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Heart, Lung and Circulation Abstracts S2072008;17S:S1–S209

Methods: ACS survivors not accessing cardiac rehabilita-tion were randomly allocated to conventional care (n = 72)or a modular risk factor reduction program (n = 72) pack-aged as a clinic visit plus telephone support. Risk factorswere blindly assessed at baseline and 12 months andcompared with the frequency of GP and Cardiologist con-sultations.Results: Most control and modular patients saw their GP≥5 times (85% vs. 90%) and their Cardiologist at leastonce (65% vs. 57%). Modular patients were more likelythan controls to see a Cardiologist ≥3 times (46% vs. 28%,p = 0.04) and had significantly lower levels for major riskfactors at 12 months. Controls had no significant reductionin either TC or SBP irrespective of medical visit frequencyincluding those who saw their Cardiologist ≥3 times. Inthe modular group, the significant reduction in TC wasunrelated to medical visit frequency but the reduction inSBP was only significant in patients who saw their GP ≥ 5versus those who saw their GP ≥ 4 times (−7.4 ± 15.9 vs.7.8 ± 18.1 mmHg, p < 0.001) or their Cardiologist at leastonce compared to no Cardiologist visits (−6.8 ± 17.8 vs.−2.1 ± 15.8 mmHg, p < 0.01).Conclusion: Despite most ACS survivors in the controlgroup seeing their doctors frequently they had no signifi-cant improvement in risk factors over 12 months. Modularpatients significantly reduced TC independent of medicalvisit frequency but SBP was reduced only in patients whos

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cise. IPS was seen in all 27 athletes and was profound in16 (59%). In these 16 athletes, PVR increased by 10 ± 7%as compared with 20 ± 8% in those with minimal IPS,p = 0.01). The difference in peak exercise PaO2 and exercisecapacity was not significant between the two groups.Conclusions: The novel finding of IPS with exercise is asso-ciated with an amelioration of increases in pulmonarypressure and resistance. This may be at the expense ofhypoxemia but this relationship requires further investi-gation.

doi:10.1016/j.hlc.2008.05.493

493Both Major and Minor Depression Can be AccuratelyAssessed Using the Cardiac Depression Scale

William Shi 1,∗, Andrew Stewart 2, David Hare 1

1 University of Melbourne, Melbourne, Victoria, Australia;2 Austin Health, Melbourne, Victoria, Australia

Objective: The Cardiac Depression Scale (CDS) wasdesigned to measure adjustment disorder with depressedmood common in cardiac patients. The Beck DepressionInventory (BDI), commonly used in cardiac patients, wasdesigned for measuring depression in psychiatric patients.This study examines the predictive accuracy of the CDSand BDI in cardiac patients.Ma93tDnCRmm9vdpdaa86Ctpd

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aw their doctors frequently.

oi:10.1016/j.hlc.2008.05.492

92ntra-pulmonary Shunting Moderates Rises in Pul-

onary Vascular Resistance with Exercise in Endurancethletes—A Novel Description of Exercise Physiology

ndre La Gerche ∗, Andrew T. Burns, Donald J. Mooney,ndrew I. MacIsaac, David L. Prior

St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia

ntroduction: Exercise in athletes results in hypoxemiand increased pulmonary pressures. This would seemounter-productive for performance and so we sought toetter explain this paradox.ethods: Twenty-seven athletes performed maximal exer-

ise on a supine bicycle. PaO2 was measured at baselinend peak exercise. Echocardiographic measures wereecorded in 2 min cycles and agitated saline contrast wassed to enhance Doppler signals. Pulmonary arterial sys-

olic pressure (PASP) was calculated from the tricuspidegurgitation velocity (TRV). Pulmonary vascular resis-ance (PVR) was calculated as: TRV/RV outflow tractime velocity integral. Intra-pulmonary shunting (IPS) wasefined by late appearance of contrast in the LV.esults: Athletes exercised for 21 ± 3 min (mean ± S.D.).ASP was measurable in 26/27 subjects. There was aignificant (p < 0.001) increase in PASP (22 ± 4 mmHg vs.6 ± 13 mmHg), TVI (19 ± 3 cm vs. 26 ± 3 cm) and PVR0.13 ± .02 m/(s cm) vs. 0.17 ± .02 m/(s cm)) whilst PaO2 fell102 ± 7 mmHg vs. 89 ± 9 mmHg, p < 0.001) during exer-

ethod: One hundred and forty-one cardiac outpatientsnd inpatients (with one or more of coronary artery disease3, post-myocardial infarction 63, post-bypass surgery5, heart failure 39, valve disease 44), after completinghe CDS and BDI, underwent blinded, clinical rating ofSM-IV major and minor depression using the Mini Inter-ational Neuropsychiatric Interview. Receiver Operatorharacteristic curves were constructed.esults: The CDS demonstrates normal distribution withean 75.8 ± 30.8S.D., Cronbach’s α 0.96. For detectingajor depression, A CDS cut-off score of ≥100 provides

5% sensitivity and 92% specificity. A cut-off of ≥94 pro-ides 100% sensitivity and 86% specificity. A BDI (skewedistribution with mean 8.5 ± 8.0S.D., α 0.90) cut-off of ≥10rovides 92% and 90%, respectively. For detecting minorepression, a CDS cut-off of ≥80 provides 94% sensitivitynd 77% specificity. A CDS cut-off of ≥76 provides 100%nd 73%, respectively. A BDI score ≥10 provides 63% and8%, respectively. A BDI cut-off of ≥6 is optimal (88% and6%, respectively) for minor depression.onclusions: The CDS and BDI have excellent proper-

ies for detecting major and minor depression in cardiacatients. The CDS is more accurate for detecting minorepression.

oi:10.1016/j.hlc.2008.05.494