PT406 Incidental findings are common in CT scans performed prior to atrial fibrillation ablation

Abstract

Introduction: Left ventricular (LV) ejection fraction (EF), LV end systolic volume (LVESV) and scar size are well described predictors of adverse cardiovascular events post myocardial infarction (MI). Objectives: The purpose of this study was to evaluate the relationship between early reduction in LVEF, scar size and altered diastolic function. Methods: Acute STEMI patients (n1⁄4101), treated with percutaneous coronary intervention, were prospectively enrolled (May 2012 to February 2013). Transthoracic echocardiograms (TTE) were performed at 5 3 days (baseline) and 60 14 days (follow up) post STEMI. LVESV, LVEF, and LV diastolic parameters: (diastolic function grade: 01⁄4normal; 11⁄4impaired relaxation; 21⁄4pseudonormal; and 31⁄4restrictive filling, E/E’ ratio, E/A ratio, and deceleration time) were measured from TTE. CMRI with delayed gadolinium enhancement images was used to assess scar size at follow-up. Results: 101 consecutive patients (mean age 56 10 years; 90% males) were recruited. 15.8% had diabetes mellitus; 85% were first presentation of MI. Mean LVEF was 45.3 9.1% (baseline) and 49.2 10.8% (follow up). Twenty-one patients underwent negative remodelling (had a reduction in LVEF from baseline: Group 1). This group had significantly lower E’ (p1⁄40.014), larger E/E’ ratio (p1⁄40.010) and LVESV (p1⁄40.012) at follow-up compared with the group in whom LVEF remained unchanged or improved (Group 2). Negative remodelling was also associated with worse diastolic function grade, and a higher percentage with restrictive filling {Group 1 9/21 (42.8%) vs. Group 2 6/79 (7.5%)} at follow-up. Furthermore, change in LVEF correlated with CMRI scar percentage (R1⁄4 -0.264, P1⁄40.008) and scar volume (R1⁄4 -0.219, P1⁄40.028) at follow-up, such that reduction in LVEF from baseline was present in those with greater scar size. Conclusion: Early LV remodelling changes post STEMI, demonstrated by a reduction in LVEF from baseline, is a predictor for worsening diastolic dysfunction, and is associated with larger scar size. Early LV remodelling changes may contribute useful clinical information to help identify patients at higher risk post-MI. Longer term outcome data will help to further elucidate its prognostic value. Disclosure of Interest: None Declared CT average S-C 4.26 0.001 0.89