Pub Date : 2020-09-01DOI: 10.1136/HEARTJNL-2020-BSCI.16
M. Rahiminejad, V. Patel, A. Billé, G. Benedetti, R. Preston, S. Mak
Introduction Coronary artery calcification (CAC) is a known risk factor for myocardial infarction (MI). CAC score is demonstrated to have prognostic value in predicting the incidence of cardiovascular events. CAC can be visually estimated on non-gated CTs, even when not formally quantified. It is a strong prediction tool for risk stratification in the asymptomatic population. We noticed that CAC is not routinely reported as part of routine CT thorax. The aim of our study is to evaluate the percentage of CAC reported by radiologists, and if there is a link to peri-operative myocardial infarction (within 5 days of surgery). Methods The study is retrospective and 100 ungated thoracic CTs acquired for lung cancer surgical planning are included. An ordinal score of 1 to 10 was visually assigned. The medical records of these patients were reviewed. Results 61 out of 100 patients had CAC visible on their CTs. However, this was only mentioned in 1 report (1%). There was no peri-operative MI. 5 patients (5%) had MI in the past, and all of them had CAC. Conclusion CAC is not routinely reported by our radiologists on non-gated thoracic CTs. Although there is no link to increased peri-operative myocardial infarction in our cohort, this is an opportunity for clinicians to risk stratify their patients. More awareness needs to be raised in our local institution to improve current practice.
{"title":"P03 Reporting of coronary artery calcification on non-gated pre-surgical CT thorax","authors":"M. Rahiminejad, V. Patel, A. Billé, G. Benedetti, R. Preston, S. Mak","doi":"10.1136/HEARTJNL-2020-BSCI.16","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BSCI.16","url":null,"abstract":"Introduction Coronary artery calcification (CAC) is a known risk factor for myocardial infarction (MI). CAC score is demonstrated to have prognostic value in predicting the incidence of cardiovascular events. CAC can be visually estimated on non-gated CTs, even when not formally quantified. It is a strong prediction tool for risk stratification in the asymptomatic population. We noticed that CAC is not routinely reported as part of routine CT thorax. The aim of our study is to evaluate the percentage of CAC reported by radiologists, and if there is a link to peri-operative myocardial infarction (within 5 days of surgery). Methods The study is retrospective and 100 ungated thoracic CTs acquired for lung cancer surgical planning are included. An ordinal score of 1 to 10 was visually assigned. The medical records of these patients were reviewed. Results 61 out of 100 patients had CAC visible on their CTs. However, this was only mentioned in 1 report (1%). There was no peri-operative MI. 5 patients (5%) had MI in the past, and all of them had CAC. Conclusion CAC is not routinely reported by our radiologists on non-gated thoracic CTs. Although there is no link to increased peri-operative myocardial infarction in our cohort, this is an opportunity for clinicians to risk stratify their patients. More awareness needs to be raised in our local institution to improve current practice.","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132604179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1136/HEARTJNL-2020-BSCI.26
An Lun, M. Williams, Arshan Hussain, C. Bucciarelli-Ducci
Introduction Previous research has identified the pattern of scarring associated with different aetiologies of myocardial infarction with non-obstructive coronary arteries (MINOCA). However, the association between the characteristics of scar and the impact these characteristics have on the strain of the myocardium has not been investigated. The purpose of this study is to investigate whether the left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) of the myocardium is affected by the amount and pattern of late gadolinium enhancement (LGE). Methods 150 patients (mean age 59.0 ± 15.1 years) who were referred for cardiac MRI (CMR) were recruited retrospectively. Patients with known heart failure, previous myocarditis or not meeting the ESC working group definition of MINOCA were excluded. All patients were scanned at least 28 days after presentation. Their CMRIs were analysed for LVEF, GLS and amount of LGE. SPSS was used to run linear regression, T- test and Kolmogorov-Smirnov Test (K-S) for data analysis. Results 57 of the 150 patients had LGE (mean LGE size 1.43g ± 2.89). There was no significant correlation between the amount of scarring and GLS (p=0.350) overall. However there was a significant association between the amount of ischaemic scar and worsening GLS (p=0.025). There was no significant difference in GLS between ischaemic and non- ischaemic patterns of LGE (t=0.914, p=0.188). Conclusion The amount and pattern of scar do not independently have a direct impact on the GLS of the myocardium in MINOCA patients. Our data suggests that there is a significant correlation between the amount of ischaemic scar and the GLS.
{"title":"P13 The anatomical and functional characteristics of myocardial scar in MINOCA patients","authors":"An Lun, M. Williams, Arshan Hussain, C. Bucciarelli-Ducci","doi":"10.1136/HEARTJNL-2020-BSCI.26","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BSCI.26","url":null,"abstract":"Introduction Previous research has identified the pattern of scarring associated with different aetiologies of myocardial infarction with non-obstructive coronary arteries (MINOCA). However, the association between the characteristics of scar and the impact these characteristics have on the strain of the myocardium has not been investigated. The purpose of this study is to investigate whether the left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) of the myocardium is affected by the amount and pattern of late gadolinium enhancement (LGE). Methods 150 patients (mean age 59.0 ± 15.1 years) who were referred for cardiac MRI (CMR) were recruited retrospectively. Patients with known heart failure, previous myocarditis or not meeting the ESC working group definition of MINOCA were excluded. All patients were scanned at least 28 days after presentation. Their CMRIs were analysed for LVEF, GLS and amount of LGE. SPSS was used to run linear regression, T- test and Kolmogorov-Smirnov Test (K-S) for data analysis. Results 57 of the 150 patients had LGE (mean LGE size 1.43g ± 2.89). There was no significant correlation between the amount of scarring and GLS (p=0.350) overall. However there was a significant association between the amount of ischaemic scar and worsening GLS (p=0.025). There was no significant difference in GLS between ischaemic and non- ischaemic patterns of LGE (t=0.914, p=0.188). Conclusion The amount and pattern of scar do not independently have a direct impact on the GLS of the myocardium in MINOCA patients. Our data suggests that there is a significant correlation between the amount of ischaemic scar and the GLS.","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123125262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1136/HEARTJNL-2020-BSCI.29
L. Price, A. Asher, R. Chung, A. Joshi, Si-Han Liu, A. Morley-Smith, S. Tyebally, L. Menezes
Introduction Positron Emission Tomography/Computed Tomography (PET/CT) has many advantages over Single Photon Emission Computed Tomography in Myocardial Perfusion Imaging (MPI). However, UK availability, has been limited. We describe a new Rubidium (Rb) PET MPI service; the third in the National Health Service in England. Methods Audit of the first 100 patients from November 2019 to January 2020. 66 men, 34 women, mean age 65 ±11, mean Body Mass Index 28.3 ±6.8. Imaging comprised CT for attenuation correction, CT for Agatston scoring if no known Coronary Artery Disease (CAD) or prior intervention, and PET with and without adenosine vasodilation. Results The commonest indication was symptoms post-revascularization (36%). 31% had had previous percutaneous intervention, 15% had had previous coronary surgery. 21% had had prior cardiac CT. The mean wait from request to scan was 30 days. 98% were reported the same or next working day. 96% received 140 mcg/kg/min adenosine, 4% received 210 mcg/kg/min. Two patients did not show adequate vasodilation. All PET MPI scans were diagnostic quality. 43% had Agatston scoring. The mean total Agatston score was 511. The normalcy rate for PET MPS was 60%. The prevalence of infarction was 20%. The mean Myocardial Flow Reserve was 2.3 ±0.8. Conclusion Rb PET MPI is feasible and high quality in a new service. It provides detailed coronary assessment, with plaque burden, relative perfusion and absolute myocardial blood flow quantification. It will be an essential contributor to patient diagnosis, treatment response and risk stratification.
正电子发射断层扫描/计算机断层扫描(PET/CT)在心肌灌注成像(MPI)中比单光子发射计算机断层扫描有许多优点。然而，英国的可用性有限。我们描述了一种新的铷(Rb) PET MPI服务;在英国国民健康服务体系中排名第三方法对2019年11月至2020年1月的前100例患者进行审计。男性66例，女性34例，平均年龄65±11岁，平均体质指数28.3±6.8。成像包括CT进行衰减校正，CT进行Agatston评分，如果没有已知的冠状动脉疾病(CAD)或先前的干预，以及PET有无腺苷血管舒张。结果最常见的指征是血运重建术后的症状(36%)。31%曾接受过经皮介入治疗，15%曾接受过冠状动脉手术。21%的患者既往有心脏CT检查。从请求到扫描的平均等待时间为30天。98%是在同一天或下一个工作天报告的。96%接受140 McG /kg/min腺苷，4%接受210 McG /kg/min。2例患者未表现出足够的血管扩张。所有PET MPI扫描均符合诊断质量。43%的人有Agatston得分。Agatston平均总分为511分。PET MPS正常率为60%。梗死发生率为20%。心肌血流储备平均值为2.3±0.8。结论Rb PET MPI是一种可行的、高质量的新服务。它提供详细的冠状动脉评估，包括斑块负荷、相对灌注和绝对心肌血流量化。这将是对患者诊断、治疗反应和风险分层的重要贡献。
{"title":"P16 Rubidium myocardial perfusion PET-CT: initial experience in first 100 patients","authors":"L. Price, A. Asher, R. Chung, A. Joshi, Si-Han Liu, A. Morley-Smith, S. Tyebally, L. Menezes","doi":"10.1136/HEARTJNL-2020-BSCI.29","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BSCI.29","url":null,"abstract":"Introduction Positron Emission Tomography/Computed Tomography (PET/CT) has many advantages over Single Photon Emission Computed Tomography in Myocardial Perfusion Imaging (MPI). However, UK availability, has been limited. We describe a new Rubidium (Rb) PET MPI service; the third in the National Health Service in England. Methods Audit of the first 100 patients from November 2019 to January 2020. 66 men, 34 women, mean age 65 ±11, mean Body Mass Index 28.3 ±6.8. Imaging comprised CT for attenuation correction, CT for Agatston scoring if no known Coronary Artery Disease (CAD) or prior intervention, and PET with and without adenosine vasodilation. Results The commonest indication was symptoms post-revascularization (36%). 31% had had previous percutaneous intervention, 15% had had previous coronary surgery. 21% had had prior cardiac CT. The mean wait from request to scan was 30 days. 98% were reported the same or next working day. 96% received 140 mcg/kg/min adenosine, 4% received 210 mcg/kg/min. Two patients did not show adequate vasodilation. All PET MPI scans were diagnostic quality. 43% had Agatston scoring. The mean total Agatston score was 511. The normalcy rate for PET MPS was 60%. The prevalence of infarction was 20%. The mean Myocardial Flow Reserve was 2.3 ±0.8. Conclusion Rb PET MPI is feasible and high quality in a new service. It provides detailed coronary assessment, with plaque burden, relative perfusion and absolute myocardial blood flow quantification. It will be an essential contributor to patient diagnosis, treatment response and risk stratification.","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122154878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1136/HEARTJNL-2020-BSCI.22
R. Foley, S. Lyen, N. Manghat, M. Hamilton
Introduction The quantification of aortic valve (AoV) calcification on computed tomography (CT) has been recommended for the grading of patients with aortic stenosis. We aim to characterise the relationship between AoV calcification and the aortic valve area. Methods Data was prospectively collected on all patients undergoing CT for consideration of transcatheter aortic valve implantation (TAVI) from July 2019 - January 2020. CT was performed on multidetector scanners, (Siemens SOMATOM AS+ and Canon Aquilion ONE) and measurements of AoV calcification and AoV area were performed using validated software (TeraRecon, California). The Agatson method was used to calculate AoV calcification. Spearman correlation analysis was performed using R v3.3.3. Results The cohort consisted of 81 consecutive patients. There were a range of AoV calcium scores from 129–7791, with a mean score of 2,592 arbitrary units. There was a very weak negative correlation between AoV calcification and the CT derived AoV area (rs=-.08, p=0.46). Subgroup analysis demonstrated weak negative correlation in patients with tricuspid valves (n=62), rs=-.17, p=0.18 and in bicuspid valve patients (n=19), rs=-.26, p Conclusion The relationship between AoV calcification and AoV area is unclear, with no significant correlation demonstrated. It is important to understand the relationship between AoV calcification and AoV area before its use in clinical practice can be advocated.
{"title":"P09 The relationship of aortic valve calcification and aortic valve area on computed tomography","authors":"R. Foley, S. Lyen, N. Manghat, M. Hamilton","doi":"10.1136/HEARTJNL-2020-BSCI.22","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BSCI.22","url":null,"abstract":"Introduction The quantification of aortic valve (AoV) calcification on computed tomography (CT) has been recommended for the grading of patients with aortic stenosis. We aim to characterise the relationship between AoV calcification and the aortic valve area. Methods Data was prospectively collected on all patients undergoing CT for consideration of transcatheter aortic valve implantation (TAVI) from July 2019 - January 2020. CT was performed on multidetector scanners, (Siemens SOMATOM AS+ and Canon Aquilion ONE) and measurements of AoV calcification and AoV area were performed using validated software (TeraRecon, California). The Agatson method was used to calculate AoV calcification. Spearman correlation analysis was performed using R v3.3.3. Results The cohort consisted of 81 consecutive patients. There were a range of AoV calcium scores from 129–7791, with a mean score of 2,592 arbitrary units. There was a very weak negative correlation between AoV calcification and the CT derived AoV area (rs=-.08, p=0.46). Subgroup analysis demonstrated weak negative correlation in patients with tricuspid valves (n=62), rs=-.17, p=0.18 and in bicuspid valve patients (n=19), rs=-.26, p Conclusion The relationship between AoV calcification and AoV area is unclear, with no significant correlation demonstrated. It is important to understand the relationship between AoV calcification and AoV area before its use in clinical practice can be advocated.","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130064001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1136/HEARTJNL-2020-BSCI.28
N. Khan, P. Hall-Barrientos, A. Radjenovic, P. Douglas, G. Roditi
Introduction Clinical course for patients with type B aortic dissection is unpredictable. In addition to morphological factors, flow dynamics is integral. Early identification of patients at risk of aortic expansion and rupture will allow elective endoluminal stent graft placement. 4D flow MRI allows evaluation of flow patterns in large volumetric field of view but can be time consuming. Aim of this pilot study was to apply rapid 4D-PC MRI to visualize and quantify flow characteristics in patients with aortic dissection. Methods Imaging of the thoracic aorta was acquired using an accelerated WIP sequence (785k) on Siemens Prisma (3.0 Tesla). Following optimisation on healthy volunteers, 7 patients with stable medically managed Type B aortic dissection were studied. Centre lines from true lumen in normal proximal aorta through true and false lumens were generated allowing haemodynamic parameters assessment at multiple levels. Measurements relating to velocities, flows, regurgitant fraction, pressure gradients and maps of wall shear stress were recorded using Circle CVi42 and proprietary Siemens software. Animated 4D visualisations were qualitatively assessed for vorticity. Results 4D flow was successfully acquired in all subjects in acceptable times ( Conclusion Future work will focus on optimisation to preserve low flow visualisation prior to a prospective study of patients to identify those who would benefit from endovascular therapy.
{"title":"P15 Assessment of blood flow patterns in patients with type B aortic dissection by 4-dimensional flow phase contrast magnetic resonance imaging – a pilot study","authors":"N. Khan, P. Hall-Barrientos, A. Radjenovic, P. Douglas, G. Roditi","doi":"10.1136/HEARTJNL-2020-BSCI.28","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BSCI.28","url":null,"abstract":"Introduction Clinical course for patients with type B aortic dissection is unpredictable. In addition to morphological factors, flow dynamics is integral. Early identification of patients at risk of aortic expansion and rupture will allow elective endoluminal stent graft placement. 4D flow MRI allows evaluation of flow patterns in large volumetric field of view but can be time consuming. Aim of this pilot study was to apply rapid 4D-PC MRI to visualize and quantify flow characteristics in patients with aortic dissection. Methods Imaging of the thoracic aorta was acquired using an accelerated WIP sequence (785k) on Siemens Prisma (3.0 Tesla). Following optimisation on healthy volunteers, 7 patients with stable medically managed Type B aortic dissection were studied. Centre lines from true lumen in normal proximal aorta through true and false lumens were generated allowing haemodynamic parameters assessment at multiple levels. Measurements relating to velocities, flows, regurgitant fraction, pressure gradients and maps of wall shear stress were recorded using Circle CVi42 and proprietary Siemens software. Animated 4D visualisations were qualitatively assessed for vorticity. Results 4D flow was successfully acquired in all subjects in acceptable times ( Conclusion Future work will focus on optimisation to preserve low flow visualisation prior to a prospective study of patients to identify those who would benefit from endovascular therapy.","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"116 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122074816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1136/HEARTJNL-2020-BSCI.24
A. Hameed, S. Tyebally, L. Menezes, R. Patel
Introduction Early studies of patients with familial hypercholesterolemia (FH) reported mostly on high prevalence and incidence of clinical coronary artery disease (CAD) events. Little data exists on the prevalence of subclinical CAD in the computed tomography coronary angiography (CTCA) era. Methods As part of a wider quality improvement project on appropriateness of CTCA at a tertiary centre in London, we documented core demographics, symptoms, CTCA findings and outcomes in patients with FH undergoing CTCA between 2015–2019. All patients underwent CT calcium scoring (Agatston) and CTCA. CAD presence was defined as having at least mild plaques (>25% stenosis). Results We identified 42 patients with FH and a CTCA (22 men; mean age 49.5 ± 10.6 years). Of these, 23 (54.8%) were mutation positive and 24 (57.1%) were asymptomatic. Additional cardiac risk factors included hypertension (n=5; 11.9%), type 2 diabetes mellitus (n=2, 4.76%), current cigarette smokers (n=8, 19.0%) and a family history of CAD (n=36, 85.7%). Mean LDL was 4.13 mmol/L ± 1.70 mmol/L with mean BMI of 24.6kg/m2. The average Agatston calcium score was 112, equating to a mean age/sex adjusted percentile of 44.7%. CAD was identified in 22 (52.4%) patients, and the majority had plaque in the LAD (LMS = 4; LCx = 7; LAD = 19 and RCA = 13). Conclusion Among a highly selected population with FH, we confirm a high prevalence of CAD identified by CTCA. Larger studies are needed to confirm true prevalence in an unselected population and whether knowing this information helps guide preventive or therapeutic measures.
{"title":"P11 Coronary artery disease prevalence by computed tomography coronary angiography in patients with familial hypercholesterolaemia","authors":"A. Hameed, S. Tyebally, L. Menezes, R. Patel","doi":"10.1136/HEARTJNL-2020-BSCI.24","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BSCI.24","url":null,"abstract":"Introduction Early studies of patients with familial hypercholesterolemia (FH) reported mostly on high prevalence and incidence of clinical coronary artery disease (CAD) events. Little data exists on the prevalence of subclinical CAD in the computed tomography coronary angiography (CTCA) era. Methods As part of a wider quality improvement project on appropriateness of CTCA at a tertiary centre in London, we documented core demographics, symptoms, CTCA findings and outcomes in patients with FH undergoing CTCA between 2015–2019. All patients underwent CT calcium scoring (Agatston) and CTCA. CAD presence was defined as having at least mild plaques (>25% stenosis). Results We identified 42 patients with FH and a CTCA (22 men; mean age 49.5 ± 10.6 years). Of these, 23 (54.8%) were mutation positive and 24 (57.1%) were asymptomatic. Additional cardiac risk factors included hypertension (n=5; 11.9%), type 2 diabetes mellitus (n=2, 4.76%), current cigarette smokers (n=8, 19.0%) and a family history of CAD (n=36, 85.7%). Mean LDL was 4.13 mmol/L ± 1.70 mmol/L with mean BMI of 24.6kg/m2. The average Agatston calcium score was 112, equating to a mean age/sex adjusted percentile of 44.7%. CAD was identified in 22 (52.4%) patients, and the majority had plaque in the LAD (LMS = 4; LCx = 7; LAD = 19 and RCA = 13). Conclusion Among a highly selected population with FH, we confirm a high prevalence of CAD identified by CTCA. Larger studies are needed to confirm true prevalence in an unselected population and whether knowing this information helps guide preventive or therapeutic measures.","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115074412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1136/HEARTJNL-2020-BSCI.25
A. Hameed, S. Tyebally, L. Menezes, R. Patel
Introduction Computed tomography coronary angiography (CTCA) is increasingly requested in asymptomatic patients with familial hypercholesterolaemia (FH) to risk stratify and determine cholesterol management strategies. Currently there is no consensus regarding the value of calcium scoring or CTCA for this purpose. We sought to evaluate how often CTCA leads to positive changes in management in this patient group. Methods As part of a wider quality improvement project on CTCA use at a tertiary centre in London, we retrospectively identified patients referred for CTCA from the lipid clinic with confirmed FH between 2015 and 2019. Patient records were reviewed to determine clinical outcomes following CTCA. CTCA reports were scored as having coronary artery disease (CAD) if at least one mildly stenotic plaque (>25%) was identified. Results We identified 42 patients with FH and a CTCA, of which 24 were asymptomatic. 14 had CAD, with most having plaque in the LAD (LMS=2; LAD =13; LCx = 6; RCA = 10). As a result, 10 patients (71.4%) had intensification of their cholesterol management and half (n=7) were initiated on novel PCKS9 inhibitors. The remaining 4 patients with CAD and those with no CAD (n=10) continued on the same treatment without de-escalation. 3 patients had downstream testing for ischaemia. Conclusion In this small case series, we find supporting evidence that CTCA leads to a positive change of management in asymptomatic patients with FH once coronary anatomy is known. Further studies on cost effectiveness, safety and outcomes are needed before this practice can be widely recommended.
{"title":"P12 Exploring the value of computed tomography coronary angiography in guiding management of asymptomatic patients with familial hypercholesterolaemia","authors":"A. Hameed, S. Tyebally, L. Menezes, R. Patel","doi":"10.1136/HEARTJNL-2020-BSCI.25","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BSCI.25","url":null,"abstract":"Introduction Computed tomography coronary angiography (CTCA) is increasingly requested in asymptomatic patients with familial hypercholesterolaemia (FH) to risk stratify and determine cholesterol management strategies. Currently there is no consensus regarding the value of calcium scoring or CTCA for this purpose. We sought to evaluate how often CTCA leads to positive changes in management in this patient group. Methods As part of a wider quality improvement project on CTCA use at a tertiary centre in London, we retrospectively identified patients referred for CTCA from the lipid clinic with confirmed FH between 2015 and 2019. Patient records were reviewed to determine clinical outcomes following CTCA. CTCA reports were scored as having coronary artery disease (CAD) if at least one mildly stenotic plaque (>25%) was identified. Results We identified 42 patients with FH and a CTCA, of which 24 were asymptomatic. 14 had CAD, with most having plaque in the LAD (LMS=2; LAD =13; LCx = 6; RCA = 10). As a result, 10 patients (71.4%) had intensification of their cholesterol management and half (n=7) were initiated on novel PCKS9 inhibitors. The remaining 4 patients with CAD and those with no CAD (n=10) continued on the same treatment without de-escalation. 3 patients had downstream testing for ischaemia. Conclusion In this small case series, we find supporting evidence that CTCA leads to a positive change of management in asymptomatic patients with FH once coronary anatomy is known. Further studies on cost effectiveness, safety and outcomes are needed before this practice can be widely recommended.","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"362 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115900554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1136/HEARTJNL-2020-BSCI.15
M. Hoe, S. Qayyum, D. Auger, N. Damani, A. Griguer, P. Jain, N. Keenan, Masood Khan, Anish Prabhakar, Kevin Rosenfeld, J. Sehmi
Introduction Computer tomography coronary angiography (CTCA) can be performed with improved image quality and at lower radiation dose when heart rate is lowered to less than 60 beats per minute (bpm). In our centre intravenous Metoprolol is administered on the CT table targeting a heart rate below 60 bpm. The aim of this audit was to assess the efficacy of intravenous beta-blockade to achieve optimal heart rates in patients undergoing CTCA. Methods We carried out a retrospective case note review of all patients undergoing CTCA between 1 – 30 November 2018. Scanning was performed using a 320-detector row scanner with prospective gating (Toshiba Aquilon One). Data collected included attending radiologist/cardiologist, dose of Metoprolol, heart rate at time of image acquisition and baseline patient characteristics. Results Case notes of 131 consecutive patients referred for CTCA were reviewed. The mean heart rate achieved was 61.7 bpm (range 30–130 bpm). The average administered dose of metoprolol was 15.5 mg (range 0–60 mg). 51% of patients achieved a heart rate less than 60 bpm at the time of scanning. For patients achieving target heart rates below 60 bpm the average dose of metoprolol was 9.3 mg, and 22.4 mg for those with heart rates greater than 60 bpm at the time of image acquisition. Conclusion Routine administration of intravenous beta-blocker peri-procedure fails to achieve optimal heart rate control in approximately half of all patients undergoing CTCA. Alternative protocols including pre-treatment with a short course of oral beta-blockers should be considered.
{"title":"P02 Efficacy of intravenous metoprolol for heart rate control in patients undergoing CT coronary angiography","authors":"M. Hoe, S. Qayyum, D. Auger, N. Damani, A. Griguer, P. Jain, N. Keenan, Masood Khan, Anish Prabhakar, Kevin Rosenfeld, J. Sehmi","doi":"10.1136/HEARTJNL-2020-BSCI.15","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BSCI.15","url":null,"abstract":"Introduction Computer tomography coronary angiography (CTCA) can be performed with improved image quality and at lower radiation dose when heart rate is lowered to less than 60 beats per minute (bpm). In our centre intravenous Metoprolol is administered on the CT table targeting a heart rate below 60 bpm. The aim of this audit was to assess the efficacy of intravenous beta-blockade to achieve optimal heart rates in patients undergoing CTCA. Methods We carried out a retrospective case note review of all patients undergoing CTCA between 1 – 30 November 2018. Scanning was performed using a 320-detector row scanner with prospective gating (Toshiba Aquilon One). Data collected included attending radiologist/cardiologist, dose of Metoprolol, heart rate at time of image acquisition and baseline patient characteristics. Results Case notes of 131 consecutive patients referred for CTCA were reviewed. The mean heart rate achieved was 61.7 bpm (range 30–130 bpm). The average administered dose of metoprolol was 15.5 mg (range 0–60 mg). 51% of patients achieved a heart rate less than 60 bpm at the time of scanning. For patients achieving target heart rates below 60 bpm the average dose of metoprolol was 9.3 mg, and 22.4 mg for those with heart rates greater than 60 bpm at the time of image acquisition. Conclusion Routine administration of intravenous beta-blocker peri-procedure fails to achieve optimal heart rate control in approximately half of all patients undergoing CTCA. Alternative protocols including pre-treatment with a short course of oral beta-blockers should be considered.","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"368 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124619915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1136/HEARTJNL-2020-BSCI.21
R. Foley, S. Glenn-Cox, B. Hudson, R. MacKenzie-Ross, J. Suntharalingam, G. Robinson, J. Rodrigues
Introduction The right ventricle to left ventricle (RV:LV) ratio >1 on CT pulmonary angiography (CTPA) is the most important predictor of adverse outcomes in acute pulmonary embolism (PE). The 2019 National Confidential Enquiry into Patient Outcome and Death for PE demonstrates that this metric is poorly reported. We assess the feasibility of an entirely automated RV:LV analysis and determine its clinical impact in a real-world setting. Methods 101 consecutive patients with CTPA-proven acute PE (April 2019 to August 2019) were retrospectively analysed with automated post-processing software (Imbio, USA). RV and LV volumes were segmented on 1.5 mm contrast-enhanced axial slices and maximal ventricular diameters were derived for RV:LV ratio. Clinical reports were reviewed for mention of right heart strain. The automated RV:LV ratio was compared with clinical reports to determine how this would have altered practice if it has been available at the time of the report. Results Entirely automated RV:LV analysis was feasible in 87% (n=88). RV:LV ratios ranged from 0.67–2.43, with 64% (n=65) >1.0. Terms implying RV strain were mentioned in 66% (67/101) but RV/LV ratio itself was provided in 4% (4/101). Where RV:LV was >1.0, right heart strain was mentioned in 46% (n=30/65) clinical reports. Automated RV:LV ratio would have added important prognostic information in 54% (n=35/65). Conclusion In a real-word setting of acute PE, automated RV:LV analysis is reliable when LV intraventricular attenuation >100HU. Applied routinely, this technology would improve risk stratification in the majority.
{"title":"P08 Automated calculation of the RV:LV ratio in acute pulmonary embolism: a real-world feasibility and clinical impact study","authors":"R. Foley, S. Glenn-Cox, B. Hudson, R. MacKenzie-Ross, J. Suntharalingam, G. Robinson, J. Rodrigues","doi":"10.1136/HEARTJNL-2020-BSCI.21","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BSCI.21","url":null,"abstract":"Introduction The right ventricle to left ventricle (RV:LV) ratio >1 on CT pulmonary angiography (CTPA) is the most important predictor of adverse outcomes in acute pulmonary embolism (PE). The 2019 National Confidential Enquiry into Patient Outcome and Death for PE demonstrates that this metric is poorly reported. We assess the feasibility of an entirely automated RV:LV analysis and determine its clinical impact in a real-world setting. Methods 101 consecutive patients with CTPA-proven acute PE (April 2019 to August 2019) were retrospectively analysed with automated post-processing software (Imbio, USA). RV and LV volumes were segmented on 1.5 mm contrast-enhanced axial slices and maximal ventricular diameters were derived for RV:LV ratio. Clinical reports were reviewed for mention of right heart strain. The automated RV:LV ratio was compared with clinical reports to determine how this would have altered practice if it has been available at the time of the report. Results Entirely automated RV:LV analysis was feasible in 87% (n=88). RV:LV ratios ranged from 0.67–2.43, with 64% (n=65) >1.0. Terms implying RV strain were mentioned in 66% (67/101) but RV/LV ratio itself was provided in 4% (4/101). Where RV:LV was >1.0, right heart strain was mentioned in 46% (n=30/65) clinical reports. Automated RV:LV ratio would have added important prognostic information in 54% (n=35/65). Conclusion In a real-word setting of acute PE, automated RV:LV analysis is reliable when LV intraventricular attenuation >100HU. Applied routinely, this technology would improve risk stratification in the majority.","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114802198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1136/HEARTJNL-2020-BSCI.23
R. Foley, S. Lyen, N. Manghat, M. Hamilton
Introduction The latest guidelines from the European Society of Cardiology on the management of valvular heart disease have recommended the use of calcium scoring of the aortic valve (AoV) on computed tomography (CT) in patients with severe aortic stenosis (AS) on echocardiography (Baumgartner, Falk, et al., 2017). The objective of this study was to calculate the AoV calcification in patients with severe AS on echocardiography. Methods Data was prospectively collected on all patients undergoing CT for consideration of transcatheter aortic valve implantation (TAVI) from July 2019 - January 2020. CT was performed on multidetector scanners, (Siemens SOMATOM AS+ and Canon Aquilion ONE) and measurements of AoV calcification and AoV area were performed using validated software (TeraRecon, California). Severe AS was defined as an aortic valve area of Results The cohort consisted of 81 patients, 18 of whom contemporaneous echocardiography was available. There were a range of AoV calcium scores from 373–5478, with a mean score of 2,832 arbitrary units. There was a very weak negative correlation between the AoV area and the AoV calcification r=-.06, p=0.42 (Pearson’s). This relationship was not statistically significant. Conclusion In patients with severe aortic stenosis on echocardiography, there is no correlation between AoV calcification and AoV area. It is important to understand the relationship between AoV calcification and AoV area before its use in clinical practice can be advocated.
{"title":"P10 Correlation of aortic valve calcification on CT with aortic valve area estimated by the continuity equation using transthoracic echocardiography","authors":"R. Foley, S. Lyen, N. Manghat, M. Hamilton","doi":"10.1136/HEARTJNL-2020-BSCI.23","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BSCI.23","url":null,"abstract":"Introduction The latest guidelines from the European Society of Cardiology on the management of valvular heart disease have recommended the use of calcium scoring of the aortic valve (AoV) on computed tomography (CT) in patients with severe aortic stenosis (AS) on echocardiography (Baumgartner, Falk, et al., 2017). The objective of this study was to calculate the AoV calcification in patients with severe AS on echocardiography. Methods Data was prospectively collected on all patients undergoing CT for consideration of transcatheter aortic valve implantation (TAVI) from July 2019 - January 2020. CT was performed on multidetector scanners, (Siemens SOMATOM AS+ and Canon Aquilion ONE) and measurements of AoV calcification and AoV area were performed using validated software (TeraRecon, California). Severe AS was defined as an aortic valve area of Results The cohort consisted of 81 patients, 18 of whom contemporaneous echocardiography was available. There were a range of AoV calcium scores from 373–5478, with a mean score of 2,832 arbitrary units. There was a very weak negative correlation between the AoV area and the AoV calcification r=-.06, p=0.42 (Pearson’s). This relationship was not statistically significant. Conclusion In patients with severe aortic stenosis on echocardiography, there is no correlation between AoV calcification and AoV area. It is important to understand the relationship between AoV calcification and AoV area before its use in clinical practice can be advocated.","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132481362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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