N. Stoyanov

Utility of Resting Perfusion Scans in Assessing Low Risk Chest Pain

Background: Successful transcatheter closure of atrial septal defects (ASD) relies heavily on pre-procedural morphological evaluation for appropriate patient selection. 2-Dimensional transoesophageal echocardiography (2DTOE) has been used traditionally for assessment of ASD anatomy. However characterization of the major axis of a defect and appreciation of its geometric shape can be difficult using 2DTOE. Real time 3-dimensional transoesophageal echocardiography (RT3DTOE) may allow dynamic enface visualization andmore precise assessment of ASD dimensions. Methods:Elevenpatientsundergoingpercutaneousclosure using the Amplatzer septal occluder device had prior 2DTOE and RT3DTOE using the fully sampled matrix array transducer (X7-2T, Phillips). Measurement of the maximum diameter of the ASD by blinded observers was made on RT3DTOE using QLab7.0 offline quantification software and compared with both 2DTOE and balloon stretched diameter (BSD) obtained during percutaneous Aim:Todetermine the patient characteristics of patients at RPH that have undergone resting perfusion scans including TIMI risk scores, average length of stay and disposition. Method:Retrospective study of patients that hadundergone a resting Myocardial Perfusion Scan (Technicium 99mTc Sestamibi) at our institution, a tertiary hospital, between 2005 and 2009. Results: 156 patients were included, 52% male, average age 48 years. Average length of stay was 17h and 68% of patients were discharged directly from ED. Patients with low-risk perfusion scans (70% of patients) had an average length of stay of 9 h, compared to patients with abnormal scans (remaining 30% of patients) whose length of stay was 37h. Patients with higher TIMI scores (≥2) were more likely to require further investigation (OR 4.0) with demonstrable ischaemia (OR 6.0) and had a longer average length of stay (32 h vs. 16 h) than patients with TIMI scores of 0/1. Conclusion:The resting perfusion scanwas a useful test in patients with low-risk and intermediate risk chest pain presentations to ED, allowing early discharge. Patients with higher TIMI risk scores had a greater likelihood of needing further investigation.