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Despite cardiovascular disease (CVD) being the leading cause of death of women globally, research on CVD over the past several decades has focused primarily on men. CVD research has led to progress in diagnosis and treatment, medical education, and public awareness; however, few of these advances have applied specifically to women’s cardiovascular health. There is a paucity of sex- and gender-specific educational material regarding CVD in clinical training programs for physicians. The irregularity in integrated curricula across medical schools in Canada may be a factor in persistent disparities in clinical care and outcomes experienced by women, compared with men. In response to this gap, the Training and Education Working Group of the Canadian Women’s Heart HealthAlliance undertook the planning, development, and dissemination of a Canadian Women's Heart Health Education Course. The development of the course was guided by a 6-step approach for curriculum development for medical education, which included conducting a needs assessment, determining and prioritizing content, setting goals and objectives, selecting educational strategies, implementation, and evaluation. Résumé: Bien que les maladies cardiovasculaires (MCV) soient la principale cause de décès chez les femmes dans le monde, la recherche sur les MCV au cours des dernières décennies a été centrée principalement sur les hommes. La recherche sur les MCV a permis de faire des progrès en matière de diagnostic et de traitement, de formation médicale et de sensibilisation du public; toutefois, peu de ces progrès touchaient spécifiquement la santé cardiovasculaire des femmes. Les programmes de formation clinique des médecins ne comportent que peu de matériel éducatif sur les MCV propre à chaque sexe et à chaque genre. Il est possible que l’irrégularité des programmes de formation intégrés des écoles de médecine au Canada contribue aux disparités persistantes dans les soins prodigués aux femmes et les résultats cliniques obtenus chez celles-ci, comparativement aux hommes. Pour combler cette lacune, le Groupe de travail sur la formation et l’éducation de l’Alliance canadienne de santé cardiaque pour les femmes a entrepris la planification, la préparation et la diffusion de l’Initiative nationale de sensibilisation à la santé cardiaque des femmes. La conception de l’Initiative a été guidée par une approche en six volets axée sur l’élaboration d’un programme de formation médicale, qui comprenait une évaluation des besoins, la détermination et la hiérarchisation du contenu, la formulation des buts et des objectifs, la sélection des stratégies de formation, ainsi que la mise en œuvre et les modalités d’évaluation.

Background The prognosis of cardiovascular disease is worse in women than men, and coronary microvascular dysfunction explains the excess cardiovascular risk in women. In addition, age-related increases in pulsatile arterial load are greater in women than men; and lower arterial compliance has been shown to independently predict cardiovascular events. However, whether arterial load differentially affects the coronary microvasculature in men and women remains unknown. We hypothesized that lower arterial compliance would be associated with coronary artery microvascular dysfunction in women. Methods and results 285 subjects (60% women, age: 61.2 ± 11.0 yrs) undergoing cardiac 82Rb positron-emission tomography between 2010 and 2013, with ejection fraction ≥50%, no heart failure, dyspnea, coronary artery disease or regional perfusion defects were included. Left ventricular microvascular function was assessed by myocardial flow reserve (MFR). Pulsatile arterial load was estimated by indexed arterial compliance [ACi: (stroke volume/pulse pressure)/BSA]. Multivariable linear regression evaluated associations of arterial compliance with myocardial flow reserve after adjustment for confounders. ACi was lower in women than men [0.39 ± 0.15 vs. 0.52 ± 0.28 (mL/mm Hg)/m2, P Conclusions Lower ACi was associated with altered coronary microvascular function in women, but not in men. Our findings highlight low arterial compliance as a potential link between hypertension, coronary microvascular dysfunction and adverse cardiovascular events in women.

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in women. Peripheral arterial disease (PAD), a manifestation of CVD and a marker for other adverse CVD outcomes such as ischemic heart disease and stroke, remains underrecognized and undertreated in women. Contrary to the previous belief that PAD is mainly a disease of white men, contemporary data suggest equal, if not higher, prevalence rates in nonwhite women. Women often present with asymptomatic or atypical disease and seek medical attention with more advanced disease. Cardiovascular morbidity and mortality rates, as well as procedural mortality rates, remain elevated in women compared with men. There are sex-specific markers and comorbidities with a higher female prevalence that are associated with PAD. Greater focus on PAD in cardiovascular trials, equivalent enrollment of women in large trials, and focused prevention strategies may help reduce the economic burden and adverse outcomes associated with PAD in women.

BACKGROUND: 51 years ago, the first Mustard operation was performed at our institution and was successful; the patient is still alive today. The procedure’s success was such that many thought they were “cured”. They were not; “failing Mustards” with severe RV failure, TR and often pulmonary hypertension present to us with increasing frequency. We reviewed our experience with an emphasis on this “Mustard dilemma”. METHODS: In 2010-2013, we undertook multiple iterations of cross-sectional follow-up of all 546. Mustard procedures as part of a “double-switch” operation were not included. All points of last known contact were pursued via as many avenues (primary cardiologists, surgeons, institutions, family physicians). RESULTS: Institutional data protection policies were extremely difficult obstacles, as were breaks in follow-up continuity caused by physician retirement or death. The 546 Mustards (1963 2007) were performed at mean age 2.1 years for diagnoses including predominantly variants of arterial transposition or DORV. Most had undergone prior palliation via atrial septectomy (249), systemic-pulmonary shunt (19), PA band (44) or cavopulmonary connection (3). DHCA was used in w60% (mean 55 minutes). In-hospital mortality was 9%. Following discharge, late survival was excellent, with very slow rising late hazard for death over the subsequent decades (instantaneous risk w1%/ year after 40 years). Estimated survival 50 years after surgery is w46% overall (but 58% for isolated TGA). There have been 184 known deaths (33%). Of the 372 presumed survivors, the median age today would be 36 years (IQ range 30 40). More than 20% of adult Mustards we follow have decompensated heart failure by age 36, and this proportion rises disproportionately thereafter (figure). At last follow-up, prevalence of moderate TR was 20% and RV dysfunction 34%. Nevertheless, follow-up with a cardiologist is known for only 50% (182/372) of presumed survivors since 2010, and 60% (224/372) since 2000. The remaining 148 (40% of survivors) only had last known points of cardiology contact in the 1980s or 1990s. CONCLUSION: The bulk of adult Mustard survivors are approaching high-risk periods for onset of heart failure. The insidious onset of RV dysfunction, TR and pulmonary hypertension emphasizes the need for national tracking registry for this and other complex CHD patients, similar to those for cancer patients, to prevent patients re-presenting with excessive risk for any intervention, including transplantation. Canadian Cardiovascular Society (CCS) Poster HEART FAILURE: IMAGING, TREATMENT AND OUTCOMES Sunday, October 26, 2014

s S279 Young Investigator Award Winner e Clinical Science 528 CORONARY ARTERY MICROVASCULAR DYSFUNCTION: ROLE OF SEX AND ARTERIAL LOAD T Coutinho, L Mielniczuk, K Srivaratharajah, R deKemp, RS Beanlands