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Tricuspid Regurgitation Velocity in the Assessment of Pulmonary Hypertension: Is it Accurate at All?
Abstracts
Fig 3. CT coronary angiogram showing RCA originating from the Aorta & Left coronary artery/circulation originating from the pulmonary artery (PA) Fig 4. CT coronary angiogram showing the origin and course of the right and left coronary arteries Fig 5. 3D reconstruction images from CT coronary angiogram showing the origin and course of RCA Fig 6. 3D reconstruction images from CT coronary angiogram showing origin and course of left coronary circulation from the pulmonary trunk. http://dx.doi.org/10.1016/j.hlc.2016.06.595 594 Trends in the Use of CT Coronary Angiography and Conventional Angiography July 2011 - December 2015 A. Vlachadis Castles 1,2,∗ , I. Tsay 1,3 , W. van Gaal 1,4 1 Northern
Heart, The Northern Hospital, Epping, Australia 2 Austin Health, Heidelberg, Australia 3 Canberra Hospital, Canberra, Australia 4 University of Melbourne, Melbourne, Australia Background: CT coronary angiography (CTCA) has been included in the Australian Medicare Benefits Schedule (MBS) since July 2011. This study examines the trends of use of CTCA and conventional angiography since subsidisation was introduced. Methods: Medicare Australia statistics on the number of MBS-subsidised CTCA scans and conventional angiograms from July 2011 to December 2015 were analysed, to examine the trends in use of these services. This data does not capture all services, as it is limited to those that were MBS-subsidised. For conventional angiography, this fails to capture inpatient angiograms. Results: The figures below demonstrate the number of MBS-subsidised CTCA scans and conventional angiograms performed from July 2011 to December 2015.
Conclusion: The number of MBS-subsidised CTCA scans performed per quarter has more than doubled since the service was first introduced into the MBS in July 2011, from approximately 5000 to approximately 12000 scans per quarter. Over the same time, the number of conventional angiograms has remained approximately static. This suggests that clinicians are increasingly recognising the value of CTCA as a non-invasive investigation for coronary artery pathology. However, the increased use of CTCA has not significantly affected the rates of conventional coronary angiography. http://dx.doi.org/10.1016/j.hlc.2016.06.596
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595 Tricuspid Regurgitation Velocity in the Assessment of Pulmonary Hypertension: Is it Accurate at All? S. Kyranis 1,2,∗ , J. Latona 1,2 , M. Savage 1,2 , N. Kelly 1,2 , D. Burstow 1,2 , G. Scalia 1,2 , D. Platts 1,2 1 The
Prince Charles Hospital, Brisbane, Australia 2 University of Queensland, Brisbane, Australia
Background: Tricuspid regurgitation velocity (TRV) as a surrogate for invasive mean pulmonary artery pressure (mPAP) is integral in the assessment of pulmonary hypertension (PHT). Current practice suggests patients with a TRVmax ≤ 2.8m/s are unlikely to have PHT. Aim: To assess the accuracy of echocardiographic derived TRVmax in the non-invasive classification of PHT. Methods: 97 patients who were referred for assessment of breathlessness were prospectively enrolled and underwent right heart catheterisation (RHC) and echocardiography (mean time difference between the two procedures 137.5 minutes). Correlation between TRVmax (‘chin’ measurement) and invasive mPAP was assessed. Patients were defined as having PHT if the mPAP was ≥25 mmHg during RHC. Using echocardiography, patients were classified as having PHT if the TRVmax ≥3.4m/s, possible PHT between 2.8m/s and 3.4m/s and no PHT if TRVmax ≤2.8m/s. Results: All patients had sufficient TRVmax to be included in the analysis. There was a statistically significant correlation between TRVmax and mPAP for all patients (r = 0.84, p<0.001). All patients with a TRVmax ≥3.4m/s had a mPAP > 25 mmHg. In patients with a TRVmax between 2.8m/s and 3.4m/s, 21 (84%) patients were found to have PHT invasively, while 4 patients did not have PHT at RHC. 5 patients (16%) with TRVmax ≤2.8m/s, were misclassified using echocardiography and were found to have PHT on RHC. Conclusion: Elevated TRVmax (≥2.8m/s) is highly accurate in correctly identifying PHT. The significant false-negative rate of isolated low velocities emphasises the need for use of additional ancillary echocardiographic features of PHT. http://dx.doi.org/10.1016/j.hlc.2016.06.597 596 Unusual Cause of Cardiomyopathy in 21-Year-Old Female - Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) L. Carr ∗ , I. Mohasseb, M. Dooris, A. Lo, S. Prasad, A. Dahiya Royal Brisbane and Women’s Hospital, Brisbane, Australia A 21-year-old female immigrant presented with decompensated heart failure. She had a mechanical mitral valve replacement previously in Nepal for unknown indication. Transthoracic echocardiogram revealed a dilated left ventricle
Fig 3. CT coronary angiogram showing RCA originating from the Aorta & Left coronary artery/circulation originating from the pulmonary artery (PA) Fig 4. CT coronary angiogram showing the origin and course of the right and left coronary arteries Fig 5. 3D reconstruction images from CT coronary angiogram showing the origin and course of RCA Fig 6. 3D reconstruction images from CT coronary angiogram showing origin and course of left coronary circulation from the pulmonary trunk. http://dx.doi.org/10.1016/j.hlc.2016.06.595 594 Trends in the Use of CT Coronary Angiography and Conventional Angiography July 2011 - December 2015 A. Vlachadis Castles 1,2,∗ , I. Tsay 1,3 , W. van Gaal 1,4 1 Northern
Heart, The Northern Hospital, Epping, Australia 2 Austin Health, Heidelberg, Australia 3 Canberra Hospital, Canberra, Australia 4 University of Melbourne, Melbourne, Australia Background: CT coronary angiography (CTCA) has been included in the Australian Medicare Benefits Schedule (MBS) since July 2011. This study examines the trends of use of CTCA and conventional angiography since subsidisation was introduced. Methods: Medicare Australia statistics on the number of MBS-subsidised CTCA scans and conventional angiograms from July 2011 to December 2015 were analysed, to examine the trends in use of these services. This data does not capture all services, as it is limited to those that were MBS-subsidised. For conventional angiography, this fails to capture inpatient angiograms. Results: The figures below demonstrate the number of MBS-subsidised CTCA scans and conventional angiograms performed from July 2011 to December 2015.
Conclusion: The number of MBS-subsidised CTCA scans performed per quarter has more than doubled since the service was first introduced into the MBS in July 2011, from approximately 5000 to approximately 12000 scans per quarter. Over the same time, the number of conventional angiograms has remained approximately static. This suggests that clinicians are increasingly recognising the value of CTCA as a non-invasive investigation for coronary artery pathology. However, the increased use of CTCA has not significantly affected the rates of conventional coronary angiography. http://dx.doi.org/10.1016/j.hlc.2016.06.596
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595 Tricuspid Regurgitation Velocity in the Assessment of Pulmonary Hypertension: Is it Accurate at All? S. Kyranis 1,2,∗ , J. Latona 1,2 , M. Savage 1,2 , N. Kelly 1,2 , D. Burstow 1,2 , G. Scalia 1,2 , D. Platts 1,2 1 The
Prince Charles Hospital, Brisbane, Australia 2 University of Queensland, Brisbane, Australia
Background: Tricuspid regurgitation velocity (TRV) as a surrogate for invasive mean pulmonary artery pressure (mPAP) is integral in the assessment of pulmonary hypertension (PHT). Current practice suggests patients with a TRVmax ≤ 2.8m/s are unlikely to have PHT. Aim: To assess the accuracy of echocardiographic derived TRVmax in the non-invasive classification of PHT. Methods: 97 patients who were referred for assessment of breathlessness were prospectively enrolled and underwent right heart catheterisation (RHC) and echocardiography (mean time difference between the two procedures 137.5 minutes). Correlation between TRVmax (‘chin’ measurement) and invasive mPAP was assessed. Patients were defined as having PHT if the mPAP was ≥25 mmHg during RHC. Using echocardiography, patients were classified as having PHT if the TRVmax ≥3.4m/s, possible PHT between 2.8m/s and 3.4m/s and no PHT if TRVmax ≤2.8m/s. Results: All patients had sufficient TRVmax to be included in the analysis. There was a statistically significant correlation between TRVmax and mPAP for all patients (r = 0.84, p<0.001). All patients with a TRVmax ≥3.4m/s had a mPAP > 25 mmHg. In patients with a TRVmax between 2.8m/s and 3.4m/s, 21 (84%) patients were found to have PHT invasively, while 4 patients did not have PHT at RHC. 5 patients (16%) with TRVmax ≤2.8m/s, were misclassified using echocardiography and were found to have PHT on RHC. Conclusion: Elevated TRVmax (≥2.8m/s) is highly accurate in correctly identifying PHT. The significant false-negative rate of isolated low velocities emphasises the need for use of additional ancillary echocardiographic features of PHT. http://dx.doi.org/10.1016/j.hlc.2016.06.597 596 Unusual Cause of Cardiomyopathy in 21-Year-Old Female - Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) L. Carr ∗ , I. Mohasseb, M. Dooris, A. Lo, S. Prasad, A. Dahiya Royal Brisbane and Women’s Hospital, Brisbane, Australia A 21-year-old female immigrant presented with decompensated heart failure. She had a mechanical mitral valve replacement previously in Nepal for unknown indication. Transthoracic echocardiogram revealed a dilated left ventricle