The Utility of Cardiac MRI in Patients Presenting with Myocardial injury Without Obstructive Coronary Artery Disease

Conclusion: ApHCM is a rare condition and colour Doppler and CE imaging can be helpful in its diagnosis by improving the visualisation of ventricular morphology with the incremental benefit of visualising CALVF. The selected use of CE for equivocal cases of ApHCM can improve diagnosis by TTE. doi:10.1016/j.hlc.2011.05.479 476 The Utility of 3D TOE in the Assessment of Crista Terminalis Mimicking a Right Atrial Mass J. Sedgwick ∗ , D. Sathianathan, D. Platts, D. Burstow, J. Chan The Prince Charles Hospital, Australia Background: A prominent Crista Terminalis (CT) may mimic a right atrial (RA) mass. The fibromuscular CT runs between the smooth-walled posterior RA and the trabeculated anterolateral wall/appendage. Aim: To assess the utility of 3D transoesophageal echocardiography (TOE) in the assessment of RA masses detected on transthoracic echocardiography (TTE). Methods: Patients with a RA mass of unknown aetiology on TTE were prospectively collected and assessed using a Philips (iE33) scanner and X7-2t TOE probe to obtain 2D, simultaneous biplane, real-time (RT) 3D and full volume 3D datasets. Results: Over six months, 4/7245 studies (M = 2, average age = 68.8 years) had a prominent CT on TTE requiring referral for 3DTOE. Indications for TTE: chest pain, dyspnoea, endocarditis, and stroke. 3DTOE images were able to clearly define the exact anatomical location and course of the CT and exclude RA pathology, thereby altering clinical management. Whilst 2DTOE images improved resolution of RA morphology over TTE, 3DTOE images provided clearer spatial delineation of the CT in all cases, with the ability to visualise the majority of the structure in a single clip (either 3D zoom or reconstructed 3D full volume).

Conclusion: RA anatomical variants may mimic mass lesions on TTE resulting in misdiagnosis. 3DTOE imaging helps define the complex anatomical structure of the right atrium, enabling differentiation of apparent masses seen on TTE, resulting in improved diagnostic accuracy when compared to 2DTTE and conventional 2DTOE. doi:10.1016/j.hlc.2011.05.480

Abstracts

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477 The Utility of Cardiac MRI in Patients Presenting with Myocardial injury Without Obstructive Coronary Artery Disease M. Indrajith ∗ , S. Butterly, J. Amin, B. Jesuthsan, A. Ng, S. Ngai, W. Wang Princess Alexandra Hospital, Brisbane, Australia Background: Cardiac Magnetic Resonance (CMR) imaging is useful in distinguishing different causes of acute myocardial injury such as infarction and myopericarditis. We investigate the diagnostic utilities of CMR in patients with myocardial injury without obstructive coronary artery disease (CAD). Methods: Data collated over nine months (June 2010 to March 2011) from patients in Princess Alexandra Hospital, a tertiary referral hospital in Brisbane. Patients with myocardial injury (troponin-I > 0.1) and non-obstructive coronary artery disease (<50% stenosis) who had a clinically indicated CMR were included. CMR images were reviewed independently by two specialists. Results: In total, 39 patients had raised troponin-I and non obstructive CAD on coronary angiogram were identified and 24 patients had CMR. Diagnosis at CMR included: myopericarditis (17%), myocardial infarction (14%), takotsubo cardiomyopathy (13%), non-specific left ventricular dysfunction (18%) and normal findings (38%). Myocardial infarction noted in three patients by CMR despite apparently non-obstructive CAD initially. In total, CMI helped to establish a new diagnosis in five out of the 24 patients (21%) and consolidated diagnosis in another nine patients (38%). Conclusions: CMR is a highly valuable tool in the assessment of patients with acute myocardial injury without significant CAD where the diagnosis is often unclear. doi:10.1016/j.hlc.2011.05.481

478 Transthoracic Echocardiography Inside a Hyperbaric Chamber B. King 1,∗ , B. McKeown 1 , D. Playford 2 , K. Brown 1 , I. Gawthrope 1 1 Fremantle 2 University

Hospital, Australia of Notre Dame, Australia

Hyperbaric therapy is an established treatment for a variety of conditions including decompression ill-

ABSTRACTS

Heart, Lung and Circulation 2011;20S:S156–S251