ECGd (ms) ECGd <130ms 130-150ms 150-170ms >170ms.

EF Change 9.1 � 4.8 11.2 � 6.4 12.5 � 6.9 13.2 � 9.2

IEGM (ms) IEGM< 90ms 90-110ms 110-130ms >130ms

EF Change 7.8 � 5.9 10.3 � 8.8 14.3 � 6.4 18.3 � 8.1

%QLV %QLV<70% 70-80% 80-90% >90%

EF Change 2.9 � 4.0 12.5 � 10.2 14.3 � 6.8 16.5 � 7.5

Group 1 (n[28) Group 2 (n[91) p value

Age (years) 71�2 64�11 0.0011

Female Gender % 32(N¼9) 46(N¼42) -

Functional MR % 46(N¼13) 15(N¼14) -

Mean LVEF % 44�2 60�11 <0.0001

Mean Euroscore II % 12�3 3.2�3.2 <0.0001

ORALABST

RACTS

Educating children is crucial in combating the disease since they are especially vulnerableto streptococcal infection. The role of innovative training approaches (technology-based)among school-going children remains unverified.Objectives: The current project therefore sought to train school-going children on RHDusing an interactive digital module from WiRED international, a US based non-profit or-ganization working in Kenya.Methods: The module offered simplified animated presentations linking sore throat, rheu-matic fever and RHD, as well as ways of their prevention. The module also introduced ques-tions throughout the presentation and provided instant feedback to reinforce key concepts.Upper primary pupils from two schools were randomly assigned into control (n¼100)

and experimental (n¼100) groups. The experimental group was trained using the module,while the control group did not have any teaching. Both groups then answered 23 multiplechoice questions (MCQs). During a follow-up visit one week later, the students were re-administered with the same final exam. The results were analyzed using SPSS version 16.0.Results: The mean age of the pupils was 12.71 years. On the first visit test, the experimentalgroup had higher average scores compared to the control group (16.3�2.5 vs. 10.5�2.3marks; p<0.001). The follow-up test results were 15.7�2.7 for experimental and 10.4�2.4marks for the control, p<0.001. Age, class level or gender did not affect performance.Conclusion: The use of interactive digital modules to train school-going children on RHDincreases knowledge, awareness and is feasible, efficacious and sustainable. This approachis beneficial, and could potentially reduce the toll of RHD if tailored to the specific learningneeds of the children and applied more widely.Disclosure of Interest: None Declared

O029

Patterns And Clinical Manifestations Of Tuberculous Myocarditis: A SystematicReview Of Cases

Brian N. Michira*, Faraj O. Alkizim, Duncan M. MathekaSchool of Medicine, University of Nairobi, Nairobi, Kenya

Introduction: Tuberculosis is a rare cause of myocarditis. It is, however, associated with ahigh mortality when it occurs and is often diagnosed at post-mortem. Although case re-ports have been documented, comprehensive reviews compiling the patterns and clinicalmanifestations of tuberculous myocarditis are lacking.Objectives: The low incidence, late diagnosis, and under-reporting of tuberculousmyocarditis have with time created a knowledge gap among health care workers. Thisreview therefore seeks to restore awareness among the practitioners, to promote a highindex of suspicion for early diagnosis, and thereby timely management of TB myocarditis.Methods: A Pubmed search using the key words: “Tuberculous myocarditis” or “Tuber-culosis myocarditis” and limited to the time frame between 2000 and 2013, was conducted.Out of 136 articles retrieved, 23 case reports were found to be highly relevant to the review.There was no geographical focus in consideration of the case reports selected.Results: Most of the reported cases of tuberculous myocarditis were predominantly inimmunocompetent patients. Out of the reported fatalities (sudden cardiac deaths), eightyone percent (81%) occurred in the ‘young’ patients (below 45years). Of all these cases, 80%were females. Left ventricular involvement was seen in all the cases of sudden cardiac death.Tuberculous myocarditis with concomitant pulmonary infection was reported in 56% of thecases; whereas concomitant pericarditis was recorded in 47% of the cases. Antituberculosisdrug therapy did not appear to offer mortality benefit against sudden cardiac deaths. Elec-trical conduction abnormalities in the myocardium did not seem to be entirely dependent onserum electrolyte levels, as two case reports with similar clinical presentation of S3 heartsound with sinus tachycardia recorded significantly different serum electrolyte levels.Conclusion: Tuberculous myocarditis has a multifaceted clinical presentation and is oftenundiagnosed. Sudden cardiac death mostly occurred in the young (below 45years), withtwice as many females affected as males. In TB endemic areas, a high index of suspicion isnecessary in patients presenting with unexplained non-ischemic arrhythmias, congestiveheart failure or cardiogenic shock, to make the diagnosis.Disclosure of Interest: None Declared

O031

Predicting response to CRT: Intracardiac EGM, QRS duration or %QLV

Hariharan Sugumar*, Michael D. Flannery, Andrew Teh, David O’DonnellCardiology, Austin Health, Melbourne, Australia

Introduction: Predicting response to cardiac resynchronisation therapy (CRT) is difficultand imprecise. A number of clinical, imaging and electrical methods of predicting responsehave been proposed. Our previous analysis has demonstrated the value of ECG andintracardiac electrogram measures at the time of implant to predict response, however therelative importance of these measures has not previously been assessed.Objectives: We sought to determine which electrical parameters at implant are best atpredicting response to CRT.Methods: One hundred consecutive patients undergoing CRT between 2011 and 2012using multipolar LV leads were enrolled. At implant a 12 lead ECG was performed and thelongest QRS duration recorded. Intracardiac EGM (IEGM) recordings were measured be-tween the right ventricular electrogram and latest activated left ventricular electrogramduring intrinsic rhythm. % QLV was defined as the time from first surface ECG deflec-tion(ECGd) to LV electrogram peak during sinus rhythm as a % of total QRS dura-tion(QRSd). Echocardiographic measurement of ejection fraction was preformed prior toimplant and at six months post implant. Each variable was divided into quartiles ECGd<130ms, 130-150ms, 150-170ms, >170ms. IEGM < 90ms, 90-110ms, 110-130ms,

e8

>130ms and %QLV <70%, 70-80%, 80-90%, >90%. Mean change in ejection fraction(EF) for each parameter and each quartile was recorded.Results:

An increasing quartile of each parameter was a univariate predictor of improved ejectionfraction. On multivariate analysis the increasing quartiles of IEGM were the best predictorsof response. A %QLV < 70 was the most powerful differentiator of poor response.Conclusion: Implant electrical characteristics are fundamental in maximising response toCRT. Whilst baseline prolongation of QRSd predicts response to CRT, the lead parametersat implant can predict response with greater certainty.Disclosure of Interest: H. Sugumar: None Declared, M. Flannery Grant/research supportfrom: Medtronic, A. Teh: None Declared, D. O’Donnell Grant/research support from:Medtronic and St Jude Medical, Consultancy for: Medtronic and St Jude Medical

O032

Severe symptomatic mitral regurgitation: real world cost of conservative and surgicaltreatment.

Peace Tamuno, John Newland*, Sanjeevan Pasupati, Samuel Whittaker, Gerard Devlin,Rajesh NairCardiology, Waikato Hospital, Hamilton, New Zealand

Introduction: Severe symptomatic MR (ssMR) is treated conservatively due to highoperative risks in up to 50% of patients. Percutaneous mitral valve repair using MitraCliphas been shown to be clinically effective and safe in selected patients and may be costeffective in this cohort.Objectives: To evaluate clinical outcomes and healthcare cost implications of currentmanagement strategies for ssMR in a single centre.Methods: Patients deemed unsuitable for conventional surgery were screened usingtransoesophageal echocardiography to ascertain suitability for MitraClip (group 1, n¼28)and prospectively followed up from March 2011 to March 2013. Retrospective analysis wasdone for patients undergoing mitral valve surgery for predominant MR (group 2, n¼91;group 2(a) Euroscore < 6%, n ¼ 80, group 2(b) Euroscore �6%, n¼11). In hospital costwas obtained from accounts department.Results: Patients in group 1 were older (p<0.05), had higher Euroscore (p<0.001), lowerleft ventricular ejection fraction (p<0.0001) and were more likely to have functional MR(46% vs 15%). 57 % of patients in group 1 had �2 hospital admissions with a meancumulative length of hospital stay of 27�7 days. Mortality was higher in the conservativearm (group 1 - 39 % vs. group 2 - 5.5%). Patients undergoing mitral valve surgery with ahigh surgical risk stayed longer in hospital when compared to low risk patients (group 2(a)12�15 vs. group 2(b) 21�17, p 0.06).High risk patients undergoing surgery had higher mortality rate (group 2(a) 2.5 % vs

group 2(b) 27%) and higher mean in-hospital costs (group 2(a) NZ$35,708.36 vs group2(b) NZ$ 63552.71). Mean cost of conservative treatment (group 1) was NZ$36,814�7,818. Projected cost for MitraClip procedure is NZ$ 36,000.

Conclusion: Patients with ssMR treated conservatively have recurrent hospital admissionsand poor prognosis. Surgery for high-risk patients is associated with higher mortality andexpense. Percutaneous repair of mitral valve using MitraClip may be cost effective for highrisk and surgically unsuitable patients in a New Zealand setting.Disclosure of Interest: None Declared

O034

Association of amino-terminal-B-type natriuretic peptide levels with structural heartdisease in a community cohort at increased risk of heart failure - the SCREEN-HFstudy

Jennifer M. Coller*1,2, Duncan J. Campbell2, Henry Krum3, Michele McGrady4, Louise Shiel3,Chris Reid3, Umberto Boffa5, Rory Wolfe4, Simon Stewart6, David L. Prior71Department of Medicine, St Vincent’s Hospital, 2St Vincent’s Institute, 3Centre for

GHEART Vol 9/1S/2014 j March, 2014 j ORAL/2014 WCC Orals