D. Playford

Pulmonary hypertension: prevalence and mortality in the Armadale echocardiography cohort

Background Pulmonary hypertension (PHT) lacks community prevalence and outcome data. Objective To characterise minimum ‘indicative’ prevalences and mortality data for all forms of PHT in a selected population with an elevated estimated pulmonary artery systolic pressure (ePASP) on echocardiography. Design Observational cohort study. Setting Residents of Armadale and the surrounding region in Western Australia (population 165u2008450) referred to our unit for transthoracic echocardiography between January 2003 and December 2009. Results Overall, 10u2008314 individuals (6.2% of the surrounding population) had 15u2008633 echo studies performed. Of these, 3320 patients (32%) had insufficient TR to ePASP and 936 individuals (9.1%, 95% CI 8.6% to 9.7%) had PHT, defined as, ePASP>40u2005mmu2002Hg. The minimum ‘indicative’ prevalence for all forms of PHT is 326 cases/100u2008000 inhabitants of the local population, with left heart disease-associated PHT being the commonest cause (250 cases/100u2008000). 15 cases of pulmonary arterial hypertension/100u2008000 inhabitants were identified and an additional 144 individuals (15%) with no identified cause for their PHT. The mean time to death for those with ePASP >40u2005mmu2002Hg, calculated from the first recorded ePASP, was 4.1u2005years (95% CI 3.9 to 4.3). PHT increased mortality whatever the underlying cause, but patients with PHT from left heart disease had the worst prognosis and those with idiopathic pulmonary arterial hypertension receiving disease-specific treatment the best prognosis. Risk of death increased with PHT severity: severe pulmonary hypertension shortened the lifespan by an average of 1.1u2005years compared with mild pulmonary hypertension. Conclusions In this cohort, PHT was common and deadly. Left heart disease was the most common cause and had the worst prognosis and treated pulmonary arterial hypertension had the best prognosis.

Prevalence of pulmonary arterial hypertension in an Australian scleroderma population: screening allows for earlier diagnosis

Background:u2002 We sought to determine the prevalence of pulmonary complications and especially pulmonary arterial hypertension (PAH) in an Australian scleroderma population.

Improving stress testing compliance following chest pain presentations to the emergency department

To determine whether a booked appointment time improves early outpatient exercise stress testing (EST) guideline adherence in patients discharged from the ED following assessment for possible acute coronary syndrome (ACS).

Mortality from Aortic Stenosis Across the Spectrum of Severity: Analysis of Big Data from the National Echo Database of Australia

Geoff Strange1, Simon Stewart2, David Celermajer3, Tom Marwick4, Greg Scalia5, David Prior6, Marcus Ilton7, David Playford1. 1University of Notre Dame, Fremantle, Australia; 2University of Adelaide, Adelaide, Australia; 3University of Sydney, Sydney, Australia; 4Baker IDI, Melbourne, Australia; 5University of Queensland, Queensland, Australia; 6University of Melbourne, Melbourne, Australia; 7Royal Darwin Hospital, Darwin, Australia Background: Echocardiography (echo) is pivotal in evaluation of aortic valve gradients. We evaluated prognostic implications of the full spectrum of aortic stenosis severity in a large patient cohort, matched with mortality data. Methods: NEDA is a vendor-agnostic cloud-based database, containing echo measurement data (1997 -2017) from laboratories (N=10) across Australia (currently >530,000 Echos). Data linkage to the National Death Index (NDI) provided survival status on each induvial from the last recorded echo to a census date in October 2017. Data were available from 352,844 individuals comprising 186,820 men (60.8±18.0 yrs) and 166,024 women (60.9±19.2 yrs) with a mean follow up of 5.4 years per person and 63,142 fatal events. Results: Overall, a peak aortic valve velocity (AVvel) was recorded in 278,955 patients, demonstrating a J-shaped mortality pattern with highest ageand sex-adjusted risk profi le in those individuals (n=52,010) in the upper quintile (> 1.8 m/s and mean aortic gradient of 13mmHg); HR=1.29 (95% CI 1.25-1.32, p<0.001) relative to the lowest quintile. 1and 5-year mortality was 5.0% and 14.9% in the lowest vs 9.2 and 28.1% in the highest (p<0.0001) quintile, respectively. Th ose cases in the upper quintile were then further examined for survival against increasing gradients (n=44,340). Aft er adjusting for age, gender and ejection fraction, the mortality risk plateaued at a threshold of a mean gradient ≥30.9±1.3mmHg (AVvel > 3.71±0.26m/s), with an adjusted HR=0.94(95% CI 0.82-1.08, p=0.4) compared with those in the upper quintile of that group (mean gradient 59.9±9.4mmHg, AVvel 4.96±0.47m/s). 1and 5-year mortality profi les were equivalent for those with mean aortic pressure gradients 20-30mmHg (10.9%, 32.6% respectively), 30-40mmHg (11.8%, 33.0%) and >40mmHg (13.7%, 34.5%). Conclusion: Aortic stenosis is associated with signifi cant mortality across the spectrum of severity, including mild disease. Th ere is no discernible diff erence in survival between “moderate” and “severe” aortic stenosis. P1-115

Mortality from Left Atrial Enlargement Based on Method of Measurement: Analysis of Big Data from the National Echo Database of Australia

G. Strange 1,∗, S. Stewart 2, D. Celermajer 3, T. Marwick 4, G. Scalia 5, D. Prior 6, M. Ilton 7, D. Playford 1 1 University Of Notre Dame, Fremantle, Perth, Australia 2 Queen Elizabeth HOspital, Adelaide, Australia 3 University of Sydney, Sydney, Australia 4 Baker IDI, Melbourne, Australia 5 The Prince Charles Hospital, Brisbane, Australia 6 University of Melbourne, Melbourne, Australia 7 Royal Darwin Hospital, Darwin, Australia

A Comparison of Long-Term Mortality Prediction Using Two Methods of Ejection Fraction Assessment from the National Echo Database Australia

An 82-year-old woman was hospitalised in our institution because of worsening dyspnoea on effort. She had a history of aortic valve reconstruction with autologous pericardium (AVrC) for severe aortic stenosis 1 year and 9 months ago. Her transthoracic echo examination revealed that she had severe aortic regurgitation with preserved left ventricular systolic function. Compared with her previous echo findings shortly after AVrC, her left ventricle was clearly dilated with newly detected moderate mitral regurgitation. Transoesophageal echo was performed for further investigation, which showed that, in particular, her right coronary cusp (RCC) was obviously prolapsed toward the left ventricular outflow tract with wide aortic regurgitant jet. After conservative medical therapy, aortic valve replacement and mitral annular plasty were performed. Her removed autologous aortic cusps clarified the details: not only did the RCC, but also left coronary cusp have two clefts on both ends of each cusp, and the non–coronary cusp had one fissure on one end. Her symptoms improved dramatically after aortic valve replacement. Aortic valve reconstruction with autologous pericardium is characterised by excellent valvular durability with a low mortality. However, the patient in this case suffered from rapid deterioration of the reconstructed autologous aortic valve. According to a previous report, one AVrC case was required reoperation due to aortic regurgitation caused by prolapse of RCC, which was the same cusp as in this case. Autologous RCC for AVrC is usually the smallest and made from thinner side of pericardium. This may be the reason why RCC is the culprit cusp when aortic regurgitation occurs shortly after AVrC.

A case of vascular Ehlers-Danlos Syndrome with a cardiomyopathy and multi-system involvement

Ehlers-Danlos Syndrome comprises a heterogeneous group of heritable connective tissue disorders resulting from various gene mutations. We present an unusual case of vascular Ehlers-Danlos Syndrome with distinctive physical characteristics and a cardiomyopathy with features suggesting isolated left ventricular non-compaction. The cardiac features represent the first report of a cardiomyopathy associated with a mutation in the COL3A1 gene. This case also illustrates the multi-system nature of Ehlers-Danlos Syndrome and the complexity of managing patients with the vascular subtype.

The National Echocardiography Database Australia (NEDA): Rationale and methodology

&NA; The National Echocardiography Database Australia (NEDA) is a new echocardiography database collecting digital measurements on both a retrospective and prospective basis. To date, echocardiographic data from 435,133 individuals (aged 61.6 ± 17.9 years) with linkage to 59,725 all‐cause deaths during a median of 40 months follow‐up have been collected. These data will inform a number of initial analyses focusing on pulmonary hypertension, aortic stenosis and the role of artificial intelligence to facilitate accurate diagnoses of cardiac abnormalities.

IMPROVING STRESS TESTING COMPLIANCE FOLLOWING CHEST PAIN PRESENTATIONS TO THE EMERGENCY DEPARTMENT

Patients who are risk stratified as intermediate risk of acute coronary syndrome (ACS) are recommended to have exercise stress testing (EST) within 72 hours. EST allows further refinement of the patients risk of having undiagnosed obstructive coronary disease. However, compliance is poor with