ECG CRITERIA FOR LEFT ATRIAL ENLARGEMENT LACKS SENSITIVITY

Abstract

s S219 measurements of LAA dimensions prior to implantation. Preimplantation measurements are typically performed using trans-esophageal echocardiogram (TEE). Patients are usually fasting for these procedures, and may be volume deplete. The purpose of this observational study was to evaluate the change in LAA dimensions following volume loading. METHODS: Eight consecutive patients who underwent percutaneous LAA closure (with either the Amplatzer Cardiac Plug or Watchman devices) were included in this study. The patients were fasting prior to the procedure as per standard protocol. After induction with general anesthesia, a TEE probe was inserted. Measurements of the LAA orifice and depth were taken at 90 degrees and 135 degrees. After initial measurements were complete, the patients were given a bolus of approximately one litre of Normal Saline. Measurements of the LAA were repeated after the bolus was complete. RESULTS: The average age of the patients were 75 9.1 years, and the mean CHADS2 score was 3.3 1.4. All patients had underlying atrial fibrillation with contraindications to anticoagulation. The average dimension of the LAA at 90 degrees was 20.9 2.6 mm, and at 135 degrees was 20.3 3.0 mm. Following volume loading, the averaged dimension increased to 22.9 3.0 mm at 90 degrees, and 22.3 2.0 mm at 135 degrees. The depth of the LAA at baseline was 24.3 4.8 mm, and at 135 degrees was 20.9 4.1 mm. After volume loading, the depth of the LAA was26.4 3.5 mm at 90 degrees, and 24.4 3.3 mm at 135 degrees. The average increase in width was 2.0 mm (p1⁄40.0004), and increase in depth was 2.8 mm (p1⁄40.0013). All patients had mean left atrial pressure >15mmHg after volume loading. CONCLUSION: The dimensions of the LAA increased with normal saline volume loading during percutaneous LAA closure. Given the importance of pre-implantation measurements for accurate device sizing and the increase in LAA dimensions observed in our study with volume loading, operators should ensure that patients are adequately volume loaded prior to making final measurements and device sizing choices during percutaneous LAA closure. Canadian Cardiovascular Society (CCS) Poster IMAGING POSTER SESSION II Sunday, October 26, 2014 322 ECG CRITERIA FOR LEFT ATRIAL ENLARGEMENT LACKS SENSITIVITY TS Tsang, P Nair, P Lee, J Jue, K Gin Vancouver, British Columbia BACKGROUND: Left atrial (LA) enlargement is associated with diastolic dysfunction, atrial fibrillation (AF), recurrence of AF events, heart failure, stroke, and premature death. ECG criteria for LA enlargement were developed long before the prognostic implications of LA enlargement became known. The present study sought to determine the accuracy of ECG criteria to diagnose LA enlargement, using standard echocardiography (echo) criteria for comparison. MATERIAL AND METHOD: The first 200 patients with AF seen at the UBC Vancouver General Hospital AF Clinic were evaluated. All had ECGs performed during their first visit, and 182 patients underwent echo within 8 weeks of their first visit. Of these, 136 patients were in sinus rhythm at the time of ECG and echo and are included in this analysis. LA volume was determined using biplane area length method as per American Society of Echocardiography (ASE) criteria. In addition to the use of the current ASE partition at 28 mL/m2 to separate normal from mild LA enlargement, we also analyzed our laboratory cut-off value for enlargement of LA from internal data validated against MRI but not yet published. ECG LA enlargement was based on standard ECG criteria. RESULTS: The mean age of the he 136 patients (78 men, 58 female), was 63 11 years, and mean BMI was 26 4.7 kg/m2. Meanheart ratewas 76 15bpmwithmeanbloodpressure146/ 72 19/10 mm Hg. A history of hypertension, diabetes, heart failure, TIA or stroke, was present in 94 (69%), 20 (15%), 27 (20%), and 11(8%), respectively.MeanCHADS2 score was 2 1.3. Mean indexed LA volume was 43 18 mL/m2 and mean LV ejection fractionwas 59 8%.ByASE echo criteria with cutoff at 28 mL/m2, LA enlargement was present in 98% of all patients.ByUBCVGHecho lab criteria for LA enlargementwith cut-off at 32mL/m2 based on internal data, LA enlargement was present in 92% of the patients. In these patients, sensitivity of ECG finding of p>120ms was 31%, biphasic P wave in V1was 27%, and notched P >40 ms was only 6%. Specificity of any individual ECG criteria for LA enlargement was 100%. CONCLUSION: ECG is insensitive for detection of LA enlargement and cannot be used as a diagnostic modality for purposes of prognostication in patients with paroxysmal AF 323 [18F]-SODIUM FLUORIDE IS A NOVEL BIOMARKER OF ACTIVE CALCIFICATION AND POSITIVE PLAQUE REMODELING: A SUB-STUDY OF THE CANADIAN ATHEROSCLEROSIS IMAGING NETWORK (CAIN-2) MS Cocker, J Spence, GA Wells, R Hammond, B Mc Ardle, R deKemp, C Lum, T Karavardanyan, A Adeeko, A Hill, S Nagpal, G Stotts, J Renaud, C Kelly, J Brennan, L Garrard, MAlturkustani, L Hammond, J DaSilva, M Yaffe, J Tardif, R Beanlands