POST

ERABST

RACTS

Results: Over a period of 8 weeks, 173 cases were included of which 111 were coronaryangiography (64%) and the remainder PCI. There was a good correlation between PSD andFT r¼ 0.80, dose area product (DAP) r¼0.87 and Kar r¼0.92. 8 % of patients wereregarded as high risk on PSD, 5% on Kar 4% on FT all of whom underwent PCI. 5 cases(3%) were only at risk on PSD.Patients undergoing angiography who were obese, had higher PSD (p ¼ 0.001), DAP

(p¼ 0.001) and Kar (p ¼0.003). Radial access (n ¼ 57) compared with femoral conferredno difference in FT (6.7 vs 4.9 p ¼0.194,) Kar (0.696 vs 0.691 p ¼ 0.943) or PSD (0.322 vs0.344 p ¼ 0.891).Conclusion: Peak skin dose as defined on DTS correlates well with Kar and fluoroscopytime. Whilst obesity is related to increased PSD, radial access site results in no increase. Realtime PSD monitoring may allow greater risk stratification for patient safety in coronaryprocedures.Disclosure of Interest: None Declared

PM420

Does The Presence of Diabetes Influence Referral for Coronary Revascularizationafter Myocardial Perfusion Imaging?

Shigeru Fukuzawa*1, Shinnichi Okino1, Atsushi Ikeda11Division of Cardiology, Funabashi Municipal Medical Center, Chiba, Japan

Introduction: Previous data suggest diabetic patients are at greater risk for future cardiacevents than non-diabetics. However, data regarding the referral pattern for cardiac cathe-terization or coronary revascularization after myocardial perfusion imaging (MPI) arelimited.Objectives: The purpose of this study was to evaluate the incremental role of stress single-photon emission computed tomography imaging in diabetic patients in the prediction ofcardiac catheterization or coronary revascularization.Methods: 2452 patients without any prior coronary artery disease (CAD) referred for MPIduring 2001 - 2010 were identified. All MPI studies were interpreted using 4-point systemwith 17- segment model and summed stress score (SSS) were categorized as: normal (SSS< or ¼ 3), mild (SSS 4-8), and severe (SSS > or ¼ 9) defects. Significant CAD by cardiaccatheterization was defined as > 70% stenosis of any vessel or > 50% left main stenosis.Results: In 2452 patients, 909 (37.0 %: Diabetes 449, Non-diabetes 460) underwentcardiac catheterization within 90 days of study and 673 (27.4%: Diabetes 363, Non-diabetes 310) patients required revascularization therapy. The referral trends for cathe-terization were similar between diabetic and non-diabetic patients across all perfusioncategories (Normal/Mild/Severe: 4.2%/73.4%/99.4% in Diabetes, 3.4%/67.3%/99.7% inNon-Diabetes), whereas the referral for revascularization of diabetic patients was higherthan non-diabetic patients in relation to imaging results (Normal/Mild/Severe: 0.8%/38.5%/92.6% in Diabetes, 0.2%/26.9%/78.9% in Non-Diabetes).Conclusion: Referral for cardiac catheterization in diabetic patients with suspected CADwas no different from non-diabetic patients. On the other hand, diabetes is an independentpredictor of revascularization based on severity of perfusion abnormalities on MPI.Disclosure of Interest: None Declared

PM421

The Usefulness Of Stress Myocardial Perfusion Imaging As A Predictor ofCardiovascular Events In Patients With Prior Coronary Artery Disease

Tatsuhiko Furuhashi*1, Masao Moroi1, Toru Awaya1, Megumi Minakawa1, Hirofumi Masai1,Taeko Kunimasa1, Hiroshi Fukuda1, Kaoru Sugi11Division of cardiovascular medicine, Toho University Ohashi Medical Center, Tokyo, Japan

Introduction: Stress myocardial perfusion imaging (MPI) is well established for coronaryartery disease (CAD) diagnosis and prognosis.Objectives: However, the fixed and/or reversible defect of stress MPI results variesconsiderably among patients with CAD history. We compared the usefulness of stress MPIresults and baseline clinical factors as independent predictors of cardiovascular events inpatients with CAD history.Methods: Summed stress score (SSS), summed rest score (SRS), and summed differencescore (SDS) were calculated for 354 patients with CAD history (n ¼ 354, 281 males; meanage, 71 years; mean CAD duration before stress MPI, 7.1 years; mean observation period,32 months; myocardial infarction history, n ¼ 179 patients) who underwent stress MPI.Cardiovascular events were defined as cardiac death, non-fatal myocardial infarction andBraunwald III unstable angina requiring hospitalization.Results: Cardiovascular events were observed in 45 patients (13%). Univariate Coxregression analysis identified the following as significant predictors of events; peripheralartery disease (PAD), diabetes, chronic kidney disease (CKD), current smoking, leftventricular ejection fraction (LVEF) and SDS of stress MPI result. Multivariate Coxregression analysis revealed that PAD (hazard ratio ¼ 5.41; P ¼ 0.002), current smoking(hazard ratio ¼ 6.80; P < 0.001), CKD (hazard ratio ¼ 2.97; P < 0.001) and SDS ofstress MPI (hazard ratio ¼ 1.21; P ¼ 0.002) were independent and significant risk factorsof cardiovascular events. Kaplan-Meier survival curves shown in Figure 1 revealed thatthe prognosis of cardiovascular events was significantly better in patients with noreversible defect abnormality (SDS <2) than in patients with reversible defect abnor-mality (SDS �2). In addition, as shown in Figure 2, we compared patients with 0-1coexisting risk factors (PAD, current smoking, and CKD) and patients with 2-3 riskfactors. In patients with and without reversible defect abnormality, the prognosis ofcardiovascular events was significantly better in patients with 0-1 factors compared withthose with 2-3 factors.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Conclusion: In patients with CAD history, baseline clinical factors (PAD, current smokingand CKD), and SDS of stress MPI results are significant predictors of cardiovascular events.Stress MPI may have a relatively limited role in predicting cardiovascular events.Disclosure of Interest: None Declared

PM422

Can Myocardial Blushing Grade Predicts Myocardial Viability?

Ismail Johan*1, Ibrahim Zubin1, Arshad Kamal1, Abd Rahman Effarezan1,Zainal Abidin Hafisyatul1, Lim Chiao Wen1, Kasim Sazzli11Cardiology, UiTM, Sungai Buloh, Malaysia

Introduction: Reperfusion strategy with thrombolysis is still widely practised. Despitetimely reperfusion, occluded infarct related vessels are seen during angiography in theabsence of ischemic symptoms. Revascularisation is an option if sufficient ischaemicburden demonstrated. Little is known on assessing myocardial viability using myocardialblush grade and confirmation with dobutamine stress echo in these patients.Objectives: Myocardial viability assessment using myocardial blush grade and associationwith dobutamine stress echocardiogram.Methods: Stable patients post acute coronary syndrome that undergo coronary angiog-raphy from year 2011 to 2012 were recruited. A total of 135 arteries were analyzed. Duringcoronary angiogram the Myocardial Blush Grade (MBG) was scored. Dobutamine echo-cardiography was done for viability assessment of the related artery and read independentof the angiography result.Results: Majority of the study samples were men (66.7%) with mean age of 61.8 � 7.8years. MBG 0 was present in 22 (16.3%) arteries, grade 1 in 53 (39.3%) arteries, grade 2 in44 (32.6%) arteries, and grade 3 in 16 (11.9%) arteries. Among the 22 arteries with MBGscore 0, 17 (77.3%) were still viable when assessed with dobutamine stress echocardio-gram. There was no association MBG score and myocardial viability found, x2 (3, N ¼ 135)¼ 7.53, p ¼ 0.06.Conclusion: In stable patients post ACS, using MBG alone may not be sufficient to fullydemonstrate viability, as those with MBG 0 the myocardium may still be viable.Disclosure of Interest: None Declared

PM423

Exercise Left Ventricular Diastolic Filling Pressure: Relationship To Ischemia

Marina Deljanin Ilic*1, Stevan Ilic1, Viktor Stoickov1, Dimitra Kalimanovska Osric2,Vladimir Ilic11Cardiology, Institute of Cardiology, Medical Faculty University of Nis, Nis, 2Cardiology, Clinicof Cardiology-Kcs, Belgrade, Serbia

e147