Conclusion: Trends in use of non-invasive cardiac diagnostic imaging modalities in Australia have not been affected by the introduction of CTCA in the Medicare Benefits Schedule. While there has been moderate uptake of the new technology, increasing rates of echocardiography have continued over the last five years and there has been little change in the rates of NM MPS studies. Reference: Mohasseb I, Gericke C, Atherton J, Dahiya A, Chao C and Younger J. Reim- bursement for CT Coronary Angiography Did Not Lead to a Decrease in Invasive Coronary Angiography or Stress Echocardiography in Australia. Heart, Lung and Circulation 2013;22:S194-195 Disclosure of Interest: None Declared PT389 Relationship of coronary stenosis with degree of myocardial perfusion assessed by integrated PET/CT imaging in patients with suspected ischemic heart disease Erick Alexanderson-Rosas* 1 , Bruno Strada 2 , Sergio Maury 1 , Antonio Jordán-Rios 1 , Monserrat Martínez-Aguilar 1 , Elisa Magaña-Bailón 1 , Luis Juárez 1 , Juan C. De La Fuente 1 , Aloha Meave 1 1 National Heart Institute "Ignacio Chavez", Mexico, Mexico City, Mexico, 2 Sanatorio San Geronimo, Santa Fe, Argentina Introduction: The value of CTA for predicting myocardial ischemia is unclear, so inte- grated PET/CCTA imaging could be used nonivasively to assess functionality of detected coronary lesions allowing better guidance for subsequent therapy. Objectives: We aimed to evaluate the relationship between coronary stenosis and its functional impact with ammonia PET in patients with suspected CAD. Methods: We studied 348 consecutive patients (median age, 62 +-11.3 years; 68.1% male, 31.9% female) with suspected CAD with rest/adenosine stress 13N-Ammonia PET imaging for myocardial perfusion and CTA for coronary stenosis evaluation in the same setting. Results: Of the 348 patients studied,254 (73%)patients had ischemia and/or necrosis detected for PET and 192 (55.2%) had coronary stenosis by CCTA; 162 (84%) of the 192 patients with lesions detected by CCTA had ischemia detected by PET, and 95 (92%)of the 103 patients had significant lesions had ischemia. 156 patients had normal coronary ar- teries, and 92(59%) of them had ischemia detected by PET. The relationship between the degree of stenosis on CCTA and PET ischemia was significant (p¼0.001), and the rela- tionship between PET ischemia and CT stenosis was also significant (p¼0.001).The rela- tionship between the degree of ischemia (moderate or severe) and the presence of coronary significant stenosis was also significant (p¼0.001). PET sensitivity for detecting CCTA significant lesions was 92%, and specificity was 35%, Positive Predictive Value (PPV) was 37%, Negative Predictive Value (NPV) was 91%. Conclusion: PET/CT allows simultaneous evaluation of the perfusion and coronary anatomy, providing complementary information regarding the functional significance of the coronary lesions. We found a good correlation between significant and non significant coronary stenosis identified by coronary CCTA with moderate and severe perfusion defects obtained by 13-N-Ammonia PET. However, cases with no stenosis with ischemic defects by PET were patients with mild ischemia that may be related to vascular dysfunction caused by risk factors such as DM, dyslipidemia, hypertension, smoking, as well as other vascular anomalies. Disclosure of Interest: None Declared PT390 Left ventricle ejection fraction assessment through three imaging methods: A study in oncologic women Erick Alexanderson-Rosas* 1,2 , Lucely Cetina-Perez 3 , Roberto Jiménez-Lima 3 , Antonio Jordan-Rios 1 , Luis Eduardo Juárez-Orozco 4 , Myriam Monserrat Martínez-Aguilar 1 , Sergio Maury-Ordaz 1 , Elisa Magaña-Bailon 1 , Aloha Meave-González 5 , Cynthia Romero-Aragones 5 1 Nuclear Cardiology, National Heart Institute "Ignacio Chavez", Mexico, 2 PET/CT Cyclotron Unit, National University of Mexico, 3 Oncology, National Institute of Oncology, Mexico city, Mexico, 4 Universitair Medisch Centrum Groningen, Groningen, Netherlands, 5 Cardiovascular Magnetic Resonance, National Heart Institute "Ignacio Chavez", Mexico, Mexico city, Mexico Introduction: It is well known that chemotherapy conveys a degree of risk for car- diotoxicity in oncologic patients. Therefore choosing the most appropriate imaging method in their follow-up is crucial for evaluation before and after each chemotherapy administration. Nowadays, cardiac magnetic resonance (CMR) is considered the gold standard for left ventricle ejection fraction (LVEF) evaluation. Nevertheless, this is an expensive method and is not available in every medical center, especially in developing countries. At the same time there are other widely spread and accessible non-invasive imaging methods such as echocardiography (ECHO) and radionuclide ventriculography (RV). Objectives: The aim of this work is to determine whether there are differences in the assessment of LVEF between these imaging methods as well as to determine which one may be the most suitable for oncologic patients in developing countries. Methods: We analyzed an established cohort of Mexican women. 52 patients were included, with ages in the range of 18-70 years old with diagnosis of cervical cancer stage IV-B and no previous cardiovascular history. We performed RV, ECHO and CMR in one a one or 2 day session, one week before chemotherapy administration. We applied a t-test for paired groups to assess for the difference of means, a value of p<0.05 was considered statistically significant. Results: The mean LVEF using RV was 62.1%Æ7.21, the mean LVEF using ECHO was 64%Æ8.82 and the mean LVEF using CMR was 61.5%Æ6.49. When comparing RV vs CMR the result was p¼0.46, meanwhile when comparing ECHO vs CMR the result was p¼0.03. Conclusion: As expected there was no statistically significant difference between RV and CMR Interestingly, there was statistically significant difference between ECHO and CMR. This can be attributed to the fact that ECHO is an operator dependent study which in turn conveys a wider variability. Since there was no difference between RV and CMR we consider appropriate to utilize RV when CMR is not available since it offers adequate measurements and it is less prone to inter-observer variability. Nevertheless, the decision about which method to use should be based on availability, radiation exposure, economic burden and patient comorbidities. Disclosure of Interest: None Declared PT391 Building a monitoring system for clinician-led governance and quality Improvement: beginning with the end in mind Ian Smith 1,3 , John Rivers* 1,2 , James Cameron 1,2 , Kelley Foster 1 , Russell Brighouse 1 1 St Andrew’s Medical Institute, 2 Queensland Cardiovascular Group, 3 St Andrew’s War Memorial Hospital, Brisbane, Australia Introduction: Collection of new data into a clinical registry is often proposed as the initial step in establishing a monitoring program for service-level clinical governance and clini- cian-led quality improvement. However without an agreed step-by-step pathway of action for subsequent analysis and findings, this activity risks becoming an end unto itself - rather the means to that end. Objectives: To outline a theory-based framework for clinician-led design and imple- mentation of an integrated outcomes monitoring and quality improvement program. Methods: Program design begins with the clinicians identifying a minimum set of in- dicators which summarise from the clinician’s perspective, performance of the speciality’s clinical processes and outcomes. Potential indicators are prioritised according to the extent that when longitudinally tracked, significant differences from a risk-adjusted target rate could be investigated – and whether variation of the indicator requires meaningful action. Composite indicators are often chosen as meeting these requirements where single low frequency indicators may not provide adequate signals. The framework describes a collaborative process for the systematic optimisation of clinical outcomes at individual and craft group levels. Results: Starting comprehensive data collection can give a sense of progress towards generic improvement goals. However, commencing collection of whatever data is available may be at the expense of data that is most relevant and useful to the program’s real pur- pose. We advocate a framework that begins by developing an agreed step-by-step pathway to help ensure authentic findings from the monitoring program are properly actioned. Clinician-led application of the framework is intended to develop and generate agreement on protocols on: - Response to authentic outlier performance or patterns - Investigation of outlier performance or patterns Descriptive Statistics (Mean +/- standard deviation) n[52 Imaging method LVEF (mean) p CMR 61.5% Æ6.49 Gold Standard ECHO 64% Æ8.82 0.03 RV 62.1% Æ7.21 0.46 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e247 POSTER ABSTRACTS