improvement and there has been strong sonographer support ... 2 University of Sydney, Sydney, Australia. 3 Royal Prince Alfred Hospital, Sydney, Australia.
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being presented in an anonymised whole-practice form, and the strong support of an engaged cardiologist group. QA meetings provide a forum to discuss opportunities for quality improvement and there has been strong sonographer support and uptake. Conclusion: HeartCare Partners’ QA program demonstrates that conducting a large-scale program in a busy, multi-centre practice is feasible and effective.
Reference [1] Eccelston D, Cehic D, Mohammed H, Cross D. Genesis of clinical quality activities within a national echocardiography database: observations from the Heartcare group registry. Heart Lung and Circulation 2015;24(3):S343.
http://dx.doi.org/10.1016/j.hlc.2016.06.550 549 Implications of Late Gadolinium Enhancement for Diastolic Function in Cardiac Sarcoidosis P. Gupta 1,2,∗ , K. Stanton 1,2 , A. Pope 2 , S. Grieve 2,3 , J. Ayer 2 , R. Puranik 1,2,3 1 CMR
Sydney, Australia of Sydney, Sydney, Australia 3 Royal Prince Alfred Hospital, Sydney, Australia 2 University
Background: Late gadolinium enhancement (LGE) detected on Cardiac Magnetic Resonance Imaging (CMR) in patients with cardiac sarcoidosis (CS) is associated with ventricular arrhythmia and systolic dysfunction. However, the correlation between LGE and diastolic dysfunction is not well understood. Hence, we evaluated diastolic function in patients with definite sarcoidosis and in whom LGE was detected on CMR. Methods: Fifty consecutive patients referred for CMR (1.5T) to evaluate for CS, with biopsy proven extracardiac sarcoidosis and LVEF ≥50% were enrolled. The cohort was divided into two groups based on the presence or absence of LGE. LV diastolic function was assessed using through-plane phase contrast imaging of transmitral flow. Result: Fifteen patients (30%) were LGE positive. Baseline characteristics were comparable between the LGE positive and LGE negative groups (age [59 ± 23 yrs vs 56 ± 17 yrs, p=0.22], sex [Male: 9/15 vs 23/35, p=0.79], BSA [1.98 ± 0.36 kg/m2 vs 2.00 ± 0.45 kg/m2 , p=0.83]). Compared with patients without LGE, the LGE positive group had significantly reduced diastolic time/RR interval ratio (0.52±0.15 vs 0.58±0.15, p=0.03), shortened late diastolic filling time (154 ±68ml vs 180±54ml, p=0.009) and increased early diastolic flow rate (170±146ml/s vs 136±96ml/s, p=0.01). The RR interval, LV stroke volume and cardiac index were comparable between the two groups. Conclusion: Diastolic dysfunction is an important manifestation of cardiac sarcoidosis. Late gadolinium enhancement is associated with diastolic dysfunction in CS and can be reliably quantified on CMR. These findings may become useful predictors of prognosis. http://dx.doi.org/10.1016/j.hlc.2016.06.551
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550 Initial Experience of a New TTE Score as a Predictor of Paravalvular AR Post-Transcatheter Aortic Valve Replacement T. Hall, G. Scalia ∗ , B. Fitzgerald, A. Rainbird Heartcare Partners Wesley Hospital, Brisbane, Australia Background: Paravalvular aortic regurgitation (PAR) affects prognosis of patients following transcatheter aortic valve replacement (TAVR). Degree of calcification of the aortic valve is a known predictor of PAR. We sought to determine if the extent and pattern of valvular calcification determined by a novel transthoracic echocardiography (TTE) score correlated with the degree of PAR following Portico TAVR (St Jude Medical) implantation Methods: From October 2015 to February 2016, 11 patients underwent a Portico TAVR. Four cardiologists independently scored the valvular calcification on a preoperative TTE. The aortic valve calcium score (AVCS) comprised the following variables – leaflets affected, extent of calcium, commissures affected, sub and supravalvular calcification. The average score for each patient was determined. Degree of PAR on day 1 TTEs was graded from 0 and 4 according to American Society of Echocardiograhy guidelines Results: The mean AVCS was 7.5 (5.75-8.5). There was significant interobserver variability in absolute scores between raters however if scores were clustered to mild, moderate or severe calcification there was significantly improved agreement (mean % agreement =62%).The AVCS was not a reliable predictor of PAR in this initial series.
Conclusion: AVCS is a novel tool to grade calcium prior to TAVR on TTE. In this initial experience it was not shown to predict postoperative PAR but shows promise as a feasible and reproducible tool amongst users. Further research with more patients is needed to determine its utility as a PAR predictor with the Portico system and its correlation with CT calcium mapping. http://dx.doi.org/10.1016/j.hlc.2016.06.552
