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Background: Global longitudinal strain (GLS) is associated with major adverse cardiovascular outcomes independent of LVEF. However, the association of GLS with the development of adverse left ventricular remodelling (LVR) is not well established. Aim(s): To study the relationship between abnormal GLS (>-16%) and LVR in patients with normal resting LVEF. Method(s): Embase, Medline and Cochrane databases were systematically searched to identify studies utilising GLS and LVEF in predicting LVR. The primary outcome was mean difference in GLS in patients who develop LVR compared to those who do not develop LVR at >=3 months. The reviewers followed PRISMA protocol. Result(s): Eleven studies were included in the final quantitative analysis of 700 patients (mean age 59.5 +/- 11.9, Male = 68%). When patients who developed LVR were compared with those without LVR, mean baseline LVEF was: 56.1% (95%CI = 54.9-57.3, P < 0.0001) vs. 61.6% (60.6-62.6, P < 0.0001) and mean baseline GLS was: -15.7% (-16.5 to -15.1, P < 0.0001) vs. -19.5% (-20 to -18.9, P < 0.0001) whereas, mean differences of baseline GLS and EF in LVR group were statistically significant: 3.8% (3.0-4.6, P < 0.0001) and -5.5% (-7.0 to -3.9, P < 0.0001) respectively. When baseline and follow-up LVEF and GLS are compared in LVR group, mean LVEF difference was 3.62 (2.06 to 5.18, I2 = 38%, P < 0.0001) and mean GLS difference was -2.17 (-3.21 to -1.13, I2 = 71%, P < 0.0001) (Fig. 1 ) whilst in those without LVR, mean LVEF and GLS difference were 2.71 (-4.92 to -0.50, I2 = 75%, P = 0.02) and 0.64 (-0.74 to 2.03, I2 = 84%, P = 0.36). Conclusion(s): Abnormal GLS at baseline and further worsening at follow-up is associated with the development of adverse LVR. Therefore, patients with abnormal resting GLS may benefit from closer surveillance and earlier therapy.Copyright © 2019, P. Thein, MonashHeart and Monash Cardiovascular Research Centre, Monash Health and Monash University, Melbourne, Australia, CONFERENCE ABSTRACT

Background: Studies have observed higher incidence of cardiovascular mortality in South Asians (SA), and lower prevalence in East Asians (EA), compared with Caucasians. These observations are not entirely explained by ethnic differences in cardiovascular risk factors and mechanistic factors such as variations in cardiac anatomy and physiology may play a role. This study compared ethnic differences in CT-assessed left ventricular (LV) mass, coronary anatomy and non-invasive fractional flow reserve (FFRCT). Method(s): Three-hundred symptomatic patients (age 59 +/- 7.9, male 51%) underwent clinically-mandated CT-coronary-angiography (CTA) were matched for age, gender, BMI and diabetes (100 each ethnicity). Assessment of coronary stenosis, luminal dimensions and vessel dominance was performed by independent observers. LV mass, coronary luminal volume and FFRCT were quantified by blinded core-laboratory. A sub-analysis was performed on patients (n = 187) with normal/minimal disease (0-25% stenosis). Result(s): Stenosis severity was comparable across ethnic groups. EA demonstrated less left-dominant circulation (2%) compared with SA (8.2%) and Caucasians (10.1%). SA compared with EA and Caucasians demonstrated smallest indexed LV mass, coronary luminal volumes and dimensions. EA compared with Caucasians had comparable indexed LV mass, coronary luminal dimensions and highest luminal volumes. The latter was driven by higher prevalence of right-dominance including larger and longer right posterior left ventricular artery. FFRCT in the left anterior descending artery (LAD) was lowest in SA (0.87) compared with EA (0.89; P = 0.009) and Caucasians (0.89; P < 0.001), with no difference in other vessels. All observed differences were consistent in patients with minimal disease. Conclusion(s): This single-centre study identified significant ethnic differences in CT-assessed LV mass, coronary anatomy and LAD FFRCT. These hypotheses generating results may provide a mechanistic expla

Background. Despite the high prevalence of coronary bifurcation lesions in routine interventional cardiology practice, the best strategy for managing this challenging lesion subset remains debatable. Due to potential for complications, the routine practice of side-branch (SB) predilation is controversial. Methods. An electronic search was performed of online databases up until April 2018 for studies reporting periprocedural angiographic outcomes comparing provisional main-branch stenting with and without SB predilation. Random-effects model odds ratios (ORs) were calculated. Results. Eight studies were selected for a qualitative review, with 47.3% (1367/2890) of included subjects having angiographic outcomes following SB predilation reported. Of these, four studies included details of periangiographic outcomes comparing two groups. Bifurcation lesions stented without SB predilation demonstrated lower odds of requiring further SB intervention compared with lesions receiving upfront SB predilation (OR, 2.44; 95% confidence interval [CI], 1.71-3.47; I2=21%; P<.001). No difference was demonstrated regarding final SB TIMI flow <3, SB dissection, or intraprocedural SB occlusion. Although the odds of performing final kissing-balloon inflation were in favor of the group without SB predilation (OR, 1.62; 95%CI, 1.11-2.37; I2=61%; P=.01), there was no statistical difference in long-term major cardiovascular outcome (MACE) between the two groups (risk ratio, 1.29; 95%CI, 0.94-1.75; I2=11%; P=.33). Conclusion. SB predilation during coronary bifurcation percutaneous coronary intervention did not alter overall procedural angiographic outcomes. However, SB predilation is associated with increased SB intervention, including increased requirement for SB stenting, without demonstrable long-term MACE benefit, compared with a standard strategy without SB predilation.Copyright © 2020 HMP Communications. All rights reserved.

Background: On-site workstation based computed tomography derived fractional flow reserve (CT-FFR) is an emerging method to assess the vessel specific ischaemia in coronary artery disease (CAD). The impact of coronary calcification on its diagnostic performance is unknown. Purpose(s): To evaluate the impact of coronary calcification on the diagnostic performance of reduced-order CT-FFR at detecting vessel specific ischaemia. Method(s): This is a retrospective pooled analysis of 141 patients with suspected CAD enrolled from 3 global centres who underwent CTcoronary angiography (CTA), onsite CT-FFR and invasive FFR. Coronary calcification was assessed by Agatston score (AS). The diagnostic performance of CT-FFR (<=0.8) and CTA (>=50%) in evaluation of vessel specific ischaemia (FFR <= 0.8) was assessed across AS quartiles (Q1-4). A comparison of diagnostic performance of the low to mid AS (Q1 to Q3) versus high AS (Q4) was performed. Result(s): Mean age and median AS was 65.8 +/- 9.9 and 327.3 (interquartile range = 78.5 - 798.1). Diagnostic accuracy, sensitivity and specificity of CT-FFR for low-mid AS (0-798) and high AS (799-4019) were 77.4% vs 82.9%; 78.9% vs 94.7%; 68.8% vs 76.5% respectively with no statistical difference between the two groups. The AUC for ischaemia of CT-FFR in low to mid AS was comparable with AUC in the high AS (0.76 [95% CI: 0.66-0.86] vs 0.84 [0.69-0.99]; P = 0.397). The AUC for ischemia for CT-FFR in both low to mid AS and high AS was significantly higher than for CTA (0.76 [0.66-0.86] vs 0.57 [0.50-0.64]; P = 0.003 and 0.84 [0.69-0.99] vs 0.48 [0.38-0.57]; P < 0.001 respectively). Conclusion(s): On-site workstation CT-FFR demonstrated consistently high diagnostic performance in patients with high AS. Its diagnostic performance was superior when compared with significant stenosis assessment on CTA across all spectrum of Agatston scores.

Introduction: Coronary artery disease (CAD) contributes to poorer health outcomes for Aboriginal and Torres Strait Islander (ATSI) people and people from rural areas. Lower high-density lipoprotein (HDL) is a major driver of CAD. The CT derived Leaman score provides quantitative total coronary atherosclerotic plaque burden on computed tomography coronary angiography (CTCA). This audit of CTCA in the Northern Territory examines the relationship between CAD and HDL in ATSI and rural cohorts. Method(s): Patients with a CTCA performed between 2013 and 2018 at the Royal Darwin or Alice Springs Hospitals were retrospectively screened. Patients with a full lipid profile within 12 months of CTCA and no previous IHD were included. Result(s): 213 patients were included (Male: 57.7%, Mean age: 48.2 years, ATSI: 17.8%). Patients with CAD adjudged by a positive Leaman score were more likely to have hypertension (41.3% vs 18.3%,p<0.001) and statin use (48.6% vs 22.1%,p<0.001). ATSI patients were significantly younger (41.9 vs 49.9years,p<0.001) with lower HDL (0.91 vs 1.17mmol/L, p<0.001) and higher triglycerides (2.35 vs 1.63mmol/L,p=0.018) whilst there was no difference in LDL (2.8 vs 3.1mmol/L,p=0.25), total cholesterol (4.7 vs 5.0mmol/L,p=0.25), or HbA1c (7.2 vs 7.5,p=0.87).The presence of CAD or magnitude of Leaman score did not significantly vary with respect to serum HDL, ethnicity or geographic location. Conclusion(s): There was no relationship between CAD on CTCA and HDL in a primary prevention cohort, regardless of ethnicity or location. Despite this, Aboriginal and Torres Strait Islander patients were significantly younger with lower HDL and higher triglycerides. More may be revealed in future by examining novel markers of inflammatory coronary plaque on CTCA.Copyright © 2020

Spinning kenaf fibers into yarns is challenging due to the stiffness and lack of cohesiveness of the fibers. Alkali treatment is known to remove hemicellulose, wax, and breaks down lignin, reducing stiffness of kenaf fiber and improving its spinnability. Kenaf fibers were treated at percentages of 4% and 6% and blended with cotton fibers at blend ratios of 40:60 and 50:50 prior to a ring spinning process to produce a double ply yarn of 70 tex. Yarn were twisted at three sets of twist. The responses were measured in terms of carding waste percentages and yarn strength. The results showed that the optimized yarn structural parameter is kenaf fiber treated at 6% and with a kenaf/cotton 40/60 blending ratio based on its tenacity and minimum carding waste. ANOVA shows that there is a good interaction effect between NaOH and kenaf/cotton ratio, and NaOH concentration and twist.