicted a higher radiation dose. With the advent of new scanners that continously push the limits with the ability to scan at faster heart rates and non-stable heart rhythms, judicious patient selection remains of utmost importance. Disclosure of Interest: None Declared PS253 Cardiac Tumors: 16 Years of Experience in the National Institute of Cardiology Ignacio Chavez M. Naranjo*1 1 Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico Introduction: Cardiac neoplasms are rare with an extremely low incidence. The differential diagnosis includes vegetations, thrombus and tumors; The benign tumors represent 80% of the primary cardiac neoplasms and myxomas are the most prevalent type. Angiosarcoma is the most frequent malignant neoplasm. There is no much information about this rare disease in latino population. Objectives: We report our experience with a cohort study in a tertiary care hospital in Mexico city since 1998 to 2014, and asses the non invasive imagenologic behavior of cardiac masses on cardiac magnetic resonance and its clinical and histological correlation. Methods: We retrospectively analyzed 99 patients diagnosed at our institution with a cardiac tumor since January-1998 to December-2014. The diagnosis was established with
e55
POSTER ABSTRACTS
CAD (+) N[130