Jun 7, 2018 - Hospital* & Royal Brompton Hospital**, Cardiology, Harrow*, London**, United ... Park Hospital, Harrow, United Kingdom; 3Royal Brompton.
1266
Best Posters in stress echocardiography
tween the 2 groups. During a mean of follow up of 3.0 years, the pre-specified, combined endpoint of death, non-fatal myocardial infarction, late revascularization and hospitalization for chest pain occurred in 26 patients in the Ex-ECG arm (3.7%) and 20 patients in the SE arm (3.2%) (hazard ratio, 1.15; 95% confidence interval [CI], 0.39 to 3.43; P=0.38). Resource consumption data were collected on emergency department visits, days in hospital, specialist clinic review, coronary angiography and coronary revascularization procedures. In total, 26 patients in the Ex-ECG arm and 12 patients in the ESE arm underwent invasive angiography (13.4% vs 6.3%, p=0.02) (Fig 1). At 1 year, the mean cost difference between the groups was £81.31. In year 2, the mean cost difference increased by £34.42, and in year 3, the mean cost difference increased further by £19.29. The overall cumulative costs for the entire duration of follow up were £154,382 for Ex-ECG and £120,425 for ESE, giving a unit cost of £796 and £631 respectively (p=0.04). This equated to a greater than 20% reduction in cost with an ESE strategy. Conclusion: In patients with suspected angina, an ESE management strategy is significantly more cost-effective than Ex-ECG during long term follow up, and leads to less invasive angiography. ESE and not Ex-ECG should be the first line test in suspected CAD which has implications on the present guidelines.
P6026 | BEDSIDE Diagnostic concordance and clinical outcomes in patients undergoing fractional flow reserve and stress echocardiography for the assessment of coronary stenosis of intermediate severity S. Gurunathan 1 , A. Ahmed 2 , N. Karogiannis 2 , I.S. Ramzy 2 , A. Vamvakidou 1 , G. Young 2 , S. Zidros 2 , M. Akhtar 3 , A. Elghamaz 2 , R. Senior 1 . 1 Northwick Park Hospital* & Royal Brompton Hospital**, Cardiology, Harrow*, London**, United Kingdom; 2 Northwick Park Hospital, Harrow, United Kingdom; 3 Royal Brompton Hospital, Cardiology, London, United Kingdom Introduction: The ischaemic consequences of a coronary artery stenosis can be assessed by invasive fractional flow reserve (FFR) or by non-invasive imaging. We sought to determine (i) the concordance between wall thickening assessment and FFR during clinically indicated stress echocardiography (SE) and FFR measurements and (ii) the predictors of hard events in these patients. Methods and results: 194 patients who underwent SE and invasive FFR measurements in close succession were analysed for diagnostic concordance and clinical outcomes. At the vessel level, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SE for identifying significant disease as assessed by FFR was 70%, 78%, 46% and 91% respectively. In patients with single vessel disease, the sensitivity, specificity, PPV and NPV were 86%, 66%, 38% and 95% respectively. The greatest discordance was seen in patients with wall thickening abnormalities (WTA) and negative FFR. During a follow up of 3.0±1.9 years there were 15 cardiovascular (CV) events. The number of wall segments with inducible WTAs emerged as the only independent predictor of CV events (HR 1.22 (1.05 – 1.43), p=0.01). FFR was not a predictor of outcome. There was a significant increase in event rate in patients with WTA/ negative FFR and WTA/ positive FFR, compared to patients with no WTA (p=0.04). However, no significant difference was seen between patients with WTA/negative FFR versus WTA/positive FFR (p=0.38)
posed as a noninvasive tool for the diagnosis of coronary vasospasm after confirmation of no obstructive coronary artery disease. However, concern over the safety of ErgECHO remains because of the perceived inability of immediately reversing vasospasm with intracoronary nitroglycerin. Purpose: This study was undertaken to investigate the safety and prognostic value of ErgECHO in a large population for the evaluation of coronary vasospasm. Methods: We studied 3094 consecutive patients from a single-center registry who underwent ErgECHO from November 2002 to June 2009. Medical records, echocardiographic data, and laboratory findings obtained from follow up periods were analyzed. Results: The overall positivity rate of ErgECHo was 8.6%. No procedure-related mortality or myocardial infarction (MI) occurred. Nineteen patients (0.6%) had transient symptomatic complications during ErgECHO, including one who was successfully resuscitated. Cumulative Major adverse cardiac events (MACEs) occurred in 14.0% and 5.1% of the patients in the positive and negative ErgECHO groups, respectively (p
