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ObjectivesThis study was conducted in order to evaluate the accuracy of a compressed sensing (CS) real-time single-breath-hold cine sequence for the assessment of left and right ventricular functional parameters in daily practice.MethodsCardiac magnetic resonance (CMR) cine images were acquired from 100 consecutive patients using both the reference segmented multi-breath-hold steady-state free precession (SSFP) acquisition and a prototype single-breath-hold real-time CS sequence, providing the same slice number, position, and thickness. For both sequences, the left (LV) and right ventricular (RV) ejection fractions (EF) and end-diastolic volumes (EDV) were assessed as well as LV mass (LVM). The visualization of wall-motion disorders (WMD) and signal void related to mitral or tricuspid regurgitation was also analyzed.ResultsThe CS sequence mean scan time was 23 ± 6 versus 510 ± 109 s for the multi-breath-hold SSFP sequence (p < 0.001). There was an excellent correlation between the two sequences regarding mean LVEF (r = 0.995), LVEDV (r = 0.997), LVM (r = 0.981), RVEF (r = 0.979), and RVEDV (r = 0.983). Moreover, inter- and intraobserver agreements were very strong with intraclass correlations of 0.96 and 0.99, respectively. On CS images, mitral or tricuspid regurgitation visualization was good (AUC = 0.85 and 0.81, respectively; ROC curve analysis) and wall-motion disorder visualization was excellent (AUC ≥ 0.97).ConclusionCS real-time single-breath-hold cine imaging reduces CMR scan duration by almost 20 times in daily practice while providing reliable measurements of both left and right ventricles. There was no clinically relevant information loss regarding valve regurgitation and wall-motion disorder depiction.Key Points• Compressed sensing single-breath-hold real-time cine imaging is a reliable sequence in daily practice.• Fast CS real-time imaging reduces CMR scan time and improves patient workflow.• There is no clinically relevant information loss with CS regarding heart valve regurgitation or wall-motion disorders.

ObjectiveNICE guidelines 2016 recommend CT coronary angiography (CTCA) first line for patients with typical or atypical angina. There is a paucity of studies investigating the utility of CTCA in young adults (<40-years-old) with chest pain. We sought to evaluate temporal changes in the number of CTCA performed and the presence of coronary artery disease (CAD) in young adults following guideline update.MethodsPatients under 40-years-old who underwent CTCA for chest pain evaluation during different time periods were included. Group 1 and Group 2 included patients scanned during 6-month periods immediately before and 1 year after the NICE guideline update respectively. Patients in Group 3 were scanned in a 3-month period in 2019 and Group 4 included patients scanned during a 3-month period in 2021. CAD severity was classified using the CAD-RADS system.Results544 patients were included (Group 1 n=129, Group 2 n=212, Group 3 n=109, Group 4 n=94). Mean age was 34.3 and 188 (34.6%) were female. Family history of CAD was present in 37.1%, smoking 30%, hypertension 16.7%, hypercholesterolaemia 27.8%, diabetes 10.3% and CAD was present in 69 (12.7%) of which severity was minimal n=14, mild n=30, moderate n=12, severe n=13 with no significant differences between the groups. 11 patients were subsequently revascularised (10 males) of whom all had ≥2 cardiovascular risk factors.ConclusionThere was a considerable sustained increase in CTCA numbers performed after NICE guideline update, however, the presence and severity of CAD remained similar. Only 0.5% of young females required revascularisation, of particular relevance given the increased radiation risk in this cohort.

IntroductionCT coronary angiography (CTCA) is the preferred test in patients with low to intermediate likelihood of coronary artery disease. This retrospective study was conducted to determine a new cut for calcium score without adversely affecting the diagnostic accuracy of CTCA.MethodsCTCA was performed on a third generation dual-source CT scanner (Siemens Force 512 slice). Agatston method was used for the quantification of the coronary artery calcium. The degree of luminal narrowing was classified using the CAD-RAD scoring system. The coronary plaques were classified into calcified, non-calcified and mixed subtypes. We reviewed the results of any subsequent non-invasive (stress echocardiography, cardiac magnetic resonance perfusion imaging) and invasive (coronary angiography) tests to assess the correlation with CTCA.Results296 patients were included in the analysis. 22% (64/296) did not go on to further investigations. 78% (232/296) underwent non-invasive or invasive tests. The correlation of CTCA with further investigations did not depend on total calcium score. 76% of CTCAs correlated with further investigations, 5% did not correlate and 19% had inconclusive results. (Multiple artefacts preventing complete CTCA interpretation).ConclusionThe correlation or non-correlation of the CTCA results with further investigations was not affected by the total calcium score. Therefore we deem it is reasonable to proceed with a CTCA even when the calcium score exceeds 1000.

IntroductionCardiac computed tomography (CCT) is recommended in prosthetic infective endocarditis (IE) and has been shown to have prognostic significance, although in practice its use is limited. We aimed to assess for prognostic markers from CCTin surgically proven prosthetic valve endocarditis.MethodThis is a retrospective analysis of patients with surgically proven endocarditis who underwent CCT and TOE, identified from prospective institutional database between Feb 2016- July2023. Imaging findings related to endocarditis from TOE, CT and FDG PET and significant ancillary findings affecting surgical planning on CCT were recorded.ResultsFifty-two patients who underwent both CCT and TOE before surgery were included, 8 (15%) patients underwent FDG PET in addition. Patient characteristics are summarised in table 1. 6 deaths occurred before discharge (in hospital mortality rate 11.5%). The cases discharged alive were followed up for a median of 50 (IQR 31–78) months.CTCA had a sensitivity of 86.2% and specificity of 95.2% for surgically confirmed vegetations. CCT had a sensitivity of 81.6% and a specificity of 90.9% for surgically confirmed paravalvular involvement as opposed to a sensitivity of 97.4% and a specificity of 72.7% for TOE. FDG PET had a sensitivity of 75%. Ancillary findings identified in 24 (46%).Univariable logistic regression analysis was done for clinical and imaging parameters from CCT, TOE and FDG PET for occurrence of death. Multivariable regression analysis adjusted for gender, previous endocarditis, prosthetic valves, intracardiac device, blood cultures, diabetes and stroke. This showed odds ratio (OR) for ancillary findings on CT of 4.026, OR of 3.629 for paravalvular findings on CT; none reached statistical significance. Table 2 shows regression analysis results.ConclusionCardiac CT has complementary diagnostic and prognostic role to TOE

BackgroundThe first wave of the COVID-19 pandemic required rapid reconfiguration and reallocation of resources. We triaged all cardiac imaging requests from our referral network serving 2.5 million people, to our tertiary centre, performing only clinically urgent studies and cancelling non-urgent studies. Requesters received notification of cancellation in the same format as test reports and were encouraged to repeat their request when pandemic conditions had improved. The impact of this cancellation on patient outcomes is assessed.MethodsRetrospective analysis of routinely collected clinical and administrative data from the institutional data warehouse determined patient outcomes for those with cancelled and performed stress echocardiography, nuclear stress perfusion studies, cardiac CT angiography and cardiac MRI. Mortality data was drawn from the NHS spine. Data analysis was performed using R.Results1600 cardiac studies for 1592 patients were cancelled in April 2020, and 2234 cardiac studies were performed for 2184 patients between April and July 2020, representing high-risk outpatient requests. 41 patients who had cancelled scans died, and 105 patients with performed scans died (table 1). Of cancelled scans, 787 patients had a subsequent scan in some modality, of which 701 were the same modality as the original test. 761 patients had no repeat outpatient testing until October 2021. Mortality was higher in patients for whom scans were performed (log-rank p = 0.03, figure 1A). Non-elective admissions were higher in patients who had scans performed (4% in cancelled vs. 8% performed after 574 days of follow-up, log-rank p <0.001 figure 1B). Over the course of the pandemic, our wait-times for cardiac testing did not exceed the national standard of 16 weeks.Limitations: Data was not collected prospectively, due to the level of emergency; cancellation data may not be complete. All cause mortality under pandemic conditions cannot be extrapolated to non-pandemic situations.Abstract 160 Table 1Demographic and outcome data for patients with cancelled or completed cardiac scans during the first wave of the COVID-19 pandemicAbstract 160 Figure 1All cause mortality in patients with cancelled or completed outpatients cardiac tests from the time of the first round of cancellations (18/04/2020) at the beginning of the COVID-19 pandemic. Clinically urgent scans, as triaged by expert clinicians, were completed, and others cancelled. Mortality was greater for those with completed scans detected over a mean follow-up of 581 days. (B) Acute admissions to emergency, cardiac or cardiothoracic services in patients with cancelled or completed cardiac tests after cancellations of low-risk patients. In keeping with triage, patients with completed scans had worse outcomes. Patients with low-risk clinical features had a reassuring rate of admissionConclusionOur approach to diagnostic testing in cardiology during the first wave of the COVID-19 pandemic accurately identified and tested high-risk patients without causing harm to those at lower risk, demonstrated by higher admission rates in patients in whom tests were performed, and the absence of an adverse impact on mortality. 49% of patients underwent subsequent cardiac testing after a cancelled test. We maintained low waiting times throughout the pandemic.Conflict of InterestNone

BackgroundEmerging evidence suggests a potential role of coronary computed tomography angiography (CCTA) for coronary assessment pre-renal transplantation. Therefore, we aimed to evaluate the diagnostic utility and safety of CCTA in such patients.MethodsWe retrospectively evaluated data from 58 consecutive patients who had pre-renal transplant CCTA between 2010-2018. The diagnostic value of non-obstructive (<70% stenosis) and obstructive (≥70% stenosis) coronary artery disease by CCTA in predicting subsequent myocardial infarction (MI) and/or percutaneous coronary intervention (PCI) was assessed. Results were expressed as mean±SD.ResultsMean age of patient cohort was 50±11 years old with a follow-up duration of 46±20 months from CCTA. Baseline demographics include male (58%), hypertension (65%), diabetes (42%), hemodialysis (70%), peritoneal dialysis (18%), not on dialysis (12%). Among those not on dialysis, no patients experienced contrast-induced nephropathy post-CCTA. All patients subsequently underwent renal transplant. CCTA demonstrated mean DLP 503±535 mGym2 and calcium score 167±309. Number of patients with obstructive coronary disease: 1-vessel (n=5), 2-vessels (n=6), 3-vessels (n=1). Independent of symptoms, CCTA demonstrated a positive predictive value 41%, negative predictive value 100%, sensitivity 100%, and specificity 86%, in predicting subsequent MI/PCI over the follow-up period.ConclusionIn this cohort of pre-renal transplant patients, CCTA is safe, and has a high sensitivity and negative predictive value in ruling out obstructive coronary disease and subsequent MI/PCI over a 4-year follow-up period. CCTA also acts as a valuable diagnostic gatekeeper prior to subsequent functional and/or invasive testing.

IntroductionScimitar syndrome is a well-known, but exceedingly rare condition, characterised by anomalous pulmonary venous return of all or part of the right lung to the IVC, normally in association with right lung hypoplasia, dextroposition of the heart and right pulmonary artery hypoplasia. Anomalous coronary anatomy is not, however, a well-described association. We reviewed the coronary anatomy of all patients diagnosed with scimitar syndrome, at a single institution, over a 24-year period.MethodsRetrospective review of medical records, cardiac imaging and operative notes of all patients diagnosed with scimitar syndrome at a single institution between 1992 and 2016.Results54 patients were identified. Within this cohort 3 patients (5.5%, 1 male, 2 female) had anomalous origin of the left circumflex coronary artery from the pulmonary artery (ALCAPA), all arising close to the pulmonary bifurcation.ConclusionsThere are many common and uncommon variants of scimitar syndrome. The relatively high incidence (5.5%) of anomalous origin of the left circumflex coronary from the pulmonary artery is not well described and should be borne in mind when reviewing cross-sectional imaging of these patients, particularly during the neonatal period, when coronary anatomy is often particularly difficult to assess.

IntroductionApproximately 21–23 computed tomography coronary angiograms (CTCAs) are performed daily at Bart’s Heart Centre, amongst the largest performed per year in the UK. This is one of only two regions in the UK performing near the projected numbers required for successful implementation of the recent ‘Chest pain of acute onset’ guidelines. A significant increase in demand of current resources is likely. Subjectively, patient flow through the cardiovascular CT department is already contributing to sub-optimal staff and patient satisfaction.Our aim was to ensure that 95% of all patients undergoing CTCA at Bart’s Heart Centre would be scanned and discharged within 60 min of their appointment time by December 2017.MethodsWe undertook initial process mapping to understand the existing patient pathway following thier arrival in the department. We constructed a driver diagram to identify primary and secondary drivers and generate change ideas. We completed two plan-do-study-act (PDSA) cycles thus far: PDSA#1 – Clinician assistance with patient preparation; PDSA#2 – Post-scan observation time reduced from 30 min to 15 min in keeping with guidelines for standard practice.ResultsAt baseline 43% of patients were scanned and discharged within 60 min. Following the first change this increased to 81% and after second change to 89%. Baseline median time in department was 71 min, which fell to 47.5 min after the first change with a further fall to 45 min after the second change. Both change ideas have subsequently been adopted in to routine clinical practice.ConclusionWe demonstrated successful implementation of two changes in practice which have improved patient flow through the CCT department.Our aim is to identify further areas of improvement to better our patient flow through the department, and maintain high scanning numbers to meet proposed guidelines.

Introduction The scimitar syndrome comprises hypoplastic right pulmonary artery and lung, anomalous right pulmonary venous drainage to the inferior caval vein, aortopulmonary collateral(s) to the right lung, and bronchial anomalies. Aim The aim of this study was to describe the morphological and clinical spectrum of variants from the classical scimitar syndrome in a single institution over 22 years. In total, 10 patients were recognised. The most consistent feature was an aortopulmonary collateral to the affected lung (90%), but there was considerable variation in the site and course of pulmonary venous drainage. This was normal in 3 (one with meandering course), anomalous right to superior caval vein in 1, to the superior caval vein and inferior caval vein in 2, and to the superior caval vein and the left atrium in 1; one patient had a right pulmonary (scimitar) vein occluded at the insertion into the inferior caval vein but connected to the right upper pulmonary vein via a fistula. There were two left-sided variants, one with anomalous left drainage to the coronary sinus and a second to the innominate vein. Among all, three patients had an antenatal diagnosis and seven presented between 11 and 312 months of age; 90% of the patients were symptomatic at first assessment. All the patients underwent cardiac catheterisation; collateral embolisation was performed in 50% of the patients. Surgical repair of the anomalous vein was carried out in two patients, one patient had a right pneumonectomy, and one patient was lost to follow-up. There was no mortality reported in the remainder of patients during the study period. The heterogeneity of this small series confirms the consistent occurrence of an anomalous arterial supply to the affected lung but considerable variation in pulmonary venous drainage.

BackgroundScimitar syndrome is a rare combination of cardiopulmonary abnormalities found in 1–3 per 1000 live births. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is only found in 1 in 250–400 congenital heart disease patients.ObjectiveWe aimed to investigate the incidence of left circumflex ALCAPA within our referral center’s cohort of scimitar syndrome patients.Materials and methodsA review of medical records, cardiac imaging and operative notes from all patients diagnosed with scimitar syndrome at our center between 1992 and 2016 was undertaken and all imaging reviewed.ResultsFifty-four patients with scimitar syndrome and imaging were identified. Of these, 3 patients (1 male and 2 female) with ALCAPA were identified, representing an incidence of 5.5% (95% confidence interval [CI] 0–11.67%). In all three cases, the anomalous coronary arising from the pulmonary artery was the left circumflex coronary artery (LCx) and the point of origin was close to the pulmonary arterial bifurcation.ConclusionWe hypothesize that the prevalence of LCx-ALCAPA, in the setting of scimitar syndrome, may be greater than previously thought. We suggest that any patient with scimitar syndrome, especially with evidence of ischaemia, should be investigated for ALCAPA. Given its noninvasive nature and simultaneous imaging of the lungs, we suggest that cardiovascular CT is the most appropriate first-line investigation for these patients.