CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
153
p
=
0.0046). The mortality reduction was driven by significantly
fewer heart failure-related deaths (0 vs 22%,
p
=
0.0010). In multi-
variate analyses, steroids were associated with an 89% lower rate
of new-onset cardiomyopathy (hazard ratio 0.11, 95% confidence
interval 0.04–0.29,
p
<
0.0001). The annual rate of decline in left
ventricular ejection fraction (–0.43 vs –1.09%,
p
=
0.0101) and
shortening fraction (–0.32 vs –0.65%,
p
=
0.0025) was less steep in
steroid-treated patients. Consistently, the increase in left ventricular
end-diastolic dimension was of lesser magnitude (+0.47 vs +0.92 mm
per year,
p
=
0.0105).
Conclusion:
In patients with Duchenne muscular dystrophy, steroid
therapy was associated with a substantial reduction in all-cause
mortality and new-onset and progressive cardiomyopathy.
266: ASSESSMENT OF ATRIAL SEPTAL DEFECTS WITH
REAL-TIME THREE-DIMENSIONSAL TRANSOESOPHA-
GEAL ECHOCARDIOGRAPHY: A NEW INSIGHT INTO
DYNAMIC CHANGES WITH CARDIAC CYCLE
Martin Ngie Liong Wong
1
, Sian Kong Tan
2
, Tiong Kiam Ong
2
1
Paediatric Cardiology Unit, Sarawak General Hospital Heart Centre,
Malaysia
2
Department of Cardiology, Sarawak General Hospital Heart Centre,
Malaysia
Background:
Accurate assessment of ASD anatomy and size are
paramount in selecting treatment option and guiding transcatheter
device closure. ASDs are well known to have complex geometry
and real-time three-dimensional transoesophageal echocardiography
(RT3D TEE) may provide superior imaging assessment of ASD
compared to conventional two-dimensional TEE. The objectives of
this study were to compare measurements of ASD size obtained by
RT3D and 2D TEE and to study the dynamic changes of ASD during
the cardiac cycle.
Methods:
RT3D and 2D TEE imaging were acquired in 34 patients
with ASD (age 40.1
±
16.4 years).
En face
views were used to assess
the shape and type of defects. Following full volume acquisition, the
ASD diameters in both major and minor axes were measured offline
using Xcelera QLab software and compared with values obtained
by 2D imaging. Defect areas by 3D planimetry were evaluated for
changes during cardiac cycles.
Results:
Out of 34 ASDs, 28 were oval, four were multiple and two
were complex. RT3D TEE
en face
views enabled better appreciation
of ASD shape and orientation in those with multiple and complex
ASDs. There was high agreement between ASD diameters measured
by RT3D and 2D TEE along both major axis (19.6
±
5.5 vs 19.0
±
5.3 mm,
r
=
0.92,
p
<
0.001) and minor axis (14.8
±
4.4 vs 14.8
±
4.1 mm;
r
=
0.93,
p
<
0.001). There was significant change in ASD
size during the cardiac cycle; being smallest during atrial systole and
largest during ventricular end-systole. The major axis, minor axis and
defect area varied as much as 4.5
±
3.1 mm, 4.1
±
2.5 mm and 0.69
±
1.8 cm
2
(
p
<
0.05), respectively. The defects became more elliptical
during atrial systole (eccentricity index increased from 0.61
±
0.19
to 0.67
±
0.17,
p
=
0.029).
Conclusions:
RT3D TEE was highly accurate in assessing the anato-
my and size of the ASD. It also provided new insight on the dynamic
changes of ASD size and shape during the cardiac cycle.
271: LONG-TERM OUTCOMES OF LYMPHOCYTIC
MYOCARDITIS IN INFANTS AND CHILDREN: A SINGLE-
CENTRE EXPERIENCE
Peta MA Alexander
1
, Lissane B De Ruiter
1
, Jane Koleff
1
, CW Chow
2
,
Robert G Weintraub
1,3
, Michael Cheung
1,3
1
Department of Cardiology, Royal Children’s Hospital, Melbourne,
Australia
2
Department of Anatomical Pathology, Royal Children’s Hospital,
Melbourne, Australia
3
Murdoch Children’s Research Institute, Melbourne, Australia
Background:
Lymphocytic myocarditis is a cause of dilated cardio-
myopathy (DCM) in children. Survival in the era of immunosup-
pressive therapy approaches 80 to 100% in registry populations. We
assessed long-term outcomes in patients with recovery of ventricular
function during early follow up.
Methods:
Institutional databases identified patients diagnosed by
endomyocardial biopsy with DCM due to lymphocytic myocarditis
(Dallas criteria) at the Royal Children’s Hospital, Melbourne between
1989 and 2007. Patients younger than six years at latest follow up
and post-partum women were excluded. Baseline characteristics
and most recent investigations were obtained. Consenting patients
were prospectively reviewed with standardised cardiac ultrasound,
including assessment of left ventricular diastolic function and tissue
Doppler imaging.
Results:
Nineteen local patients met eligibility criteria. Fifteen
patients consented for study, with no baseline difference between
eligible and study populations. Median presenting age was 1.3 years
(IQR 0.9, 2.8); four of 15 patients were male. All patients were
treated with corticosteroids and cyclosporine, two of 15 patients also
received intravenous immunoglobulin post diagnosis. Long-term
follow up occurred at a median of 10.3 years (IQR 6.2, 14.3) post
illness. No eligible patients had died. All patients were symptom
and medication free. Echocardiographic parameters demonstrated
median LVEDD
z
-score 2.1 (IQR 1.4, 2.6) and median LVEF 62%
(IQR 58, 66). Seven of 15 patients (47%) had mild left ventricular
dilatation, LVEDD
z
-score median 2.6 (IQR 2.4, 3.0); 1/15 (7%)
also had impaired systolic function, LVEF 53%. Diastolic function
assessed by mitral inflow Doppler, pulmonary venous flow Doppler,
and tissue Doppler imaging was within normal limits in all patients.
Conclusions:
Long-term outcomes of lymphocytic myocarditis in
children are good with rare systolic dysfunction, but almost 50%
had mild left ventricular dilatation 10 years post illness. There was
no evidence of diastolic dysfunction by routine echocardiographic
assessment in our paediatric population.
273: THE DIAGNOSTIC VALUE OF PLASMA BRAIN
NATRIURETIC PEPTIDE IN SYNCOPE OF CHILDRENAND
ADOLESCENTS
Qingyou Zhang, Jianguang Qi, Hui Yan, Junbao Du
Department of Paediatrics, Peking University First Hospital, Beijing,
PR China
Background:
Syncope is a common problem in childhood and
caused by a variety of underlying diseases. The study was designed
to evaluate the diagnostic value of B-type natriuretic peptide (BNP)
in syncope in children and adolescents.
Methods:
Fifty-seven consecutive children and adolescents hospi-
talised for syncope were collected from Peking University First
Hospital from January 2008 until December 2011. Routine evalua-
tion included patient’s history, physical examination, measurement of
supine and orthostatic blood pressure and heart rate, standard ECG
and basic laboratory examinations. Plasma BNP concentration was
measured by radioimmunoassay method. Logistic regression analy-
sis was used to find the independent predictors for cardiac syncope.
The diagnostic value of plasma BNP was assessed by ROC curve
analysis.
Results:
Out of 57 children and adolescents hospitalised for syncope,
34 patients (59.6%) had autonomic-mediated reflex syncope (22
vasovagal syncope, 10 postural othrostatic tachycardia syndrome
and two micturition syncope), 10 (17.5%) had cardiac arrhythmias,
11 (19.3%) had structural cardiac/cardiopulmonary disease, and two
(3.6%) patients with unknown causes. Patients with structural cardiac
syncope had significantly higher plasma BNP values than those with
non-cardiac and arrhythmic cardiac syncope (1 955.95
±
3 322.24 vs
31.01
±
23.59 and 36.83
±
25.63 pg/ml,
p
=
0.000). However, there
was no significant difference in plasma BNP level between patients
with arrhythmic cardiac syncope and with non-cardiac syncope
(31.01
±
23.59 vs 36.83
±
25.63 pg/ml,
p
=
0.991). At cut off of
71.24 pg/ml, plasma BNP was associated with a significant risk for
