23. Does the maximum allowable contrast dose (MACD) predict the risk of contrast induced nephropathy (CIN) in patients with chronic kidney disease (CKD)

BackgroundCIN is associated with high in-hospital mortality. Some studies recommend the utilization of the MACD formula to guide safe contrast dosing, however the evidence supporting use of this measure is limited.ObjectiveThe purpose of this study was to determine if MACD is helpful in predicting the risk of CIN in patients with CKD.Methods8670 patients who underwent coronary angiography in our center with or without Percutaneous Coronary Intervention (PCI) (2008–2013) were included. Patients with CKD (n=144) were selected. Patients in shock, on intra aortic balloon pump, on prophylactic hemofiltration or on dialysis were excluded.Creatinine was measured 48–72h post procedure. T-test, Chi-Square and multiple regression were used to compare those patients who developed CIN and those who did not develop CIN. CIN was defined as an increase in serum creatinine by ⩾25% or 0.5mg/dL from baseline within 48–72h after contrast exposure.ResultsCIN occurred in 28 patients (19.4%). Only 8 (5.6%) of the 144 patients exceeded MACD and 2 of these patients developed CIN. The use of biplane angiography explains the lower contrast dose. For this reason the impact of exceeding MACD could not be evaluated. Primary PCI was associated with CIN (p=0.012; OR 5.1)).ConclusionOverall it is best to limit contrast dose to the extent possible as this is a known risk factor, however MACD is not a useful variable in a risk model for predicting CIN in our population. Primary PCI was the only predictor of CIN in our population

Quality of anticoagulation control among patients with atrial fibrillation: An experience of a tertiary care center in Saudi Arabia

Background: Atrial fibrillation (AF) is the most common chronic rhythm disorder. Patients with AF are at an increased risk of ischemic stroke. Therefore, optimal anticoagulation is essential to reduce the risk of stroke. The aim of this study was to assess the level of anticoagulation control achieved in patients with nonvalvular AF receiving medical care in a tertiary care hospital. Methods: This was a retrospective cohort study in ambulatory care clinics at tertiary care hospital in Saudi Arabia. We included 110 nonvalvular AF patients treated with warfarin for at least 3 months at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between May 1, 2012, and July 31, 2012. Thereafter, international normalized ratio results were collected for 1 year. Anticoagulation control was assessed by calculating time within therapeutic range (TTR) as per the Rosendaal method. Results: The mean age was 64.9 ± 16.5 years; 60.9% were female. The mean TTR was 59%. Almost one third of the patients (32.7%) had poor anticoagulation control; TTR of <50%. Poor anticoagulation control was significantly associated with higher CHADS2 (congestive heart failure, hypertension, age, diabetes, stroke) score (p = 0.043). TTR was not significantly different between men and women. Similarly, TTR was not associated with age or duration of anticoagulation. There was no adequate information to assess the effect of other factors such as diet, compliance, and level of education on anticoagulation. Thirty-one patients (28.2%) had a history of prior stroke. The overall quality of anticoagulation was not significantly different between patients with and without stroke, (TTR was 56.3% and 60.1%, respectively; p = 0.46). Conclusion: Quality of anticoagulation in patients with AF receiving medical care in a tertiary care hospital was suboptimal, with nearly 40% of the time spent outside the therapeutic range. Methods to improve anticoagulation control among patients with AF should be implemented

33. Two dimensional and M-mode measurements of tricuspid annular systolic plane excursion, are they comparable?

Right ventricular (RV) function has been shown to be a major determinant of clinical outcome. American Society of Echocardiography (ASE) recommends using several measurements to assess RV function including tricuspid annular systolic plane excursion (TAPSE). Conventionally, TAPSE is measured from M-mode interrogation of tricuspid annulus in 4-chamber view which was not routine measurement in many echocardiographic laboratories prior to the guidelines. In this study we sought to determine the feasibility to measure TAPSE from 2-dimensional echo (2D-TAPSE) and to compare it with that obtained by M-mode (MM-TAPSE). Methods: We included 45 patients referred for RV function assessment. MM-TAPSE measurements were obtained from routinely performed echocardiography. 2D TAPSE measurements were obtained offline by an experienced echocardiologist. It was calculated as the difference in the distance between tricuspid annular plane and a fixed point in the image sector in diastole and systole. Results: The mean age was 34.9 ± 13 years, males were 46%. The 2D-TAPSE measurements were feasible in all the patients (100%). MM-TAPSE was 2.05 ± 0.49 cm and 2D-TAPSE was 1.96 ± 0.47 cm, the mean difference was −0.08 ± 0.2 cm. There was good correlation between the two methods; the correlation coefficient was 0.81. Intra-class correlation (ICC) test also showed very good agreement between MM-TAPSE and 2D-TAPSE (ICC coefficient = 0.90, p < 0.001). Conclusion: MM-TAPSE and 2D-TAPSE correlate strongly. 2D-TAPSE can provide a reliable alternative to MM-TAPSE to quantitatively measure RV systolic function and may be especially useful in situations where retrospective comparisons are sought

3. Clinical features and outcome of patients with recurrent myocarditis

Clinical research. Presentation Type: Oral presentation. Introduction: Myocarditis can be associated with short and long term major cardiac event. However, most episodes are self-limited and rarely recurrent. The aim of this analysis was to describe a series of six patients who had multiple episodes of recurrent myocarditis and characterize their clinical, laboratory, electrocardiographic (ECG) and imaging features. Methodology: The patients were identified from cardiac MRI (CMR) database during the period of 2007–2016. Patients records were reviewed for demographic data, laboratory results including serum troponin I, ECG findings, coronary angiography, imaging findings from echocardiography and CMR. The diagnosis of acute myocarditis was ascertained by a combined clinical and imaging findings. Patients with myocarditis related to connective tissue disease were excluded. Results: During the study period, a total of 37 patients presented with acute myocarditis of which 6 (16.2%) patients (mean age 31.7 ± 10.4 years, 100% males) had multiple recurrent episodes; twice in 4 patients and 4 episodes in 2 patients (Table 1). The mean interval period between the first and last attack was 3.3 years (range was 0.8–5.0). After a median follow-up of 4.4 years, there was evidence of new epicardial or mid-wall myocardial delayed enhancement (MDE) with every new episode and all patients had persistent MDE on the last CMR. However, no patient developed persistent heart failure symptoms or left ventricular ejection fraction <40%. Only one patient had transient heart failure symptoms which improved on angiotensin converting enzyme inhibitors and beta blockers. Table 1 demonstrates imaging findings from the last echocardiography and CMR examinations. Conclusion: Recurrent myocarditis in our population is probably under-reported. One in six patients with myocarditis had clinical and imaging proven recurrence. The use of CMR may help to ascertain the diagnosis in otherwise unexplained elevated cardiac markers. The long term management and outcome of recurrent myocarditis requires further study

Paradoxical embolism in acute myocardial infarction in a patient with congenital heart disease

We present a case of a young male with severe pulmonary stenosis, hypoplastic right ventricle, and atrial septal defect. Acute embolic myocardial infarction, followed by cardiac arrest, occurred during hospitalization after Glenn operation. The therapeutic challenges are discussed. Insufficient anticoagulation therapy during the postoperative period was a possible contributing factor leading to embolic myocardial infarction

4. Comparing risk factors profile in patients with Coronary Artery Disease who underwent cardiac catheterization with those revealed to have normal coronary arteries: A case-control study

Coronary Artery Disease (CAD) is one of the major causes of morbidity and a leading public health issue, comprising the death causes of millions of men and women worldwide. Most of prior studies in the region of the modifiable risk factors were cross-sectional studies. Objectives: Study was conducted to compare those who revealed to have CAD after cardiac catheterization with those who shown to be free from CAD. The comparison planned based on the following variables: age, gender, Body Mass Index (BMI), smoking, hypertension, dyslipidemia, diabetes mellitus, and the presence or absence of family history of CAD, in order to identify significant risk factors of CAD in our population. Second objective was to identify the most important predictors for CAD, in order to help clinicians identifying main characteristics of a cardiac cath candidate in our population. Methods: A case-control study was conducted by extracting data of patients who underwent cardiac cath between 10th of June 2008 and 8 July 2013. Patients’ information was taken from King Abdulaziz Cardiac Center in Riyadh (KACC) catheterization lab with the following inclusion and exclusion criteria: • Inclusion criteria: Age >18, both genders, suspected to have CAD and had at least one visit prior to catheterization. • Exclusion criteria: other cardiac diseases including valvular disease, vacuities, congenital anomalies, and cath done not primarily to rule out CAD Sample size was calculated based on presence of family history with estimated proportion of 0.048 in controls, odd ratio of 3, 95% confidence level and 90% power to be 484 subjects in total (with a case to control ratio of 1:1, 242 for each group). The sample size then was maximized to include all patient who were found not having CAD after heart cath (total of 456 for control group), cases (those found to have CAD) were minimized to 456 subjects through computerized based simple random sampling technique. Data was recorded in data collection sheet based on subjects’ disease status (diseased, or not diseased), and their exposure to single or multiple factors. Results: Total of 912 subjects included in the analysis, 456 for each group. The mean was 58.52 ± 13, and the mean BMI was 29.8 ± 6. Smoker were 25.5%, those with hypertension were 58%. Hyperlipidemia was experienced in 49%, diabetes in 50.7% of subjects. Family history of CAD presented in 4.8% of total subject who went for cardiac cath. All expected risk factors entered in the logistic regression analysis, and showed significantly different prevalence in patients with CAD compared to those without; gender (P < 0.001),diabetes (P < 0.001),age (P < 0.001), BMI (P < 0.001), dyslipidaemia (P < 0.001), smoking (P = 0.017), family history (P = 0.994) and hypertension with P < 0.001. Conclusion: The most important predictors of CAD in our population were age, gender, BMI, dyslipidaemia, diabetes mellitus and smoking. Whereas, family history was not recognized as predictor, this is may be due improper documentation of this variable in patient records