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SIGNIFICANT HETEROGENEITY BETWEEN AORTIC ROOT AND AORTIC ANNULUS IN BICUSPID AORTIC VALVE
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guideline-recommended delays. Patients most likely to receive timely reperfusion treatment were those treated with fibrinolysis; least likely were those transferred for PPCI. These results support the creation of a provincial protocol to improve timely STEMI care in Québec.
Canadian Pediatric Cardiology Association (CPCA) ePoster GENERAL PEDIATRIC CARDIOLOGY Sunday, October 23, 2016
Canadian Journal of Cardiology Volume 32 2016
p¼1) and remained stable throughout recovery (42920 vs 43521, p¼1). Similar trends were recorded for the various correction formulas. Corrected QT using the Bazett formula was significantly higher at all point in times compared to the Fridericia, Framingham and Hodge formulas (p<0.001). Boys and girls, as well as children and adolescents had similar QT/QTc response to standing. CONCLUSION: This study provides pediatric reference values for normal QT and QTc interval responses to the brief tachycardia provoked by standing, which differ from published adult values. Potential applications of this easy bedside diagnostic test include, amongst other, screening for long QT syndrome.
242 QT INTERVAL DYNAMIC CHANGES FROM SUPINE TO STANDING IN CHILDREN A Dionne, A Fournier, F Kelly, K Dominique, N Dahdah, S Abadir Montréal, Québec BACKGROUND:
QT interval shortening in response to heart rate (HR) acceleration usually occurs within seconds, and may vary between healthy and disease conditions. QT hysteresis has been reported in children and adults performing exercise testing, and more recently in adults undergoing the standing test. A paradoxical QT interval increase has been used to confirm diagnosis of long QT syndrome in patients with borderline corrected QT (QTc). Studying QT hysteresis during a quick standing challenge may compensate for exercise testing; yet no pediatric data is available. METHODS: The standing test was performed in 50 healthy children (mean age 9.22.8 yrs, 33 male) having a normal echocardiogram and negative family history for sudden death and long-QT syndrome. Following 10 min supine, fast standing with continuous ECG recording was performed. QT intervals were measured at baseline, maximal tachycardia, maximal QT and each minute of recovery (5 min), using a computerised software (leads II/V5), and corrected for HR using Bazzett (QTcB), Fridericia, Framingham, and Hodge formulas. RESULTS: In response to standing, HR increased from 75.213.1 to 101.111.6 beats/min. QT intervals at baseline and maximal tachycardia were similar (38932 vs 38434 msec, p¼1), however QTcB increased upon standing (43122 vs 49536 msec, p<0.001). The 95th percentile for QTcB was 464 msec at baseline and 551 msec at maximal tachycardia. The QTcB increased by 6333 msec upon standing, and the magnitude of the change was positively related to heart rate acceleration (r¼0.74, R2¼0.55, p<0.001), but not to baseline QTcB (p¼0.17). QT during recovery was significantly shorter than at baseline and upon standing (37129 msec versus 38132 msec and 38434 msec respectively, p<0.001), but stayed similar throughout recovery. QTcB reached baseline values after 1 min of recovery (42920 msec at 1 min vs 43122 msec at baseline,
243 SIGNIFICANT HETEROGENEITY BETWEEN AORTIC ROOT AND AORTIC ANNULUS IN BICUSPID AORTIC VALVE L Meloche-Dumas, S Blais, F Dallaire, A Fournier, N Dahdah Montréal, Québec BACKGROUND:
Bicuspid aortic valve (BAV) is associated with aortic dilatation and potential dissection. There are 3 major patterns of leaflets fusion in BAV: left and right coronary leaflets fusion (BAV-1), right and non-coronary leaflets fusion (BAV-2), and the rare three-leaflet fusion (BAV-3). We sought to determine the pattern of dilatation according to commonest types of BAV fusion, and whether this could modify patient management. The embryologically different true bicuspid valve is not included in this study. METHODS: In this retrospective cross-sectional study, echocardiography reports were reviewed to evaluate the homogeneity of normalized diameters of the aortic valve, the aortic root and the ascending aorta according to fusion morphology. Relative segmental Z-scores (calculated difference Aortic Root Aortic Valve and Ascending Aorta - Aortic Valve), were also compared. RESULTS: From 272 BAV patients followed at CHU SainteJustine between 2009 and 2014 (mean diagnostic age 8.52 7.39 years; 71% males), 167/272 (61.4%) had BAV-1, and
Abstracts
65/272 (23.9%) had BAV-2; p¼NS for age. Aortic valve stenosis was present in 83/272 (30.5%) patients, with a lower prevalence 42/167 (25.15%) in BAV-1 compared to 28/65 (43.08%) in BAV-2 (p¼0.012). Aortic coarctation affected both groups similarly (29/167 (17.4%) vs. 11/65 (17.0%) respectively; p¼0.91). There was no statistically significant difference in the ascending aorta between the study groups (Table 1). However, BAV-1 had increased aortic root Z-score compared to BAV-2 (p¼0.004) despite a trend towards larger aortic annulus in BAV-2 (p¼0.07). The difference was not significant between BAV-1 and BAV-2 in cases with valvular stenosis (0.421.28 vs. 0.171.69; p¼0.5), but significant in the absence of stenosis (0.801.66 vs. -0.051.19; p¼0.004). The discrepancy is more significant when comparing Z-score differences (aortic root - aortic annulus) (p<0.0001). In BAV-1, valvular stenosis was associated with homogeneous aortic roots, whereas those without stenosis had relatively larger roots (Z-score difference -0.091.15 vs. 0.471.32; p¼0.02). In BAV-2, stenosis did not affect relative aortic root Z-score (-0.90 1.32 vs. -0.88 1.24; p¼0.96). The same observations were present in presence or absence of coarctation of the aorta (data not shown). Altogether, there was no significant differences in the ascending aorta dimension in either case (BAV-1 vs. BAV-2, or valvular stenosis vs. no stenosis). CONCLUSION: In type-1 BAV fusion aortic roots are larger, and represent significant heterogeneity with the aortic valve (unlike type-2 fusion). The observed difference suggests potential modifications in patient approach with this valvular disease according to the type of fusion.
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validity of oscillometric and aneroid BP devices compared to the mercury sphygmomanometer for the measurement of BP in children aged 19 yrs. METHODS: We systematically searched 4 electronic databases (MEDLINE, Embase, CINAHL, Web of Science) and relevant journals for eligible articles. We used relevant medical subject headings and keywords, and the following inclusion criteria: 1) age 3-19 years; 2) BP measured by mercury and at least one other method; 3) BP measurement on the arm. One author screened 1415 articles’ titles and abstracts, and two authors independently reviewed 92 full-text articles. We included 29 articles (38 studies) with 26,879 children included in our analyses. RESULTS: Random-effects model meta-analyses revealed that oscillometric devices yield higher measurements of systolic BP than auscultation with a mercury sphygmanometer (pooled effect estimate ¼ 2.54 mmHg; 95%CI 0.57-4.50; p<0.05); there was no significant difference for diastolic BP (pooled effect estimate ¼ 1.55 mmHg; 95%CI -0.38-3.48). There was considerable heterogeneity between studies, explained in part by differences in manufacturer, study setting and observer training. Only three studies compared BP using aneroid and mercury devices and found comparable readings by the two methods. CONCLUSION: Oscillometric devices may serve as a suitable alternative to auscultation for initial BP screening in the pediatric population. The use of oscillometric devices in children is complicated by the automated cuff inflations to high pressures, causing discomfort to the child and possibly precluding the BP measurement. Diagnosis of hypertension and pre-hypertension in children should be confirmed by auscultation by a trained health professional.
245 UNDERUSE OF UPPER EXTREMITIES IN 4-MONTH-OLDS WITH CONGENITAL HEART DISEASE: AN EARLY AND EASY TO IDENTIFY PREDICTOR OF GROSS MOTOR DIFFICULTIES L Beaulieu-Genest, L Carmant, N Poirier, A Doussau, L Dagenais, M Materassi, J Prud’homme, K Gagnon, R Mazine 244 A SYSTEMATIC REVIEW AND META-ANALYSIS OF BLOOD PRESSURE MEASUREMENT TECHNIQUES IN CHILDREN SL Duncombe, C Voss, K Harris Vancouver, British Columbia BACKGROUND:
The phase-out of mercury from clinical settings calls for valid alternatives to assess blood pressure (BP) in children. Aneroid devices provide a mercury-free alternative to BP measurements by auscultation, whereas oscillometric (automated) devices are increasingly becoming the norm in clinical practice due to their ease of use. The aim of this systematic review and meta-analysis was to investigate the
Montréal, Québec BACKGROUND:
Developmental issues are prominent in children born with congenital heart disease (CHD). A common finding emerged from 4-month-assessments: many infants were not yet bringing their hands to midline when supine. METHOD: Data from patients assessed between 04/2013 and 01/2016 was reviewed. Infants who could not bring their hands to midline (Alberta Infant Motor Scale 3 in supine position) at the 4-month-assessment were identified as the underuse group. We then compared this group with the other infants (normal group, supine AIMS >3). RESULTS: Of the 93 infants who had a 4-month evaluation, 30 (32.3%) did not yet bring their hands to midline. These infants had significantly longer open chest (median 2 vs.
guideline-recommended delays. Patients most likely to receive timely reperfusion treatment were those treated with fibrinolysis; least likely were those transferred for PPCI. These results support the creation of a provincial protocol to improve timely STEMI care in Québec.
Canadian Pediatric Cardiology Association (CPCA) ePoster GENERAL PEDIATRIC CARDIOLOGY Sunday, October 23, 2016
Canadian Journal of Cardiology Volume 32 2016
p¼1) and remained stable throughout recovery (42920 vs 43521, p¼1). Similar trends were recorded for the various correction formulas. Corrected QT using the Bazett formula was significantly higher at all point in times compared to the Fridericia, Framingham and Hodge formulas (p<0.001). Boys and girls, as well as children and adolescents had similar QT/QTc response to standing. CONCLUSION: This study provides pediatric reference values for normal QT and QTc interval responses to the brief tachycardia provoked by standing, which differ from published adult values. Potential applications of this easy bedside diagnostic test include, amongst other, screening for long QT syndrome.
242 QT INTERVAL DYNAMIC CHANGES FROM SUPINE TO STANDING IN CHILDREN A Dionne, A Fournier, F Kelly, K Dominique, N Dahdah, S Abadir Montréal, Québec BACKGROUND:
QT interval shortening in response to heart rate (HR) acceleration usually occurs within seconds, and may vary between healthy and disease conditions. QT hysteresis has been reported in children and adults performing exercise testing, and more recently in adults undergoing the standing test. A paradoxical QT interval increase has been used to confirm diagnosis of long QT syndrome in patients with borderline corrected QT (QTc). Studying QT hysteresis during a quick standing challenge may compensate for exercise testing; yet no pediatric data is available. METHODS: The standing test was performed in 50 healthy children (mean age 9.22.8 yrs, 33 male) having a normal echocardiogram and negative family history for sudden death and long-QT syndrome. Following 10 min supine, fast standing with continuous ECG recording was performed. QT intervals were measured at baseline, maximal tachycardia, maximal QT and each minute of recovery (5 min), using a computerised software (leads II/V5), and corrected for HR using Bazzett (QTcB), Fridericia, Framingham, and Hodge formulas. RESULTS: In response to standing, HR increased from 75.213.1 to 101.111.6 beats/min. QT intervals at baseline and maximal tachycardia were similar (38932 vs 38434 msec, p¼1), however QTcB increased upon standing (43122 vs 49536 msec, p<0.001). The 95th percentile for QTcB was 464 msec at baseline and 551 msec at maximal tachycardia. The QTcB increased by 6333 msec upon standing, and the magnitude of the change was positively related to heart rate acceleration (r¼0.74, R2¼0.55, p<0.001), but not to baseline QTcB (p¼0.17). QT during recovery was significantly shorter than at baseline and upon standing (37129 msec versus 38132 msec and 38434 msec respectively, p<0.001), but stayed similar throughout recovery. QTcB reached baseline values after 1 min of recovery (42920 msec at 1 min vs 43122 msec at baseline,
243 SIGNIFICANT HETEROGENEITY BETWEEN AORTIC ROOT AND AORTIC ANNULUS IN BICUSPID AORTIC VALVE L Meloche-Dumas, S Blais, F Dallaire, A Fournier, N Dahdah Montréal, Québec BACKGROUND:
Bicuspid aortic valve (BAV) is associated with aortic dilatation and potential dissection. There are 3 major patterns of leaflets fusion in BAV: left and right coronary leaflets fusion (BAV-1), right and non-coronary leaflets fusion (BAV-2), and the rare three-leaflet fusion (BAV-3). We sought to determine the pattern of dilatation according to commonest types of BAV fusion, and whether this could modify patient management. The embryologically different true bicuspid valve is not included in this study. METHODS: In this retrospective cross-sectional study, echocardiography reports were reviewed to evaluate the homogeneity of normalized diameters of the aortic valve, the aortic root and the ascending aorta according to fusion morphology. Relative segmental Z-scores (calculated difference Aortic Root Aortic Valve and Ascending Aorta - Aortic Valve), were also compared. RESULTS: From 272 BAV patients followed at CHU SainteJustine between 2009 and 2014 (mean diagnostic age 8.52 7.39 years; 71% males), 167/272 (61.4%) had BAV-1, and
Abstracts
65/272 (23.9%) had BAV-2; p¼NS for age. Aortic valve stenosis was present in 83/272 (30.5%) patients, with a lower prevalence 42/167 (25.15%) in BAV-1 compared to 28/65 (43.08%) in BAV-2 (p¼0.012). Aortic coarctation affected both groups similarly (29/167 (17.4%) vs. 11/65 (17.0%) respectively; p¼0.91). There was no statistically significant difference in the ascending aorta between the study groups (Table 1). However, BAV-1 had increased aortic root Z-score compared to BAV-2 (p¼0.004) despite a trend towards larger aortic annulus in BAV-2 (p¼0.07). The difference was not significant between BAV-1 and BAV-2 in cases with valvular stenosis (0.421.28 vs. 0.171.69; p¼0.5), but significant in the absence of stenosis (0.801.66 vs. -0.051.19; p¼0.004). The discrepancy is more significant when comparing Z-score differences (aortic root - aortic annulus) (p<0.0001). In BAV-1, valvular stenosis was associated with homogeneous aortic roots, whereas those without stenosis had relatively larger roots (Z-score difference -0.091.15 vs. 0.471.32; p¼0.02). In BAV-2, stenosis did not affect relative aortic root Z-score (-0.90 1.32 vs. -0.88 1.24; p¼0.96). The same observations were present in presence or absence of coarctation of the aorta (data not shown). Altogether, there was no significant differences in the ascending aorta dimension in either case (BAV-1 vs. BAV-2, or valvular stenosis vs. no stenosis). CONCLUSION: In type-1 BAV fusion aortic roots are larger, and represent significant heterogeneity with the aortic valve (unlike type-2 fusion). The observed difference suggests potential modifications in patient approach with this valvular disease according to the type of fusion.
S207
validity of oscillometric and aneroid BP devices compared to the mercury sphygmomanometer for the measurement of BP in children aged 19 yrs. METHODS: We systematically searched 4 electronic databases (MEDLINE, Embase, CINAHL, Web of Science) and relevant journals for eligible articles. We used relevant medical subject headings and keywords, and the following inclusion criteria: 1) age 3-19 years; 2) BP measured by mercury and at least one other method; 3) BP measurement on the arm. One author screened 1415 articles’ titles and abstracts, and two authors independently reviewed 92 full-text articles. We included 29 articles (38 studies) with 26,879 children included in our analyses. RESULTS: Random-effects model meta-analyses revealed that oscillometric devices yield higher measurements of systolic BP than auscultation with a mercury sphygmanometer (pooled effect estimate ¼ 2.54 mmHg; 95%CI 0.57-4.50; p<0.05); there was no significant difference for diastolic BP (pooled effect estimate ¼ 1.55 mmHg; 95%CI -0.38-3.48). There was considerable heterogeneity between studies, explained in part by differences in manufacturer, study setting and observer training. Only three studies compared BP using aneroid and mercury devices and found comparable readings by the two methods. CONCLUSION: Oscillometric devices may serve as a suitable alternative to auscultation for initial BP screening in the pediatric population. The use of oscillometric devices in children is complicated by the automated cuff inflations to high pressures, causing discomfort to the child and possibly precluding the BP measurement. Diagnosis of hypertension and pre-hypertension in children should be confirmed by auscultation by a trained health professional.
245 UNDERUSE OF UPPER EXTREMITIES IN 4-MONTH-OLDS WITH CONGENITAL HEART DISEASE: AN EARLY AND EASY TO IDENTIFY PREDICTOR OF GROSS MOTOR DIFFICULTIES L Beaulieu-Genest, L Carmant, N Poirier, A Doussau, L Dagenais, M Materassi, J Prud’homme, K Gagnon, R Mazine 244 A SYSTEMATIC REVIEW AND META-ANALYSIS OF BLOOD PRESSURE MEASUREMENT TECHNIQUES IN CHILDREN SL Duncombe, C Voss, K Harris Vancouver, British Columbia BACKGROUND:
The phase-out of mercury from clinical settings calls for valid alternatives to assess blood pressure (BP) in children. Aneroid devices provide a mercury-free alternative to BP measurements by auscultation, whereas oscillometric (automated) devices are increasingly becoming the norm in clinical practice due to their ease of use. The aim of this systematic review and meta-analysis was to investigate the
Montréal, Québec BACKGROUND:
Developmental issues are prominent in children born with congenital heart disease (CHD). A common finding emerged from 4-month-assessments: many infants were not yet bringing their hands to midline when supine. METHOD: Data from patients assessed between 04/2013 and 01/2016 was reviewed. Infants who could not bring their hands to midline (Alberta Infant Motor Scale 3 in supine position) at the 4-month-assessment were identified as the underuse group. We then compared this group with the other infants (normal group, supine AIMS >3). RESULTS: Of the 93 infants who had a 4-month evaluation, 30 (32.3%) did not yet bring their hands to midline. These infants had significantly longer open chest (median 2 vs.