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Screening Low Risk Patients Referred for Echocardiography with a 5-min Scout and Advanced Electrocardiography
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heart failure and three-vessel coronary disease. Areas under the curve (95% confidence intervals) for predicting new AF were El-Chami index 0.600 (0.553-0.647), CHADS2 0.559 (0.512-0.606), CHA2DS2-VASc 0.594 (0.547-0.642), logistic EuroSCORE 0.594 (0.545-0.643), EuroSCORE II 0.546 (0.498-0.595) and STS Score 0.584 (0.535-0.634). Conclusion: New AF after CABG was common, and associated with prolonged hospital stay, but was modestly and suboptimally predicted by AF and cardiac surgery risk models. More accurate scores need to be developed to guide clinical practice. http://dx.doi.org/10.1016/j.hlc.2017.05.070 Imaging P36 Screening Low Risk Patients Referred for Echocardiography with a 5-min Scout and Advanced Electrocardiography Patrick Gladding 1*, Todd Schlegel 2,3, Helen Walsh 1, Liane Dawson 1, Barbara O’Shaughnessy 1, Tony Scott 1 1
Waitemata District Health Board, Auckland, New Zealand 2 Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden 3 Nicollier-Schlegel Sa`rl, Tre´lex, Switzerland * Corresponding author. Aim: The use of scout transthoracic echocardiography (sTTE), and machine learning enhancements of conventional tools, e.g. A-ECG or biomarkers could be a low cost solution to waiting lists. We evaluated the use of A-ECG as a prescreen for a sTTE and full TTE. Method: 169 patients waiting for >12 months on a low risk echocardiography waiting list were allocated to either AECG or human read ECG screening. Patients with normal ECGs underwent a 5-min sTTE, but proceeded to TTE if moderate structural heart disease (major SHD) was found. A-ECG was compared to human read ECGs and the resultant sTTE or TTE. Results: 99 patients were allocated to A-ECG and 70 to human screened ECGs. 28 patients did not attend. A-ECG streamed 40 patients to sTTE, 3 (8%) had a major SHD. Human ECGs streamed 34 patients to sTTE, 12 (35%) had a major SHD (Z score 2.9, p = 0.004). A-ECG streamed 43 patients to TTE, 7 (35%) were normal or had minor SHD. Human ECGs streamed 24 to TTE, 5 (21%) were normal or had minor SHD (Z score -1.9, p = 0.06). Overall accuracy of AECG exceeded a human reader (A-ECG; Sens 81%, Spec of 92% vs Human Sens 79% Spec 65%) for detecting major SHD. Cohens kappa demonstrated greater agreement between AECG and echo than human read ECGs, 0.43 vs 0.09. Conclusion: Low risk patients referred for echocardiography could effectively be screened with A-ECG and a 5-min sTTE. This has the potential to radically reduce waiting lists, and cost. http://dx.doi.org/10.1016/j.hlc.2017.05.071
Abstracts
P37 There Is Wide Variation Across New Zealand in Left Ventricular Assessment After ACS: An ANZACS-QI Audit Chethan Kasargod Prabhakar 1*, Andrew Kerr 1, Mildred Lee 1, Ian Murray 2, Niels Van Pelt 1 1
Counties Manukau District Health Board, Auckland, New Zealand 2 Capital and Coast District Health Board, Wellington, New Zealand * Corresponding author. Background: Left ventricular (LV) imaging [echocardiography or left ventriculogram (LV gram)] is recommended in patients presenting with acute coronary syndrome (ACS). International guidelines recommend LV function assessment usually with echocardiography in all ACS patients. Our aim was to investigate the current practice in ACS patients in New Zealand. Methods: 12,321 consecutive patients with ACS who underwent coronary angiogram from 1st January 2015 to 31st October 2016 were recorded in the ANZACS-QI registry. This registry collects data regarding whether LV systolic function was assessed during the admission by either transthoracic echocardiogram and or a LV-gram. The registry doesn’t specify the mode of assessment. In this analysis we focussed on whether either modality was used. Results: Overall 72% of patients had LV assessment with a district health board (DHB) range of 51 to 85%. In the subgroup with ST elevation myocardial infarction (STEMI) 83% (DHB range 48 to 95%) had LV assessment. Of those with non-STEMI (NSTEMI) and unstable angina (USA) 68% had LV assessment (DHB range 42 to 85%). Sub-group analysis showed 14% of ACS patients had LV function assessed (DHB range 0 to 40%) by LV-gram.
Conclusion: We have found there is significant regional variation in the LV function assessment and the modality of assessments. Improved provision for echocardiography is needed. http://dx.doi.org/10.1016/j.hlc.2017.05.072
heart failure and three-vessel coronary disease. Areas under the curve (95% confidence intervals) for predicting new AF were El-Chami index 0.600 (0.553-0.647), CHADS2 0.559 (0.512-0.606), CHA2DS2-VASc 0.594 (0.547-0.642), logistic EuroSCORE 0.594 (0.545-0.643), EuroSCORE II 0.546 (0.498-0.595) and STS Score 0.584 (0.535-0.634). Conclusion: New AF after CABG was common, and associated with prolonged hospital stay, but was modestly and suboptimally predicted by AF and cardiac surgery risk models. More accurate scores need to be developed to guide clinical practice. http://dx.doi.org/10.1016/j.hlc.2017.05.070 Imaging P36 Screening Low Risk Patients Referred for Echocardiography with a 5-min Scout and Advanced Electrocardiography Patrick Gladding 1*, Todd Schlegel 2,3, Helen Walsh 1, Liane Dawson 1, Barbara O’Shaughnessy 1, Tony Scott 1 1
Waitemata District Health Board, Auckland, New Zealand 2 Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden 3 Nicollier-Schlegel Sa`rl, Tre´lex, Switzerland * Corresponding author. Aim: The use of scout transthoracic echocardiography (sTTE), and machine learning enhancements of conventional tools, e.g. A-ECG or biomarkers could be a low cost solution to waiting lists. We evaluated the use of A-ECG as a prescreen for a sTTE and full TTE. Method: 169 patients waiting for >12 months on a low risk echocardiography waiting list were allocated to either AECG or human read ECG screening. Patients with normal ECGs underwent a 5-min sTTE, but proceeded to TTE if moderate structural heart disease (major SHD) was found. A-ECG was compared to human read ECGs and the resultant sTTE or TTE. Results: 99 patients were allocated to A-ECG and 70 to human screened ECGs. 28 patients did not attend. A-ECG streamed 40 patients to sTTE, 3 (8%) had a major SHD. Human ECGs streamed 34 patients to sTTE, 12 (35%) had a major SHD (Z score 2.9, p = 0.004). A-ECG streamed 43 patients to TTE, 7 (35%) were normal or had minor SHD. Human ECGs streamed 24 to TTE, 5 (21%) were normal or had minor SHD (Z score -1.9, p = 0.06). Overall accuracy of AECG exceeded a human reader (A-ECG; Sens 81%, Spec of 92% vs Human Sens 79% Spec 65%) for detecting major SHD. Cohens kappa demonstrated greater agreement between AECG and echo than human read ECGs, 0.43 vs 0.09. Conclusion: Low risk patients referred for echocardiography could effectively be screened with A-ECG and a 5-min sTTE. This has the potential to radically reduce waiting lists, and cost. http://dx.doi.org/10.1016/j.hlc.2017.05.071
Abstracts
P37 There Is Wide Variation Across New Zealand in Left Ventricular Assessment After ACS: An ANZACS-QI Audit Chethan Kasargod Prabhakar 1*, Andrew Kerr 1, Mildred Lee 1, Ian Murray 2, Niels Van Pelt 1 1
Counties Manukau District Health Board, Auckland, New Zealand 2 Capital and Coast District Health Board, Wellington, New Zealand * Corresponding author. Background: Left ventricular (LV) imaging [echocardiography or left ventriculogram (LV gram)] is recommended in patients presenting with acute coronary syndrome (ACS). International guidelines recommend LV function assessment usually with echocardiography in all ACS patients. Our aim was to investigate the current practice in ACS patients in New Zealand. Methods: 12,321 consecutive patients with ACS who underwent coronary angiogram from 1st January 2015 to 31st October 2016 were recorded in the ANZACS-QI registry. This registry collects data regarding whether LV systolic function was assessed during the admission by either transthoracic echocardiogram and or a LV-gram. The registry doesn’t specify the mode of assessment. In this analysis we focussed on whether either modality was used. Results: Overall 72% of patients had LV assessment with a district health board (DHB) range of 51 to 85%. In the subgroup with ST elevation myocardial infarction (STEMI) 83% (DHB range 48 to 95%) had LV assessment. Of those with non-STEMI (NSTEMI) and unstable angina (USA) 68% had LV assessment (DHB range 42 to 85%). Sub-group analysis showed 14% of ACS patients had LV function assessed (DHB range 0 to 40%) by LV-gram.
Conclusion: We have found there is significant regional variation in the LV function assessment and the modality of assessments. Improved provision for echocardiography is needed. http://dx.doi.org/10.1016/j.hlc.2017.05.072