Transcatheter Aortic Valve Implantation in Patients with Low Gradient Aortic Stenosis and Preserved Left Ventricular Ejection Fraction

CSANZ 2013 Abstracts

481

LSE: Echocardiography vs Surgical Findings Sensitivity NVIE

Specificity PVE

S203

NVIE

PVE

Transthoracic Echo Has Little Diagnostic Utility in Nonselect Patients with Transient Ischaemic Attack

TTE

71%

48%

95%

93%

2DTOE

89%

100%

94%

84%

D. Balakrishnan ∗ , R. Perry, A. Lee, M. Joseph, J. Duncan

3DTOE

84%

100%

86%

86%

Flinders Medical Centre, Australia

http://dx.doi.org/10.1016/j.hlc.2013.05.481 480 Transcatheter Aortic Valve Implantation in Patients with Low Gradient Aortic Stenosis and Preserved Left Ventricular Ejection Fraction S. Lockwood ∗ , P. Mottram, I. Meredith, J. Cameron, S. Moir MonashHeart and Monash Cardiovascular Research Centre, Southern Clinical School, Monash University, Melbourne, Australia Background: Transcatheter Aortic Valve Implantation (TAVI) is an established alternative to surgery for selected patients with severe symptomatic aortic stenosis. Low gradient AS (LGAS) with preserved LV ejection fraction (AVA < 1.0 cm2 , MAVG < 40 mmHg and LVEF > 50%) is thought to be due to low stroke volume and patients are said to have a poorer prognosis. The impact of TAVI in these patients has not been previously explored. Method: All patients undergoing TAVI with CoreValve at MonashHeart were eligible for study inclusion. Detailed quantitative echocardiography was performed according to ASE guidelines. Only patients with LVEF ≥50% at baseline were included and further stratified according to baseline mean aortic valve gradient (≥40 mmHg or ≤40 mmHg). Echocardiographic and clinical outcomes were compared at 12 months. Results: Thirty-eight patients (mean age 83 ± 8 years, 46% female, mean EuroScore 17 ± 9%) were analysed. Twelve month echo and clinical data was available for 34 patients; 11 (29%) with LGAS and 23 (61%) with MAVG > 40 mmHg (four patients were lost to follow up (1 LGAS)). There were no deaths in either group. At 12 months, echo parameters were similar for both groups, including LVEF, global longitudinal strain and markers of diastolic function. Quality of life score (Minnesota Living with Heart Failure Questionnaire) and functional status (NYHA class) post TAVI were similar in both groups. Conclusion: TAVI is an effective therapy for patients with low gradient severe aortic stenosis with similar improvements in post procedural aortic valve haemodynamics, quality of life and functional status as those patients with high gradient severe aortic stenosis. http://dx.doi.org/10.1016/j.hlc.2013.05.482

Introduction: Transthoracic echocardiogram (TTE) is recommended [1] in patients with transient ischemic attack (TIA) with suspected cardio embolic source or with no obvious cause after standard workup [1]. In our institution it is routinely performed on all patients presenting to the TIA service. Method: We retrospectively reviewed records and TTE of 201 consecutive patients diagnosed with TIA at Flinders Medical centre (2011–2012). Results: Of 201 patients, average age 70+ to 14 years, 118(59%) were males. Main symptoms were expressive dysphasia (34%) and focal weakness (24%). ECG showed normal sinus rhythm in 168(84%), AF in 31(15%) and rest were paced. On reviewing TTE no thrombus was found and only 3% had a patent foramen ovale detected. Abnormalities on TTE included wall motion abnormalities (17), LVH (78), aortic stenosis (10), left atrial enlargement (62) and diastolic dysfunction (137). Discussion: Utility of TTE is low in the investigation of TIA as a tool to exclude cardiac source of embolus but helpful in diagnosing other structural abnormalities associated with higher risk of vascular disease. This study shows that routine TTE, given the low yield is unlikely to change management in majority of patients with TIA. Indeed a routine ECG only may have a greater yield in detecting a cardiac source. The indiscriminate use of TTE in all TIA patients cannot be justified.

Reference [1] Donald Easton J, Jeffrey L, Saver, Gregory W, Albers, Mark J, Alberts, Seemant Chaturvedi, Edward Feldmann, et al. Definition and Evaluation of Transient Ischemic Attack. A Scientific Statement for Healthcare Professionals from the American Heart Association/American Stroke Association Stroke Council. Stroke 2009;40(6):2276–93.

http://dx.doi.org/10.1016/j.hlc.2013.05.483 482 Transthoracic Echocardiography Guided Assessment of Pulmonary Vascular Resistance – Time for a New Formula M. Brown 1,∗ , C. Hamilton-Craig 1,2 , G. McKenzie 1,2 , D. Platts 1,2 , D. Burstow 1,2 1 The

Javorsky 1 , S.

Prince Charles Hospital, Australia of Queensland, Brisbane, Queensland, Australia

2 University

Background: Invasive right heart catheterisation (RHC) is the gold standard for assessment of pulmonary vascular resistance (PVR) but transthoracic echocardiography (TTE) is conventionally used as a non-invasive method. Recent small studies suggest that estimated PVR on TTE

ABSTRACTS

Heart, Lung and Circulation 2013;22:S126–S266