Gender Based Differences in the Clinical Utility of Computed-Tomography Coronary Angiography (CTCA)

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  • ABSTRACTS

    S180 Heart, Lung and CirculationCSANZ 2013 Abstracts 2013;22:S126S266

    as circumferential, radial and area strain in the one anal-ysis.

    http://dx.doi.org/10.1016/j.hlc.2013.05.428

    427

    Feasibility of a Novel Echocardiographic Imaging Tech-nique, Intracatheter Echocardiography, to Guide Venove-nous Extracorporeal Membrane Oxygenation CannulaePlacement in a Validated Ovine Model

    D. Platts 1,2,3,, A. Hilton2, S. Diab3, C. MacDonald3, M.Tunbridge3, S. Chemonges3, K.Dunster 3, K. Shekar 3, D.Burstow1, J. Fraser 3

    1 Echocardiography Department, The Prince Charles Hospital,Australia2 The Austin Hospital, Melbourne, Australia3 Critical Care Research Group, The Prince Charles Hospital,Australia

    Background: Echocardiography plays a fundamentalrole in cannulae insertion and positioning for venovenousextracorporeal membrane oxygenation (VV-ECMO). Cor-rect access (AC) and return cannulae (RC) orientation isrequired to prevent recirculation. The aim of this studywas to compare a novel imaging technique, intracatheterechocardiography (iCATHe), with conventional intracar-diac echocardiography (ICE) to guide placement of bothcannulae.

    Methods: Twenty sheep were commenced on VVECMO. ICEwasperformed followingplacement of the ini-tial AC, thenRC. Location of cannula tipwas documented.After each cannula was positioned using the standard(ICE guided) technique, the ICE probe was passed insidethe cannula, noting location of the tip. At 24 h, the sheepwereeuthanisedandcannulaepositiondeterminedatpostmortem. The two-tailed McNemar test was used to com-pare iCATHe with ICE cannulae positioning.

    Results: Cannula position in 20 sheep on ECMO wasassessed using both ICE and iCATHe. Therewas no signif-icant difference between the two methods in assessing ACposition (proportion correct for each 90%, incorrect 10%).However, there was a signicant difference between ICEand iCATHesuccess rates for theRC (p= 0.001). Proportioncorrect for iCATHeand ICEwas 81%and 19% respectively.iCATHewas 62%more successful (95%CI: 2671%) at pre-dicting placement of the RC. There were no complicationsrelated to the ICE or iCATHe imaging.

    Conclusion: iCATHe is a safe and feasible imaging tech-nique to guide real time VV ECMO cannulae placementand improvesaccuracyofRCpositioningcompared to ICE.

    http://dx.doi.org/10.1016/j.hlc.2013.05.429

    428

    Gender Based Differences in the Clinical Utility ofComputed-Tomography Coronary Angiography (CTCA)

    D. Murdoch1,2,, R. Mason1, A. Basavaraj 1,3, D. Tromp1,R. Markham1, R. Jayasinghe1,3

    1 The Gold Coast Hospital, Australia2 The University of Queensland, Australia3 Grifth University, Australia

    Introduction:CTCA is a sensitive test for detecting clin-ically signicant coronary artery disease. Gender baseddifferences have been observed, withmales having highercalcium scores and higher rates of obstructive coronaryartery disease.However, few studies have outlined clinicalutility: which patients have a negative, reassuring result,and which patients require further investigation.

    Methods: Patients who underwent CTCA for evaluationfor coronary artery disease at the Gold Coast Hospitalfrom 2008 to 2012 were analysed. Data were collected ondemographics, risk factors, prior investigation and refer-ral source. CTCA outcomes and further investigationswere recorded. Comparison was made between male andfemale groups.

    Results: 439 patients were analysed; 221 were males and218 were females. Mean age was 55 years (IQR 4765).In female patients less than 60 years (n= 143), 86% hada normal CTCA and no further test was performed. 12.5%tested positive and 2% underwent intervention. In con-trast, males less than 60 years (n= 131) had a normalCTCA in 58% (p= 0.0001). Twenty-four percent of under-went angiography and 12% required intervention.

    In females over 60 years (n= 75), 60% had a normalCTCA, compared with males over 60 years (n= 90) whereonly 37.7% had a negative test (p= 0.0041).

    Conclusion: For female patients, particularly under theage of 60, CTCA is useful as a rule-out test for signicantcoronary artery disease. This is not the case for males inthis cohort, particularly over the age of 60, with a signif-icantly higher number requiring subsequent testing andintervention.

    http://dx.doi.org/10.1016/j.hlc.2013.05.430

    429

    Global Longitudinal Strain is a Superior Predictor of All-cause Mortality When Compared to Ejection Fraction inPatients with Mild to Moderate Chronic Kidney Disease

    T. Stanton1,, R. Krishnasamy2, R. Leano1, B. Haluska1,C. Hawley2, N. Isbel 2, T. Marwick3

    1 University of Queensland, Brisbane, Australia2 Princess Alexandra Hospital, Brisbane, Australia3 Menzies Research Institute, Tasmania, Australia

    Background: Cardiovascular disease is a major cause ofdeath in chronic kidney disease (CKD). Ejection fraction(EF) is insensitive to minor changes in cardiac function,especially with LVhypertrophy. Global longitudinal strain

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