A Comparison of Local Referral Patterns For Transthoracic Echocardiography Versus ACC Appropriateness Criteria

S160

Heart, Lung and Circulation 2010;19S:S1–S268

Abstracts

ABSTRACTS

gram, retail pharmacy, pathology services, hospital, GP or remote clinic: (A) all services ≤30 min; (B) >30 min and ≤60 min; (C) >60 min. Examples of the index indicate that the majority of population locations within capital cities were category 1A; Alice Springs and Byron Bay were 3A; and the Northern Territory town of Maningrida had minimal access to cardiac services with an index ranking of 5C. Conclusion: The Cardiac ARIA index provides an invaluable tool to inform appropriate strategies for the use of scarce cardiac resources. doi:10.1016/j.hlc.2010.06.1047 Cardiac Imaging 381 2D Speckle Tracking Strain for assessment of RV function in Healthy Normals E. Chia 1,∗ , C. Hsieh 2 , D. Leung 1 , L. Thomas 1 1 Liverpool

Hospital, Sydney, Australia Hospital, Australia

2 Westmead

Background: The echocardiographic (TTE) assessment of the right ventricle (RV) is difficult due to its complex geometry. Our aim was to evaluate RV function using 2D speckle tracking derived strain (S) and strain rate (Sr). Method: 102 healthy volunteers (ages 20–81) underwent a TTE. Recruits were divided into three age groups (see table). RV systolic and diastolic function were evaluated by Simpson’s RV ejection fraction (RVEF), tissue Doppler S and E and tricuspid peak E velocity. Using 2D speckle tracking, peak systolic S and S-Sr and diastolic E-Sr and A-Sr of the RV lateral wall were measured from basal, mid and apical segments. Results: Although RVEF was similar, S velocity, peak systolic S and S-Sr were reduced in the basal and mid segments with increasing age. A similar reduction was noted in the early diastolic relaxation. Conclusion: Speckle tracking is a useful tool in assessing regional and global RV function and is superior to traditional measures. Normal ageing results in altered RV contractile and relaxation properties. Group 1 (20–34 yrs) (n = 33) RVEF (%) S (cm/s) Basal sys S (%) Basal S-Sr base (s−1 ) Tricuspid peak E (cm/s) Basal peak E (cm/s) Basal E-Sr base (s−1 )

55.9 12.5 29.8 2.1 56.3 13.1 2.34

± ± ± ± ± ± ±

7.6 1.7 7.0 0.7 2.7 2.7 0.7

Group 2 (35–49 yrs) (n = 41) 56.0 11.6 30.1 2.1 51.0 11.2 2.55

∗

p < 0.05 when compared with group 1.

†

p < 0.05 when compared with group 2.

doi:10.1016/j.hlc.2010.06.387

± ± ± ± ± ± ±

7.5 1.4 10.3 0.6 7.9* 2.6* 0.9

Group 3 (>50 yrs) (n = 19) 53.9 11.4 23.4 1.5 44.3 10.1 1.98

± ± ± ± ± ± ±

5.8 1.5* 7.6* 0.5* , † 5.7* , † 2.1* 0.6†

382 A Comparison of Local Referral Patterns For Transthoracic Echocardiography Versus ACC Appropriateness Criteria S. Murch ∗ , D. Prior, A. MacIsaac St Vincent’s Hospital Melbourne, Australia Background: Transthoracic echocardiography (TTE) is a simple and low risk modality for defining cardiac structure and function. However the relative ease of use creates the potential for overuse in patients who may not obtain benefit, with subsequent cost considerations and increased burden on echocardiography services. In light of this, appropriateness criteria for the rational use of transthoracic echocardiography were developed and reported by the American College of Cardiology in 2007. We compared these criteria to local referral patterns for TTE at a metropolitan tertiary referral hospital. Methods: 53 consecutive TTE requests were reviewed prospectively and classified as either appropriate or inappropriate based on clinical information provided. Data was also collected in relation to the source and indication for referral. Results: Of the 53 requests, 40 were for current outpatients and 13 were for inpatients. The majority (27) were requested by cardiology services. 12 were requested by other medical teams, and 9 by GPs. Overall, 41 (77.4%) were classified as appropriate and 12 (22.6%) inappropriate. Of the inappropriate requests, there were no significant differences in relation to source of referral. The most common cause of a request being classified inappropriate was for too frequent monitoring of valvular heart disease. Conclusion: Over one-fifth of TTE requests received locally were considered inappropriate, suggesting that there is scope for improvement in the efficient use of echocardiography services. doi:10.1016/j.hlc.2010.06.388 383 A High Coronary Calcium Score Does Not Preclude Coronary Evaluation by 320 Detector-Row Cardiac CT J. Otton ∗ , N. Sammel, K. Sesel, J. McCrohon, J. De Villiers, L. Bester, D. Boshell, C. Wainwright, M. Feneley St Vincent’s Hospital, Sydney, Australia Background: It has been suggested that CT coronary angiography (CTCA) should not be undertaken in patients with Agatston calcium score (CAC) > 600.