Abstracts
May 2008 and March 2015. All perioperative and follow-up
data on LVAD recipients was collected in a prospective
manner. We reviewed the patient characteristics and clinical
outcomes between the two groups.
RESULTS: During the study period, 32 HMII and 76 HVAD
were implanted. Baseline characteristics for the HMII and
HVAD were: age 49.5 yrs. vs. 48.4 yrs. (p¼0.77), male sex
65.6% vs. 65.8% (p¼0.98), ischemic cardiomyopathy 28.1%
vs. 40.8% (p¼0.005). The treatment strategy at time of LVAD
implantation was 15.6% BTC and 81.3% BTT for HMII and
39.5% BTC and 57.9% BTT for HVAD (p¼ 0.05). The
mean duration of support was 377.3 days for HMII and 264.4
days for HVAD. Seven (21.9%) HMII’s and 5 (6.6%)
HVAD’s were explanted, respectively (p¼0.005). The 1-year
survival was 86% for HMII and 83% HVAD (p>0.05). Table 1
shows the number of events per patient year (EPY) for LVAD
related complications. There were no significant differences
between the two groups related to gastrointestinal or cerebral
bleeding, thromboembolic events, or driveline infections.
Patients with HVAD devices had significantly more strokes
than HMII (0.38 EPY vs. 0.09 EPY, respectively, p¼0.04).
CONCLUSION: Although one-year survival was similar in HMII
and HVAD patients, the incidence of stroke was significantly
higher in HVAD patients, a finding that is consistent with
those reported in previous studies. Larger comparative ana-
lyses are necessary to support our findings and further eluci-
date clinically relevant difference between the two devices.
Canadian Cardiovascular Society (CCS) Oral
LEST WE FORGET: THE RIGHT HEART
Sunday, October 25, 2015
383
THE EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON
RV FUNCTION IN PATIENTS WITH CHF AND OSA: A
RANDOMIZED CONTROL TRIAL
S Promislow, IG Burwash, J Leech, L Mielniczuk, A Guo,
K Chan, L Beauchesne, R deKemp, H Haddad, O Walter,
L Garrard, J Floras, R Beanlands, G Dwivedi
Ottawa, Ontario
S203
BACKGROUND: Obstructive sleep apnea (OSA) is common in
patients with congestive heart failure (CHF) and can
contribute to disease progression. Continuous positive airway
pressure (CPAP) is used to treat OSA and has been shown to
improve left ventricular function in CHF patients. However,
the effects of CPAP therapy on right ventricular (RV) func-
tion, an independent predictor of outcome in CHF patients,
are not known.
METHODS: In this randomized controlled trial, 45 patients
with OSA (apnea/hypopnea index >10 events/hour by
nocturnal polysomnography) and stable CHF (left ventricular
ejection fraction 45% and at least NYHA Class II symp-
toms) were randomized to receive CPAP (n¼22) or no CPAP
(n¼23) therapy. Echocardiography was used to measure RV
systolic and diastolic function parameters at baseline and after
6-8 weeks.
RESULTS: In the CPAP treatment group, RV fractional area
change (FAC) improved from baseline to follow-up study
(38.2  10.9% to 41.4  11.5%, p¼0.04). In contrast, there
was no change in RV FAC in the no CPAP group (43.9 
7.2% to 44.4  7.8%, p¼0.60). Tricuspid annular systolic
excursion velocity, RV myocardial performance index, and
tricuspid E/A and E/e’ ratios did not change in either cohort.
On subgroup analysis, patients with impaired RV systolic
function at baseline demonstrated an improvement in RV
FAC with CPAP therapy compared to those who did not
receive CPAP therapy (+5.0  4.5% vs. -0.5  5.2%,
p¼0.04). No improvement in RV FAC was observed in pa-
tients with normal RV systolic function at baseline (+1.7 
6.4% vs. +1.4  2.0%, p¼0.87).
CONCLUSION: In patients with CHF and OSA, short-term
CPAP therapy improved RV FAC but had no effect on other
measures of RV systolic and diastolic function. The
improvement in RV FAC with CPAP was limited to those
patients with abnormal baseline RV systolic function. Further
studies are required to elucidate the potential longer-term
effects of CPAP therapy on RV function in CHF patients with
OSA.
384
THE UTILITY OF BEDSIDE CLINICAL ASSESSMENT OF
INTRAVASCULAR VOLUME STATUS WITH HAND CARRIED
ULTRASOUND DEVICES IN HEMODIALYSIS CLINICS
H Bews, Y Zhang, C Rigatto, M Sood, N Tangri, A Eng,
P Komenda, DS Jassal
Winnipeg, Manitoba
BACKGROUND: In Canada, the majority of end stage renal
disease (ESRD) patients undergo conventional facility based
hemodialysis. Despite technological advancements, conven-
tional hemodialysis is associated with significant patient
morbidity and mortality related to fluid imbalances. Inaccu-
rate hemodialysis prescriptions calculated from clinical esti-
mates of intravascular volume status (IVS) may serve as a
major contributor to patient morbidity. Previous studies have
S204
demonstrated improved patient outcomes by adjusting he-
modialysis prescriptions based on echocardiographic volume
assessments. However, implementation of this platform in
practice remains impractical, warranting further research in
order to assess whether Hand-Carried Ultrasound (HCU)
provides similar benefits in chronic hemodialysis patients.
OBJECTIVE: The primary objective of this study is to investi-
gate the utility of inferior vena cava (IVC) measurements
using HCU as an imaging modality to accurately assess IVS in
hemodialysis patients. The potential impact would be a
portable, cost-efficient, and accurate measurement of patient
volume status in order to improve hemodialysis prescriptions
and fluid homeostasis.
METHODS: This prospective study involved ESRD patients on
hemodialysis at a single tertiary care centre. IVC diameter
(IVCdi) and collapsibility index (IVCci) were measured at three
hemodialysis sessions for each patient. At each dialysis session,
pre-, mid-, and post-dialysis values were collected. IVC pa-
rameters were compared to clinical indices of volume status
including blood pressure, patient symptoms, and ultrafiltration.
RESULTS: A total of 29 patients were included in this study
(19 males, mean age 6316 years). The mean IVC diameter
for the pre-dialysis, mid-dialysis, and post-dialysis time points
was 1.650.40 cm, 1.29  0.33 cm, and 1.390.32 cm,
respectively (p<0.05). The IVCdi decreased in size from the
pre-dialysis to mid-dialysis time points and subsequently
increased at the post-dialysis measurement (Figure 1). A
subset of 5 patients came back for an additional scan two
hours after their dialysis session ended; their IVC diameters
continued to increase in size toward pre-dialysis levels. A
comparison of IVCdi measurements and clinical indices
demonstrated a significant correlation only between post-
dialytic IVCdi and post-dialytic symptoms. IVCci did not
correlate with blood pressure, volume removal, or patient
symptoms at any of the three time points.
CONCLUSION: IVC indices by HCU did not correlate with
changes in systolic blood pressure, ultrafiltration, or patient
symptoms. These clinical determinants of volume status are
inherently inaccurate and do not disprove the validity of HCU
in volume assessments. Further studies are warranted to
evaluate the benefit of HCU guided hemodialysis pre-
scriptions on patient morbidity and mortality.
Canadian Journal of Cardiology
Volume 31 2015
385
DIABETES MELLITUS PREDICTS FOR THE DEVELOPMENT
OF RIGHT VENTRICULAR DYSFUNCTION POST ST-ELEVATION
MYOCARDIAL INFARCTION
I Roifman, N Ghugre, MI Zia, ME Farkouh, A Zavodni,
GA Wright, KA Connelly
Toronto, Ontario
BACKGROUND: The World Health Organization estimates
that diabetes mellitus (DM) will affect 347 million people
worldwide and will be the 7th leading cause of death by
2030. Right ventricular dysfunction (RVD) complicating
STEMI is independently associated with a higher mortality.
Emerging research suggests that mechanisms for RVD may be
different than those governing left ventricular dysfunction.
The relationship between DM and RVD is currently un-
known. The primary purpose of this study was to determine
whether DM is an independent predictor for the develop-
ment of RVD.
METHODS: 106 patients post primary percutaneous coronary
intervention for STEMI were enrolled in this study between
the years 2009-2013. Each patient had a cardiac MRI done on
a 1.5T scanner within 48-72 hours of admission. Cardiac
function was determined using contiguous short axis slices
covering the left and right ventricle acquired with a standard
SSFP sequence. RVD was defined as an MRI derived RVEF
<50%. Univariate analyses were performed using the chi
square, Fisher’s exact, t-test, or Wilcoxon rank sum test as
appropriate. Subsequently, multivariable logistic regression
analysis was done in order to determine if the presence of DM
was independently predictive of RVD. Predictor variables
with p-values  0.25 on univariate analyses were included in
the multivariable model.
RESULTS: Median age of the patient population was 58 years
(IQR 53, 67). 30% of the patients had diabetes, 44% had
hypertension, 42% were active smokers and 32% had dysli-
pidemia. Out of 99 patients for which RV data was available,
40 had RVD and 59 did not. The presence of DM was
associated with a significantly higher percentage of patients
with RV dysfunction (45% for patients with DM vs. 22% for
patients without DM, p¼0.03). There was no significant
difference in age, hypertension, smoking status, dyslipidemia,
serum creatinine or peak CK levels between the two groups.
After adjusting for other factors, presence of DM remained an
independent predictor for the development of RVD (OR
2.78, 95%CI 1.12, 6.87, p¼0.03, see Table). Amongst
diabetic patients, those with HBA1c  7% had greater odds
of developing RVD vs. those with HBA1c <7% (OR¼5.58
(1.20, 25.78), p¼0.02).
CONCLUSION: The presence of DM is an independent pre-
dictor for the development of RVD post STEMI. Its presence
was associated with an approximately 3 fold greater odds of
developing RVD. No other major cardiovascular risk factors
were independently associated with the development of RVD
in our cohort.