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226
Abstracts
POSTER SESSION 3
Monday 19 May 2014 08:30– 18:00
Room: Poster Area
ACUTE HEART FAILURE – POSTER PRESENTED
P1218
Cardiogrenic shock in the context of ST elevated myocardial infartion:
caracterization of the population and evaluation of prognosis
B FBruno Filipe Lourenco Marmelo; AP Delgado; D Moreira; L Abreu; JG Pereira;
PLC Ferreira; J Oliveira Santos
Hospital Sao Teotonio, Viseu, Portugal
Purpose: Cardiogenic shock (CS) is a major determinant in mortality in the context
of acute myocardial infarction (AMI). It’s treatment is a challenge. This work aims to
understand the characteristics of patients with CS and determine their in-hospital
and follow-up after 1 year prognosis.
Methods: A retrospective study of 481 patients admitted to UCIC for AMI with ST
elevation (STEMI). Patients were divided into 2 groups, with CS at admission or during hospitalization (GA) and without CS (GB). Analytical, clinical and angiographic
parameters. Statistical analysis in SPSS.
Results: In the sample studied the mean age was 66.4 years and the prevalence of males was 70.9%, without significant differences between groups. About
3.2% of patients presented with CS at admission while 9,4% developed CS
during hospitalization. Those without CS, 53.3% were admitted in Killip class I,
40% in Killip II and 6.7% in Killip III. There were no differences between groups
regarding previous diseases, namely diabetes mellitus, dyslipidemia or hypertension. Only 5 patients (8.3%) of GA had history of coronary disease. There
were no significant differences in symptoms-to-admission and door-to-balloon
times in both groups but GA had an higher time until admission (GA 632.6 min
vs 448.3 min GB, p% = 0.73) and lower until the balloon (GA 94.3min GB vs
260.0 min, p% = 0.23). Electrocardiography shows a higher prevalence of inferior
infarction (31.6%) compared with the anterior (33.3%), infero-lateral (13.3%) and
lateral locations (0.05%). ECG changes suggestive of fibrosis were present in
the input% of patients in the GA. In patients of GA the most common culprit
was the right coronary artery (50.0%), followed by anterior descending (37.5%)
and circumflex (9.4%), and occlusion of the common core responsible for 3.1%
. The complication were more frequent in GA, as ventricular fibrillation or ventricular taquicardia (GA 36.7% vs GB 15.2%) or mechanical complications (GA
23.3% vs GB 0.96%). The resulting ejection fraction in GA was 48.9% and in GB
was 56.1%.
The GA had higher in-hospital mortality (GA 68.3% vs GB 1.2%, p < 0.001).
The mortality after 1 year post discharge was not different between the two
groups (5.9% vs GB GA 3.7%, p% = 0.49). Recurrence of ACS in 11.7%
of patients in the GA and 4.0% of patients in the GB, without significant
difference.
Conclusions: CS is responsible for the greatest mortality in the context of
STEMI. Appears most frequently associated with occlusion of the right coronary artery, probably in association with right ventricular infarction and mechanical
complications.
P1219
Impact of obesity patients diagnosed with heart failure in outpatient
FDCFatima Das Dores Cruz; BC Oliveira; EA Bocchi
Heart Institut, São Paulo, Brazil
Background: Heart failure (HF) is a complex syndrome characterized by failure of
the cardiovascular system to meet the demand for oxygen and nutrients throughout the body, leading to neuroendocrine and inflammatory pro activation and elevation of filling pressures. Studies show that obesity is responsible for subsequent changes in diastolic and systolic function and factor predisposes to HF.
Its etiology is multifactorial process and is related to genetic and environmental
aspects The body mass index (BMI) defined as the weight Kg divided by height
in meters squared, is a measure of the degree of obesity of a person, that is < 18.5
is considered underweight, 18.5-24.9 (normal weight), 30-34.9 (obesity class I),
35-39.9 (obesity class II), > 40 (obesity class III). According to the health ministry,
Brazil, the adult population has shown prevalence in overweight . Currently, data
have shown increased prevalence of obesity in both developed and developing
countries.
Objectives: To analyze the percentage of body mass index (BMI) in patients with
diagnosis of heart failure outpatients .
Methods : We analyzed 4527 patients with HF followed in ambulatory unit specializing in heart failure
Results: In the analysis, 67 % male, 55 ± 13 years, whites: 80 %, mulatto 10 %,
black 8 %, Yellow : 2% Not specified : 0.7 %, with varying functional class I to IV
(NYHA). BMI (kg/m2 ) < 18.5 : 2.5 %, 18.5 to 24.9 : 41 %, 25 to 29.9 : 35 %, 30 to
34.9 : 14.5%, 35 39.9% to 5%, > 40: 2%
Conclusion : In this review we observed the prevalence of male gender and white,
and a small number of patients below ideal weight, which can be correlated with
the evolution of the disease (cardiac cachexia), but the BMI range considered ideal /
healthy weight was found a considerable percentage, however patients overweight
prevail in higher incidence.
P1220
Predictors of major adverse cardiovascular events at 6 months after a
hospitalization for acute heart failure
M Bougiakli1 ; S Giannitsi1 ; A Bechlioulis2 ; I Gkirdis2 ; A Kotsia1 ; L Lakkas2 ;
S Antoniou1 ; K Pappas2 ; LK Michalis2 ; KK Naka2
1 Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece;
2 Department of Cardiology, University of Ioannina, Ioannina, Greece
Purpose: Increased readmission and cardiovascular event rates have been reported
in the short-term after an admission for acute heart failure (AHF). The role of vascular
function on prognosis has been little studied in patients hospitalized with AHF. The
aim of the current study was to investigate the prognostic role of vascular function
on major adverse cardiovascular events (MACE) at 6 months after a hospitalization
for AHF.
Methods: Our study included 60 patients (mean age 72 years, 78% males) who were
admitted for AHF syndrome (new onset or decompensation of chronic heart failure)
and were followed-up for 6 months after discharge. A comprehensive medical history was taken and the functional status at admission (NYHA class) was recorded.
Standard demographic, clinical and laboratory parameters were included in analyses. A complete echocardiographic (conventional and tissue Doppler parameters)
study, a 6-minute walking test and peripheral vascular studies were performed in
all subjects 24-48 hours prior to discharge. Vascular studies included assessment
of brachial artery flow mediated dilation (FMD), carotid-femoral pulse wave velocity (PWV), central augmentation index, estimated central aortic pressures, large and
small vessel compliance using tonometry and ankle-brachial index. Patients with
recent acute coronary syndromes, other severe chronic diseases and atrial fibrillation were excluded.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
Results: Left ventricular ejection fraction (LVEF) was 38 ± 16% (mean ± SD). There
were 12 (20%) patients with preserved LVEF >45% (HFPEF), 37 (62%) had ischemic
etiology of heart failure, while 14 (23%) appeared with NYHA IV on admission.
During the 6 month follow-up, 21 (35%) patients experienced MACE including
rehospitalization for heart failure, non fatal myocardial infarction, non fatal stroke
and deaths. In univariate Cox regression analysis, LVEF (HR 2.0 per one SD,
p% = 0.002), the presence of HFPEF (HR 3.4, p% = 0.006), HDL (HR 0.51 per one
SD, p% = 0.006), E/E′ >14 (HR 3.6, p% = 0.015) and systolic blood pressure (HR
1.6 per one SD, p% = 0.042) were associated with occurrence of MACE. In multivariate analysis, the presence of HFPEF (p% = 0.006), lower HDL (p% = 0.022)
and E/E′ >14 (p% = 0.032) were independent predictors of MACE at 6 months in
our population.
Conclusion: In our population of AHF patients, the presence of HFPEF and increasing left ventricular filling pressures were associated with increased MACE rates
indicating the high morbidity associated with HFPEF and pulmonary congestion.
Interestingly, vascular function did not appear to play a role in the MACE rates at
6-month follow-up.
P1221
The dilemma of Congestive Heart Failure (CHF) among Yemeni patients
presented with cute Coronary Syndrome (ACS), data from phase one the Gulf
Registry of Acute Coronary Events (GULF RACE I)
AHMED Alansi; A-NASSERAbdulnasser Munibari; AHMED Almotarreb
Al-Thawara General Teaching Hospital – The Cardiac Center, SANA’A, Yemen
Introductions & Aims: Acute Coronary Syndrome (ACS) and its consequences
is one of the most common cardiac diseases world-wide .Yet in Yemen ; GULF
RACE I data are the first nation- wide information that highlight the magnitude of this problem. We would like to point out the problem of CHF among
Yemeni ACS population, its prognostic importance and impact in patients
outcomes.
Methods and Patients: Yemen data arm was a part from the GULF RACE phase I,
which is a prospective, multinational, multicentres survey of consecutive patients
hospitalized with the final diagnosis of ACS in six Arabian Peninsula/Gulf countries over a period of six month: Gulf RACE I is a prospective, multinational,
multicentres survey of consecutive patients hospitalized with the final diagnosis of ACS in six Arabian Peninsula/Gulf countries over a period of six month.
Yemeni patients were 1054 patients included from 20 major hospitals all over the
country with ACS pointing out cases of ST Elevation Acute Myocardial Infarction
(STEMI) or newly developed Left Bundle Branch Block (LBBB) .The manifestations of CHF based ACS patients with Killip Class II/III on presentation or
during hospital stay . The end point of this study was all causes of in-hospital
mortality.
Results: Out of 1054 hospitalized with ACS, 181 patients (17.3%) had CHF on
presenting to the hospital or during hospitalization itself. They were relatively older
63.2 ± 10.7(SD) years (P < 0.001) with male predominance (72.4%). In spite of
Anterior /Anteriolateral STEMI was a common feature of presentation (69.6%), still
LBBB MI were more predominant . Echocardiographic feature were more consistent with CHF group, Left Ventricular Ejection Fraction (LVEF) was (40% Vs 51%
P < 0.001). Those patients were in co-morbid condition more than the rest of the
group of ACS . Evidently were less treated utilizing evidence based treatment . Congestive heart failure was linked to higher in hospital mortality (30.4 % Vs 4.8% with
P < 0.001).
Conclusion: Acute coronary syndrome Yemeni patients complicated with congestive heart failure had more worse prognosis regarding in-hospital morbidity and
mortality.
227
However there were a decrease of in hospital mortality, acute pulmonary edema and
right heart failure. Acute pulmonary edema 4 % in 2010 became 2,7 % in 2012. Right
heart failure from 7 % in 2010 became 5 % in 2012.
Heart failure with Preserved EF was still around 17 %.
Conclusion: Heart Failure registry is a valuable tool for reflection and improvement
for doctors who look-after patients. Dissemination of the results of this registry will
make a better management in the near future.
P1223
Predictors of 6-month mortality in patients hospitalized with an acute heart
failure syndrome
S Giannitsi1 ; M Bougiakli1 ; A Bechlioulis2 ; I Gkirdis2 ; A Kotsia1 ; L Lakkas2 ; S
Antoniou1 ; K Pappas2 ; LK Michalis2 ; KK Naka2
1 Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece;
2
Department of Cardiology, University of Ioannina, Ioannina, Greece
Pupose: Increased short-term mortality and high rehospitalization rates have
been reported after an acute heart failure (AHF) admission. The role of vascular function on cardiovascular prognosis has not been adequately studied in
patients with AHF. The aim of the current study was to investigate the prognostic role of vascular function on short-term mortality in patients presenting with an
AHF syndrome.
Methods: Our study included 57 patients (mean age 72 years, 79% males) who
were admitted for AHF syndrome (new onset or decompensation of chronic heart
failure) and were followed-up for 6 months after discharge. A comprehensive medical history was taken and the functional status at admission (NYHA class) was
recorded. A complete echocardiographic (conventional and tissue Doppler parameters) study, a 6-minute walking test and peripheral vascular studies were performed
in all subjects 24-48 hours prior to discharge. Vascular studies included assessment
of brachial artery flow mediated dilation (FMD), carotid-femoral pulse wave velocity (PWV), central augmentation index, estimated central aortic pressures, large and
small vessel compliance using tonometry and ankle-brachial index. Patients with
recent acute coronary syndromes, other severe chronic diseases and atrial fibrillation were excluded.
Results: Forty-six (81%) patients had reduced ejection fraction < 45%, 35 (61%)
had ischemic etiology of heart failure while 13 (23%) appeared with NYHA class IV
on admission. During the 6 month follow-up, 7 deaths (12.3%) occurred, all related
to cardiovascular diseases. In univariate Cox regression analysis, the presence of
severe aortic valve stenosis (HR 12.66, p% = 0.001), NYHA class IV vs II/III (HR
9.69, p% = 0.007), FMD < 3.3% (HR 8.1, p% = 0.053), increasing age [HR 3.3 per
one standard deviation (SD), p% = 0.038], increasing PWV (HR 3.0 per one SD,
p% = 0.036) and longer hospitalization in days (HR 1.6 per one SD, p% = 0.012)
were associated with death occurrence. In multivariate analysis, severe aortic stenosis, higher PWV and NYHA class IV at admission were independent predictors of
6-month mortality in our population.
Conclusion: Severe aortic stenosis was the most important predictor of short-term
mortality in our population. Severely impaired functional status on admission identified AHF patients at increased risk in the short term. Increased aortic stiffness
independently predicted 6-month mortality, indicating probably the significance of
peripheral circulation in the prognosis of patients with AHF.
P1224
Dilated cardiomyopathy and acute heart failure due to Epstein Barr viral
infection
J Grapsa; M Sajjad; A Vaziri; H Thomas; S Sundar
Papworth Hospital NHS Trust, Cardiology, Cambridge, United Kingdom
P1222
Heart failure registry at national cardiovascular center jakarta 2010 - 2012
SP Rarsari; BBBambang Budi Siswanto; N Hersunarti
University of Indonesia, Faculty of Medicine, Department Cardiology & Vascular
Medicine, Jakarta, Indonesia
Purpose: To know the condition of heart failure at National Cardiovascular Center
Jakarta in comparison from 2010 to 2012
Methods: Retrospective compilation from medical records of patients admitted with
acute heart failure at National Cardiovascular Center Jakarta from 2010 to 2012
using the registry from ESC.
Results: There were an increase of new onset younger heart failure patients, male
more than female more smokers, atrial fibrillation, new onset type 2 diabetes,
cardio-renal syndrome, AHFS on ACS and high readmission rate.
Ischemic heart disease as the most common etiology increased from 51 % in
2010 became 57,6 % in 2012. Atrial fibrillation increased from 15 % in 2010
became 19,1 % in 2012. Type 2 DM 36 % in 2010 increased to 42,4 % in
2012. Hypertensive Heart Failure increased from 9 % in 2010 became 10 % in
2012.
Purpose: To present the case of a 37 years old patient who presented to our hospital with shortness of breath and increasignly reduced exercise tolerance.
Case presentation: A 37 years old man, previously fit and well, was admitted through
Accident and Emergency Department with shortness of breath and increasignly
reduced exercise tolerance. His ECG demonstrated signs of left ventricular strain
and his chest X-ray revealed cardiomegaly. Subsequently, a bedside echocardiogram demonstrated dilated left ventricular dimensions (end-diastolic: 65 mm and
end-systolic: 59 mm) and an estimated left ventricular ejection fraction 12%. The
patient had also dilated right ventricle with moderate to severe systolic impairment,
severe mitral and free flow tricuspid regurgitations. Raised filling pressures while
right ventirucular systolic pressure was not feasible to be measured due to the
free flow tricuspid regurgitation. The patient underwent extensive virology screening
which revealed that he was affected by Epstein Barr virus. After discussion with the
infectious diseases department, we decided not to employ antiviral medication or
interferones.
The patient deteriorated clinically by developing pulmonary oedema and he was
managed with intravenous furosemide and dopamine infusions. He was persistently intolerant of small dose of b-blockers (driven into acute pulmonary oedema
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
228
Abstracts
with 1.25 mg of bisoprolol). The clinical stability of the patient was monitored with
the direct measurement of central venous pressure and weekly echocardiographic
scans.
His repeat echocardiogram revealed a further significant increase of left ventricular
dimensions (end-diastolic: 75 mm, end-systolic: 68 mm) and a significant deviation
of the interatrial septum which indicated significantly raised left atrial pressure. The
patient - after 6 weeks as an inpatient - underwent a successful heart transplant
operation and his post-operative recovery was uncomplicated.
Conclusion: Epstein Barr might be a cause of futile myocarditis causing dilated
cardiomyopathy and acute heart failure. All patients should be considered for heart
transplant if there is ongoing increase of left ventricular dimension and ongoing
failure.
P1225
Giant left atrial myxoma presenting as congestive heart failure
B LBenjamin Lawrence Green1 ; S Morais2 ; KC Javangula3
Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; 2 Leeds General
Infirmary, Department of Cardiology, Leeds, United Kingdom
1
Case description: A 58 year old female patient with no significant medical problems
presented to the emergency department following a three week history of cough
and rapidly progressive nocturnal dyspnoea. This reportedly started following a
medium-haul flight. On assessment she was hypoxic (SpO2 92%), with examination
revealing coarse crepitations bilaterally and a variable systolic murmur.
Initial investigations revealed a raised d-dimer, with an electrocardiogram showing
incomplete right bundle branch block and a non specific atrial abnormality. Plain
chest films showed acute pulmonary oedema with CT pulmonary angiography
(CTPA) revealing a significant left atrial filling defect (Figure 1). Echocardiography
confirmed a 5.7 × 4.8 × 6 cm myxoma, adherent to the inter-atrial septum via a
stalk, prolapsing into the mitral valve orifice, and partially occluding pulmonary
venous drainage.
Discussion: Atrial myxoma is the most common intracardiac tumour with a
prevalence of 0.001% to 0.3%, normally occurring in isolation (90%) or as part
of autosomal dominant familial syndromes (10%). Clinical features are broadly
grouped as constitutional, embolic, or obstructive. This case is unusual in that it
involves a relatively acute presentation of congestive heart failure secondary to
mitral valve obstruction.
Definitive management involves complete surgical excision, which is curative in the
majority of cases. Prognosis is generally excellent with a recurrence rate of around
1-5%, although this is significantly higher in familial syndromes.
Patient outcome: The patient underwent successful excision of the myxoma, stalk
and adherent left atrial wall: histology confirmed a benign myxoma. The patients’
post-operative course was uneventful and she was successfully discharged one
week post-operatively.
P1226
Characteristics and predictors of one year mortality in patients with acute
heart failure
MMarko Banovic; Z Vasiljevic-Pokrajcic; B Vujisic-Tesic; S Stankovic; I
Nedeljkovic; D Popovic; D Trifunovic; M Asanin
University Institute for Cardiovascular Diseases, Belgrade, Serbia
Purpose: Acute heart failure (AHF) is one of the most common diseases in emergency medicine, associated with poor prognosis and high in-hospital and long-term
mortality. The aim of this study was to investigate characteristics, outcomes and one
year mortality of unselected patients with AHF in the local population.
Methods: This prospective study consisted of 64 consecutive unselected patients
treated in the University Coronary Care Unit of the Emergency Centre and were followed for one year after the discharge.
Results: Mean age of the patients was 63.6 +/- 12.6 years and 59.4% were
males. Thirty nine percent had de novo AHF and 61% had acute decompensation of chronic HF. Acute congestion (43.8%) and pulmonary edema (39.1%)
were the most common presentations of AHF. Mean left ventricular ejection fraction (LVEF) was 39.7% +/- 9.25%, while 44.4% of the patients had LVEF > or
% = 50%. At discharge, 55.9% of the patients received therapy with P-blockers,
94.9% diuretics, out of which 47.7% spironolactone, 94.9% patients were given
ACE-inhibitors or angiotensin receptor blockers. The 12-month all-cause mortality was 26.5%. Mean admission BNP value in patients who died during follow-up
was 1631,80 (2364,5)pg/ml, while in survivors was 838,19 (1706,68)pg/ml. Independent predictors of one year mortality were previous hospitalization due to heart
disease, LVEF < 32%, fraction of shortening < 18% and a higher tricuspid velocity
(>0.7m/s).
Conclusion: Our study present a real, unselected population of AHF patients. One
year mortality of our patients with AHF was high, pointing to the severity of this clinical syndrome. Better understanding of this syndrome may help us to improve the
diagnostic and therapeutic strategies, which will consequently improve prognosis
of these patients.
P1227
Epidemiology of acute cardiac insufficiency in intensive care unit
HHela Maamouri; A Jamoussi; T Merhabene; K Ben Romdhane; K Belkhouja; J
Ben Khelil; M Besbes
Abderrahmen Mami Hospital, intensive care unit, Ariana, Tunisia
Background: Acute cardiac insuffiency is a frequent and serious pathology responsable for heavy mortality. It can arise on a healthy heart, or be the decompensation
of a chronic cardiac insufficiency. The incidence as well as
factors threatening its outcome in the ICU, remains insufficiently found in the litterature.
Purpose: To study the epidemiological profile of the cardiac insufficiency in IUC and
to determine factors associated with mortality.
Methods: We led a retrospective study including patients of more than 18 years old,
presenting an acute cardiac insuffiency and admitted in IUC between January 2011
and July 2013. Patients having a chronic cor pulmonale were excuded. The dermographic, clinical and biological parameters echocardiac, therapeutic and outcome
were systematically found .The factors of prognosis was realized in analysis univarious then by a logistic regression (SPSS 17.0).
Results: 71 patient were included in the study .The global incidence of the ACI was
5,87%.The median age was of 67 years with a sex ratio in 1,95. The hypertension
and ischaemic heart disease was found in respectively 50,7% and 35,2%. The type 4
was most fraquently found in 44,3% of the cases. In a state of shock was observed in
25 patients (35,2%). The renal insuffiency was reported in 60,6% of the cases with a
median clearance (Mdr4) of 46 ml/mn. The median of the rate of lactate was 3 mmol/l
and those of Troponine Ic and NT PROBNP respectively of 0,00ug/ml and 6823. The
median P/F was 197,5. The cardiac insufficiency was a systolic type in 70,4% and
diastolic in 29,6%. The dilated cardiomiopathy and ischaemic heart disease was frequently observed in echocardiography in 39,4% each. The median of the FELV, the
aortic ITV and E/E′ were respectively 35%, 13,5% and 12%.The recourse to invasive
mechanical ventilation was necessary in 34,3% of the cases. The dobutamine was
the agent inotrope most frequently used in 27,1% of the cases.The global mortality
was 29% with a median length of stay of 3 days. The independent factors associated mortality was an aortic ITV < 12 cm [OR% = 17,2; IC(1,3-222,9)] and the
arisen of complications (cardiogenic shock, SDMV, renal insuffiency) [OR% = 20,2;
IC(1,6-242,4)].
Conclusions: The type 4 of the ACI was most frequently reported in our series. An
aortic ITV < 12 cms and the arisen of complications during the stay were independent factors associated with mortality.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
229
Galectin-3: an important biomarker in acute heart failure
investigation is needed to identify whether ethnicity, case selection or care account
for the observed differences in outcome.
DDoroteia Silva; A Magalhaes; A R Ramalho; N Cortez-Dias; AR Francisco; T
Guimaraes; C Calisto; D Pereira; A Nunes Diogo; D Brito
Hospital Lisbon North, Hospital Santa Maria, Lisbon, Portugal
P1230
P1228
Background: Along with neurohormonal biomarkers, galectin-3 (a soluble
𝛽-galactosidase) is a marker of ventricular remodelling and fibrosis, which has
assumed a major importance in the field of heart failure, especially studied in stable
chronic heart failure.
Aim: To assess the long-term prognostic value of galectin-3 in patients (pts) with
acute heart failure (AHF).
Methods: Prospective study of consecutive pts admitted to a tertiary hospital
with the diagnosis of systolic and/or diastolic AHF [Framingham plus echocardiographic (echo) criteria]. At admission, clinical, biochemical (including galectin-3
and NT-proBNP plasma levels determination) and echo evaluation were performed.
Follow-up (FUp) was conducted after 6 and 12 months post-discharge. Primary
endpoints: 1) death; 2) death or rehospitalization for AHF. The association of
galectin-3 with the endpoints was evaluated by Kaplan-Meier and Cox-regression
survival analyses and the prognostic accuracy was assessed by the area under the
receiver operator curve (AUC).
Results: Seventy pts were included (71 ± 14 years old, 40 men), 59% in NYHA
class III, 46% with ischemic cardiomyopathy and 92% with systolic dysfunction.
At admission, galectin-3 levels were elevated and correlated with NT-proBNP
(R% = 0.5, p% = 0.001), but did not significantly differ according to NHYA functional class or ejection fraction (EF). Higher values of galectin-3 were observed
in patients with higher left ventricular filling pressures, assessed by the E/E′ ratio
(R% = 0.4, p% = 0.02). During a mean FUp of 8 ± 6 months, 25 pts (36%) died
and 38 (54%) suffered death or rehospitalization for AHF. Patients who died had
higher galectin-3 levels at admission (p < 0.001). Galectin-3 values >28.16 ug/mL
(3rd tertile) were associated to three times higher risk of mortality (HR: 2.47,
95%CI 1.27-4.77, p% = 0.007) and mortality or rehospitalization (HR: 2,65 95%CI
1.34-5.23, p% = 0.005). ROC curve analysis shows that the prognostic accuracy of
galectin-3 in the prediction of the composite endpoint was moderate (AUC: 0.74,
95%CI 0,60-0,88; p% = 0.03). Finally, in the multivariable predictor model, that
included EF, NT-proBNP and galectin-3, only galectin-3 had an independent prognostic value of mortality or rehospitalization for AHF (HR: 2.38, CI95% 1.01-5.64,
p% = 0.049).
Conclusion: In AHF, galectin-3 at admission is a long-term prognostic marker
of morbidity and mortality, with an independent prognostic value in relation to
NT-proBNP and ejection fraction.
P1229
Patient characteristics and outcomes in Japanese and British patients
admitted with heart failure; the West Tokyo - Kingston-upon-Hull
collaboration
Y Shiraishi1 ; B Dicken2 ; S Kohsaka1 ; A Rigby2 ; R Rasool2 ; T Inohara1 ; A Goda1 ; T
Nagai1 ; T Yoshikawa1 ; JGF Cleland2
1
Keio University Hospital, Department of Cardiology, Tokyo, Japan; 2 University of
Hull, Department of Academic Cardiology, Hull, United Kingdom
Background: Although acute heart failure (AHF) is common in both Japan and the
United Kingdom, the clinical characteristics and outcomes of patients in these two
countries have never been directly compared.
Methods and Results: We analyzed the in-hospital, and 180-day outcome of 197
patients from a single university hospital in the UK and 327 patients from Japan
(multicenter registry from three hospitals) admitted with AHF between 2010 and
2013. The median (Interquartile range [IQR]) age of patients in the UK was 78 (70-84)
years and 77 (68-83) years in Japan. 38% of the patients in the UK were women
compared with 40% in Japan. A greater proportion of patients with left ventricular
systolic dysfunction (LVEF < 45%) was noted in the UK (64% vs. 48%). There were
significant differences in serum creatinine and NT-proBNP upon presentation; both
of which were higher in patients in the UK compared to Japan. In the UK, the median
(IQR) NT-proBNP was 4957 (2291-10,897)ng/L and 2938 (1110-6437)ng/L in Japan.
Length of stay was longer in Japan; median time 11 (7-18) days in the UK compared
with 14 (10-22) days in Japan. In-hospital mortality rate was slightly higher in the
UK (7.1% vs. 4.5%). Subsequent to discharge, mortality at 90- and 180-days was
substantially higher in the UK (13.1% vs. 3% for 90-days mortality, 21.3% vs. 3.9%
for 180-days mortality, P < 0.001 for both comparisons). The UK mortality rates are
consistent with those reported by the National Audit of England & Wales in more
than 100,000 patients.
Conclusion: Important differences exist in patient demographics, renal dysfunction
and plasma concentrations of NT-proBNP in Japanese compared to British patients
but these did not explain the much better prognosis of Japanese patients. Further
Withdrawn
P1231
Usefulness of non-invasive monitoring of the net lung impedance in chronic
heart failure patients in out hospital clinic
MMichael Shochat; A Shotan; M Kazatsker; D Blondheim; I Shochat; I Dahan; A
Asif; A Frimerman; L Vasilenko; S Meisel
Hillel Yaffe Medical Center, Heart Institute, Hadera, Israel
Background: Prevention of hospitalizations for decompensation in Chronic Heart
Failure (CHF) patients is an unresolved issue. The accuracy of existing devices in
predicting deterioration is only 38-76%.
Aim: We evaluated the ability of the new a non-invasive method for lung impedance
monitoring to predict decompensation in CHF patients.
Methods: Monitoring CHF patients was accomplished by a device which measures
“net” lung impedance (LI) instead of traditionally used transthoracic impedance. A
decreasing LI reflects accumulation of lung fluid. Changes in the clinical status and
LI were recorded at each monthly outpatient visit. Normal baseline LI was calculated
according special algorithm for each patient. LI changes are represented as percent
from baseline.
Results: 222 CHF patients (67 ± 11 years-old, male - 85%, LVEF - 26 ± 7%) at NYHA
II/III/IV (97/86/39) were recruited after index hospitalization for acute heart failure
(AHF) and followed in an outpatient clinic for 32 ± 21 months. Initial NT-proBNP
level was 3771 ± 5185 pg/ml. During the follow-up period 48 patients (23.4%)
died due to cardiovascular deaths. 99 patients were not hospitalized while the
other 123 required 386 re-hospitalizations for AHF. 279 hospitalizations for other
causes were recorded. LI decreased progressively before hospitalization. Values
of LI at 1 m, 3 w, 2 w, 1 w, 3 days prior to and at the day of hospitalization decreased by 23.7 ± 11; 24.7 ± 11; 27.8 ± 13.2; 33.1 ± 12.2; 34.1 ± 10.5 and
36.8 ± 10.5% (p < 0.001) from baseline value. At the time of hospitalization for a non
AHF cause, LI diminished only by 12.9 ± 5.9% (p < 0.001). Importantly, in all cases
of AHF hospitalizations LI decreased by more than 24% from baseline while in 90%
of non-AHF hospitalizations, LI decreased by less than 20%. In CHF patients who
had no hospitalizations for AHF during the monitoring period, LI decreased only
by 10.2 ± 5.2%.
Conclusions: Noninvasive “net” LI monitoring is a very sensitive to predict hospitalization for exacerbation of CHF. LI decrease by > than 24% from baseline represents
a high risk zone for re-hospitalization for AHF with 100% sensitivity and 90% specificity. Changes and intensification of therapy is mandatory when LI decreases by
more than 24%.
P1232
Effect of levosimendan on renal and hepatic function in patients with acute
myocardial infarction complicated by cardiogenic shock
IIgor Katsytadze1 ; K Amosova1 ; I Prudkyi1 ; O Gerula2
O. Bogomolet’s National Medical University, Kyiv, Ukraine; 2 Kiev Alexander Clinical
Hospital, Kiev, Ukraine
1
Purpose: To determine the effects of intravenous infusion of levosimendan (Lv) on
heart, liver and kidney functions in patients with cardiogenic shock (CS) with acute
myocardial infarction (AMI).
Materials and methods. 34 patients with AMI, complicated CS were infused Lv on
2-3 days of AMI on a background infusion of middle and high doses of dopamine.
The middle age of patients 57 ± 5,6 years, body mass index 25,7 ± 1,2. All patients
were assessed three times: before LV infusion (D0), next day after LV infusion (D1)
and on 4,1 ± 0,3 days (D4). Systolic function was assessed with ejection fraction
(EF) of LV and effective arterial elastance (Ea), that was calculated as a ratio of
end-systolic pressure to stroke volume. Glomerular filtration rate (GFR) was calculated with MDRD.
Results: During infusion 4 patients had episodes of arterial hypotension to 80/50
mmHg, that passed independently less than 30 minutes, after infusion paused. By
D1 diuresis increased on 75% (from 680 ± 75 to 1200 ± 110 ml). On D4 the middle dose of dopamine decreased from 6,8 ± 1,0 mkg/kg/min to 3,1 mkg/kg/min
(p < 0,01). Other results see in Table.
Conclusion: Intravenous infusion of Lv improves cardiac and haemodynamic
parametres, renal function and doesn’t worse liver function, in group of severe
patients with AMI and severe forms of acute heart failure.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
230
Abstracts
Time
Ea, mmHg/ml
EF, %
GFR, ml/min/1,73m2
Creatinine, mg/dL
ALT, un/l
AST, un/l
Total bilirubin, mmol/l
D0
1,63±0,04
36±2,8
43,2±5,3
1,82±0,07
32,1±3,2
69,4±6,3
17,4±2,1
D1
-
-
49,1±5,7
1,65±0,06
34,0±3,5
60,2±5.6
17,8±2,2
D4
1,55±0,04*
42±3,1**
61,4±6,4**
1,41±0,04**
30,5±3,1
52,8±,5,0*
17,5±2,1
* - p < 0,05, ** - p < 0,01 compared to D0.
P1233
Influence of predictive modeling in implementing optimal heart failure
therapy- inpatient experience at a community teaching hospital
FFahad Ali; H Prasad; P Tenneti; D Stapleton
Guthrie Clinic, Medicine, Sayre, PA, United States of America
Agap remains between evidence-based guidelines in the treatment of CHF and
current pharmacologic and device therapy and the reasons for this gap are multiple,
including the failure to recognize the benefit of increased therapeutic intervention in
heart failure patients.
The Seattle Heart Failure Model (SHFM) is an accurate predictive tool that allows
the clinicians to quantitatively assess the influence of pharmacologic and device
therapy. We hypothesized that interactive, personalized computer modeling of the
benefit of these evidence based medical and device approaches will influence the
outcome of the patients. This study was done at an inpatient setting. Medical record
of 60 patients was reviewed who were admitted with acute or acute on chronic
CHF. The SHFM was used to assess the baseline survival of the patients based
on their baseline parameters at the time of discharge considering the therapeutic
interventions that were performed. Finally the SHFM was used to calculate the
predictive survival and predictive life expectancy by applying the hypothetical
therapeutic interventions which the patients would have received at the time of
discharge from hospital.
It was noticed that alteration of therapy was required in 62% (n = 37) of cases and
that increased the estimated mean life expectancy from 4.9 years to 6.4 years
(p < 0.05) with an improvement in 1 year survival from 79.65 % to 86.95%.
Limitations of this study are small sample size and single center based study.
Details of the interventions performed during the hospital stay or the hypothetical
interventions done by using SHFM are not described however further studies with
more detailed observations are anticipated. Therapy was grouped as dichotomous
variable. Optimal dose of oral therapy was not addressed. We conclude with the
notion that significant “room for improvement” exists in heart failure therapy. SHFM
helps in intensifying the CHF therapy.
Comparation between the two scores
P1235
P1234
Functional dependence as a short-term predictor of mortality in patients with
acute decompensated heart failure
IIrene Rilo Miranda1 ; S Garcia Gutierrez2 ; A Unzurrunzaga Garate2 ; JJ Onaindia
Gandarias2 ; M Morillas Bueno2 ; N Murga Eizagaechevarria3 ; JR Beramendi
Calero1 ; M Telleria Arrieta1 ; L Quintas Ovejero4 ; F De La Cuesta Arzamendi1
1
Hospital Donostia, San Sebastian, Spain; 2 Hospital Galdakao-Usansolo, Bilbao,
Spain; 3 Hospital de Basurto, Bilbao, Spain; 4 Hospital Comarcal de Mendaro,
Cardiology, Mendaro, Spain
There is a lack of tools to assess short-term severity in acute decompensated heart
failure. Barthel index has been proved to enhance predictive ability of validated
models to assess severity in acute heart failure.Objective: To create a predictive
model to assess short-term severity in acute decompensated heart failure.
Methodology: We included 657 patients admitted to the emergency departmentdue
to acute decompensated heart failure collecting sociodemographic, cardiovascular
risk factors, comorbidities, functional status (Barthel Index) and general medical
history of heart disease and analytical and echocardiographic data.Statistical
analysis: A predictive model was created by means a logistic regression model,
being dependent variable mortality at three months after ED visit and independent
variables those who presented p-value < 0.20 in univariate analysis.
Results: In our sample, 52.36% were women, mean age 79.76 (10.07), with a more
than two comorbidities in the 65.6% of the cases. Total dependence was present
in 4.41%, severe in 23.37, moderate in 25.27%, low in 9.59% and 38.36% of
the patients were independents.Basal NYHA scale, Barthel index, blood pressure
and age resulted statistically significative in the final model (AUCIC95%% = 0.82
0.76-0.89).Those in total dependence were 16.94 times more likely to die in the next
three months, those with severe dependence were 4.94 times more likely to die and
moderates were 1.01 times more likely to die than those with low dependence or
no dependents.
Conclusions: It seems clinical variables are playing a role in the evolution of these
patients and in adittion patient reported outcomes (dyspnea scale and functional
dependence) could serve us to assess probability of mortality in the next three
months.
Presentation of acute heart failure patients and its links to haemodynamic
and effect on prognosis
AAhmad Shoaib1 ; R Perveen2 ; M Shahid3 ; M Zuhair2 ; A Djahit2 ; K Goode1 ; K
Wong1 ; A Rigby1 ; A Clark1 ; J Cleland1
1
University of Hull, Department of Academic Cardiology, Hull, United Kingdom;
2
University of Hull, Hull York Medical School, Hull, United Kingdom; 3 Castle Hill
Hospital, Hull, United Kingdom
Background: It is commonly assumed that most patients admitted to hospital with
a primary diagnosis of heart failure are severely breathless at rest but data from the
National Audit for England and Wales suggest that this is the case for only 30%. If
true, this has important implications for management.
Methods: We conducted a retrospective case-note review in patients with a primary
hospital death or discharge diagnosis of heart failure to determine what proportions
were Short Of Breath At Rest (SOBAR) or Comfortable At Rest but Breathless On
Slight Exertion (CARBOSE). We collected blood pressure (BP) and heart (HR) and
respiratory rate (RR) at initial presentation and frequently thereafter for the first 24
hours and tracked mortality for 180 days.
Results: Of 311 patients, the median age was 77 (IQR 71-84) years, 34% were
women, 51% were in atrial fibrillation and median N-terminal pro b-type natriuretic
peptide was 4082 (IQR: 1895-10279ng/L); 42% had SOBAR and 56% had CARBOSE. Compared to patients with CARBOSE, patients with SOBAR were of similar
age (76 v 78 years; p% = 0.9 but had higher HR (100 v 85 beats per minute; p
< 0.001), systolic BP (141 v 122 mmHg p < 0.001and RR (24 v 18 per minute;p
< 0.001). When you give results, you must be clear what you’re presenting. Is this
the mean? the median? and what was the distribution? If mean, give SD; if median,
give 25th and 75th quartiles – and say what it is that you are quoting. The vital signs
changed little amongst patients with CARBOSE in the first 4-6 hours but declined
in those with SOBAR (141 to 128 mmHg, 100 to 90bpm, and 24 to 20 rpm at
presentation and 4-6 hours respectively).again, give SD/IQR and tell us if median,
mean, mode, or something else. At presentation, systolic BP was >125mmHg in
73% patients with SOBAR and 46% with CARBOSE, dropping to 52% and 37%
respectively by 4-6 hours. By 180 days follow up, 27% of patients with SOBAR
and 45% of CARBOSE patients had died (HR for CARBOSE 1.58, CI 1.08-2.29;
p% = 0.02).
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
Conclusion: CARBOSE is a common presentation of heart failure leading to
admission. Although patients with SOBAR may have more alarming initial symptoms, patients with CARBOSE have a worse prognosis, perhaps reflecting more
severe cardiac dysfunction. Clinical trials may exclude the most needy patients by
focussing on breathlessness rather than peripheral congestion
P1236
A simple prognostic model of in-hospital mortality risk in acutely
decompensated chronic heart failure
TTeodora Zaninovic Jurjevic1 ; A Matana1 ; Z Matana Kastelan1 ; G Brumini2 ; S
Kovacic1 ; N Jurjevic3 ; L Skorup1 ; A Ruzic1 ; L Zaputovic1
1
Clinical Hospital Center Rijeka , Rijeka, Croatia; 2 Rijeka University School of
Medicine, Department of Medical Informatics, Rijeka, Croatia; 3 Rijeka University
School of Medicine, Rijeka, Croatia
Purpose: To develop a simple formula for assessing the risk of in-hospital mortality
in patients with acutely decompensated chronic heart failure (ADCHF) using already
known risk indicators.
Methods: We performed single-centre retrospective study of patients consecutively
hospitalised for ADCHF. The study was approved by the institution’s Ethics Committee. The retrospective analysis of a derivation group enrolled patients from 2006 –
2009, (533 survivors, 121 deceased) and identified six risk indicators (age, admission
heart rate [AHR], systolic blood pressure [SBP] at admission, blood urea [UR] concentration, serum sodium [Na], and uric acid [UA]). Age, HR and SBP were combined
in a formula ([age/10]2 × HR / SBP), that was previously used for risk assessment
in patients with acute myocardial infarction and proved to be useful in predicting
post-discharge mortality and risk for developing HF. However, it has never been
used to assess the risk in patients with HF.
Since in HF there is an increase of the UR level and decrease of the Na level in the
serum, it was assumed that the difference between the UR and Na values would
have a greater predictive value than each individual component, thus obtained indicator was (UR - Na/10). UA was a sole parameter. The final formula ([age/10]2 × AHR
/ SBP) + (UR - Na/10) + UA/100 was tested in a validation group of 591 patients (527
survived, 64 died), enrolled from 2010 – 2011.
Results: In the derivation group the value of the area under the ROC curve (AUC) for
the final formula was 0.741 (95% confidence interval 0.701 - 0.776). At the cut-off
point of 53.17, sensitivity was 53.7% and specificity 83.3%. The discriminative
capacity of the formula was significantly higher in relation to each of its components. In the validation group AUC was 0.741 also, (95% confidence interval 0.706
- 0.774). Using the proposed formula, with the cut-off point of 53, sensitivity was
65.6%, specificity 75.7%, the positive predictive value 34.4% and the negative predictive value 94.8%.
Conclusions: The identification of individuals at high risk of death among hospitalized patients with ADCHF presents a continuous challenge. In this study, by combining six significant indicators of increased risk of in-hospital mortality (age, AHR,
SBP at admission, UR, Na and UA) in a common formula, the predictive power with
respect to each individual component was increased. The resulting formula makes
possible a simple, rapid and inexpensive assessment of the risk for in-hospital mortality in patients with ADCHF.
P1237
Pro-B-type natriuretic peptide and cardiac performance after
hormonetherapy and chemotherapy in women with breast cancer
WWalckiria Romero; FB Silva; ALR Carvalho; MV Borgo; MHC Amorim; SA
Gouvea; GR Abreu
Federal University of Espirito Santo, Nursing, Vitoria, Brazil
Purpose: To evaluate the plasma concentration of pro-B-type natriuretic peptide
(proBNP) and the left ventricular ejection fraction in women undergoing hormonetherapy with tamoxifen and chemotherapy for breast cancer.
Methods: Over a period of 12 months, we followed 60 women with a diagnosis
of breast cancer. The patients were separated into the following groups: a group
that received only chemotherapy (n = 23); a group that received chemotherapy plus
hormonetherapy with tamoxifen (n = 21); and a group that received only hormonetherapy with tamoxifen (n = 16). Plasma levels of proBNP were assessed at 0 (T0),
6 (T6), and 12 (T12) months of treatment and echocardiography data were assessed
at T0 and T12.
Results: Plasma proBNP levels were increased in the chemotherapy alone group at
T6 and T12, whereas elevated proBNP levels were only found at T6 in the chemotherapy plus tamoxifen group. At T12, the chemotherapy plus tamoxifen group exhibited
a significant reduction of the peptide to levels similar to the group that received
tamoxifen alone. The chemotherapy alone group exhibited a significant decrease
in left ventricular ejection fraction at T12, while the chemotherapy plus tamoxifen
and tamoxifen alone groups maintained levels similar to those at the beginning of
treatment.
Conclusion: Hormonetherapy with tamoxifen for 6 months after chemotherapy significantly reduces the plasma levels of proBNP and enhances ventricular function
after chemotherapy for breast cancer.
231
P1238
Prediction of short-term mortality after index hospitalization for acute heart
failure syndrome
RRoger Hullin1 ; K Sotiropoulos1 ; P Tozzi2 ; N Yarol1 ; P Yerly1
CHUV and Faculty of Biology and Medicine, Department of Medicine, Internal
Medicine, Lausanne, Switzerland; 2 University Hospital Centre Vaudois (CHUV),
Department of Cardiac Surgery, Lausanne, Switzerland
1
Background: Thirty-days mortality remains high in patients hospitalized for acute
heart failure. Our objective was to compare prediction of early mortality after index
hospitalisation on the basis of clinical parameters obtained at baseline and at
discharge.
Patients and Methods: A total of 408 patients (mean age 78 years, 57.4% males)
were hospitalized for a mean of 10 days. History of chronic heart failure was present
in 61.8%, 23.5% had been previously hospitalized for acute heart failure. At baseline, 4.1% of patients presented with cardiogenic shock, 25.5% with pulmonary
edema, 10.8% showed right heart decompendation, 10.3% were hypertensive
(mean blood pressure (BP) 190/103 mmHg). Diabetes/BMI >% = 30/eGFR < 30
ml/min/1.73m2 was present in 39/26.3/18.4%. Mean length of stay was 10 days,
mean in-hospital mortality 6.4%, 30-days mortality after discharge was 2.2%.
Results: At discharge more study patients received beta blockade (39% vs 49.8%),
ACE inhibition (40.4% vs. 64.8%), mineralcorticoid receptor antagonists (15.1% vs
20.5%), and loop diuretics (56.1% vs 81.3%) (always p < 0.0001) while less patients
received angiotensin II receptor antagonist and thiazide treatment. Significant
changes during hospitalization were observed for systolic BP (n = 324 pairs : 141.5
to 128 mmHg), diastolic BP (n = 324 pairs : 84 to 64.5 mmHg), heart rate (n = 319
pairs : 90 to 79 bpm), weight (n = 296 pairs :72.7 to 71.9 kg), potassium (n = 314
pairs : 4.3 to 4.2 mmol/l), creatinine (n = 317 pairs : 105 to 103 mmol) (p always
p < 0.0001). Multivariate analysis for prediction 30 days mortality showedfor the
following parameters no relevance at baseline but at discharge: heart rate (n = 319
pairs ; baseline 95% CI :0.95-1.01, discharge 95% CI :1-1.09 ; p% = 0.0404), potassium (n = 314 pairs ; baseline 95% CI :0.53-5.34, discharge 95% CI :0.02-0.89;
p% = 0.0347), and start of loop diuretic (n = 327 pairs ; baseline 95% CI :0.16-3.99,
discharge 95% CI :0.02-0.6; p% = 0.011).
Conclusion: The results of this small study suggest that prediction of 30
days-mortality after hospital discharge should improve when based on discharge
parameters. These promising results need confirmation in a larger study collective.
ACUTE HEART FAILURE – POSTER DISPLAY
P1239
The importance of admission and discharge BNP assessment in patients
hospitalized for acutely decompensated chronic systolic heart failure
OOndrej Ludka1 ; V Musil1 ; R Stipal1 ; Z Pozdisek1 ; J Jarkovsky2 ; J Spinar1
of Internal Medicine and Cardiology, University Hospital Brno, Brno,
Czech Republic; 2 Masaryk University, Institute of biostatistics and analyses, Brno,
Czech Republic
1 Department
Introduction: The assessment of B-type natriuretic peptide (BNP) plasma levels is
not only useful for the differential diagnosis of acute dyspnea, but also for the prognostic stratification of patients with heart failure.
Aim: To determine the importance of admission and discharge values of BNP and
its changes during hospitalization for identification of patients with acutely decompensated chronic systolic heart failure at higher risk of unfavorable course of the
disease.
Methods: A prospective monocentric study determining plasma BNP levels at
admission and at discharge in patients hospitalized for acutely decompensated
chronic systolic heart failure.
Patients: 130 consecutive patients, 77% men, mean age 70 years, body mass index
(BMI) 27.8 kg/m2 , etiology of chronic heart failure – 65.9% ischemic heart disease,
29.5% dilated cardiomyopathy, 4.6% others, signs and symptoms at admission
– peripheral edema 58.9%, pulmonary rales 88.3%, orthopnea 53.1%, median of
admission BNP 1 101 pg/ml, median of discharge BNP 650 pg/ml, median left ventricular ejection fraction 26.5%, average length of hospitalization 9 days.
Results: During the follow-up (mean 15 months) the total mortality rate reached
almost 40% and the annual mortality of our cohort was 29%. The most common causes of death included progression of heart failure and acute coronary
syndromes. To evaluate the long-term risk of mortality, we used time-dependent
ROC curves for the definition of cut-off values of BNP at admission and discharge. The relationship of BNP levels and the survival of patients was assessed
using the hazard ratio (HR) calculated by the Cox proportional hazards model.
BNP at admission and at discharge with a cut-off value of 1 699 pg/ml and
434.5 pg/ml are significant prognostic factors for patients hospitalized for acutely
decompensated chronic systolic heart failure with a HR 2.79 and 3.29, respectively. During the follow-up, more than half of patients required readmission to
hospital. The most common reasons for rehospitalization were cardiovascular
causes.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
232
Abstracts
Conclusion: BNP levels at admission and at discharge are an important predictive factor of survival in patients with acutely decompensated chronic systolic heart
failure.
P1240
Hemoglobin bun ratio predicts cardiovascular mortality in patients with heart
failure
H Yucel1 ; OOsman Beton1 ; A Ekmekci2 ; D Oguz3 ; H Gunes1 ; M Eren2 ; AU Uslu1 ;
MB Yilmaz1
1
Cumhuriyet University, Cardiology, Sivas, Turkey; 2 Dr. Siyami Ersek Thoracic and
Cardiovascular Surgery Center, Cardiology, Istanbul, Turkey; 3 Baskent University,
Cardiology, istanbul, Turkey
Introduction: Organ cross talk is highly prevalent among patients with HF. For
example, renal dysfunction has been reported to occur in one of four patients with
HF. In this setting, BUN was shown to designate prognosis in patients with HF, and
it can identify high-risk patients when it exceeds 43 mg/dl. An association of anemia
with poor prognosis in patients with HF has also been demonstrated previously by
a number of studies. However, combination of hemoglobin and BUN have not been
studied in patients without significant anemia and significant renal dysfunction. In
this study association of “hemoglobin to BUN ratio” with cardiovascular mortality
was sought in patients with HF.
Methods: 580 patients with HF were enrolled into a retrospective cohort study out
of three HF centers. Follow up data for cardiovascular mortality were available in 548
patients, who underwent both hemoglobin and BUN analysis during index admission, in these centers. Out of hemoglobin and BUN levels, hemoglobin to BUN ratio
was derived. Quartiles of HB/BUN ratio was produced in the data set and cardiovascular mortality was investigated.
Results: This study included 548 patients with HF. Median ejection fraction was
25% (20-35%, 25-75th percentiles) with a median follow up period of 19 months
(8-35 months, up to 111 months). There were 400 males, 148 females. Median age
was 57 years (45-72 years). Median BUN was 20 mg/dl (15.775-30 mg/dl) and creatinine was 1.01 mg/dl (0.88-1.30). Median hemoglobin was 13.3 gr/dl (12.10-14.90)
Median hemoglobin to BUN ratio was 0.66 (0.42-0.89) in the whole cohort. During
follow up, 15% of those in the 4th quartile (mean ratio 1.15) versus 28.8% of those in
the 3rd quartiles (mean ratio 0.76) versus, 38.6% of those in the 2nd quartile (mean
ratio 0.54) versus 53.3% of those in the 1st quartile (mean ratio 0.28) experienced
CV death (p < 0.001).
Kaplan Meier survival curves of quartiles of hemoglobin to BUN ratio diverged from
each other significantly (p% = 0.01) (Figure 1) yielding the fourth quartile having the
best prognosis, and the first quartile having the worst prognosis (p < 0.001).
Conclusion: Hemoglobin and BUN levels are important blood parameters in
patients with HF. Decreasing hemoglobin levels in harmony with increasing BUN
seems to be a sign of poor prognosis in patients with HF.
P1241
Evaluating quality of care for patients with heart failure in Saudi Arabia
AAyman Soliman; D Sandburg; T Farahat; Y Al Alawy; A Alqarni; A Al Johiman; T
Nasef; W Ahamed; H El Samiri
King Abdulaziz Hospital, Medicine - Cardiology, Al hasa, Saudi Arabia
Aim of the study: To assess current level of care provided to our patients with heart
failure (HF) as per international guidelines and or standards.
To make recommendations to improve quality of care provided to patients with heart
failure.
Patients and Methods: We reviewed the results of our hospital’s one year heart
failure registry. 126 patients consecutive patients admitted with heart failure from
1st January 2010 to 31 December 2010 will retrospectively be reviewed.
Data collected from our hospital’s one year heart failure registry and medical
records.
All data will be statistically analyzed using SPSS program.
Quality Measures tool used are documented LV ejection fraction (LVEF) < 0.40,
Internationally recommended medications for heart failure, length of stay, recurrent
admission within 3 month. Mortality rate within 6 month, CRT or ICD for patients with
EF < 0.40, patient education, internationally recommended vaccinations for heart
failure.
Results: 52% of the patients were male. The mean age was 69 years in female and
70.5 years in male. The Median age for female was 72 years and 70.5 years in male.
The maximum age was 88 years in female and 108 years in male. The minimum age
in female was 24 years and 44 years in male. (Figure 1)
The median length of stay in hospital was 5 days. (Figure 2). 54.8% of the patients
were diagnosed with preserved EF HF (an EF> or% = 40%). 45.2% of the patients
were diagnosed with low EF HF (an EF < 40%). (Figure 3). 27% of the patients
had recurrent admissions with heart failure over the subsequent 6 months after
discharge. There was an overall mortality of 6%.
90% of the patients were discharged on diuretics, 77% were on ACE-i/ARB, 75%
were on beta-blockers, 45.6% were on aldosterone receptor blockers. 23% of the
patients that had low EF HF were with CRT/ICD. (Figure 4)
71% of patients were a critical area admission. 60% of patients were admitted
to a cardiology ward and 40% admitted to a medical ward. 0% of patients were
vaccinated for pneumococcal and flu.
61% of patients were nonsmokers, Of the remaining 39% of smoking patients,19%
had no smoking cessation education, and 20% had smoker cessation education.
(Figure 5)
Conclusion: The study was able to reflect the positive aspects of our patient
care. However we did have some identifiable weaknesses in our practice. These
include, Pneumococcal and flu vaccinations health priority for our heart failure
patient numbers admitted to medicine high. Lacking specialist HF services. The use
of the device therapy is less.
P1242
Relationship between level of tumor necrosis factor alpha in serum with
gradation of left ventricular dysfunction
AKMALAkmal Mufriady Hanif
Internal Medicine Department Andalas University, Padang, Indonesia
Heart failure (HF) is a major health problem in developed countries and developing
countries with high mortality rates. Echocardiography is a routine examination to
assess left ventricular structure and function in HF and is used to assess the
presence of left ventricular dysfunction, both diastolic dysfunction and systolic
dysfunction. Tumor Necrosis Factor (TNF) 𝛼, is one of the inflammatory mediators
produced by several cell types, mainly by macrophages and cardiac myocites
The aim of this research is to determine the relationship between levels of TNF 𝛼.with
gradation of left ventricular dysfunction, left ventricular ejection fraction (LVEF) and
functional class (FC) of New York Heart Association (NYHA).
Subjects were patients with congestive heart failure functional class II, II and IV
with left ventricular dysfunction who fit into the inclusion and exclusion criteria on
May until October 2013. The results, the subjects were 42 people, 19 men (45.2%)
and 22 women (54.8%). Mean age was 53.33 ± 8.66 years with the largest age
group 50-59 years were 22 people (52.38 %). The most common causes of the
disease were coronary heart disease 12 (28.4%) and hypertension 12 (28.4%). In
class functional NYHA, 18 people (42.9%) were found in class II NYHA, 16 people
(38.1%) were found in class III NYHA and 8 people (19%) were class IV NYHA. On
echocardiography examination, we found LVDD 5 (11.7%), LVSD 17 (40.7%) and
LVDD and LVSD 20 (47.6%). Level of mean TNF 𝛼 on NYHA class II was 104.62 ± 9.61
pg/ml, class III was 115.55 ± 8.20 pg/ml and class IV was 157.21 ± 22.62 pg/ml.
There was significant difference in the level of mean TNF 𝛼 based on FC of HF
(p% = 0.040 and p% = 0.00). There was strong correlation between levels of TNF
𝛼 with FC NYHA (r% = 0.74). There was strong negative correlation between level
of TNF 𝛼 with LVEF (r% = -0.835). Level of mean TNF 𝛼 in LVDD 93.51 ± 4.88
pg/ml, LVSD 114.19 ± 13.54 and both LVDD and LVSD 127.61 ± 26.23. If we analyze,
there was significant difference of level of mean TNF 𝛼 between LVDD and LVSD
(p% = 0.01). There was strong correlation between level of TNF 𝛼 with gradation of
LVDD and LVSD (r% = 0,727).
Conclusions are there was relationship between level of TNF 𝛼 with FC, TNF 𝛼 with
LVEF, and level of TNF 𝛼 with gradation of LVD.
P1243
Thrombotic thrombopenic purpura in a patient with Takotsubo
cardiomyopathy: a case report
IP Ioannis M Panayiotides; EN Evagoras Nikolaides
Nicosia General Hospital, Department of Cardiology, Nicosia, Cyprus
Introduction: Takotsubo Cardiomyopathy is a transient form of left ventricular dysfunction that occurs in the absence of obstructive epicardial coronary disease or
other specific aetiology. Thrombotic thrombocytopenic purpura is a combination of
acquired microangiopathic hemolytic anemia and thrombocytopenia, with or without renal failure or neurologic abnormalities, that requires prompt plasma exchange
treatment.
Case presentation: A 59 year old female Caucasian patient without predisposing
factors for coronary artery disease presented with acute onset of chest discomfort
and dyspnea. The electrocardiogram revealed biphasic T waves in the precordial
leads and troponin T was borderline positive. A bedside echocardiogram identified
apical anterior wall hypokinesia and dyskinesia of the apex of the left ventricle. Coronary angiography showed no obstructive epicardial coronary disease. Therefore the
clinical condition was attributed to Takotsubo Cardiomyopathy. During hospitalisation mild thrombocytopenia was noted, but was suggested to be caused to the
initially administered antiplatelets and heparin. Four days after discharge, the patient
presented with profound fatique, nausea and vomiting. Laboratory results indicated profound thrombocytopenia and haemolytic anemia. The patient was urgently
transferred for plasma exchange therapy with a diagnosis of thrombotic thrombocytopenic purpura. A significant resolution of symptoms and recovery of laboratory
abnormalities were achieved with the applied therapy. The patient was found to
be in the subgroup of patients with severe deficiency of plasma ADAMTS13 activity, which is suggested to gain benefit by steroids. Exploration of the data in our
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
department actually identifies a trend of thrombocytopenia in all cases of Takotsubo
Cardiomyopathy.
Conclusion: The association of Takotsubo cardiomyopathy with thrombocytopenia
has been previously reported. However, this particular case is regarded unique due
to the late presentation of thrombotic thrombocytopenic purpura. Also, the documentation of severe deficiency of plasma ADAMTS13 activity in the case presented
here, may be suggestive of a possible linkage with the vulnerability to develop Takotsubo Cardiomyopathy. It remains to be established by repeated testing of plasma
ADAMTS13 activity in cases of Takotsubo Cardiomyopathy, whether this association
can be applied in treatment, prognosis or even prevention of this condition.
P1244
Effective of early cardiac rehabilitation by using classification of the status on
admission for patients with congestive heart failure
YYasushi Tanaka
Yodogawa Christian Hospital, Osaka, Japan
Background: It is unclear when cardiac rehabilitation (CR) should be started for
patients with congestive heart failure (CHF). The purpose of this study is to evaluate the effective of early CR by using classification of the status on admission for
patients with CHF.
Methods: 92 patients of Intervention CR group (I group) and 37 patients of Control CR group(C group) were enrolled. Patients in I group were scored by respiratory status (0:Oxygen < 3L/min, 1: Oxygen 3L/min, 2: treatment with NPPV
or Endotracheal intubation), Activity of Daily Living (0: Independence, 1:outside
activity with support, 2:limited activity only inside), and BNP (0: < 500pg/ml,
1:500-1999pg/ml, 2:>2000pg/ml), and were classified into four groups by total score
(mild:0, moderate:1-3, severe:4-5, most severe:6). Then according to this classification, CR was started quickly. We evaluated age, total score, the days of introduction of CR, duration in hospitalization. CR in C group was started without this
classification.
Resluts: Average age and total score were no differences between two groups
on admission. CR in I group could be started significantly earlier than C group (I
2.5 ± 2.3 days vs C 4.3 ± 4.8 days, p < 0.05) and Duration in hospitalization in I group
could be shorter(I 21.0 ± 10.9 days vs C 25.9 ± 12.3 days p < 0.05). BNP, eGFR,
Re-hospitalization were no difference between two groups.
Conclusion; This classification could be performed without serious accident. We
considered that early mobilization prevent ADL decline and led to early discharge.
P1245
Acute decompensated heart failure in patients with atrial fibrillation
A Galyavich1 ; L Galimzyanova2 ; G Nazmieva2 ; D Yakupova2 ; D Mukhametgatova3 ;
R Galyavi3
1
State Medical University, Kazan, Russian Federation; 2 Interregional
Clinico-Diagnostic Center, Kazan, Russian Federation; 3 Kazan State Medical Univ,
Kazan, Russian Federation
Purpose: To compare hemodynamic and echo parameters and N-terminal pro-brain
natriuretic peptide (NT-proBNP) level in patients with acute decompensated heart
failure (ADHF) depending on the presence of atrial fibrillation or sinus rhythm.
Methods. The study included 71 patients admitted to the emergency cardiology
department with acute decompensation of chronic heart failure. Depending on the
presence of sinus rhythm or atrial fibrillation all patients were divided into two groups:
group 1 - 35 patients with atrial fibrillation, group 2 - 36 patients with sinus rhythm.
We compared age, systolic blood pressure, heart rate, left ventricular ejection fraction by Simpson’s method and NT-proBNP level.
Results: There was no significant difference in age, systolic blood pressure and
mean heart rate between groups of patients with atrial fibrillation and sinus rhythm:
67.6 ± 16.8 years and 65.6 ± 13.5 years; 127.4 ± 28.9 and 128 ± 27.8 mm Hg;
102 ± 28.8 and 92.1 ± 18.7 per minute respectively. Also, there was no significant difference in the level of NT-proBNP between two groups - 9436 ± 9164.9
and 11063 ± 8800 pg/ml respectively. A significant difference was revealed only
in the case of parameters of left ventricular ejection fraction in patients with atrial
fibrillation, it was higher by 29.8% (36.2 ± 15.2% and 26.6 ± 9.5% respectively,
p% = 0.0062).
Conclusion: Acute decompensated heart failure occurs in patients with atrial fibrillation with significantly higher left ventricle ejection fraction than in patients with
sinus rhythm in the case of approximately equal numbers of heart rate, systolic blood
pressure and levels of NT-proBNP.
233
The objective of this study is to develop a prognostic model with easily obtainable
variables for patients with heart failure.
Methods and Results: Our lot included 101 non-consecutive hospitalized patients
with heart failure diagnosis. There were 50 (49,5%) women and 51 men included,
with average age 71.23 years (40-91 years) followed up for an average of 35.1
months (5-65 months). Survival data were available for all patients and the median
survival duration was 44.0 months.
A large number of variables (demographic, etiologic, comorbidity, clinical, echocardiographic, ECG, laboratory and medication) were evaluated. We performed a complex statistical analysis, studying: survival curve, cumulative hazard, hazard function, lifetime distribution and density function, meaning residual life time, Ln S
(t) vs. t and Ln(H) t vs. Ln (t). The Cox multiple regression model was used in
order to determine 15 factors that allow forecasting survival and their regression
coefficients.
Discussion: Our model is derived from a relatively small lot of patients hospitalized
in an emergency department of cardiology, some with major life-altering co morbidities. The benefit of being aware of the prognosis of these patients with high risk is
extremely beneficial. The survival model could not include a series of parameters
with statistic significance in the univariate analysis.
P1247
Prevalence and outcome of cardiogenic shock in patients with tako-tsubo
cardiomyopathy
B Schneider1 ; A Athanasiadsis2 ; J Schwab3 ; W Pistner4 ; U Gottwald5 ; W Toepel6 ;
T Mueller-Honold7 ; R Schoeller8 ; C Stoellberger9 ; U Sechtem2
1 Sana Kliniken, Luebeck, Germany; 2 Robert-Bosch-Krankenhaus, Stuttgart,
Germany; 3 Klinikum Nuernberg, Nuernberg, Germany; 4 Klinikum Aschaffenburg,
Aschaffenburg, Germany; 5 Allgemeines Krankenhaus Celle, Celle, Germany;
6
Klinikum Idar-Oberstein, Idar-Oberstein, Germany; 7 Klinikum Augsburg,
Augsburg, Germany; 8 DRK-Kliniken Westend, Berlin, Germany; 9 Rudolfstiftung,
Vienna, Austria
Purpose: Tako-tsubo cardiomyopathy (TTC) is regarded a benign disease since left
ventricular (LV) function returns to normal within a short period of time. However,
severe complications have been described in a limited number of patients (pts).
This study evaluated the frequency and outcome of cardiogenic shock in a large
TTC registry.
Methods: From 37 heart centres, 324 pts (296 f, 28 m, age 68 ± 12) were included in
the registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte
according to the following criteria: 1) acute chest symptoms, 2) ischemic ECG
changes, 3) reversible LV akinesia not corresponding to a single coronary artery
territory, 4) absence of coronary artery stenoses. Complete data on complications
were available in the last 209 registry pts.
Results: Complications developed in 108/209 pts (52%) within 2.6 ± 2.9 days
(median 1 [IQR 1-3] days) after symptom onset; 51 of these pts (24%) experienced >1 and 23 (11%) >2 complications. Most complications (77%) occurred
within 3 days after symptom onset, however, 23% developed later (from day
4 to 56).
Fourteen of 209 pts (7%) experienced cardiogenic shock which developed on
the day of admission in 11 pts (79%) and from day 2 to day 4 after admission
in 3 pts (21%). Seven of these patients (50%) were also in pulmonary oedema.
The ECG on admission showed a higher heart rate (92 ± 24 vs. 76 ± 17 beats per
minute, p < 0.001) and more Q waves in pts with cardiogenic shock (54% vs. 27%,
p% = 0.043). Cardiac markers were significantly higher (creatine kinase 4.3 ± 5.7
vs. 1.8 ± 3.8 [p < 0.05] and troponin 62.1 ± 109 vs. 10.7 ± 11.9 [p < 0.001] times
the upper limit of normal), and ejection fraction was lower (38 ± 9 vs. 51 ± 15%,
p < 0.005). Intraaortic balloon pumping was applied in 2/14 pts, and catecholamines
were administered in 8 pts. Four of 14 TTC pts with cardiogenic shock (29%) died,
2 from multiorgan failure and 1 pt each from refractory cardiogenic shock and LV
rupture. In the latter pt ST-segment elevation persisted for 3 days when myocardial
perforation occurred.
Conclusion: Cardiogenic shock occurs in 7% of pts with TTC. The prevalence
of cardiogenic shock is similar to findings in reperfused myocardial infarction
(5-10%). However, the mortality of cardiogenic shock in TTC pts appears to
be lower (29%) than reported in reperfused patients with STEMI (42-62%).
This may be due to the early spontaneous reversibility of LV dysfunction
in TTC.
P1248
P1246
Challenges in heart failure: new prognostic model
LLucian Axente1 ; G Bazacliu2 ; C Sinescu1
Bagdasar-Arseni Emergency Hospital, Department of Cardiology, Bucharest,
Romania; 2 "Politehnica" University of Bucharest, Bucharest, Romania
1
Abstract: Heart failure is a progressive disease characterized by high prevalence in
society, significantly reducing physical and mental health, frequent hospitalization
and high mortality.
The effect of at admission observed liver dysfuntion of acute heart failure
patients on hospital mortality. Learnings from EuroHeart Failure SurveyII
(EHFSII)
J Tolonen1 ; MJ Parry1 ; T Tarvasmaki1 ; JPE Lassus2 ; MS Nieminen2 ; V-P Harjola3
Helsinki University Central Hospital, Department of Medicine, Helsinki, Finland;
2
Helsinki University Central Hospital, Heart and Lung Centre, Helsinki, Finland
1
Purpose: Patients hospitalized due to acute heart failure (AHF) have high hospital
mortality. Our aim was to analyze the effect of liver dysfunction observed at
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
234
Abstracts
admission on hospital mortality.
Methods: Laboratory results from EuroHeart Failure Survey II patients (n = 3580)
were analyzed retrospectively. Liver dysfunction was defined as alanyl transaminase
(ALT) level at least twice the upper limit of normal (ULN). ALT levels at admission were
compared statistically between deceased and survived patients. Student’s T-test
and ANOVA were used. Cox regression model was used to evaluate risk factors for
hospital mortality. In multivariate analysis variables were adjusted to age, gender,
renal dysfunction at admission(eGFR < 60 ml/1.72m2 /min), degree of tricuspid
valve leakage (I-III), type of heart failure (de novo or acutely decompensated chronic
HF [ACDHF]) and clinical AHF class (decompensated AHF, pulmonary oedema,
hypertensive heart failure, right heart failure and cardiogenic shock).
Results: Admission ALT was recorded from 2558 patients. Hospital mortality was
6.7% (n = 172). ALT differed significantly between deceased, mean 130 (SD 492) U/l
and survived, 58 (217) U/l patients (p < 0.001). ALT was the highest in cardiogenic
shock patients followed by decompensated AHF, pulmonary oedema, right heart
failure and hypertensive heart failure (p% = 0.002). ALT was also higher in chronic
heart failure (ADCHF) than in de novo (p% = 0.023). In multivariate Cox regression
model liver dysfunction (HR 2.1[CI 1.2-3.5]), class of heart failure (HR 1.6 [CI 1.4-1.8])
and age (HR 1.04 [CI 1.02-1.06]) were independent predictors of hospital mortality.
Conclusions. Liver dysfunction was associated with ADCHF and cardiogenic shock.
Deceased patients had higher ALT levels as compared to the surviving. We conclude
that liver dysfunction was an independent predictor of increased in-hospital mortality
in AHF patients.
Introduction: Hyponatremia at hospital admission is a well-known risk factor of morbidity and mortality in patients with heart failure(HF). However, there
are a very few data about the effect of quartiles of sodium on mortality.
The present study compares quartiles of sodium in HF patients with respect
to outcome.
Methods: 580 patients with HF were enrolled into retrospective cohort study.
Follow up data for cardiovascular mortality were available in 564 patients, who
had available sodium measurement during index visit in three different HF centers.
Quartiles of sodium was obtained for survival analysis.
Results: Median follow up period was 19 months (8-35 months, 25-75th percentiles). Patients in this cohort had 18 months of previous history of HF (9-35
months). Median left ventricular ejection fraction was 25% (20-35%) with a median
age of 57 years (45-73 years,) There were 410 males, 154 females in this cohort.
Median sodium was 138 mEq/L (135-140 mEqL) in the whole cohort. Survival
curves of quartiles of sodium diverged from each other significantly (p% = 0.01)
with the third quartile (mean 140 mEq/L) having the best prognosis, the first and
the second quartiles (means 132 and 137 mEq/L respectively) having the worst
prognosis and the fourth quartile lying in between (mean 142 mEq/L) [Figure 1].
Conclusion: It is important to understand the prognostically normal range of
sodium, which seems to be significantly different from healthy range.
P1251
Noninvasive hemodynamic assessment of the cardio-renal syndrome
P1249
Value of plasma renin activity as a prognostic biomarker in patients with heart
failure
JHJae Hee Kim; SY Jang; MH Bae; JH Lee; DH Yang; HS Park; Y Cho; SC Chae;
SH Park
Kyungpook National University Hospital, cardiology, Daegu, Korea, Republic of
Purpose: Heart failure may be considered as the fatal finishing line of all cardiovascular disorder. Activation of different neurohormone systems, especially the
sympathetic and renin-angiotensin-aldosterone systems, plays a central role in the
progression of heart failure. The aim of this study is to evaluate the prognostic value
of serum levels of plasma renin activity in patients with heart failure.
Method & Results: A total of 298 consecutive patients presenting with heart failure
were enrolled between March 2003 and May 2012. The last follow-up was performed June 2013. The ischemic origins of heart failures were 79 (26.6%) patients.
Main outcome was all cause mortality during follow-up period.
During the follow up, 35 patients died. On Cox multivariate analysis, PRA(hazard
ratio 1.043, 95% confidence interval 1.008 to 1.078), log N-terminal pro-brain natriuretic peptide(hazard ratio 1.366, 95% confidence interval 1.011 to 1.846), Troponin
I(hazard ratio 1.008, 95% confidence interval 1.004 to 1.013), Sodium (hazard
ratio 0.895, 95% confidence interval 0.810˜0.990) were independent predictors of
all cause mortality. Receiver operating characteristic curve analysis identified a
cutoff value for PRA of 4.1ng/ml/hour that best predicted mortality(AUC 0.678 ;
sensitivity 54%, specificity 77%). Patients with greater PRA >4.1 ng/ml/hour had a
much greater rate of death(Figure 1). The association of high NT-proBNP and high
PRA(14.1% of the study population) identified a subgroup with the greatest risk of
death(Figure2).
Conclusion: PRA resulted an independent prognostic marker in our patients with
heart failure addictive to NT-proBNP level. The prognostic role of PRA should be
confirmed in larger populations. PRA might be valuable as either a prognostic
marker or a potential therapeutic target.
R Cheikh Khelifa; JB Vignalou; M Djebbar; N Hammoudi; F Pousset; M Komajda;
R Isnard
Hospital Pitie-Salpetriere, Institut de cardiologie, Paris, France
Background: cardiorenal syndrome (CRS) in acute heart failure (AHF) is associated
with poor prognosis. A better knowledge of the hemodynamic determinants of CRS
might contribute to a better management.
Objective: To evaluate non invasively the relationships between hemodynamics and
renal function in AHF.
Methods: prospective study, consecutive patients admitted for AHF with clinical
signs of congestion, NT-proBNP >1000 pg/ml LVEF < 50% were included. Clinical,
biological and echocardiographic data were evaluated at baseline (D0) and at day 4
(D4). Right atrial pressure (RAP) was assessed according to the patterns of inferior
vena cava.
Results: 36 patients were included (age 62 ± 5 years, weight 75 ± 11kg, creatinine
(Cr) 1.42 ± 0.53 mg/dl, NT-proBNP 8691 ± 7428 pg/ml, cardiac index (CI) 2 ± 0.6
l/mn/m2 , LVEF 24 ± 8%, RAP 13.8 ± 3 mmHg).
Between D0 and D4, significant decreases in weight, mean arterial pressure (MAP)
and NT-proBNP were observed, but the changes of Cr and RAP were not significant.
At D0, we observed a correlation between Cr and RAP and between Cr and MAP, but
at D4 correlation persisted only for MAP and Cr. There was no correlation between
CI and Cr whatever the time.
Regarding the changes (Δ), only ΔCr and ΔNT-proBNP (r% = 0.34, p < 0.05) was
positively correlated.
Conclusion: we did not find any relation between hemodynamic and creatine
changes during AHF treatment. However, “decongestion” assessed by the decrease
in NT-proBNP is associated with an improvement in renal function.
P1252
Characteristics of female patients with acute pulmonary edema: are there
differences compared with men?
A NAnastasia N Kitsiou; K Grigoriou; A Karamanou; P Arsenos; K Papadopoulos;
D Mytas; G Gkionakis
Sismanoglio Hospital, Athens, Greece
Figure1 and Figure2
P1250
Sodium Quartiles Predict Cardiovascular Mortality in Patients with Heart
Failure
OOsman Beton1 ; A Ekmekci2 ; H Yucel1 ; D Oguz3 ; H Gunes1 ; AA Ugurlu1 ; M Eren2 ;
MB Yilmaz1
1
Cumhuriyet University, Cardiology, Sivas, Turkey; 2 Dr. Siyami Ersek Thoracic and
Cardiovascular Surgery Center, Cardiology, Istanbul, Turkey; 3 Baskent University,
Cardiology, istanbul, Turkey
Introduction: This study aims to describe characteristics of female patients admitted to the Cardiology Department and the Intensive Cardiac Care Unit of our hospital
with an admitting diagnosis of “acute pulmonary edema” and compare them with
characteristics of men.
Methods and Results: We studied 196 patients, 106 men (54%) and 90 women
(46%). Women were older (80.1 ± 8.5 years for women versus 74.5 ± 8.0 years for
men, p < 0.002), had less often acute coronary syndrome at presentation (31%
women versus 40% men) and had a higher prevalence of systolic blood pressure>
160 mmHg at presentation (45% women versus 38% men). Twice the rate of women
had normal ejection fraction (60% women versus 30% men, p < 0.001). Women had
a greater prevalence of diabetes (57% women versus 41% men, p < 0.03). Women
had similar rates of atrial fibrillation (39% women versus 37.8% men, p% = NS). The
duration of hospitalization was longer for women (8.1 ± 6.3 versus 7.0 ± 6.5 days,
p < 0.05). In contrast, the in-hospital mortality was lower in females (7.8% women
versus 11.32% men, p < 0.01).
Conclusions: Women with acute pulmonary edema demonstrate several different
clinical and laboratory characteristics compared with men. Women show a higher
prevalence of hypertension on admission and have longer hospital stay compared
with men.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
235
P1253
Epidemiological profile of decompensated heart failure patients with
preserved ejection fraction in a south brazilian general hospital
LC Danzmann1 ; AV Azevedo1 ; NB Kreuz2 ; JP Zimmer1 ; A Stein2 ; EB Oliveira2 ; LF
Zimmer1 ; G Guerra1 ; LC Bodanese1 ; JC Guaragna1
1 Hospital São Lucas da PUCRS, Porto Alegre, Brazil; 2 Universidade Luterana do
Brasil, Porto Alegre, Brazil
Purpose: the study aims to assess the general characteristics, precipitating factors
and in-hospital medical treatments and mortality of patients with acute decompensated heart failure (ADHF) with preserved ejection fraction (HFpEF) in compairs to
patients with reduced ejection fraction (HFrEF) diagnosed by the American College
of Cardiology guidelines criteria.
Methods: we allocated 385 patients admitted with criteria of ADHF were entered to
the database from a general hospital from south of Brazil by January 2009 to December 2011. The patients were dichotomized in HFpEF when left ventricle ejection
fraction (LVEF) was ≥ 40%. Epidemiological characteristics, precipitating factors
and medication registries were elected for analisys. Mortality curves were analised.
Results: we found a prevalence of 67.7 % of HFpEF patients, in which group had
a significant predominance of females (61.1 %), higher blood pressure and lower
heart rate at admission. Therefore, infection, arrhythmias and hypertensive crisis
were more frequent decompensated factors and spironolactone, beta-blocker and
digitalis were less in-hospital prescribed in this group. There was no difference
in-hospital mortality (7.3%) between the groups.
Conclusion: our preliminary involving south Brazilian ADHF subjects data demonstrated a high prevalence of HFpEF and their characteristics and mortality were
similar to the other published registries.
Baseline patients characteristics
LVEF
< 40%
≥ 40%
P
Age (years)
63,7 ±12,5
70,0 ±13,9
< 0,001
Female gender (%)
34,70%
61,10%
< 0,001
Hypertension (%)
33,3 % (41)
45,4 %(119)
0,021
Infection (as a precipitating factor)
14,0 %(17)
23,8 % (61)
0,006
Hypertensive crisis (%)
8,3 % (10)
11,7 % (30)
0,006
Hypertensive etiology (%)
89,5 % (111)
93,9 % (246)
NS
Diabetes Mellitus (%)
42,7 % (50)
47,1 % (121)
NS
COPD (%)
41,8 % (46)
27,8 % (67)
0,009
Renal failure (%)
41,8 % (46)
47,6 % (111)
NS
Tabagism (%)
26,3 % (30)
14,6 % (36)
0,007
Alcoholism
32,7 % (35)
13,9 % (34)
< 0,001
15 (22.7%) men and 14 (56.1%) women developed HF during hospitalization.
Overall multivariable analyses, showed that women had higher odds of developing
early HF compared to men (OR% = 4.73; 95% CI 1.50-14.96). When analyses were
repeated in different age groups, such gender difference in the odds of early HF
was observed only among younger (≤ 65 years) AMI patients (OR% = 17.63; 95%
CI 2.37-131.32) but not among their older (>65 years) counterparts (OR% = 1.78,
95% CI 0.39-8.12).
Conclusions: Among patients hospitalized for an incident AMI, women were more
likely to develop HF while admitted to the hospital than men. However, this gender
difference was observed among younger patients aged ≤ 65 years and not among
older ones. Further analyses (with larger number of patients) will be performed to
confirm these preliminary findings.
P1255
Filter mask prevents adverse cardiovascular effects of diesel exhaust
inhalation in heart failure patients: a randomized cross-over study
J L Vieira1 ; GV Guimaraes1 ; PA De Andre2 ; PHN Saldiva2 ; EA Bocchi1
Heart Institute (Incor) - São Paulo University Medical School, Dept. of Heart
Failure , Sao Paulo, Brazil; 2 São Paulo University Medical School, Dept. of
environment health, são paulo, Brazil
1
Short-term exposure to air pollution is associated with acute heart failure (HF)
decompensation. A particle retention facemask has the potential to reduce these
cardiovascular events. Our purpose is to investigate the effects of reducing diesel
exhaust (DE) inhalation on endothelial function (non-invasive reactive hyperemia index - RHi), cardiopulmonar capacity (oxygen uptake-VO2; ventilatory
efficiency-VE slope; 6 minute walking test-6mwt) and heart rate variability (HRV) in
HF patients, by using a polypropylene filter-mask (FM). In a double-blind, randomized, crossover study, 19 HF patients (HF group) and 8 matched healthy volunteers
(control group) were exposed to diluted DE (300 𝜇g/m3 particulate concentration),
filtered DE or filtered air during 15 minutes of rest and 6 minutes stress testing
in a controlled-exposure facility. Clinical and laboratory variables were normal in
both groups. DE worsened RHi in both groups [2,5 vs. 1,9; 95%CI 0,01-1,04;
(P% = 0,043)], and this effect was attenuated by the FM (P% = 0,012) (Figure). There
was a significant worsening of VO2 [24,1 vs 14,3 ml/Kg/min; 95%CI 16,9-31,3;
(P% = 0,048)] and VE slope [27,5 vs. 38,3; 95%CI 1,7-19,9; (P% = 0,018)], also
attenuated by the FM (P% = 0,007). However, these intervention significantly
reduced both groups 6mwt’s [265,9 vs. 211,3m; 95%CI 1,04-108,3; (P% = 0,045)].
Brief exposure to air pollution did not alter HRV in well-treated HF patients. We
concluded that the FM could mitigate the DE inhalation effects on endothelial and
cardiopulmonary function in HF patients and healthy volunteers, though it causes
respiratory discomfort and reduces the walking distance. Our results, although
partial, provide some insight into the mechanisms involving particulate matter and
cardiovascular diseases.
LVEF- left ventricle ejection fraction;COPD - chronic obstructive pulmonary disease.
P1254
Younger women but not older ones carry a greater risk of developing early
heart failure after the first acute myocardial infarction compared to men
S Myftiu1 ; I Sharka1 ; XH Belshi1 ; E Saja1 ; E Sulo2 ; G Sulo2
"University Hospital Center “"Mother Theresa”"", Department of Cardiology,
Tirana, Albania; 2 Department of Global Public Health and Primary Care, Bergen,
Norway
1
Purpose: Early heart failure (HF) is a frequent complication of acute myocardial
infarction and is associated with high mortality rates. Studies have suggested that
women carry a higher risk of developing early HF after an AMI but such association
has not been explored in different age groups. We aimed at exploring early HF incidence following AMI and gender differences in such occurrence; overall and by age
group among patients hospitalized for an incident AMI.
Methods: All patients hospitalized for their first AMI during June-November 2013 in
the coronary care unit (CCU), in a hospital center in Tirana -the only tertiary governmental health care facility in Tirana - were included in the study.
Information on patient’s demographics, blood tests, and discharge diagnoses, were
retrieved from patient’s medical files. Information on AMI risk factors and previous
medical history (including previous AMI and other comorbidities) was obtained from
questionnaires administered by trained health personnel.
Gender differences in risk of developing early HF were explored using logistic regression analyses. Gender was introduced as independent variable and early HF (defined
as HF developed during hospitalization – yes versus no) as dependent variable.
The model was adjusted for age, percutaneous coronary intervention during hospitalization, diabetes, hypercholesterolemia and renal function. The analyses were
performed for all patients (overall) and by age group (≤ 65years and > 65 years)
Results: 94 consecutive patients (25.8% women) aged 64.2 (13.7) years were hospitalized for the first AMI and included in the study. Women were on average 6 years
older than men (68.3 years versus 62.7 years, p < 0.05) A total of 29 (31.9%) patients;
DE inhalation and endothelial function
P1256
Prognostic significances of systolic blood pressure and brain natriuretic
peptide at admission in acute heart failure: A report from the ATTEND registry
NNaoki Sato1 ; K Kajimoto2 ; T Takano1
Nippon Medical School, Tokyo, Japan; 2 Sensoji Hospital, Tokyo, Japan
1
Background/Aim: Systolic blood pressure (SBP) is one of strong prognostic
factors in acute heart failure (AHF). Brain natriuretic peptide (BNP) is also known
as a prognostic marker as well as diagnostic one in AHF. Both factors are very
commonly used in AHF, but prognostic significance of the combination of SBP and
BNP remains unknown. Therefore, we analyzed to clarify it using the data from the
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
236
Abstracts
acute decompensated heart failure syndromes (ATTEND) registry.
Method: Prognostic significance regarding total and cardiac death during hospitalization of SBP and/or BNP at admission were analyzed by receiver operating
characteristic curve analysis in 4493 AHF patients of the ATTEND registry, which is
a nationwide, multicenter, and prospective cohort study.
Results: Adding BNP to SBP was not useful for prognostic significance in AHF
(figure).
Conclusion: Thus, the present study revealed prognostic significance of SBP at
admission was so strong, which was not changed by adding BNP at admission in
AHF.
Figure
P1257
Uric acid, allopurinol therapy and mortality in patients with acute heart failure
F Malek1 ; P Ostadal1 ; J Parenica2 ; J Jarkovsky3 ; J Vitovec3 ; J Spinar2
Na Homolce Hospital, Department of Cardiology, Prague, Czech Republic;
2
University Hospital Brno, Department of Cardiology and Internal Medicine,, Brno,
Czech Republic; 3 Masaryk University, Brno, Czech Republic
1
Backround: Previous observations showed increased uric acid (UA) levels as well
documented allopurinol therapy (AL) were in acute heart failure patients associated
with increased hospital and long-term mortality. AL was not a cause, but the identifier
of high risk subjects.
Study objective: To assess prognostic role of UA and AL for hospital and long-term
mortality from the Acute HEart FAilure Database registry in the subgroups according
to age, gender, aetiology of cardiac dysfunction, clinical syndrome, LV EF, creatinin,
eGFR, haemoglobin and NT-proBNP levels.
Patients and Methods: The study included 1255 patients who were admitted to
the AHEAD participating centres with acute decompensated CHF, de novo HF or
cardiogenic shock between September 2006 and October 2009, and who had
information of UA and AL on hospital admission available. The hospital and long
term mortality was followed using the centralised database of the Ministry of Health,
Czech Republic.
Results: AL therapy before hospital admission didn ́ t influence the hospital mortality
in AHF.
UA > 515mmol/l was associated with increased hospital mortality in patients above
80 years old (odds ratio OR 4,376, p% = 0,002), in patients with ischemic HF (OR
2,476, p% = 0,010), in patients with diabetes mellitus (OR 2,241, p% = 0,011), LV EF
> 50 % (OR 4,978, p% = 0,001), eGFR 30-60 and > 60 ml/min (OR 2,31, p% = 0,005
and OR 3,372, p% = 0,033), in subjects Hgb < 120 g/l (OR2,244, p% = 0,007). UA
> 500 mmol/l was associated with increased long term mortality in patients < 60
and > 80 years (HR 1,824, p < 0,001 a HR 1,068, p < 0,001), and ischemic HF
(HR 1,512, p% = 0,029), in patients with diabetes mellitus (HR 1,820, p < 0,001),
in LV EF ≤ 30 % (HR 1,562, p < 0,001) and eGFR 30-60 ml/min (HR 1,548, p <
0,001). AL therapy identified patients with higher long term mortality in a subgroup
with LV EF > 50 % (hazard ratio HR 1,471, p < 0,001), Hgb < 120 g/l (HR 1,477,
p% = 0,001) and NTproBNP > 10 000 pg/ml (HR 0,503, p% = 0,032) at the time of
hospital admission.
Conclusion: AL therapy and UA > 515mmol/l for hospital mortality and > 500
mmol/l for long-term mortality identified patients with high risk of death in defined
subgroups: higher age, ischemic HF, diabetes mellitus and mild to moderate CKD.
Surprising is association of AL therapy with risk of long term mortality in subjects
with preserved EF.
P1258
Rationale and design of ARTS-HF: a randomized, double-blind active
comparator study of finerenone in patients with worsening chronic heart
failure, diabetes and/or chronic kidney disease
G Filippatos1 ; CChristina Nowack2 ; B Pitt3
Attikon University Hospital, Heart Failure Unit, Department of Cardiology, Athens,
Greece; 2 Bayer HealthCare AG, Leverkusen, Germany; 3 University of Michigan,
School of Medicine, Ann Arbor, United States of America
1
Aim: Mineralocorticoid-receptor antagonists (MRAs) are considered life-prolonging
therapy for patients with heart failure with reduced ejection fraction (HFrEF). However, the risk of hyperkalemia and worsening renal function is the main obstacle
of guidelines implementation and even broader use of MRAs in clinical practice.
Type 2 diabetes mellitus (T2DM) as well as chronic kidney disease (CKD) have
been identified as risk factors for hyperkalemia under treatment with an MRA. The
prevalence of CKD and/or T2DM is high in patients hospitalized for worsening signs
and symptoms of HFrEF precluding physicians to broadly initiate MRAs in the hospital/on discharge. Finerenone is a next-generation oral, non-steroidal MRA which
showed less serum potassium increase and eGFR decrease than spironolactone
(25/50mg) at doses which reduced levels of natriuretic peptides and albuminuria
to at least the same degree as spironolactone in patients with stable HFrEF and
moderate CKD (ARTS).
Methods: ARTS-HF is an international phase 2b, multicentre, randomized,
double-blind, active comparator-controlled, adaptive, parallel-group study investigating up to five different treatment arms of finerenone given once daily over 90
days, compared with eplerenone, in up to 1060 patients with worsening chronic
heart failure and reduced ejection fraction and either T2DM with or without CKD
or moderate CKD alone. Primary efficacy variable will be the relative decrease
in NT-proBNP from baseline to Day 90. Secondary outcome measures include
safety and tolerability, the change in serum potassium, blood pressure and
heart rate.
Conclusion: Because of its potential favorable balance of cardiac anti-remodeling
effects vs. renal (electrolyte) effects, finerenone might provide a relatively higher
level of cardiac mineralocorticoid-receptor blockade in comparison to eplerenone in
this high-risk patient population investigated in ARTS-HF assuming an acceptable
safety profile of all investigated doses. Given the substantial risk of morbidity and mortality of this population and the well-established overall efficacy of
MRAs in randomized clinical trials, a next generation MRA with an improved
efficacy and safety profile could help to reduce cardiovascular mortality, hospitalizations for heart failure (HF), and healthcare resource use in the targeted
population. In addition, a next generation MRA such as finerenone could overcome the current underuse of MRAs in HF patients in general which is partly
due to safety concerns, in particular in patients with concomitant T2DM and /
or CKD.
P1259
Acute heart failure in settings of acute coronary syndromes; an analysis from
Romanian Acute Heart Failure Syndromes (RO-AHFS) registry
OOvidiu Chioncel1 ; D Deleanu1 ; D Vinereanu2 ; A Ambrosy3 ; A Petris4 ; D Filipescu1 ;
S Bubenek1 ; C Macarie4 ; M Gheorghiade5
1
Institute of Cardiovascular Diseases “Prof. Dr. CC Iliescu”, Bucharest, Romania;
2
Emergency Hospital Bucharest, Bucharest, Romania; 3 Stanford University
Medical Center, Stanford, United States of America; 4 "G I.M. Georgescu"
Cardiovascular Diseases Institute, University of Medicine and Pharmacy Gr T Popa,
Iasi, Romania; 5 Northwestern University, Chicago, United States of America
Purpose: To evaluate independent predictors for all cause mortality (ACM) in
patients hospitalized with acute heart failure syndrome(AHFS) who had concomitant acute coronary syndromes(ACS) at presentation.
Methods: RO-AHFS registry enrolled 3224 consecutive patients at 13 medical
centers admitted with a primary diagnosis of AHFS, over a 12 month period. A
multivariate logistic regression model was developed to identify baseline clinical
variables predictive of all cause mortality (ACM) in patients hospitalized for AHFS
and concomitant ACS.
Results: 11.3% (n = 365) of patients were diagnosed with ACS, 41% with STEMI,
43% with NSTEMI and 16% with unstable angina(UA).
Differences in baseline characteristics between patients with ACS and those without
ACS are shown in Table 1.
The unadjusted in-hospital mortality for AHF patients with or without ACS were
12.7% vs 7.1% and the adjusted mortality risk for patients with ACS was 1.58
(95%CI 0.98-2.14).
Independent predictors of in-hospital ACM in patients presenting with ACS
are: age(HR% = 1.12;95%CI 1.08-1.23), Systolic Blood Pressure(SBP) at admission(HR% = 1.17;95%CI 1.03-1.34), left bundle brunch block(LBBB) (HR 1.58,
95% CI 1.18-2.11), whereas left ventricular hypertrophy(LVH) (HR% = 0.91, 95%CI
0.88-0.96) was protective.
Conclusions: Some clinical variables readily available at presentation may predict
ACM in patients with concomitant AHFS and ACS.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
237
Table 1
ACS
nonACS
p
Age
68.3±11
70.2±12
0.03
Male(%)
59
55
0.1
Diabetes(%)
38.7
30.9
0.02
Previous MI(%)
18.1
16.4
0.06
SBP < 110mmHg(%)
16.8
11.4
0.05
HR(beats/min)
98.7
98.0
0.7
RR(breath/min)
27±4
26±4
0.1
AFib(%)
28.5
45.8
0.002
LBBB(%)
19.2
15.9
0.04
LVEF(%)mean
39±12
37.5±11
0.04
HEART FAILURE DIAGNOSIS – POSTER PRESENTED
metoprolol (M) daily, the second one (n = 23) received 160 mg sotalol (S) daily.
No differences were noted in the standard therapy which included ACE inhibitors,
aldosterone antagonists, diuretics and warfarin. To assess LVDD, Doppler patterns of early filling peak velocity (E), atrial peak velocity (A), E/A ratio, mitral
annulus velocity (E‘), E/E′ ratio, deceleration time (DT), isovolumic relaxation time
(IVRT), LA volume index (LAVI) were measured before and 3 months after AAD
treatment.
Results: Holter ECG showed a significant decrease in average heart rate (HR)
from 68 ± 2 to 63 ± 1 bpm (p < 0.02) in group A+M and from 66 ± 3 to 61 ± 4 bpm
(p < 0.03) in group S, as well as decrease in the maximum HR from 122 ± 4 to
110 ± 4 bpm (p < 0.02) and 128 ± 6 to 115 ± 7 bpm (p < 0.02), respectively. The
number of supraventricular extrasystoles decreased from 1012 ± 90 to 494 ± 45
(p < 0.03) in group A+M and from 1465 ± 92 to 358 ± 85 (p < 0,004) in group
S. The period of sinus rhythm maintenance was an average of 2.6 months in
group A+M and 2.3 months in group S. In patients with LVDD at baseline, E′
increased from 0.06 ± 0.01 to 0.08 ± 0.01 m/s (p < 0.05) in group A+M and from
0.05 ± 0.02 to 0.09 ± 0.01 m/s (p < 0.03) in group S. E/E′ ratio significantly reduced
from 11.0 ± 0.4 to 8.9 ± 0.3 (p < 0.05) and from 10.8 ± 2.2 to 8.2 ± 2.6 (p < 0.05) in
both groups, respectively. LAVI decreased from 42.1 ± 10.3 to 36.1 ± 5.2 ml/m2
(p < 0.05) in group A+M and from 41.2 ± 6.6 to 37.4 ± 4.9 ml/m2 (p < 0.04) in
group S.
Conclusion: Both groups showed improvement of LV diastolic function which led
to better clinical effect on AF. No differences in effects on LVDD parameters were
noted between the groups.
P1261
What is the burden of disease that may require cardiac re-synchronisation
therapy amongst patients of the incident heart failure clinic?
P1263
AAbdallah Al-Mohammad; L Yates; O Watson; P Sheridan
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
Elevated levels of ST-2 are linked with prognostic pathomorphological
parameters of heart fibrosis in patients with severe heart failure
Purpose: Patients with heart failure (HF) due to significantly severe left ventricular systolic dysfunction (HF-LVSD) and electrical dys-synchrony (QRS complex >120 m sec) may benefit from cardiac re-synchronisation therapy (pacing
+/-defibrillator) (CRT-P/D). We investigated the incidence of the condition requiring
CRT-P/D amongst patients referred to an incident HF clinic.
Methods: We interrogated the incident heart failure clinic data-base in our institution serving a city with 550,000 inhabitants. Patients with suspected HF whose
NTproBNP is >400 pg/ml (ng/l) receive an echocardiogram and a clinical assessment by a heart failure cardiologist. We collected data on the patients seen between
14th of April 2012 and 12th of January 2014. We concentrated on the patients with
moderate to severe or severe LVSD whose QRS complexes on the 12 lead electrocardiogram (ECG) were >120 m sec, as potential candidates for CRT-P/D. This
would allow us to predict the burden of disease requiring these devices in the cohort
of incident heart failure patients.
Results: In the 21 months, we saw 1232 patients. There were 293 patients (24%)
with no evidence of HF. HF of any type was diagnosed in 939 patients (76% of
those with raised NTproBNP), their age range was 40-100 years (90% of them were
between 60 and 89 years). There were 466 patients (38% of the patients seen in
clinic, and 49.6% of all the heart failure patients) with HF-LVSD. Of these, the LVSD
was moderate to severe or severe in 149 patients (32% of the HF-LVSD patients).
Of the patients with HF-LVSD, the QRS duration was >120 m sec in 122 patients.
Fifty eight patients (12% of all the HF-LVSD patients) had significantly severe LVSD
and QRS duration >120 m sec (53 of these patients had left bundle branch block,
the most common ECG pattern known to be associated with benefit from CRT-P/D).
The annual incidence of all types of HF is therefore, 98 cases per 100,000 PA, of
HF-LVSD is 48 cases per 100,000 PA, and of significant HF-LVSD with QRS >120 m
sec is 6 cases per 100,000 PA.
Conclusions: Epidemiological data based on real world experience predicts the
incidence of new cases of HF potentially requiring CRT-P/D at 6 cases per 100,000
people per annum, far lower than the incidence of heart failure cases at 98 patients
per 100,000 PA. This should inform health care planners of the potential need for
resources including personnel recruitment.
A KAlena Kurlianskaya1 ; Y P Ostrovsky1 ; M G Koliadko1 ; O A Udina1 ; T L
Denisevich1 ; S Di Somma2 ; I I Russkich1 ; T A Trofimova1 ; A Z Smolensky1
1
Research & Practical Centre “Cardiology”, Minsk, Belarus; 2 Sapienza University of
Rome, Medical-Surgery Sciences, Rome, Italy
Aim: To investigate a relationship of biomarkers ST-2, pathomorphological parameters of the fibrosis (according to histological evaluation of explanted hearts) and
heart hemodynamic in patients with severe heart failure (HF).
Methods and Results: ST2 blood assessment and histological evaluation of
explanted hearts fibrosis was performed in 109 consecutive patients with end-stage
heart failure (age of 44,96 ± 13,71) undergoing heart transplantation. In vivo ST2
blood level of and the average square of fibrosis showed significant and strong correlation (rs% = 0,72 and 𝜌% = 0,002). Median of ST2 level was significantly higher
in patients with prevalence of postnecrotic type of myocardial fibrosis: 3.8 times
(p% = 0.002) higher compared to those in patients who had interstitial fibrosis
in prevalence (Fig 1). Comapred to patients with non–ischemic cardiomyopathy
(DCMP) (tabl. 1), patients with HF of ischemic etiology (ICMP) presented higher
median of ST2 level than that in patients and increased prevalence of postnecrotic
fibrosis.
Conclusions: In patients with severe heart failure the use of blood ST2 assessment
could be useful for distinguishing different pathomorphological parameters of heart
fibrosis and and in in the clinical assessment of heart failure severity.
ST-2 in ischemic and non-ischem etiology
DCMP
ICMP
p
ST-2, ng/ml, (Me (LQ-UQ))
36,82 (27,55-57,58)
69,34 (29,8-85,9)
0,036
Square of fibrosis, mcm2 ,
(Me (LQ-UQ))
10295 (4278-28742)
25580 (1809-42214)
0,065
Incidence of patients with
the prevalence of
postnecrotic fibrosis, (p±sp )
(66,7 ± 11,1) %
(70,0 ± 11,8) %
0,683
P1262
Effects of amiodarone and sotalol on diastolic function in post-myocardial
infarction patients
AAkmal Yusupov; AA Shavarov; GK Kiyakbaev; VS Moiseev
Peoples Friendship University of Russia (PFUR), Moscow, Russian Federation
Left ventricular diastolic dysfunction (LVDD) appears to play an important role in the
pathogenesis of atrial fibrillation (AF) in patients with coronary artery disease (CAD). It
is still unclear how class III antiarrhythmic drug (AAD) affect LVDD indices in patients
with recurrent AF.
Purpose: To evaluate effects of amiodarone and sotalol on LVDD in AH and CAD
patients with recurrent AF.
Materials and Methods: The study included 48 patients (mean age 66,3 ± 8,6
years old) with a history of myocardial infarction (MI) and either paroxysmal or persistent AF. The first group (n = 25) received 200 mg amiodarone (A) plus 100 mg
P1264
Access to investigation and diagnosis in patients presenting to an acute
hospital in the UK with heart failure and either preserved or reduced ejection
fraction
MY Kim; A Seed
Lancashire Cardiac Centre, Blackpool, United Kingdom
Purpose: Hospitalisation for acute heart failure (AHF) is associated with significant
morbidity, mortality and financial burden. Without access to B type natriuretic
peptide (BNP) or specialist cardiologist assessment acutely, in the majority of
acute trusts in the UK, there is often over reliance on echocardiogram. Although an
essential test, echocardiogram can be misleading to the non specialist, particularly
in patients with preserved ejection fraction (HF-PEF), reducing commitment to
management. In an Acute Trust in the UK, we report the proportion of AHF patients
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
238
Abstracts
Results: Of the included patients, 51.6% had GFR < 60ml/min/1.73m2 . In 61.3% the
photoplethysmographic wave was type 4 and 30.6% type 3. In the endothelial function parameters, we obtained a reduced percentage of change in wave amplitude
postiquemia ( < 10%) in 30.6% of the total population; In the comparison groups it
was found that the MAT/TT post-ischemia index was higher in NYHA stage 3 patients
compared with NYHA stages 1 and NYHA 2 (21.52 ± 10.21 versus 17.04 ± 4.14 and
16.40 ± 3.5, p% = 0.04, respectively) independently of kidney damage.
Conclusion: About a third of the patients had a reduced percentage of chances in
wave amplitude post-ischemia. Likewise the endothelial function, measures by de
MAT/TT post-ischemia index, worsens in parallel with NYHA functional class independently of kidney damage.
presenting with HF-PEF and compare access to investigation, specialist management and outcome with those with reduced EF (HF-REF)
P1266
Left ventricular diastolic function and autonomic balance in patients with
atrial fibrillation
AAkmal Yusupov; AA Shavarov; GK Kiyakbaev; VS Moiseev
Peoples Friendship University of Russia (PFUR), Moscow, Russian Federation
Objective: To compare indices of left ventricular (LV) diastolic function and heart rate
variability (HRV) in coronary artery disease (CAD) patients with paroxysmal and persistent atrial fibrillation (AF).
Materials and Methods: A total of 40 patients with the history of AH and myocardial
infarction (mean age 65 ± 6 years) were divided into 2 groups: paroxysmal (n = 18)
and persistent (n = 22) AF. To estimate LV diastolic function a Doppler method of
transmitral flow velocity pattern (TMF) was used. LA volume index (LAVI) was calculated by biplane method. To assess HRV the following time domain indices were
analyzed: standard deviation of RR-intervals (SDNN) and the standard deviation
of RR-intervals (rMSSD). All measurements were performed in the sinus rhythm
period.
Results: In patients with paroxysmal AF mitral annulus velocity (E‘) was significantly
higher than in persistent AF (0,06 ± 0,01vs 0,05 ± 0,01, 𝜌 < 0,05). LA volume in paroxysmal AF was lower than in persistent AF (73 ± 24 vs 94 ± 23 ml, 𝜌% = 0,01), as
well as LAVI (32 ± 4 vs 48 ± 11 ml/m2 , 𝜌% = 0,001) respectively. Isovolumic relaxation time (IVRT) was not significant between the groups (88 ± 13 and 97 ± 14 ms,
𝜌% = 0,06, respectively), but in persistent AF it was a bit higher. rMSSD value was
comparable in both groups, SDNN was significantly higher in paroxysmal AF compared to patients with persistent AF (117 ± 18 vs 95 ± 26 ms, 𝜌% = 0,01); 3 (14%)
patients in persistent AF group had SDNN < 70 ms, in the other group no patient
had SDNN < 70 ms.
Conclusion: Patients with persistent AF have a more impaired LV diastolic dysfunction and heart rate variability (HRV) than patients with paroxysmal AF.
61024 ST-2 levels with type of fibrosis
Methods: Single-centre, retrospective analysis. Patients admitted with primary
heart failure diagnosis, validated by clinicians, from July – October 2013 inclusive, were considered in two groups according to their EF: ≥ 45%% = HF-PEF,
< 45%% = HF-REF. BNP was not available. We compared access to echocardiography and specialist management, length of stay and risk of readmission, between
groups.
Results (see table below)
Conclusions: In our trust the proportion of patients with AHF who have preserved
ejection fraction is consistent with previous reports. These patients are less likely
to have echocardiography acutely, face a significant delay to that investigation and
therefore diagnosis, are less likely to be managed by a specialist and spend more
days in hospital. Although they are less likely to be readmitted and the literature
would suggest they have a lower mortality risk, this group clearly face significant
morbidity and place a significant financial burden on the NHS. We look forward to
National guidance on management of patients admitted with acute heart failure and
specifically the strategy suggested to ensure timely diagnosis in those with HF-PEF.
It is our belief that additional diagnostic test such as BNP, made available to non
specialists would improve patient experience, diagnosis and outcome by supporting
clinical diagnosis at presentation.
Results
n
HF-PEF
AGE (mean, yrs)
Male (%)
Echo performed
during/ < 14 days
from admission (%)
Time to echo
(mean, days)
Length of admission
(mean, days)
Discharged from
cardiology ward (%)
Re-admission
within 6 months
(%)
57
75
24 (42)
27 (47)
14
14
8 (14)
14 (24)
HF-REF 71
71
44 (62)
35 (49)
12
12
17 (23)
31 (44)
HF-PEF; heart failure with preserved ejection fraction, HF-REF; heart failure with reduced ejection fraction
P1265
Evaluation of endothelial function through photoplethysmography in patients
with heart failure whit and without kidney damage: differences by nyha
functional class
P1267
E Alcala-Davila; L Castillo-Martinez; AArturo Orea-Tejeda; F Davila-Radilla;
E Calvario-Mayorga; A Hernandez-Izelo; R Jimenez-Torres; J Dorantes-Garcia; R
Narvaez-David
Instituto Nacional de Ciencias Médicas y Nutrición “SZ”, Mexico, Mexico
GAYANEGayane Chngryan; TM Solomenchuk
Lviv national medical university n.a. Danylo Halytsky , Lviv, Ukraine
Background: Endothelial dysfunction (ED) is an earliest face of atherosclerosis process and cardiovascular disease. In the pathophysiological link between Heart Failure (HF) and renal damage (RD), endothelial dysfunction plays a very important role
and is also a major risk factor for death and hospitalization in HF and RD. The photopletysmography, a simple and low-cost optical technique allows assessing the
endothelial function and is able to detect changes in blood flow, pulse and swelling
of the microvascular space of tissues. Objective: To identify differences in the volume pulse wave by photoplethysmography obtained in patients between NHYHA
functional class and with and without kidney damage. Method: In an observational,
cross-sectional, study, were included 62 patients of the HF clinic of the “INCMNSZ”,
divided into groups according to NYHA functional class and stage of renal function.
Registration of photoplethysmography wave was performed by hyperemia technique, and the maximum amplitude time index on total time (MAT/TT), percentage
of change in the amplitude of the wave, stiffness index and reflectivity, was determined.
Informative assessment of regional myocardium contractility and its viability
in patients with postinfarction cardiosclerosis
Methods: We examined 59 patients with postinfarction cardiosclerosis who were
hospitalized for unstable angina. Patients were divided into 2 groups: group I
- 27 patients with viable myocardium, II group - 32 patients with nonviable
myocardium. The criterion of myocardium viability was improved left ventricular
(LV) ejection fraction (EF) of ≥ 5% in dynamics echocardiographic examination
in 14 days of observation. For a more detailed assessment of LV contractile ability was estimated - the degree of local contractility disorder (DLCD) of the LV
(total score segments - 16 / number of segments with impaired contractility) and
asynergy index (AInd) (total score segments / 16) on the first day and 14 days of
hospitalization.
Results: In assessment of standard measure of myocardial contractility of the LVEF
were found an increase in two groups of patients: group I – in 18% (from 38,82 ± 2,37
to 47,35 ± 2,37, p < 0.001), in group II - 8.4% (from 36,72 ± 2,39 to 40,09 ± 1,85, p
< 0.001). However, the analysis of DLCD and AInd in two groups of patients was
found completely opposite trend. In particular, DLCD in the first group patients
decreased from 1,58 ± 0,15 to 1,39 ± 0,13, p < 0.001, which indicates improved
myocardial contractility in 12%, while in the second group, the other way round
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
rise DLCD was observed from 1,32 ± 0,1 to 1,54 ± 0,14, p < 0.001 which is a sign
of deepening of disorders of myocardial contractility by 14.3% .AInd in patients in
group I decreased in the interval between the 1st and 14th days from 1,8 ± 0,1 to
1,68 ± 0,12, p < 0.001, indicating a decrease in total area of hibernated segments
at 6.7%. In group II it increased from 1,47 ± 0,09 to 1,59 ± 0,09, p < 0.001, which
indicates increase of area nonviable myocardium by 7.5% probably due to acute
ischemia, on a background of unstable angina.
Conclusions: In many cases, LVEF assessment does not provide complete information regarding changes in myocardial contractility. Even with some improvement
against the background, LVEF, DLCD and AInd characterizing the dynamics of local
contractility of the left ventricle, show differently directed trends. This is especially
noticeable in patients with nonviable myocardium (group II), whereas the relative
improvement of LVEF (8.4%) also experienced deterioration of DLCD by 14.3%, and
AInd - by 7.5%, indicating the emergence of new lesions hibernated myocardium or
extension of nonviable myocardium regions. Therefore, a full assessment of myocardial viability along with definition of LVEF should be used DLCD and AInd.
P1268
The severity of breathlessness and the incidence of angina in patients with
incident heart failure due to left ventricular systolic dysfunction and heart
failure with preserved ejection fraction
AAbdallah Al-Mohammad; L Yates
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
Purpose: Heart failure (HF) affects presents with breathlessness amongst other
symptoms. Ischaemic heart disease is one of the important causes of heart failure.
We sought to investigate the severity of breathlessness and frequency of angina
amongst patients with incident HF who have either left ventricular systolic dysfunction (HF-LVSD) or heart failure with preserved left ventricular ejection fraction
(HFPEF).
Methods: Patients suspected of having new onset HF are referred to the incident HF clinic if they have tiredness, breathlessness or peripheral oedema and
their NTproBNP is > 400 pg/ml (ng/l). Our clinic serves a city populated by
550,000 inhabitants. They undergo detailed echocardiography and are assessed
by a HF consultant cardiologist. We collected data on the symptoms at presentation of the patients seen between 14th of April 2012 and 12th of January 2014.
We concentrated on the patients with HF-LVSD and HFPEF who are the majority
of the incident HF patients. Breathlessness was measured according to the New
York Heart Association Classification (NYHA class). Comparison between categorical data was carried out using a two-tailed Z test with significance at p value
of < 0.05.
Results: Of 1232 patients seen in 21 months, HF of any type was diagnosed in
939 patients (76% of those with raised NTproBNP). There were 466 patients (49.6%
of all HF patients) with HF-LVSD and 350 patients (37% of all HF patients). NYHA
class II breathlessness was significantly more prevalent in patients with HFPEF (230
patients, 66%) than in patients with HF-LVSD (261 patients, 56%); p < 0.05. Conversely, NYHA class III was significantly more prevalent amongst HF-LVSD patients
(129 patients, 28%) than in HFPEF patients (49 patients, 14%); p < 0.05. On the
other hand, no significant differences were found in the prevalence of NYHA class
IV breathlessness between patients with HF-LVSD and patients with HFPEF (17
patients [4%] with HF-LVSD vs. 5 patients [1%] with HFPEF). NYHA class IV was
uncommonly seen in incident HF clinic, as one would expect. Similarly, there is no
significant difference in the prevalence of angina between patients with HF-LVSD
(107 patients, 23%) and patients with HFPEF (62 patients, 18%).
Conclusions: NYHA class II breathlessness is more prevalent in HFPEF than in
HF-LVSD, while NYHA class III breathlessness is more prevalent in HF-LVSD than in
HFPEF patients. There is no difference in the incidence of angina between HF-LVSD
and HFPEF (around one fifth).
239
CHF-PEF group and 26 patients (14 (54%) male and 12 (46%) female) without signs
of CHF, comparable by gender and concomitant pathologies, were included in the
reference group. All patients underwent 6-minute walk test as well as clinical examination and Echo, to evaluate their functional status, and total plasma concentrations
of organic peroxides were determined by the ELISA test. Results: Average of the
total organic peroxide concentration is significantly higher in CHF patients (𝜌 < 0.02)
and makes 581.0 ± 280.9 mkmol/l in CHF patients with lowEF and 523.4 ± 299.6
mkmol/l in CHF patients with preserved EF, and patients from the reference group it
equals 345.0 ± 260.0 mkmol/l. The average levels of total organic peroxide concentration in CHF patients with lowEF and CHF-PEF do not differ significantly (𝜌% = 0.4).
There are correlations between levels of total organic peroxide concentration and
clinical status (CHF stage (p% = 0.001), NYHA FC (r% = 0.35), exercise tolerance
according to the 6-minute walk test results (r% = -0.34)), laboratory findings (ESR
(r% = 0.24)) and instrumental study results (sizes of the left (r% = 0.30) and the rights
atrium (r% = 0.25) according to EchoCG).
Conclusion: This study demonstrates that the determination of total concentration
of organic peroxides may provide important additional information for the assessment of severity and progression of CHF. As CHF progresses, increased total concentration of organic peroxides can be used as a marker of treatment effectiveness.
P1270
Factors affecting the development of diastolic dysfunction in arterial
hypertension patients with high cardiovascular risk
T YU Kuznetsova; DDenis Gavrilov
Petrozavodsk State University, Medical Faculty, Petrozavodsk, Russian Federation
Objective: To analyze the factors affecting the diastolic dysfunction (DD) development in patients with high cardiovascular risk (CVR).
Material and methods: patients with arterial hypertension (AH) have been
examined. High and very high cardiovascular risks were determined. Women
made up 28.8%, average age was 52.9 years (32 to 74). The examination was
carried out in accordance with the established AH recommendations. DD was
recorded in the presence of 3 criteria of 4. Coronary calcium (CC) was determined
using 64-slice CT scanner, calcium index (CI) was calculated using the Agatson and
surround methods.
Results: Distribution of patients according to the AH degree: 1st - 116 (52%), 2nd 92 (42%), 3d - 14 (6%). The additional risk factors occurrence: family history - 23%,
smoking - 49.5%, obesity - 37%, dyslipidemia - 51%, diabetes - 7%. Frequency
of target organ damage: MAU - 1.8%, left ventricular hypertrophy (LVH) - 31%,
vasoconstriction fundus - 59%, ultrasound signs of carotid arteries - 76%. Associated clinical conditions were diagnosed: stroke - 5.4%, obliterating atherosclerosis
of legs - 3%. DD was detected in 58 patients (26%). High CVR was diagnosed
in 142 people (63.9%), very high in 80 (36.1%). The analysis of DD dependence
from AH, risk factors and CC was conducted. DD was significantly more frequent
in men (31% vs. 14% in women, OR 3.2, p% = 0.048), patients older than 50
years (32% vs. 14% in those younger than 50 years, OR 2.77, p% = 0.006) and
the presence of LVH (42% vs. 19% in patients without LVH, OR 3.1, p% = 0.0003).
Significant DD association with the presence of obesity, diabetes, degree and
prescription of AH have not been identified. CC was detected in 111 people (50%).
77 of them were above the age norm. 43 people were referred to medium and
high CI risk (19%). DD significantly depended on the presence of CC (DD frequency in the presence of CC - 33% and 20% in its absence, OR 1.54, p% = 0.03).
Among patients with high and medium risk of CAD, calculated as measured by
CT, the percentage of patients with DD was also higher (44% vs. 22%, OR 2.5,
p% = 0.0036).
Conclusions: DD in AH patients with high risk was associated with male sex, age
older than 50 years, the presence of LVH and CC. CC detection in AH patients
is a marker of DD and requires more aggressive tactics in the prevention of
atherosclerosis and heart failure progression.
P1269
Clinical diagnostic implication of an oxidative stress marker in coronary heart
disease patients
O Drapkina; L Palatkina
I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
Inrecent years, there has been a search for new biological markers that can improve
diagnosis and treatment of this challenging disease. Intensification of peroxidation
process substantially contributes to the development and progression of CHD.
Organic peroxides are first resultants of reactions between cell constituents and
reactive oxygen species (ROS). There is a direct correlation between the presence
of ROS and circulating biological peroxides.
Objective: Determine clinical and diagnostic implication of total concentration of
organic peroxides in CHF patients and substantiate using this biological marker for
CHF diagnosis and severity assessment.
Materials and Methods: The study enrolled 81 patients from 37 to 90 years old, of
whom 28 CHF patients (12 (43%) male and 16 (57%) female) with normal EF (>50%)
and diastolic dysfunction were included to the CHF-PEF group; 27 CHF patients (13
(48%) male and 14 (52%) female) with reduced LVEF ( < 50%) were included to the
HEART FAILURE DIAGNOSIS – POSTER DISPLAY
P1271
The usefulness of the electrocardiogram for the diagnosis of stage B and
symptomatic heart failure in primary care
E T Mesquita; AJAntonio Jose Lagoeiro Jorge; J P P Cassino; R G Rocha; L N
Cruz; J A Costa; L C M Fernandes; D M S Correia; C V Souza Junior; M L G Rosa
Universidade Federal Fluminense, Niterói, Brazil
Introduction: The electrocardiogram (ECG) is a highly available low cost tool that
has been widely studied for the diagnosis of symptomatic heart failure (HF) in
primary care. The ECG has not been used in primary care in the characterization
of patients with HF in stage B. The aim is to identify the major ECG alterations in
patients with stage B and symptomatic HF.
Methods: A Cross-sectional randomized study that included 633 patients
(62% women, 59.6 ± 10.4 years) underwent clinical examination, BNP, ECG
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
240
Abstracts
and tissue Doppler imaging (TDI). The diagnosis of HF was made using criteria of the European Society of Cardiology. Stages classification was based
on the ACC/AHA recommendations. The ECG alterations assessed were
atrial fibrillation, atrio-ventricular block, right or left bundle branch block, left
atrium enlargement, left ventricular hypertrophy and changes of ventricular
repolarization.
Results: The Prevalence of HF was 9.3% and stage B of 42.7%. The proportion of
abnormal ECG at the differents stages of HF was: healthy (23%), stage A (31%),
stage B (53%) and stage C (78%). The main findings observed in stage B were:
alterations in ventricular repolarization (n = 79, 29.3%), LV hypertrophy (n = 54,
20%), increase of the left atrium (n = 31, 11.5%), left bundle branch block (n = 3,
1.1%). The abnormal ECG had a sensitivity of 53%, specificity 63%, accuracy of
59%, negative predictive value 64%, positive predictive value 51% and positive
likelihood ratio 1.4 to identify stage B patients. In patients with symptomatic HF
the main findings were: ventricular repolarization abnormalities (n = 33, 55.9%), LV
hypertrophy (n = 18, 30.5%), left atrial enlargement (n = 16, 29, 6%), atrial fibrillation
(n = 6, 10.2%), and left bundle branch block (n = 5, 8.5%). The abnormal ECG
had a sensitivity of 78%, specificity 60%, positive predictive value 17%, negative
predictive value 96%, positive likelihood ratio of 1.93 and negative likelihood ratio
of 0.36 for the diagnosis of HF.
Conclusions: The results demonstrated that one in every two patients in stage B
and one in every five with HF have a normal ECG. The data reinforce the recommendations of the use of echocardiogram to exclude or confirm the presence of
stage B and HF in primary care.
through cardiopulmonary exercise test (CPET), expressed as the minute ventilation/carbon dioxide production (VE/VCO2) slope, has been reported to correlate with
the right ventricular (RV) function.
Objectives: to assess the correlation of RV echocardiographic parameters with
VE/VCO2 slope.
Methods: Sixty one patients (mean age 55 ± 10 years, 64 % ischemic aetiology, mean EF 30 ± 8%) performed a CPET during outpatient evaluation and
underwent a complete echocardiographic study. Selected parameters for RV
morpho-functional assessment included: end-diastolic basal right ventricular diameter (RV EDD), fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), Tissue Doppler systolic velocity (s’), free wall right ventricular longitudinal strain, (RV LS). According to VE/VCO2 slope values, patients were categorized in 4 groups: VE/VCO2 > 40 group 1, 39-35 group 2, 34-30 group 3, <
29 group 4.
Results: at univariate analysis all parameters for RV assesment, EF and E/E′
ratio strongly correlated with VE/VCO2 slope (Table 1). At multivariate analysis only RV EDD, TAPSE and EF were independent predictors of VE/VCO2
slope. In patients with the highest values of VEVCO2 slope (groups 1 and
2), only RV EDD retained a strong correlation with VE/VCO2 slope (r 0.61,
p < 0.001).
Conclusions: the reduction of ventilatory efficiency is a marker of RV remodeling
and dysfunction in patients with HFrEF. The combination of functional and echocardiographic data may unmask patients with severe systolic right heart dysfunction
carrying a worse prognosis.
table 1
P1272
Validation of the MICE clinical prediction rule in a new diagnostic clinic for
community based patients
J Gallagher; E O Connell; S James; T Murphy; D Waterhouse; R O Hanlon;
K Mcdonald; M Ledwidge
St Vincent’s University Hospital, Heart Failure Unit, Dublin, Ireland
Purpose: The MICE clinical prediction rule aids in diagnosis and referral for suspected heart failure in general practice utilising a model based upon four simple
clinical features (Male, history of myocardial Infarction, Crepitations, Edema: MICE).
Concerns that have been raised regarding its use outside research settings. Other
diagnostic tests available in general practice to support diagnosis include ECG and
point of care B Type Natriuretic Peptide (BNP). We sought to retrospectively evaluate the MICE rule in a rapid access clinic for the new diagnosis of heart failure and
evaluate it in combination with ECG and BNP.
Methods: This study evaluates the MICE rule in a prospectively collected dataset of
patients referred by their general practitioner to a rapid access clinic for the diagnosis of heart failure between 2002 and 2012. The rule was validated using area under
the receiver operating characteristic curve (AUROC) both alone, in combination with
ECG and in combination with BNP testing. It was also validated in both the HF-REF
and HF-PEF subsets. We also quantified the most reliable cut-off levels of the BNP
assay in this group
Results: A total of 733 patients were seen in the clinic for potential new cases of
incident of heart failure. 38.9% (n = 285) were diagnosed with heart failure, 40.7%
(n = 116) with HF-REF and 59.3% (n = 169) with HF-PEF. AUROC for the MICE rule
alone was 0.7, for the MICE rule and ECG it was 0.75 for the MICE rule combined
with log[BNP] it was 0.89. For the MICE rule with BNP and ECG theAUROC was
0.91. The AUROC for log BNP alone was 0.86 with sensitivity and specificity of 0.8
when BNP% = 100pg/ml. A bnp of 70pg/ml has a sensitivity of 0.9 and specificity
of 0.64 while a BNP of 200pg/ml has sensitivity of 0.6 and specificity of 0.9. No
significant differences were found between HF-REF and HF-PEF in the validation
of the rule
Conclusion: The MICE rule is a useful tool to aid the diagnosis of heart failure in the
community and combined with BNP may help effectively triage those with suspected
heart failure.
P1273
Ventilatory inefficiency as a marker of right ventricular remodeling and
dysfunction in patients with reduced ejection fraction heart failure
AAntonio Pagliaro1 ; R Molle2 ; M Caputo2 ; V Zaca1 ; S Bernazzali3 ; F Furiozzi1 ;
S Mondillo2 ; R Favilli1
1
University Hospital AOUS, Department of Heart, Thorax and Vessels, Cardiology
Division, Siena, Italy; 2 University of Siena, Cardiology, Siena, Italy; 3 Polyclinic Santa
Maria alle Scotte, Cardiothoracic Surgery, Siena, Italy
Background: in heart failure patients with reduced ejection fraction (HFrEF) the right
heart function is a strong prognostic marker. Ventilatory efficiency as determined
Pearson Correlation
Significance (p value)
FE
-0.52
< 0.0001
E/E′ ratio
0.36
< 0.001
RV EDD
0.48
< 0.0001
s’
-0.38
< 0.001
TAPSE
-0.36
< 0.001
FAC
-0.52
< 0.0001
RV LS
-0.48
< 0.0001
Univariate correlation among echocardiographic variables and VE/VCO2 slope.
P1274
Magnitude of changes in NT-proBNP, intrathoracic impedance, physical
activity and body weight in patients with decompensated Heart
Failure
KKristjan Gudmundsson1 ; M Rosenqvist2 ; F Braunschweig1
Karolinska Institute, Department of Cardiology, Stockholm, Sweden; 2 Karolinska
Institute, Danderyd Hospital, Department of Cardiology, Stockholm, Sweden
1
Purpose: Decompensated Heart Failure (HF) is associated with a dismal prognosis. Serial measurements of NT-proBNP, device based monitoring of intrathoracic impedance (Z), physical activity (ACT) and heart rate (HR) as well as daily
body weight (BW) have been proposed to track changes occurring prior to
decompensation. The magnitude of changes of these parameters has not been
investigated.
Methods: This prospective study included 43 HF patients (NYHA II-IV, 86% male)
with a previous HF hospitalization within 12 months who had an ICD providing daily
values of Z, ACT and HR. Daily BW was monitored using digital telemonitoring
scales. NT-proBNP was measured at inclusion, every second month and upon hospitalization. Physicians were not aware of BW trends. The ICDs were interrogated
every 2nd month.
Results: During follow-up (380 ± 118 d) there were 25 episodes of acute HF
decompensation in 12 patients requiring hospitalization. For 19 episodes paired
values of all variables at the time of last NT-proBNP measurement prior to
decompensation (47 ± 24 d; range 12-92) and upon hospitalization were available.
NT proBNP increased by 5056 ng/L (95% CI 2900-7208; p < 0.001) or 118%.
There was significant increase in BW by 1.5 kg (95% CI 0.3-2.5; p < 0.05) or
1.4% while intrathoracic impedance dropped by 7.1 ohm (95% CI -10.7 - -3.5;
p < 0.001) or 9.5%. Furthermore, ACT decreased by 0.7 hours/day (95% CI -1.1-0.3; p < 0.05) or 26.9%. No significant change in day- or night time HR was
observed.
Conclusion: Episodes of decompensated heart failure are associated with significant increase in body weight and NT-proBNP and significant decrease in impedance
and activity.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
241
Table 1, results
Before
Hospitalization
Change (CI)
Body Weight (kg)
96.9
98.3
1.5 (0.3 - 2.5)
p-value
< 0.05
Impedance (ohm)
74.8
67.7
-7.1 (-10.7 - -3.6)
< 0.001
< 0.001
NT-proBNP (ng/L)
4731
9787
5056 (2900 - 7208)
Activity (hours/day)
2.6
1.9
-0.7 (-1.1 - -0.3)
< 0.05
Day HR (bpm)
76.8
78.0
1.2 (-2.6 - 5.0)
% = 0.51
Night HR (bpm)
76.7
78.1
1.4 (-5.8 - 2.9)
% = 0.50
Table 1 Values at 47 ± 24 days before and at hospitalization.
P1275
Prevalence of fragmented QRS complex and factors related with its
occurrence
L Martinez-Dolz1 ; D Plaza-Lopez1 ; H Morillas-Climent1 ; I Sanchez-Lazaro1 ;
E Rosello-Lleti2 ; E Tarazon-Melguizo2 ; JM Rivera-Otero2 ; D Domingo-Valero1 ;
A Salvador-Sanz1 ; L Almenar-Bonet1
1
Hospital Universitario y Politécnico La Fe, Valencia, Spain; 2 Fundacion para la
Investigacion del Hospital Universitario y Politecnico La Fe, VALENCIA, Spain
Purpose: Fragmented QRS complexes (fQRS) have been described as a variable
which worsens the prognosis in ischemic heart disease and dilated cardiomyopathy. Our aim is to describe the prevalence of fQRS in patients with advanced heart
failure and find potential factors related with its occurrence.
Methods: fQRS was defined as the presence of an additional R wave, notching
of the R or S waves in two contiguous leads, less than 120 ms duration and without known bundle branch block morphology. 157 patients from a monographic heart
failure unit were included in the study, after excluding 213 patients with any of the following features: right bundle branch block (RBBB), left bundle branch block (LBBB),
QRS duration greater than 120 ms and paced rhythm. Rhythm, duration of PR, QRS
and cQT intervals, underlying heart disease, left ventricular ejection fraction (LVEF),
presence of hypertension (HT), dyslipidemia, diabetes and smoking were analyzed.
Student T test for independent samples, the Pearson 𝜒2 test and logistic regression
were used as statistical tests.
Results: fQRS was present in 59(37.6%) of the patients. QRS duration was
95.07 ± 10.72 ms in the group without fQRS and 103.80 ± 8.95 ms in the group with
fQRS (p < 0.001). Mean LVEF was 45.43% in the group without fQRS and 35.25%
in the group with fQRS (p% = 0.001). Results are shown in table 1.
Conclusions: fQRS occurs frequently in patients with advanced heart failure. The
presence of fQRS is associated with increased QRS duration and worse LVEF.
Table 1: Results
QRS
fQRS
p
85.7
88.1
0.666
PR(%)
174.25±29.83
181.48±33.24
0.102
QRSd(ms)
95.07±10.72
103.80±8.95
< 0.001
cQTd(ms)
436.68±35.16
443.39±36.06
0.253
Age
59.52±15.46
53.74±12.94
0.019
Men(%)
62.9
72.9
0.199
HT(%)
72.1
55.6
0.096
SR(%)
LVEF(%)
45.43
35.25
0.001
Dyslipidemia(%)
60
60.4
0.963
Diabetes(%)
39.4
28.3
0.216
Smoking(%)
24.3
21.6
0.284
Case Presentation: A 73 years old man was admitted to the Cardiology Department
complaining of angina to efforts, with progressive worsening in the previous months,
associated with fatigue on minimal exertion, orthopnea and edema of the lower
limbs. He had personal history of hypothyroidism, a macroglossia with three years
of development, attributed to hypothyroidism, and smoking habits in the past. On
physical examination he presented an exuberant macroglossia, periorbital purpura
and peripheral edema of the lower limbs; in pulmonary auscultation there was
an abolition of breath sounds in the right pulmonary base. There were performed
diagnostic procedures including ECG (sinus rhythm, with the presence of left anterior
fascicle block and low voltage), chest x-ray (which showed the presence of right
pleural effusion), transthoracic echocardiography (which revealed a marked wall
thickening of the left ventricle, especially of the lower septum, with preserved global
function, an index of 13.4 Strain with a low Strain in basal segments and type 2
diastolic dysfunction), and coronary angiography (which showed a lesion of 90% in
middle segment of the right coronary artery, having been inserted two stents coated).
On suspicion of infiltrative disease there were performed additional tests such as
analytical study with serum and urinary immunofixation, cardiac MRI and biopsy of
abdominal fat, which ultimately concluded the presence of systemic AL amyloidosis
with presumably cardiac involvement.
Conclusions: This study demonstrates the diagnostic journey in a case of systemic
amyloidosis with cardiac involvement, in which macroglossia had appeared years
before the final diagnosis, indicating the importance of a high degree of suspicion
towards some signs and symptoms. The disease is usually diagnosed late, often
after the onset of signs or symptoms suggestive of heart disease, when clinical
and additional tests performed raise strong suspicion of the diagnosis of infiltrative
disease.
P1277
The ECG in the diagnosis of heart failure
J Gallagher; T Murphy; S James; E O Connell; D Waterhouse; V Voon; M
Ledwidge; R O Hanlon; K Mcdonald
St Vincent’s University Hospital, Heart Failure Unit, Dublin, Ireland
Purpose: The ECG is a fundamental part of the assessment of patients with suspected heart failure and has been suggested as part of a triage tool to help exclude
heart failure if the ECG is normal. Although it is recognized that systolic dysfunction
is unlikely with a normal ECG less is known about the nature of the ECG in HFPEF.
A description of the pattern of ECG abnormalities in heart failure may also aid the
development of education tools particularly for general practitioners.
Methods: This study analysed ECGs of patients referred by their general practitioners to a rapid access clinic for those with suspected heart failure between 2002 and
2012 12-lead ECG were interpreted by two cardiology research fellows. In cases
of disagreement or uncertainty a third and deciding opinion was obtained from a
staff cardiologist. An abnormal ECG was defined as evidence of myocardial infraction (acute or old), pacemaker rhythm, repolarisation abnormalities (ST segment
and QT duration abnormality), voltage criteria for chamber hypertrophy, intraventicular conduction disorders, atrioventricular conduction disorders, clinically significant
ventricular arrhythmia, clinically significant supraventricular rhythms and sinus arrest
or block.
Results: A total of 733 patients were seen in Rapid Access Clinic for potential new
cases of incident of heart failure. 38.9% (n = 285) were diagnosed with heart failure,
40.7% (n = 116) with HF-REF and 59.3% (n = 169) with HF-PEF. The ECG was normal
in 56.8% of those without heart failure and 14.1% of those with heart failure (12.2%
HF-REF and 15.4% HF-PEF). The commonest abnormalities in HF in descending
order were atrial fibrillation/flutter (47.5%), left axis deviation (19%), non specific ST
abnormalities (16.7%), intraventricular conduction defect (16%) and evidence of old
myocardial infarction (13.7%). 15 types of ECG classifications accounted for 98.8%
of abnormalities identified. Atrial fibrillation was more common in HF-PEF compared
to HF-REF (54.5% vs 37.4%) as was non specific ST changes (19.2% vs 13.1%)
Conclusion: The ECG is abnormal in the majority of cases of both HF-REF and
HF-PEF. A relatively small number of ECG types account for the majority of abnormalities found which may help in the development of education programmes.
QRS% = no fragmented QRS, fQRS% = fragmented QRS.
P1278
P1276
A rare cause of heart failure suspected by the tongue
CCatia Costa; B Santos; F Valente; ML Pitta; M Leal
Hospital of Santarem, Cardiology, Santarem, Portugal
Introduction: Systemic amyloidosis is a rare, multisystem disorder characterised
by the extracellular deposition of insoluble fibrillar proteins in various tissues and
organs, leading to a progressive lesion. The usual late diagnosis and cardiac
involvement affect the prognosis of these patients.
Purpose: The aim of this work is the presentation of a case of systemic amyloidosis
with cardiac involvement, describing the diagnostic route in a case of irregular
contours, whose diagnostic clues had emerged about three years before the final
diagnosis.
Evaluation of a simple regional wall motion score index to predict left
ventricular ejection fraction by cardiac MRI
A C MAlexandra Thompson1 ; DW Wilson2 ; RF Duncan3 ; JG Crilley3 ; JJ Murphy1
University of Durham, County Durham and Darlington NHS Foundation Trust,
Durham, United Kingdom; 2 County Durham and Darlington NHS Foundation Trust,
Durham, United Kingdom
1
Purpose: Evaluation of a simple regional wall motion score index (RWMSI) to predict
left ventricular ejection fraction (LVEF) measured by cardiac magnetic resonance
(CMR); a methods-comparison study.
Methods: We retrospectively reviewed the CMR data for 279 patients that had both
LVEF measured by the standard method of endocardial tracing, and a 16 segment
RWMSI documented. The indication for CMR was varied, and incorporated wide
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
242
Abstracts
ranges of LVEF. Using the previously validated equation “RWMSI LVEF% = Total
(RWMS/16) × 30” along with a simplified RWMSI where “normal”% = 2, “hypokinetic”% = 1, “akinetic” and “dyskinetic”% = 0, we performed a Deming regression
analysis for those with a RWMSI LVEF >10% and < % = 55%. These cut offs were
chosen to avoid the possible ceiling effect of the RWMSI whereby the maximum
possible LVEF of 60% could skew the regression line. This reduced the sample size
to 160 subjects. We performed a Bland Altman plot to assess agreement between
the two methods, depicting heart failure subgroups from the CMR LVEF according
the British Society of Echocardiography.
Results: Regression analysis demonstrated that the two methods were highly
comparable (Slope% = 0.85, 95% CI 0.77 to 0.94, intercept -2.1, 95% CI -5.95 to
1.75). However, the RWMSI LVEF would consistently underestimate the endocardial
LVEF with a mean difference of 8.3% based on original percentage units, and this
applied to all the heart failure subgroups.
Conclusions: This simplified RWMSI LVEF is highly comparable with MRI LVEF
by endocardial tracing but tends to underestimate the true LVEF. This constant
difference in agreement lends itself to the development of a modified equation to
produce an accurate RWMSI LVEF. This forms the basis of on-going work that will
be presented.
HF-related sign/test. Isolated leg edema presented at 23 visits (26% of 90 leg edema
events): among these visits, symptomatic worsening presented at only 2 visits, and
BNP levels from stability to worsening HF were decreased in 9 visits or mildly elevated (50 pg/mL>) at 10 visits. Compared with isolated leg edema (n = 23), leg
edema events in addition to other HF-related signs/tests (n = 67) were associated
with symptomatic worsening (7% vs. 55%, p < 0.0001), and a greater incidence
(61% vs. 96%, p% = 0.0002) and magnitude of BNP increase. Isolated fluid weight
gain presented at 31 visits (29% of 107 fluid weight gain events): symptomatic
worsening did not present at any of these visits, and BNP levels from stability to
worsening HF were decreased at 8 and mild elevated (50 pg/mL>) at 10 visits. Compared with isolated fluid weight gain (n = 31), fluid weight gain events in addition to
other HF-related signs/tests (n = 76) were associated with symptomatic worsening
(0 vs. 54%, p < 0.0001), and a greater incidence (74% vs. 95%, p% = 0.0047) and
magnitude of BNP increase. Upon occurrence of the HF-related event, there were
3 (6%) extra/urgent clinic visits and 1 (2%) HF-related hospitalization among a total
of 54 events of isolated leg edema or fluid weight gain compared with 43 (46%) and
40 (43%) events, respectively, among a total of 94 events with 2 or more HF-related
signs (p < 0.0001 in each). Up to the next regular clinic visit after the event of isolated leg edema or fluid weight gain, only one event of isolated fluid weight gain
progressed to worsening HF event, which required an urgent clinic visit and hospitalization.
Conclusions: During follow-up of HF, isolated leg edema or fluid weight gain each
occurred in ˜30% of patients, which might seem to be clinically insignificant. Participants caring for HF should have a clear understanding of the nature of these
important HF-related clinical signs.
CANCER/CARDIOTOXICITY – POSTER DISPLAY
P1281
Cardio-protective effect of ACEI and BB during chemotherapy for breast
cancer assessed by two-dimensional strain echocardiography
Regression analysis and agreement plot
P1279
Anemia, congestive heart failure and renal failure
MMimoza Lezha1 ; A Gjata2
University Hospital Center Mother Theresa, Department of Cardiology & Cardiac
Surgery, Tirana, Albania; 2 Regional Hospital, Fier, Albania
1
Background: Anemia, congestive heart failure(CHF) and chronic kidney disease
(CKD) interact as a vicious circle so as to cause or worsen each other- the
so-called cardio renal anemia syndrome. An important interrelationship between
them is becoming increasingly apparent. The anemia in CHF is due mainly to the
frequently-associated CKD
Purpose: To evaluate correlation between anemia, heart failure and renal failure
Methods: 453 patients(pts) with CHF of any aetiology were enrolled in this restrospective study. They were classified into two groups: anemic group (222pts) and
non-anemic group (231 pts) according to the definition of anemia from WHO.
The mean serum creatinine value was estimated. Pts were classified into two
groups: the group with normal renal function and the group with altered renal function(ARF). The altered renal function was considered as mean serum creatinine value
>1,5mg/dl. Pts were divided in three groups based on the mean serum creatinine
value (1,5-2mg/dl, 2,1-2,5mg/dl and >2,5mg/dl)
Results: 15% of the pts with HF had ARF and 23,4% of the 222pts in the anemia
group had significantly higher prevalence of ARF, p% = 0,0000. 13,06% of pts in
anemia group had mean serum creatinine value 1,5-2mg/dl, 5,4% had mean serum
creatinine value 2,1-2,5mg/dl and 4,95% had serum creatinine value >2,5mg/dl,
p% = 0,0000. The mean value of hemoglobin were 11,15 vs 10,9 vs 9,4% respectively.
Conclusions: Pts with heart failure and anemia had more ARF.
P1280
Clinical implications of isolated leg edema or fluid weight gain during
follow-up of mild-to-moderate heart failure patients
AAnna Nowicka1 ; R Dankowski1 ; M Michalski1 ; J Galczynska2 ; K Szymanowska1 ;
D Kaszuba1 ; E Wojcik3 ; A Sowinska4 ; A Szyszka1
1 Poznan University of Medical Sciences, 2nd Department of Cardiology, Poznan,
Poland; 2 Hipolit Cegielski Medical Center, Cardiology, Poznan, Poland; 3 Poznan
University of Medical Sciences, Poznan, Poland
Myocardial deformation parameters are early markers of chemotherapy-induced
cardiotoxicity. The potential cardio-protective effects of ACE inhibitors (ACEI) and
beta blockers (BB) are well known, but they are used to treat rather than prevent
development of left ventricular dysfunction.
We sought to measure global systolic longitudinal strain (GLS) to evaluate myocardial function in patients who received ACEI and BB as protection against cardiovascular toxicity caused by antracyclines (AC).
Methods: 35 otherwise healthy women (age 51 ± 12 years) with breast cancer
were evaluated before- and every 3 months during chemotherapy with AC. Clinical
assessment with echocardiography including GLS, troponin, NTproBNP, cholesterol
(TC) was performed at baseline and repeatedly during follow-up. None of the women
showed signs or symptoms of heart failure or left ventricular impairment in the initial
evaluation. Pts were treated with ACEI (n = 26), BB (n = 9) as a protective strategy
(ramipril 2,5 mg or bisoprolol 2,5 mg daily were started with first dose of AC). The
increase in TpT, NTproBNP and > 12 % change in GLS during treatment was taken
as additional predictors of cardiotoxicity.
Results: Cumulative dose of AC was 235 ± 10 mg/m2 . 23 pts received taxanes.
Cardio-protective treatment was well tolerated. We did not observe changes in
NYHA class, NTproBNP or EF throughout 6 months’ follow-up. However, significant rise in troponin has been observed since 3rd month visit. We detected also
worsening in GLS (ΔGLS >12% in 2 pts).
Results are presented in the table.
Conclusions:
Cardio-protective treatment with ACEI and BB is well tolerated and seems to be
effective according to NYHA class, BNP and EF.
ΔGLS and TpT rise could be markers of early subclinical left ventricular impairment
but the significance of these changes needs further evaluation.
HHajime Kataoka
Nishida Hospital, Oita, Japan
Purpose: The implications of isolated leg edema or fluid weight gain in patients
with heart failure (HF) are not fully elucidated. The present study examined the clinical implications of isolated leg edema or fluid weight gain during follow-up of HF
patients.
Methods: Clinical records of mild-to-moderate HF patients were retrospectively
examined. Evaluated HF-related signs/tests included leg edema, pulmonary crackles, S3, fluid weight gain, ultrasound pleural effusion.
Results: 83 HF patients (39% men, 77 ± 12 years) were enrolled. Over a mean
follow-up of 652 ± 456 days, 1826 visits (mean interval, 28 days) were evaluated.
Among the 83 study patients, 161 visits of 75 patients revealed at least one positive
baseline visit
3 months
TC [mg/dl]
243 ± 57
236 ± 43
6 months
223 ± 45
NTproBNP [ng/ml]
80,11 ± 62.73
95,4 ± 63.73
98,77 ± 112,53
EF [%]
62,6 ± 2.1
61,8 ± 2.1
61,8 ± 3.0
TpT [ng/ml]
0,0077 ± 0.057*
0,0176 ± 0.0146*
0,0237 ± 0.0569*
GLS
21,66 ± 2.79**
20,81 ± 2.67
20.31 ± 2,7**
*p% = 0.00006 baseline vs 3mos, baseline vs 6 mos **p% = 0.025 baseline vs 6 mos
/to simplify GLS values were changed into positive/
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
243
P1282
P1284
Acute heart failure secondary to mitoxantrone toxicity
Cardiac surgery in patients with previous thoracic radiation therapy
DJDavide Severino; CC Costa; LM Marta; FX Valente; VB Martins; DL Durao; ML
Pitta; IM Monteiro; ML Leal
Hospital of Santarem (HDS), Santarem, Portugal
SSamuel Hurni1 ; A Weber1 ; T Suter2 ; K Loessl3 ; C Huber1 ; M Weidenbusch1 ; J
Schmidli1 ; T Carrel1
1
Bern University Hospital, Department of Cardiovascular Surgery, Bern, Switzerland
Introduction: Mitoxantrone is an approved drug for the treatment of progressive
multiple sclerosis. Secondary cardiovascular effects have been reported, mainly left
ventricular systolic dysfunction, prolonged QT interval and ventricular arrhythmias.
Case Report: A 35-year-old woman presented to the emergency department with a
one week evolution of progressive and severe exertional dyspnea (class IV NYHA)
associated with generalized edema and oliguria. She had a history of multiple
sclerosis and was undergoing treatment with mitoxantrone. She had no known
cardiovascular risk factors. Upon admission, she was pale and sweaty, tachypneic,
tachycardic (HER – 120 bpm) and with a stable SBP 90 – 100 mmHg. An S3
was audible on auscultation, as well as decreased bilateral breath sounds and
crackles on the lower halves of the lung fields. Laboratory results showed a Hb
of 11 g/dL, elevated BNP 3462 pg/ml and serum creatinine of 1.5 mg/dL. Cardiac
necrosis biomarkers were normal and there were no electrolyte disturbances.
The transthoracic echocardiogram revealed a moderate to severe left ventricular
systolic dysfunction with hypokinesia of the interventricular septum and distal
segment of the anterolateral wall; mild tricuspid regurgitation and an estimated
pulmonary artery systolic pressure of 55 mmHg. In the right atrium, an echodense
image was found at the tip of the jugular venous catheter and extending into
the superior vena cava, which was suggestive of a thrombus. She was admitted
on the coronary care unit with and started on treatment with levosimendan, with
excellent clinical response. Despite several days of anticoagulation with enoxaparin,
the thrombus remained unchanged. Thrombolysis was therefore performed with rPA
with complete resolution of the thrombus. Coronary angiography was performed to
clarify the etiology of the acute heart failure as well as a cardiac magnetic resonance,
which excluded significant coronary artery disease and myocardite. As progressive
improvement in systolic function was observed, the diagnosis of acute heart failure
secondary to mitoxantrone cardiotoxicity was assumed. Currently the patient is
asymptomatic in class I NYHA and with a normal systolic function.
Conclusion: We report the case of an acute heart failure secondary to mitoxantrone
which was fully reversible with drug suspension and optimization of pharmacological
treatment. It emphasizes the importance of drug cardiotoxicity as a potential and
reversible cause of heart failure, a fact that nowadays takes a special interest as
more and more drugs with cardiotoxic effects are identified.
Background: Thoracic radiotherapy for various hematologic and solid malignancies
often involves incidental exposure of the heart and the great vessels to ionizing
radiation. Aim of this study was to analyze the early and long-term outcome of
cardiac surgery in patients suffering from postactinic valvular and coronary lesions.
Methods: Between 2001 and 2013, 43 patients (18 females, 25 males) with mean
age 57.4 ± 10 years underwent combined (53.5%) or isolated valvular and coronary
bypass surgery at a mean interval of 26.5 ± 11 years following thoracic radiation
therapy.
Results: Total follow-up was 193 patient years (mean 4.49 ± 3.46 years) and was
98% complete. In-hospital mortality was 12% (n = 5). Cumulative survival at 5 and
10 years was 83.2% ± 5.8 and 42.5% ± 16.1. Patients treated for solid tumors (breast
and lung cancer or mediastinal metastases) and age over 55 years were associated
with increased early mortality (p% = 0.011). The initial better survival of patients
treated for hematologic tumors was limited by malignancy and heart failure after
10 years. Even if radiation therapy is not included as a risk factor Cox regression
showed additive Euroscore to be a good mortality predictor (p% = 0.02).
Conclusions: Cardiac surgery in patients with previous thoracic radiation therapy
for solid tumors was associated with higher in-hospital mortality than in patients
with prior lymphomas, probably due to lower radiation doses and less aggressive
chemotherapy. In selected patients (those with excessive calcification of the aorta
or severely compromised diastolic LV-function), percutaneous interventions may
decrease the peri-procedural risk and should be carefully evaluated.
P1283
A 33-year-old man with severe heart failure and mediastinal adenopathies
CCarla Fernandez-Vivancos Marquina; T Garcia Manrique; FJ Rivera Rabanal; AJ
Castro Fernandez; RJ Hidalgo Urbano; JM Cruz Fernandez
University Hospital of Virgen Macarena, Seville, Spain
Clinical Case: A 33-year-old man was admitted to the emergency room because
of shortness of breath, increase in abdominal perimeter and diffuse abdominal
pain. He reported no medical problems or prescription medication use. He drank
alcohol occasionally and never smoked or used illicit drugs. Physical examination
revealed a third cardiac tone and crackles in the lower lobes of both lungs. The
pulse was 123 bpm and the blood pressure 95/60 mmHg. Electrocardiography
showed a sinus tachycardia with no other alterations. Chest radiography showed
cardiomegaly and changes consistent with interstitial pulmonary edema. Echocardiogram revealed severe left ventricular dilatation (74 mm) and severely reduced
global systolic function (ejection fraction 20%), with global hypokinesis. Cardiac MRI
ratified echocardiogram findings, and showed a diffuse late gadolinium enhancement pattern. Multiple large lymph nodes in the mediastinum were found in the
MRI. A fine-needle aspiration puncture was done. The biopsy of lymphadenopathies
showed a non-Hodgkin lymphoma.
Once the diagnosis is made, the Department of Oncology becomes responsible
for the treatment of this patient; taking in mind that anthracyclines should not be
included among the drugs to be administered, due to the severe ventricular dysfunction. And, in a parallel and coordinated way, the patient is still monitored by the
Department of Cardiology, with a treatment for heart failure consisting of ACEIs in
low doses (ramipril 2,5 mg a day), intravenous bolus of furosemide, and spirinolactone. Initial patient ́ s evolution is suboptimal, with persistence of heart failure, sinus
tachycardia and hypotension. After the first chemotherapy cycle, the patient does
not show any significative change in his heart function, with a slow trend to the progressive estabilization that is achieved with the established treatment. Treatment is
monitorized by means of echocardiograms and blood analysis including BNP. The
oncologic disease shows a very favourable response to treatment, with a complete
remission once treatment is finished. Nowadays (one year follow-up) he is stable in
NYHA class I-II, with an improvement in echocardiographic diameters and systolic
function (ejection fraction 35-40%)
Conclusion: Case evolution suggests that fulminant myocardial injury was associated with the neoplasm as a possible paraneoplastic syndrome. In a large bibliographic searching we found few similar cases. Coordinated work between oncology
and cardiology teams was essential to the success of this complex case.
P1285
Cardio protective effect of metformin in diabetic patients treated with
antrhacyclines
FFederico Garcia Trobo1 ; JP Alderuccio2 ; A Garofoli2
New York Medical College, Internal Medicine, New York, United States of
America; 2 Metropolitan Hospital Center, New York Medical College, Internal
Medicine, New York, United States of America
1
Purpose: Doxorubicin (DOX) is well-known for causing cardiotoxicity. Recent studies established that metformin (MET), an oral anti diabetic drug, has an antioxidant
activity. In rats models of DOX-induced cardio-toxicity cotreatment with MET significantly decreased DOX-induced biochemical, histopathological, and ultrastructural
changes. The aim of this study is to assess the effect of metformin against heart failure development in Hispanic and Black female patients with breast cancer treated
with doxorrubicin.
Method: We reviewed medical charts of Hispanic and Black female patients from
the chemotherapy infusion center between 2006 and 2012. We included oncologic
active patients with type II diabetes mellitus and normal left ventricular ejection fraction assessed by nuclear cardiac scan who received doxorrubicin-based treatment
for breast cancer. We defined new onset heart failure (HF) as left ventricular ejection fraction < 45% by assessing at the end of the treatment. We compared new
onset HF in patients with and without metformin. Metformin treatment was the independent variable and new onset HF was the outcome. Statistical analyses were
performed by Pearson’s chi-square test.
Results: 199 charts from female diabetic patient who were treated with doxorubicin
due to breast cancer were analyzed; mean age [SD] 55.5 [9.7] years; 52%Hispanic,
48% African American. After treatment, HF developed in 25/199 (12.6%). Metformin
group included 129 subjects meanwhile 70 were controls. New onset HF was found
in 14/70 (20%) in controls and 11/129 (8.5%) within metformin group, OR 0.37 (95%
CI 0.16 – 0.87) p% = 0.019.
Conclusion: These findings suggest that MET might prevent DOX-induced cardiotoxicity in this specific population.
CARDIOMYOPATHY – POSTER PRESENTED
P1287
Heart failure and chronic kidney disease-a clinical case
A PAnne Paula Bohlen Delgado; B Marmelo; D Moreira; L Abreu; G Pereira; M
Correia; P Gama; E Correia; O Santos
Hospital Sao Teotonio, Viseu, Portugal
66year old woman with a history of hypertension, type 2 diabetes, stroke, hyperthyroidism and kidney transplantation in 2001 for polycystic kidney disease. Admitted
to 1.1.14 by dyspnea NYHA class III.
made diuretic treatment without significant improvement
A transthoracic echocardiogram revealed severe biauricular dilatation and small ventricles. Was visible severe concentric LV hypertrophy (IVS 24 mm). Hypertrophy of
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
244
Abstracts
the RV free wall (7-9 mm). The myocardium had a abnormal sonographic appearance, type “speckles”.
grade III diastolic dysfunction. E /e′ 18.
The global LV systolic function is preserved in terms of radial contractility, but with
evidence of significant comprmisso longtudinal contractility (GLS < - 10%).
Moderate mitral regurgitation and moderate tricuspid
Dilatation of inferior cava vein but with respiratory gauge variation> 50%
Circumferential pericardial effusion without hemodynamic compromise.
Analytically with type1 respiratory failure, At admission the creatinine was 1,5 mg/dl,
urea 87 mg/dl, sodium 133 mEq/L, potassium 3,7 mEq/L; glycemia 393 mg/dl; BNP
1085 pg/mL; hemoglobin 13,1 g/dl; TSH 2,19 mUI/L (0,350-5,500).
Renal ultrasound revealed pyelocaliceal slight dilation of the transplanted kidney. no
pictures perirenal fluid transplanted kidney.
The coronary angiography was normal.
As diagnostic hypotheses are placed:
- Fabry disease
- amyloidosis
the huge operative risk and the patient has been discharged with medical therapy:
Aspirin, ACE inhibitor, diuretic, aldosterone receptor antagonist, oral anticoagulant
therapy, statin, Amiodarone. She was followed-up for one year and she is now cardiopulmonary compensated, she doesnt have any anginal symptoms, symptoms of
the heart failure are controled by medical therapy, there was no activation of ICD.
P1288
Long term progression of patients with arrhythmogenic right ventricular
cardiomyopathy
A M Dragos1 ; B Pinamonti1 ; A Pivetta1 ; M Merlo1 ; F Brun1 ; M Russo1 ; G Barbati1 ;
S Viviani2 ; G Sinagra1
1 University Hospital Riuniti, Cardiovascular Departament, Trieste, Italy; 2 Sapienza
University of Rome, Department of Statistics, Rome, Italy
Purpose: The aim of this study was to determine the disease progression and
its impact on prognosis of a large cohort of patients affected by arrhythmogenic
right ventricular cardiomyopathy (ARVC), as data regarding the clinical/instrumental
course of this disease are currently lacking.
Methods: The study population consisted of 81 patients enrolled in our Heart Muscle Disease Registry, diagnosed according to the 2010 ARVC diagnostic criteria.
All patients underwent systematic clinical and instrumental evaluation at presentation and during follow-up. The primary end-point was a composite of cardiovascular death and heart transplantation (HTx). We introduced the concept of “ordinal dysfunction”, arbitrarily classifying the presence of ventricular dysfunction into
four stages: 0% = absence of right or left ventricular dysfunction; 1% = mild right
ventricular dysfunction; 2% = severe right ventricular dysfunction or mild biventricular dysfunction; 3% = severe biventricular dysfunction. The disease progression
was defined as an increase of at least one stage in the ordinal dysfunction during
follow-up period.
Results: During a median follow-up of 93 months, 31% of the patients died or underwent HTx. The primary end-point occurred at a median time of 53 months after
diagnosis. After a median follow-up of 23 months, 24% of the patients preserved
a normal biventricular function and 11% normalized it. On the contrary, almost half
of the patients (47%) maintained a degree of ventricular dysfunction and 18% of
patients worsened.
At Cox time-dependent multivariable analysis, the persistence of ordinal dysfunction greater than 0 or its worsening evaluated at 23 months from diagnosis (range:
18-32 months), resulted as an independent predictor of death/HTx (hazard ratio :
2.2; 95% confidence interval : 1.22–3.96; p% = 0.008).
Conclusion: In our ARVC population, the persistence or the development of right
or left ventricular dysfunction after 2 years from diagnosis was able to identify a
subgroup of patients with poorer long-term prognosis.
P1289
Coronary artery ectasia in a patient with heart failure: a case report
NNatasa Jankovic; DV Simic; S Aleksandric; M Marinkovic; V Kovacevic; A
Kocijancic; N Mujovic; S Mrdja; B Parapid; A Ristic
Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
A66year-old woman was admitted to our hospital because of severe heart failure
with resting dyspnea, ortopnea, edema of the legs and bilateral pleural effusion.
She has never had a chast pain. Electocardiography showed ST elevations with
reduction of the R wave in leads II, III, aVf, V1-V5. The echocardiography demonstrated a large left ventricle (EDD 7,2 cm, ESD 4,8 cm) with decreased contractile
function (EF% = 20%), akinesia of the distal two thirds of the left ventricle. Holter
ECG monitoring showed non-sustained ventricular tachycardia. Selective coronary
angiography revealed ectasia in left main, ectasia in proximal segment of the left
coronary artery and in the proximal segment of the circumflex coronary artery
(Figure 1), total thrombotic occlusion in the midportion of the left coronary artery
and in the proximal part of thr right coronary artery. She was threated with diuretics, aldosterone receptor antagonist, ACE inhibitors, beta-blockers, Amiodaron
and anticoagulant therapy. Because of the non-sustained ventricular tachycardia
that was revealed by holter ECG monitoring, implantable cardioverter-defibrillator
(ICD) was implanted as a prevention of sudden cardiac death. We consulted heart
surgeons but they refused to perform coronary artery bypass surgery because of
Ectasia in coronary artery
P1290
Restrictive Cardiomyopathy: a rare form of heart failure
RRita Ferreira; F Soares; L Leite; S Lazaro Mendes; H Martins; R Baptista; S
Costa; F Franco; S Monteiro; M Pego
University Hospitals of Coimbra, Coimbra, Portugal
Background and Objectives: Restrictive cardiomyopathy (RCM) is a rare form of
cardiomyopathy in which the walls are rigid, and the heart is restricted from stretching and filling with blood properly.
RCM can be primary (uncommon form) or secondary to infiltrative disease (amiloidosis or sarcoidosis) or systemic storage disease (hemochromatosis).
The aim of this study was to describe the characteristics of patients from a single
center with the diagnosis of RCM.
Methods: We retrospectively studied 20 patients with RCM who were hospitalized
for decompensated heart failure in a single advanced heart failure unit, between June
2009 and August 2013. Median follow-up time was 2 years. All patients underwent
standard clinical, laboratorial, echocardiographic evaluation or radionuclide angiography (RNA). We analysed the cardiovascular mortality and heart transplantion.
Results: During follow-up time were hospitalized 20 patiens with RCM which 16
were men and 4 were women. The mean ages of the patients were 52 +/- 16 years.
About 50% of the patients had family history of cardiovascular disease. At admission, 75% of the patients were in IV/IV NYHA class, with a mean ejection fraction 48
+/- 16% and BNP 657 pg/mL. Only a few patients (15%) needed aminergic support.
The mean hospitalization time was 11 +/- 11 days.
During the follow-up time, approximately 20% of patients received a heart transplant. The long-term mortality was about 35%.
Conclusions: RCM is a rare disease with a variable prognosis but in most cases
progressive, which has a high mortality rate and little is known about the most appropriate treatment to offer to those patients.
P1291
Assessment of left ventricular mechanics in patients with cirrhotic
cardiomyopathy using 3D speckle tracking echocardiography
FFrancesca Cucchi1 ; G Iacovone2 ; G Giura1 ; T Dominici1 ; D Del Prete1 ; P
Pellicori3 ; O Riggio2 ; PE Puddu1 ; M Merli2 ; C Torromeo1
1
Sapienza University of Rome, Department of Cardiovascular, Respiratory,
Nephrologic, Anesthesiologic and Geriatric Sciences, Rome, Italy; 2 Castle Hill
Hospital, Department of Academic Cardiology, Hull, United Kingdom
Purpose: Cirrhotic cardiomyopathy (CCM) implies the presence of subtle left ventricular diastolic dysfunction, electro-physiological abnormalities and/or myocardial
structural changes in patients with liver cirrhosis. However, the diagnostic criteria
are still vague, as there are many methods of describing cardiac dysfunction. Therefore, we aimed to assess left ventricular (LV) mechanics using 3D Speckle Tracking
Echocardiography (3D-STE) in CCM patients.
Methods: 10 patients with liver cirrhosis (7 in Child-Pugh Class A and 3 in B; MELD
score 11.2 ± 3.26; 5 with esophageal varices and 2 with ascites) and 32 healthy
controls were investigated by both conventional 2D echocardiography and 3D-STE
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
245
(3D Wall Motion Tracking). The results were analyzed according to the Guidelines of
American Society of Echocardiography.
Results: By conventional echocardiography and compared to controls, patients with
cirrhosis had increased LV mass index and ejection fraction (105 ± 21 vs 70 ± 14
g/m^2, p≤0.001 and 62 ± 7 vs 57 ± 5%, p% = 0.009). By 3D-STE, global peak circumferential LV strain was significantly reduced in patients with cirrhosis (24.6 ± 4.5
vs 27.3 ± 3.4%, p% = 0.045). Global peak LV twist and global peak LV torsion were
similar (5.2 ± 1.3 vs 4 ± 2.8, p% = 0.20 and 1.1 ± 0.4 vs 0.9 ± 1.1, p% = 0.60).
Conclusions: In patients with liver cirrhosis 3D-STE identifies reduced LV peak circumferential strain, although LV ejection fraction is increased. Larger studies are
needed to better characterize LV mechanic alterations in patients with CCM.
of the disease (early electrical phase before the appearance of structural changes).
Also it is important to note that VT presence was discovered in the third of cases
only during ETT which is not included in diagnostic criteria tests.
P1292
Background: Apical cardiomyopathy (ACM) is an uncommon variant of hypertrophic
cardiomyopathy in European population. Reports on coexistence of ACM and
coronary artery – left ventricle fistulae is scarce.
Case Presentation: 76-year-old female was admitted to the department of cardiology
with a diagnosis of acute coronary syndrome (ACS) after 2-hour anginal chest pain
at rest. She reported recurrent exertional chest discomfort for several years, which
became stronger to class III by CCS in the last 5 months. She had a history of
thyroidectomy and Dupuytren’s contractures. Her coronary arteries disease risk
factors included arterial hypertension and dylipidemia. She had no family history
for cardiovascular diseases or sudden cardiac deaths. At admission she was
hemodynamically stable. 12-lead ECG showed regular sinus rhythm of 60 bpm,
left axis deviation, large R waves up to 3 mV in V3 and V4, inverted T waves of
˜ 5 mm in I, aVL, V3 to V6, positive T waves in II, III, aVF and V1, biphasic P
waves, PQ interval of 200ms and the QRS complex of ˜120ms. Laboratory findings
revealed elevated high sensitivity troponin T (hsT) with normal levels of creatine
kinase (CK) and CKMB and the NT-proBNP of 2519 pg/mL. Echocardiography
showed enlargement of the left and right atrium, thickening up to 20 mm of the mid
and apical segments of interventricular septum, lateral, posterior and anterior walls
without mid-ventricular gradient in rest or exercise, mildly decreased EF of ˜50%,
pseudonormal mitral inflow pattern, mild mitral regurgitation, RVSP of 28 mmHg
and multiple, abnormal colour flow signals within the apex and surrounding muscle
observed on Colour-coded Doppler. Coronary angiography revealed no significant
stenoses but showed multiple fistulae from distal segments of diagonal branch
to the left ventricle (LV). Left ventriculography showed “spade-like” configuration.
Elevation of the LV end-diastolic pressure to 19 mmHg was measured. Holter ECG
recorded several episodes of ventricular tachycardia (VT) of max 4 beats and 142
bpm. Cardiopulmonary exercise test (CPEx) disclosed peak oxygen consumption of
12,2ml/kg/min. The patient was administered nebivolol 5mg dalily, perindopril 5mg
daily, spironolactone 25mg daily, furosemide 40mg daily and propaphenone 150mg
twice a day. She remains stable in the follow-up without symptoms at rest.
Conclusion: Little is known about the pathophysiology and clinical aspects of
the combination of ACM and coronary arteries to LV fistulae. In order to improve
awareness and enhance the management of these patients, accumulating evidence
is desirable.
Alcoholic cardiomyopathy with liver cirrhosis: relationship between immune
inflammation and structural and functional cardiac parameters
AS Goncharov; VS Moiseev; LF Panchenko; GK Kiyakbaev; AA Shavarov; VA
Romanova
Peoples Friendship University of Russia (PFUR), Moscow, Russian Federation
Purpose: To evaluate relationship between immune inflammation and hemodynamic
parameters in alcoholic cardiomyopathy (ACMP) patients with liver cirrhosis (LC).
Methods. Of the 45 ACMP male (mean age 52,6 ± 6,0 years) with NYHA class III-IV
chronic heart failure (CHF) included in the study 11 patients had LC. Patients with
active inflammatory disease were excluded. Standard and tissue Doppler imaging
echocardiographic parameters were collected. Plasma values of NT-proBNP and
cytokines (IL-6, IL-8, IL-12, TNF𝛼, soluble TNF𝛼 receptor) were evaluated.
Results: Despite similar left ventricular ejection fraction (LVEF) ACMP patients
with LC (n = 11) compared to subjects without LC (n = 34) had significantly higher
E/E′ (16,2 vs 13,7; p < 0,05), as well as LV myocardial mass index (238 vs 174
g/m2 ; p < 0,05), the systolic pulmonary artery pressure (PAP) (53,2 vs 37,8 mm Hg;
p < 0,05), IL-8 (90,3 vs 15,5 pg/ml; p < 0,05), soluble TNF𝛼 receptor (5,7 vs 2,3 ng/ml;
p < 0,05), NT-proBNP (2076 vs 1271 pg/ml; p < 0,05) and lower value of IL-12 (87,2
vs 127,0 pg/ml; p < 0,05). Significant correlations between IL-8 and LV myocardial
mass index (r% = 0,41, p < 0,05) and E/E′ (r% = 0,32, p < 0,05); between NT-proBNP
and systolic PAP (r% = 0,44, p < 0,05) and E/E′ (r% = 0,40, p < 0,05); between IL-12
and LVEF (r% = 0,65, p < 0,05) and LV end-diastolic diameter (r% = -0,63, p < 0,05)
and LV end-systolic diameter (r% = -0,75, p < 0,05) were observed in ACMP patients
with CHF and LC.
Conclusion: ACMP patients with versus without LC were characterized by worse
diastolic dysfunction, higher NT-proBNP level and pulmonary hypertension, higher
proinflammatory cytokines. IL-8 and IL-12 were associated with diastolic dysfunction and LV remodeling.
P1293
Criteria of diagnosis of arrhythmogenic right ventricular dysplasia
IIvan Zemskov
Federal Almazov Medical Research Centre, Laboratory of electrocardiology,
St.Petersburg, Russian Federation
Oneof the causes of the sudden cardiac death is arrhythmogenic right ventricular
dysplasia (ARVD/C). The first symptom is ventricular arrhythmias (VA) in the most
cases. From 2010 there is a new guideline for diagnosis of ARVD/C. It was actually
to compare the sensitivity of various diagnostic schemes, and it was necessary to
review the criteria of the disease in patients with VA.
The aim of the study was to compare the detection of ARVD/C rate and to analyze
criteria of diagnosing ARVD/C in patients with VA.
369 patients with nonischemic frequent VA (175 m and 194 f., 45 ± 25 years) were
included in the study. We analyzed family history, ECG, echocardiography, Holter
monitoring ECG (HM ECG), MRI, EMB, exercise training test (ETT).
Initially, according to the criteria 1994, the diagnosis ARVD/C was established in
17 patients (5 m, 12 f., 40 ± 20 years) - 4.6% of the total patient number. However,
according to the criteria 2010, ARVD/C diagnosis was revised and established in 47
patients (15 m, 32 f., 40 ± 25 years) - 12.74% of the total.
We found criteria such as: the presence of ventricular extrasystoles more than
500 beats per 24 hours (10 patients (58.8%)), the paroxysms of right ventricular
tachycardia (9 patients (52.9%)), increased RV wall thickness in combination with
reduced ejection fraction, RV enlarging according to echocardiogram (8 patients
(47.1%)), the presence of epsilon waves (2 patients (11.7%)) and the diagnosis
was coincided only in 17 patients (36%) of the total number of patients ARVD/C
diagnosed using 2 different diagnostic schemes.
According to the criteria 2010 18 patients (38.3%) had 2 major criteria, 27 patients
(57.4%) - 1 major and 2 minor criteria, 2 patients (4.3%) 4 minor criteria. Also
we found a linear correlation between the findings on ECG and echocardiography
(r% = -0,096).
So we diagnosed ARVD/C in 36% more cases often by using the criteria 2010
than using the criteria 1994. Also we discovered an inverse and weak relationship
between ECG and echocardiography, which is probably explained by the staging
P1294
Rare combination of apical cardiomyopathy and multiple coronary
artery-to-left ventricle fistulae in an elderly Caucasian female presenting as
an acute coronary syndrome
JJakub Stepniewski; M Komar; P Wilkolek; A Sarnecka; P Podolec
Jagiellonian University Medical College, John Paul II Hospital, Dpt of Cardiac &
Vascular Diseases , Krakow, Poland
P1295
Analysis of serum hemoglobin levels in relation to clinical, echocardiographic,
neurohormonal, inflammatory parameters and mortality in pacients with
Chronic Chagas Cardiomyopathy
FFernando Botoni1 ; CP Miranda1 ; MCP Nunes1 ; BMR Oliveira1 ; AM Reis1 ; MM
Teixeira2 ; WC Tavares Jr1 ; ALS Botoni1 ; ALP Ribeiro1 ; MOC Rocha1
1
Federal University of Minas Gerais, School of Medicine, Postgraduate Course of
Tropical Medicine, Belo Horizonte, Brazil; 2 Departments of Biochemistry and
Immunology, Institute of Biological Sciences; Federal University of , Belo Horizonte,
Brazil
Background: Trypanosoma cruzi infection triggers a chronic inflammatory process that can lead to functional and morphometrical alterations in cardiac tissue.
Hemoglobin levels and iron metabolism have become a high relevance prognostic
marker in patients with heart failure (HF), given its correlation with iron status at the
cardiometabolism . Our objective was to investigate the serum levels of hemoglobin
and its relation to
clinical, echocardiographic, neuhormonal, inflammatory parameters and mortality
in patients with Chronic Chagas Cardiomyopathy (CCC).
Methods: Patients with CCC were prospectively enrolled with a mean follow-up
of 84months. Inclusion criteria were at least two positive serology test confirming
Chagas disease and the presence of dilated cardiomyopathy on echocardiogram.
All diseases that could independently affect hemoglobin levels were excluded. The
levels of serum hemoglobin were measured and correlated with clinical, echocardiographic, neurohormonal and inflammatory parameters. Hemoglobin level was
also associated with
cardiovascular mortality.
Results: 42 patients were assigned, the mean age was 48.10 ± 10 years, 30 male.
The Framingham Score (FSc) was 3.2 ± 1.7, functional class (NYHA I% = 50%,
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
246
Abstracts
II% = 33.3%, III% = 16.7%), LVEF was 43.2 ± 14.5%, LVDD was 62.5 ± 6.5, Left Ventricular Systolic Diameter (LVSD) was 50.8 ± 9.8, LV Tei index (LVTI) was 0.79 ± 0.40.
Cardiothoracic index (CTI) was 0.56 ± 0.06, BNP was 111.5(22.7-299.1), TNF𝛼
61,4(21,9−272,0), MCP1% = 112.1(84.6-194.7), MIP1𝛼% = 126.5(102.9−154.0),
RANTES% = 5466.7(2780.2- 10210.7).(Table I). Serum hemoglobin was correlated
with quality of life assessed by SF36 (functional capacity: r% = 0.320, p% = 0.050,
and emotional aspects: r% = 0.360, p% = 0.027), with 6-minute walking distance
(r% = 0.395, p% = 0.014), and a trend to FSc (r% = -0.294, p% = 0.059). There
was also a correlation between hemoglobin level and the severity of myocardial
dysfunction expressed by LV dimensions, LVEF, and RV function. In addition, BNP
levels and creatinine clearance were correlated with serum hemoglobin.(Table II).
During a mean follow-up of 84 months, 20 patients (48%) died. In Cox proportional
hazards model, hemoglobin level was a predictor of death (hazard ratio, 0.655; 95%
CI, 0.457-0.939; p% = 0.021),
Conclusion: In conclusion, serum levels of hemoglobin in patients with CCC were
correlated with clinical, neurohormonal, ventricular remodeling parameters, and
mortality as observed in HF from other causes. It suggests that could be a faulty
iron metabolism in CCC, as already demonstrated in different causes of HF.
We found 3 cases of preserved LV function (>55%), one of them with LV dilatation. In the total population the mean LV telediastolic volume (TDV) was 133 ± 65
ml/m2 and telesystolic volume (TSV) was 86 ± 58 ml/m2 . LV systolic dysfunction was
noted (39 ± 19%), together with low left atrium ejection fraction (40 ± 18%). Concerning right ventricle (RV) there were 2 cases of systolic dysfunction (mean RV
ejection fraction 53 ± 8%), but all pts had normal RV volumes (mean TDV 73 ± 20
ml/m2 ; mean TSV 35 ± 13 ml/m2 ). Hypertrabeculation was confirmed in the entire
population, with a mean of 6 ± 2 segments (including apex). A diastolic ratio of
non-compaction /compaction >2.3 was identified in 5 ± 2 segments with predominance of apical segments (maximum ratio 4.1 ± 0.8 in apical lateral segment). At
mid segments we observed this ratio in 11 pts (55%; ranging from one segment
in 4 pts to three segments in 2 pts), with extension in one case to basal segments.
There was no correlation of number of hypertrabeculated segments with LV volumes
or ejection fraction. Late gadolinium enhancement (LGE) was evaluated in 17 pts.
Forty-five percent of the population had LGE, in 4 cases with an ischemic pattern
and the remaining with mid-wall (3 cases) and subepicardial enhancement (1 case).
Conclusions: The advances in cardiovascular imaging contributes to improved
accuracy in diagnosis of LVNC. However these heterogeneity data demonstrate the
need to obtain more stringent criteria in order to accept this phenotype as a distinct
cardiomyopathy.
P1296
Acute myocarditis: single experience in a tertiary center
FFilipa Melao; M Paiva; T Pinho; A Madureira; E Martins; I Ramos; F Macedo; J
Maciel
Centro Hospitalar São João, Porto, Portugal
P1298
Introduction: Myocarditis is an inflammatory cardiac disease, frequently of viral
cause and with a benign curse, but potentially lethal. We sought to describe
the clinical characteristics, management and prognosis of patients admitted with
myocarditis in the last five years.
Methods: We included 56 patients (pts) admitted consecutively (from 2007 to 2012)
in a tertiary center after an episode of acute myocarditis, in whom cardiovascular
MRI was performed during hospitalization for myocarditis diagnosis. Clinical files
wereretrospectively reviewed in order to obtain baseline demographic, clinical,
echocardiographic and MRI data.
Results: 45 (80%) patients were men, mean age of 34 ± 11years. Hypertension
and Dyslipidemia were present only in a few pts (18% and 19%, respectively).
Acute chest pain was the main inaugural symptom (93%) and fever was detected
in 31 (55%). A viral prodrome was frequently (71%). Troponin I elevation was
found in all patients (mean peak level of 22 ± 34ng/ml).Mean BNP, C-reactive
protein values at admission were 194 ± 354 pg/ml and 77 ± 81 mg/dl, respectively.
Variations of the ST-T segment at ECG were present in 34 (60%) pts. Coronary
angiography performed in 29 (52%) pts was normal in all of them. Moderate
to severe left ventricular (LV) systolic dysfunction (ejection fraction < 45%) was
present at admission in 12 pts (21%). CMR was displayed at 4 ± 2 days after
admission and mean LV systolic function was normal (58 ± 8%), myocardial oedema
was present in 68% and LGE in 95%, with an inferior-lateral location in most
cases (36%) and involving 4 ± 3 myocardial segments. The type of LGE was
predominantly subepicardial (66%). The mean of hospitalization time was 6 ± 2 days.
After discharge LV function was re-evaluated (after 12 ± 7 months) and although all
of them had improved LV function, only nine showed normalization of LV function.
3 pts had recurrent myocarditis; all of them before the first year (mean 8 months)
of disease diagnosis; which was associated only with higher left and right cardiac
indices in the first episode (4.2 ± 0.6 vs 3.3 ± 0.6 l/min/m2 ; 3.8 ± 0.6 vs 3.0 ± 0.5
l/min/m2 , respectively). No deaths occurred.
Conclusions: In this cohort, most of patients with myocarditis were male, at 3rd
decade of life, without cardiovascular risk factors. A viral prodrome and chest pain
were the main complains. Despite the favorable outcome, some pts do not fully
recover LV function and others had recurrence of myocarditis. Recommendations
for clinical and imagiological follow-up of patients with myocarditis must be better
defined, because predictors of unfavorable outcome are still yet unknown.
HHanane Benhalla; S Raboukhi; I Haddad; R Habbal
Ibn Rochd University Hospital, Casablanca, Morocco
P1297
Left ventricular non-compaction cardiomyopathy: insights from cardiac
magnetic resonance imaging
1
1
1
1
2
MMariana Vasconcelos ; S Leite ; C Sousa ; T Pinho ; A Madureira ; J Silva
Cardoso3 ; I Ramos2 ; MJ Maciel1
1
Sao Joao Hospital, Department of Cardiology, Porto, Portugal; 2 Sao Joao
Hospital, Department of Radiology, Porto, Portugal; 3 University of Porto, Faculty of
Medicine, Porto, Portugal
Introduction: Left ventricle non-compaction (LVNC) cardiomyopathy has been considered as a well-defined individual entity. However recent data reveal a broad spectrum of clinical and pathophysiological findings. We aimed to study our population
of patients (pts) with LVNC diagnosis based on echocardiographic criteria.
Methods: We analyzed 20 pts who performed cardiac magnetic resonance (CMR)
at our institution.
Results: The majority of pts were male (60%), with a mean age of 50 ± 8 years.
Epidemiological profile of the hypertension and the accession to the
recommendations of the Moroccan patient
High blood pressure (HBP) is a public health problem . The aim of our study
was to determine the clinical and therapeutic profile of our patients. This is a
descriptive study on a population of 100 hypertensive patients followed in cardiology
consultation Ibn Rushd University Hospital of Casablanca during the period from
January 2013 to June 2013. We put the focus on risk factors (RF), the overall
cardiovascular risk (CVRF), the target-organ damage associated and therapeutic
strategies followed. The average age of patients was 78 years, ranging from 33
years to 90 years . Patients aged between 60-69 years accounted for 37 % of
cases. A female predominance was noted with a sex ratio F / H: 4.5 . Menopause,
dyslipidemia and diabetes were the main CVRF, 4 patients were smokers . The
combination of three CVRF was found in 30 people. Angina of effort is found in 24
cases, 12 patients with stroke, myocardial infarction was found in 7 cases. Electric
left ventricular hypertrophy was found in 14 cases. Good LV systolic function in
89 patients and 19 cases of hypertensive heart disease . 4 cases of hypertensive
retinopathy were found in the fundus. Only 21 patients received blood pressure
holter which 18 patients were balanced . The fourth of patients treated had chronic
renal failure (CRF) < 60 mL / minute without proteinuria, VIT D deficiency was found
in 20 cases . The dietary habit measures are recommended in all patients . 83
patients are monitored by the threshold processing to 140/90 mmHg . Monotherapy
was introduced in a quarter of cases Angiotensin-converting enzyme (ACE) inhibitors
and channel calcuim blockers (CCB), were the first choice drugs in more than half
of the case . Combination therapy was used in 1/ 3 of patients, the most effective
combination was ACE + CCB in 30 % of cases. Triple therapy was used in 15 cases
and quadruple in 9 cases. Non- adherence to treatment was a factor in therapeutic
resistance.
P1299
The potential usefulness of serum melatonin level to predict heart failure in
patients with hypertensive cardiomyopathy
M Martin-Cabezas1 ; AAlberto Dominguez Rodriguez1 ; C Mendez-Vargas1 ;
J Gonzalez1 ; B Mari-Lopez1 ; P Abreu-Gonzalez2 ; RJ Reiter3
1
University Hospital of Canarias, Tenerife, Spain; 2 University of La Laguna, Tenerife,
Spain; 3 The University of Texas Health Science Center at San Antonio, Department
of Cellular and Structural Biology, San Antonio, Texas, United States of America
Purpose: Numerous studies have shown that melatonin lowers blood pressure.
However, no study has investigated any posible association between melatonin levels and hypertensive cardiomyopathy in humans. The present study we sought to
determine the relationship between serum melatonin levels and heart failure at 6
months after diagnostic in ambulatory patients with cardiomyopathy hypertensive.
Methods: This prospective study included 16 patients with cardiomyopathy hypertensive who were referred to the non-invasive stress laboratory in a tertiary hospital
to evaluate symptoms of exertional dyspnoea. The patients with hypertensive cardiomyopathy were followed for 6 months regarding occurrence of hospitalization for
heart failure. Serum melatonin concentrations were measured at the time of the cardiopulmonary exercise testing, during the light period.
Results: During the 6 month follow-up period, 6 patients required hospital admission
due to symptomatic heart failure. Patients were subdivided into two groups: subjects
with hypertensive cardiomyopathy and heart failure and subjects with hypertensive
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
247
cardiomyopathy and without heart failure (Table 1). All patients received antihypertensive drugs including: diuretics, 𝛽-blockers, calcium antagonists, angiotensin
II-receptor antagonists or ACE-inhibitors. There were no statistical differences in
baseline characteristics, with the exception of melatonin levels. Multivariate analysis
showed that melatonin levels (OR% = 1.10, CI 95% 1.04-1.870, p < 0.001) were an
independent predictor of heart failure at 6 months follow-up in patients with hypertensive cardiomyopathy.
Conclusions: To our knowledge, this is the first study to show the relationship
between melatonin and patients with hypertensive cardiomyopathy who developed
heart failure at 6 months.
Variable
Hypertensive
cardiomyopathy
without heart failure
Hypertensive
cardiomyopathy
with heart failure
Value P
Age, years
56 ± 8
60 ± 14
0.57
Men
6 (60)
2 (33.3)
0.30
Smokers
1 (10)
0 (0)
0.42
Body mass index
(kg/m2 )
26.21 ± 6.30
26.62 ± 6.16
0.90
Therapeutic
strategies for arterial
hypertension Single agent Twodrug combination
4 (40) - 6 (60)
4 (66.7) - 2 (33.3)
0.30
Brain Natriuretic
peptide (pg/ml)
447.37 ± 42.42
461.65 ± 36.44
0.50
Melatonin (pg/ml)
14.59 ± 2.89
7.43 ± 0.87
< 0.0001
P1300
The correlation between heart rate with diastolic parameters in arterial
hypertension with left ventricular hypertrophy in the presence of normal
systolic function
1
University of Medicine Victor Babes, Cardiology Clinic of the Emergency County
Hospital Timisoara, Timisoara, Romania; 2 Eastern Clinical University Hospital, Riga,
Latvia; 3 Emergency Hospital of Timisoara, IT Department of the of the Emergency
County Hospital Timisoara, Timisoara, Romania; 4 University School of Medicine
Grigore T Popa, Iasi, Romania; 5 Emergency Hospital of Arad, Arad, Romania
Purpose: Hypertension is a risk factor for the development of heart failure (HF),
both because hypertension increases cardiac work, which leads to the development
of left ventricular hypertrophy, and because hypertension is a risk factor for the
development of coronary heart disease. Knowing the role of the autonomic nervous
system (ANS) in the mechanism of hypertension, the challenge is to evaluate
the arrhythmic risk of hypertensive patients. Disturbances in the activity of the
autonomic nervous system (ANS) also significantly influence the outcome of patients
with chronic heart failure (CHF). A subject open to debate is to compare heart rate
variability (HRV) parameters and the chaos theory methods for the assessment of the
clinical status and the outcome in hypertensive cardiopathy. Method. In this study
we evaluate the level of the autonomic dysfunction in hypertension (n: 26, mean
age: 53,6 yrs) compared to the more well known autonomic disturbances in heart
failure (n: 39, mean age: 58.5 yrs) using non-linear dynamics methods compared
with heart rate variability. Results. Hypertensive patients have a high sympathetic
tone, expressed as the power spectral density (PSD, s2/Hz, ms2) of heart rate
variability parameters and the low to high frequency ratio (LF/HF) compared with the
control group (LF/HF ratio:1.16 vs. 0.94 p < 0,01). A significant difference was found
between patients with heart failure and healthy controls in short time scales (DFA
a1: 0.72 vs 0.87 p < 0.05). The DFA a1 showed higher values in the hypertensive
group compared with the heart failure group (0.84 vs 0.72 p: ns). It was found that
the short-term fractal scaling exponent alpha (1) is significantly lower in arrhythmic
hypertensive patients (0.75 vs. 0.84; p < 0.03). Left ventricular ejection fraction
(LVEF %), SDNN (ms), LF/HF ratio, and the baroreflex sensitivity (BRS) parameters
had been proved to be independent risk factors for ventricular arrhythmia. BRS is
correlate with QT/RR ratio (r: 0.48) and with DFAa1 (r: 0.40).
Conclusions: The nonlinear dynamic methods could have clinical and prognostic
applicability also in short-time ECG series. Dynamic analysis based on chaos
theory point out the multi-fractal time series in patients who loss normal fractal
characteristics and regularity in HRV. Nonlinear analysis technique may complement
traditional ECG analysis.
It seems possible to conclude that patients with hypertensive cardiopathy are
vulnerable to arrhythmias like in patients with heart failure and it is necessary to
improve ventricular arrhythmia prophylaxis in hypertensive patients.
SSnezana Lazic
Internal Clinic, Cardiology, Gracanica, Serbia
Introduction: The increase of heart rate in individuals with hypertension who have
left ventricular hypertrophy with preserved systolic function may affect the complex
process of diastole and result in diastolic heart failure.
Aim - To evaluate the relationship between heart rate with diastolic parameters in
individuals with hypertension and left ventricular hypertrophy in the presence of
normal systolic function.
Method: The study included subjects with hypertension in whom left ventricular
hypertrophy was initially confirmed by echocardiography. The measurements were
performed according to ASE recommendations, and diastolic parameters were
evaluated using standard PW technique. The mass was determined by Penn
convention and indexed by body surface area (LVMI). Heart rate was recorded using
ECG.
Results: The study analyzed 111 subjects with hypertension, 65 with concentric
LVH and 46 with eccentric LVH (54 males and 57 females). Mean LVM(g) was
326 ± 47, and LVMI (g/m2 ) was 172 ± 27. Maximum E velocity (cm/s) was 57.1 ± 11.1,
maximum A velocity was 85.4 ± 7.0, and the mean E/A ratio was 0.7 ± 0.13. Mean
IVRT (ms) was 110 ± 4.2, while the mean DT (ms) was 291 ± 8.9. Mean EF (%) was
61.6 and the mean heart rate was 74 ± 10 beats/minute.
Positive correlation between heart rate and maximum E velocity was observed (r +
0.226; p < 0.05), as well as maximum A velocity (r + 0.216; p < 0.05). No correlation
was found between hear rate and E/A ratio, or time intervals DT and IVRT (p>0.05).
Conclusion: The observed positive correlation between heart rate and maximum
velocities of E and A waves on mitral spectrogram suggests the possibility of
initial potentiating of ventricular filling by heart rate acceleration. However, these
hemodynamic effects on diastolic function have to be interpreted as a function
of time. In this study, during the initial stage of diastolic dysfunction, heart rate
acceleration had no significant effects on E/A ratio as global index of diastolic
function. As a function of time, treatment goal needs to be aimed at strict heart rate
regulation in order to prevent diastolic heart failure, because it is known that it occurs
during attacks of increased heart rate in the presence of underlying hypertensive
hypertrophic left ventricle with preserved systolic function.
P1301
Chaos theory and non-linear dynamics in hypertensive cardiopathy and heart
failure
V D Moga1 ; I Kurcalte2 ; M Moga3 ; F Vidu3 ; C Rezus4 ; I Cotet5 ; R Avram1
CARDIOMYOPATHY – POSTER DISPLAY
P1302
Performance and application of T-preamplified real-time RT-PCR analyses of
endomyocardial biopsies
VJ Patil1 ; C Konstas2 ; N Kehler2 ; HR Figulla2 ; M Noutsias2
Faculty of Biology, Philipps-Universität Marburg, Marburg, Germany;
2
University Hospital Jena, Department of Internal Medicine I, Jena, Germany
1 Genetics,
Background: Low RNA amounts and low expression of certain target genes limit
conventional real-time RT-PCR analyses of endomyocardial biopsies (EMB). In
the methodology published 2008, a novel T-preamplification technique (T-PreAmp)
proved superior compared to a multiplex preamplification following a sequence
specific reverse transcription (SSRT-PreAmp). The T-PreAmp enables a robust
PreAmp of multiple target genes (>92 gene assays), by a mean Ct improvement
around 7 cycles, and with a low inter- and intra-assay variance ( < 5%).
Aims of the study: Systematic evaluation of publications on the establishment and
application of T-PreAmp in EMB.
Results: Our survey identified 19 publications applying the T-PreAmp protocol. 5
publications dealt with RNA extracted from EMB, while the remaining publications
were not related to cardiovascular research. The T-PreAmp has been applied to cell
cultures, blood cells, snap frozen and paraffin embedded tissues. In EMB, CDKN1B
was ascertained as a novel housekeeping gene for myocardial tissues. T-PreAmp
in EMB revealed a significant association between the immunohistological proof of
DCMi and the expression of CD3d, CD3z and of the constant T-cell receptor beta
region (TRBC). The criterion of significantly increased TRBC or CD3d expression
was associated with differential expression of several T-cell related genes, cytokines,
and genes of the extracellular matrix (ECM). Differential TRBV dominances in
human DCMi have been associated to the PCR proof of various viral genomes.
In a patient presenting with acute myocarditis and parvovirus B19 (B19V) viremia,
TRBV11 dominance was identified in the peripheral blood leukocytes. Expression
of ECM genes was associated to clinical parameters of diastolic heart failure.
EMB of patients with transcriptionally active B19V infection were characterized
by a differential expression of type I interferon response, of B19V receptor, of
mitochondrial energy and apoptosis related genes, as compared to B19V latent
infections.
Conclusions: T-PreAmp is a powerful tool for preamplification and robust expansion
of comprehensive target gene expression analyses of EMB. In gene expression
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
248
Abstracts
analyses of EMB, the T-PreAmp technique elucidated a novel housekeeping gene for
myocardial tissues (CDKN1B), and confirmed that the immunohistological diagnosis
of DCMi is associated with differential expression of several T-cell related genes,
cytokines and ECM related genes. Furthermore, it elucidated differential gene
expression associated with diastolic heart failure, and with transcriptionally active
versus latent B19V infection.
P1303
Predictors of outcome in patients with suspected myocarditis
A Gkouziouta; G Karavolias; D Kalogerakis; L Kaklamanis; D Degiannis;
S Adamopoulos
Onassis Cardiac Surgery Center, Athens, Greece
Purpose: The objective of this study was to identify the prognostic indicators in
patients with suspected myocarditis who underwent endomyocardial biopsy.
Methods and Results: Between 2006 and 2013, 111 consecutive patients (age,
42 ± 15 years) with clinically suspected viral myocarditis were enrolled and followed
up for a mean of 59 ± 42 months. Endomyocardial biopsies were studied for
inflammation with histological (Dallas) and immunohistological criteria. Virus genome
was detected by polymerase chain reaction. The primary end point was time to
cardiac death or heart transplantation. In 38% of the patients (n = 34), the Dallas
criteria were positive. Immunohistological signs of inflammation were shown in
50% (n = 55). Genomes of cardiotropic virus species were detected in 79 patients
(71%). During follow-up, 22% of the patients (n = 24) reached the primary end point.
Three independent predictors were identified for the primary end point, namely
New York Heart Association class III or IV at entry immunohistological evidence
of inflammatory infiltrates in the myocardium and 𝛽-blocker therapy . Ejection
fraction, left ventricular end-diastolic pressure, and left ventricular end-diastolic
dimension index were predictive only in univariate, not in multivariate, analysis.
Neither the Dallas criteria nor the detection of viral genome was a predictor of
outcome.
Conclusions: For patients with suspected myocarditis, advanced New York Heart
Association functional class, immunohistological signs of inflammation, and lack
of 𝛽-blocker therapy, but not histology (positive Dallas criteria) or viral genome
detection, are related to poor outcome.
P1304
Prognostic value of cardiac magnetic resonance imaging in patients with left
ventricular noncompaction cardiomyopathy
B Schneider1 ; TH Huemme2 ; B Gerecke3 ; J Schwab4 ; U Desch1 ; H Vorbringer2
Sana Kliniken, Lübeck, Germany; 2 Röntgenpraxis im Tesdorpfhaus, Lübeck,
Germany; 3 Klinikum Wolfsburg, Wolfsburg, Germany; 4 Klinikum Nuernberg,
Nuernberg, Germany
1
Purpose: Left ventricular noncompaction (LVNC) cardiomyopathy is usually diagnosed by echocardiography (ECHO) but cardiac magnetic resonance imaging
(CMRI) has evolved as an alternative method. This study assessed the diagnostic and prognostic value of CMRI in adults with LVNC.
Methods: Thirty four pts (19m, 15f, age 53 ± 16) with ECHO diagnosis of LVNC
underwent cine and contrast-enhanced CMRI with a 1.5 T scanner. LV diameter,
volume, ejection fraction, degree of mitral regurgitation, ratio of noncompacted to
compacted myocardium (NC/C) and the presence and localization of late gadolinium enhancement (LGE) were determined. CMRI findings were correlated to clinical
events, ECHO and angiography.
Results: Twenty pts (59%) were in heart failure NYHA III or IV, 14 (41%) had a
left bundle branch block (LBBB) and 6 (19%) documented ventricular tachycardia. In 3 pts (9%) a thrombus was seen within the trabecular layer which resolved
under anticoagulation, and 6 additional pts (18%) without detectable thrombus
suffered a stroke. By CMRI, LV diameter in end-diastole (66 ± 8 mm), end-systole
(53 ± 10 mm), end-diastolic volume (229 ± 69 ml) and end-systolic volume (150 ± 68
ml) were enlarged and ejection fraction (36 ± 14 %) was reduced, with similar values determined by ECHO and angio. The NC/C ratio was 3.2 ± 1.4 in end-diastole
and 2.6 ± 1.4 in end-systole. One pt had right ventricular involvement and a RV
thrombus.
LGE was detected in 9/32 pts (28%). LGE was present in the compacted myocardial layer (n = 6), in the noncompacted trabecular layer (n = 6) and within the papillary
muscles (n = 3). LGE was seen in all 3 areas in 1 and in 2 areas in 4 pts. All 3 pts with
papillary muscle LGE also had trabecular LGE and high grade mitral regurgitation,
and 1 of these pts died while awaiting HTx. Thrombus and stroke occurred mainly
in pts with LGE (6/9 vs 2/23 pts, p% = 0.002). Five of 14 pts with LBBB and 3/6
pts with ventricular tachycardia exhibited LGE. A high NC/C ratio, however, was not
associated with heart failure, thrombus and stroke, LBBB, VT or ejection fraction.
Conclusions: In LVNC, evaluation by CMRI and demonstration of LGE identifies
pts at high risk for clinical events. Extensive LGE may predispose to thrombus formation and stroke, warranting anticoagulation. LGE within the papillary muscles is
associated with high grade mitral regurgitation, aggravating heart failure in these
patients.
P1305
Clinical characteristics of cardiac sarcoidosis;Low ejection fraction is related
to ventricular tachycardia
MMie Seya; T Sasaoka; S Tao; K Kurihara; T Sasaki; S Yosikawa;
Y Yokoyama; T Asikaga; K Hirao; M Isobe
Tokyo Medical And Dental University, Cardiovascular, Tokyo, Japan
Background: Sarcoidosis is a multisystem disease, and cardiac sarcoidosis may
be present in as many as 25 % of the patients with systemic sarcoidosis. Cardiac
sarcoidosis affects patient’s prognosis because of congestive heart failure and ventricular arrhythmias, however the details are remained to be elucidated. This study
aimed to reveal the predictors of prognosis in patients with cardiac sarcoidosis.
Methods and Results: We retrospectively analyzed consecutive 34 patients diagnosed cardiac sarcoidosis in our institution. Mean age of the patients were 62 ± 14
years old, and 24 patients (71%) were female. Solitary cardiac sarcoidosis was
found in 10 patients (29%). 12 patients had decreased left ventricular ejection fraction (LVEF) ( < 50%) and 4 patients (12%) had the thinning of LV wall, 4 patients
(12%) had no abnormal change of the echocardiography. VT (ventricular tachycardia) was tend to be occurred in patients with low EF (EF < 50%) than with preserved
EF (EF50%). VT were observed in 13 patients (38%), and they had significantly
lower LVEF compared to no-VT patients. (48 ± 14% vs. 58 ± 10% p% = 0.03) Also,
LV dimension had a tendency to be dilated in patients with VT. Treatments of Corticosteroid were started in 27 patients of 34 patients (79%), the prognosis and the
echocardiographic changes were not significantly different according to the steroid
usage. There were no differences in treatments and clinical outcomes in VT patients
and no-VT patients.
Conclusion: In this study, we found that lower LVEF was associated with VT in cardiac sarcoidosis.
P1306
Massive myocardial calcification: case of a stone heart
DDavid Zizek; M Zakelj; N Zima
University Medical Centre Ljubljana, Department of Cardiology, Ljubljana, Slovenia
Background: Massive calcification of the myocardium is a rare clinical finding,
mostly associated with myocardial infarction, infection or metastatic depositions.
Case report: 72-year-old female with history of arterial hypertension and diabetes
was admitted to our hospital due to progressive dyspnoea on mild exertion and
peripheral oedema. Transthoracic echocardiography revealed severe diastolic dysfunction with hyperechogenicity of the myocardium (Figure A). On computerized
tomography diffuse intramural calcification of the left ventricle and mitral annulus
was suspected (Figure B). Angiography showed normal coronary arteries. Biopsy
confirmed the diagnosis of myocardial calcification. However, there were no histological signs of fibrosis, inflammation or other known cardiomyopathies. In addition,
calcium and parathyroid hormone levels were within normal range.
Conclusions: The presented case is elusive due to the lack of findings that could
reveal the aetiology of this process. Although dystrophic myocardial calcification is
the most likely diagnose, comprehensive evaluation of these patients is warranted
for making best clinical decisions.
Echo and CT of myocardial calcification.
P1307
Atrial fibrillation in the context of left ventricle non-compaction
cardiomyopathy; are its implications similar to those of other
cardiomyopathies?
D ADavid Antonio Moreira; CE Correia; AP Delgado; BF Marmelo; LM Abreu; LM
Nunes; J M Oliveira-Santos
Hospital Sao Teotonio, Viseu, Portugal
Introduction: Atrial fibrillation (AF) is the most prevalent sustained arrhythmia; by
itself, it doubles the risk of death, it increases fivefold the risk of stroke, and increases
the risk of hospitalization for acute heart failure (AHF) by threefold. It commonly
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
arises in the context of left ventricle non-compaction cardiomyopathy (LVNC); however, its impact is not well known.
Purpose: To assess the impact of AF in a population sample with LVNC, over one
year of follow-up.
Methods: The study comprised 25 subjects of a database of patients suffering
from LVNC with previous exclusion of those individuals with pacemaker rhythm. An
assessment of heart rhythm was performed with this sample; patients were then
divided in 2 groups (G): GA – patients with long-term persistent AF, or permanent
AF (n = 5); and GB: patients in sinus rhythm (n = 20). Their respective characteristics were subsequently compared. A two-year follow-up was performed using a
combined clinical endpoint defined as hospitalization for AHF, or acute myocardial
infarction, or death from any cause. Statistical analysis was performed with a significance level set at 0.05.
Results: Overall mean age is 47 ( ± 22), being significantly lower in GA (66.6 vs. 42.2
y, p% = 0.02). Male gender prevails in GA, while the female one prevails in GB. Oupatient dyspnoea is more frequent in GA than in GB (% in NYHA III/IV: 20% vs 5.0%, p
< 0.01). Regarding outpatient medication, GA uses significantly more warfarin than
GB (100% vs 21.1%, p < 0.01). With regard to echocardiographic parameters, GA
has a higher prevalence of dilated LV (defined by M-mode cut-off values of 59mm for
men and 53mm for women: 80.0 vs 27.8%, p% = 0.05), a lower LVEF by the Simpson method (26.2% vs 51.4% p < 0.01), a dilated left atrium (46.6mm vs 36.3 mm,
p% = 0.03), and higher PSAP values (47.2 vs. 24.2 mmHg, p% = 0.01). Throughout
the follow-up period, all of the patients from GA met the endpoint - three were admitted for AHF, and two died; on the other hand, only 30% of patients within GB have
met the combined endpoint (p < 0.01).
Conclusions: Results demonstrate that AF correlates with poor prognosis in the
context of LVNC, as already described in regard to other cardiomyopathies; however, taking into account its uncommonness, further studies are needed on this
pathology.
P1308
Diagnosis and clinical course of left ventricular non compaction
BASSEM Rekik; RANIA Hammami; FATEN Triki; DORRA Abid; LEILA Abid;
MOURAD Hentati; SAMIR Kammoun
Hedi Chaker University Hospital, Cardiologie department , Sfax, Tunisia
Aims: The isolated left ventricular non-compaction is a structural cardiac disease
characterized by prominent trabeculae and deep recesses. We evaluated retrospectively the clinical characteristics and the natural history of isolated left ventricular
non-compaction in adults in our center.
Methods: Descriptive study of 13 cases of isolated left ventricular non-compaction
diagnosed by trans thoracic echocardiography as the presence of deep recesses in
hypertrophied segments according to the diagnostic criteria Coll.
Results: Thirteen adult patients (9 men, 4 women, mean age 46.3 ± 18 years) carrying isolated left ventricular non-compaction were evaluated. The prevalence of
the disease was 0.1% compared to all echocardiograms performed in our center.
Ten patients had dyspnea. Five patients had angina chest pain. The electrocardiogram was abnormal in 4 patients with left ventricular hypertrophy in 3 patients and
right ventricular hypertrophy in one patient. The left ventricular systolic function was
reduced in 9 patients with a mean left ventricular ejection fraction of 35% (range 15%
to 50%) when diagnosed. The predominant localization was the apical myocardium.
Patients with left ventricular dysfunction were older and had more extended damage
with much affected segments and lower non-compaction / compaction ratio.
During a mean follow-up of 12 months (range of 8-70 months), 3 patients had a
supra ventricular tachycardia, 2 patients were hospitalized for heart failure.
Conclusions: This study suggests that isolated left ventricular non-compaction is
rare in our population; the non-compaction / compaction ratio and the number of
affected segments appear to be the major determinants of left ventricular systolic
dysfunction.
249
angiography, a significant stenosis of the coronary arteries could be excluded.
Furthermore, by echocardiography, an increased trabeculisation of the apical and
posterolateral wall was remarkable. The wall showed two layers. With high suspicion
of a non-compaction cardiomyopathy, a cardiac MRI was performed and the
diagnosis was confirmed. The ratio of the compacted to not compacted myocardium
is 2,3/1. Because the patient had syncope three months ago and the ECG showed
a complete left bundle branch block and a changing AV block (Wenckebach type
I-II), there was an indication for the pacemaker implantation. As according to the
literature, in case of non-compaction cardiomyopathy, ventricular tachycardia can
be expected to 50% and therefore an ICD implantation is justified as primary
prophylaxis, we wanted to provide the patient with an ICD. Taking into account the
complete left bundle branch block with a QRS width of 177 ms and the high grade
mitral valve insufficiency, we decided for the implantation of a CRT-D system. The
CRT-D was implanted without complications.
In the present case the diagnosis of non-compaction cardiomyopathy was made
for a 78 year old female patient. She attracted attention by a previous syncope and
signs of heart failure. This clearly shows that one should think even in older patients
with heart failure entirely to the diagnosis of a non- compaction cardiomyopathy.
P1310
Massive pulmonary embolism and apical left ventricle clots as first
presentation of non-compaction cardiomyopathy.
SStylianos Karvounaris; V Karampetsos; C Rotos; C Kontos; A Stylianou;
E Theocharous; S Lanara; P Mavrommatis
Paphos General Hospital, Department of Cardiology, Paphos, Cyprus
Introduction: Non-compaction cardiomyopathy (NCC) is a rare cause of heart
failure, characterized by the presence of extensive myocardial trabeculation and
deep intertrabecular recesses.
Case presentation: A 71-year-old man, who travelled a week earlier, hospitalised
due to pneumonia. Ten days later he developed acute dyspnoea, tachypnea and
hypotension. Clinical examination was unremarkable. ECG showed sinus tachycardia and new RBBB suggesting severe pulmonary embolism. Initial ECG had
QS in precordial leads compatible with ‘old’ myocardial infarction. Urgent CT-scan
confirmed clinical diagnosis of pulmonary embolism. In addition, a deficit in left ventricular apex was noted. Echocardiography revealed dilated left ventricle, severely
reduced ejection fraction, two large thrombus and near normal right cavities.
Thrombolysis was avoided and patient treated with LMWH, oxygen and inotropes.
After stabilization a more detailed echocardiogram (contrast, 3D) showed typical
findings of NCC (Figures 1). Coronary angiogram showed extensive obstructions,
despite the absence of risk factors, and he underwent CABG.
Conclusion: We described a case of NCC associated with three-vessel coronary
artery disease. To the best of our knowledge, this combination is extremely rare.
The coincidence of massive pulmonary embolism and clots in left ventricle made
management more challenging.
P1309
Left ventricular non-compaction cardiomyopathy
E NEdibe Nuray Saatci
Istanbul Bilim University, Cardiology, Istanbul, Turkey
A78year old female patient came with a since three months increasing exertional
dyspnoea. In August 2013, she was delivered with syncope to a general hospital
of rule supply. Now, three months after this event, the patient returned with further
existing exertional dyspnoea for further clarification to our clinic. On admission, the
blood pressure was 120/80 mm Hg, the pulse 80/min, rhythmic. The heart sounds
were moderately loud and rhythmic. An apical 4/6 pansystolic murmur. In both lungs
diffuse crepitation rales. The coarse-orientating neurological status is unremarkable.
In the ECG, a complete left bundle branch block and a varying AV block between
I and II degree Wenckebach type were remarkable. Echocardiography showed
slightly dilated cardiac caves, an EF of 45%, diffuse hypokinesia with marked
hypokinesia of the inferior wall, a high grade mitral valve insufficiency and pulmonary
hypertension with systolic PA pressure of 65 mm Hg. By means of coronary
P1311
Base to apex left ventricular longitudinal strain gradient in patients with
hereditary transthyretin-related cardiac amyloidosis
M Gospodinova1 ; S Sarafov2 ; V Guergelcheva2 ; Z Kuneva1 ; L Vladimirova1 ;
I Tournev2 ; S Denchev1
1
Clinic of Cardiology, University Hospital Alexandrovska, Medical University, Sofia,
Bulgaria; 2 Clinic of Neurology, University Hospital Alexandrovska, Medical
University, Sofia, Bulgaria
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
250
Abstracts
Background: The hereditary transthyretin-related amyloidosis (ATTR) affects mainly
the peripheral nerves and the heart and has a poor prognosis. The cardiac involvement is characterized by an infiltrative cardiomyopathy with various degree of diastolic dysfunction, usually with preserved ejection fraction (EF).
Purpose: The purpose of the study was to evaluate the global and regional left
ventricular (LV) longitudinal systolic function by speckle tracking echocardiography
aiming to assess the systolic function for subtle changes in the setting of predominant diastolic dysfunction in a group of patients with ATTR.
Materials and Methods: Sixteen patients with ATTR (9 men) at mean age of
58,44 ± 6,20 years and fourteen healthy controls (6 men) at mean age of 52 ± 8,53
years were evaluated. All patients were genetically verified – twelve with a
Glu89Gln mutation, two with a Val30Met mutation, one with a Ser77Phe mutation and one with a Ser52Pro mutation. Conventional transthoracic and Doppler
echocardiography, pulse wave tissue Doppler (TDI) and 2D speckle tracking were
performed.
Results: A reduced global LV longitudinal strain was measured in all the evaluated patients in comparison with the control group (-9,53 ± 2,55%; -17,94 ± 2,54%
respectively, p < 0,0001). A significant base to apex gradient in the regional systolic strain was found in the patient group (-2,74 ± 2,03; -7,90 ± 0,87; -13,34 ± 2,36;
-20,77 ± 6,89) in comparison with the control group (-17,28 ± 1,82%, -16,50 ± 1,37,
19,38 ± 1,46%, -20,96 ± 3,81). Reduced systolic myocardial velocities were found
using pulse tissue Doppler imaging at mitral valve annulus (s sept. 5,47 ± 1,52
cm/s, s lat. 6,08 ± 1,90 cm/s) in the patient group, but not in the controls (s sept.
10,87 ± 1,25 cm/s, s. lat. 12,56 ± 3,13 cm/s). A reduced EF < 50% was measured
in one of the patients and the mean EF for the whole group was 58,0 ± 8,63%. In
the control group, the measured EF was 65,8 ± 5,42%. In all the patients there was a
significant increase in the left and right ventricular wall thickness and various degree
of LV diastolic dysfunction.
Conclusion: In all the evaluated patients a subclinical LV systolic dysfunction was
found by speckle tracking echocardiography, despite the preserved EF in most of
them. The presence of a reduced LV global longitudinal strain and base to apex longitudinal strain gradient in patients with LV “hypertrophy” and peripheral polyneuropathy is suggestive of transthyretin-related amyloidosis. It remains unclear if adding
other than beta-blocker medication could prevent further deterioration of the cardiac
pumping function.
P1312
Prevalence and clinical relevance of right ventricular involvement in patients
with takotsubo cardiomyopathy: an echocardiographic study
B Schneider; U Desch; J Stein
Sana Kliniken, Lübeck, Germany
P1313
Chagas cardiomyopathy : prognostic value of genetic polymorphisms of TNF
-alpha
SM Alves1 ; J Lannes Vieira2 ; LEA Arnez2 ; MO Moraes2 ; WA Oliveira Jr3 ; C
Sarteschi3 ; MGA Melo3 ; FJA Ramires1 ; C Mady1
1 Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil; 2 Oswaldo
Cruz Foundation, Rio de Janeiro, Brazil; 3 University of Pernambuco, Recife, Brazil
Introduction: Chagas disease remains as one of the most important infectious and
parasitic diseases related to poverty in Latin America. During the last century, was
detected in non- endemic countries, North America, Western Pacific Region and
recently in Europe . This is a clinical entity that has several features, varies from
asymptomatic patients to heart failure with very poor prognosis. As proved by recent
studies, this broad spectrum of clinical forms may be influenced by genetic factors.
The main objective is to characterize the association of genetic variant that could
lead to the cardiac form of the disease.
Methods: we performed a case-control association study 146 patients enrolled with
positive serology for Chagas infection in two tests with different methodology principles, excluded digestive form. For inclusion in the case group (N : 84 patients)the
patient had heart failure, electrocardiogram alterations and an ejection fraction less
than 45% in ecodopplercardiogram . The control group - asymptomatic and had
normal exams (include electrocardiogram, chest X-ray and echodopplercardiogram)
: N = 62 .Genotypes were determined by polymerase chain reaction (PCR) of functional single nucleotide polymorphisms of -308 TNF .The sample size was calculated
with a 80% of power to detect differences. Qui square, Fisher exact and Student t
test were used. All conclusions were based on a 5% significance level.
Results: The distribution was similar between two groups for sex (p% = 0.260), Systemic arterial hypertension (p% = 0.073) and Diabetes (p% = 0.839). The mean age
of control group was 51 (SD% = 12) case: 59 years (SD% = 12) (p% = 0.001). The
Ejection Fraction average(case group) : 35.1% (SD% = 7.5). The frequency of alleles between groups (case x control (respectively) GG (81% × 75.8%), AG (19%
× 22.6%) and AA (0% vs. 1.6%) showed no significant difference (p% = 0.464).
When separated by age with HF manifest until 45 years there was no distinction between groups of alleles (p% = 0.208), nor between greater than 45 years
(p% = 0.806).
Conclusions: Despite being proved by other trials that genetic test positivity is associated with a worse prognosis, our results, suggest that -308 gene polymorphisms
do not influence the susceptibility to develop chagasic cardiomyopathy. Further
research may clarify the genetic involvement and influence the course of disease
progression
P1314
Purpose: Takotsubo cardiomyopathy (TTC) is a transient form of acute heart failure. Besides ballooning of the left ventricle (LV), some patients develop wall motion
abnormalities of the right ventricle (RV).
This study assessed the prevalence, clinical significance and time course of RV
involvement in patients with TTC by echocardiographic follow-up.
Methods: Over a 10-year period, we observed 88 TTC patients (79f, 9m, age
71 ± 12). By echocardiography, 24 pts (27%) had RV involvement. Clinical parameters, ECG, echocardiographic and angiographic findings were compared in patients
with and without RV involvement.
Results: RV wall motion abnormalities involved the apicolateral (n = 16), mediolateral (n = 4), anterolateral (n = 2) and inferior (n = 2) segments. Normalization of RV
contraction always occurred before normalization of LV function (10 ± 6 vs 22 ± 17
days).
In patients with RV involvement, time from symptom onset to hospital admission was
shorter (6.3 ± 6.1 vs 9.8 ± 10.2 hours, p% = 0.05). The ECG on admission showed a
higher heart rate (98 ± 23 vs 86 ± 22 beats per minute, p < 0.05), and more patients
with RV involvement developed giant negative T waves during follow-up (55% vs
16%, p < 0.001). Other ECG parameters were not different. Troponin was higher
in RV involvement (12 ± 10 vs 7 ± 6.5 × upper limit of normal, p% = 0.03). Angiographic ballooning pattern of the LV and end-diastolic LV pressure were similar in
both groups. LV ejection fraction, however, was significantly lower in patients with
RV involvement (45 ± 12 vs 53 ± 13 %, p% = 0.01). Global right ventricular function
according to TAPSE (16.3 ± 2.7 vs 19.5 ± 9 mm, p% = ns) and pulmonary artery pressure estimated by the tricuspid regurgitation velocity (3.1 ± 0.4 vs 3.0 ± 0.2 m/sec,
p% = ns) were similar in patients with and without RV involvement.
Overall, patients with RV involvement more frequently developed complications
(59% vs 39%, p% = 0.05) and especially severe complications (29% vs 8%, p < 0.01)
during the acute clinical course. There was a higher frequency of ventricular tachycardia (17% vs 5%, p% = 0.05) and acute mitral regurgitation (13% vs 3%, p < 0.03)
in patients with RV involvement. Time to complete normalisation of LV function was
longer (29 ± 25 vs 20 ± 13 days, p < 0.05).
Conclusion: As assessed by echocardiography, RV involvement occurs in 27% of
patients with TTC and is associated with a significantly higher rate of severe complications. Since ventricular tachycardia is frequently observed, prolonged monitoring
is advisable in these patients.
Tachycardia-induced cardiomyopathy: a reversible form of left ventricular
dysfunction
AAdriana Pereira; N Moreno; A Castro; R Pontes Dos Santos; H Guedes; D
Araujo; P Pinto
Hospital Centre do Tamega e Sousa, Penafiel, Portugal
Background: Tachycardia-induced cardiomyopathy (TIC) is characterized by ventricular systolic dysfunction and congestive heart failure resulting from persistent or
highly frequent tachyarrhythmias with uncontrolled heart rate. The diagnosis is usually made retrospectively after significant improvement in systolic function is noted
after control of the heart rate.
The purpose of this study was to describe demographic, clinical and echocardiographic characteristics of TIC in our population.
Methods: This was a retrospective study, including patients (pts) admitted in a
single centre, between January 2008 and October 2013, for congestive heart failure with reduced left ventricular ejection fraction (LVEF) and tachyarrhythmia, who
had significant improvement or normalization of left ventricular systolic function
after termination of or control of the tachyarrhythmia. Patients with heart failure
caused by a condition other than tachyarrhythmia, such as ischemic heart disease, valvular heart disease and drug or alcohol induced cardiomyopathy, were
excluded.
Results: 39 pts were identified; 59% women. The mean age was 67,6 ± 9,7 years.
Atrial fibrillation was the underlying arrhythmia in 69,2% and atrial flutter in 30,8%.
The mean heart rate on admission was 150,2 ± 18.8 beats/min . The majority of
patients had severe heart failure, with a NYHA functional class of 2.7 ± 0.8. On
admission the mean LVEF was 30,9%; 10 patients had right ventricular systolic dysfunction associated. The mean left ventricular end-diastolic diameter before treatment was 55,2 mm. Mean follow-up was 31,5 ± 18,7 months. During follow-up, it
was observed total recovery of LVEF in 69,2% pts; 12 pts (30,8%) had only partial recovery. Right ventricular systolic function normalized in total of pts. Mean
LVEF after recovery was 55,3 ± 6,9%; mean left ventricular end-diastolic diameter was 52,1 ± 3,9 mm. 2 pts had recurrence of tachyarrhythmia with deterioration
of LVEF.
Conclusion: TIC remains poorly understood and is likely under-diagnosed. Restoration of LV function and reversal of LV remodeling can be achieved with successful
elimination of tachycardia in the majority of patients.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
P1315
Increased circulating mesenchymal stem cells in patients with essential
hypertension and left ventricular hypertrophy
MMaria Marketou; F Parthenakis; N Kalyva; CH Pontikoglou; S Maragkoudakis; E
Zacharis; A Patrianakos; F Maragkoudakis; H Papadaki; P Vardas
Heraklion University Hospital, Heraklion, Greece
Purpose: Stem and progenitor cells are implicated in ventricular remodelling and
have great clinical significance in many cardiovascular diseases. However, there are
limited data regarding the involvement of mesenchymal stem cells (MSCs) in the
pathophysiology of arterial hypertension. The aim of this study was to investigate
the circulation of MSCs in patients with essential hypertension.
Methods: We included 24 patients with untreated essential hypertension and 19
healthy individuals. All subjects underwent a complete echocardiographic study. In
addition, peripheral blood samples from all participants were immunostained with
antibodies against the cell surface markers CD34, CD45 and CD90. Using flow
cytometry, we measured MSCs as a population of CD45-/CD34-/CD90+ cells and
also as a population of CD45-/CD34-/CD105+ cells. The resulting counts were
translated into the % percentage of MSCs in the total cells of peripheral blood.
Results: Hypertensive patients were shown to have increased circulating
CD45-/CD34-/CD90+ compared to controls (0.0069 ± 0.012% compared to
0.00085 ± 0.0015%, respectively, p% = 0.039). No statistically significant difference in circulating CD45-/CD34-/CD105+ cells was found between hypertensives’
and normotensives’ peripheral blood (0.018 ± 0.013% compared to 0.015 ± 0.014%,
respectively, p% = 0.53). Notably, CD45-/CD34-/CD90+ circulating cells were positively correlated with left ventricular mass index (LVMI) (r% = 0.516, p < 0.001).
Conclusions: Patients with essential hypertension have increased circulating MSCs
compared to normotensives, and the number of MSCs is correlated with LVMI. Our
findings contribute to the understanding of the pathophysiology of hypertension
and might suggest a future therapeutic target.
CO–MORBIDITIES (INC COPD, ANAEMIA, CACHEXIA) –
POSTER PRESENTED
251
and N-terminal fragment of brain natriuretic peptide (NT-proBNP) in patients with
heart failure (CHF) and chronic obstructive pulmonary disease (COPD).
Methods and materials: 60 patients with ischemic CHF and COPD were divided
into two groups depending on forced expiratory volume for the 1st second (FEV-1)
according to spirometry. The 1st group included patients with FEV-1 ≥ 80%, and the
2nd group – those patients who had FEV < 80%. SFTPA was determined in plasma
by enzyme-linked immunoassay using reagent BioVendor (Czech). To evaluate collagen matrix condition TIMP-1 level was estimated; and for severety of myocardial
stress NT-proBNP had been analyzed. To evaluate respiratory function spirometry
was done. Average functional class (FC) of CHF was 2,64 ± 0,48; and FEV-1 was
74,5+23,8%; average age was 55,28 ± 7,81 years.
Results: SFTPA level was reliably lower in the 2nd group than in the 1st :
28,4[23,4;35,8] ng/mL vs 23,1[18,3;25,8] ng/mL (p% = 0,003). NT-proBNP level
was significantly higher in the 2nd group than in the 1st : 9,0[6,2;22,8] fmole/L
vs 18,4[10,6;27,5] fmole/L (p% = 0,018). In both groups slow-up of collagenolisis was indicated more evident in in the 2nd group: 756,7[312,1;944,2] ng/mL
vs 928,7[539,4;1388,2] ng/mL (𝜌% = 0,004). Correlation analysis showed indirect
reliable interconnection of moderate dependency between SFTPA and TIMP-1
(r% = -0,45; 𝜌% = 0,036); and indirect reliable interconnection of severe dependency between SFTPA and TIMP-1 (r% = -0,57; 𝜌% = 0,011).
Conclusions: in patients with ischemic CHF and COPD as bronchial obstruction
raised, there more evident immune disorders connected with SFTPA decrease were
found, which were accompanied with escalation of myocardial stress and collagen
forming.
P1319
Clinical efficacy and safety of tiotropium and indacaterol administration in
patient with chronic heart failure due to coronary artery disease combined
with chronic obstructive pulmonary disease
VVladimir Evdokimov1 ; A Evdokimova1 ; K Tebloev1 ; O Zolotova2
State University of Medicine & Dentistry, Moscow, Russian Federation; 2 City
Clinical Hospital #52, Moscow, Russian Federation
1
Purpose: Among non-cardiac comorbidities, renal dysfunction represents a
frequent complication in heart failure (HF), thus contributing to progression of
ventricular dysfunction. In order to better assess this issue, we investigated traditional [creatinine, eGFR (MDRD), BUN] and emergent [cystatin C (CysC), neutrophil
gelatinase-associated lipocalin (NGAL)] renal function parameters according to age
and gender in HF patients.
Methods: Ninety-five chronic HF patients [NYHA II-IV, left ventricular ejection
fraction (LVEF)≤40%], were studied. Renal function parameters and NT-proBNP
values were evaluated. Estimated glomerular filtration rate (eGFR), calculated by
the Modified Diet in Renal Disease (MDRD) equation, was also assessed.
Results: By investigating renal function parameters according to age groups
( < 65yrs, 65-69yrs, ≥ 70 yrs), higher levels of renal parameters with advancing age were observed. In particular, patients older than 70yrs exhibited
significantly higher concentrations of all parameters investigated [creatinine:
p% = 0.02, eGFR(MDRD): p% = 0.001; BUN: p% = 0.001, CysC: p < 0.0001, NGAL:
p% = 0.001]. Older patients exhibited significantly higher serum NT-proBNP concentrations (p% = 0.009), whereas no significant differences in QRS duration, left
ventricular function, remodeling parameters, and traditional cardiovascular risk
factors according to age groups were found. As concerns the relationship between
renal markers and gender, significantly higher creatinine and NGAL concentrations
in males than in females were observed. No significant differences in NT-proBNP
levels, QRS duration, left ventricular function, remodeling parameters and risk factors according to gender were evidenced. Conclusions: Present findings provide
information concerning the relationship between renal parameters and both age
and gender, thus further contributing to assess the clinical profile in HF patients.
Purpose: to compare clinical efficacy and safety of tiotropium and indacaterol
administration in patient with chronic heart failure (CHF) due to coronary artery
disease (CAD) combined with chronic obstructive pulmonary disease (COPD).
Methods: after enrollment in this trial 100 patients (73 men and 27 women), aged
67.1 ± 5.7 years, with CHF classes II to III (New York Heart Association) combined
with moderate to severe COPD (GOLD-2011) and with initial ejection fraction of the
left ventricle (LVEF) less than 45%, were randomized to three groups - tiotropium (18
𝜇g daily, n = 30), indacaterol (150 𝜇g daily, n = 36) and tiotropium+indacaterol group
(18/150 𝜇g daily, n = 34). Patients of all groups received the complex CHF treatment
comprising diuretics, nebivolol, losartan, cardiac glycosides (subject to indications)
and basic COPD therapy (inhalation corticosteroids). Echocardiography, exercise
tolerance (6-min walk distance), 24-hour electrocardiography and blood pressure
monitoring were assessed at baseline and after 6 months of treatment, respiratory
function test was assessed at baseline, after 1 month and after 6 months. The quality
of life was evaluated by MYHFQ, SGRQ and mMRC.
Results: after 6 months of therapy the improvement of clinical condition and quality
of life were marked in all groups. In 1st , 2nd and 3rd group LVEF was increased
by 7.2%, 6.3% and 12.5%, pulmonary hypertension decreased by 8.7%, 9.3%
and 16.7%, episodes of silent myocardial ischemia decreased by 14%, 16.8%
and 22.5%, respectively. Towards the end of the observation period, in all groups
there was a confident and authentic increase of forced expiratory volume during
1st second (FEV1) witch made 5.3%, 7.8%, and 11.9% accordingly. 6-min walk
distance increased by 18.7%, 22.3% and 29,4% accordingly. Patients showed
statistically significant and clinically meaningful reduction of SGRQ score (17.4%,
19.6%, 24.4%) and MYHFQ score (28%, 24.7%, 32.9%), significant improvements
in MMRC dyspnea grade (22.1%, 25.2%, 28,5% respectively). All treatments were
well tolerated.
Conclusions: the tiotropium and indacaterol inclusion in the structure of complex
therapy in patients with CHF combined with COPD raises efficiency of treatment,
improves quality of life, basic parameters of central hemodinamics and pulmonary
function. Efficacy of long-acting inhaled anticholinergic agent (tiotropium) and
long-acting 𝛽-agonist (indacaterol) in patient with CHF due to CAD combined with
COPD are similar. Combination of these drugs significantly enhances the positive
effects of the therapy.
P1318
P1320
Interconnections between pulmonary surfactant proteins, collagenolisis
markers, and N-terminal brain natriuretic peptide in patients with heart failure
and chronic obstructive pulmonary disease
Iohexol clearance is superior to renal function equations for detection of renal
function decline in chronic heart failure
P1317
Relationship between cystatin c, ngal, and age and gender in chronic heart
failure patients
EElena Sticchi; C Fatini; I Romagnuolo; P Pieragnoli; G Ricciardi; P Attana; GF
Gensini; L Padeletti; R Abbate; A Michelucci
University of Florence, Experimental and Clinical Medicine, Florence, Italy
NNatalia Koziolova; E Kozlova; O Masalkina
Medical Academy, Perm, Russian Federation
Objectives: to evaluate interconnections between pulmonary surfactant-associated
protein A (SFTPA), tissue inhibitor of matrix metalloproteinases of 1st type (TIMP-1),
K Cvan Trobec1 ; M Kerec Kos2 ; S Von Haehling3 ; SD Anker4 ; IC Macdougall5 ;
P Ponikowski6 ; M Lainscak7
1
University Clinic of Respiratory and Allergic Diseases Golnik, Pharmacy
Department, Golnik, Slovenia; 2 University of Ljubljana, Faculty of Pharmacy,
Ljubljana, Slovenia; 3 Charite - Campus Virchow-Klinikum (CVK), Applied Cachexia
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
252
Abstracts
Research, Department of Cardiology, Berlin, Germany; 4 San Raffaele Pisana
Hospital IRCCS, Center for Clinical and Basic Research, Rome, Italy; 5 King’s
College Hospital, Department of Renal Medicine, London, United Kingdom;
6
Wroclaw Medical University, Wroclaw, Poland; 7 University Clinic of Respiratory
and Allergic Diseases Golnik, Division of Cardiology, Golnik, Slovenia
Purpose: In chronic heart failure (HF) patients, several equations for renal function
evaluation are available but were not tested for ability to detect changes over time.
We therefore aimed to compare iohexol clearance and renal function equations for
longitudinal monitoring of renal function in chronic HF patients.
Methods: Renal function was measured with iohexol in 43 chronic HF patients
(mean age 73 years, mean NT-proBNP 2329 pg/ml, 58% men) at baseline and after
at least 6 months. Simultaneously, renal function was estimated with five equations
(four- and six-variable Modification of Diet in Renal Disease (MDRD4 and MDRD6),
Cockcroft-Gault (CG), CG adjusted for lean body mass (CGLBM), Chronic Kidney
Disease Epidemiology Collaboration (CKD-EPI) equation).
Results: During mean follow-up of 8 months (range 6 -17 months), iohexol clearance declined significantly (52.8 vs. 44.4 mL/(min × 1.73 m2 ), p% = 0.001). More
than 25% of patients experienced the decline greater than 15 mL/(min × 1.73 m2 ) Figure. This decline was significantly higher in patients, receiving mineralocorticoid
receptor antagonist at baseline (mean decline -22% of baseline value vs. -2%,
p% = 0.028) and was not associated with other variables. Mean serum creatinine concentration and equation estimated renal function did not change during
follow-up. Using iohexole clearance, 6 patients would advance from stage II to
stage III, and further 6 from stage III to stage IV chronic kidney disease. Individual
equations identified only up to 16% of these patients.
Conclusions: In chronic HF patients iohexol clearance was superior over renal
function equations for evaluation of renal function changes and identified more
patients in whom adjustment or termination of pharmacological therapy should be
considered.
(AUC-ROC) for questionnaire was 0.68. The sensitivity and specificity were 0.92 and
0.30 at a cut-off value of 17 points and 0.75 and 0.54 at a cut-off value of 20 points,
respectively.
Conclusions: Simple patient self-administered questionnaires designed in Western
countries can be used to identify COPD in Japanese patients with HF. Somewhat
higher cut-off values should be required, when these questionnaires are used in
Japan.
P1322
Community acquired pneumonia like the main prognostic factor in acutely
decompensated HF patients
AG Arutyunov
Pirogov Russian State Medical University, Moscow, Russian Federation
Purpose: Investigation of different cardiac co-morbidities in acutely decompensated heart failure (ADHF) patients leads to more questions in non-cardiac
co-morbidities. The role of community-acquired pneumonia(CAP) in patient prognosis is still unclear. Among classic registry aims like rehospitalizations, death rate
and others, one of the main aims of this registry, was to confirm the hypothesis of
severe influence of CAP on this endpoints.
Methods: Men and woman hospitalized with ADHF were included the registry in
27 cities of Russian Federation during 2012 year). Observation period lasts for 360
days, with define points on discharge, day 30,90,180, 360. Among demographic
clinical and laboratory data, more then 20 cardiac and non-cardiac co-morbidities
were analyzed for their influence on endpoints.
Results: 1958 patients were included the final analysis. 93% of man and 96% of
woman had non-cardiac co-morbidities. During primary hospitalization 16,08%
(n = 315) patients had CAP. Rehospitalization rate was 51,6% during one year for all
population and 55,9% for CAP patients p < 0,05. One year death rate was 37,5%
for all population and 45,7% for patients with CAP during the primary hospitalization p < 0,05. Duration of hospitalization was 17,0 ± 5,2 days in CAP patients and
15,1 ± 4,8 days for non CAP patients. Death rate on day 30 in CAP + any other
non-cardiac co-morbidity was 19,6%, and 12% for non CAP patients p% = 0,01.
Creatinine levels in CAP and non CAP patients at hospitalization/discharge - 126,93
and 104,7mmol/l versus 117,62 and 97,6 mmol/l. The most lethal combination of
non-cardiac co-morbidities of AHDF was CAP + CKD + Cirrhosis, the death rate
for this combination was 56,1% during one year. CAP had the most dramatic effect
on analyzed parameters between both cardiac and non-cardiac co-morbidities.
Conclusion: CAP is one of the most often non-cardiac co-morbidity for ADHF
patients and affects essentially the risk of 30 day and one year lethality, duration
of hospitalization, rehospitalization rate and is associated with more severe kidney
injury. CAP during ADHF needs more investigations.
P1323
Impact of non-cardiovascular disease comorbidity on symptom severity in
heart failure and other cardiovascular diseases: a population-based study
Renal function decline during follow-up
C AClaire Rushton; U T Kadam
Keele University, Health Services Research Unit, Stoke-on-Trent, United Kingdom
P1321
Symptom-based questionnaires for identifying chronic obstructive pulmonary
disease in Japanese patients with heart failure
KKeisuke Kida; N Suzuki; K Teramoto; K Ashikaga; K Yoneyama; K Suzuki; YJ
Akashi
St.Marianna University School of Medicine, Department of Internal Medicine,
Division of Cardiology, Kawasaki, Japan
Background: The clinical symptoms and signs of heart failure (HF), such as
shortness of breath, fatigue and cachexia, overlap with those of chronic obstructive
pulmonary disease (COPD). The coexistence of HF and COPD is estimated to range
from 10% to 33%. The symptom-based questionnaire designed by the International
Primary Care Airway Group (IPAG) may help identify COPD in HF patients.
Purpose: This study aimed to evaluate whether COPD questionnaires designed in
Western countries were applicable to Japanese patients with HF.
Methods: Two hundred ninety Japanese patients with HF aged 40years and
over, who answered questions covering demographics and symptoms and then
underwent spirometry, were enrolled. A ratio of forced expiratory volume in one
second (FEV1) to forced vital capacity (FVC) less than 70% was defined as a study
diagnosis of COPD according to the guideline described by Global Initiative for
Chronic Obstructive Lung Disease (GOLD). Mild COPD was defined as FEV1 ≥
80% of predicted value, moderate COPD as 50% ≤ FEV1 < 80% of predicted
value, and severe COPD as FEV1 < 50% of predicted value. Results: Of the
study population, 84 patients (29%) were identified as having COPD: 29 patients
(10%) had mild, 49 (17%) had moderate, and 6 (2%) had severe COPD. The COPD
group was significantly older (72.8 ± 8.2 vs. 65.7 ± 12.4 years, p < 0.0001) than the
non-COPD group. A significant difference in the total questionnaire score (22.1 ± 5.0
vs. 18.7 ± 5.5 points, p < 0.0001) was observed in a comparison between the COPD
and non-COPD groups. The area under the receiver operating characteristic curve
Purpose: Non-cardiovascular comorbidity is prevalent in heart failure and other
cardiovascular disease (CVD) populations, but its influence on the common CVD
symptoms that patients experience such as shortness of breath and chest pain is
unknown. Currently interventions aimed at improving symptoms are targeted at specific diseases and we wanted to test the a priori hypothesis that an unrelated comorbidity would increase CVD chest pain and shortness-of-breath symptom-specific
physical limitations. Furthermore we wanted to investigate whether the impact of
non-cardiovascular disease on CVD symptoms would be less in more severe disease such as heart failure. This information is important in developing patient centred
interventions aimed at improving symptoms and quality of life.
Methods: The study was based on 5,426 patients from ten population-based family
practices with linked diagnostic-survey data. The 8 a priori exclusive cohort groups
were: (i) no CVD or Osteoarthritis (OA) (reference), (ii) index hypertension, ischemic
heart disease (IHD) and heart failure (HF) without OA (iii) index OA without CVD
and (iv) same CVD groups with comorbid OA. The Seattle Angina Questionnaire
survey measured chest pain physical limitations and the Kansas City Cardiomyopathy questionnaire measured shortness-of-breath limitations. Adjusted associations
between the cohorts and physical limitations were assessed using linear regression
methods.
Results: Of the 5,426 study population, 1443 (27%) reported chest pain and 2097
(39%) shortness-of-breath. Chest pain and shortness of breath physical limitations
increased with CVD severity in the index and comorbid groups. To assess the effect
of OA on the symptom limitations directly we compared the comorbid groups to
their respective index CVD group. The difference in the chest pain physical limitations score were: -14.7 (95%CI -21.5, -7.8) for hypertension, -5.5 (-10.4, -0.7) for IHD
and -22.1 (-31.0, -6.7) for HF. The CVD comorbid differences for shortness of breath
physical limitations estimates were -9.2 (-13.8, -4.6) for hypertension, -6.4 (-11.1,
-1.8) for IHD and -8.8 (-19.3, 1.65) for HF. OA added to the symptom limitations in
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
each CVD group and for chest pain was most prominent in the heart failure group.
Conclusions: In all CVD groups, chest pain and shortness-of-breath are common
symptoms, and OA increases the physical limitations associated with these symptoms additively even in more severe disease such as heart failure. Specific comorbidity interventions need to be developed for CVD and heart failure specific health
outcomes.
P1324
253
6347 pg/mL (IQR 2534,75-10315,75) at baseline to a median of 1657,5 pg/mL (IQR
1003,25-4274, p% = 0.002) at discharge. On the other hand QoL compromising
improved from a score of 8.6 ± 1.6 at baseline to 7.8 ± 1.7 after 30 days (p% = 0.034).
Conclusions: Transcatheter edge-to-edge repair leads to a significant short-term
improvement in symptoms, functional status and quality of life in patients considered
at high risk for conventional cardiac surgery. These are useful measurements of
functional capacity easily performed, not expensive and repeatable. In addition in the
subset of heart failure patients NT-proBNP can be very useful not only in diagnosis
but also in monitoring the results after mitra clip implantation.
Absence of obesity paradox for acute heart failure with diabetes, whereas
evidence of obesity paradox for acute heart failure without diabetes
KKazumasa Harada1 ; T Sakai2 ; S Kohsaka2 ; N Sato2 ; A Takagi2 ; T Miyamoto2 ; K
Iida2 ; S Tanimoto2 ; K Nagao2 ; M Takayama2
1
Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; 2 Tokyo CCU Network
Scientifc Committee, Tokyo, Japan
Purpose: Patients with acute heart failure (AHF) are often complicated with diabetes
mellitus (DM), and are associated with poor outcomes. Although DM is a major
complication of obesity, obesity is paradoxically related to survival benefit in patients
with AHF. Therefore, we studied the association between obesity and outcomes in
HF patients with or without DM.
Methods: The CCU Network Database is an on-going emergency medical service
registry supported by 71 hospitals. Among 3136 patients hospitalized for AHF in
2011 (75.0 ± 0.2 years; men, 59%), data on DM medications or HbA1c levels were
available in 2125 patients.
Results: DM was complicated in 29% of the patients. In-hospital mortality rate
during hospital stay was 8.4%, and 28.9% of the patients had a history of AHF
admission. Logistic regression analysis with an in-hospital mortality rate as a
dependent variable showed that LVEF, hemoglobin concentration (Hb), body mass
index (BMI), and the total cholesterol level were independent factors after adjusting
age and sex. On the other hand, LVEF, Hb, BMI, and complications of atrial
fibrillation or flutter were independent determinants of AHF re-admission. DM was
not associated with any clinical outcomes. In patients with AHF and DM, high BMI
conferred no survival benefit (OR 0.97; 95%CI 0.87-1.09; P% = 0.59), but high Hb
conferred survival benefit (OR 0.77; 95%CI 0.62-0.97; P% = 0.027). In contrast, in
patients with AHF and no DM, high BMI was associated with survival benefit (OR
0.89; 95%CI 0.82-0.96; P% = 0.005), but Hb was not associated with survival (OR
0.89; 95%CI 0.78-1.01; P% = 0.07).
Conclusions: Absence of obesity paradox for AHF and DM may be explained with
a complex interaction of two nutritional factors (BMI and Hb). In patients with AHF
and DM, anemia rather than emaciation might be a better expression of cachexia.
VALVULAR HEART DISEASE (DIAGNOSIS, MANAGEMENT
AND INTERVENTIONAL THERAPIES) – POSTER PRESENTED
P1326
P1327
Percutaneous closure of residual interatrial communication after
transcatheter edge-to-edge procedure in heart failure patients
GP Ussia; VValeria Cammalleri; S Muscoli; G Pascuzzo; E Mazzotta; D Rubino; F
De Persis; M Macrini; M Marchei; F Romeo
University of Rome, Polyclinic “Tor Vergata”, Department of Cardiology, Rome, Italy
Purpose: Aim of our study was to assess the hemodynamic impact of the intracardiac shunt due to the residual interatrial communication (IAC) after transcatheter
edge-to-edge repair.
Methods: From January 2012 to December 2013, 60 consecutive patients (70%
males; mean age 73 ± 9 y.o.; mean logistic EuroSCORE 22 ± 18%), have been
treated with mitra clip. Forty-seven patients (78%) had secondary mitral regurgitation (MR) with a mean left ventricle ejection fraction (LVEF) of 30 ± 10%; 13 patients
suffered from primary MR with a LVEF of 56 ± 8% (p < 0.00001). The residual IAC
was immediately evaluated with transesophageal echo after the guiding-catheter
was withdrawn; additionally the right cardiac catheterization was performed before
and after the procedure.
Results: The procedures were performed in deep-sedation and spontaneous
breathing in 36 patients (60%), whereas 24 (40%) were intubated under general
anesthesia; one, two and three clips were implanted in 23 (38%), 36 (60%), 1 (2%)
patients, respectively. The mean device time was 41 ± 26 minutes and no intraprocedural deaths occurred. The IAC measured 0,6 ± 0,4 cm and Qp/Qs was estimated
1,4 ± 0,2. Six patients (10%) needed percutaneous closure of the residual defect,
using devices for patent foramen ovale, because the shunt was judged to have
significant hemodynamic impact. In 4 patients the closure was performed acutely
during the same session. Among these the shunt was bidirectional in 3 cases,
whereas one patient had acute right ventricle overload with severe acute cardiac
failure. Sequentially two patients, who developed chronic right cardiac failure, have
been treated treated after one month and eight months, respectively. In addition
another patient treated five years before for secondary MR and severe left ventricular failure in another institution developed a severe pulmonary hypertension, which
improved after closure.
Conclusions: In patients with very low LVEF and right ventricle dysfunction even
small IAC with Qp/Qs < 1,4 can cause signs of cardiac failure. A careful monitoring
and hemodynamic assessment are mandatory to select patients who need percutaneous closure of the defect.
Functional parameters to assess clinical benefit after transcatheter
edge-to-edge repair
VValeria Cammalleri; S Muscoli; G Pascuzzo; E Mazzotta; F De Persis; D Rubino;
M Macrini; M Marchei; F Romeo; GP Ussia
University of Rome, Polyclinic “Tor Vergata”, Department of Cardiology, Rome, Italy
P1328
Purpose: We assessed the role of NYHA functional class, six-minutes-walking
distance (6MWD), N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma
level and quality of life (QoL) as integrative parameters to evaluate efficacy and
clinical impact of transcatheter edge-to-edge repair in patients with severe mitral
regurgitation (MR).
Methods: In patients who underwent mitra clip repair, we evaluated NYHA functional
class and 6MWD before the procedure, at the discharge and after 30-days. During
the hospitalization, before the procedure and the day of discharge, BNP serum levels
have been collected. Furthermore we calculated QoL using a self-administration
questionnaire. Acute procedural success was defined as stable implant of one (or
more) clip(s) resulting in MR 2+.
Results: From January 2012 to December 2013, 60 consecutive patients (mean
age 73 ± 9 years old, males 86%) underwent transcatheter edge-to-edge repair
with one (38%), 2 (60%) or 3 clips (2%). The mean of left ventricle ejection
fraction was 35 ± 13%. Functional MR and degenerative MR were present in 78%
and 22%, respectively. Acute procedural success was obtained in all patients. At
discharge 82% of patients had MR1+; 18% MR2+. At 30 days 75% of patients
had MR1+; 23% MR2+ and 2% MR 3+. During in-hospital stay one patient died
for pneumonia at the 13 day after the procedure. Overall NYHA improved from
3.3 ± 0.7 at baseline to 1.8 ± 0.5 at discharge (p < 0.0001), and 1.8 ± 0.7 after 30
days (p < 0.0001 when compared with baseline; p% = ns when compared with
discharge). 6MWD improved significantly from a median of 95 m (IQR 67,50-170)
at baseline to 174 m (IQR 103-202,50) at discharge (p < 0.002) and 180 m (IQR
135-220) at follow-up (p% = 0.005 when compared with baseline; p% = 0.066 when
compared with discharge). NTproBNP plasma levels decreased from a median of
VValeria Cammalleri1 ; S Muscoli1 ; E Mazzotta1 ; G Pascuzzo1 ; G Liciani2 ; M
Macrini1 ; P De Vico2 ; D Colella2 ; F Romeo1 ; GP Ussia1
1 University of Rome, Polyclinic “Tor Vergata”, Department of Cardiology, Rome,
Italy; 2 University Hospital Policlinico Tor Vergata, Anaesthesia, Rome, Italy
Anaesthesiological management using deep sedation and spontaneous
breathing during transcatheter edge-to-edge repair
Purpose: As general anaesthesia can be associated with potential hemodynamic
and respiratory complications, we have developed an approach where transcatheter
edge-to-edge procedures are performed under deep sedation and spontaneous
breathing. We report here our initial experience.
Methods: The study population includes 60 consecutive patients (mean age 73 ± 9
y.o.; males 70%; median logEuroSCORE 22 ± 18%) treated with mitra clip for mitral
regurgitation (MR) ≥ 3+. Twenty-four (40%) patients received general anaesthesia
and orotracheal intubation; 36 (60%) patients underwent deep sedation management, consisting of administration of midazolam and fentanyl citrate as anaesthesia inductors, followed by continuous infusion of remifentanil hydrochloride. Once
sedation was achieved the transesophageal probe was placed and the procedure
performed in a standard fashion.
Results: Anaesthesia and procedural time were significantly shorter in remifentanil group when compared to general anaesthesia patients (119 ± 35 vs. 80 ± 35;
100 ± 36 vs. 60 ± 34; respectively, p% = .001 for both). Similarly device time was
briefer in patients treated under deep sedation (51 ± 30 vs. 35 ± 20, p% = .015).
No differences in the number of clips implanted were presented between the
two groups. All procedures were carried out successfully resulting in final MR
< 2+ and acute procedural success, without major intraprocedural complications.
In-hospital and 30-days outcomes were similar in both groups. At 30-day follow-up
a persistent MR reduction and improvement in NYHA functional class were observed
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
254
Abstracts
uniformly.
Conclusions: Transcatheter edge-to-edge repair under deep sedation with spontaneous breathing may be a viable alternative, with particular advantages in patients
at high risk for general anaesthesia and with ideal mitral valve anatomy, being associated in significant reduction of anaesthesia and procedural time.
P1329
Anaesthesiological management using Remifentanil-based deep sedation
and spontaneous breathing during TAVI
G P Ussia1 ; S Muscoli1 ; VValeria Cammalleri1 ; D Rubino1 ; F De Persis1 ; G
Pascuzzo1 ; E Mazzotta1 ; M Macrini1 ; P De Vico2 ; F Romeo1
1
University of Rome, Polyclinic “Tor Vergata”, Department of Cardiology, Rome,
Italy; 2 University Hospital Policlinico Tor Vergata, Anaesthesia, Rome, Italy
Background: General anesthesia in patients underwent TAVI is hazardous and associated with significant complications, prevalently in very ill patients. We assessed
the feasibility and safety of deep sedation (DS) with local anesthesia during TAVI in
patients with high surgical risk.
Methods: From November 2011 to November 2013, 81 patients at high risk for
open-heart surgery (mean age 81 ± 7, aortic valve area 0,65 ± 0,2;), with severe aortic stenosis, were treated with TAVI using CoreValve Revalving System® (Medtronic,
Minneapolis, Minnesota). The assessment of surgical risk was based on Logistic EuroScore (36,74 ± 13,68%), STS mortality score (22,9 ± 16%) and evaluation
of NHYA functional class (2,8 ± 0,3). Adjunctive risk criteria were: frailty, porcelain
aorta, sever liver disease/cirrhosis, hostile chest or other critical conduits adherent to the sternum, severe right ventricle dysfunction, chest radiation, degenerative
neurological disorders, or any contraindication to extracorporeal circulation. DS was
performed using midazolam and fentanyl citrate as anesthesia inductors, followed
by continuous infusion of remifentanil hydrochloride, small bolus of propofol, monitoring capnometry and saturation of O2. Adverse events were evaluated according
to VARC2 criteria.
Results: All interventions were completed in DS except for 1 patient who required
oro-tracheal intubation for unexpected systemic desaturation (extubation performed in cath-lab). 4 patients required supra-glottic device. Procedural time was
62,2 ± 17,6 minutes. Procedural success was achieved in all cases. The mean
trans-aortic valve gradient decreased from 60,94 ± 18,65 mmHg to 7,78 ± 4 mmHg
after the procedure (p% = 0.0021). In intensive care unit-stay was 3,2 ± 1,5 days and
the discharged was obtained after 6,1 ± 1,6 days. Although the patients were treated
with DS we observed a stable blood gas analysis during the procedure and hospitalization. A significant clinical benefit was immediately observed at discharged,
after 30 days and 6 months. All patients showed a significant improvement of NYHA
functional class from 2,8 ± 0,3 to 1,5 ± 0,7 at 30 days; (p < 0,00001) and to 1,4 ± 0,5
(p < 0,0001) at 6 month.
Conclusions: TAVI can be performed under DS and spontaneous breathing with
particular advantages in patients at high risk for general anesthesia. Furthermore
DS could reduce procedure duration, time to ambulation, overall hospital-stay and
additionally healthcare costs.
P1331
Trimetazidine improves symptoms, myocardial function, and quality of life in
operated valvular heart disease: results from a randomized, open-label,
case-control 1-year study
IRIlshat Gaisin1 ; AS Gazimzyanova2 ; TV Sokolova2 ; NI Maksimov1 ; AA Galimova2 ;
MA Voronova2 ; EA Chernikch2 ; IR Poyarkina2
1
State Medical Academy, Izhevsk, Russian Federation; 2 Clinical Diagnostic Centre
of the Udmurt Republic, Izhevsk, Russian Federation
Background: Successful surgery for valvular heart disease prolongs life and generally improves symptoms and cardiac function. Nevertheless, myocardial dysfunction and health-related quality of life (HRQoL) impairment may persist and worsen
postoperatively. We hypothesized that long-term trimetazidine would help improve
symptoms and HRQoL after valve replacement.
Methods: 150 patients [aged 55.3 ± 3.2 years; 58% males; 62% NYHA class III, 38%
NYHA class II; 38.7% concomitant SCAD, 24% CABG; median (IQR) 6-min walk distance (6-MWD) 354 (159–438) m; mean (SE) left ventricular ejection fraction (LVEF)
58.5 (2.9)%] 2–4 weeks after conventional aortic (n = 84) or mitral (n = 66) valve
replacement by mechanical prostheses (40% due to degenerative, 32% rheumatic,
12% myxomatous, 10% congenital valve diseases and 6% infectious endocarditis)
were randomized 1:1 to receive either optimal standard therapy or trimetazidine 35
mg b.i.d. added to conventional treatment. Efficacy endpoints included changes
from preoperative baseline in 6-MWD, NYHA functional class, echo-parameters,
heart failure hospitalizations, and all-cause mortality. HRQoL was assessed by the
Short Form (SF-36 v.1) Health Survey.
Results: At baseline, there were no significant differences between trimetazidine
and control group. Patients reported poor postoperative HRQoL. At month 12,
patients receiving trimetazidine (n = 75) had a mean increase in 6-MWD of 168
m (p < 0.0001); control patients (n = 75) had a mean 6-MWD increase of 124 m
(p < 0.001), with a control-adjusted difference of +44 m (p% = 0.036). NYHA status improved by two classes in 42.7% of trimetazidine versus 24% of controls
(p% = 0.032), by one class in 57.3% versus 76% (p% = 0.032). Trimetazidine delayed
the time to clinical worsening (p% = 0.018) and reduced the heart failure admissions
(p% = 0.0038). Improvements were noted in control-adjusted changes in postoperative heart remodelling, e.g. in mean LVEF (+4.2%; p% = 0.0024), left ventricular
end-diastolic diameter (–5.8 mm; p% = 0.0015), and end-systolic diameter (–3.8
mm; p% = 0.004). Combination therapy with trimetazidine was well tolerated. In both
groups, SF-36 scores substantially rose after follow-up. Trimetazidine patients had
significant higher improvements in HRQoL over time compared to controls. One
patient died in the control group (p% = 0.78).
Conclusions: Long-term trimetazidine therapy for patients with mechanical aortic/mitral valve prostheses improves symptom status, cardiac function, and HRQoL.
This study provides the evidence that trimetazidine may be a new additional therapy
for patients after proceeding with surgical valve replacement.
P1332
Prognostic value of concomitant pathology on severity of heart failure after
valve replacement
AAndrey Zhadan1 ; E Zigvinidze1 ; O Romanenko2
Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine; 2 CIty
Clinical Hospital #8, Kharkiv, Ukraine
1
P1330
Abnormal heart chords prevalence and topogtraphical characteristic
E LEugenie Trisvetova; OA Yudina
Belarusian State Medical University, Minsk, Belarus
Theaim of the study was to determine the frequency and topography of abnormal
heart chords (AHC) by autopsy. Methods included macro- and microscopic investigation of heart structures, their morphometry.
Results: Of a list of the 578 departed (mean age 63.1 ± 1.08 years), 51% men, 49%
women, 107 AHC were found in 70 hearts (12.1%). AHC prevailed in men (60.9%).
AHC were observed in one heart chamber in 82.9% of cases, more frequent in the
left ventricle (76.6%) than in right ventricle (20.6%) and right atrium (2.8%). Solitary abnormal bands in the left ventricle were diagnosed in 65.7% of cases in the
right ventricle - in 18.6% of cases. Abnormal chords occurred in twos in a one heart
chamber (in the left ventricle - 17.4% in the right ventricle - 4.3%) and in threes (in
the left ventricle - 5.7% in the right ventricle - 1.4%). A combination of right and left
heart chambers chords anomalies was found in 7% of cases. The abnormal chords
had two insertion sites to the heart chambers walls in 94.3% of cases, three or
more sites - in 5.7%. Abnormal bands occupied the diagonal, transverse, longitudinal position, and connected various anatomical heart structures: frequently papillary
muscles with interventricular septum, papillary muscles together, papillary muscles
with the wall of the ventricle, ventricular walls together. The chords thickness was
1-2 mm, in the diagonal position - 10 - 75 mm, in the transverse position - 7-79 mm,
contractility and extensibility - 0 to 12 mm.
Conclusion: AHC are defined in the left, right ventricle and right atrium, frequently
in men by autopsy. Solitary bands with two insertion sites are more common, occupying the diagonal and transverse position.
Objectives: To evaluate the prognostic value of concomitant pathology on severity
of heart failure in patients who underwent heart valve replacement after 6 months
follow-up period.
Methods and Results:153 patients (mean (SD) age 57.5 ± 11,3 years) who underwent heart valve replacement (VR) with aortic (95 patients) and mitral valve disease
(58 patients). 64 were male and 89 were female. 79 patients has atrial fibrillation
(AF), 54 has arterial hypertension (AH), 28 has coronary artery disease (CAD), 20
has severe pulmonary hypertension (PH) and 16 patients has diabetes mellitus type
2 (Dm2 ). Before operative treatment 110 patients has NYHA class III-IV heart failure. 6 months after valve replacement majority (133 patients) has NYHA class I-II
heart failure. But in some cases (20) patients remained NYHA class III-IV. This study
was conducted with the aim of identifying the most unfavorable prognostic factors
among concomitant pathology. Correlation analysis (Spearman rank order correlations) was carried between the severity of HF after 6 months and the presence of
most common concomitant diseases such as AH, AF, CAD, Dm2 , PH. Most pronounced correlation was found between the degree of heart failure (Table 1) and
the presence of severe pulmonary hypertension (correlation coefficient – 0.87) and
atrial fibrillation (0.73). Also it was observed a statistically significant (p < 0.05) association between the presence of heart failure and arterial hypertension (0.51). Much
more expressed relationship observed between arterial hypertension and atrial fibrillation, Dm2 , CAD. The least predictive value for the severity of HF 6 months
after valve replacement has coronary artery disease (0.46) and type 2 diabetes
mellitus (0.27).
Conclusions: Presence of PH and AF before surgery are the most unfavorable prognostic factors in patients 6 months after the valve replacement.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
255
Table 1.
PH
AH
AF
Dm2
CAD
HF NYHA III-IV
class 6 months
after VR
0.87&
PH
1.0
0.14
0.3
-0.13
0.62
AH
0.14
1.0
0.74&
0.67&
0.76&
0.51&
AF
0.31
0.74&
1.0
-0.42
-0.35
0.73&
Dm2
-0.13
0.67&
-0.42
1.0
0.65&
0.27
CAD
0.62
0.76&
-0.35
0.65&
1.0
0.45
HF NYHA III-IV
class 6 months
after VR
0.87&
0.51&
0.73&
0.27
0.45
1.0
& - p < 0.05
P1333
Effect of transcatheter aortic valve implantation on improvement of heart
failure symptoms and functional class in patients with severe degenerative
aortic stenosis
W Kong; M Liang; K Kyu; KK Poh; E Tay; J Yip
National University Heart Centre, Department of Cardiology, Singapore, Singapore
Purpose: Severe degenerative aortic stenosis (AS) is always causing symptoms of
congestive heart failure impairing quality of life in elderly patients. We assessed the
effect of transcatheter aortic valve implantation (TAVI) on improvement of heart failure symptoms and also New York Heart Association (NYHA) functional class.
Methods: From April 2011 to April 2013, symptomatic patients with severe aortic stenosis (aortic valve area < 1 cm2 ) and the indication for TAVI were included.
Aortic valve prosthesis (all are Edwards Sapien XT bioprosthesis) was implanted
via transfemoral, transapical and transaortical methods. All procedures were guided
through transeosphageal echocardiography. Clinical evaluation and all parameters
of LV systolic and diastolic function was done at baseline and at six-months after
TAVI. Echocardiography included standard 2D and Doppler analysis of global systolic and diastolic function as well as Tissue Doppler echocardiography.
Results: Thirty patients successfully underwent TAVI (66% were male). The mean
age was 79.3 ± 7 years and mean log EuroSCORE was 20.2 ± 8.4. Maximum
transvalvular aortic pressure gradient and mean transvalvular aortic pressure gradient were reduced from 90 ± 30 to 15 ± 7 mm Hg and from 55 ± 15 to 10 ± 4 mm
Hg, respectively (P% = .01), accompanied by significant clinical improvement. The
mean LV ejection fraction improved from 52 ± 17% to 56 ± 17% during follow-up
(P% = .016). The septal E/e ratio decreased from 27 ± 13 to 20 ± 7 (p% = .005), the
lateral wall E/e ratio decreased from 19 ± 10 to 16 ± 7 (p% = .041). Short-term clinical
follow up (mean 180 days after TAVI) revealed an improvement of NYHA functional
class (mean 2.9 ± 0.9 vs. 1.5 ± 0.8, p < 0.001)
Conclusions: After successful TAVI for severe AS, LV systolic and diastolic function was remarkably improved in most patients after 6 months, which is associated
with an improvement of NYHA functional status and symptoms of congestive heart
failure.
P1334
Hemodynamic assessment of percutaneous versus surgical bioprostheses
for aortic stenosis during exercise: a pilot study
GGuilherme Portugal; A V Monteiro; A Abreu; L Patricio; D Cacela; L Moura
Branco; P Rio; S Silva; R Cruz Ferreira
Hospital Santa Marta, Department of Cardiology, Lisbon, Portugal
Background: Poor hemodynamic performance as assessed by transprosthetic gradient (TG) after aortic bioprosthesis implantation is associated with less symptomatic improvement and worse prognosis. This effect is magnified in smaller valves.
Transcutaneous aortic valve implantation (TAVI) has been associated with lower TG
when compared to surgical aortic valve replacement (SAVR) in previous studies.
However, no data are available on the hemodynamic response to exercise in this
population.
Aim: To assess the hemodynamic performance of TAVI versus SAVR in small sized
valves at rest and exercise
Methods: Twenty patients (P) were prospectively assessed, consisting of 10 P submitted to TAVI with the Corevalve prosthesis (23 & 26) and 10 age-matched SAVR
controls with similar valve dimensions, who had been submitted to valve implantation within a similar interval. A symptom-limited treadmill exercise protocol (EP)
modified for frail/elderly patients was used. Echocardiographical evaluation was performed at rest and peak exercise.
Results: No significant differences between groups were found on patient age (TAVI
81,7 + 6.66 y vs SAVR 80.2 + 3.37 y), BMI (25.0 +0.9 vs 27.8 +1.15, all p% = NS)
or time since implantation (17.2 +3.6 vs 14.7 +5.3 months, p% = NS). The logistic
Euroscore was higher in TAVI patients (15.2% vs 8.7%; p 0.013). SAVR patients
were more likely to be under betablocker therapy (20% vs 70%, p% = 0.025), with
no other differences in medication. Max heart rate during EP was 107 +10.9 vs 121
+10.4 and exercise duration was 7.21 + 1.8 vs 14.0 + 4.7 minutes (p% = 0.002).
No differences were found on left ventricular (LV) ejection fraction (EF)(LVEF < 50%:
30% vs 20%) or LV dimensions (LV end-diastolic diameter (d) 50.8 +2.3 vs 50.5
+2.6, LV end-systolic d 29.1 +1.9 vs 31.8 +2.3, p% = NS). Resting TG was significantly lower in TAVI patients (Max TG 14.43 +1.79 vs 21.5 +1.15, p% = 0.003, mean
TG 7.5 +1.0 vs 12.5 +0.8, p% = 0.0019). TG at peak exercise was also significantly
lower in TAVI patients (Max TG 23,3 +3,1 vs 38.7 +3.6, p% = 0.004; mean TG 11.7
+2.1 vs 21.1 +2.3, p% = 0.01). Systolic pulmonary artery pressure, transmitral wave
velocities and peak LVEF were similar. After multi-variate analysis of baseline clinical and echocardiographical variables, TAVI was the only independent predictor of
lower max TG at rest and at peak exercise(p% = 0.032, p% = 0.023)
Conclusion: Patients submitted to TAVI have a better transprosthetic hemodynamic
profile at rest and during exercise than SAVR. TAVI may be a more suitable option in
AVR in patients when a small diameter bioprosthetic valve is implanted.
P1335
Functional capacity, depression, anxiety and frailty assessment of patients
undergoing transcatheter versus surgical aortic prosthetic valve implantation
AAndre Monteiro; G Portugal; A Abreu; L Patricio; D Cacela; R Soares; M
Nogueira; S Silva; S Alves; R Ferreira
Hospital Santa Marta, Department of Cardiology, Lisbon, Portugal
Background: Transcatheter aortic valve implantation (TAVI) has emerged as an
alternative treatment modality for high-risk and inoperable aortic stenosis patients
(P). Nevertheless, few comparative data is available regarding functional capacity, depression, anxiety and frailty in TAVI, when compared to surgical aortic valve
replacement (AVR).
Aims: Pilot study for objective comparative assessment of functional aerobic capacity change, using cardiopulmonary exercise test (CPET), and depression, anxiety and
frailty modification after a traditional AVR versus TAVI.
Methods: Ten TAVI P (aged 81.7 ± 6.66 years; 30% male; BMI 26 ± 3.62) submitted
to Corevalve prosthesis (number 23 or 26) implantation were submitted to CPET
(Group A) and compared to 10 surgical biological AVR P (aged 80.2 ± 3.37 years;
50% male; BMI 27 ± 3.66) (Group B). Both types of biological prosthesis had similar
dimensions. An adjusted protocol for frail/elderly P was used and PECR functional
capacity parameters were obtained. For the assessment of depression and anxiety,
the Hospital Anxiety and Depression Scale (HADS) and a Frailty Index were used.
Results: As expected, Group A had more comorbidities with a higher Euroscore
score (15.2% vs 8.7%; p 0.013). All P underwent CPET, with shorter duration in
Group A (7 ± 4.06 vs 13.89 min; p 0.002). No severe complications such as syncope,
ischemic or arrhythmic events occurred. Maximum oxygen consumption (VO2max)
was superior in group B (17.48 ± 3.59 vs 13.32 ± 3.20 ml/kg/min; p 0.029), when
considering the absolute value. However, after adjustment for gender, weight, physical activity and age (VO2 %) this superiority lost significance (103% vs 83%;
p% = NS). Group A presented a significantly inferior anaerobic threshold (4.73 ± 1.98
vs 8.31 ± 3.19; p% = 0.018) and a non significantly higher slope ratio between minute
ventilation and CO2 production (31 ± 6.21 vs 28 ± 10.47; p% = NS). Assessment of
depression and anxiety variation, as well as in frailty index variation revealed no differences between Group A and B (respectively 12 ± 7.96 vs 13 ± 9.53, p% = NS and
9 ± 5.86 vs 7 ± 3.58, p% = NS).
Conclusion: Overall, both AVR and TAVI populations presented an acceptable functional aerobic capacity without a clear superiority of either group after adjustment
to baseline features. Both the psychological status of depression/anxiety and frailty
improved after aortic intervention with no significant difference between surgical and
TAVI groups.
DEVICES ARTIFICIAL HEART CRT ICD/SURGERY – POSTER
PRESENTED
P1337
Novel noninvasive direct lung water measurement using KYMA technology in
CHF: A First In Man Clinical validation comparison study using invasive
hemodynamic and “gold standard” extravascular Lung
MMichael Jonas1 ; A Nini2 ; G Karp3 ; A Nimrod3
Medical Center, heart institute, Rehovot, Israel
1 Kaplan
Pulmonary congestion/edema is an acute increase in extravascular lung fluid. No
direct, reliable, simple and non-invasive method is available for accurate assessment of lung water. KYMA developed a miniature external patch device, monitoring
lung water content by analyzing electromagnetic ("radar") signals, propagated
through tissue layers. Positive results were found in pre-clinical animal studies. we
now compared KYMA’s non-invasively measured Lung water index (KLWI) with
Picco invasive thermodilution based assessment of extravascular lung water in ICU
patients.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
256
Abstracts
Methods: Patients hospitalyzed in a respiratory ICU with clinically indicated invasive Picco monitoring were included. KYMA lung water index was compared to
invasive PICCO thermodilution based extravascular lung volume water (EVLW) as
the reference gold standard.
Results: data for 12 patients is available, 50% male, age 65 ± 16. Measured 4-12
data points per patient (total 125 measurement points), each data point include
PiCCO lung water reading and simultaneous, KYMA patch reading. The KYMA
patch performed well, no side effects or interference to ICU monitors/workflow.
A consistent linear correlation between measurements of invasive EVLW and
non-invasive Kyma KLWI was found (Figure). KYMA’s lung water accuracy ranged
between 60-70cc while the change in fluid content between normal and congested
lung ranges between 250-500cc
Conclusions: KYMA’s external, miniature patch device yielded a lung water fluid
index with excellent correlation to invasive measurement. The demonstrated accuracy of the Kyma technology supports its use for high resolution precise thoracic
fluid monitoring. KYMA’S device may improve CHF in-hospital management,
and potentially reduce Re-hospitalizations. clinical trials with the Kyma patch are
on-going
KYMA and Picco correlation
P1338
Effectiveness of an interactive platform with disease management facilities,
and of the ESC/HFA heartfailurematters.org website: a 3-arm multicenter
randomised trial, the e-Vita heart failure study
K P Wagenaar1 ; B D L Broekhuizen1 ; T Jaarsma2 ; A Mosterd3 ; F F Willems4 ;
K Dickstein5 ; A W Hoes1 ; F H Rutten1
1 University Medical Center Utrecht, Julius Centre for Health Sciences and Primary
Care, Utrecht, Netherlands; 2 Linköping University, Department of Social and
Welfare Studies, Linköping, Sweden; 3 Meander Medical Center, Amersfoort,
Netherlands; 4 Rijnstate Hospital, Arnhem, Netherlands; 5 University of Bergen,
Bergen, Norway
Background: Electronic health support (e-health) may improve quality of life
(QoL) and self care of patients with heart failure (HF). We aim to assess whether
an adjusted care pathway with replacement of routine consultations by e-health
improves self care and QoL compared to usual care. Additionally, we aim to assess
whether the use of the heartfailurematters.org (HFM website) improves patient
outcomes compared to usual care.
Methods: A three-arm parallel randomised trial. Arm 1 consists of usual care; arm
2 is usual care plus the HFM website; and arm 3 is the adjusted care pathway with
an interactive platform for disease management and a link to the HFM website,
replacing routine consultations with HF nurses. In total, 750 patients enlisted in ten
Dutch HF outpatient clinics or from general practices in the vicinity will be included
and followed up for 12 months. Participants should have an established diagnosis
of HF, either with or without reduced ejection fraction for at least 3 months, receive
the medication according to the current HF guidelines and have been provided with
essential education. The primary outcomes will be self care and QoL measured with
validated questionnaires. Secondary outcomes are all-cause mortality, HF-related
hospitalizations, duration of the hospitalizations, use and user satisfaction of the
HFM website, and cost-effectiveness.
Conclusions: This study will provide important prospective data on the impact
and cost-effectiveness of the HFM website, and the effect of substitution of routine
face-to-face contacts by an interactive platform for disease management in HF
patients.
P1339
Organization of home rehabilitation based on telemedicine health information
technologies in patients with cardiovascular diseases
NNadezda Lyamina; E Kotelnikova; E Karpova; E Bizyaeva
Saratov Scientific Research Institute of Cardiology, Saratov, Russian Federation
Purpose: Compare the effectiveness of home physical rehabilitation programs
in patients with cardiovascular diseases (CVD) in different ways of organization:
telemedicine health information technology (tHIT) and ordinary physicians’ office
visit.
Methods: Medical information system with electronic database in the form of
electronic case report form (eCRF), physicians’ computer workstation and computer
appliance of the patient, was used. The system performed remote monitoring
of the patients’ physical status, hemodynamics indices in mode of postponed
consulting and data exchange “physician-patient-physician”. Patients with chronic
heart failure and safe systolic function, anamnesis of revascularization and after
surgical treatment of arrhythmias participated in the program of tHIT. Inclusion
criteria: ability to perform physical exercise test, preserved cognitive function. In
home rehabilitation programs physical exercises (PE) with various training factors
were used: moderate intensity (50-60%) by ergocycle or treadmill, dosed walking,
weighted walking. As consisted with feedback principle and system of electronic
reminders completion reports on physicians’ prescriptions and adverse events
(AE) were registered. Effectiveness of tHIT was defined by the results of treadmill
stress-test after 12 weeks of PE by blood pressure (BP) dynamics, load duration
(LD) and metabolic equivalent of oxygen demand (MET). During the follow-up
period patients’ complaints and AEs were analysed according to the reports. Final
electronic report was automatically included in eCRF.
Results: After 12 weeks of home organized PE average LD (8.8 ± 1.1 min vs. initial
5.5 ± 1.5 min, p < 0.05) and MET (10.8 ± 1.8 ME vs. 6.3 ± 1.6 ME, 𝜌 < 0.05).) in tHIT
group increased. These changes were comparable to the corresponding data in
patients with ordinary physician-controlled PE during 12 weeks (8.9 ± 2.5 min vs.
initial 5.2 ± 1.8 min and 9.9 ± 1.3 ME vs. 6.6 ± 0.6 ME). Rate of patients attained
target BP in tHIT group was significantly higher than in comparison group (86%
vs. 55%, p < 0.05, correspondingly). This was directly related with high compliance
to physicians’ medicated (95%) and drug-free (90%) prescriptions alternatively to
comparison group (81% and 79%, correspondingly). During analysis of objective
safety indices in tHIT group there were no clinically significant episodes of ischemia
or arrhythmia of high grade.
Conclusions: Telemedicine health information technology allows to overcome one
of the most important problems of home rehabilitation – increment of compliance
to medicated and drug-free prescriptions of physicians.
P1340
Can an automated education and coaching program increase self-care
among heart failure patients? A report from the HeartCycle project
W Stut1 ; C Deighan2 ; W Armitage2 ; M Clark2 ; JG Cleland3 ; T Jaarsma4
Philips Research, Eindhoven, Netherlands; 2 NHS Lothian, The Heart Manual,
Edinburgh, United Kingdom; 3 University of Hull, Hull, United Kingdom; 4 Linkoping
University, Faculty of Health Sciences, Linkoping, Sweden
1
Purpose: It is generally assumed that appropriate self-care can reduce readmissions in patients with heart failure (HF) but patient adherence to most self-care
behaviours is poor. In the HeartCycle project we tested an intervention to increase
self-care in HF patients using a novel on-line automated education and coaching
program.
Methods: The on-line automated program was developed from a well-established,
face-to-face, home-based cardiac rehabilitation approach. Education is tailored to
the behaviour and knowledge of the individual patient and the system supports
patients in adopting self-care behaviours. Patients are guided through a goal setting
process that they conduct at their own pace through the support of the system, and
record their progress in an electronic diary such that the system can provide appropriate feedback. Only in challenging situations a HF nurse intervenes to offer help.
A pre-post test intervention study was used to evaluate the effects of the program on
the change in self-care after 6-18 months measured by questions based on the European Heart Failure Self-care Behaviour scale. Data were collected relating to daily
weight, fluid and dietary salt restriction, physical activity and medication intake. Data
were analyzed using a paired T-test. The system database was analyzed for data on
the patients’ interaction with the program.
Results: Of 123 patients enrolled (mean age 66 ± 12 years, 29% NYHA II, 66%
NYHA III, 79% men), 92 completed the self-care questions at both baseline and
study end. The percentage of patients who were adherent increased from 74%
at baseline to 97% at study end (p < 0.05) for daily weight, from 79% to 89%
(p% = 0.06) for fluid restriction, from 79% to 95% (p < 0.05) for low salt diet, and
from 53% to 68% (p < 0.05) for physical activity. No difference was found for medication intake adherence (98% at baseline, 97% at study end).
Further analysis showed that about 80% of patients who started the coaching program for physical activity and low salt diet became adherent by achieving their personal goals for 2 consecutive weeks. After becoming adherent,
61% continued physical activity coaching, but only 36% continued low salt diet
coaching.
Conclusions: The multi-center HeartCycle study showed that self-care adherence
amongst patients with HF who have already received substantial conventional education was improved, and that the automated coaching was the likely mechanism
for this improvement. If telehealth systems can take care of more routine coaching
tasks this liberates expert staff to focus their efforts on patients that require more
personal attention.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
P1341
Home telemonitoring, algorithm-assisted, diuretic-minimization in patients
with heart failure stabilised after recent hospitalization. A report from the
HeartCycle Programme
J G FJohn Cleland1 ; L Frankenstein2 ; K Slottje2 ; R Dierckx1 ; C Whitehead1 ;
M Domingo3 ; H Reiter4 ; I Sokoreli4 ; P Gastelurrutia3 ; A Bayes-Genis3
1 University of Hull, Kingston Upon Hull, United Kingdom; 2 University Hospital of
Heidelberg, Heidelberg, Germany; 3 Germans Trias i Pujol University Hospital,
Badalona, Spain; 4 Phillips Research Europe, Eindhoven, Netherlands
Background: Diuretics are the mainstay of treatment for congestion in patients with
heart failure. The severity of congestion may fluctuate from day-to-day but, conventionally, most patients take the same dose of diuretic each day and once a patient
is initiated on a diuretic, attempts to withdraw them are rare. This inertia reflects
the difficulty in reliably educating patients in diuretic management and the risk of
decompensation with attempted diuretic dose reduction or withdrawal. Home telemonitoring (HTM) is an enablingtechnology that could provide safe and effective
guidance.
Methods: Patients with a recent hospitalisation for worsening heart failure were
enrolled into the HeartCycle HTM programme. After a run-in period of therapy optimisation, patients who were considered stable and whose symptoms appeared well
controlled were invited to participate in a randomised cross-over study comparing
usual daily dose of diuretic compared to diuretic down-titration with a symptom and
weight-based safety algorithm to prevent excessive reductions in dose. Each treatment period lasted 4 weeks.
Results: Of 126 patients enrolled, the median age was 68 years and the median
plasma concentration of NT-proBNP was 2,796 (IQR 1,443-4,983)ng/L. One hundred
patients (79%) completed the run-in phase, 13 never activated the system or discontinued monitoring after a few days, three died and ten continued with monitoring
but did not complete questionnaires. Of these 100 patients, 29 had symptoms that
were sufficiently severe or unstable to preclude attempts at diuretic down-titration
and 71 were considered stable, of whom 35 were initially assigned to diuretic minimization (of whom 30 subsequently crossed back to usual diuretic dose at one
month) and 36 were initially assigned to continue their usual diuretic dose (of whom
32 were crossed over to diuretic minimization as planned at one month). The algorithm achieved a reduction in diuretic dose in 55% of patients with 26% achieving
a reduction in furosemide equivalents of >80mg/day. Diuretic dose did not change
in 23% and increased in 22%. Of 62 patients who completed both phases, 21 preferred lower doses of diuretic, 17 preferred their usual daily dose and 24 had no
preference.
Conclusion: A symptom and weight-based algorithm implemented through a HTM
system can safely explore and facilitate diuretic-minimization in patients with adequately controlled symptoms. Many patients tolerated and preferred reduction in
diuretic doses. Whether, this can influence longer-term outcome is unclear.
P1342
Results of CABG in the patients with concomitant NAFLD: influence upon
myocardial function
M Dolzhenko; S Potashev; L Konoplyanik
National Medical Academy of Postgraduate Education the name of P.L. Shupik,
Department of Cardiology, Kiev, Ukraine
Aim: to study whether concomitant non-alcoholic fatty liver disease (NAFLD) can
influence myocardial function in the patients after AMI, planned for CABG with LV
aneurysm resection.
Methods: Patients after AMI planned for CABG with LV aneurysm resection underwent EcoCG, abdominal sonography and MSCT. According to EchoCG results
patients were divided into two groups: LV EF ≤ 35% (61 pt.); 2) LV EF >35% (62
pts.).
According to abdominal US and MSCT patients were diagnosed with present
or absent NAFLD. Patients with alcohol abuse or other known reason for liver
pathology were excluded from the study. EchoCG was repeated in 5-10 days after
surgery. Results are presented in the table.
CABG in the patients with marked systolic dysfunction showed good results both
with (28,47 ± 5,03 vs. 35,73 ± 5,42) or without concomitant NAFLD (28,32 ± 4,46 vs.
40,22 ± 6,19), 𝜌 < 0,0001. In the patients with moderate systolic dysfunction significant results were observed only in the patients without NAFLD (47,10 ± 8,62 vs.
52,67 ± 6,0, 𝜌 < 0,01), while patients with concomitant NAFLD showed insignificant
LV systolic function improvement (48,97 ± 9,11 vs. 51,84 ± 7,25, 𝜌% = 0,2). In group
1 patients had similar LV EF regardless of concomitant NAFLD (28,47 ± 5,03 vs.
28,32 ± 4,46, 𝜌% = 1,0), while after surgery patients with NAFLD showed significantly lower LV EF (35,73 ± 5,42 vs. 40,22 ± 6,19, 𝜌 < 0,01). In group 2 LV EF did
not significantly differ depending on concomitant NAFLD before (48,97 ± 9,11
vs. 47,10 ± 8,62, 𝜌% = 0,4), and after surgery (51,84 ± 7,25 vs. 52,67 ± 6,0,
𝜌% = 0,6)
Conclusions:
1) CABG with LV aneurysmectomy is equally effective in the patients with severe LV
systolic dysfunction regardless of concomitant NAFLD, while in the patients with
257
moderate systolic dysfunction concomitant NAFLD is associated with absence of
significant LV EF growth.
2) NAFLD is able to indirectly obliquely negatively influence upon LV systolic function
improvement after CABG with LV aneurysm resection.
Study results
LV EF before
CABG
LV EF after
CABG
𝜌
Group 1
With NAFLD
(n% = 30)
28,47±5,03
35,73±5,42
Without
NAFLD(n% = 31)
28,32±4,46
40,22±6,19
𝜌 < 0,0001
Group 2
With
48,97±9,11
NAFLD(n% = 32)
51,84±7,25
Without NAFLD
(n% = 30)
47,10±8,62
𝜌 < 0,01
52,67±6,0
𝜌 < 0,0001
𝜌% = 0,2
P1343
Effective combined off-pump surgical treatment and autologous
bone-marrow transplantation for end-stage ischemic cardiomyopathy:
5- years experience
S Prapas1 ; I Panagiotopoulos1 ; I Linardakis1 ; K Katsavrias1 ; D Protogeros1 ;
F Danou2 ; E Chandrinou3
1 Errikos Dunant Hospital, Cardiac Surgery Department, Athens, Greece
Objective: To evaluate the mid-term results of an alternative method for the
treatment of end-stage ischemic cardiomyopathy consisting of off-pump revascualization of ischemic areas, external reshaping of the LV and autologous bone
marrow-derived mononuclear cell (BM-MNC) implantation.
Methods: Sixty eight patients (mean age 58 ± 8.9 years) underwent the above procedure between July 2005 and November 2010. All patients were NYHA III-IV, whereas
four of them were transplantation candidates. They underwent standard laboratory evaluation, transthoracic echocardiography, dipyridamole thallium scintigraphy (DTS) and cardiac MRI, preoperatively. After revascularization and external LV
reshaping, BM-MNCs were injected into predetermined peri-infarct areas.
Results: Sixty three patients survived during a follow up period of 36-88 months.
Ejection fraction improved from 21.7 ± 7.4% to 30.6 ± 6.9%, 36.5 ± 4.3% and
37.7 ± 4.2% at 3, 6 and 12 months respectively. Left ventricular end-diastolic
diameter was reduced from 66.1+4.9mm to 62.6 ± 3.9mm, 60.5 ± 2.9mm and
59.3 ± 4.2mm, respectively. Previously non-viable areas on DTS were found to contain viable tissue and MRI showed hypokinesia in previously akinetic areas. NYHA
class improved to I-II. No significant arhythmias were noted during the follow-up
period. Three patients died due to cardiac and one patient due to non cardiac reason. One patient suffered stroke and two patients underwent additional PCI.
Conclusions: Combined off-pump surgical treatment and autologous bone-marrow
mononuclear cell transplantation for end-stage ischemic cardiomyopathy is safe and
feasible and appears to improve the patients’ functional status.
P1344
Is right heart failure a justified fear for isolated re-do tricuspid valve surgery?
G Faerber; H Kirov; M Diab; T Doenst
Friedrich Schiller University Jena, Department of Cardiothoracic Surgery, Jena,
Germany
Objectives: Isolated tricuspid valve surgery as re-do procedure is considered a
high risk with perioperative mortality rates up to 30%. Comorbidities such as
liver congestion and cirrhosis as well as technical aspects such as paper thin
atrial walls or adhesions make this procedure a challenge. While the technical
aspects can be overcome the fear of postoperative right heart failure may prevent
surgeons from taking on the challenge. We reasoned that the reduction in TR-related
volume overload with tricuspid valve repair (TVR) should overcome the relative
increase in afterload. Here, we analysed our recent experience with isolated TVR
and replacement (TVE).
Methods: From June 2011 to December 2013, 12 patients with severe isolated
tricuspid regurgitation and previous cardiac surgery for various reasons underwent
tricuspid repair (n = 11) or replacement (n = 1) at our institution. The causes for
TR were annular dilatation in 9 patients and failed previous TVR in 3 patients.
Additionally, 5 patients had a transvalvular pacemaker lead. Child classification was
B in n = 3 and C n = 1 patient.
Results: In 10 patients, surgery was performed minimally invasively through a right
sided minithoracotomy and groin cannulation for cardiopulmonary bypass. Two
cases were performed through sternotomy because of severe adhesions between
the chest wall and the lung in one case and in the other case because of bilateral
dissection of the femoral arteries with no option for peripheral arterial cannulation.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
258
Abstracts
All cases were done on the beating heart. Preoperative right ventricular function was
generally impaired (TAPSE 14 ± 3mm). The procedures were performed successfully
in all 12 patients. Postoperatively, there was no bleeding that required revision.
One patient died within 30 days (8%) in multi organ failure, not related to right
heart failure. Another patient died after discharge during follow up. At discharge,
postoperative TR-grade was absent in 5, mild in 4 and moderate in 2 patients.
One patient developed a recurrence of severe regurgitation due to partial ring
dehiscence. Overall, TVR reduced TR from grade 3.9 ± 0.3 to 1.0 ± 1.0. Importantly,
right ventricular function was not impaired through surgery and did not negatively
influence outcome.
Conclusions: Isolated TVR or TVE as re-do procedure may be performed with low
perioperative risk, especially when surgery is done on the beating heart and using
minimally invasive techniques. Fear of right heart failure in these patients does not
appear to be justified. Further pathomechanistic studies and a larger clinical trial are
needed.
Ejection fraction increased significant on 7.6% (p < 0.05) in taurine group after
VR and increased on 2.4% in standard therapy group after VR. Ejection fraction
increased significant on 9.0% (p < 0.05) in taurine group after VR and increased on
5.3% in standard therapy group after VR.
Left ventricular mass index (LVMI) decreased significant from 136.9 ± 6.8 to
128.8 ± 7.7 g/m2 (p < 0.05) in taurine group after VR and decreased from 138.8 ± 9.2
to 134.8 ± 4.3 g/m2 in standard therapy group after VR. LVMI decreased significant
from 137.1 ± 8.7 to 129.1 ± 8.7 (p < 0.05) in taurine group after VR and decreased
from 138.1 ± 9.1 to 134.1 ± 7.1 in standard therapy group after VR.
Quality of life (QoL) increased significant from 35.1 ± 2.3 to 26.9 ± 2.5 point (p < 0.05)
in taurine group after VR and increased from 35.3 ± 2.3 to 29.5 ± 2.5 point in standard therapy group after VR. QoL increased significant from 33.1 ± 2.4 to 24.9 ± 2.5
(p < 0.05) in taurine group after VR and increased from 32.6 ± 2.4 to 27.3 ± 2.5 in
standard therapy group after VR.
P1347
P1345
Sudden cardiac death after surgical ventricular restoration
Outcomes of mitral annuloplasty combined with SVR and CABG and with
isolated CABG in patients with ICMP
J Sieira1 ; JJ Cuenca-Castillo2 ; E Barge-Caballero1 ; MJ Paniagua-Martin1 ;
R Marzoa-Rivas1 ; L Perez-Alvarez1 ; C Iglesias2 ; JM Herrera-Norena2 ;
F Estevez-Cid2 ; MG Crespo-Leiro1
1
University Hospital La Coruna, Department of Cardiology, Corunna, Spain;
2
University Hospital La Coruna, Department of Cardiac Surgery, Corunna, Spain
VMVladimir Shipulin1 ; RV Aimanov1 ; SL Andreev1 ; VH Vaizov1 ; SS Gutor1 ; EA
Aleksandrova1 ; VE Babokin2
1
State Research Institute of Cardiology of Tomsk, Cardiovascular Surgery, Tomsk,
Russian Federation; 2 Budgetary Institution “Republican Cardiological Clinic”,
Cheboksary, Russian Federation
Objective: The objective of the study was evaluation of the outcomes of mitral
annuloplasty combined with SVR and CABG and with isolated CABG in patients
with ICMP.
Materials and Methods: Twenty eight patients eligible for CABG, with severe mitral
regurgitation (ERO ≥ 30 mm2 ), with LV EF less than 40% and ESVI more than 60
ml/m2 were enrolled into the study. Mean age was 56,5 ± 7,1 years. Mitral valve repair
was performed in all the patients using rigid rings of 28mm and 30mm diameter.
Closing function of the mitral valve was controlled during the surgery with TEE. The
patients were allocated into two groups depending on the volume of the surgery.
The patients from group I (n = 14) underwent restrictive mitral annuloplasty combined
with SVR by Menicanti and CABG. The patients from group II (n = 14) were subjected
to restrictive mitral annuloplasty combined with CABG only. EchoCG examinations
were performed before the surgery, in 1 month after the surgery and in 2 years after
the surger. Initially the patient groups did not differ; all the patients had had type III of
postinfarction remodeling. Student t-test and chi-squared test were used to analyze
values differences.
Results: In 1 month follow-up period the groups did not differ by the sizes of a left
atrium, levels of RVSP and severity of MR. In 2 years after the surgery significant
MR was observed in patient group II if compared with that in group I (𝜒 2 % = 7,260;
p% = 0,046). Left ventricular dimensions in group I were 45,7 ± 5,7 mm, in group II 47,6 ± 4,6 mm and did not differ significantly (t% = –1,290; p% = 0,083). The values
of RVSP did not differ between the groups too (t% = 0,614; p% = 0,559). RVSP in
group I was 41,0 ± 12,1 mmHg and in group II - 39,8 ± 10,2 mmHg. In group I EDVI
was 85,9 ± 20,0 ml/m 2 and ESVI - 50,2 ± 16,2 ml/m 2 which were significantly lower
than these values in group II: EDVI - 102,8 ± 23,4 ml/m2 , ESVI - 66,1 ± 20,7 ml/m2 (p
< 0,05).
Conclusion: SVR stabilizes the outcomes of mitral annuloplasty combined with
CABG in patients with ischemic cardiomyopathy and with type III of postinfarction
remodeling by M. Di Donato.
Purpose: Sudden cardiac death (SCD) due to ventricular arrhythmias is an important
cause of mortality after a myocardial infarction. Surgical anterior ventricular restoration (SAVER) might reduce the burden of these arrhythmias and therefore reduce the
long-term incidence of SCD. The purpose of this study is to investigate the long-term
incidence of these events in a single centre cohort.
Methods: Consecutive patients undergoing SAVER between 1994 and 2009 were
included. Statistical analysis: Univariate analysis was performed using the t-student,
pair t-student or Mann Whitney test. Qualitative variables were analysed with the
chi-square or Fisher exact test. Survival analysis was performed with Kaplan Meier
analysis, using log-rank test to analyse difference.
Results: 70 patients were included in our study, 55 (78.6%) men, mean age of 62.8
years, sd: 8. 48.5% of patients in NYHA class III or IV and 64.1% had angina. Mean
ejection fraction was 32.1% (sd: 9.2). After a mean follow up of 6.1 years (sd: 4.5
and range: 0.1 years to 17.1), 80% of patients had a clinical improvement. One
year after SAVER the percentage of patients in NYHA class III or IV was reduced to
12.9% (p < 0.01). Mean increment of EF at one year was 5.6% (95% CI 2.4 – 8.9,
p% = 0.001).
Six patients had an arrhythmic event during follow up. These were: 3 sustained ventricular tachycardia, one ventricular fibrillation, one appropriate ICD shock and one
SCD.
Patients with previous history of arrhythmic events presented higher incidence of
new arrhythmias: IR 4,81 (95% CI 0,88 - 26,3, p% = 0,04). No other variable presented significative differences.
Those patients who after surgery had no indication for an ICD implantation (according to clinical guidelines) did not present any arrhythmic events.
Conclusions: SCD after SAVER is an infrequent cause of death. Ventricular arrhythmic events were more frequent in patients who had prior events. However the incidence of arrhythmic events is very low in those patients without ICD indication after
SAVER.
P1348
Long term survival in patients with heart failure after surgical ventricular
restoration
P1346
Effects of taurine during rehabilitation after CABG or valve replacement:
results of open-lable randomized trial
E Averin
Russian State Medical University, Cardiology Department of Faculty of
Postgraduate education , Moscow, Russian Federation
JJ Cuenca-Castillo1 ; J Sieira2 ; E Barge-Caballero2 ; MJ Paniagua-Martin2 ;
R Marzoa-Rivas2 ; L Perez-Alvarez2 ; C Iglesias1 ; JM Herrera-Norena1 ;
F Estevez-Cid1 ; MG Crespo-Leiro2
1
University Hospital La Coruna, Department of Cardiac Surgery, Corunna, Spain;
2 University Hospital La Coruna, Department of Cardiology, Corunna, Spain
Inarandomized, open-label study enrolled 48 patients (pts). Patients were randomizes into four groups: 1st –12 pts after CABG with Taurine, mean age
55.9 ± 1.4 years; 2nd – 12 pts after CABG with standard therapy, mean age
54.6 ± 1.5 years; 3rd–12 pts after valve replacement (VR) with Taurine, mean
age 43.5 ± 1.3 years; 4th -12 pts after valve replacement with standard therapy,
mean age 42.7 ± 1.5 years.All pts were ≥ 18 years old with stable congestive
heart failure II-III NYHA functional class. Pts 1st and 3rd groups was added
to standard evidence-based therapy taurine 250 mg 2 time a day per os.
Start therapy taurine was on 3rd week after cardiac surgery. Study duration
of 12 weeks.
During treatment with taurine after VR HF functional class significant decreased
from 2.0 ± 0.1 to 1.67 ± 0.1 (p < 0.05), but didn’t significant decreased standard
therapy from 2.1 ± 0.1 to 2.0 ± 0.1. During treatment with taurine after CABG functional class significant decreased from 1.9 ± 0.1 to 1.6 ± 0.1 (p < 0.01), but didn’t
significant decreased standard therapy from 1.9 ± 0.1 to 1.8 ± 0.1.
Purpose: Ventricular remodelling following an acute myocardial infarction (AMI) is
a main cause for the development of heart failure (HF). Surgical anterior ventricular
restoration (SAVER) may improve outcomes in these patients. The objective of this
study is to assess the long-term survival after SAVER in a single centre.
Population and Methods: Consecutive patients undergoing SAVER between 1994
and 2009 were included. Statistical analysis: Univariate analysis was performed
using the t-student, pair t-student or Mann Whitney test. Qualitative variables were
analysed with the chi-square or Fisher exact test. Survival analysis was performed
with Kaplan Meier analysis, using log-rank test to analyse difference. Predictive
models were constructed using Cox regression model.
Results: 70 patients were included in our study, 55 (78.6%) men, mean age of 62.8
years, (sd: 8). 48.5% of patients presented with NYHA class III or IV and 64.1%
had angina. Mean ejection fraction (EF) was 32.1% (sd: 9.2). Mean follow up was
6.1 years (sd: 4.5 and range: 0.1 years to 17.1). 80% of patients had a clinical
improvement. One year after SAVER the percentage of patients in NYHA class III
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
or IV was reduced from 48.5% to 12.9% (p < 0.01). Mean increment of EF at one
year was 5.6% (95% CI 2.4 – 8.9, p% = 0.001).
Survival at one year was 87.1%, 73.9% at five years and 58.2% at 10 years. 22
patients died. Surgical mortality was 7.1%, accounting for the 22% (n = 5) of all
deaths. Heart failure deaths were 18.2% (n = 4), acute ischemic event for 9.1%
(n = 2) and sudden cardiac death for 4.5% (n = 1). Univariate analysis identified age
older than 70 years (HR: 2.5, 95% CI 1.03-5.9), p% = 0.04), LV ejection fraction
lower than 30% (HR: 3.4 95% CI 1.1-10.4, p% = 0.03) and LVEDD per mm (HR:
1.1 95% CI 1-1.1, p% = 0.04) as predictors of death. They all remained significative
in a multivariate model. LVEF < 30% had a HR of 11.4 (95% CI 1.9 – 68.6, p < 0.01),
age (per year) had a HR of 1.1 (95% CI 1-1.2, p% = 0.03) and LVEDD (per mm) had
a HR of 1.1 (CI 1- 1.2, p% = 0.04).
Conclusions: SAVER provides beneficial effects in terms of improved clinical status
and increase in EF. Survival at 1 and 10 years is 87,1% and 58,2% respectively. Age,
EF and LVEDD are independent determinants of long-term survival.
DEVICES / ARTIFICIAL HEART / CRT / ICD:SURGERY –
POSTER DISPLAY
259
semester); 98 and 179, respectively, in 2012 and 2013. Phone calls with doubts
about medication were 33.3%, 41.2% were because of worsening or medical problem and other issues were 25.2% of calls. Looking at the evolution of the three years,
it is showed that the percentage of calls with doubts about medication remained stable, while clinical problem calls progressively increased (20.8%, 40.8% and 44.1%)
and other issues call (often administrative calls) decreased (45.8%, 24.4% and
22.9%). This is due to a better use of resources by both patients and professionals.
Regarding worsening and medical problem calls, there were a total of 13 admissions
(10,5%), 58 who did not need admission (46.8%) while 53 admissions were avoided
(42,7%).
Conclusion: Phone based telemonitoring is an easy and cheap monitoring system
for heart failure patients. For this reason, it is cost-effective in situations where other
more complex models of monitoring have failed in achieving objectives. Additional
benefits include the reduction in the number of readmissions providing the ambulatory resolution of patient decompensations, the improvement in patient ́ s quality of
live by facilitating access to the medical team, and an increased therapeutic compliance thanks to an easier answer to doubts about their medications.
P1351
P1349
Potential role for clinical calibration to increase engagement with and
application of home telemonitoring. A report from the HeartCycle Programme
A Bayes-Genis1 ; L Frankenstein2 ; R Dierckx3 ; M Domingo1 ; C Whitehead3 ; W
Stut4 ; H Reiter4 ; P Gastelurrutia1 ; J Lupon1 ; JG Cleland1
1
Germans Trias i Pujol University Hospital, Badalona, Spain; 2 University Hospital of
Heidelberg, Heidelberg, Germany; 3 University of Hull, Kingston Upon Hull, United
Kingdom; 4 Phillips Research Europe, Eindhoven, Netherlands
Background: Home Telemonitoring (HTM) may be a useful way of organizing
and engaging patients with clinical care. Methods of increasing adherence with
monitoring could increase it’s value. The effects of variations in daily routine on HTM
measurements are unknown and might provide additional insights into physiological
responsiveness and disease stability for individual patients. Providing patients with
programmed variations in their daily routine might increase compliance and provide
information on the sensitivity of individual patients to common interventions, such
as dietary or medication compliance.
Methods: Patients with a recent hospitalisation for worsening heart failure were
enrolled into the HeartCycle HTM programme. Patients were asked to report
symptoms and measure weight, heart rate and blood pressure on a daily basis.
After a period of stabilisation and diuretic optimisation, patients entered a two month
follow-up phase. Patients were given a diary scheduling an activity approximately
twice each week before making measurements; activities included taking salty food,
skipping a dose of diuretic, listening to loud and irritating noise or relaxing music,
drinking tea or coffee, taking a large meal or when hungry, after exercise or bathing.
Results: The 61 patients who agreed to participate in this phase of the study
completed more than 1000 of 1220 scheduled assessments over the two month
period. As anticipated, on average, heart rate (+6pbm) and systolic blood pressure
(+5mmHg) were higher when measured after exercise and weight was slightly
greater the day after a heavy meal (+0.7kg). However, other interventions had little
average effect on readings although some marked individual patient variations were
observed.
Conclusion: Patients who agreed to take part in this programme showed a high
degree of compliance with scheduled activities and measurement of vital signs.
Whether individual patient variability in the response to these or other interventions
has implications for treatment or prognosis remains to be explored. Providing such
a programme of activities might be useful for patient education and could improve
long-term adherence to HTM.
P1350
Results of basic telephone answering telemonitoring
CCarla Fernandez-Vivancos Marquina; R Gomez Dominguez; P Bastos Amador;
AJ Castro Fernandez; FJ Rivera Rabanal; RJ Hidalgo Urbano; JM Cruz Fernandez
University Hospital of Virgen Macarena, Seville, Spain
Objectives: Heart failure is a relevant condition today because of its high prevalence
and its costs to health systems. These costs are largely due to an increasing number
of hospital admissions, given the frecuent hospital readmission of these patients.
Methodology: We describe all the telephone calls recorded on the Heart Failure Unit answering machine during the years 2011, 2012 and 2013. Regarding
the reason for the call, calls were divided into worsening and medical problem
calls, questions about treatment and other issues. Medical problem calls were then
divided into admissions, potentially avoided admissions and no admissions. Those
patients who, according to their clinical condition, would have needed hospital
admission if they had not had this method of contact, were considered as avoided
admissions.
Results: 24 phone calls where recorded in the first year (2011, only second
Nurse-led telephone follow-up for heart failure patients could not predict 90
days readmission
HHiromi Iizuka1 ; Y Matue2 ; K Takanashi1 ; H Saito3 ; M Suzuki2 ; A Matsumura2 ; Y
Hashimoto2
1
Kameda Medical Center, Department of Nursing, Kamogawa, Japan
Introduction: Heart failure (HF) readmission rate is high after discharge. Although
nurse-led telephone interview might reduce readmission rate of HF, preferred contents of the interview and its predictive ability for future HF readmission is not well
elucidated.
Methods: 63 HF patients (age: 75.7 ± 12.6, 50.8% male) were followed-up by telephone interview by nurse within 30 days after discharge. In telephone interview,
patients were asked whether they have been performing self-care behaviors which
are recommended in ESC guideline. All patients were followed-up for 90 days.
Results: Median and quartiles of days after discharge for follow-up telephone interview were 12.6 (8-18) days. During followed-up, 13 (20.6%) patients were readmitted
due to HF exacerbation. However, there were no statistically significant differences
in heart failure readmission rate between whether or not taking drugs properly, controlling alcohol intake, controlling fluid intake, and exercising as advised, as well
as presence of edema, appetite, dyspnea, and dyspnea, which were obtained by
the telephone interview. Moreover, the score consisted by the answers for these
questions did not predict HF readmission within 90 days in receiver-operatating
characteristic curve (AUC: 0.52, 95% CI: 0.37-0.67).
Conclusion: By simply telephone interview of questions based on European Society of Cardiology guideline, HF readmission was not predicted. How and when to
perform the follow-up has to be elucidated.
P1352
Prognostic impact of long-term remote monitoring in heart failure patients
with implantable devices: preliminary analysis
JJoana Feliciano; MM Oliveira; RM Soares; M Nogueira Silva; PS Cunha;
T Pereira Silva; LM Branco; S Alves; R Pimenta; R Cruz Ferreira
Hospital Santa Marta, CHLC, Lisbon, Portugal
Background: Repeated hospitalizations in patients with chronic heart failure with
low left ventricular ejection fraction (CHF) are a leading cause of hospital readmission, with impact on mortality. Remote monitoring in CHF patients with implantable
devices has been a target of interest, as it may facilitate the identification of
patients facing higher risk of acute decompensation, allowing tailored intervention
and therefore avoiding hospital admission. It will ultimately affect CHF outcomes,
economic burden of heart failure and quality of life, and is an area of great clinical
interest and under active investigation.
Purpose: To evaluate the first incoming results of the remote monitoring in CHF
patients submitted to cardiac resynchronization therapy (CRT) devices implantation.
Methods: Ninety-four patients with CRT devices (65% male, age 66 ± 11 years,
ejection fraction of 25 ± 6% previous to CRT, 68% with non-ischemic cardiomyopathy, 28% with atrial fibrilation, 89% having a CRT combined with
cardioverter-defibrillator) and more than 2-year follow-up. There were 73% of
clinical responders (stable functional improvement ≥ 1 NYHA class). From the
potential measurements for CHF monitoring, we considered automatic alarm
checks of intrathoracic impedance and atrial or ventricular tachyarrhythmias detection, and retrospectively analysed acute decompensated heart failure episodes with
hospital admission and overall mortality.
Results: After a mean follow-up of 2.8 ± 1.4 years, there were 13 (12.2%) hospital admissions and three fatal outcomes. In 77% of the hospitalised patients,
device alert occurred previously, with elevated threshold of intrathoracic impedance
(p < 0.001) and arrhythmia detection (both atrial and ventricular) (p < 0.0001). These
alarms were activated on the remote monitoring system on a medium period of
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
260
Abstracts
29 days previous to the hospital admission. Regarding fatal outcomes, two were
due to heart failure (one patient had arrhythmia detection two days before and
other had an elevated threshold of intrathoracic impedance) and one patient had
no alarm check (non-cardiac death). In this population, left ventricular telesistolic
diameter was an independent predictor of mortality (p < 0.05) and the absence of
clinical response to CRT (p < 0.05) and post-CRT ejection fraction (p < 0.05) were
independent predictors of hospital admissions.
Conclusion: Remote monitoring systems represent an advantage in the complex
follow-up of CHF patients with CRT devices, and can play a fundamental role in
future strategies of therapeutic optimization to reduce hospital admissions due to
acute decompensated heart failure.
c release from the mytochondria to cytoplasm, increased proapoptotic caspase-3
activity, increased mRNA expression of BAX and miR1, and decreased mRNA
expression of BCL2 and miR 133A relative to sham.
Conclusion: The alterations in S100 proteins may contribute in defining the state of
cardiac apoptosis in a population of patients undergoing CABG surgery with CPB
and an animal model of CPB.
DIURETICS AND FLUID STATUS – POSTER PRESENTED
P1357
P1353
Comparison of patient and health care professional measurement of brain
natriuretic peptide using the Alere HeartCheck system
NNNinian Nicholas Lang1 ; CM Wong1 ; JR Dalzell1 ; S Jansz1 ; SJ Leslie2 ; RS
Gardner1
1
Golden Jubilee National Hospital, Scottish Advanced Heart Failure Service,
Glasgow, United Kingdom; 2 Raigmore Hospital, Department of Cardiology,
Inverness, United Kingdom
Aims: There is increasing interest in the utility of home monitoring of circulating
brain-type natriuretic peptide (BNP) in selected patients with heart failure. We
examined the ease of use and the reproducibility of a novel point-of-care BNP
measurement system when used by patients and healthcare providers.
Methods and Results: Patients with symptomatic heart failure were recruited
from out-patient clinics at four hospitals. They were provided with brief training
and instructional material for the use of the Alere Heart Check point-of-care BNP
measurement system. Finger-prick blood BNP concentration was measured by
the healthcare provider (HCP) and subsequently by the patient (n = 150). Results
obtained by the patient and HCP were compared. One hundred and sixty-four
patients completed a questionnaire on the ease of use of the system. 79.9% of
patients found the system either ‘very easy’ or ‘quite easy’ to operate overall.
There was excellent correlation of BNP measurement compared between patients
and HCP (r% = 0.966, p < 0.001). Median percentage difference between healthcare
provider and patients was 0.0% [interquartile range: - 9.3% to 15.8%].
Conclusions: Patients find the Alere Heart Check BNP measurement system easy to
operate after brief training. BNP concentration measurements obtained by patients
show excellent correlation with those obtained by health care providers. These
findings lend further to support to the use of home BNP monitoring in selected
patients for remote multi-modality assessment of heart failure status.
P1354
Post cardiac surgery with cardiopulmonary bypass, the differential regulation
of the S100 proteins, A1, A6 and B modulates cardiac apoptotic events
JJames Tsoporis; D Mazer; G Proteau; S Izhar; D Latter; L Errett; TG Parker
St. Michael’s Hospital, Toronto, Canada
Purpose: Coronary artery bypass grafting (CABG) surgery with cardiopulmonary
bypass (CPB) is associated with the production of reactive oxygen species resulting
in cardiomyocyte death due to apoptosis. Oxidative stress also upregulates the
receptor for advanced glycation end products (RAGE) and their ligands the S100
calcium binding proteins - the proapoptotic S100B and the antiapoptotic S100A1
and S100A6. In 14 patients (11 male, 3 female) mean age 63.5 years ± 11.6 (SD)
undergoing coronary artery bypass grafting (CABG) surgery with cardiopulmonary
bypass (CPB) (n = 9), aortic valve replacement (n = 2) or mitral valve repair (n = 3), we
investigated levels of RAGE and its ligands pre- and post-surgery and determined a
possible association with the apoptotic proteins BCL2 (anti), BAX (pro) and miRs 1
(pro) and 133A (anti) in atrial biopsies.
Methods and Results: Plasma, tissue mRNA and protein levels of S100 proteins
and RAGE were detected by ELISA, PCR and Western analysis respectively. BCL2,
BAX, miRs 1 and 133A mRNA levels were measured by PCR. Significant increases
were detected in plasma levels of S100B (p% = 0.027) and RAGE (p% = 0.026) postvs pre-surgery. A significant decrease was seen in plasma levels of S100A6 postvs pre-surgery (p% = 0.003). There was a positive correlation between atrial S100B
protein and i) the atrial BAX/BCL2 mRNA ratio (n = 14, p% = 0.025, r% = 0.593)
and ii) atrial miR 1 (n = 14, p% = 0.41, r% = 517). Also, negative correlations were
detected between atrial S100A6 with i) BAX/BCL2 mRNA ratio (n = 14, p% = 0.048,
r% = -0.536), ii) miR 1 (n = 14, p% = 0.038, r% = 576) and S100A1 with BAX/BCL2
mRNA ratio (n = 14, p% = 0.046, r% = -0.541). In an experimental rat model of CPB,
adult male rats (n = 6) underwent normothermic CPB for one hour with a neonatal
membrane oxygenator and then weaned from the CPB circuit and continued
anesthetized and intubated, receiving 100% oxygen with isoflurane for 6 hours
post-CPB. Sham animals (n = 6) were instrumented but did not undergo CPB. CBP
induced increases (1.5-3 fold) in plasma and ventricular tissue levels of S100B and
RAGE and decreases (4-6 fold) in S100A1 and S100A6 relative to sham. CPB also
induced left ventricular apoptosis as evidenced by increased TUNEL, cytochrome
Safety of torasemide in patients with stable congestive heart failure treated
with standard evidence-based therapy, including spironolactone: results of
open-lable randomized crossover trial
S Gilarevsky1 ; E Averin2 ; M Golshmid1 ; I Sinitcina1 ; V Vygodin3
Russian State Medical University, clinical pharmacology and therapy , Moscow,
Russian Federation; 2 National Research Center for Preventive Medicine, statistical ,
Moscow, Russian Federation
1
Weconducted a randomized open crossover trial to compare safety and tolerance
of torasemide and furosemide in 19 patients ≥ 18 years with stable congestive
heart failure II or III NYHA functional class. All patients were treated with standard evidence-based therapy, including spironolactone 25 mg/day, which was not
changed at least 1 month befor randomization. Patients were randomizes into two
groups: group of initial treatment with furosemide (n = 8) and group of initial treatment with toresemide (n = 11). Both study drugs was used in the doses adjusted
to patient clinical needs. Each treatment period with study drug (furosemide or
toresemide) during 4 weeks without wash-out period between two treatments.
Primary end-point: changing plasma potassium and sodium concentration from
baseline to the end of follow-up during 8 weeks. Secondary end-point: changing in
6 min walking test (6MWT) from baseline.
Results: 19 patients were randomized, mean age 68,2 ± 9,5; 52.6% men.Mean
dose of torasemide was 24.5 ± 7.4 mg/week, and furosemide 111.6 ± 16.8
mg/week.During treatment with furosemide plasma potassium concentration
did not change significantly (from 4.51 ± 0.44 to 4.45 ± 0.49 mmol/l, mean change
–0.08 ± 0.49 mmol/l), as with toresemide (from 4.43 ± 0.50 to 4.51 ± 0.43; mean
change 0.08 ± 0.33). During using of furosemide plasma level of sodium statistically
significant decreased from 138,42 ± 2,41 to 133,21 ± 10,43 mmol/l; mean change
–5.21 ± 9.32 mmol/l; p < 0.05), as with using torasemide from 139,21 ± 2,64 to
136,21 ± 5,46 mmol/l; mean change –3.00 ± 4.73 mmol/l; p < 0.05). There were
not statistically significant difference before periods of using furosemide and toresemide in changing of potassium and sodium during study drug treatment. Plasma
creatinine concentration did not changed significantly in both treatment periods
and there were not differences in these changing between using of furosemide
and toresemide. There were statistically significant difference between treatment
periods in secondary end-point of changing in 6MWT from baseline. 6 min distance 6MWT decreased statistically significant from 261,1 ± 49,3 to 296,7 ± 47,2 m
(mean change 35,6 ± 24,9 m; p < 0.001) with toresemide, but did not changed with
furosemide (changed from 290,8 ± 43,4 to 287,7 ± 51,5 m; mean change –3.1 ± 31,0
m). Torasemide was better tolerated by patients in compare with furosemide.
P1358
Effects of hydrochlorothiazide added to spironolactone on cardiac remodeling
in patients with acute myocardial infarction and reduced ejection fraction
DDilek Ural; E Dervis; R Onuk; H Cakmak; K Karauzum; T Sahin; T Kilic;
U Bildirici; G Kahraman; E Ural
Kocaeli University, Faculty of Medicine, Department of Cardiology, Kocaeli, Turkey
Conventional medical management of the patients with an acute myocardial infarction (MI) and reduced ejection fraction includes ACE inhibitors, beta-blockers and
aldosterone antagonists in patients with heart failure or diabetes. Diuretics are
regarded as the first-line treatment for symptomatic relief in patients with heart
failure, but their benefits on cardiac remodeling and cardiac outcome after MI are
not clear. The aim of this study was to investigate the effect of hydrochlorothiazide
added to spironolactone on cardiac remodeling and new coronary events in post-MI
patients without symptoms and signs of congestion.
Methods: Records of patients admitted with an acute MI and underwent primary
PCI were reviewed retrospectively. Patients with an ejection fraction ≤40%, Killip
class I and II and treated with spironolactone 25 mg alone (n = 60, 88% male, mean
age 59 ± 13 years) or with spironolactone 25 mg and hydrochlorothiazide 12.5 mg
combination (n = 43, 88% male, mean age 61 ± 12 years) were included in the study.
An echocardiography was performed before hospital discharge and after 3 months
in the follow-up period.
Results: Baseline characteristics of the two patient groups were similar to each
other (Killip I 81%, mean EF 30 ± 6% and mean left ventricular end-systolic diameter
36 ± 7 mm). Mean follow-up period was 3 ± 3 months. New coronary events (defined
as cardiac death, acute coronary event and new onset heart failure) occurred in 13%
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
of the patients treated with spironolactone alone and in 19% in those treated with
spironolactone and hydrochlorothiazide combination (P% = NS). Absolute change
in ejection fraction (3.8 ± 4.6% in spironolactone vs. 3.7 ± 3.3% in combination) and
percent change in left venticular end systolic diameter (0.00 ± 0.18% in spironolactone vs. 0.03 ± 0.18% in combination) were similar in both groups. No clinically
significant change occurred in estimated GFR and potassium levels.
Conclusion: Addition of hydrochlorothiazide on top of spironolactone provides no
benefit on clinical outcome and left ventricular remodeling in post-MI patients without symptoms and signs of congestion.
261
P% = 0,002). No significant changes in SC were observed during f-u (1,55 ± 0,50
mg/dL at discharge vs 1,68 ± 0,71 mg/dL at f-u; P% = 0,580).
Conclusions: LD therapy, administered by means of continuous infusion, yielded a
reduction in volume overload and pulmonary venous congestion, as documented
by significant reduction in body weight, BNP levels and PAPs. We found no evidence of kidney dysfunction induced by LD therapy, and SC actually decreased
across hospitalization. Moreover, patients with lower eGFR at admission showed
the greater improvement in renal function.
P1361
P1359
Effect of individualized sodium diet in total and extracellular body water
corporal in patients with heart failure
B Zepeda-Marquez; L Cartillo-Martinez; AArturo Orea-Tejeda; LR
Garcia-Castaneda; E Calvario-Monarca; MF Bernal-Ceballos; J Lares-Valdivia; B
Santillano; F Davila-Radilla
Instituto Nacional de Ciencias Médicas y Nutrición “SZ”, Mexico, Mexico
Background: In heart failure (HF) patients low sodium intake is associated with
increased activity of the renin-angiotensin-aldosterone system as a compensatory
mechanism, which results in decreased renal blood flow and sodium and water
retention, with the worsening of ventricular function and increased symptoms in
these patients. Objective: To evaluate the effect on the total and extracellular body
water status in patients with heart failure according to the quantity and dose of
sodium prescribed dietary
Methods: in a pilot study 13 subjects were included, each one received a menu
and recommendations to sodium restriction, 7 patients (intervention group) also
received salt in envelopes with the exact dose for daily salt consumption, which was
calculated considering the sodium content on diet during a 4 months of follow-up.
Phase angle, total and extracellular body water was measured using bioelectrical
impedance tetra polar and multi frequency equipment (BodyStat QuadScan 4000).
Results: It was observed that patients in the intervention group increased serum
sodium (135 ± 5.76 to 139 ± 2.44) without exceeding the normal values. In addition,
it was found that the phase angle increased (4.5 ± 1.2 to 5.1 ± 0.85), total body
water remained unchanged but the extracellular water decreased (17.2 ± 1.89 to
17.0 ± 3.0) and also the impedance index (0.83 ± from 0.03 to 0.82 ± 0.29) decreased
as diastolic blood pressure (76.5 ± 4.7 to 73.5 ± 13.9) and weight of the patients
(76 ± 12.9 to 74.7 ± 15.4).
Conclusions: Keep track of the amount of sodium ingested by patients improve
body water status of HF patients compared with subjects were delivered only in
sodium intake recommendations.
P1360
Daily adjusted continuous infusion of loop diuretics in acute decompensated
heart failure: changes in renal function
E Favilli; PPaolo Giordano; C Alderighi; N Scelza; MR Ferraro; E Corsi; L
Rondinini; R Mariotti
University of Pisa AOUP-Heart Failure Unit, Pisa, Italy
Purpose: The presence of renal dysfunction portends a poor prognosis in patients
with heart failure (HF). Moreover, coexisting renal impairment is associated with
diuretic resistance and often hampers adequate therapeutic management, due
to concern about the adverse effects of drugs on development of kidney injury.
However, venous congestion could be partly responsible for renal dysfunction
in HF: therefore, diuretic therapy could improve renal function by relieving fluid
overload. The aim of this study was to evaluate renal function in patients with Acute
Decompensated Heart Failure (ADHF) who received loop diuretic (LD) treatment by
continuous infusion.
Methods: 40 patients hospitalized for ADHF and administered LDs by continuous infusion (8-10 hours) were studied. LD dose was daily adjusted based on
diuresis, clinical evaluation, electrolytic balance and renal function. Echocardiography was performed at admission and discharge. Renal function was evaluated
by means of serum creatinine (SC) and estimated Glomerular Filtration Rate
(eGFR) at the time of admission and at discharge. Patients were divided into
two groups, based on eGFR as documented at admission, and changes in renal
function were compared between the two groups. Follow-up (f-u) period lasted
3 months.
Results: Body weight decreased significantly during hospitalization, from
79,8 ± 11,0 Kg to 75,0 ± 10,8 Kg (P% = 0,021). Echocardiography documented
a statistically significant lowering in systolic pulmonary artery pressure (PAPs) from
49,41 ± 9,75 mmHg to 42,72 ± 9,58 mmHg (P% = 0,003). Mean BNP changed from
3113,55 ± 1925,1 pg/mL to 1692,09 ± 1050,52 pg/mL (P < 0,001). SC decreased
(from 1,82 ± 0,69 mg/dL to 1,55 ± 0,50 mg/dL, P% = 0,044) and eGFR improved
(from 41,77 ± 15,42 mL/min/1,73m2 to 48,54 ± 15,89 mL/min/1,73m2 , P% = 0,057)
from admission to discharge. Patients with worse renal function ( < 45 mL/min/m2 )
at the time of admission showed a significantly greater reduction in SC after
LD therapy compared to those with eGFR>45 mL/min/m2 (-18,81% vs -4,72%,
Health state and satisfaction of patients with stable congestive heart failure
treated with standard evidence-based therapy: results of open-lable
randomized crossover trial Torasemide versus Furosemi
S Gilarevsky1 ; EEvgeny Averin2 ; M Golshmid1 ; I Sinitcina1 ; V Vygodin3
State Medical University, clinical pharmacology and therapy , Moscow,
Russian Federation; 2 Volgograd State Medical University, Volgograd, Russian
Federation; 3 National Research Center for Preventive Medicine, statistical ,
Moscow, Russian Federation
1 Russian
Anti-aldosterone/anti-mineralocorticoid receptor property of spironolactone was
suggested on the basis of the results of several small randomized and experimental
trials. But recently results of experimental study did not confirme that toresemide
significantly antagonize aldosterone receptors. On the other hand many practical doctors believe that torasemide could interfere with mineralocorticoid receptor
antagonist (MRA), i.e. with spironolactone and eplerenone, and will increase plasma
concentration of potassium.
19 patients were randomized: 1st group of initial treatment with furosemide (n = 8)
and 2nd group of initial treatment with toresemide (n = 11). Mean age 68,2 ± 9,5;
52.6% men. Mean dose of torasemide was 24.5 ± 7.4 mg/week, and furosemide
111.6 ± 16.8 mg/week.There were not statistically significant changed plasma
potassium, creatinine concentration in both groups.Heart rate decreased significant
from 69,6 ± 7,9 to 65,9 ± 5,7 m (mean change 3,7 ± 4,5 m; p < 0.01) with toresemide
and increased significant from 68,3 ± 6,9 to 72,6 ± 7,1 m (mean change 4,3 ± 4,9 m;
p < 0.01) with furosemide. 6 min distance 6MWT increased statistically significant
from 261,1 ± 49,3 to 296,7 ± 47,2 m (mean change 35,6 ± 24,9 m; p < 0.001) with
toresemide, but did not changed with furosemide (changed from 290,8 ± 43,4 to
287,7 ± 51,5 m; mean change –3.1 ± 31,0 m). Torasemide was better tolerated by
patients in compare with furosemide.
Health state (HS) and satisfaction we assessed by visual analogue scale (VAS). 0 is
the best and 10 is the worst health state. HS decreased (improved) statistically significant from 4,7 ± 1,4 to 3,7 ± 1,3 point (mean change - 1,0 ± 1,1 point; p < 0.001)
with toresemide and increased (worsened) from 4,3 ± 1,0 to 4,7 ± 1,5 point (mean
change 0,4 ± 1,4 point) with furosemide. At the end of study HS was significant better
on 1,0 ± 1,0 point (p < 0.001) in the torasemide group compared furosemide group.
Satisfaction decreased (improved) statistically significant from 4,6 ± 1,7 to 3,3 ± 1,4
point (mean change - 1,3 ± 1,8 point; p < 0.01) with toresemide and increased (worsened) from 3,8 ± 1,5 to 4,4 ± 1,5 point (mean change 0,6 ± 1,8 point) with furosemide.
In the end study Satisfaction was significant better on 1,1 ± 1,5 point (p < 0.01) in the
torasemide group compared furosemide group.
P1362
Novel noninvasive direct lung water measurement using KYMA technology in
CHF: a validation comparison study using invasive hemodynamic and “gold
standard” extravascular Lung Water determination.
MMichael Jonas1 ; T Mandelbaum2 ; G Karp3 ; A Nimrod3
Medical Center, heart institute, Rehovot, Israel; 2 Chaim Sheba Medical
Center, Department of Anesthesia and Critical Care, Tel Hashomer, Israel
1 Kaplan
Introduction: Decompensation of heart failure may manifest as pulmonary congestion/edema – an acute increase in extravascular lung fluid. No direct, reliable, simple
and non-invasive method is available for accurate assessment of lung water. Such
a device may improve in-hospital management, and reduce Re-hospitalizations
For ambulatory CHF patients. KYMA developed a miniature external patch device,
monitoring thoracic fluid content by analyzing electromagnetic ("radar") signals,
propagated through tissue layers. We compared KYMA’s non-invasively measured
Lung water index (KLWI) with invasive hemodynamic and thermodilution based
assessment of extravascular lung water level in a unique sheep model of acute
pulmonary edema.
Methods: Pulmonary edema was induced in 7 sheep by IV volume (dextrane) and
pressure overload (noreadrenaline) . KYMA measurements of LWI were compared
to PICCO thermodilution based extravascular lung volume water (EVLW) as the
reference gold standard. Hemodynamic invasive parameters including LVEDP and
swan ganz catheter were collected.
Results: All 7 sheep, developed increase in LVEDP with onset of pulmonary congestion and edema. A consistent linear correlation between measurements of invasive
EVLW and non-invasive Kyma patch KLWI was found (Figure). KYMA’s system
was able to detect dynamic accumulation of lung water in a range of 40-50cc
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
262
Abstracts
increments while the change in fluid content between normal and congested lung
ranges between 250-500cc
Conclusions: KYMA’s external, miniature patch device yielded a lung water fluid
index with excellent correlation to invasive measurement. The demonstrated accuracy and sensitivity of the Kyma technology supports its use for high resolution
precise thoracic fluid monitoring. Human clinical trials with the Kyma patch are
on-going
KYMA and Picco correlation
P1363
Superior clinical influence of implementing pocket-size focused ultrasound
for early adaption of heart failure treatment in a nurse-led outpatient heart
failure - a randomized cross-over study
HHavard Dalen1 ; G Gundersen2 ; HH Haug2 ; JO Kleinau2 ; K Skjetne2 ; TM
Norekvaal3 ; T Graven2
1
Norwegian university of science and technology , Trondheim, Norway; 2 Levanger
Hospital, Levanger, Norway; 3 Haukeland University Hospital, Department of
Cardiology, Bergen, Norway
Purpose: Body fluid retention and congestion is a hallmark of worsening heart
failure (HF). However, neither clinical signs nor laboratory tests seem sufficient
to detect deterioration of HF as well as hypovolemia due to overtreatment with
diuretics. Thus, we aimed to study the clinical influence of ultrasound examinations
of the pleural cavity and the inferior vena cava (IVC) performed by trained nurses in
a nurse-led outpatient HF clinic compared with clinical signs and laboratory tests.
Methods: Patients visiting an outpatient HF clinic were prospectively included.
Cross-over design: all patients underwent laboratory tests, history taking and
clinical examination by two specialized nurses who worked in teams with separate
cardiologists. In a random order one of the nurses performed a pocket-sized
ultrasound examination of the pleural cavity and IVC (dimension/collapsibility) in all
patients, the second team was blinded to the ultrasound results. The two teams
independently determined any therapeutic changes.
Results: In total 119 examinations were performed in 62 patients, 30 (48%) women.
Mean (SD) age was 74 (12) years, ejection fraction 34 (13) %, NYHA 2.4 (0.6),
and N-terminal pro brain natriuretic peptide (proBNP) 3761 (3072) ng/l. Time consumption for focused ultrasound performed by nurses was median 5 minutes.
Correlations of the end expiratory diameter of the IVC and the craniocaudal diameter of pleural effusion in both cavities with the reference method (cardiologist) was
high, all r ≥ 0.89, all p < 0.001.
Dosing of diuretics (reduction, no change, or increase) differed between the teams
which had or did not have access to ultrasound examinations in 31 out of 119
consultations. In univariate analyses weight change, volume status assessed clinically (with/without ultrasound) predicted dose adjustment of diuretics at follow
up. Change of oedema, proBNP, creatinine and change of NYHA class did not (all
p ≥ 0.06). In adjusted analyses (all above variables) only volume status based on
ultrasound predicted dose adjustment of diuretics (p ultrasound ≤0.01, all other
p ≥ 0.2).
Conclusions: Adding focused ultrasound examinations of the pleural cavity and
IVC, performed by nurses in an outpatient HF clinic, significantly predicted dose
adjustments of diuretics compared to standard care with medical history, clinical
signs and laboratory tests, including NT-ProBNP. Acknowledging the lack of a
gold standard for assessing volume status, implementing pocket-sized ultrasound
seems attractive to improve the monitoring of volume status, and thus, optimize
treatment of HF.
Acute kidney injury (AKI) occurs up to 70% in ADHF. Bioimpedance vector analysis
(BIVA) is a non-invasive accurate technique for hydration status (HS) evaluation.
The aim of the study was to evaluate HS in ADHF patients by BIVA and clinical/
radiographic criteria and to determine the diagnostic and prognostic value of these
methods.
Methods: in 183 patients admitted with ADHF (125 male, 69 ± 9 years (M ± SD),
arterial hypertension 87%, ischemic heart disease 56%, myocardial infarction 53%,
atrial fibrillation 51%, diabetes mellitus 36%, known chronic kidney disease 40%,
ejection fraction (EF) 44 ± 15%) HS was assessed by BIVA and clinical/ radiographic
criteria. AKI was defined using 2012 KDIGO Guidelines. Mann-Whitney test was performed. P < 0.05 was considered statistically significant.
Results: In 78% overhydrated patients clinical evaluation corresponded to BIVA
results (G1), 9% patients were overhydrated only by BIVA (G2). Patients G1
compared with patients G2 had more marked clinically presentation of systemic congestion: ascites (37 vs 0%, p < 0.01), Rg-hydrothorax (70 vs 0%,
p < 0.001), echo-hydropericardium (20 vs 0%, p < 0.05). Patients G1 compared
with patients G2 were older (70 ± 9 vs 60 ± 10 years, p < 0.01), had higher rate
of prior HF hospitalizations (81 vs 53%, c2% = 7, p < 0.01), lower EF (45 ± 15
vs 53 ± 13%, p < 0.01), higher level of NT-proBNP (13171 ± 3655 vs 8945 ± 2301
fmol/ml, p < 0.05). There were no differences between groups in frequency of AKI
(41 in G1 vs 53% in G2, p>0.05), but all AKI in G2 was transient (100 vs 41%,
p < 0.01). Patients G1 compared with patients G2 had higher rate of HF rehospitalization (54 vs 0%, c2% = 17, p < 0.001) and 30-days mortality (9 vs 0%, c2% = 10,
p < 0.01).
Conclusions: In 78% of patients with ADHF and overhydration clinical/ radiographic
criteria corresponded to BIVA results, 9% patients were overhydrated by BIVA only.
Patients with overhydration by BIVA only had less evident systemic congestion; AKI
was transient and was not associated with poor short-term and long-term outcomes.
Hydration status evaluation by BIVA has no independent prognostic value in patients
with ADHF.
P1365
UK real life experience of ultrafiltration for refractory diuretic resistant heart
failure
R Baruah1 ; D Sado1 ; P Cowburn2 ; S Ellery3 ; MD Thomas1
The Heart Hospital, London, United Kingdom; 2 University Hospital Southampton
NHS Foundation Trust, Cardiology, Southampton, United Kingdom; 3 Sussex
Cardiac Centre, Brighton, United Kingdom
1
Background: Ultrafiltration (UF) is a recognised method of salt and fluid removal
in heart failure (HF) which can be used in the management of diuretic resistant HF.
There have been concerns, from the trial data, that UF may be associated with
worsening renal function compared with diuretics. We describe the initial real-life
United Kingdom, UF experience.
Methods: Retrospective observational analysis of HF patients with significant
peripheral oedema and diuretic resistance, who underwent UF treatment between
2009 and 2013. Data are expressed as mean and range unless stated.
Results: 79 patients (60 male), NYHA ≥ 3, age 67 (41-93) years, EF 35% (5-76%)
underwent UF with mean fluid removal of 8.1 (3-22) litres over a mean of 58 (8-150)
hours. This was achieved using a mean removal rate of 145 ml/hr. There was no
significant change in creatinine compared with baseline (pre-UF creatinine 158
mmol/l versus 149 mmol/l at discharge p% = NS). In-patient stay was 21.4 (3-110)
days. Mortality at twelve months was 34 % compared to an expected probability of
nearer 50%.
Conclusions: In this, the first UK observational data, UF was found to be a safe
and effective method of fluid removal in heart failure patients with diuretic resistant
peripheral oedema. Following UF, there was no significant deterioration in creatinine
at discharge and the majority of patients were still alive at one year.
P1364
Prognostic value of bioimpedance vector analysis versus clinical
characteristics in patients with acute decompensation of heart failure
A Klimenko; S Villevalde; Z Kobalava
Peoples Friendship University of Russia (RPFU), Moscow, Russian Federation
Objective: Volume overload is the known main driver for morbidity, mortality and
hospital readmission in patients with acute decompensation of heart failure (ADHF).
Expected survival (L) vs follow-up (R)
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
P1366
In congestive heart failure addition of hypertonic saline to iv furosemide
results in better renal and clinical outcomes compared with iv furosemide
alone. A meta-analysis of the literature data
R De Vecchis1 ; A Pucciarelli1 ; C Esposito2 ; C Ariano1 ; S Cantatrione1
Cardiology Unit, Presidio Sanitario Intermedio “Elena d’Aosta”, Naples, Italy;
2 Institute of Hygiene and Preventive Medicine, Second University of Naples,
Naples, Italy
1
Background: In the advanced congestive heart failure (CHF), intravenous (iv)
inotropic agents, iv diuretics, ultrafiltration, and haemodialysis have been shown to
not yield better clinical outcomes. In this scenario, the simultaneous administration
of hypertonic saline solution (HSS) and furosemide may offer a more effective
therapeutic option with good safety profile.
Methods: Therefore, a meta-analysis was performed to compare combined therapy, consisting of iv furosemide plus concomitant administration of HSS, with iv
furosemide alone for acutely decompensated heart failure (ADHF). The outcome we
chose were all-cause mortality, risk of re-hospitalisation for ADHF, length of hospital
stay, weight loss, and variation of serum creatinine.
Results: Based on five randomised controlled trials (RCTs) involving 1032
patients treated with iv HSS plus furosemide vs 1032 patients treated with iv
furosemide alone, a decrease in all-cause mortality in patients treated with HSS
plus furosemide was proven (RR% = 0.57; 95% confidence interval [CI]% = 0.44
- 0.74, p% = 0.0003). Likewise, combined therapy with HSS plus furosemide was
shown to be associated with a reduced risk of ADHF-related re-hospitalisation
(RR% = 0.51; 95% CI% = 0.35 - 0.75, p% = 0.001). Besides, combined therapy with
HSS plus furosemide was found to be associated with a reduced length of hospital
stay (p% = 0.0002), greater weight loss (p < 0.00001), and better preservation of
renal function (p < 0.00001).
Conclusions: HSS as an adjunct to iv furosemide for diuretic-resistant CHF
patients predicted better renal safety profile and improved clinical endpoints such
as mortality and heart failure-related hospitalisations.
263
improve BNP and NYHA class. However, reductions in renal function and systolic
blood pressure were observed.
P1368
Efectiveness and safety of tolvaptan in hyponatremic patients with heart
failure
L Martinez-Dolz1 ; Y Rodriguez-Pichardo1 ; I J Sanchez Lazaro1 ; J Ruiz-Ramos2 ; M
Montero-Hernandez2 ; M Portoles-Sanz3 ; M Rivera-Otero3 ; E Marques-Sule4 ; A
Salvador-Sanz1 ; L Almenar-Bonet1
1
Hospital Universitario y Politécnico La Fe, Cardiology Department, Valencia,
Spain; 2 University of Valencia, Department of Physiotherapy, Valencia, Spain
Hyponatremia worsens the prognosis of patients with heart failure. Tolvaptan is
a vasopressin receptor antagonists (V2) that allows pure water excretion without
altering any other electrolyte. Since it is a new treatment, there is no much evidence
of its use in heart failure patients.
We evaluated 35 patients admitted for heart failure worsening. All of them had
hyponatremia that could not be treated with standard treatment, so tolvaptan was
initiated. The patients were under tolvaptan treament for an average of 4.48 ± 2.64
days, and ion levels and renal function was evaluated daily.
At the end of treatment, sodium (123 ± 5.6 vs. 136 ± 5.9 mEq/L; p% = 0.001) and
diuresis (1,391 ± 639 vs. 2,686 ± 1,252 mL; p% = 0.001) significantly improved. Only
two patients reached levels above 150 mEq/L but without problems after tolvaptan
discontinuation. Renal function (creatinine 1.51 ± 0.78 vs. 1.52 ± 1 mg/dL; p% = NS)
and potassium (4,6 ± 0.91 vs. 4,4 ± 0.69 mEq/L; p% = NS) did not change under
treatment with tolvaptan.
The administration of tolvaptan for the management of hyponatremia in the context
of heart failure is effective for a faster recovery, also well tolerated and without
affecting the levels of other electrolytes or renal function.
DIURETICS AND FLUID STATUS – POSTER DISPLAY
P1367
Single centre observational study examines the use of rescue Metolazone in
reducing episodes of de-compensating heart failure and re-admissions in an
Irish population.
CC Lewis1 ; C Raleigh1 ; F Doyle2 ; B Mcadam1
Beaumount Hospital Supportive Heart Unit, Dublin, Ireland; 2 Royal College of
Surgeons in Ireland, Dublin, Ireland
1
Background: Managing patients with Advanced Heart failure in an ambulatory setting remains a challenge with multiple co-morbidities including chronic kidney disease. There is limited data on continual use of maintenance Metolazone in improving
well being, reducing re-admission, BNP and NYHA class. We examined the use of
maintenance Metolazone over a period of 6-12 months in combination with an oral
loop diuretic in 20 outpatients in NYHA III-IV attending a outpatient heart failure
service.
Methods: A retrospective study examined a cohort of 20 patients (average age
76.4 years) in NYHA III-IV, EF >45% (n = 11), EF < 35% (n = 9), with at least 2
re-admissions with heart failure in addition to 3 episodes of de-compensating
heart failure, managed in an ambulatory setting with IV diuretics over a 6-12
month period. Patients were commenced on regular Metolazone in combination
with a loop diuretic and renal parameters, systolic blood pressure, BNP, Metolazone dosage, re-admissions and episodes of de-compensating heart failure were
measured pre commencement, and then over a 6-12 month period following
commencement.
Results: Over the study period before commencement of regular Metolazone there
were on average 2.35 episodes episodes of de-compensating heart failure managed in an outpatient setting with intravenous diuretics and 3.65 re-admissions
with heart failure. Patients were in NYHA III- IV on maximal tolerated HF therapy.
Prior to initiation of regular Metolazone the total average creatinine was (128.15
umol/L), EGFR (42.5 ml/min), BNP (793.65 pg/ml) and systolic blood pressure (118.6
mmHg). The average dose of maintenance diuretics was 3.35mg of Burinex and
120mg-160mg of frusemide. Patients were commenced on 2.5mg of Metolazone on
average twice weekly. Significant reductions were seen in re-admissions post commencement (mean episodes 0.45, p < 0.0001) and episodes of de-compensating
HF (mean episodes 1.25 p% = 0.0001), as well as improvements in NYHA class
(p% = 0.0029) and BNP (mean 524.8 pg/ml, p% = 0.0002). There were no adverse
events however, there were reductions in systolic blood pressure with a mean b/p of
111.8 mmHg (p% = 0.0016) as well as an increase in creatinine levels (mean 136.75
umol/L, p% = .0002) and reduction in EGFR mean 38. 45 ml/min (p% = .0088).
Conclusion: This study suggests that use of maintenance Metolazone 2.5mg given
weekly in moderate to severe heart failure can significantly reduced HF events,
P1369
Effect of prednisone on refractory decompensated congestive heart failure
R Raymond; R Guindy; Y Gomaa; H Estafanos
Ain Shams University, cairo, Egypt
Objective: To determine the effect of prednisone, added to conventional treatment
of patients with refractory decompensated congestive heart failure (DCHF) on
congestive symptoms and clinical state.
Background: Diuretic-based strategies, as the mainstay in DCHF management, are
not always effective in eliciting diuresis. Glucocorticoids have been proven to have
potent diuretic effects in animal studies; however, their efficacy in congestive heart
failure patients with diuretic resistance is not known.
Methods: Forty patients with refractory DCHF were enrolled in this prospective
study. Subjects were randomized to receive prednisone (1 mg/kg/day with maximum
dosage of 60 mg/day) added to the conventional treatment for 9 days (n = 20) or
control group (n = 20). Primary endpoints were the effects on daily urine volume,
NYHA functional class. Secondary end points were the effect on renal function &
serum electrolytes.
Results: The addition of prednisone induced potent diuresis (table 1) . As a result
of this diuretic effect, congestive symptoms improved markedly in 80% of those
who received prednisone at the end of the study (13 patients (65%) improved
from NYHA functional class IV to II and 3 patients (15%) improved to class III)
(P < 0.001). More important was the improvement of serum creatinine from 1.5
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
264
Abstracts
mg/dL at baseline to 0.95 mg/dL at the end of our study (P < 0.001) which was
associated with significant increase in creatinine clearance from 57.65 ml/min to
101.75 ml/min (P < 0.001). These effects could not be achieved in control group.
Conclusion: Adding prednisone to conventional care of the patients with refractory
DCHF induced potent diuresis accompanied by a dramatic relief of congestive
symptoms and improvement in clinical status and renal function.
Table (1):Urine output (ml/24 hour).
1st day
Case
Control
P value
1000
1050
>0.05
< 0.01
2nd day
1650
1150
3rd day
2000
775
< 0.001
4th day
2050
1050
< 0.001
9th day
2500
1100
< 0.001
P value (Base/9th day)
< 0.001
>0.05
Table (1): Urine output (ml/24 hour).
Results: The median age was 64 (54, 70) years, and 227 patients (44%) were
female. Preserved LVEF was observed in 216 patients (42%), while 299 patients
had reduced LVEF (58%). At baseline, hyponatraemia was found in 12.8% of
the patients (n = 66). General characteristics of hyponatraemic vs. other patients
(n = 449): women [27 (41%) vs. 200 (44.5%)]; age, years [68 (56, 71) vs. 64 (53,
70), p% = 0.035]; emergency admission [32 (48.5%) vs. 97 (21.6%), p% = 0.001];
systolic blood pressure (SBP), mm Hg [106 (98, 135) vs. 132 (114, 148), p% = 0.045];
NYHA class III-IV [66 (100%) vs. 210 (47%), p < 0.001]; LVEF, % [35 (28, 47) vs. 44
(34, 55), p < 0.001]; ischaemic aetiology [30 (45.5%) vs. 225 (50%), p% = 0.765];
atrial fibrillation [54 (82%) vs. 156 (35%), p < 0.001]; angiotensin-converting enzyme
inhibitor (ACEI) / angiotensin-II receptor blocker use (ARB) [34 (51.5%) vs. 376 (84%),
p% = 0.036]; beta-blocker use [24 (36%) vs. 284 (63%), p% = 0.034]; loop diuretic
use [66 (100%) vs. 256 (57%), p% = 0.004]; thiazide diuretic use [29 (44%) vs. 108
(24%), p% = 0.020]; mineralocorticoid receptor antagonist use [22 (33%) vs. 100
(22%), p% = 0.175]; digoxin use [45 (68%) vs. 177 (39%), p% = 0.013]; statin use
[11 (17%) vs. 82 (18%), p% = 0.925]; sodium, mmol/L [131 (128, 134) vs. 143 (140,
146), p < 0.001]; potassium, mmol/L [4.4 (4.1, 4.8) vs. 4.4 (4.2, 4.6), p% = 0.904];
eGFR, ml/min/1.73m2 [43 (22, 69) vs. 68 (38, 84), p < 0.001].
Conclusions: Higher NYHA class, as well as diuretic and digoxin use; lower SBP,
LVEF, and eGFR, as well as ACEI/ARB and beta-blocker use, were characteristic
for the patients with CHF and hyponatraemia. Also, the prevalence of emergency
admission and atrial fibrillation were much higher among these patients.
P1370
The prognostic value of hemoconcentration in acute heart failure
DRUG THERAPY, OTHER – POSTER PRESENTED
R ARui Alexandre Pontes Dos Santos; N Moreno; A Silva Castro; A Pereira; H
Guedes; C Lourenco; P Pinto
Hospital Centre do Tamega e Sousa, Penafiel, Portugal
Introduction: Hemoconcentration (HC) has been used as a parameter able to measure the effectiveness of diuretic therapy in patients with acute heart failure (AHF).
However, its prognostic significance remains poorly known.
Purpose: To evaluate the medium-term prognostic value of HC in patients hospitalized for AHF.
Methods: We conducted a retrospective study with 213 patients (pts) admitted consecutively for AHF between January 2005 and December 2008. Pts who underwent
blood transfusion during hospitalization were excluded from the sample. HC was
defined as a positive change in hemoglobin (Hb) and hematocrit (Hct) from admission to discharge, i.e. ΔHb> 0 and ΔHtc> 0. Anemia was defined according to the
WHO criteria (Hb < 13 g/dL for men and Hb < 12 g/dL for women). The primary composite endpoint was all-cause mortality and/or rehospitalization for AHF during the
6 months follow-up. For statistical analysis, the sample was divided into 2 groups:
pts with HC vs. without HC. A Kaplan-Meier survival curve was used to describe
the impact of HC after 6 months and these differences were compared using the
log-rank test. For multivariate adjustment we used the Cox regression model.
Results: The mean age of our sample was 73 ± 11 years; 54.5% of pts were male. In
46% of all pts the primary etiology of heart failure was ischemic heart disease. Anemia was identified in 41.3% of all pts and HC in 42.7%. Rehospitalization for AHF
after 6 months occurred in 13.6% and the mortality rate was 5.2%. The comparative
study between the 2 groups showed that pts with HC were associated with higher
total doses of intravenous furosemide (308 vs 186 mg / dL, p < 0.01) and worse
deterioration in renal function (estimated by the percentage change of serum creatinine: 10.73% vs -0.08%, p < 0.01). The Kaplan-Meier survival curve showed that
HC is related to a larger number of pts without events (94.5% vs. 74.6%, log-rank
p < 0.01). After multivariate analysis, the impact of HC in the combined result of
rehospitalization for AHF and all-cause mortality was statistically significant: hazard
ratio: 0.189 (95% confidence interval: 0.060 to 0.592), p < 0.01.
Conclusions: As previous studies suggest, HC appears to be associated with higher
doses of diuretics and consequently with worse deterioration in renal function. Nevertheless, in our sample HC proved to be an independent marker of good clinical
outcome.
P1373
Ivabradine in patients with chronic heart failure and low blood pressure
AE Bagriy; EV Schukina; OV Samoilova; OA Pricolota; SI Malovichko; AG Gukov;
AS Vorobiev; AV Pricolota; EA Bagriy
Donetsk National Medical University, Donetsk, Ukraine
Background: Standard therapy for heart failure (HF) management, such as loop
diuretics, ACE inhibitors, and 𝛽-blockers, induces hypotension. Ivabradine, a specific If current inhibitor, reduces heart rate (HR) in patients with chronic HF and has no
effect on blood pressure (BP). This prospective, open-label study assessed whether
initiating ivabradine could effectively and safely control HR in patients with chronic
heart failure and low BP.
Methods: Patients in sinus rhythm with chronic HF (NYHA class III-IV), HR ≥ 70
bpm, and hypotension considered as a contraindication to initiation of 𝛽-blockers
(systolic BP ≤95 mm Hg) were included in this study from the hospital or outpatient
clinic. Ivabradine was started at a dose of 5 mg bid and uptitrated to 7.5 mg bid
2-4 weeks later if HR ≥ 70 bpm. Carvedilol 3.125 mg bid was initiated later when
systolic BP ≥ 100 mm Hg.
Results: 19 patients (8 men) were included in this study. Mean age was 61.7 ± 10.1
years and mean ejection fraction was 34.6 ± 3.6%. Ten patients had NYHA class III
heart failure. Carvedilol was initiated in 13 patients 2 weeks after initiation of ivabradine and in 6 patients 4 weeks after. The table indicates changes in HR, systolic BP
and therapeutic doses. The 6-minute walking test distance increased after 5 months
from 165 ± 57 to 443 ± 139 meters (P < 0.05). The therapy was well tolerated. After
initiation of carvedilol, 2 patients had fatigue, which did not lead to withdrawal of
treatment.
Conclusions: Introducing ivabradine before 𝛽-blocker is safe and allows effective
HR control and increase in exercise capacity in patients with chronic HF and low
blood pressure.
Period of
treatment
Heart rate, bpm Systolic BP,
mm Hg
P1371
Initial
92.6 ± 11.5
92.4 ± 11.5
-
10
General characteristics of patients with chronic heart failure associated with
hyponatraemia
2 weeks
80.3 ± 9.9*
105.3 ± 4.6*
5.7 ± 1.3
13.4 ± 2.4
KKonstantin Bobrishev; AV Galusyak; OO Kiva; VV Kolomiets; SM Tiurina
Donetsk National Medical University, Donetsk, Ukraine
Purpose: To evaluate the clinical features of patients with chronic heart failure (CHF)
and hyponatraemia.
Methods: Between January 2006 and December 2010, all patients (n = 515) with
verified CHF, admitted to cardiology department, were consecutively included in
the study. All laboratory values were measured from venous blood samples drawn
the first day in hospital. Sodium level was measured by indirect ion-selective
electrode. Cut-off for hyponatraemia were defined as serum sodium level < 135
mmol/L. The estimated glomerular filtration rate (eGFR) was calculated according
to MDRD formula. Left ventricular ejection fraction (LVEF) was determined by
echocardiography and defined as reduced (≤45%) or preserved (>45%). Variables
were expressed as n (%) and median (quartiles). P-value of 0.05 was considered
significant.
Carvedilol
Ivabradine
dose, mg/day dose, mg/day
4 weeks
73.4 ± 6.7**
111.6 ± 7.2**
11.0 ± 3.0
14.2 ± 1.9
6 weeks
66.2 ± 4.9***
118.4 ± 7.6*** 17.4 ± 7.7
13.9 ± 2.1
3 months
62.9 ± 5.9***
117.4 ± 7.7*** 21.3 ± 9.6
14.5 ± 1.6
5 months
61.3 ± 4.6***
119.5 ± 3.2*** 25.6 ± 12.1
13.9 ± 2.1
* - P < 0.05 versus initial; ** - P < 0.05 versus 2 weeks; *** - P < 0.05 versus 4 weeks
P1374
The effect of dark chocolate in the treatment of patients with mild cognitive
impairments which caused by chronic heart failure
N Akimova; NDM Mikhel; A Hromyh; YURY Shvarts
Saratov State Medical University, Faculty therapy department, Saratov, Russian
Federation
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
Purpose: to study the effect of dark chocolate in the treatment of the mild cognitive
impairments in patients with chronic heart failure, which caused by ischemic coronary disease.
Methods: The double open randomized study of the effect of dark chocolate in the
treatment of the mild cognitive impairments in patients with chronic heart failure
(CHF), which caused by ischemic coronary disease (ICD) was performed. The study
was approved by Local Ethic Committee and was registered in the Russian Federal
information center. The inclusion criteria: mild cognitive impairments in patients with
CHF II-IV functional class in the background of the ICD. The presence of mild cognitive impairments was determined by the decreasing of parameters of 5th Wexler
below 12 and 7th Wexler below 50 points, and the results of the MMSE should
be not less than 24 points. The exclusion criteria: acute and sub-acute forms of
the ICD, apparent somatic pathology, that can give its own effect on the development of the cognitive deficiency, particularly, diabetes mellitus, stroke and transient
ischemic attack in past history, significant stenosis and atherosclerotic plaque of the
arteries of the head and the neck, psychoactive drugs taking, age over 65, hospitalization for any reason during last 90 days. After the signing of informed consent
eligible patients were randomized in two groups: active group and comparison.
Each group included 30 patients. The patients of the active group administrated
20 mg of dark chocolate (75% of cacao) per day during 12 weeks. Cognitive functions were estimated by Burdon’s test, 5th and 7th Wexler subtests on the visit of
screening and visit of 12 weeks. Method of factorial dispersion analysis “ANOVA”
was used.
Results: At the final visit there was observed a significant increase in results of the
5th (from 10,75 ± 1,4 to 12,15 ± 1,22 points, p < 0.05) and the 7th (from 48,4 ± 9,0
to 55,5 ± 8,6, p < 0.05) subtests of Wexler in patients from active treatment group.
The improvement of the parameters of Burdon’s test was observed in patients
from active treatment group as well: concentration of attention increased from
0,89 ± 0,12 to 0,93 ± 0,09 points, p < 0,05; speed of processing of test increased
from 117,60 ± 25,9 to 129,28 ± 36,3 points, p < 0,05 and accuracy of Burdon’s test
increased from 6,00 ± 5,71 to 9,88 ± 8,43, p < 0,05.
Conclusion: At the final visit of 12 weeks significant improvements in the characteristics of memory and attention in patients of the active group were revealed.
Dark chocolate can improves the cognitive functions of the patients with CHF
and ICD.
P1375
Nitrates and hydralazine alone or combined for the management of chronic
heart failure: a systematic review
MMohamed Farag1 ; T Mabote2 ; AF Nabhan3 ; AL Clark4 ; JG Cleland4
Castle Hill Hospital, Cardiology, Hull, United Kingdom; 2 Huddersfield Royal
Infirmary, Cardiology, Huddersfield, United Kingdom; 3 Ain Shams University, Cairo,
Egypt
1
Background: Hydralazine (H) and nitrates (N), when combined, are effective treatments for chronic heart failure, at least in some populations. It is unclear whether
either agent used alone provides similar benefits to the combination and whether
they add value to contemporary guideline-indicated therapy in 2014.
Methods: PubMed/MEDLINE, EMBASE and Cochrane Databases were searched
until February 2013. All randomized controlled trials assessing the effects of H and
N, alone or in combination, on clinical end points were included in patients with
chronic heart failure. The impact of baseline patients’ characteristics and quality of
the trials were also explored. Results are presented by qualitative description or statistical meta-analysis, as appropriate. For the purposes of statistical meta-analysis,
only the endpoint of death is provided in this report.
Results: Thirty three relevant trials were identified. In seven trials that evaluated both H&N in 2,574 patients, combination therapy reduced all-cause mortality (OR 0.72; 95% CI 0.55-0.94; P% = 0.02), and cardiovascular mortality (OR
0.75; 95% CI 0.56-0.99; P% = 0.04), as compared to placebo. At least amongst
African-Americans, similar benefits were observed when the combination was
added to contemporary therapy. However, when compared to Enalapril, all-cause
mortality (OR 1.32; 95% CI 0.99-1.75; P% = 0.05), and cardiovascular mortality
(OR 1.35; 95% CI 1.01-1.82; P% = 0.04) were higher with H&N. For therapy with
H alone, only nine trials (322 patients) were identified, none of which were in
addition to contemporary therapy with no clear evidence of benefit. For therapy
with N alone, nineteen trials were identified (597 patients), all but two conducted
before 1999, of which ten trials (375 patients) reported all-cause mortality (13
deaths in those assigned to nitrates and 7 to placebo; OR 2.12; 95% CI 0.88-5.12;
P% = 0.09).
Conclusions: Compared to placebo, H&N in combination reduced mortality in
patients with chronic heart failure in the pre-ACE inhibitor era but this benefit may
persist at least in some racial groups. However, ACE inhibitors are superior to
H&N. There is little evidence to support the use of either drug alone in chronic
heart failure, which is surprising given the widespread use of nitrates. More studies are needed to evaluate the safety and efficacy of these agents in the modern era of guideline-directed use of ACE inhibitors and beta blockers in heart
failure.
265
P1376
Folic acid:an endothelial function marker in patients with acute
decompensated chronic heart failure treated with prophylactic subcutaneous
anticoagulants
IIrina Shevchenko; AA Shavarov; GK Kiyakbaev; VS Moiseev
Peoples Friendship University of Russia (PFUR), Moscow, Russian Federation
Objective: To evaluate the impact of folate deficiency on endothelial function (EF)
markers in patients with acute decompensated chronic heart failure (ADCHF) treated
with prophylactic subcutaneous anticoagulants to prevent venous thromboembolism (VTE)
Materials and Methods: The study included 37 patients, mean age 68,6 ± 10,9
years, 19 women (57%) with ADCHF treated with prophylactic subcutaneous anticoagulants (heparin, enoxaparin or fondaparinux) for the average of 9,5 ± 3,7 days.
Non-invasive brachial artery (BA) flow mediated dilation (FMD) measurements were
made on admission and after anticoagulants had been discontinued. Folic acid and
vitamin B12 values were measured at baseline. All patients also received standard
CHF treatment.
Results: 27 patients (75%) appeared to have folic acid deficiency. Vitamin B
12 value in all patients was within normal ranges. BA endothelium-independent
FMD test showed endothelial dysfunction in all patients (100%). In patients with
folate deficiency brachial artery FMD ratio (artery diameter before/after compression) decreased by 2.3%, while in patients with normal baseline folic acid value it
decreased by 0.2% (p < 0.05). After treatment, BA diameter ratio increased in both
groups (with and without folate deficiency) by 11.7 and 12.5 %, respectively (p <
0.05). There was a positive correlation between folic acid values and an increase in
BA diameter ratio after treatment with anticoagulants (r% = 0.26, p < 0,05). No correlation between vitamin B12 and endothelial function markers was revealed.
Conclusion: Folic acid deficiency was associated with an increase in BA FMD diameter in patients with ADCHF under anticoagulants
P1377
Effect of ivabradine on severely impaired left ventricular diastolic dysfunction
in patients with chronic heart failure
HHamayak Sisakian; TS Sargsyan; A Khachatryan
Yerevan State Medical University Hospital 1: University Cardiology Clinic,
Department of General and Invasive Cardiology, Yerevan, Armenia
Diastolic dysfunction severity contributes to the clinical state, progression and prognosis in patients with chronic heart failure (CHF) with left ventricular (LV) dysfunction.
The combination of transmitral pulsed Doppler flow and pulsed tissue Doppler study
of mitral annulus reflects LV filling pressure in unmasking Doppler inflow pseudonormal pattern, a hinge point towards advanced CHF. We aimed to study the effect of
ivabradine, sinus node If current inhibitor, on diastolic dysfunction.
Methods: 54 patients with systolic heart failure (ejection fraction < 40 %) and
pseudonormal/restrictive type of diastolic dysfunction with E Deceleration time (DT)
≤ 140 msec randomly allocated either ivabradine treatment with a 10 mg / daily
dose (27 patients) and controls (27 patients) during 3 month period . All patients had
resting HR > 70 bpm, sinus rhythm, stable clinical state and were on conventional
therapy of CHF before inclusion in study. The following diastolic function parameters were determined by transmitral pulsed wave and mitral annulus tissue doppler
study before and after therapy period:DT E/A ratio and E/Em ratio. The Student s t
-test was used for comparability configuration in both groups at baseline. Parametric variables were compared by a two-set analysis of variance (time and treatment)
with a repeated measurement for the time factor. A p value < 0,001 was considered
statistically significant.
Results: At baseline E/A ratio, Dec Time and E/Em ratio did not differ significantly between ivabradine – and control treated patients. Ivabradine treatment was
accompanied by marked increase of DT (+30 ± 6,2 msec in ivabradinee, versus +
1,4 ± 4,7 msec in controls ,95% CI, p% = 0,00001), decrease of E/A ratio (- 8,6 ± 1,6,
in ivabradine versus - 1,3 ± 0,7 in controls, p% = 0,0001) and decrease of E/Em ratio
(- 5,4 ± 2,9 in ivabradine versus + 1,6 ± 7,9, p% = 0,0002 in controls). Ivabradine also
improved left atrial volume index (- 6, 2 ± 9,6 ml/m2 versus + 0,8 ± 11,3 ml /m2 in controls, p < 0,0001). After 3 month of treatment heart rate was significantly reduced in
the ivabradine group (p < 0.0001)
Conclusions: Treatment with ivabradine improves LV diastolic function through
reducing E/A ratio, E/Em ratio and increasing DT. These changes contribute to
the improvement of intracardiac hemodynamics with decrease of left atrial volume
index, improvement of LV filling. Beneficial effects of ivabradine on diastolic function
potentialy may lead to the better clinical state and prognosis in patients with CHF
P1378
Influence of Ivabradine on markers of collagenolisis and on arterial wall
functional status in patients with chronic heart failure and renal dysfunction
NNatalia Koziolova; A Chernyavina; M Surovtceva
Medical Academy, Perm, Russian Federation
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
266
Abstracts
Objectives: to evaluate influence of Ivabradine on markers of collagenolisis and on
arterial wall functional status in patients with chronic heart failure (CHF) and renal
dysfunction.
Materials and Methods: 60 CHF patients with preserved ejection fraction (EF)
and stable angina were divided into two groups depending on glomerular filtration
rate (eGFR by MDRD). The 1st group consisted of patients who had eGFR>60
mL/min/1.73m2 , and the 2nd group was of patients with eGFR≤60 mL/min/1.73m2 .
All patients, additionally to standard therapy of stable angina and CHF, received
ivabradine in average daily dose 6,21+2,05 mg depending on baseline heart rate.
Duration of treatment was 6 months. To estimate arterial wall status volume sphygmography was done with VaSera VS-1000 device (Fucuda, Japan). To evaluate
collagen matrix condition TIMP-I and C-terminal telopeptide (CTP-I) were used.
Results: during therapy TIMP-1 decreased in 2nd group significantly more than
in 1st one: 19,06 ± 5,69% vs 14,57 ± 7,32% (𝜌% = 0,011). CTP-I increased in 2nd
group more than in 1st : 13,84 ± 4,62%, vs 11,11 ± 3,13% (𝜌% = 0,010). PWV in
ankle-brachial segment in 2nd group decreased reliably, and significantly more
than in 1st group: 6,94 ± 1,75% vs 4,45 ± 1,63% (p < 0,001). CAVI1 in 2nd group
became reliably lower than in 1st : 13,47 ± 3,94% and 10,28 ± 4,64% respectively
(𝜌% = 0,012). PWVcf and PWV Ao decreased in 2nd group on 16,35 ± 7,53%
19,68 ± 3,64% and in 1st group on 9,08 ± 3,41% 15,85 ± 2,40% (𝜌 < 0,001
𝜌% = 0,002, respectively). Augmentation indices (R-AI and C-AI) decreased in
2nd group significantly more than in 1st one: (𝜌% = 0,027 𝜌% = 0,030 respectively).
Conclusions: insertion of Ivabtadine in complex treatment of ischemic CHF
provides both of positive vascular remodeling and favorable transforming of arterial collagen matrix, which are significantly more evident in patients with renal
dysfunction.
(ACEi)/angiotensin receptor blockers (ARB’s), beta blockers (BB) and mineralocorticoid receptor antagonists (MRA).
Results: Of 210 eligible patients, 198 patients (77 ± 8 years, 52% men, 84% NYHA
class III/IV, length of stay 11 ± 7 days) were discharged alive. Systolic dysfunction
was present in 30%, 49% had HF with preserved left ventricular ejection fraction,
whilst 21% had no available echocardiography report. Overall, prescription rates of
ACEi/ARB, BB and MRA were 78%, 58% and 20% on admission and 72%, 65%
and 23% at discharge, respectively. The mean daily dose of all drugs was higher on
admission than at discharge. At least 50% of target dose was prescribed to 81%,
53%, and 90% on admission and to 72%, 51%, and 96% at discharge, respectively.
At discharge 36% receiving ACEi, 15% receiving BB and 84% receiving MRA were
at target. Overall, 14% of patients met GAI-3 at discharge, and only 7% were prescribed at least 50% of target dose. None of them reached all three target doses. No
significant differences were observed between patients with respect to echocardiography report. In 53 (27%) patients, the GAI-3 drugs were stopped or down-titrated,
but reasons were given only for 45% of those patients.
Conclusions: Pharmacotherapy of patients with HF is suboptimal irrespective of left
ventricular function, and did not improve during hospitalization. In significant proportion of patients GAI-3 therapy was terminated or reduced, mostly without specific
justification.
P1381
Planned repetitive use of levosimendan for heart failure in cardiology and
internal medicine in Sweden
TTonje Thorvaldsen1 ; L Benson1 ; I Hagerman1 ; U Dahlstrom2 ; M Edner1 ; L H Lund1
Karolinska Institute, Stockholm, Sweden; 2 Linkoping University Hospital,
Linkoping, Sweden
1
P1379
Levosimendan improves hemodynamic status in critically ill patients with
severe aortic stenosis and left ventricular dysfunction. An interventional study
M JMartin Jesus Garcia Gonzalez; MG Cordero; P Jorge Perez; M Martin Cabeza;
S Sanchez Lopez; C Mendez Vargas; M Padilla Perez; E Gonzalez Cabeza; A
Jimenez Sosa
Hospital Universitario de Canarias, S. Cristóbal de La Laguna - Tenerife, Spain
Background: Patients with acute heart failure (HF), severe aortic stenosis (AS) and
reduced left ventricular ejection fraction (LVEF) have a dismal prognosis. Effects of
Levosimendan in this subgroup of patients has not been studied. We hypothesized
that levosimendan could improve hemodynamic status, symptoms, and short-term
prognosis of these patients.
Methods: We determined the response to 24h intravenous levosimendan infusion
(0.1 𝜇g/kg/min without a loading dose) in nine 76 ± 10 years old patients (5 male)
with severe AS (aortic valve area ≤1 cm2 on echocardiography), reduced LVEF (LVEF
≤40%). and a depressed cardiac index (CI) (CI < 2.2 liters/min/m2 ).
Results: At baseline, mean LVEF was 0.33 ± 0.7%; mean aortic-valve area was
0.37 ± 0.11 cm2 /m2 , with peak and mean gradients of 63.6 ± 20.53 and 36.7 ± 12.62
mm Hg, respectively; and mean CI was 1.65 ± 0.20 L/min/m2 . At six and twelve
hours of treatment, mean CI had increased to 2.00 ± 0.41 L/min/m2 (P% = 0.02) and
2.17 ± 0.40 L/min/m2 (P% = 0.01), respectively. At 24 hours, mean CI had increased
further, to 2.37 ± 0.49 L/min/m2 (p% = 0.01 compared to baseline). All the haemodynamic parameters and the NTproBNP levels showed significant improvement.
Treatment was well tolerated and no side effects were observed. Five patients subsequently underwent aortic valve replacement. One died (of post-operative multi-organ
failure). At 30 days, overall survival was 75%.
Conclusions: Levosimendan administration improves CI and cardiac performance
index in patients with acute heart failure, severe AS and reduced LVEF and it provides
a safe and effective bridge to aortic-valve replacement or oral vasodilator therapy in
these patients.
Purpose: Levosimendan is used in acute heart failure (HF) and increasingly as
planned repetitive infusions in stable chronic HF, but the extent of this practice
is unknown. The aim was to assess the use of levosimendan vs. conventional
inotropes and the use as planned repetitive vs. acute treatment, in Sweden.
Methods: We performed a descriptive study with patient validation assessing
the use of levosimendan and conventional intravenous inotropes, indications for
levosimendan, clinical characteristics and survival in the Swedish Heart Failure
Registry between 2000 and 2011. For repetitive levosimendan, we assessed potential indications for alternative interventions.
Results: Of 53,548 registrations, there were 655 confirmed with inotrope use (597
levosimendan, 37 conventional, 21 both) from 22 hospitals responding to validation,
and 6,069 in-patient controls with NYHA III-IV and ejection fraction < 40%. The
indications for levosimendan were acute HF in 384 registrations, and planned repetitive in 234 registrations. Planned repetitive as a proportion of total levosimendan
registrations and total levosimendan patients by hospital ranged from 0-65% (left
figure) and 0-54% (right figure), respectively. Of planned repetitive patients without
existing cardiac resynchronization therapy, implantable cardioverter-defibrillator,
transplant and/or assist device, 46-98% were potential candidates for such interventions.
Conclusion: In HF in cardiology and internal medicine in Sweden, levosimendan was the overwhelming inotrope of choice, and the use of planned repetitive
levosimendan was extensive, highly variable between hospitals and may have
pre-empted other interventions. Potential effects of and indications for planned
repetitive use needs to be evaluated in prospective studies.
P1380
Modification of heart failure pharmacotherapy and adherence to guidelines
during hospitalization
A Deticek1 ; T Roblek1 ; A Mrhar1 ; M Lainscak2
University of Ljubljana, Faculty of pharmacy, Ljubljana, Slovenia; 2 University Clinic
of Respiratory and Allergic Diseases Golnik, Division of Cardiology, Golnik, Slovenia
1
Aim: Guideline recommended heart failure (HF) pharmacotherapy is not optimally
translated to clinical practice. Hospitalization provides ample opportunity for pharmacotherapy optimization and individual tailoring. We aimed to assess prescription
and dosing of key pharmacological agents on admission and at discharge, including
reasons for treatment termination or dose reduction.
Methods: This was a prospective observational survey which screened 1372 admissions for presence of known HF diagnosis, left ventricle dysfunction, symptoms
and signs of HF with elevated serum NT-proBNP or treatment with a loop diuretic
within 24 hours after admission for other reason than renal failure. Demographic
characteristics, medical history, laboratory test results and pharmacological treatment on admission and at discharge were collected. Guideline adherence index-3
(GAI-3) was defined as prescription of angiotensin-converting enzyme inhibitors
P1382
Individualization of angiotensin ii receptor beta-blocker treatment and its
combination with spironolactone in patients with hypertrophic
cardiomyopathy
SSvetlana Komissarova
Republican Scientific and Practical Centre of Cardiology, Minsk, Belarus
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
Hypertrophic cardiomyopathy (HCM) represents a genetically determined disease
characterized by left ventricular (LV) hypertrophy, diastolic dysfunction combined
with excessive collagen deposits (myocardial fibrosis). The use of combination of
angiotensin II receptor blockers (ARB) and aldosterone antagonists (spironolactone)
allows obtaining a stronger effect on PAAC activity in patients with HCM. Additionally, a possible association between therapeutic efficacy and polymorphism of
-344C>T CYP11B2 gene coding aldosterone synthase and catalyzing conversion of
11-desoxycorticosterone into aldosterone.
Objective: assessment of the effect of polymorphism -344C>T of CYP11B2 gene
on therapeutic efficacy of ARB (losartan) and its combination with spironolactone in
patients with HCM to produce strategies of individualized therapy.
Materials and Methods: 82 patients with HCM aged between 34 to 70 years old
(61 males and 21 females) were examined, including 25 patients diagnosed with
obstructive form of the disease, and 57 patients had non-obstructive form. All
patients initially received basic therapy with beta-adrenergic blockin agents (bisoprolol). Additionally, Group I (n = 42) received combination therapy with losartan
dosed at 50 mg/day and spironolactone (verospiron) at a dose of 25 mg/day, and
Group II (n = 41) received losartan 50 mg/day. The follow-up period was 12 months.
All patients were categorized into “susceptible” and “non- susceptible” to treatment
depending on the results obtained. Polymorphism -344C>T of CYP11B2C gene was
detected using PCR-RFLP method.
Results: administration of combined losartan and spironolacton is associated with
evidently decreased NYHA functional class (p% = 0,05) and E/Em ratio (p% = 0,06)
reflecting LV filling pressure which was not seen in Group administered losartan
alone. Moreover, group I comprised 1.3-fold more patients with a positive response
to treatment compared to group II. In addition, the correlation between therapeutic efficacy and CYP11B2 gene polymorphism was established. The TT genotype
carriers were more susceptible to treatment in both groups (72,7% patients having
this genotype treated with losartan and 88,9% treated with losartan/spironolactone
combination). The CT gene carriers were susceptible to LS combination treatment
in 70% of cases whereas only 42% showed a positive response to losartan administration.
Conclusions: patients with HCM who had TT genotype are susceptible to ARB treatment (𝜌% = 0,05), and combination of ARBs and spironolactone is effective these
patients and for those having CT genotype, i.e. for carriers of at least one T allele.
267
audit should increase awareness among physicians about the importance of managing heart rate in patients in sinus rhythm.
P1384
Different influence of digoxin on prognosis in CHF according the heart rhythm
YYury Mareev1 ; MA Danielyan2 ; V Mareev2 ; Y Belenkov2
A.L. Myasnikov Institute of Cardiology, Moscow, Russian Federation; 2 M.V.
Lomonosov Moscow State University, Faculty of Basic Medicine, Moscow, Russian
Federation
1
Aim: to study influence of digitalis on prognosis in patient with overt heart failure.
Materials and Methods: We followed for 6 years 1114 consecutive patients hospitalized with CHF (NYHA II-IV) in single clinical center. Patients have been divided
into Sinus Rhythm (SR) group (n = 621) and permanent or persistent atrial fibrillation
(AF) group (n = 493).
Results: On unadjusted analysis, patients received digitalis had higher risk of death
(HR 1,379; 95% CI 1,097-1,732; p < 0,001), mostly because increased mortality
in SR (HR 1,847; 95% CI 1,418-2,406 p < 0,001), while risk of death in CHF pts
with AF had been unchanged (RR 0,849; p% = 0,506). As one can expect, patients
received digoxin have lower systolic (123 mm Hg vs 130 mmHg p < 0,05) and
diastolic pressure (79,4mm Hg vs 82,5 mmHg p < 0,05) and higher HR (96,4bmp
vs 83,6bpm, p < 0,001) and have some other difference.
After adjustment by different variables (sex, age, NYHA functional class, heart rate,
blood pressure, LVEF) we didn‘t found significant influence of digitalis on prognosis
in CHF pts with SR (HR 0,790; p% = 0,281), but among pts with CHF and AF,
treatment with digitalis was associated with significant reduction in mortality (HR
0,473 95% CL 0,226-0,988; p% = 0,046).
Conclusion: Our data suggest that treatment with digitalis plus to optimal medical
therapy could improve survival in pts with advanced CHF with permanent AF, but
not in sinus rhythm, where effect of digoxin on prognosis was neutral.
P1383
Heart rate as a therapeutic target in heart failure: analysis of 1000
consecutive outpatient appointments to a heart failure clinic
R Dierckx1 ; S Parsons1 ; P Putzu1 ; B Dicken1 ; P Pellicori1 ; J Zhang1 ; J Weston1 ; J
Davis2 ; A Clark1 ; J Cleland1
1
University of Hull, Hull York Medical School, Centre for Cardiovascular and
Metabolic Research, Hull, United Kingdom; 2 Castle Hill Hospital, Hull, United
Kingdom
Background: Amongst patients with heart failure (HF) due to left ventricular systolic
dysfunction (LVSD) in sinus rhythm, those with higher resting heart rate (HR) have
a worse prognosis. Reducing sinus rate to 50-60bpm improves outcomes. If beta
blockers (BB) are not tolerated or HR remains >70 bpm despite BB, ivabradine may
reduce HR and improve outcome.
Aims: To characterize patients attending a HF clinic and identify the proportion eligible for optimization of BB or ivabradine treatment. The clinic accepts referrals from
primary and secondary care and offers long term follow-up to patients regardless of
LVEF.
Methods and Results: Between January 2013 and July 2013, 1000 consecutive HF clinic follow-up appointments were reviewed and demographic, clinical
and echocardiographic data were collected in patients who attended (n = 959, 644
male). The median duration between initial assessment and follow-up was 941 (IQR
347-2153) days. Most patients had mild to moderate HF (25% NYHA I, 51% NYHA II
and 24% NYHA III/IV). Median age was 76 years (IQR 68-82), NTproBNP 1091 ng/L
(IQR 396-2230) and ejection fraction (EF) 45%(IQR 36-54), with 370 patients (39%)
having a reduced EF ( < 40%), of whom 257 were in sinus rhythm (mean HR 69 ± 12
bpm) and 113 in atrial fibrillation (mean HR 75 ± 15 bpm). Patients treated with BB
(n = 331, 92%) had a mean HR of 69 ± 12 bpm compared to 82 ± 19 bpm in those
not taking BB.
In those with LVSD, sinus rhythm and a HR above 70 bpm (n = 90), 18 patients were
already treated with guideline-target doses of BB, 24 had BB dose increased, 19
were known to be intolerant of higher dose and 26 were eligible for uptitration of BB
but did not receive appropriate advice (‘missed indication’). Thirty seven patients
who were receiving maximally tolerated BB doses or were BB intolerant, were eligible for ivabradine. Seven patients were already taking ivabradine at the time of
assessment and in 5 of these the dose was increased, 13 were started on treatment
following the clinic visit, and in 17 patients, the indication was initially ‘missed’.
Conclusion: Among patients with LVSD (about 37% of those with HF), most are
treated with a BB at a dose that maintains HR < 70bpm and only about 10% are eligible for ivabradine (∼4% of overall HF clinic population). However, even in an expert
clinic missed opportunities to intervene to reduce HR are common. Education and
P1385
The Clopidogrel or Aspirin in Chronic Heart Failure (CACHE) Study
SSunaina Parsons1 ; A S Rigby1 ; C Gittus1 ; T A Mcdonagh2 ; J J Mcmurray3 ; I B
Squire4 ; M T Kearney5 ; J Taylor6 ; I B Wilkinson7 ; J G F Cleland8
1
University of Hull, Department of Academic Cardiology, Hull, United Kingdom;
2
King’s College Hospital, London, United Kingdom; 3 University of Glasgow,
Glasgow, United Kingdom; 4 University of Leicester, Leicester, United Kingdom;
5
University of Leeds, Leeds, United Kingdom; 6 NHS Greater Glasgow and Clyde,
Glasgow, United Kingdom; 7 University of Cambridge, Cambridge, United Kingdom;
8
Imperial College London, London, United Kingdom
Background: Previous studies suggest that relatively high doses of aspirin
(>150mg/day) may impair renal function, increase blood pressure (BP) and plasma
concentrations of amino-terminal pro-brain natriuretic peptide (NT-proBNP) and be
associated with worse outcomes in patients with heart failure.
Methods: Patients with a clinical diagnosis of heart failure, in sinus rhythm with
an NT-proBNP>400ng/L receiving diuretic therapy were randomised, open-label,
to either aspirin (75mg/day) or clopidogrel (75mg/day). Patients were assessed at
baseline and at 6 months.
Results: The median (IQR) age of the 87 patients randomised was 75 (82,69)
years, 22 were women, 15 were in New York Heart Association (NYHA) class III
or IV and 67 had been treated with aspirin prior to study. By 6 months, of 38
patients assigned to aspirin, five had died and six withdrew from treatment and
of 49 assigned to clopidogrel three had died and three withdrew. At 6 months,
serum creatinine increased more in those assigned to aspirin rather than clopidogrel (11+17 v 0+24𝜇mol/L; p% = 0.04) with a similar trend for serum urea
(0.7+2.2 v 0.4+2.5mmol/L; p% = 0.60). Systolic BP declined to a similar extent in
patients assigned to aspirin and clopidogrel (-7+27 v -11+27mHg respectively;
p% = 0.61) but diastolic BP declined more with clopidogrel (1+14 v -6+10mmHg;
p% = 0.023). The median change in NT proBNP was similar on clopidogrel and
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
268
Abstracts
aspirin (Clopidogrel -78(-452,201); Aspirin -88(-341,167) p% = 0.91) and NYHA
class was similar in each group.
Conclusions: These data confirm other reports suggesting that aspirin use is associated with more impairment of renal function and higher BP in patients with heart
failure. These effects may be mediated by inhibition of vascular prostaglandins.
However, it is not clear if this leads to greater cardiac stress (higher NT-proBNP) or
worse clinical outcome.
DRUG THERAPY, OTHER – POSTER DISPLAY
P1386
Features of heart remodelling performed in accordance with the therapy
adherence at the patients with five year anamnesis of myocardial infarction
and chronic heart failure
values and MACE were evaluated for 2 years of follow up. Statistic analysis: multiple
regressions, chi square test.
Results: In patients with stable angina and non ST acute coronary syndrome
treatment with drugs with mentioned effects was followed by significant reduction
in incidence of readmission fir heart failure (p < 0.01) sudden cardiac death (p <
0.05), cardiovascular death (p < 0.05), nonfatal AMI (p < 0.025), improving of
blood pressure control (p < 0.05), and renal function(p < 0.05) in comparison with
control group. Decreased incidence of oxidative stress, platelets hyperactivity and
endothelial dysfunction in groups treated by drugs with mentioned effects was
significantly correlated with reduced incidence of MACE.
Conclusions: In patients with stable and non ST acute coronary syndrome, a
significantly reduced incidence of: readmission for heart failure, sudden death,
other cardiovascular death, acute myocardial infarction and a significantly improved
blood pressure control and renal function were observed in groups treated with
drugs with reducing effect on oxidative stress, platelets hyperactivity and endothelial
dysfunction in comparison with control groups.
AI Chesnikova; VViktoria Safronenko
State Medical University, Rostov-on-Don, Russian Federation
Objective: Research was aimed at the features of the left ventricle (LV) structure
functional state analysis at the patients with five year myocardial infarction (MI)
anamnesis and chronic heart failure (CHF) taking into account their therapy adherence.
Methods: LV structure functional state estimation was carried at 72 patients with five
year MI anamnesis and with CHF symptoms who were taking angiotensin converting
enzyme inhibitor (ACEI), beta-adrenergic blocking agent (BAB) and their combinations. The patients who were taking such medication continuously during the five
year time period were considered to be therapy adherenced. According to the therapy adherence all patients were subdivided into 4 groups: the 1st group was regularly
taking ACEI, the 2nd group was regularly taking BAB, the 3rd group was regularly taking ACEI in BAB combination, and the 4th group of patients was taking ACEI or BAB
monotherapy or their combination but not on a regular basis.
Results: Throughout the observation period ACEI therapy adherenced patients
made up 23.6 %, BAB therapy patients - 25 %, the patients with the combined
ACEI and BAB therapy - 29.2% and the patients with no monotherapy adherence
of ACEI or BAB or their combination made up 22.2 %. Myocardial hypertrophy progressing was revealed in the 2nd and 4th groups with the reliable increase of index of
left ventricular mass (IMLV) by 43.16 g/m2 and 19.11 g/m2 respectively. LV myocardial hypertrophy regress was revealed in the 3nd group with the decrease of IMLV by
25.52 g/m2 (𝜌% = 0.000). LV systolic functional analysis has revealed a myocardial
stress decrease in ACEI or BAB monotherapy or in their combination. The lowest
decrease (by 16.9 g/sm2 , 𝜌% = 0,031) was observed against the combined therapy.
Favourable changes in LV diastolic functions were reliable only against combined
ACEI and BAB therapy (VE/AMincreased by 0.25 m/s, 𝜌% = 0,000).
Conclusions. Adherence to intaking only ACEI or BAB group medication did
not significantly affect heart structure functional indicators. The combination of
medication taken on a regular basis, which reduces the activity of both reninangiotensin-aldosterone and sympathoadrenal systems being used in optimum
doses, has contributed to the registered regress of pathological heart remodelling
and to the decrease of CHF evidence.
P1387
Cardiovascular and renal protection decreased incidence of heart failure in
coronary artery disease
E Bobescu1 ; D Dobreanu2 ; L Rogozea1 ; A Pascu1 ; C Strempel3 ; N Aldulea1 ; A
Covaciu1
1
Transilvania University of Brasov, Faculty of Medicine, Brasov, Romania;
2
University of Medicine and Pharmacy Targu Mures, Targu Mures, Romania;
3
Transilvania University , Brasov, Romania
Purpose: In patients with stable angina (SA) and non ST acute coronary syndrome
(unstable angina-UA, acute myocardial infarction with ST elevation - STEMI and
without ST elevation – NSTEMI) incidence of heart failure, sudden cardiac death,
other major acute cardiovascular events (MACE), blood pressure control and renal
function were evaluated in relation with administration of drugs with reducing effects
on oxidative stress, platelets hyperactivity and endothelial dysfunction.
Methods: 400 patients (pts) with coronary artery disease were divided in 8 groups:
Group SA T – 40 pts with SA, Group UA T - 62 pts with UA, Group STEMI T –
42 pts with STEMI and Group NSTEMI T - 62 pts with NSTEMI treated with drugs
with complementary mechanisms mentioned above: omega-3 polyunsaturated fatty
acids nebivololum, zofenoprilum, rosuvastatinum, and trimetazidine; Group SA –
38 pts with SA, Group UA - 60 pts with UA, Group STEMI – 40 pts with STEMI
and Group NSTEMI - 60 pts with NSTEMI treated with drugs without mentioned
proprieties: metoprololum, enalaprilum, simvastatinum. All other drugs recomanded
for SA and UA treatment were simillar in groups of study. Biomarkers for oxidative
stress (Total antioxidant status, Myeloperoxidase), platelets hyperactivity (ASPItest,
ADPtest by Multiplateâ), endothelial dysfunction (von Willebrand factor activity, flow
mediated dilation -FMD), kidney disease - creatinine clearance, blood pressure
P1388
Application of home telemonitoring, algorithm-assisted, optimization of
guideline-indicated therapy in patients recently discharged with heart failure.
A report from the HeartCycle Programme
L Frankenstein1 ; A Bayes-Genis2 ; R Dierckx3 ; K Slottje1 ; P Atkin3 ; A Guillen4 ; A
Tesanovich5 ; M Domingo2 ; J Lupon2 ; J G FJohn Cleland3
1 University Hospital of Heidelberg, Heidelberg, Germany; 2 Germans Trias i Pujol
University Hospital, Badalona, Spain; 3 University of Hull, Kingston Upon Hull,
United Kingdom; 4 Medtronic Iberica SA, Madrid, Spain; 5 Phillips Research Europe,
Eindhoven, Netherlands
Background: Treatment of heart failure is effective but complex. Many patients do
not receive guideline-indicated medication at target doses, perhaps due to a failure of implementation. However, forced-titration to guideline-targets may be unsafe
due to adverse effects such as worsening heart failure, bradycardia, hypotension
and renal dysfunction. Home telemonitoring (HTM) provides an opportunity to apply
algorithms that facilitate rapid, safe titration of medication.
Methods: Patients with a recent hospitalisation for worsening heart failure were
enrolled into the HeartCycle HTM programme. Patients were asked to report symptoms and measure weight, heart rate and blood pressure on a daily basis for approximately 4 weeks. Specialist clinicians provided individual-patient target-doses based
on heart rate, blood pressure, potassium and renal function and supervised their
implementation.
Results: Of 126 patients enrolled, the median age was 68 years, 96 had a
reduced LVEF and the median plasma concentration of NT-proBNP was 2,796
(IQR 1,443-4,983)ng/L. Thirteen patients never activated the system or discontinued monitoring after a few days and three died. Of the remaining 110 patients, four
were considered contra-indicated for ACE inhibitors (ACEi) or angiotensin receptor
blockers (ARB) and two for beta-blockers (BB). For 72 patients with paired data on
ACEi/ARB the Expert Careplan and Guideline target was the same in 61% of cases,
with 36% of patients having a Careplan Target less than half of the Guideline target
dose, mostly due to low blood pressure and renal dysfunction. At baseline, 24% and
40% of patients were receiving, respectively, doses of ACEi/ARB at least 50% of the
Guideline and Careplan targets and this rose to 37% and 67% by 4 weeks. For 84
patients with paired data on BB, the Expert Careplan and Guideline target was the
same in only 38% of cases, with 62% of patients having a Careplan Target less than
half of the Guideline target dose, mostly due to low blood pressure and bradycardia.
At baseline, 16% and 36% of patients were receiving, respectively, doses of BB at
least 50% of the Guideline and Careplan targets and this rose to 25% and 68% by
4 weeks.
Conclusion: Expert Careplans devised for individual patients often target doses
different from Guidelines. HTM algorithms may facilitate dose titration but even individual Careplan targets were often not met. This may reflect appropriate care in the
light of changes in vital signs or clinical inertia. Ensuring that patients know what the
therapeutic goals are might assist clinicians in achieving targets.
P1389
Prescription of evidence based heart failure therapies in patients hospitalized
for worsening heart failure who received intravenous inotropes during
hospitalization
E-LElena-Laura Antohi1 ; D Dobreanu2 ; D Vinereanu3 ; G Tatu-Chitoiu4 ; D Deleanu1 ;
A Ambrosy5 ; C Macarie1 ; O Chioncel1
1
Institute of Emergency for Cardiovascular Diseases"Prof. Dr. C.C.Iliescu",
Bucharest, Romania; 2 Institute of Cardiovascular Diseases, Targu Mures, Romania;
3 University of Medicine and Pharmacy Carol Davila, University Emergency Hospital,
Bucharest, Romania; 4 Emergency Hospital “Floreasca”, Department of Cardiology,
Bucharest, Romania; 5 Stanford University Medical Center, Stanford, United States
of America
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
269
Background: In-hospital utilization of intravenous (IV) inotropes has been associated to higher in-hospital and post-discharge mortality.
Objective: To evaluate in-hospital utilization of evidence based heart failure therapies (EBHFT) in patients hospitalized for worsening heart failure (WHF) who received
IV inotropes during hospitalization.
Methods: Romanian National Observational Study of In-Hospital Heart Failure
(SONIC-RO) enrolled over one month period, 1222 consecutive patients, admitted with WHF, from 41 hospitals, representative for the Romanian cardiology network. Patients were divided into two groups, depending on the utilization of IV
inotropes. Use of EBHFT at hospital admission and at hospital discharge was compared between the two groups. This is a post-hoc analysis of patients who survived
at discharge.
Results: A proportion of 18.4% of WHF patients received iv inotropes during hospitalization. Demographic characteristics at admission were similar between the two
groups. IV inotropes group patients were more likely to present with lower admission
systolic blood pressure (SBP) (109 ± 28 mmHg vs 151 ± 32 mmHg;p < 0.001), higher
heart rate (98.1 ± 19 vs 90.6 ± 21;p < 0.01) and lower ejection fraction (EF) (30.2 ± 9%
vs 39.7 ± 8%;p < 0.01) Differences between the two groups, as regard to in-hospital
utilization of EBHFT is shown in table 1. IV inotropes patients had longer hospitalization (10.7 ± 3 vs 6.8 ± 3 days;p% = 0.03) and lower rate of clinical improvement
at discharge (74.8% vs 88.1%; p% = 0.01).
Conclusion: In-hospital utilization of IV inotropes has been associated to a lower
prescription of EBHFT. IV inotrope group has characteristics of “risk-treatment mismatch” and other system based strategies, including transition period till discharge
should be considered.
Table 1.
Group 1 (with
inotropes) N% = 224
Group 2 (without
inotropes) N = 985
p
BB admission (%)
51.2
52.8
0.18
BB discharge (%)
45.1
63.16
< 0.001
ACEI/ARB
admission (%)
54.06
51.8
0.037
ACEI/ARB discharge
(%)
50.3
72.5
< 0.001
MRA admission (%)
36.58
44.03
0.037
MRA discharge (%)
47.56
55.16
0.032
Conclusions: Despite the inclusion of Ivabradine in the latest ESC guidelines for
heart failure management there remains a delay in its initiation in “real world” practice. This highlights the need for on-going education to improve guideline adherence
and prescription rates.
P1391
Influence of metabolic therapy with Mildronat on left and right ventricular
function (tissue doppler study)
M Tsverava
Tbilisi Medical Academy, Tbilisi, Georgia, Republic of
Objective: To study the influence of Mildronat 1000 mg daily on left and right ventricular Tissue Doppler (TD) parameters in patients with heart failure
Material and Methods: We studied 18 patients (12 man and 6 women) with II
NYHA class heart failure (HF) due to ischemic cardiomyopathy. At last during 3
months all patients where in stable state and take standard therapy for HF (RAAS
inhibitors, beta-blockers, spirolacton, diuretics). All patient takes peroraly Mildronat
(3-(2,2,2-Trimethylhydrazinii) propionati dihydratum) 1000 mg day for 2 months. The
standard EchoCG examination was done before beginning of treatment and after
2 months of treatment with Mildronat. The pulsed wave TD examination was done
from basal parts of interventricular septum (IVS TD), lateral wall of the left (LV TD)
and right (RV TD) ventricles. On PW TD we measured systolic (S) early (E) and late
diastolic (A) wave velocity. The study was approved by the local ethics committee.
Results: After 2 months of treatment with Mildronat the left atrial dimensions, left
ventricular systolic diameter and volume was reduced and left ventricular fractional shortening (13.5 ± 2.0% versus 19.9 ± 4.3%; p < 0.01) and EF (34.5 ± 8.2%
versus 41.2 ± 4.8%; p,0.01) was significantly increased. Pulmonary arterial acceleration time, right ventricular isometric shortening velocity (10.7 ± 3.3 cm/sec versus
13.5 ± 3.5 cm/sec; p < 0.05) increased and isometric relaxation time (100.2 ± 16.5
msec versus 50.3 ± 24 msec; p < 0.01) significantly decreased which indicates of
improvement of right ventricular function. The index E/E TD and E/E IVS also
significantly decreased (10.02 ± 8.22 versus 14.71 ± 7.01 and 21.91 ± 6.23 versus
16.06 ± 6.67 respectively; p,0.05), which indicates decrease of pulmonary wedge
and left ventricular end diastolic pressure.
Conclusion: In patients with congestive heart failure the treatment with Mildronat
improves right and left ventricular function.
P1392
BB: beta-blocker; ACEI: angiotensin converting enzyme inhibitor, ARB: angiotensin
receptor blocker, MRA: mineralocorticoid receptor antagonist;
Impact of clopidogrel response on the left ventricular systolic dysfunction in
patients with acute coronary syndromes
PPredrag Kekovic; M Isailovic-Kekovic
Health Centre Toplica , Prokuplje, Serbia
P1390
Evaluation of ivabradine eligibility and prescription in chronic heart failure
1
1
1
1
2
1
BR Cole ; PF Brennan ; J Davidson ; P Lindsay ; RL Noad ; LJ Dixon
Victoria Hospital, Cardiology Department, Belfast, United Kingdom; 2 Belfast
City Hospital Trust, Cardiology Department, Belfast, United Kingdom
1 Royal
Purpose: The most recent ESC guidelines on heart failure (2012) recommend ivabradine for patients in sinus rhythm with left ventricular ejection fraction (LVEF) ≤ 35%,
suboptimal heart rate (HR ≥ 70bpm) and persistent symptoms (New York Heart
Association functional class II-IV) despite optimal conventional therapy, to reduce
the risk of heart failure hospitalisations. The adoption of guideline recommended
therapies is typically slow. Our study aimed to ascertain if our nurse-led heart failure clinic was complying with the recent ESC guidelines regarding the utilisation of
ivabradine.
Methods: A 12-month retrospective audit of consultations was collected from our
nurse-led heart failure service. The data was analysed to ascertain what proportion of patients attending the heart failure clinic would be eligible for Ivabradine and
what proportion of these were currently being treated with Ivabradine. Further analysis was carried out to establish if patient characteristics influenced the decision to
initiate Ivabradine therapy.
Results: 292 patients attended the nurse-led clinic between April 2012 and March
2013. 23 patients (8%) were currently prescribed Ivabradine. Of the remaining 269
patients, 165 (61%) were in sinus rhythm (SR) while the remaining 104 (39%) were
in persistent atrial fibrillation. Of the cohort of patients in SR 60 (36%) had a
LVEF ≤ 35%, of whom 16 (10%) had a heart rate ≥ 70bpm despite optimal (or
maximally tolerated) beta-blocker dose, or a contraindication to beta-blockade.
Therefore of the 39 patients eligible for treatment with Ivabradine, 23 (59%)
were currently prescribed Ivabradine with the remaining 16 (41%) suitable but
not yet receiving the drug. There were no significant differences in age, gender,
NYHA status, renal function or aetiology (ischaemic vs. non-ischaemic) between
patients prescribed Ivabradine compared to those eligible but not prescribed
the drug. However patients eligible for Ivabradine but not prescribed it had significantly higher serum NT-proBNP levels (6757 ± 4764 vs. 2209 ± 1368 pg/mL,
p% = 0.048).
Clopidogrel is important component of medical therapy for the patients with acute
coronary syndrome (ACS). Patients with different forms of ACS and left ventricular
systolic dysfunction have a high risk of adverse cardiac outcome. Non response to a
P2Y12 receptor antagonist was identified as an independent predictor of ishaemic
events after percutanous coronary intervention (PCI) and/or successfully fibrinolysis. Optimisation of antiplatelet therapy in patients with ACS and left ventricular
systolic dysfunction would have a great prognostic impact in this high-risk patient
population.
The purpose of the present study was to investigate the relationship between left
ventricular systolic function and response to clopidogrel in patients with ACS.
The study included 116 patients (37 females and 79 males, mean age 67.1 ± 10.9
years) who are hospitalized because of different form of ACS .
Left ventricular performance was examined using Doppler and 2D mod echocardiography and the effect of clopidogrel on platelet function was assessed by the
Multiplate ® platelet function analyzer using by ADP test 20 ± 4 hours after a loading dose of clopidogrel.
The study subjects were divided into 2 groups according to the ADP values. 37
patients fall into group with ADP value 188-467 AU*min ("therapeutic window"
or “responders group”) and 79 patients fall into group with ADP value ≥ 468
AU*min"(non-responders group")
Patients with ACS in clopidogrel responder group had a significantly higher
left ventricular ejection fraction (LVEF) than patients in non-responder group
(57,02 ± 11,07% vs. 51,18 ± 12,18% (p < 0,05))
ADP level in patients with LVEF < 40% was significantly higher (643,23 ± 177,97
AU*min) than in patients with LVEF ≥ 40% (542,02 ± 207,4 AU*min) (p < 0,05).
Proportion of non-responders to clopidogrel was 64% in patients with LVEF < 40%
and 56% in patients with LVEF ≥ 40% . (p < 0,05)
Interindividual variability in platelet response to clopidogrel was substantionaly influenced by multiple clinical factors: hyperlipidemia, obesity, hypertension, congestive
heart failure .
Many patients with severe systolic dysfunction of left ventricle has high on-treatment
platelet reactivity after PCI and/or successfully fibrinolysis. LVEF < 40% was recognized as an independent predictor of non response to clopidogrel.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
270
Abstracts
P1393
Prognosis of heart failure patients in sinus rhythm under treatment with
betablockers alone or in combination with digoxin
R M Christodorescu1 ; D Darabantiu2 ; R Lala2 ; S Ursoniu1 ; S Dragan1 ; A Pop
Moldovan2
1
University of Medicine Victor Babes, Timisoara, Romania; 2 Vasile Goldis Western
University, Arad, Romania
Purpose: Betablockers represent the established standard therapy for heart
failure(HF) patients. Digoxin however, in recently published studies would be
related to a poorer prognosis in patients (p) with HF, left ventricular (LV) systolic
dysfunction and atrial fibrillation (AF). There are no clear data regarding the outcome of these patients under therapy with betablockers and digoxin in sinus
rhythm.
Methods: The study represents a subgroup analysis of our Heart Failure registry
to assess the clinical outcome of patients with HF, LV systolic dysfunction in sinus
rhythm, treated with betablockers alone or in combination with digoxin. It included
116 consecutive HF patients (P) admitted to the hospital for an episode of decompensation, with systolic dysfunction (LVEF ≤ 40%), sinus rhythm and treated with
betablockers. The patients were divided into 2 groups: group 1 (n = 27) were taking
betablockers and digoxin, and group 2 (n = 89) only betablockers. At admission and
at the end of follow-up demographic and clinical characteristics (age, underlying
heart disease, heart rhythm, BP, HR NYHA class, LVEF) were recorded.Logistic
multivariate regression analysis was performed for predictors of death
and readmissions.
Results: In both groups most of the patients were males (70% in both groups), mean
age was 59 ± 11 y and 63 ± 13 y respectively (p% = 0.7). At baseline in group 1 there
was a higher NYHA class (2.8 ± 0.6 vs. 2.4 ± 0.6, p% = 0.003).Mean follow-up period
was 24 ± 19 months and 17 ± 14 months respectively (p% = 0.06). During follow-up
in both groups NYHA class and heart rate decreased significantly. Mean daily digoxin
dose was 0.15+0.05mg/day and mean betablocker dose (carvedilol equivalent dose)
was 15 ± 10mg/day and 21 ± 12mg/day respectively (p% = 0.01).Mean hospitalization rate for HF aggravation was 1.8 ± 1 in group 1 and 1.4 ± 0.8 in group 2 (p% = 0.2).
At logistic regression analysis the only variable associated with the risk of death was
heart rate ≥ 70 b/min at the end of follow-up period (HR:1.06,, 95% CI 0.99-1.13
- p% = 0.057) while rehospitalization was associated with BB dose (HR:0.96, 95%
CI 0.93-0.99 - p% = 0.002). Digoxin use was not associated with an increased risk
of death.
Conclusions: In HF patients with sinus rhythm digoxin did not seem to increase
the mortality risk. Higher HR at the end of follow-up period was associated with
higher mortality while lower dose of BB determined more rehospitalizations for HF.
Betablockers alone and in combination with digoxin may improve heart rate control,
should be used in highest tolerated doses and have an important prognostic value
for survival.
P1394
The assessment of impact ivabradine and nebivolol on the patients with
chronic heart failure
G A Gulnara Abuladze; MJ Nato Jinjolia; M N Marina Nebieridze
Tbilisi State University, Tbilisi, Georgia, Republic of
Purpose: The goal of the study was to compare the effects of treatment by ivabradine and nebivolol on the Left Ventricle systolic and diastolic functions in the patients
with chronic heart failure after Myocardial infarction period.
Methods: We studied 72 patients (52 male and 20 female with mean age 57.3 ± 4.5).
The patients were underwent ECG, Echocardiography and 24-hours holter monitoring for 6 month period. The patients were divided into 3 groups: I group (n = 20)
underwent standard therapy, II group (n = 22) were taken standard therapy together
with nebilet (mean dose 5mg per day), III group (n = 30) were taken standard therapy
together with coraxan (mean dose 7,5mg per day).
Results: At the end of the study in the I group was recorded angina episodes
reduction by 25.3% and improvement of physical resistant in post infarction period.
In the III coraxan group ischemic episodes reduced by 90%, heart rate reduced from
75.1 ± 11.2 till 58.1 ± 5.6 per minute. Its indicated that coraxan improves coronary
perfusion and also reserves of adaptation to physical burden.
This study shows that on the background of standard therapy nebilet and coraxan
reduced the risk of MI. In the III group was recorded increase of left ventricle EF
by 10% (p < 0.05) and also improvement of LV diastolic function (LV end systolic
sizes were reduced from 38.8 ± 2.0mm to 32.0 ± 1.0mm, end diastolic sizes from
52.8 ± 1.9mm till 48 ± 0.3mm, interventrical septum thickness from 12.6 ± 0.2mm till
9.3 ± 0.2mm)
Conclusions: During the 6 month period of study was revealed that coraxan
together with standard therapy is superior in reduction of heart rate and ensured
reliable anti ischemic effects by decreasing chronic HF in post infarction period.
Besides in coraxan group was more improved LV structural remodeling then in other
groups.
HEART FAILURE IMAGING – POSTER PRESENTED
P1396
Effects of varying dietary salt intake and of medication on echocardiographic
indices in patients with chronic heart failure
A Torabi; R Antony; J Weston; N Sherwi; J Zhang; JGF Cleland
Hull York Medical School, University of Hull, Department of cardiology, Hull, United
Kingdom
Background: In patients with chronic heart failure (CHF), variations in dietary salt
intake and ingestion of usual daily medications may cause changes in haemodynamics but this has rarely been investigated.
Design and Methods: Patients with a clinical diagnosis of CHF in New York
Heart Association Class II or III with a left ventricular ejection fraction < 35% or
NT-proBNP >400pg/ml treated with loop diuretics, ACE inhibitors or angiotensin
receptor blockers and beta-blockers were studied. Patients were randomized to
a moderately high (Hi.S; >8g/day) or a low (Lo.S; < 4g/day) salt diet for 3 days
before each study period. Echocardiographic studies were done prior to and 30-60
minutes after usually daily medications. Heart rate (HR) and systolic blood pressure
SBP), left atrial volume (LAV), left ventricular ejection fraction (LVEF), TAPSE, E/E′ ,
inferior vena cava (IVC) were measured in the supine position. The study was
ethically approved and all patients gave written informed consent.
Results: Measurements were made on 20 men with median age 71 (IQR 64-77)
years. Modest reductions in salt intake were associated with reductions in
NT-proBNP but also LVEF. Administration of usual daily medication in patients
with stable chronic heart failure on long-term treatment caused a marked acute
reduction in blood pressure and potassium, an acute rise in NT-proBNP and stroke
volume (VTI) but only modest reductions in weight and little effect on echo indices
of cardiac filling pressure.
Conclusion: Modest short-term differences in salt intake affect measures of cardiac
function in patients with chronic stable heart failure and profound changes may
occur in response to usual medication intake which have rarely been reported.
The prognostic significance of these changes are unclear but should be taken into
account when evaluating serial measurements in this population.
P1398
Ventricular remodeling after myocardial infarction evaluated with 3D speckle
tracking echocardiography (3D-STE)
D Del Prete1 ; G Giura1 ; T Dominici1 ; F Cucchi1 ; F Giordano1 ; P Pellicori2 ; PE
Puddu1 ; T Torromeo1
1 Sapienza University of Rome, Department of Cardiovascular, Respiratory,
Nephrologic, Anesthesiologic and Geriatric Sciences, Rome, Italy; 2 Castle
60872
E/E′
TAPSE mm
35±6 35±8 22±4 26±6 102±35
0.805
0.329
92±53
0.329
16±6 13±6
0.146
17±3 18±4
0.184
13.4±1.7
13.4±1.6
0.963
32±7 37±8 22±5 25±7 97±41
0.009
0.019
97±80
0.986
15±9 16±8
0.503
17±4 17±3
0.444
0.396
0.014
0.521
0.482
HR bpm
BP mmHg K+ mmol/L Weight * kg NT-proBNP ng/L Hb g/dL
EF (%)
Hi.S Pre Hi.S
Post P Value
60±12
62±11
0.343
119±16
113±17
0.024
5.0±0.4
4.5±0.4
0.001
81.1±17.2
80.9±17.3
0.007
1288(514-2129)
1310(549-2713)
0.014#
13.3±1.7
13.2±1.6
0.963
Lo.S Pre Lo.S
Post P Value
62±13
63±11
0.516
122±12
166±13
0.0001
4.9±0.4
4.5±0.4
0.003
81.4±17.2
81.0±17.0
0.006
997(496-2042)
1085(480-2451)
0.028
Hi.v Lo.S
Pre-Med P
Value
0.266
0.173
0.448
0.190
0.034
AV VTI
cm/sec
0.804
LAV mls
0.123
*Measured two hours after medication; #paired t-test was used after log transformation.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
Hill Hospital, Department of Academic Cardiology, Hull, United
Kingdom
Purpose: ST-segment Elevation Myocardial Infarction (STEMI) produces structural
deformations of the ventricular cardiomyocytes due to ischemia and necrosis
leading to cardiac remodeling, in turn responsible for left ventricular (LV) mechanical
changes. We examined, by 3D speckle tracking echocardiography (3D-STE) the long
term LV remodeling in anterior versus inferior STEMI subtypes.
Methods: 11 patients with STEMI (5 with anterior and 6 with inferior subtype) treated
with primary percutaneous transluminal coronary angioplasty (PTCA) within the
previous 24 months (15,2 ± 11,3 IQR% = 17), and 32 healthy subjects were studied
using both 2D echocardiography and 3D-STE (3D Wall Motion Tracking).
Results: Compared to controls, LV ejection fraction (EF, p≤0.001), global longitudinal
strain (GLS, p% = 0.002) and global circumferential strain (GCS, p% = 0.002) were
decreased in STEMI patients whilst LV end-systolic volume index (ESVI, p≤0.001)
was increased. Compared to patients with anterior STEMI, those with inferior
STEMI had similar LVEF, (40,6 ± 4 % vs 46 ± 5,9 % p% = 0.142), GLS (-11,1 ± 2,4 vs
-13,3 ± 2,5 p% = 0,144) and GCS(-21,1 ± 4,4 vs -21,9 ± 6,1 p% = 1,000) but lower
LVESVI (42,4 ± 8,8 vs 31,3 ± 5,7, p% = 0.05).
Conclusions: In patients who had STEMI, LV mechanics are impaired with worse
global cardiac performance. However, STEMI localization does not differentially
affect global LV mechanics.
271
and pro-brain N-terminal pro brain natriuretic peptide level (NT-proBNP) (median
7787 vs 810 pg/ml). Intraventricular dyssynchrony was associated with lower LV EF
(median 24.0 vs 31.0%), glomerular filtration rate using MDRD equation (median 51
vs 71 ml/min/1.73 m2 ), greater LV end systolic volume (median 157 vs 90 ml), LV
end diastolic volume (median 183 vs 141 ml) and alkaline phosphate level (median
89 vs 60 U/l).
Conclusions: Systolic inter- and intraventricular dyssynchronies is common
in adult patients with HFrEF and is associated with echo characteristics and
NT-proBNP.
P1399
Rest speckle-tracking echocardiography for identification of viable
myocardium in chronic CAD patients
NNadezhda Murashova; MY Gilarov; NA Novicova; VP Sedov; AL Sirkin
I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
Background: Speckle tracking echocardiography is an available method for estimating of global and regional left ventricular systolic strain. Longitudinal strain
reflects contractions of subendocardial fibers that make it’s measuring interesting
in CAD patients. The aim of present study is comparing baseline rest regional longitudinal strain with improving regional contractility after bypass surgery in post-MI
patients.
Materials and methods: 42 males, aged 41 to 73 (average 57 yo) with post-MI
CAD and indications for bypass surgery were included in the study. Standard Echo
and speckle-tracking echocardiography (GE VIVID 7, 6.0.0) were performed at the
baseline and in 6 months after surgery. Data is presented as average and standard
deviations. For estimating diagnostic accuracy of rest speckle tracking echo the
ROC curve analysis were done. P value < 0,05 was estimated to be significant.
Results: Total of 510 myocardial segments were analyzed. 333 were normokinetic,
102 hypokinetic and 72 were akinetic. Average longitudinal strain for normokinetic segments was-15,7 ± 5,5, for hypokinetic-9,3 ± 4,6 and for akinetic-5,3 ± 4,5
(p < 0,0001). The improve in regional strain after bypass surgery was observed in
segments with basal strain of-13,0 to-5,5. The ROC curve is presented in Fig.1.
According to the ROC curve the critical rest longitudinal strain of-10,5 was estimated
as a cut-off for improve in regional contractility after bypass surgery with sensitivity
of 83% and specificity of 53%.
Conclusion: Rest longitudinal strain of-10,5 was estimated to be a cut-off for identification of viable myocardium in patients with post-MI CAD
P1400
Interrelation between mechanical dyssynchrony and NT-pro-BNP in ischemic
cardiomyopathy
YVYuliya Stavtseva1 ; SV Villevalde1 ; ZD Kobalava1 ; AV Sveshnikov2
City Clinical Hospital No 64, Moscow, Russian Federation; 2 Pirogov’s National
Therapy and Surgery Centre, Moscow, Russian Federation
1
Purpose: The aim of the study was to investigate systolic mechanical dyssynchrony and its interrelation with clinical, echo and laboratory characteristics in adult
patients with heart failure with reduced ejection fraction (HFrEF).
Methods. In 73 patients with HFrEF (71.2% male, 67.3 ± 13.5 years (M ± SD),
NYHA functional class I, II, III, IV 3, 43, 34 and 20% respectively, ischemic cardiomyopathy 89%, arterial hypertension 71.2%, atrial fibrillation 37%) 12-lead
electrocardiogram and complete echocardiographic examination including tissue
Doppler imaging were performed. Atrioventricular dyssynchrony was defined as
left ventricular filling time < 40% of the RR-interval. Interventricular dyssynchrony
was measured as the difference in onset of Doppler-flow in the pulmonary and
aortic outflow tracts >40 ms. Intraventricular dyssynchrony was expressed as
a standard deviation of the time to peak systolic velocity in 12 left ventricular segments >33 ms. Mann-Witney U test was used. P < 0.05 was considered
significant.
Results: Intraventricular conduction disorders (LBBB and RBBB) were detected
in 23 (65.7%) and 1 (2.9%) patients, respectively. Atrioventricular, inter- and intraventricular dyssynchrony was present in 12 (16.4%), 51 (70%), and 66 (90.4%)
patients respectively. Interventricular dyssynchrony was associated with lower LV
EF (median 30.0 vs 35.0%), greater right ventricle dimension (median 3.1 vs 2.6 cm),
60868 Figure 1. ROC curve.
P1401
The effect of bariatric surgery in improving left ventricular diastolic function
RRenata Petroni; L Pezzi; F D’agostino; M Di Mauro; SF Altorio; S Romano; A
Petroni; M Penco
San Salvatore Hospital of l’Aquila, L’Aquila, Italy
Background: The obesity is becoming more and more a worldwide issue (globesity).
The main impact of the obesity is surely on cardiovascular disease. In fact, obese
patients have an increased cardiovascular risk, especially for ischemic heart disease and heart failure. The aim of this study is to evaluate if bariatric surgery allows
to improve left ventricular diastolic function.
Methods. From January 2010 to February 2013, 38 obese patients (average BMI
46 ± 8,9) were scheduled at our outpatient obesity clinic; all these patients underwent bariatric surgery. The prevalence of hypertension was 58%; diabetes 22% and
hypercholesterolemia 33%.
Follow up was 100% completed. All the patients were evaluated at baseline and
18 months. Diastolic function was evaluated with the following parameters: E wave
peak, A wave peak, E/A ratio, E deceleration time and E/E′ value .
Results: Among 38 patients before surgery seventeen (45%) showed a diastolic
filling pattern of impaired relaxation (grade I diastolic dysfunction); five (13%) presented a pseudo-normalized filling pattern (grade II) and sixteen (42%) showed a
normal diastolic filling pattern; no one presented a restrictive pattern (grade III). After
bariatric surgery five (13% vs 45%; p < 0,001) patients remain with a grade 1 of
diastolic dysfunction; two patients (5% vs 13%; p < 0,01) showed the persistence
of pseudo-normalized filling diastolic pattern and thirty-one patients (86% vs 42%;
p < 0,001) presented a normal filling diastolic pattern.
This variation was correlated also with cardiovascular risk factors; we evaluated if
withdrawing therapy for hypertension, diabetes and hypercholesterolemia allowed
to improve diastolic filling patterns with the following Results: there is significant
statistical difference in the percentage of patients with hypertension and grade I
or grade II of diastolic dysfunction before and after bariatric surgery (88% vs 0%;
p < 0,001 and 100% vs 50%; p < 0,001). Among diabetic subjets we have had similar
Results: for grade I of diastolic dysfunction 82% vs 20%; p < 0,001 and for grade II
of diastolic dysfunction 100% vs 50%; p < 0,001. For hypercholesterolemic subjects
with grade I of diastolic dysfunction before and after bariatric surgery this percentage are 80% vs 0%; p < 0,001 and for grade II of diastolic dysfunction 100% vs
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
272
Abstracts
50%; p < 0,001
Conclusions: Bariatric surgery is effective to improve left ventricular diastolic function, especially in patients that withdraw therapy for cardiovascular risk factors
Cox Regression analysis
Hazards ratio 95%
C.I
P value
Univariate analysis
P1402
Age
Incremental value of global longitudinal strain for predicting outcome in
chronic heart failure outpatients with systolic dysfunction
1.04 (1.01 to 1.07)
Hazards ratio
95% C.I
P value
Multivariate
analysis
0.016
1.03 (0.99 to
1.07)
0.112
Heart rate
0.99 (0.98 to 1.01)
NS
IInes Rangel1 ; A Goncalves2 ; C Sousa1 ; PB Almeida1 ; J Rodrigues1 ; F Macedo1 ; J
Silva-Cardoso1 ; MJ Maciel1
1
Sao Joao Hospital, Porto, Portugal; 2 Harvard Medical School, Cardiology, Boston,
United States of America
Systolic BP
0.98 (0.97 to 0.99)
0.001
0.99 (0.95 to
1.01)
0.058
eGFR
0.97 (0.96 to 0.98)
0.002
0.98 (0.96 to
1.02)
0.044
Background: The risk stratification of chronic heart failure (CHF) patients can be
performed using echocardiographic markers of left ventricle (LV) dysfunction, such
as the ejection fraction (EF). LV global longitudinal strain (GLS) showed to be a sensitive measure of myocardium deformation. However, its role as prognostic marker
in CHF patients with exclusively systolic dysfunction is still poorly addressed.
Objectives: This study sought to evaluate the incremental prognostic role of
two-dimensional (2D) LV GLS in CHF outpatients.
Methods: Fifty-five patients with CHF and LVEF ≤45% performed a 2D echocardiogram with assessment of conventional parameters and GLS by speckle tracking
(STE) imaging averaged from apical 4-chamber, 3-chamber and 2-chamber views.
A clinical follow-up of 12 months was performed to assess the occurrence of
composite endpoint of overall mortality and nonfatal cardiovascular events.
Results: We included 55 patients (mean age 55 ± 12 years, 80% males, 30% with
CHF of ischemic etiology, with mean LVEF of 27 ± 9%, median BNP levels 162
[P25-75 56-542] pg/ml). The mean GLS was – 10.35 ± 3.14%.
GLS was significantly correlated with NYHA functional class (R% = 0.41,
p% = 0.002) and BNP levels (r% = 0.47, p% = 0.001) and showed a good correlation with LVEF (r% = -0.687, p < 0.001).
The logistic regression analysis showed that GLS (OR 1.548 [95% CI 1.169-2.051])
and LVEF (OR 0.895 [95% CI 0.822-0.976]) were significantly associated with
the composite end-point. Other variables that were significantly related with GLS
included NYHA functional class (OR 7.333 [95% CI 2.084-25.809]) and BNP levels
(OR 1.003 [95% CI 1.001-1.005]). Multivariated regression analysis, including GLS
and LVEF, showed an independent association of GLS with adverse outcome (OR
1.460 [95% CI 1.036-2.058]).
The area under the receiver operating characteristic (ROC) curve to predict the
occurrence of the composite endpoint was 0.798 [0.678-0.919] with an optimal
thresholds of -9.5 (80% sensitivity, 70% specificity, p% = 0.001), while EF had an
area under the ROC curve of 0.276 [0.138-0.414].
Conclusions: GLS was strongly associated with severity disease status and
predicted the occurrence of adverse outcomes. Quantifying LV GLS in CHF outpatients with systolic dysfunction provides greater accuracy for cardiovascular risk
stratification than LVEF.
Plasma sodium
0.93 (0.88 to 0.98)
0.008
0.95 (0.89 to
1.01)
0.128
QRS duration
1.01 (1.0 to 1.02)
0.013
1.0 (0.98 to
1.02)
0.727
P1403
Mean ee predicts one year mortality in acute decompensated heart failure
N U HNoor Ullah Hussaini Mohammed; HAFID Narayan; PAULIN Quinn; IAIN
Squire; LEONG Ng
Cardiovascular Research Unit of Leicester, Cardiovascular Sciences, Leicester,
United Kingdom
Theaim of this study was to determine if echocardiography derived tissue Doppler
E/é was an independent predictor of all-cause mortality in patients admitted with
acute heart failure (HF).
In a prospective cohort study we recruited 173 patients admitted to hospital diagnosed with acute de novo or decompensated HF using clinical criteria. All patients
underwent transthoracic echo measurements of biplane ejection fraction (EF) and
tissue Doppler and were followed up to for a minimum of 12 months. The endpoint
was all-cause mortality at 12 months.
Patients median age was 72 years (interquartile range [63 to 79]) with 139 (80.3%)
being male. 39 (22.5%) patients had died by 12 months. Those who died were
older (75 [69 to 82] vs. 70.5 [61 to 78] years, p% = .017), had a lower admission
systolic BP (116 [105 to 139] vs. 135 [116 to 154] mmHg, p < .001) and lower
eGFR (50 [38 to 60.5] vs. 61 [48 to 73], p% = .001) compared to survivors. EF was
significantly lower in those that died compared to survivors (30 [20 to 41] vs. 36 [27
to 45] %, p% = .039) while mean E/é was significantly greater (18.5 [14.4 to 27] vs.
15.6 [12.3 to 20.9], p% = .006). In multivariate Cox hazards regression only a lower
eGFR (HR% = 0.98 [0.96 to 1], p% = .044) and greater mean E/é (HR% = 1.06
[1.02 to 1.11], p% = .008) remained significant independent predictors of
early mortality.
Mean E/é is an independent predictor of one year mortality and may be useful in
the prognostic assessment of patients with admitted with acute HF.
-
Beta blockers
1.11 (0.59 to 2.09)
NS
-
ACEi or ARB
0.87 (0.46 to 1.64)
NS
-
Ejection fraction
0.97 (0.95 to 1.01)
0.036
0.98 (0.96 to
1.02)
0.169
Mean E/e‘
1.06 (0.96 to 1.12)
0.003
1.06 (1.02 to
1.11)
0.008
P1404
Real life practice of assessing left ventricular ejection fraction
A Ioannidis1 ; D Tsounis1 ; A Fragkiskou1 ; A Pechlevanis2 ; M Paraskelidou2
Open University, Patra, Greece; 2 GHT “Agios Pavlos” - Complex
“Panagia”, Thessaloniki, Greece
1 Hellenic
Background: The recommended echocardiographic method for measurement of
left ventricular ejection fraction (LVEF) is the apical biplane method of discs (modified Simpson’s rule - MSR). The Teichholz method and the visual assessment of
LVEF ("eye-balling") are not recommended.
Aim: To determine the LVEF measuring methods that are used in real life practice
and to assess the degree of guidelines implementation.
Methods: In order to achieve wider representation we asked the non-medical personnel of our hospital to provide us with copies of transthoracic echocardiography
(TTE) studies of their family members. Echo studies were carefully inspected to
detect relevant parameters by two TTE experienced cardiologists.
Results: 318 TTE studies were collected, performed by 127 of the 270 (47.0%) cardiologists in Thessaloniki prefectural area (2.5 studies per doctor). The MSR was
utilized only by 9 (7.1%) doctors in 41 (12.8%) studies, while a relevant still with measurements was included only in 32 (78.0%) printed reports. A printed still with linear
dimensional measurements was included in the majority of the rest reports as it could
not be located in 4 reports. In 182 (57.2%) studies the calculated LVEF by Teichholz
in the printed image was also precisely included in the report, while in 79 (24.8%)
it was reported as a 5% range. Of note, in 16 studies the reported LVEF differed
by more than 5% from the one calculated in the printed image, probably reflecting
the overall “eye-balling” assessment. Studies utilizing the MSR had a lower mean
LVEF compared with the ones using Teichholz method (43.5% vs. 58.3%, p < 0.001).
Regional wall motion abnormalities were reported in 119 of the 277 (43.0%) studies who did not use the MSR. No difference was observed whether the study was
performed at a public institution or privately. There was a non-significant trend in
favour of using the MSR at university hospitals thought sample size could not allow
robust analysis. Last, but not least, 7 (77.8%) of the doctors who utilized the MSR
are EACVI accredited in adult TTE.
Conclusions: The recommended modified Simpson’s rule is utilized by less than
10% of cardiologists in Thessaloniki prefectural area. Doctors persist in using Teichholz method or “eye-balling” even when regional wall motion abnormalities are
noted. EACVI TTE accredited individuals are more likely to implement current guidelines. Further efforts are warranted to encourage doctors to train for the EACVI TTE
accreditation as well as to enforce the use of the modified Simpson’s rule for the
assessment of left ventricular ejection fraction.
P1405
Effects of levosimendan on acute mitral regurgitation : an echocardiographic
study
MMarco Cordero1 ; MJ Garcia Gonzalez1 ; P Jorge Perez1 ; MM Martin Cabeza1 ; MI
Padilla Perez1 ; E Gonzalez Cabeza1 ; C Mendez Vargas1 ; S Sanchez Lopez1 ; A
Jimenez Sosa2
1
University Hospital of the Canaries, Santa Cruz de Tenerife, Spain; 2 INCANIS
Hospital Universitario de Canarias, LA LAGUNA, Spain
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
273
Purpose: Patients with acute heart failure (AHF), severe left ventricle (LV) dysfunction and acute severe mitral regurgitation (MR) have a dismal acute phase prognosis.
Effects of levosimendan in this group of patients are not understood. The aim of
our study is to evaluate the effects of levosimendan on the degree of MR in this
population.
Methods: A group of 11 patients (3 males and 8 females), aged 65 ± 8 years old,
with de novo acute HF, of any aetiology, without evidence of cardiogenic shock, with
severe left ventricular dysfunction (EF < 35%), severe not primary MR and no contraindications to levosimendan was studied. Transthoracic echocardiography was
performed before and after a continuous 24 hours levosimendan intravenous treatment (0,1 mg/kg/min without loading dose).
Results: Echocardiographic variables and their changes before and after levosimendan treatment are shown in Table 1.
Conclusions: Levosimendan treatment shows beneficial effects in reducing the
severity of mitral regurgitation in patients with acute heart failure and left ventricular dysfunction. A clear improvement in diastolic function and ventricular filling is
also observed.
Table 1
PRE
POST
E wave peak
126±12 cm/s
109±11 cm/s
DT
138±22 msec
196±35 msec
p < 0,05
E’ wave peak
8±2 cm/s
11±5 cm/s
p < 0,05
E/E’
14±4
9±3
p < 0,05
Jet/LA area
56%±10%
35%±8%
p < 0,05
PISA
0,6±0,1 mm
0,4±0,07 mm
p < 0,05
Vena Contracta
0.68±0,13 mm
0,5±0,15 mm
NS
RF
65%±3%
42%±8%
p < 0,05
RV
66±10 mL
43±7 mL
p < 0,05
ERO
0,5±0,08 cm2
0,2±0,03 cm2
p < 0,05
p < 0,05
DT% = deceleration time; LA% = left atrium; RF% = regurgitation
RV% = regurgitaion volumen; ERO% = effective regurgitant orifice
fraction;
P1406
Papillary fibroelastomas: “the flip side”
J CJoana Catarina Duarte Rodrigues1 ; JA Jorge Almeida2 ; MC Manuel Campelo1 ;
PP Paulo Pinho2 ; MJM Maria Julia Maciel2
1
Sao Joao Hospital, Department of Cardiology, Porto, Portugal; 2 Sao Joao
Hospital, Department of Cardiothoracic Surgery, Porto, Portugal
Background: Papillary fibroelastoma (PF) is a rare primary benign tumor of cardiac origin, predominantly affecting cardiac valves. Although majority of patients
(pts) are asymptomatic, they may result in complications such as stroke, embolism
or acute valve dysfunction. The advent of echocardiography and modern imaging
improvement has allowed earlier detection and more accurate characterization of
these tumors.
Methods: Institutional records of a tertiary centre from years 1980 to 2013 for pts
with diagnosis of PF confirmed histologically were reviewed. We analyzed demographic, clinical characteristics, pathological features, echocardiography findings,
treatment modalities and prognoses.
Results: A total of 12 pts (67% male), aged 52 ± 18 years had a PF. All pts had at least
one cardiovascular risk factor: 27% arterial hypertension, 25% dyslipidemia, 8,3%
diabetes mellitus and 16,7% tabagism. All had a preserved systolic left ventricular
function, 91,7% were in sinus rhythm and one pt in atrial fibrillation. Clinically, PF
presented with neurological deficits in 33,3% pts (echocardiogram was performed
to excluded a cardiac embolism source), and 66,7% were asymptomatic: 41,7%
performed a echocardiogram routinely and 25% for other reasons. Mitral valve surface was the predominant location of tumor (66,7%), followed by aortic valve (25%)
and in only one case left ventricle was simultaneously involved. Size of the tumors
varied from 3 to 13 mm, 83,3% had a pedicle and tumor mobility was found in only
16,7% of the cases. All pts were treated surgically with successful complete resection of PF: in 91,7% isolated resection was performed and in one case (8,3%) valve
repair was also needed. No major postoperative complications occurred. Symptomatic pts were younger, aged 35 ± 10,9 years (p% = 0.014), pedicle was present
in 50 % of the cases and it was the only tumor characteristic that correlated with
embolic event (p% = 0,02). In these pts surgery delay was shorter: 20,7 ± 5,5 days
(p% = 0.02). Although all pts had the tumor located to mitral valve, no additional differences were found between symptomatic and asymptomatic pts. In asymptomatic
pts size of tumor was 10 ± 1,9 mm(vs8 ± 3,6mm, p% = 0.383), and was in the basis
of surgical indication. Mean follow-up was 50,7 ± 57,0 months and no recurrence of
tumor or embolic events were documented.
Conclusions: In this small cohort, pts with embolic events where younger and
tumors where most likely pedunculated. Complete surgical resection of the tumor
has a excellent prognosis and it seems to be a good strategy, although pts should
be followed up closely with periodic clinical evaluation.
P1407
Metabolic profile is a determinant of inadequate RAAS suppression and
biventricular dysfunction
M Gregori; B Giammarioli; G Tocci; A Befani; GM Ciavarella; A Ferrucci;
F Paneni
University of Rome “Sapienza”, Sant’Andrea Hospital, Cardiology, Department of
Clinical and Molecular Medicine, Rome, Italy
Introduction: Biventricular dysfunction is an independent predictor of cardiovascular mortality. In this setting, the renin-angiotensin-aldosterone system (RAAS) plays
a major role. Recent work has shown that the lack of RAAS suppression after postural maneuvers is associated with impaired systo-diastolic properties. However, the
determinants of inadequate RAAS suppression remain largely unknown. The present
study was designed to investigate whether metabolic alterations may be associated with inadequate RAAS suppression and subsequent biventricular dysfunction
in hypertensive patients.
Materials and Methods: Supine and upright plasma renin activity (PRA) as well
as aldosterone concentrations (PAC) were measured in 135 hypertensive subjects divided as follows: 1) normal PRA and PAC (N, n = 65); 2) suppressible
RAAS after supine position (SR, n = 36); 3) not suppressible RAAS (NSR, n = 34).
PRA and PAC were firstly assessed after the subjects had been standing for
at least 30 minutes and then after 2 hours of lying in supine position. 24-hour
ambulatory blood pressure monitoring and echocardiographic evaluation, including Tissue Doppler Imaging (TDI), were performed. Patients with cardiovascular disease or on antihypertensive treatment were ruled out. LVD was identified
by an aMPI (MPImitral+MPIseptal/2) value above 75th percentile (aMPI > 0.57).
RVD was identified by a lateral tricuspid MPI value over 0.55 according with ASE
recommendation.
Results: NSR patients had reduced indices of RV function, as compared with N
and SR. MPI of both ventricles as well as prevalence of biventricular dysfunction were also significantly higher in NSR group. Regression models showed that
inadequate RAAS suppression was independently associated with biventricular dysfunction, regardless BP. Prevalence of inadequate RAAS suppression progressively
rose across quartiles of BMI, waist circumference and fasting glycemia. Logistic
regression models showed that BMI [OR: 2.3 (95% CI: 1.34-16.8), p < 0.05], waist
circumference [OR: 3.2 (95% CI: 2.21-25.6), p < 0.05] and fasting glycemia [OR: 2.9
(95% CI: 1.22-22.7), p < 0.05] were independently associated with an increased risk
of inadequate supine RAAS suppression.
Conclusions: Patients without clinostatic normalization of RAAS display a significant impairment of biventricular function. BMI, waist circumference and fasting
glycemia are independent predictors of failed RAAS suppression after postural
maneuvers. Our findings encourage a dynamic assessment of RAAS, especially in
patients with obesity and/or diabetes, in order to better stratify individual cardiovascular risk.
HEART FAILURE IMAGING – POSTER DISPLAY
P1408
Thyroid dysfunction and heart failure: no specific echocardiographic pattern
for hypo- and hyperthyroidism
A Frigy; D Nistor; I Kocsis; L Fehervari; E Carasca
University of Medicine of Targu Mures, Targu Mures, Romania
Thyroid dysfunction, both hypo- and hyperthyroidism, can act as aggravating factor in heart failure patients. The aim of our study was to identify characteristic
echocardiographic patterns which could reveal the cardiac consequences of thyroid
dysfunction. Methods. Standardized 2D and Doppler echocardiographic data were
colected in 72 patients with hypothyroidism (40 women, 32 men, mean age 62,3 yrs)
and 42 patients with hyperthyroidism (31 women, 11 men, mean age 59,3 yrs) and
symptomatic heart failure (NYHA class III and IV). Parameters in the two groups were
compared using chi-square test. Results. LVED diameter >60 mm (p% = 0,32), LVEF
< 40% (p% = 0,35), grade 2 or 3 diastolic dysfunction (p% = 1), significant mitral
regurgitation (p% = 0,11), right ventricular enlargement (p% = 0,24), systolic pulmonary pressure > 60 mmHg (p% = 0,13) and the presence of increased pericardial
thickness (p% = 0,14) showed no statistically significant differences between the two
groups. Only an increase in the thickness of the interventricular septum (>12 mm)
was significantly more frequent in patients with hypothyroidism (p% = 0,001). Conclusions. The lack of significant difference between the vast majority of echocardiographic parameters reveals that no specific pattern could be identified in heart failure
patients who presents with the two types of thyroid dysfunction. Echocardiographic
features reflect only the usual patterns of consequences of the underlying causes of
heart failure.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
274
Abstracts
P1409
Smoker’s paradox and left ventricular systolic function parameters in patients
with acute myocardial infarction
PPredrag Kekovic; M Isailovic - Kekovic
Health Centre Toplica , Prokuplje, Serbia
Smoking is a major, independent, and modifiable risk factor for coronary heart disease and acute myocardial infarction (AMI). The mechanism of adverse effect of
cigarette smoking on coronary arterial circulation is complex and multifactorial.
Smoking raises serum LDL cholesterol and triglyceride concentrations; cigarette
smoking promotes free radical damage; impairs endothel function and impairing
release of tissue plasminogen activator and prostacyclin. Smoking may further contribute to hypercoagulability and also enhances platelet activity.
Despite increased risk for coronary disease and AMI smokers have a paradoxically
lower mortality in AMI than nonsmokers. This is often referred to a the “smoker’s
paradox”.
Our study assessed the effects of smoking on complications and outcomes in
AMI, left ventricular systolic function parameters and investigated the relationship
between the clinical factors and the paradoxical effects of smoking in patients with
AMI.
Subjects were 136 patients (65smokers and 71 nonsmokers) with AMI who were
admitted to hospital within 6 hours of the first symptoms of AMI and treated by
intravenous thrombolytic agents and/or with coronary angioplasty. The parameters
of left ventricular systolic function were associated wit ejection fraction (EF) and
shortening fraction (FS) which determinated with ultrasound examination.
Clinically, the mean age (56,5 years vs. 67,3 years), the prevalence of diabetes
mellitus (10,76% vs. 15,49%) , hypertension (24,61% vs.40,84%) and in-hospital
mortality(4,61% vs. 8,45%) were significantly lower among smokers than nonsmokers.(P < 0,01)
Left ventricular ejection fraction (57 ± 12% vs. 50 ± 14% (P < 0,05)) and shortening
fraction (28,1 ± 3,2% vs.24 ± 3,8% P < 0,05)) were significantly better in the smoking
group . The value of acute phase brain natriuretic peptide (BNP) were significantly
lower (284 ± 330 pg/ml vs. 480 ± 501 pg/ml) in the smoking group.(P < 0,01)
The early ST segment resolution rate was higher in smoking group and there were
significantly fewer patients with manifest heart failure (Killip II – IV class) in the smoking than in the non smoking group (27,69% vs. 39,43%)(P < 0,01)
In our study group there was a higher proportion of smoker than nonsmoker in
patients with inferior AMI than in patients with anterior AMI.
The reason why smokers with AMI have lower mortality rates than non smokers, the
“smoker’s paradox”, may be related to less damage to the microvascular function
after successfully thrombolysis or primary coronary intervention with lower BNP and
better left ventricular ejection fraction.
P1410
Estimation of pulmonary capillary wedge pressure by transthoracic
echocardiography: Real world case series from large cardiothoracic centre in
the UK
P Garg; H Kamaruddin; A Al-Mohammad
Sheffield Teaching Hospitals NHS Trust, Cardiology, Sheffield, United Kingdom
Background: Thransthoracic doppler echocardiography (dTTE) offers a safer and
quicker alternative for the assessment of LV filling pressures. Several doppler derived
parameters can be used to estimate LV filling pressures.
Objective: We aimed to analyse clinical impact of Doppler derived indices in estimating PCWP on patient management.
Methods: All patients had the study performed by experienced echocardiographers with national accreditation. Standard TTE views were obtained. In A4C
view, mitral-inflow velocities (E and A), tissue-doppler-integral (TDI) of basal septum and lateral wall (e′ and a’) and LVOT velocities were obtained. The scan was
repeated later as per the clinical need. PCWP was estimated using Nagueh Formula
(PCWP% = 1.24*(E/E′ )+1.9); Sugimoto method (Figure 1).
Results: Three cases are presented in Table 1.
Conclusion: Our real-world use of echocardiographic estimation of PCWP facilitated optimization of fluids, inotropic support and provided prognostic information.
Figure 1.Sugimoto results table.
P1411
The impact of total bile acids levels on fetal cardiac function in intrahepatic
cholestasis of pregnancy: fetal echocardiographic -Tissue Doppler Imaging
study
RRania Gaber; SUZAN Bayomy; WALID Attallah; DINA Ziada
tanta univeristy hospital , Tanta, Egypt
Background: The outcome of the gestational process and/or the health of the fetus
may be challenged in women with intrahepatic cholestasis of pregnancy (ICP). The
aim of the present study was to assess the total bile acids level and its impact on
systolic and diastolic functions of the fetal heart in patients with ICP.
Patients and Methods: We studied 98 pregnant women with ICP with gestational
age of 30 weeks or above. Patients were divided into 2 groups according to total
bile acids (TBA) levels. Fifty normal pregnant women were studied as controls. All
subjects were subjected to: full history and clinical examination, measurement of
serum bile acids and liver function tests, fetal echocardiography and myocardial
tissue Doppler imaging (TDI) fetal echocardiography.
Results: significant difference in the myocardial tissue velocities of both mitral and
tricuspid valves was found between the fetuses of group I (with ICP and normal bile
acids) and III (healthy mothers) versus fetuses of group II (with ICP and elevated
bile acids), meanwhile there was no statistically significant difference in myocardial
velocities of fetuses of group I versus III. There was significant increase in neonatal
respiratory distress, moconeum staining and neonatal total bile acids in group II
compared with control group and group I. there was correlation between maternal
TBA levels and preterm delivery, Apgar score and neonatal total bite acids level at
birth and The positive correlation between maternal TBA and fetal myocardial tissue
velocities of both mitral and tricuspid, and fetal diastolic myocardial tissue Doppler
velocities .
Conclusion: ICP is very serious condition especially with maternal TBA levels
>40 mmol/L suffered a significantly higher rate of complications such as fetal
distress, spontaneous preterm deliveries, meconium staining, low APGAR score
and fetal cardiac dysfunction. This raises the importance of fetal echocardiography
using advanced tissue Doppler technique for fetal assessment, follow up and
management
P1412
Left atrial echocardiographic changes in patients with heart failure with
reduced versus preserved ejection fraction.
MMohamed Abdel Ghany; YEHIA Kishk; A Heggazy
Cardiology Department, Assuit, Egypt
Purpose: Left atrium (LA) function is of great importance in diastolic function of
normal as well as in the diseased heart; therefore, evaluation of LA size and function
are useful for clinical decision making and prognosis. The aim of our study was to
examine and compare left atrial volume, dimensions and function in patients with
Table 1.Results of Echo-study.
Case-1
E(cm/s)
Case-2
Case-3
Initially
Later
Initially
Later
Initially
Later
88
117
34
92
113
125
A
42
59
40
61
29
20
E/A
2.12
1.98
0.85
1.49
3.85
6.25
e’(av)
7.38
2.93
2.6
2.8
7.5
PCWP(mmHg)
16.5
38
< 18
>18
20
>20
IV diuretics+ Inotropes
Slow IV Fluids given
IV fluids stopped
Increased IV diuretics+Inotropes
Poor Prognosis
Actions
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
heart failure with reduced (HFREF) and heart failure with preserved ejection fraction
(HEPEF).
Methods: Our study included 240 patients (120 patients with HFREF and 120 with
HFPEF). All patients were subjected to full history taking, full clinical examination and
echocardiographic examination for assessment of left atrial dimensions, volume and
function.
Results: Our study revealed that: both LA linear dimensions (anteroposterior, lateral
& superior inferior), LA volume, LA area end systole, area end diastole were
increased in both patients with HFREF and HFPEF, (4.0 ± 0.3, 4.4 ± 0.4, 5.5 ± 0.1
cm), (50.5 ± 5.9 cm), (21.6 ± 0.95 cm2 ) (16.9 ± 0.3 cm2 ) versus (3.9 ± 0.2, 4.3 ± 0.4,
5.3 ± 0.1 cm), (48.6 ± 3.2 cm), (20.9 ± 0.30 cm2 ), (16.3 ± 0.3 cm2 ) respectively, (P
values; less than 0.05).
Moreover, The LA fractional area change and LA ejection force were decreased in
both patients (27.8 ± 1.96 % and 1.57 ± 0.3 k.dynes/ m2 ) versus (27.96 ± 1.1% and
1.73 ± 0.2 k.dynes/ m2 ) respectively, (P value; 0.03 &0.001 respectively).
Conclusions: Echocardiographic changes in left atrial size and function are similar
in patients with Heart failure either with preserved or reduced EF.
275
were: 68% and 80.6% respectively in the SA group and 78% and 76% respectively
in the UA group.
Conclusion: Ultrasound-based SI demonstrates a strong correlation with CAG and
it has potential as a noninvasive diagnostic tool for detecting CAD in pts with chest
pain and without wall motion abnormalities on conventional echocardiography.
Comparison of SI and CAG
Stable angina (n = 59)
Strain positive(n = 25)
Strain negative(n = 34)
Unstable angina (n = 57)
Strain positive(n = 31)
Strain negative(n = 26)
Normal CAG(%)
6 (24%) 25 (74%)
6 (20%) 19 (73%)
Significant CAD (%)
19 (76%) 9 (26%)
25 (80%) 7 (27%)
PPV% = 76%, sensitivity
68%, specificity 80.6%
PPV% = 80.6%,
sensitivity 78%,
specificity 76%
CAG: coronary angiography CAD: coronary artery disease
P1413
Myocardial remodeling at hypertensive patients withTtype 2 diabetes mellitus
IIrina Sapozhnikova1 ; E Tarlovskaya1 ; AK Tarlovski2
Kirov State Medical Academy, Kirov, Russian Federation; 2 Kirov Regional Hospital,
Kirov, Russian Federation
BIOMARKERS – POSTER PRESENTED
1
Purpose: to study features of myocardial remodeling in patients with arterial hypertension and type 2 diabetes mellitus (DM).
Materials and Methods: 241 patients with degree 1 and 2 arterial hypertension were
studied. They were compared according to their age and gender. Of them, group 1
included 100 patients with type 2 DM. Group 2 included 41 patients with impaired
glucose tolerance (IGT). Group 3 included 100 patients with normal tolerance to glucose. Laboratory investigations such as echocardioscopy were performed.
Results: The patients of group 1 had obesity, dyslipidemia and non-compensated
DM. The patients of group 2 also had obesity and dyslipidemia. The patients with
type 2 DM more often had concentric hypertrophy of the left ventricle in comparison with the patients with normoglycemia (36% vs 7%, 𝜌% = 0.000, including the
patients without obesity (19% vs 1.8%, 𝜌% = 0.025), and patients with IGT (36% vs
17,1%, 𝜌% = 0.044). Patients with type 2 DM more often had disorders of the diastolic function of the left ventricle in comparison with the patients with normoglycemia
(93% vs 58%, 𝜌% = 0.000) and patients with IGT (93% vs 68,3%, 𝜌% = 0.00). Disorders of the diastolic function were more obvious in association of type 2 DM with
concentric variants of heart remodeling.
Conclusion: 1) Patients with hypertension and type 2 DM more often had concentric hypertrophy of the left ventricle.
2) Disorders of the diastolic function were revealed at 93% patients with hypertension and type 2 DM.
3) Patients with IGT had intermediate status of echocardiographic parameters
between patients with type 2 diabetes and patients with normoglycemia.
P1414
Diagnostic value of quantification of myocardial deformation in the
assessment of patients with suspected coronary artery disease
DDaniela Teferici; S Qirko; P Bara
University Hospital Center Mother Theresa, Tirana, Albania
Purpose: The aim of this study is to determine the diagnostic value of strain imaging
(SI) for the detection and localization of coronary lesions in pts with chest pain, but
without apparent wall motion abnormalities.
Methods: SI for advanced wall motion analysis was performed in 59 pts with
suspicious stable angina (SA) and in 57 pts with suspicious unstable angina (UA),
prior to coronary angiography(CAG). Longitudinal strain was measured in 3 apical
views, assessments of the strain value for individual segments of the LV were
performed to determine the average strain value. For the identification of ischemia
a magnitude parameter, being defined as a reduction of the peak systolic strain,
was used. A homogenous pattern of strain was defined as relatively uniform
distribution of the peak systolic strain. Heterogeneity of strain was considered
abnormal; these segments were called strain (+) and the rest were called strain
(-). Significant CAD was considered present if stenosis > 70% was noted on the
quantitative CAG.
Results: Of the 59 SA pts, 28 had >70% stenosis and 31 had normal CAG. Of the
28 pts in the ischemic-SA group, 9 pts (32%) showed (-) strain and 19 pts (67%)
showed (+) strain. Of 31 pts with normal CAG, 6 pts (19%) showed (+) strain and 25
pts (80%) showed (-) strain.The positive predictive value (PPV) of strain was 76% in
the SA group. Of the 57 UA pts, 32 had >70% stenosis and 25 had normal CAG.
Of the 32 pts in the ischemic-UA group, 7 pts (22%) were determined to be strain
(-) and 25 pts (78%) were determined to be strain (+). Of 25 pts with normal CAG,
19 pts (80%) showed (-) strain and 6 pts (19%) showed (+) strain.PPV of strain was
80.6% in the UA group. Sensitivity and specificity of 2D strain using diagnostic test
P1416
CA125 levels among patients with chronic dilated cardiomyopathy: an
emerging predictor of severity
S M RSandra Maria Resende Amorim1 ; A Sousa1 ; E Martins1 ; M Campelo1 ;
B Moura2 ; JC Silva-Cardoso1 ; MJ Maciel1
1
Sao Joao Hospital, Porto, Portugal; 2 Military Hospital, Porto, Portugal
Introduction: Carbohydrate antigen 125 (CA 125) is a glycoprotein released by
mesothelial cells in response to a mechanical or inflammatory stimulus and seems
to be marker of systemic congestion. However, little is known about the biologic role
of this substance: whether it simply reflects the increased activation of the cytokine
pathway, or whether CA125 is an active substance truly responsible for myocardial
and/or peripheral dysfunction. Its wide availability, low cost, standardized measurement and long half life support the use of this marker in routine clinical practice.
Our aim was to measure the blood levels of CA125 in a group of patients in idiopathic
dilated cardiomyopathy (DCM) and to determine the potencial relationship between
this tumoral marker and the severity of heart failure.
Methods: We prospectively evaluated 36 consecutive pts with idiopathic DCM (22
males, aged 59.6 ± 9.8 years). Serum levels of CA 125 were obtained and at the
same time we underwent a clinical, biohumoral and echocardiographic evaluation.
Results: Pts with idiopathic DCM had a ejection fraction of 25.5 ± 10.7%, LV diameter of 63.0 ± 8.1 mm, LV diameter/BSA of 34.5 ± 4.7 mm/m2 , 8.3 % had RV dysfunction. LA volume/BSA was 37.5 ± 13.1 ml/m2 and E/é ratio was 14.0 ± 7.2. BNP levels
were 81.7 ± 268.5 pg/ml (median) and high sensitivity c-reactive protein (hs-PCR)
was 4.1 ± 7.1 ml/l.
The mean value of CA125 was 44.9 ± 123.4 U/ml (range 3.4 to 637). It was higher in
pts with advanced NYHA functional class III-IV (132.7 ± 237.2 vs 23.7 ± 67.7 U/ml,
p% = 0.03), with pulmonary congestion (149.9 ± 223.6 vs 9.9 ± 5.5 U/ml, p < 0.05)
and with ankle edema (158.0 ± 176.9 vs 30.8 ± 110.9 U/ml, p% = 0.05).
CA 125 was correlated to BNP levels (r% = 0.57, p < 0.01) and to hs-PCR (r:0.62,
p < 0.01).
We evaluated simple correlations between CA 125 and several echocardiographic
variables: a significant correlation was found between LA volume (r: 0.53, p < 0.05),
LA volume/BSA (r: 0.48, p < 0.01), E/A ratio (r:0.74, p < 0.01), pulmonary systolic
artery pressure (r:0.57, p < 0.01) and RV Tei index (r:0.29, p < 0.02).
Conclusions: In our population CA125 was predictor of clinical severity and was
correlated to BNP and echocardiographic abnormalities, particularly measures of
diastolic dysfunction and pulmonary pressure. It was also correlated with hs-PCR,
so we can postulate a potential pathogenic link between inflammatory activation
and production of CA 125 in mesothelial cells.
P1417
MicroRNAs and myocardial infarction: a step forward towards personalized
medicine?
E Goretti1 ; DR Wagner2 ; YYvan Devaux1
Centre de Recherche Public - Santé, Luxembourg, Luxembourg; 2 Hospital
Centre, Luxembourg, Luxembourg
1
MicroRNAs (miRNAs) are small non-coding RNAs known to post transcriptionally
regulate gene expression. MicroRNAs are expressed in the heart, are regulated upon
pathological conditions, and are involved in the development of cardiac diseases.
As such, they emerged as promising therapeutic targets. The discovery of the
presence and stability of miRNAs in the bloodstream motivated the investigation
of their potential as cardiac biomarkers. Here, we propose to summarize the current
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
276
Abstracts
knowledge of the role of miRNAs in patients with myocardial infarction (MI) and their
value as cardiac biomarkers in the perspective of personalized medicine.
First of all, one has to consider that circulating levels of miRNAs appear to be
influenced by cardiovascular risk factors, even if this possibility has been poorly
addressed.
Second, circulating miRNAs were initially reported as promising cardiac biomarkers
with very high diagnostic value. Subsequently, large-scale studies showed that
cardiac-enriched miRNAs, although released in the bloodstream very early after MI,
do not outperform cardiac troponins for the diagnostic of MI.
Third, more encouraging data regarding the prognostic value of miRNAs after MI
recently emerged. Other than cardiac-enriched miRNAs may have some predictive
value after MI.
Fourth, miRNAs hold some promise as therapeutic targets. The use of miRNAs
as a treatment to reduce the prevalence of heart failure after MI is currently being
addressed.
Finally, in the rapidly evolving era of biomarkers, miRNAs constitute promising tools
that are expected to move personalized medicine a step forward.
Future research will have to be oriented towards panels of miRNAs rather than
single miRNAs for biomarker studies. Also, combined use of miRNAs for prediction
of outcome, treatment, and monitoring of disease progression could be a valuable
asset for personalized healthcare of patients with MI.
Results: In group 1 for 5 years marked dynamics RF: frequency dBP>90 mm Hg
increased by 52 % (p% = 0.0001), the frequency of resting HR>80 is defined by a
34% higher (p% = 0.0001), concentric remodeling LV increased 2-fold (p% = 0.004),
hypercholesterolemia, decreased by 1.3 fold (p% = 0.04). Compared with the 2nd
group of smoking were detected in 1.3 times more likely (𝜒2% = 4,34; p% = 0,04),
weighed down by family history 2 times more likely (𝜒2% = 7 ; p% = 0,008). From
visit to visit variability in sBP in the two groups had no change during the observation,
but in group 1 was 2-fold higher, accounting for 9.1 mm Hg (p% = 0.01). According
to the results of the logit regression analysis classic predictors of SCD were: smoking (OR 0,38, p% = 0.04), weighed down by the family history (OR 0,3, p% = 0.008),
hypercholesterolemia (OR 0,005, p < 0.0001), thickening of the intima-media (IMT)
>0,9 (OR 0,2, p < 0.0001) and the presence of atherosclerotic plaque (OR 0,9,
p% = 0.05); concentric left ventricular remodeling (OR 7,9, p% = 0.03). Additional
predictors determined for the year prior to the development of SCD and significantly
affecting prognosis were identified dBP>90 mm Hg (OR 0,0008, p < 0.0001), resting
HR>80 (OR 0,004, p < 0.0001) and a high of visit to visit sBP variability>9.1 mm Hg
(OR 0,005, p < 0.0001)/
Conclusion: The leading predictors of SCD in a stressful profession men with hypertension are smoking, weighed down by the family history, hypercholesterolemia,
IMT>0.9, atherosclerotic plaque, concentric LV remodeling. A year before the development of SCD also affects high from visit to visit variability in sBP, dBP>90 mm Hg
and resting HR>80.
P1418
Copeptin predicts long term prognosis in patients with worsening heart failure
P1420
AAna Ramalho; D Silva; N Cortez-Dias; C Jorge; A Magalhaes; R Placido; I
Portela; C Calisto; A Nunes Diogo; D Brito
Hospital Lisbon North, Hospital Santa Maria, Lisbon, Portugal
Electrocardiographic predictors of Total Mortality in a Heart Failure ongoing
study
Introduction: Previous studies sugest that copeptin, a neurohormonal biomarker,
has prognostic value in terms of mortality in heart failure (HF). However, its prognostic significance in terms of re-hospitalization for worsening HF is not totally clear.
Aim: To assess the prognostic value of copeptin in terms of long-term mortality
and/or re-admission for acute (decompensated) HF.
Methods: Prospective study of consecutive patients (pts) admitted to a tertiary hospital with worsening systolic and/or diastolic HF. At admission and before discharge,
clinical, biochemical (including copeptin and NT-proBNP plasma levels determination) and echo evaluation, was performed. Follow-up (FUp) was conducted after 3, 6
and 12 months post-discharge. Primary endpoint (composite endpoint) was death or
re-admission for worsening HF. MR-proADM prognostic potential was evaluated by
Kaplan-Meier survival curve and Cox regression analysis, and its prognostic accuracy determined by the area under ROC curve (AUC).
Results: Seventy pts were included (71+/-14 years old), 40 male, 41 (59%) in NYHA
functional class III, 32 (46%) with chronic coronary artery disease and 52% with
FEj.≤30%. Copeptin levels decreased significantly during hospital stay (admission:
48,33 ± 43,93 pmol/L vs. pre-discharge: 20,64 ± 11,7 pmol/L, p% = 0,01), although
with no significant correlation to NYHA functional class nor to left ventricular ejection fraction (FEj.). At admission, copeptin levels correlated with NT-proBNP levels (R% = 0,30; p% = 0,013). During a mean Fup of 8 ± 6 months 38 pts (52%)
died or were readmitted to hospital due to worsening HF (primary endpoint).
Patients with a worst outcome had significantly higher levels of copeptin at
admission (44,21 ± 51,7 vs. 51,9 ± 36,27, p% = 0,05). Copeptin levels >53,10pmol/L
(3∘ tercil) were significantly associated to an unfavorable outcome during Fup (HR:
2,28 IC95% 1,15-4,49; p% = 0,01). ROC curve analysis shows that the accuracy of copeptin in the prediction of prognosis was moderate (AUC: 0,65; IC95%
0,51-0,78; p% = 0,04). Copeptin levels before discharge, as well as NT-proBNP levels determined at both admission and pre-discharge, did not predict prognosis
in these pts.
Conclusion: Copeptin levels determined at hospital admission in pts with decompensated HF have prognostic value, predicting a higher risk of long-term mortality
and/or re-hospitalization in chronic HF pts.
P Arsenos1 ; KA Gatzoulis1 ; P Dilaveris1 ; T Gialernios1 ; N Apostolopoulos1 ; S
Sideris1 ; IE Kallikazaros1 ; D Mytas2 ; G Manis3 ; C Stefanadis1
1
First Department of Cardiology, Medical School, National & Kapodistrian
University of Athens, Athens, Greece; 2 Department of Cardiology, Sismanogleion
Hospital, Marousi, Greece; 3 University of Ioannina, Department of Computer
Science and Engineering, Ioannina, Greece
Purpose: We focused on the ECG information possibly correlated with Total Mortality (TM).
Methods: A sample of 376 heart failure patients (LVEF: 32 ± 10%, CAD:80%,
DCMP:20%) were screened with ECG, SAECG, Holter and prospectively followed up.After 38.8 months 114 out of 376 patients (30%) died. Data analyzed
for TM.
Results: After Cox regression analysis with the model adjusted for Age, Atrial Fibrillation, Diabetes, LVEF, stdQRS, QTc and SDNN both SDNN and LVEF were proved
as important TM predictors with HR:0.981,(95%CI: 0.970 - 0.992), p% = 0.001 (log
rank < 0.001 and 0.965 (95%CI: 0.936- 0.994), p% = 0.020 respectively. Furthermore
the cut off point of SDNN≤67ms (25th percentile) presented a HR: 2.122 (95%CI:
1.236 -3.643), p% = 0.006 (log rank% = 0.017) for TM.
Conclusion: ECG provides prognostic information at univariable level of analysis.
HRV extracts prognostic information even in the era of modern therapies.
All(n = 376)
Dead (n = 114)
Alive (n = 262)
p value
Male (%)
82
81
83
0.672
Age (years)
66±13
71±10
64±13
< 0.001
LVEF (%)
32±10
28±9.7
33±9.9
< 0.001
Sinus Rhythm (%0
82
75
86
0.041
Atrial Fibrillation (%0
18
25
14
0.011
RBBB (%)
13
20
10
0.008
LBBB (%)
17
15
18
0.072
LAH (%)
16
19
14
0.261
LPH (%)
2.1
2.6
2.9
0.641
Predictors of sudden cardiac death in men stressful profession (5-year
follow-up)
Repol. Abnormality
81
86
80
0.279
Std QRS (ms)
124±29
129±29
122±29
0.032
A Miroshnichenko1 ; I Osipova1 ; O Antropova1 ; N Pyrikova1 ; A Zaltsman2 ; I
Kurbatova2
1
Altay State Medical University, Barnaul, Russian Federation; 2 Railway Clinical
Hospital, Barnaul, Russian Federation
QTc Fredericia (ms)
435±36
444±37
432±35
0.020
fQRS (ms)
138±29
142±29
136±29
0.085
LAS (ms)
49±29
51±27
48±30
0.365
Aim: To identify predictors of sudden cardiac death (SCD) in men stressful profession with hypertension.
Materials and Methods: a retrospective study of 204 men with hypertension: Group
1 - 50 people with SCD; Group 2 - 154 people with hypertension. The analysis
of risk factors (RF), resting heart rate (HR), remodeling of the left ventricle (LV),
from visit to visit variability in systolic blood pressure (sBP) in the five years before
the SCD.
RMS (𝜇V)
26±18
24±17
27±18
0.249
NSVT (episodes/24h)
11±78
21±116
7±53
0.127
VPBs (episodes/24h)
1788±3881
2124±3701
1642±3954
0.286
Heart Rate (beats/min)
70±10
72±11
69±10
0.138
SDNN/HRV (ms)
93±37
76±26
100±38
< 0.001
P1419
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
P1421
Adrenomedullin: a biomarker with long term mortality impact in acute heart
failure syndromes
AAna Ramalho; D Silva; N Cortez-Dias; C Jorge; A Magalhaes; M Menezes; I
Portela; C Calisto; A Nunes Diogo; D Brito
Hospital Lisbon North, Hospital Santa Maria, Lisbon, Portugal
Introduction: Adrenomedullin (MR-proADM) is a biomarker with increasingly diagnostic and prognostic importance in Heart Failure (HF). However, its significance
regarding HF mortality has been little studied.
Aim: To assess long-term prognostic value of MR-proADM regarding mortality in
patients (pts) admitted to hospital for acute HF.
Methods: Prospective study of consecutive pts admitted to a tertiary hospital with
acutely worsening systolic and/or diastolic HF, followed during a mean follow-up
(f-up) of 8 ± 6 months after discharge. At admission and before discharge, clinical, biochemical (including MR-proADM and NT-proBNP plasma levels) and echo
evaluation were performed. Primary endpoints: 1) death (all-causes); 2) death or
rehospitalization for worsening HF (composite endpoint). MR-proADM prognostic
potential was evaluated by Kaplan-Meier survival curve and Cox regression analysis, and its prognostic accuracy determined by the area under ROC curve (AUC).
Results: Seventy pts were included (71 ± 14 years old, 40 men), most in NYHA
class III (54%), 92% with systolic dysfunction (52% with severely compromised
systolic function). At admission, MR-proADM levels (1,89 ± 1,17 nmol/L) correlated
with NT-proBNP (R% = 0,6, p% = 0,001), and the same was found before discharge
(p < 0,001). Higher values of MR-proADM were observed in patients with higher
NYHA class [1,8 ± 1,22 (NYHA class III) vs. 2,1 ± 1,0 (NYHA class IV), p% = 0,05]
as well as with higher left ventricular filling pressures, assessed by the E/E′ ratio
(R% = 0,3, p% = 0,03). During a mean f-up of 8 ± 6 months 25 pts (36%) died.
Those who died had higher MR-proADM levels at admission (2,31 ± 1,12 nmol/L
vs. 1,66 ± 0,68 nmol/L; p% = 0,017). MR-proADM levels before discharge did not
vary with the course observed during f-up. MR-proADM levels at admission were
associated with 1.5 times higher risk of mortality (HR: 1,46 IC95% 1,08-1,96,
p% = 0,03). ROC curve analysis shows that the prognostic accuracy of MR-proADM
in the prediction of long-term mortality was moderate (AUC: 0,66 IC95% 0,51-0,81,
p% = 0,03). NT-proBNP levels, determined at both admission and pre-discharge,
didn’t predict prognosis in this population.
Conclusion: Adrenomedullin is a biomarker with significant prognostic value in
terms of long-term mortality in patients admitted with acute HF syndrome.
P1422
Early serum creatinine changes and outcomes in patients admitted for acute
heart failure: the importance of renal function on admission
D Escribano; E Santas; C Bonanad; S Garcia; G Minana; S Ventura; E Valero; J
Sanchis; J Chorro; J Nunez
University Hospital Clinic of Valencia, Cardiology, Valencia, Spain
Background: In acute heart failure (AHF), renal function changes are prevalent, with
an underlying complex pathophysiology and controversial prognosis. We hypothesized that having renal failure (RF) at admission influences these changes per
se, and also their prognosis. Thus, we sought to determine if there is a differential effect on the association between early creatinine changes (ΔCr) between
admission and 48-72 hours on 1-year mortality according to the presence of RF
at admission.
Methods: We included 705 consecutive patients admitted with the diagnosis of AHF.
RF on admission
was defined as estimated glomerular filtration rate (eGFR) < 60ml/min/1.73m2
RF on admission and ΔCr at 48-72 constituted the exposure. Appropriate survival regression techniques were used to account for the censored-nature of
this data.
Results: Patients with RF had higher prevalence of extreme values in ΔCr in either
direction (increasing/decreasing). At 1 year follow-up 114 (16.2%) deaths were registered. The multivariable analysis for mortality showed a significant interaction
between RF and ΔCr (p% = 0.019) In the presence of RF, the continuum of ΔCr followed an almost linear relationship with the risk of mortality. Conversely, in patients
with no RF, most of the values along the continuum of ΔCr values were not associated to increased risk of mortality (Figure below).
Conclusion: In patients with AHF the effect of ΔCr on 1-year mortality varied according to its magnitude and RF status on admission. The prognostic
effect of early ΔCr in patients with AHF was greater in those displaying RF
on admission.
P1423
Prognostic biomarkers in heart failure: still searching for the Holy Grail
M Madeira; I Almeida; F Caetano; A Fernandes; M Cassandra; M Costa;
P Mota; L Goncalves
Hospital and University Center of Coimbra - Hospital Center of Coimbra,
Cardiology, Coimbra, Portugal
277
Purpose: The prognosis’ assessment in heart failure (HF) patients (P) is of utmost
importance. Several biomarkers have been studied as predictors of prognosis,
however, the search for the “perfect marker” still continues. Cystatin-C (Cc) has
proved to be not only an early marker of renal injury, but also has been associated
with pro-inflammatory states and an increased risk of cardiovascular events. Our
aim was to compare the prognostic value of Cc with other biomarkers (NT-proBNP,
troponin I, creatinine, urea, sodium, total bilirubin and uric acid) in P admitted with
an acute coronary syndrome (ACS) complicated by HF.
Methods: From 1040 consecutive P admitted with an ACS in a coronary unit
from 2009-2012, we identified 209 P with signs of HF (Killip-Kimball class ≥ 2),
in which the above biomarkers were assessed in the first 24 hours. Mortality,
re-hospitalization for HF and the composite endpoint of both events was evaluated
at follow-up (FU, 20.3 ± 11.0 months).
Results: In these 209 P, 54.5% were male and the mean age was 75.5 ± 10.2
years. At FU the mortality rate in this population of P was 40.1%. In the univariate
analysis, the best predictors of mortality were Cc (p% = 0.001) and NT-proBNP
(p% = 0.02). Moreover, P suffering adverse effects as compared with those who
did not experience adverse events, showed higher levels of these biomarkers (Cc:
1.9 ± 1.3 vs 1.4 ± 0.8mg/L, NT-proBNP: 21160 ± 27149 vs 11362 ± 23521pg/mL). In
multivariate analysis, Cc (p% = 0.010) proved to be the only independent predictor
of mortality during the FU, adding prognostic value to the GRACE Score.
The rate of re-hospitalization in this population was 20.1% and none of the biomarkers studied were predictive of this event.
The composite endpoint occurred in 50.8% of the cases. Higher levels of
Cc (1.8 ± 1.2 vs 1.4 ± 0.8mg/L, p% = 0.002) and NT-proBNP (26687 ± 2813 vs
23564 ± 2526pg/mL, p% = 0.05) were associated with a higher incidence of this
composite endpoint. No other biomarker has proven to be a predictor of this
composite endpoint. However, in multivariate analysis, only Cc remained an independent predictor (p% = 0.02).
Conclusions: Given the heterogeneity present in P with HF, it is imperative to
identify prognostic markers that allow a better risk stratification and a better treatment. From the large range of biomarkers evaluated in our population of P with HF,
Cc was identified as the most accurate marker of adverse events, revealing itself
superior to the “traditional” NT-proBNP. Its use in clinical practice and its integration
in prognostic risk scores may contribute in the future for a better risk stratification
of these P.
P1424
Postoperative biomarkers predict early kidney injury after heart
transplantation
LLenka Hoskova1 ; J Franekova2 ; V Melenovsky1 ; I Malek1 ; O Szarszoi3 ; P Secnik
Jr2 ; J Kautzner1 ; A Jabor2
1
Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiology,
Prague, Czech Republic; 2 Institute for Clinical and Experimental Medicine (IKEM),
Department of Laboratory Methods, Prague, Czech Republic; 3 Institute for Clinical
and Experimental Medicine (IKEM), Department of Cardiac Surgery, Prague, Czech
Republic
Purpose: Acute kidney injury (AKI) is a risk factor for negative hospital outcomes
in patients who undergo cardiac surgery. Initial stage of renal dysfunction should
be recognised as early as possible, before substantial increase in serum creatinine. We focussed on predictive value of novel biomarkers cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), microalbuminuria (ACR index) and
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
278
Abstracts
alpha-1-microglobulin (A-1M).). The purpose of this study was to describe the association between these measured biomarkers and AKI in heart transplant (HTx) recipients.
Methods: A total of 117 patients (98 men and 19 women) undergoing HTx were
enrolled in the prospective study with a follow-up of 6 months. AKI was defined as
an increase of serum creatinine of at least 50 % or worsening of renal function requiring renal replacement therapy (RRT) in the first week after HTx. Statistical analysis
was performed using JMP statistical software (JMP v. 10.0.0 SAS Institut Inc). Data
are expressed as median and interquartile range, IQR (25th – 75th percentile).
Results: Subset of 24 patients (20.5%) fulfiled criteria of AKI (AKI group), the
rest of the population (n = 93) comprised group without renal injury (non-AKI
group).Patients who developed AKI had higher median levels of cystatin C on
day 0 (1.88 (IQR: 1.36-2.05) vs 1.2 (IQR:1.02-1.56) mg/l, p% = 0.001), on day 1
(1.86 (IQR: 1.43-2.19) vs 1.31(IQR:1.06-1.78) mg/l, p% = 0.001) and on day 7 (2.55
(IQR:1.65-2.99) vs 1.49 (IQR:1.25-1.89) mg/l, p < 0.0001) compared with non-AKI
group. No differences in urinary NGAL were observed between both groups on day
0 and day1. NGAL level increased significantly only on day 3 in AKI group (median
43.90 (IQR: 23.20-118.60) vs 15.10 (IQR: 7.20-26.30 𝜇g/l, p% = 0.005).). Elevation
of A-1M and ACR index in the AKI group was not significantly higher than those of
the non-AKI group.
Conclusions: This study demonstrated strong association between elevated serum
levels of 2 biomarkers (cystatin C and NGAL) and the risk of developing AKI in
postoperative period. Serum cystatin C above 2.55 mg/l was the most significant
predictor of renal damage early after HTx.
Methods: 509 patients with HFREF out of three HF centers were investigated in a retrospective cohort and follow up data were complete in 496
patients for CV death by December 2013. Plasma osmolality was calculated
as “(2*Na)+(BUN/2.8)+(Glucose/18)”. Quartiles of plasma osmolality were produced and association with CV mortality was sought.
Results: Mean age was 56.5 ± 17.3 years (383 males, 121 females) with a mean
EF of 26 ± 8%. Mean levels of plasma osmolality were as follows in the quartiles: 1st % = 280 ± 6, 2nd % = 288 ± 1, 3rd% = 293 ± 2 (95% CI 292.72-293.3),
4th % = 301 ± 5 mOsm/kg. EF and BNP levels were similar in four subgroups. Those
in the 4th quartile was older than those in the 2nd quartile (61 ± 17 vs 54 ± 17 years,
p% = 0.006). Furthermore, those in the 4th quartile had higher creatinine levels than
other quartiles of plasma osmolality (p < 0.001 for all post hoc comparisons). Mean
follow up was 25 ± 22 months (up to 111 months).
Cox regression analysis yielded graded mortality curves with the 1st quartile having
the worst prognosis, followed by the 4th quartile and the 2nd quartile, and the 3rd
quartile was shown to have the best prognosis (Figure 1). Interestingly, when age
and creatinine were added into the model, survival curves of 4th and 2nd quartiles
of plasma osmolality merged along with similar trends in the 1st and 3rd quartiles of
plasma osmolality.
Conclusion: Normal plasma osmolality is 275-295 mOsm/kg. However, being close
to the upper limit of so called “normal range”, i.e, 292-293 mOsm/kg seems as the
best plasma osmolality in this cohort with regard to CV prognosis in patients with HF.
P1425
Using joint models to explore the association between serial measurements
of natriuretic peptides and mortality in patients with suspected heart failure
JJufen Zhang1 ; P Pellicori1 ; R Dierckx1 ; A Shoaib1 ; B Dicken1 ; S Parsons1 ; S
Kazmi1 ; K Wong1 ; AL Clark1 ; JGF Cleland2
1
University of Hull, Hull, United Kingdom; 2 Imperial College London, London,
United Kingdom
Background: Single measurements of amino-terminal pro-brain natriuretic peptide
(NT-proBNP) are strongly associated with outcome in patients with heart failure (HF)
but the value of repeated measurements of NT-proBNP that might track progression
of disease, has been paid less attention.
Aims: To investigate the association between serial measurements of NT-proBNP
and mortality at three years.
Methods: Demographic measurements, symptoms and signs and blood tests were
collected routinely from patients referred with suspected heart failure from the
local community between 2000 and 2013. NT-proBNP was measured at baseline
and at approximately, four, twelve and 24 months. The association between serial
NT-proBNP measurements and mortality was investigated using joint linear mixed
and Cox regression models. The relationships amongst NT-proBNP measurements
at different follow-up times were evaluated by correlation coefficients and scatter
plots.
Results: Of 1998 patients with suspected HF who had at least two measurements of NT-proBNP on or prior to the 2-year follow-up, 70% were men and the
median age was 73 (IQR:64-79) years, 30% were in NYHA class III/IV, 58% had
LVSD and 77% had NT-proBNP>400 pg/ml. Three year mortality was 12.7%. The
median NT-proBNP with IQR at baseline (1998 patients), 4-month (1314 patients),
12-month (1168 patients) and 24-month (930 patients) were: 1108 (448-2613), 969
(396-2109), 863 (354-1981) and 825 (318-1928)ng/L respectively. There were strong
positive linear correlations between serial measurements of log10(NT-proBNP)
(correlation coefficients (r) were: r_(baseline,4m)% = 0.836; r_(4m, 12m)% = 0.841
and r_(12m, 24m)% = 0.832, p < 0.0001 for all) although measurements that were
farther apart were less correlated (r_(baseline, 12m)% = 0.734 and r_(baseline,
24m)% = 0.679, p < 0.0001). Adjusting for age and sex, a strong association
between log(NT-proBNP) and 3-year mortality was observed (association% = 1.153
(SE% = 0.188), p < 0.0001). The last NT-proBNP (median/IQR) recorded prior to
death was 2252 (844-5711)ng/L and to survive was 266 (96-809)ng/L.
Conclusions: There is a strong association between serial measurements of
NT-proBNP and all-cause mortality in patients with heart failure.
P1426
Plasma osmolality predicts mortality in patients with heart failure with
reduced ejection fraction
MBMehmet Birhan Yilmaz1 ; A Ekmekci2 ; H Gunes1 ; AU Uslu1 ; O Beton1 ; H Yucel1 ;
D Oguz3 ; M Eren2
1
Cumhuriyet University, Sivas, Turkey; 2 Dr. Siyami Ersek Thoracic and
Cardiovascular Surgery Center, Cardiology, Istanbul, Turkey; 3 Baskent University
Istanbul Hospital, Cardiology, Istanbul, Turkey
Introduction: Heart failure is a fatal disease. Plasma osmolality combining individual
influences of sodium, BUN and glucose has not been studied prognostically.
Figure 1
P1427
Renin-angiotensin aldosterone system role in developing of heart failure in
patients with hypertrophic cardiomyopathy
MMaria Kozhevnikova; GA Shakaryants; NV Khabarova; VU Kaplunova; EV
Privalova; YUN Belenkov
I.M. Sechenov First Moscow Medical State Universityul. Trubetckay, 8, str. 2,
119992 Moscow, Russia, therapy, Moscow, Russian Federation
Purpose: to analyze polymorphisms of renin-angiotensin aldosterone system (RAS)
components: AGT; AGTR1; CYP11B2; CMA-1 and biomarkers of this system (ACE,
AII) in patients with hypertrophic cardiomyopathy (HCM) for accession of chronic
heart failure (CHF).
Materials and Methods: 58 patients (24 men, 34 women) with HCM and 54 healthy
controls were enrolled, mean age was 47,1 ± 10,0 years. 46.6% of patients had
a progressive course (PC) of the disease, stable course (SC) was observed in
36.2%, 17.2% had atrial fibrillation (AF). All patients were investigated according standard cardiac algorithm and genotyping of gene polymorphisms CMA1
A(-1903)G rs1800875, AGT m2 35T rs699, AGTR1 A1166C rs5186, CYP11B2 -344
T/C rs1799998. Angiotensin-converting enzyme (ACE) and angiotensin II (AII) levels
were measured in 40 patients with HCM and 39 controls.
Results: CHF has identified in patients with PC of HCM (56.4%). Assessment of
cardiac remodeling in patients with HCM and CHF revealed significant differences
(p < 0,5) and trends (p < 0,1): an increase of interventricular septum (IVS) 2,23 ± 0,10
mm vs. 1,79 ± 0,09 mm in the absence, left ventricular mass (LVM) 237,57 ± 10,49g
vs. 216,48+9,63g, left ventricular mass index (LVMI) 131,54 ± 76,78 g/m2 -in the
absence 113,39 ± 7,51 g/m2 . Transient ischemic attacks (angina II-III FC) and ventricle rhythm disturbances were recorded more often in patients with CHF (66-80%;
p% = 0,007 and 66.67%; p>0,05). IVS (2,380 ± 0,181sm), LVM (263,50 ± 16,69g),
left ventricle posterior wall (LVPW) (1,09 ± 0,06 sm) and LVMI (138,52 ± 11,27 g/m2 )
were significant higher (p < 0,05) in patients with CC genotype of AGT m2 35T.
Tendency to increase of LVPW (1,22 ± 0,04 sm) were revealed in patients with
AG genotype of CMA1 A(-1903)G. Significant association between the AG genotype of CMA-1 A(-1903) and angina II-III FC (𝜌% = 0,01) and ventricular extrasystole of high gradation (𝜌% = 0,1) was observed. We found out the positive correlation between AII and LVPW (r% = 0,648; p% = 0,00001). AII were significantly
decreased in patients with HCM than in healthy controls (2,27 ± 1,39 ng/ml vs.
33,36 ± 8,22 ng/ml; p < 0,05) There was not significantly differences of ACE concentration between groups (𝜌>0,05), but in patients with PC its levels were higher
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
191,42 ± 15,46 ng/ml. AGT m2 35T influences on AII level (𝜌% = 0,073), CYP11B2
-344 T/C and CMA1 A(-1903)G on ACE levels (𝜌% = 0,007 and 𝜌% = 0,072).
Conclusion: 1. AG genotype of CMA-1 A(-1903) polymorphism is the most impotent
adversity affecting course of CHF in HCM. 2. AII decreased in patients with HCM,
probably because of tissue RAS activating.
P1428
Usefulness of combined haemoglobin and NT-proBNP assessment at
discharge in predicting 30-day and long term rehospitalization and death in
patients with acute heart failure
SSilvia Navarin1 ; B Stojcevski2 ; F Vetrone1 ; B Pencic2 ; F Cristofano1 ; A Sljivic2 ;
A Majstorovic2 ; L Magrini1 ; V Celic2 ; S Di Somma1
1
Sant’Andrea Hospital Sapienza University of Rome, Emergency Department,
Rome, Italy; 2 KBC Center Dragisa Misovic, Cardiology, Belgrade, Serbia
Purpose: To compare short and long-term prognostic role of admission (A) and
discharge (D) haemoglobin (Hgb) vs NT-proBNP levels in patients hospitalized for
acute heart failure (AHF).
Methods: 317 AHF patients (mean age74.7 ± 9.4 years) were enrolled at two academic centres in Rome and Belgrade. In all patients N-terminal pro-hormone brain
natriuretic peptide (NT-proBNP) and Hgb levels were assessed at A and D. Based
on Hgb level patients were divided in two groups: Hgb < 12.0 g/dl (anaemic) and
Hgb ≥ 12.0 g/dl (non-anaemic). To evaluate death and rehospitalization, a follow-up
phone-call was performed 1, 6, 12 months after D.
Results: According to A and D Hgb level, anaemia was present in 55% and
62% AHF patients, respectively. For 30-day follow-up lower D Hgb value was
associated with higher NT-proBNP levels (both at A and at D), and with increased
risk for rehospitalization (OR 0.96, p% = 0.004). For every 1g/l Hgb decrease, the
odds of rehospitalization increased by 4.1%, while NT-proBNP showed greater
power (𝛽2% = -0.03) in predicting death. Area under the curve for D Hgb was
0.74 (p < 0.001, 95% CI 0.72-0.93) for death, while for NT-proBNP it was 0.82
(p% = 0.006, 95% CI 0.72-0.93). During 6 months follow-up, patients discharged
with anaemia had significantly increased mortality (p% = 0.032) (Fig. 1). A and
D Hgb independently significantly contributed to the increased risk of one-year
rehospitalization (A Hbg:OR 0.98, p% = 0.002; D Hbg:OR 0.97, p < 0.001).
Conclusions: In AHF patients, the presence of anaemia at D is a significant independent predictor for 30-day and long-term rehospitalization. Compared to Hgb,
NT-proBNP seems to be a better predictor for mortality. In AHF patient D Hgb
and NT-proBNP should be assessed together to detect higher risk patients for
events.
279
Methods: Two hundred twenty one HF patients were screened with ECG, SAECG,
ECHO and 24-hour HOLTER and prospectively followed up (41.2 ± 25.6 months).
The following Heart Rate (HR) indices were calculated : 1. Mean daytime HR
(08.00-21.00) (HRd), 2. Mean nighttime HR (23:00- 06.00) (HRn), 3. The entire
24-hour mean HR (08.00-08.00) (HR24h).
Results: When data were analyzed for TM (deceased n = 61), HRn was found higher
among the deceased (71.0 ± 12.8 bpm vs 66.1 ± 9.6 bpm, p% = 0.002). In the multivariable analysis based on a Cox regression model adjusted for Gender, Age,
Obesity, LVEF, fQRS, NSVT ≥ 1episode/24h, VPBs ≥ 240beats/24hour, QTc (Fredericia) and HRn a Hazard Ratio of 1.053 for HRn, (95%C.I. 1.027-1.079, p < 0.001) was
revealed. Patients with HRn above the Cutoff point ≥ 74 bpm (75th percentile) versus
the patients under the cutoff point ≤ 61 bpm (25th percentile) presented a Hazard
Ratio of 6.185 for death (95% C.I. 2.358-16.217, p < 0.001).
Conclusions: Elevated HRn consists a simple TM predictor. Whenever HR Dynamics is been estimated a separate nighttime period of analysis should be included.
Dead (n = 61)
Alive (n = 160)
p value
LVEF (%)
28.8 ≥ ±9.5
33.9±9.9
< 0.001
Age (years)
70.7±10.9
62.5±13.4
< 0.001
NYHA (class)
2.5±0.5
2.2±0.4
< 0.001
fQRS (ms)
142±31
134±28
0.077
NSVT ≥ 1 episode /24h (%)
32
29
0.713
VPBs ≥ 240beats/24h (%)
52
37
0.057
SDNN/HRV (ms)
76±26
98±37
< 0.001
QTc Fredericia (ms)
461±37
442±33
< 0.001
HR24h (beats/min)
72.4±11.2
69.6±9.5
0.063
HRd (beats/min)
73.7±11.5
72.4±10.1
0.411
HRn (beats/min)
71.0±12.8
66.1±9.6
0.002
ΔHR(% = HRd-HRn) (beats/min)
5.3±3.7
7.5±4.7
0.002
Percentage HR fall (%)
7.0±4.7
10.1±5.8
< 0.001
P1430
Additive prognostic value of cystatin C and BNP levels in patients with
cardiorenal syndrome.
PPinelopi Rafouli-Stergiou; JT Parissis; V Bistola; M Nikolaou; I Paraskevaidis; I
Ikonomidis; D Kremastinos; M Anastasiou-Nana; G Filippatos
Attikon University Hospital - 2nd Department of Cardiology - Heart Failure Unit,
Athens, Greece
Purpose: Patients with acutely decompensated heart failure (ADHF) and baseline
renal impairment may frequently develop in-hospital worsening of kidney function
with consequent adverse outcomes. The objective of this study was to evaluate
prognostic markers in patients with cardiorenal syndrome.
Methods: We investigated 96 consecutive patients hospitalized for ADHF with
symptoms of NYHA class III-IV, systolic dysfunction (LVEF ≤ 35%), and creatinine
clearance < 60 ml/min on admission. We assessed the impact of rise in cystatin
C and levels of BNP on major cardiac adverse events (MACE), including cardiac
death or re-hospitalization for ADHF, at short-term (2 months).
Fig.1 6-months survival according D Hgb
P1429
Elevated nighttime heart rate due to insufficient circadian adaptation detects
the subgroup with increased risk for total mortality among heart failure
patients
P Arsenos1 ; KA Gatzoulis1 ; P Dilaveris1 ; G Manis2 ; O Kaitozis1 ; K Manakos1 ;
K Vlachos3 ; KP Letsas3 ; M Efremidis3 ; C Stefanadis1
1
First Department of Cardiology, Medical School, National & Kapodistrian
University of Athens, Athens, Greece; 2 University of Ioannina, Department of
Computer Science and Engineering, Ioannina, Greece; 3 Second Department of
Cardiology, Evangelismos General Hospital, Athens, Greece
Background: We examine whether impaired Nighttime Heart Rate Adaptation
(NHRA) may serve in Total Mortality (TM) risk stratification of heart failure (HF)
patients.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
280
Abstracts
Results: Patients were on average 70 years old. Rise in cystatin C ≥ 0.4
mg/l was associated with significantly higher MACE rates at 2 months (75%
vs. 36%, p% = 0.035). ROC curves identified the level 777 pg/ml for BNP on
admission (sensitivity 82%, specificity 76%) and 356 pg/ml for BNP at discharge (sensitivity 90%, specificity 75%) as best cut-offs for predicting short-term
MACE. At multivariate analysis, rise in cystatin C ≥ 0.4 mg/l (HR 1.450; 95%
CI 1.122-1.874; p% = 0.004), BNP at discharge ≥ 356 pg/ml (HR% = 4.457,
95% CI% = 1.292-15.379, p% = 0.018) and inotropic use (HR% = 3.168, 95%
CI% = 1.568-6.401, p% = 0.001) were significantly associated with higher MACE
rates at short-term after adjustment for confounders. Kaplan-Meier survival curves
after adding the first two parameters showed the prognostic significance of
both worsening renal function and neurohormonal activation (log-rank% = 10.341,
p% = 0.016) [Figure].
Conclusions: In patients with ADHF and kidney dysfunction on admission, both rise
in cystatin C and BNP levels at discharge had additive prognostic value. Large-scale
prospective studies are required to clarify this impact.
BIOMARKERS – POSTER DISPLAY
P1431
Hemoglobin-BUN ratio predicts cardiovascular mortality in patients with
heart failure
H Yucel1 ; OOsman Beton1 ; A Ekmekci2 ; D Oguz3 ; H Gunes1 ; AU Uslu1 ; M Eren2 ;
MB Yilmaz1
1
Cumhuriyet University, Cardiology, Sivas, Turkey; 2 Dr. Siyami Ersek Thoracic and
Cardiovascular Surgery Center, Cardiology, Istanbul, Turkey; 3 Baskent University,
Cardiology, istanbul, Turkey
Introduction: Organ crosstalk is highly prevalent in HF. BUN was shown
to designate prognosis in patients with HF, and identifies high-risk patients
when it exceeds 43 mg/dl. Same is valid for anemia. Combination of
hemoblobin(Hgb) and BUN have not been studied. In this study association
of “Hgb/BUN ratio” with cardiovascular(CV) mortality was sought in patients
with HF.
Methods: Patients with HF were enrolled into a retrospective cohort study out
of three HF centers. Out of Hgb and BUN levels, Hgb to BUN ratio was derived.
Quartiles of Hgb/BUN ratio was produced in the data set and CV mortality was
investigated.
Results: This study included 548 patients with HF. Median ejection fraction was
25% (20-35%, 25-75th percentiles) with a median follow up period of 19 months
(8-35 months, up to 111 months). There were 400 males, 148 females. Median
age was 57 years (45-72 years). Median BUN was 20 mg/dl (15.775-30 mg/dl)
and creatinine was 1.01 mg/dl (0.88-1.30). Median hemoglobin was 13.3 gr/dl
(12.10-14.90) Median Hgb to BUN ratio was 0.66 (0.42-0.89) in the whole cohort.
During follow up, 15% of those in the 4th quartile (mean ratio 1.15) versus 28.8%
of those in the 3rd quartiles (mean ratio 0.76) versus, 38.6% of those in the 2nd
quartile (mean ratio 0.54) versus 53.3% of those in the 1st quartile (mean ratio
0.28) experienced CV death (p < 0.001). Survival curves of quartiles of Hgb to
BUN ratio diverged from each other significantly (p% = 0.01) (Figure 1) yielding the
fourth quartile having the best prognosis, and the first quartile having the worst
prognosis (p < 0.001).
Conclusion: Hgb and BUN levels are important blood parameters in patients with
HF. Decreasing Hgb levels in harmony with increasing BUN seems to be a sign of
poor prognosis in patients with HF.
P1432
Prognostic role of natriuresis
DODmitrii Dragunov; AV Sokolova; GP Arutyunov
Russian State Medical University, Internal medicine, Moscow, Russian Federation
Purpose: To verify the prognostic role of natriuresis in salt sensitive patients with
AH 1-2 stage, complicated by HF.
Methods: Men and woman with AH and HF were included the study (n = 56). Middle
age was 47 ± 7,5 years, SBP 145 ± 12,9, DBP 90 ± 8,3 mm hg. HR 74 ± 6,8 bpm, BMI
29,1 ± 2,5 kg/m2 ± , EF 44,8 ± 5,1%. Salt sensitive was measured by Weinberger
method. Natriuresis was measured by calculation of Na in 8 urine probes collected
by 3 hour intervals during the day, by spectrophotometry. Volume of fluid intake
by patient was not less then 1500 ml. All patients receive AH and HF medication
according the guidelines.
Results: By results of natriuresis measurements 3 curve types were found. 1 type
isohyponatriuretic was found at 14 persons (25%), 2 type hyponatriuretic n = 16
(29%), 3 type isonatriuretic n = 26 (46%). During the observational period changes
of curve type were found among patients. Probability of changing of the 3 curve type
to the 2 one comes to 83,93% (OR: 11,667); Probability of changing of type 2 to type
1 comes to 92,86% (OR 120,00). It was found that between patients with the most
unfavorable isohyponatriuretic (1) curve type, cardiac adverse events happens more
often: AMI (OR: 0,333[0,016; 7,140]), stroke (OR: 0,750 [0,426; 1,321]), hypertension
stroke (OR:1,333 [0,086; 20,707]), decompensation of HF (OR: 1,500[0,025; 4,401])
Conclusion: It was found that natriuretic curve type could change during time.
Worsening of curve type leads to worsening of HF and AH and aggravate patients
prognosis.
P1433
ST2 pathophysiological profile in ambulatory heart failure patients
J Lupon; M De Antonio; A Galan; E Zamora; M Domingo; A Urrutia; R Cabanes; S
Altimir; C Diez; A Bayes-Genis
Germans Trias i Pujol University Hospital, Badalona, Spain
Background: ST2 has been identified as a novel biomarker involved, at least
partially, in three patophysiological pathways: (1) cardiac stretch, (2) fibrosis and
remodelling, and (3) inflammation. Serum concentrations of ST2 provide important
prognostic information in heart failure (HF). However, the relative weight of ST2 in
each of the aforementioned pathways and up to which point its prognostic value is
affected by the different degree of stretch, inflammation or fibrosis-remodelling is
unknown.
Aim: To examine whether ST2 levels improve HF risk-stratification relative to
the concentrations of other biomarkers representative of these pathophysiological pathways: NTproBNP (stretch), galectin-3 (fibrosis-remodelling), and hs-CRP
(inflammation).
Patients: 876 patients (71.5% men, mean age 68.3 ± years) were studied. Mean
LVEF was 35.9% ± 13.6. Most patients were in NYHA class II (65.9%) or III (25.8%).
Mean follow-up was 4.2 ± 2.1 years.
Results: ST2 levels were higher as NTproBNP, hs-CRP, and Galectin-3 concentrations increased (p for trend < 0.001 in all cases). ST2 correlation was highest with
NTproBNP (r% = 0.32, p < 0.001) and lowest with Galectin-3 (r% = 0.17, p < 0.001).
386 patients died during follow-up. ST2 (above/below the median) remained an
independent prognosticator of risk at every tertile of the other three biomarkers
(Figure). This was observed even after adjustment for age, sex, LVEF, NYHA functional class and ischaemic aetiology of HF.
Conclusions: ST2 provides most-valuable long-term risk stratification information in
HF above and beyond the degree of stretch, inflammation and fibrosis-remodelling
reported by NTproBNP, hs-CRP and Galectin-3.
Figure 1
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
281
P1434
Elevated levels of Cystatin C may predict poor prognosis of chronic heart
failure in patients older than 80 years of age without advanced renal
insufficiency
Y Mitsuke1 ; A Kuwata1 ; C Kiriba1 ; R Nakaya2 ; H Tsutani1
NHO Awara Hospital, Fukui, Japan; 2 NHO Fukui Hospital, Fukui, Japan
on the health system. The benchmarking and the gathering of experience from
the Canadian model favors the discussion about the management, prevention and
treatment, principally of heart failure.
Objective: To observe and to review Canadian data on nursing standards, treatment
compliances, and use of technology for heart failure in primary care.
1
Background: Renal function have been reported an important prognostic factor in
patients with chronic heart failure (CHF). Cystatin C, a novel endogenous marker
of glomerular filtration rate, has been reported as more sensitive to detect renal
insufficiency than creatinine. However, there were few reports describing clinical
value of circulating Cystatin C levels in elderly CHF patients. Methods; We studied
consecutive 101 Japanese CHF patients older than 80 years of age (41 males,
84.1 +/- 3.2 years, all serum creatinine levels were < 1.1 mg/dl, NYHA II-III,
LVEF < 45%). We measured circulating levels of Cystatin C, noradrenaline(NAD),
B-type natriuretic peptides (BNP), and interleukin-6 (IL-6). None had evidence of
unstable angina, chronic inflammatory disease, collagen disease, or cancer at the
time of evaluation. Planar cardiac 123I-MIBG images were obtained from all patients,
and cardiac 123I-MIBG images was assessed as the heart-to-mediastinum (H/M)
ratio of the delayed image and the washout rate (WoR) from the early to the delayed
image. Patients were followed up for an average of 37.2months, and 19 patients
had death.
Results: The mean ( ± SD) serum concentrations of Cystatin C were 1.20 ± 0.29
mg/L, Values of Cystatin C increased with the severity of NYHA functional class.
Patients with events had significantly lower H/M ratio compared with those without
events, and had significantly higher Cystatin C, WoR, NAD, BNP, and IL-6. By
multivariate Cox proportional hazard analysis, Cystatin C and BNP were significant
predictors for death in those patients.
Conclusions: Values of Cystatin C correlate the severity in CHF patients. The high
value of Cystatin C is a significant predictor of clinical outcomes and a strong
predictor of all death in CHF. Cystatin C levels allow further risk stratification,
suggesting Cystatin C contribute to the occurrence of death in those patients with
CHF.
61157 Table1
p-value,
unadjusted
p-value,
adjusted
Hazard ratio
(95% CI),
adjusted
All-cause
hospitalization
First event
All pts
0.083
Age < 75
0.030
0.045
0.73 (0.530.99)
Age >75
0.827
0.887
1.02
(0.79-1.32)
Second event
All pts
0.007
0.006
Age < 75
0.005
0.005
0.69
(0.53-0.90)
Age >75
0.429
0.369
0.91
(0.75-1.11)
HF
hospitalization
First event
All pts
0.003
Age < 75
0.003
0.004
0.52
(0.33-0.81)
Age >75
0.210
0.189
0.82
(0.61-1.10)
Second event
All pts
0.054
0.022
P1435
Age < 75
0.009
0.020
NT-ProBNP guided therapy reduces repeated hospitalizations - results from
TIME-CHF
0.64 (0.440.93)
Age >75
0.699
0.619
0.94 (0.731.20)
NNasser Davarzani1 ; S Van Wijk2 ; M Maeder3 ; T Burkart4 ; P Rickenbacher5 ; W
Estlinbaum6 ; P Erne7 ; HJ Beer8 ; ME Pfisterer4 ; HP Brunner-La Rocca2
1
Maastricht University, Knowledge Engineering, Maastricht, Netherlands; 2 Cantonal
Hospital St. Gallen, Cardiology, St. Gallen, Switzerland; 3 University Hospital Basel,
Cardiology, Basel, Switzerland; 4 University Hospital Bruderholz, Cardiology,
Bruderholz, Switzerland; 5 University Hospital Liestal, Cardiology, Liestal,
Switzerland; 6 Lucerne Cantonal Hospital, Cardiology, Lucerne, Switzerland;
7
Cantonal Hospital of Baden, Cardiology, Baden, Switzerland
Purpose: To investigate the effect of NT-proBNP (NBNP) guided therapy on recurrent events in chronic heart failure (HF) patients (pts) and to test differences in
influencing HF vs. all-cause hospitalizations(hosps).
Methods: TIME-CHF randomized 499 pts, aged ≥ 60 yrs, LVEF < 45%, and
NYHA ≥ II to intensified, NBNP-guided vs. a standard, symptom-guided therapy for 18 months, with further follow-up to 5 1∕2 years. The effect of NBNP-guided
therapy on recurrent events, i.e HF-related and all-cause hosps, both endpoints
including also death, was explored using a time-between-event (gap-time) model.
Results: 102 pts experienced only one, 279 pts at least two all-cause hosp events.
For HF hosp, 135 pts experience one and 123 pts at least two events. NBNP guided
pts had a lower risk for repeated all-cause and HF-hosps including death (Table1).
The beneficial effect of NBNP-guided therapy was stronger for preventing second
all-cause hosp and less for preventing the first, whereas this was the other way
around for HF-hosp. The effect was only seen in pts aged < 75 years, with no effect
in those aged ≥ 75.
Conclusion: NBNP-guided therapy reduces the risk of recurrent events, especially
in pts < 75 years. Effects on all-cause hosp seemed to be stronger for later events,
possibly explaining the neutral effects on this endpoint when using time to first
events analysis only.
NURSING – POSTER PRESENTED
P1437
Canadian nurses of primary care and the tending to heart failure: an
exploratory study in Ontario
DMSDayse Correia1 ; M Singh2 ; ET Mesquita1 ; ME Puigbonet3
Universidade Federal Fluminense, Niterói, Brazil; 2 York University, Toronto,
Canada; 3 Georgian College, Barrie, Canada
1
Introduction: In the last decade, Canada has diminished deaths by cardiovascular
diseases in approximately 40%, deaths which, like in Brazil, have a great impact
0.060
0.74 (0.541.01)
0.70
(0.54-0.90)
0.005
0.53
(0.34-0.82)
0.63
(0.43-0.93)
NBNP-guided therapy effects on recurrence of events(adjusted% = for baseline
characteristics)
Methods: Exploratory research, involving 18 nurses from the province of Ontario,
invited through Nurse Practitioner networks, and interviews with to cardiac department nurses in the hospital and community. The gathering of data was performed
from September to November, 2013, through a semi structured questionnaire with
21 questions, devised by the head researcher.
Results: Outstandingly, health education is employed by 47% at the clinic ,62%
employ direct conversation, 50% focus on treatment as a main educational objective; and 68% identify prejudicial habits of subject and non-compliance with change
as the biggest problem in the prevention of. Self-care is considered by 74% as
fairly effective. Dispnea was pointed out by 67%, as the prevailing symptom,
and the implemmenting of standard protocols in Canada is of 100%. And as an
important action, a interdisciplinary collaboration for the tending to cardiac failure
was considered by 72% as being good.
Conclusion: The observation and reviewing of Canadian protocols enabled the
recognition of the feasibility of the practice of primary care nursing for the tending to cardiac failure, thus enabling the proposition of a model for assistance
in Brazil.
P1438
Adherence to treatment of patients with heart failure in three clinics in Brazil
FDCFatima Das Dores Cruz; AC Cavalcanti; ER Rabelo; EA Bocchi
Heart Institut, São Paulo, Brazil
Background: decompensated heart failure (HF) estfreqüentemente associated with
poor adherence to pharmacological and non -pharmacological. Strategies for education about the disease, self-care and adherence to treatment are measures that
have demonstrated benefits in clinical outcomes. In Brazil, the data are incipient in
this context.
Purpose: To assess adherence to treatment of patients diagnosed with HF followed
in three clinics (Sao Paulo, Rio de Janeiro and Porto Alegre) under the supervision
of nurses.
Methods: The membership questionnaire is an instrument developed to assess
adherence to pharmacological and non pharmacological treatment of patients with
HF. Comprises 10 questions related to the use of prescription drugs, check the
weight, salt intake, fluid intake and attending appointments and tests marked. The
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
282
Abstracts
questionnaire scores can range from zero to 26 points, so the closer to 26 points
better adherence . Was considered satisfactory adhesion a percentage of 70 %.
Results: 617 patients were analyzed in three centers : Sao Paulo (C1% = 300
patients), Rio de Janeiro (C2% = 117) and Porto Alegre (C3% = 200), all patients
underwent orientation pharmacological and non pharmacological management of
IC by nurses . In C1 patients underwent an average of 2 guidelines, adherence
score was 62 % in C2: 1 orientation score was 53 %, and C3 : 7 guidelines score
was 65 %.
Conclusion: Our data suggest that patients under treatment at a specialized clinic
with specialized approach to educational approach of nurses have adequate adherence to treatment, however, the greater the number of approaches can improve
adherence to terapêutica.Sugere that in future studies evaluating the impact of
adherence on clinical outcomes.
P1439
Empowering ICD patients towards improved quality of life
LLynne Hinterbuchner
Salzburg Clinic , Salzburg, Austria
Background: Self help groups need to be organised and founded by patients
themselves in Austria. In our practice we observed that many patients had many
unanswered questions about thier normal daily activity months after discharge from
the hospital. Patients that already suffer from heart failure were now recipients of a
primary preventive ICD. All patients receive an educative booklet before discharge.
These booklets do not help them deal with their anxiety of a suuden cardiac death
episode or the chance of receiving a shock.
We recognised the need for a support group amongst these patients and thier family.
Methods: We developed a seminar program for patients and thier families. The team
consists of an intensive care unit nurse, device clinic nurse and a psychologist. With
the help of guest speakers on a voluntary basis we provided a seminar every 2
months . Pamphlets were printed and mailed to all ICD patients from our clinic giving
the dates and topics one year in advance. Posters and pamphlets were also sent
out to community hospitals and rehab centers in the surrounding area.
Results: Our program is now in its fourth year and consists of 6 yearly seminars.
We have the attendees fill in an evaluation form after each seminar which includes
suggestions for future topics.The program has been planned with the needs and
requests from the patients and families that attend the seminars.The casual part of
the seminar occurs with a visit to a local restaurant after the seminar, where the
patients get to chat with each other and share experiences. Many patients that
had experienced fear of the unknown have come to terms and learned to live with
an ICD.
Conclusion: The way to helping patients into organising a self help group is
organising a platform for them to see a need for other patients to enjoy the support
from other ICD carriers.The patients also have a chance to learn more about
thier heart failure and how they can help themsleves through the seminars thus
empowering them to make decisions for themselves.
P1440
Baseline Clinical Characteristics:
Frailty assessments were obtained on 92 participants using the SHARE Frailty Index,
63% (n = 58) were assessed as frail.
Thromboprophylaxis information was obtained upon discharge via electronic prescription summary:
57% were prescribed warfarin
42% were prescribed an antiplatelet
4% were prescribed a novel anticoagulant
90-day Outcomes:
Of the 144 participants enrolled at index hospitalisation, 80 consented to telephone
follow up, and 69 were successfully followed up to date.
21% (n = 28) had at least 1 rehospitalisation in 90 days
All-cause mortality at 90 days was 4% (n = 6)
One participant had a stroke event% = < 1% (n = 1)
20% reported bleeding events at 90 days
Conclusions: In this frail, elderly cohort, thromboprophylaxis use was suboptimal
in this high-risk population. Rehospitalisation at 90-days was common. Greater
attention is needed to patient-centered interventions that aim to prevent potentially
avoidable rehospitalisations.
P1441
Pontocerebellar brain fiber deficits in heart failure
M AMary Woo1 ; R Kumar2
University of California Los Angeles, School of Nursing, Los Angeles, United
States of America
1
Purpose: Heart failure (HF) subjects have high incidence of breathing and blood
pressure abnormalities which are linked to morbidity and mortality. The cerebellum
and pons are brain areas which exert major control over these functions and have
gray matter loss. However, injury to the white matter tracts (pontine-cerebellar
fibers) which communicate between them could be an important source of aberrant
activity for these brain areas, but their status has not been described. Thus the purpose of this study was to examine the number of fibers connecting the cerebellum
and dorsal lateral pons in HF vs. control subjects.
Methods: Brain magnetic resonance imaging scans were collected in 10 HF (age
56+/-6 years; 8 males) and 10 healthy controls (age 56+/-4 years; 8 males). Brain
fibers extending between the cerebellum and dorsal lateral pons were counted. To
determine characteristics of these fibers, spherical regions of interest (ROI), with a
radium of 1.5 mm, were placed in native space of fractional anistrophy maps on
the left and right sides, and fibers passing from both ROIs constructed. Fiber tracts
of each ROI, with a minimum fiber length of 10 mm, were counted and compared
between groups using analysis of covariance (covariates: age and gender).
Results: There were no significant differences between the groups for age and for
the number of fibers on the left side (HF 498+/-86; controls 568+/-62; p% = 0.20).
However, there were significantly fewer fibers on the right side in HF (440+/-60) in
comparison to controls (631+/-112; p% = 0.02; figure).
Conclusions: Cerebellar-pontine tracts on the right side are damaged in HF
patients. This lateralized damage could contribute to both abnormal function
(breathing and blood pressure control) and gray matter damage in the cerebellum
and pons in HF.
The Atrial Fibrillation And Stroke Thromboprophylaxis in hEart failuRe
(AFASTER) cohort study: 90 day outcomes
C Ferguson1 ; SC Inglis1 ; PJ Newton1 ; S Middleton2 ; PS Macdonald3 ; PM
Davidson4
1
University of Technology, Sydney, Centre for Cardiovascular & Chronic Care,
Sydney, Australia; 2 Australian Catholic University, Nursing Research Institute, St
Vincent’s & Mater Health Sydney, Sydney, Australia; 3 Victor Chang Cardiac
Research Institute, Sydney, Australia; 4 Johns Hopkins University of Baltimore,
School of Nursing, Baltimore, United States of America
Purpose: Rehospitalisation is frequent but often preventable in patients with chronic
heart failure (CHF); leading to significant socio-economic and health system burden.
Co-morbidities such as atrial fibrillation (AF) add further complexity to care planning
and management.
The aim of this study was to describe 90-day outcomes in patients with CHF and
concomitant AF, following an index hospitalisation.
Methods: Prospective consecutive participants with CHF and concomitant AF of
any type and aetiology admitted to a cardiology ward were enrolled in the cohort
study during April – October 2013. Exclusion criteria included age < 18 years or AF
due to reversible causes. Socio-demographic and clinical characteristics including
medical history, frailty and thromboprophylaxis prescription were assessed at index
hospitalisation. Participants were followed up at 90 days by telephone.
Results: Baseline Socio-demographics:
A total of 144 participants were enrolled. Mean age was 72 yrs (SD 16.4), range 19 –
94 yrs, mostly male (66%), and 29% lived alone. Participants were primarily NYHA
class II – III (62%) and the mean LVEF was 43% (SD 19.0), most participants were
identified as having permanent AF. Mean Charlson Comorbidity Score% = 4.2 (SD
2.6), Mean CHA2DS2VASc score% = 4.6 (SD 2.4), Mean HASBLED Score% = 3.3
(SD 2.7). Mean number of medications on discharge% = 10 (SD 3.9).
Figure
P1442
Compromised blood brain barrier function in patients with heart failure
MA Shinnick; MA Woo; R Kumar
University of California Los Angeles, Los Angeles, United States of America
Purpose: Heart failure (HF) patients show brain injury, but the underlying cause
for this neural damage is unknown. A potential cause is alteration in the blood
brain barrier (BBB), but BBB changes have not been reported in HF. Therefore, the
specific aim of this pilot study was to examine BBB function in HF compared to
healthy controls.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
283
Methods: We assessed BBB values using diffusion-weighted pseudo-continuous
arterial spin labeling (pCASL) procedures. We collected diffusion-weighted pCASL
data from 3 HF subjects (age, 52 ± 19 years), and 6 control subjects (age,
53 ± 3 years), using a 3.0 Tesla MRI scanner. BBB maps were calculated from
diffusion-weighted pCASL data. Global brain mean BBB values were calculated
and compared between the groups using two-sample t-tests.
Results: Global brain BBB p-CASL values were lower in HF (HF vs controls;
87.8 ± 13.5 vs 105.3 ± 21.5 min-1; p% = 0.2; effect size% = 0.97), suggestive of
reduced water exchange rates across the BBB, compared to control subjects, with
arterial transit time (ATT) values (1.81 ± 0.17 vs 1.82 ± 0.12 sec; p% = 0.93; effect
size% = 0.07) comparable to controls. A set of p-CASL maps from a HF and a
control subject (Figure) are displayed showing global reduction in BBB values in HF
subject.
Conclusions: HF subjects showed lower BBB values over controls, with ATT values
equivalent to control values, indicating compromised BBB function with intact large
arteries. The compromised BBB function can contribute to damage of neural tissue
in HF subjects. The findings suggest a need to repair BBB function, with strategies
commonly-used in other fields, to protect neural tissue in the condition.
Figure
Background: Physical activity or exercise is an important issue in heart failure (HF)
patients. Most HF programmes encourage patients to perform some kind of physical activity above and beyond a rehabilitation exercise program.
Aim: To asses the actual physical activity in normal daily life in a cohort of consecutive patients attended in a HF Unit where nurses encourage patients to perform
exercise according to their status and where some patients have performed a structured 2-4 months rehabilitation exercise program.
Patients and Methods: 548 patients (71.4% men, mean age 68.6 ± 12.7 years)
were consecutively included during a 3 month period (May-July 2013). Aetiology of
HF was mainly ischemic heart disease (48.6%) followed by dilated cardiomyopathy
(16.1%) and valvular disease (9.1%). Most patients were in NYHA class II (79.6%)
or III (15.7%). Median duration of HF was 72.5 months (percentiles 25-75, 31.5-120
months). Mean LVEF was 42 ± 13%. Patients’ educational level was very low (none)
or low (primary) in 75.2% of patients. The majority of patients were married or with
couple (74.5%). The Spanish version of the short last 7 days International Physical
Activity Questionnaire (IPAQ) was used to assess the physical activity during the
previous week.
Results: Only 4% of patients reported to have performed intense physical activity
(like heavy lifting, digging, aerobics, or fast bicycling) during the previous week (only
0.5% every day). The mean time of such activity was 5 minutes. Moderate physical activity (like carrying light loads, bicycling at a regular pace, or doubles tennis)
increased to 15.5% of patients (although only 4.2% every day). The mean time of
such activity was 11.9 minutes. On the contrary, the majority of patients reported
walking for at least 10 minutes (91.1%, 73.9% every day). The mean duration of
such activity was 67.9 minutes. Finally, patients reported a mean 334 minutes/day
seated. Although the IPAQ is an easy self-administered short questionnaire, 13.9%
of our patients needed some help to complete it.
Conclusions: Despite being mostly in NYHA class II and having received educational advice on the benefit of exercise, a small number of our patients usually perform intense or moderate exercise. By contrast, the routine of daily walking seems
widely established. Anyway, the seated time exceeds 5 hours, well beyond a healthy
“siesta”.
P1443
NURSING – POSTER DISPLAY
ESC/HFA website heartfailurematters.org: its global use
1
1
2
2
K PKim Wagenaar ; F H Rutten ; L Verheijden Klompstra ; T Jaarsma ;
L Amendola3 ; A W Hoes1 ; K Dickstein4
University Medical Center Utrecht, Julius Centre for Health Sciences and Primary
Care, Utrecht, Netherlands; 2 Linköping University, Department of Social and
Welfare Studies, Linköping, Sweden; 3 European Society of Cardiology, Nice,
France; 4 University of Bergen, Bergen, Norway
1
Background: The ESC/HFA website heartfailurematters.org (HFM website) was an
initiative of the HFA, taken to address the unmet educational need, with the first
English version being launched in 2007. The website provides regularly updated
educational information for patients and their caregivers in a user friendly format,
designed to explain the concept of heart failure in lay terms. The site currently exists
in 6 languages (English, French, Spanish, German, Russian, and Dutch), and a new
improved graphic lay out is being implemented in all languages. In 2014 versions in
Arabic, Portuguese, and Greek will be launched. We aim to describe the global use
of the HFM website during the last four years.
Methods: The visits and bounce rates per language and per month were extracted
from ‘web-analytics’ of the website as were the page views. The duration of visits
were calculated for each year.
Results: The number of visits of the website increased over the last four years from
416,345 in 2010 to 796,632 in 2013. At the end 2013 the number of visits sharply
increased approaching 100,000 per month, mainly due to visits to the new English
version, the first in the new graphic lay out. The average visit duration decreased
from 3.1 minutes (2010) to 2.0 minutes (2013), and the bounce rate (percentage
of visitors who enter and leave the site rather than continue viewing other pages
within the same site) increased from 50.7% (2010) to 67.4% (2013). The pages most
often viewed were the homepage (English and Dutch version), ‘symptoms of heart
failure’ (Spanish, French, and German version) and ‘heart failure medicines’ (Russian
version). The traffic on the HFM website is responsible for one fourth of all ESC
website traffic.
Conclusion: HFM website is a worldwide, independent, and major e-health provider
of information on heart failure for patients and their caregivers. The number of visits
is steadily increasing, and should get another boost when another three languages
and a new graphic lay out are uploaded. Hopefully, the new lay out will better attract
the attention of visitors resulting in a longer visit duration and reduction of bounce
rates.
P1445
The effect of integrated nursing program on coping strategies and quality of
life in patients with heart failure
HLHui-Ling Hsieh1 ; CW Kao2
Taipie Medical University - Municipal Wan Fang Hospital, Taipei, Taiwan; 2 National
Defense Medical Center Shool of Nursing, Taipei, Taiwan
1
Background: The incidence of heart failure is increasing in recent twenty years. Most
of patients with clinical symptoms delay the best timing for treatment due to lack
of coping capability. Despite many domestic researches focus on the clinical issues
of heart failure patients, there was no study to investigate the effect of “Integrated
Nursing Program” on improvement of coping strategies in patients with heart failure.
This study aims to examine the effect of “Integrated Nursing Program” on improving
coping strategies and quality of life in patients with heart failure.
Methods: Total 78 subjects were enrolled from a cardiovascular out-patient department in a medical center. The 36 subjects were randomly assigned to the experimental group and 42 subjects to the control group. The subjects in the experimental
group received “Integrated Nursing Program” in symptom management, while the
subject in the control group received traditional nursing instruction. The subjects
were evaluated once a month for four times. The instruments included Brief-COPE
and Minneosta Living with Heart Failure Questionnaire (MLHFQ). The Generalized
estimating Eguation(GEE) was used to analyze the effect of this integrated nursing
program.
Result: (1) There were statistically significant more problem oriented coping strategies (p < .001) and less emotional oriented coping strategies (p < .001) performed
in the experimental group, and (2) There was statistically significant greater improvement on quality of life in the experimental group compared with control group
(p<.001).
Conclusion: The “Integrate Nursing Program” may help heart failure patient more
frequently use the problem oriented coping strategies to deal with their symptoms,
and then improve their life quality. Clinical professionals can provide this program to
heart failure patients to improve patient’s outcomes and the clinical care quality.
P1446
P1444
Anemia and health-related quality of life in patients with heart failure
Physical activity in ambulatory patients of a heart failure unit in the country of
the siesta
C Georgiou; E Lambrinou
Nursing Department, Cyprus University of Technology, Limassol, Cyprus
B Gonzalez; R Cabanes; M Rodriguez; M Arenas; J Lupon; P Gastelurrutia; M De
Antonio; E Zamora; M Domingo; A Bayes-Genis
Germans Trias i Pujol University Hospital, Badalona, Spain
Introduction: Evidence suggests that anemia is strongly associated with poor
outcomes in heart failure (HF) and may be a pathophysiologic contributor to HF.
According to the World Health Organization (WHO), anemia is defined as hemoglobin
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
284
Abstracts
levels less than 12g/dl for women and less than 13g/dl for men. The potential relationship between health related-quality of life (HR-QoL) and corrected anemia has
not been adequate evaluated in patients in HF.
Purpose: The purpose of the current study is to summarize the existing evidence in
regard to the association of corrected anemia and HR-QoL.
Methods: It is a literature systematic review. The search was done in the electronic databases PUBMED, CINAHL and GOOGLE SCHOLAR using the keywords
‘heart failure’, ‘quality of life’, ‘anemia’, ‘Fe supplements’, and ‘supplements’. . It
was done during the period of the September 2013 until the end of November
2013, according to predefined inclusion and exclusion criteria. Date restrictions were
not applied.
Results: Search extracted 8 studies from Europe, USA and Israel. The surveys’
methodology consisted from randomized control trials and prospective studies.
Studies support that corrected anemia improved readmission rates, days of readmissions, exercise intolerance and quality of life.
Conclusions: Corrected anemia has been found beneficial for HF outcomes. Supplement correction of decreased levels of Hb improves HR-QoL. More research is
needed defining the relation between correcting anemia and quality of life and other
factors like gender, that may affect the results.
P1447
Multimedia symptom management program improves symptom distress,
depression, and heart rate variability in heart failure patients
C-WChi-Wen Kao
National Defense Medical Center, School of Nursing, Taipei, Taiwan
Background: Physical symptoms of heart failure (HF) impair patients’ functional
capacity and affect their psychosocial well-being. A common comorbidity in HF
patients is depression. The purpose of this study was to examine the effect of a
multimedia symptom management program on symptom distress, depression and
heart rate variability (HRV) in patients with HF.
Methods: Total of 82 HF patients participated in this longitudinal experimental study.
The subjects in experimental group (n = 40) received the multimedia symptom management program, and subjects in control group (n = 42) received routine care. Data
were collected at four times: baseline, and one time per month for three months.
The Beck Depression Inventory-II was used to measure the depressive symptoms.
The Generalized Estimating Equation (GEE) was used to analyze the effect of the
multimedia symptom management program on symptom distress, depression,
and HRV.
Results: The majority of subjects were male (58.5%), with NYHA class II
(75.6%), a mean age 71.04 ± 11.01 years, and left ventricular ejection fraction
51.80 ± 11.13%. The patients receiving the multimedia symptom management
program have a significant decrease in the symptom distress (c2% = 4.792,
p% = .029), and depressive symptom (c2% = 3.668, p% = .05), compared to the
patients without obtaining this program. Even though the HRV was not significantly increased in experimental group patients when compared with the
control group patients, there was an improvement trend in HRV. Conclude: The
multimedia symptom management program is able to decrease the symptom
distress and depression, and improve the HRV in patients with HF. The clinicians
may use this program to instruct HF patients how to deal with their symptoms
and self-care.
Conclusion: Living alone was independent contributor for worse prognosis in HF
patients, and this population was identified as a high-risk cohort.
P1449
Patient satisfaction regarding healthcare is influenced by their emotional
intelligence
A DAnca Daniela Farcas1 ; L E Nastasa2
University of Medicine and Pharmacy of Cluj Napoca, Faculty of Medicine,
Department of Internal Medicine, Cluj Napoca, Romania; 2 Transilvania University of
Brasov, Faculty of Psychology and Educational Sciences, Brasov, Romania
1
Purpose: Patients often complain of communication problems with doctors. Patient
satisfaction regarding healthcare is partly influenced by the doctors’ level of emotional intelligence. Our study aims to evaluate if and how the emotional intelligence
of patients with chronic heart failure does influence their level of satisfaction and
the impact on quality of life.
Methods. Patients’ level of satisfaction was measured with The Picker Patient
Experience Questionnaire administered at discharge. The impact on the physical, emotional, social and mental dimensions of quality of life was measured
using the Minnesota Living with Heart Failure Questionnaire at hospital admission and discharge; the results were analyzed using the t test. Patients were
individually administered the Emotional Intelligence Scale (EIS) to evaluate the
level of emotional intelligence. Spearman rank order correlations was used
to examine the relationship between scores on the EIS, patient satisfaction
and MLHF.
Results: 75 patients (34 males and 36 females, average age 63 ± 12) completed the questionnaires. At hospital admission, 88% of them were in NYHA
class IV but during hospitalization and because of the cardiac (partial) compensation, the quality of life improved in all patients (85 ± 15 vs 78 ± 13, p <
0,001). The emotional dimension of quality of life remained severely impacted
in patients with low emotional intelligence. Although each and every patient
had the same hospital amenities and was treated by the same physician,
only 56% were completely (100%) satisfied. These patients scored higher on
the EIS scale and had a greater level of improvement in quality of life during
hospitalization.
Conclusions. Emotional intelligence of patients with heart failure appears to be a
significant factor in patient-centered care. Focused interventions directed towards
the development of emotional intelligence in both doctors and patients could
improve the doctor-patient communication and also patient-centered care.
EXERCISE TESTING AND TRAINING – POSTER PRESENTED
P1451
Acute effects of osteopathic manipulative treatment in heart rate variability of
patients with heart failure: a cross-over study
F AFellipe Amatuzzi1 ; R Queiroz2 ; I Barreira1 ; H Lissa1 ; A Castelo Branco1 ; APX
Oliveira1 ; V Maldaner1 ; R Jacomo1 ; G Cipriano Junior1
1 University of Brasilia, Brasilia, Brazil; 2 Escuela de Osteopatia de Madrid - Sede
Brasil, Campinas, Brazil
P1448
Living alone is a risk factor for heart failure readmission or death in Japanese
patients
1
1
2
3
2
2
KKumi Takanashi ; H Iizuka ; Y Matue ; H Saito ; M Suzuki ; A Matumura ; Y
Hashimoto2
1
Kameda Medical Center, Department of Nursing, Kamogawa, Japan
Introduction: Post discharge support by patient family is crucial for patient self-care
management in HF patients. However, there are many patients who live alone and
are socially isolated, and they are highly vulnerable to poor self-management. In this
study, we investigated whether living alone is a risk factor for re-hospitalization or
death due to HF.
Methods: A total of 113 HF patients who had been discharged from our hospital
were prospectively followed in our study. Endpoint was readmission or death due
to HF. Included patient cohort was divided into two groups by whether living alone
(n = 20) or not (n = 112).
Results: Mean age of all cohort was 76.2 ± 13.4 years old and 52.6 % were
male. During follow-up for mean of 322 days, 30 patients (22.5%) were readmitted
or died due to HF. Kaplan-Meier curve analysis showed that prognosis of living
alone group was worse compared to not living alone group (P% = 0.03). Both
in univariate and multivariate Cox regression analysis, being in the living alone
group was an independent predictor for worse prognosis in HF patients (HR
3.85, 95% CI: 1.14-13.0, P% = 0.03, and HR: 4.66, 95% CI: 1.17-18.5, P% = 0.03,
respectively)
Purpose: The sympathetic hyper stimulation in Autonomic Nervous System (ANS) plays an important role in limiting symptoms of heart failure (HF).
There is evidence that vagal stimulation and the decrease of sympatheticotonia provides a potential clinical benefit for these patients. Osteopathic
Manipulative Treatment (OMT) has the ability to regulate the ANS in health individuals, but the effects of OMT techniques in patients with HF have not been
established.
Methods: Eleven cardiac patients (EF < 40%) were evaluated with the Heart Rate
Variability (RR interval, LF, HF, LF%, HF%, LF/HF, SD1 and SD2) with a RS800CX
polar in supine and standing positions before and after OMT and sham. The procedures were randomized, the patients crossed with a one week wash-out. The
OMT ́ s high velocity low amplitude (HVLA) manipulation was made on a cervical
spine (C3 to C7) and thoracic spine (T1 to T4).
Results: The response of HRV variables in the cardiac patients after OMT technique
were: increase SDNN (Δ% = 10,8, p% = 0.01) in supine position and increase the
RR interval (Δ% = 29,00 ms, p% = 0.03) and HF norm (Δ% = 6%, p% = 0.04) in
standing position.
Conclusion: These results indicate a parasympathetic stimulation after OMT ́ s
HVLA manipulation in patients with HF. These patients may have clinical benefits
with OMT including more exercise tolerance due to the tendency to increase the
parasympathetic tone in supine and standing due to inhibition of sympathetic
stimulation.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
285
61002 Comparison between OMT and Sham
HRV variables
supine before
intervention
supine after
intervention
p-value
orthostatic
before
intervention
(mean and SD)
(mean and
SD)
(mean and
SD)
(mean and
SD)
orthostatic
after
intervention
p-value
RR1
989,2
±
159,459
1013
±
172,905
0,099
956,8
±
204,217
985,8
±
202,8
0,031*
RR2
940,43
±
116,87
961,71
±
113,721
0,132
911
±
130,112
896,43
±
126,3
0,534
SDNN1
40
±
48,151
50,8
±
53,965
0,017*
38
±
21,909
31,2
±
18,78
0,23
SDNN2
31,71
±
16,55
39,86
±
16,577
0,163
29,71
±
9,16
33,57
±
11,25
0,232
HF%1
34,8
±
27,91
35,8
±
23,669
0,804
36
±
21,68
42
±
23,6
0,047*
HF%2
40,14
±
17,1
40,43
±
26,261
0,981
39,4
±
20,36
38,86
±
27,97
0,951
1 - OMT group;2 - Sham group. Student ́ s t Test. * p < 0.05.
P1452
Effects of slow breathing training on respiratory pattern, left ventricular
function, pulmonary pressure and functional capacity in patients with chronic
heart failure and pulmonary hypertension
S Salerno1 ; GGabriella Guglielmina Barbara Malfatto2 ; E Lisi1 ; V Giuli1 ; F
Ciambellotti1 ; K Styczkiewicz3 ; K Kawecka-Jaszcz3 ; C Lombardi1 ; G Branzi2 ; G
Parati1
1
Università Milano-Bicocca & Ospedale San Luca, Istituto Auxologico Italiano
IRCCS, Milano, Italy; 2 Ospedale San Luca, Istituto Auxologico Italiano IRCCS,
Milano, Italy; 3 Jagiellonian University Medical College, Department of Cardiology
and Hypertension, Krakov, Poland
Background: Regular slow breathing is known to improve autonomic cardiac regulation and reduce chemoreflex sensitivity in chronic heart failure (CHF). In 2008
a pilot study by Parati and coworkers demonstrated that slow breathing training using a commercial system improved NYHA class, exercise capacity, pulmonary function, ventricular ejection fraction and pulmonary pressure in CHF
patients.
Aims: We explored the possibility to use slow breathing training in real life. Moreover, we investigated whether a period of non supervised respiratory training
at home could affect exercise capability and pulmonary pressure in unselected
CHF patients.
Methods: We enrolled 36 CHF patients (pts) (71 ± 7 years, left ventricular ejection
fraction EF 31 ± 6%, NYHA class 2.7 ± 0.5) to an unsupervised training period of
10-12 weeks. They learned to use the equipment for slowing their breathing rate,
but were not strictly followed up as in the previous study. In all pts, before enrollment and after the training period, we collected BNP levels and performed: 6 minutes
walking test (6MWT) or cardiopulmonary test, echocardiography, Minnesota quality
of life (MQoL) questionnaire.
Results: Three pts dropped from the study, 12 never or very seldom performed the
training (non-adherent), while 22 patients performed enough sessions (> 75%) to
be judged adherent and trained, as demonstrated by the slowing in their respiratory
rate (- 4 ± 1 breaths/min, p < 0.05).
In the 22 trained pts, slow breathing training improved : NYHA class (from 2.7 ± 0.5 to
1.55 ± 0.5, p < 0.01), EF (from 31 ± 6% to 34 ± 7%, p < 0.04), estimated pulmonary
pressure (from 40 ± 10 mmHg to 34 ± 7 mmHg, p < 0.001), 6MWT distance (from
390 ± 61 to 415 ± 82 mt, p < 0.02), VEVCO2 at cardiopulmonary test (from 39.9 ± 7.8
to 35.8 ± 6.7, p < 0.01). On the other hand, respiratory training did not significantly
change BNP levels, peak VO2 and the MQoL score. In non-adherent pts no changes
were observed in any of the variables.
Conclusions: In the real world, slow breathing training is feasible only in about 30%
of patients, since good adherence to regular exercise is requested. Changes in relevant variables are similar to those observed in the pilot study, therefore this type of
training should be offered to selected and well motivated patients.
P1453
Beneficial effects of exercise training rehabilitation in periodic breathing in
chronic heart failure
N Panagopoulou1 ; S Dimopoulos1 ; A Tasoulis1 ; L Karatzanos1 ; O Papazachou1 ; G
Tzanis1 ; V Sousonis2 ; C Kapelios2 ; Z Margari2 ; S Nanas1
1
National & Kapodistrian University of Athens, Cardiopulmonary Exercise Testing &
Rehabilitation Laboratory, Athens, Greece
Purpose: Periodic breathing in chronic heart failure (CHF) patients is associated with
reduced exercise capacity and quality of life, increased mortality and increased incidence of sudden cardiac death. Exercise rehabilitation programs improve exercise
capacity and quality of life in CHF patients. So far, there is little data on the effect
of exercise on periodic breathing. The purpose of this study was to investigate
the acute responses of exercise on the phenomenon of periodic breathing in CHF
patients.
Methods: Thirty eight consecutive stable CHF patients with ejection fraction < 45%
were evaluated. Twenty of them exhibited periodic breathing (age: 54 ± 11 years,
VO2 peak: 14.9 ± 5.1 ml/kg/min). Patients attended a program of 36 sessions of
taerobic intermittent exercise with or without strength training (3 sessions/week). All
patients underwent cardiopulmonary exercise testing before and after the program.
Determination of periodic breathing was based on the amplitude of cyclic fluctuations in breathing during rest and exercise (cyclic fluctuations in ventilation lasting
for more than 60% of exercise duration, with amplitude of greater than 15% of the
average amplitude of cyclic fluctuations at rest). Parameters evaluated, were: 1) percentage of periodic breathing duration, 2) average amplitude and 3) average length
of cyclic fluctuations in breathing during exercise. All values are mean ± SD.
Results: Patients improved (p < 0.05) VO2 peak (14.9 ± 5.0 to 17.2 ± 5.6 ml/kg/min),
maximum workload (96 ± 41 to 112 ± 48 watts) and anaerobic threshold (19.5 ± 2.8
to 10.6 ± 3.0 ml/kg/min). Exercise reduced (p < 0.01) percentage of periodic breathing duration (79 ± 13% to 50 ± 25% of total duration). No statistically significant
change was observed in average length of cyclic fluctuations breaths (44.0 ± 10.9
to 41.0 ± 6.7 sec, p% = 0.19), as well as in average amplitude of these fluctuations
(5.2 ± 2.0 to 4.9 ± 1.6 L/min, p% = 0.46).
Conclusions: A rehabilitation program of aerobic exercise, with or without strength
training, improves periodic breathing observed in CHF patients. These results need
further investigation in larger samples. The type of breathing in exercise could be
used to select the optimal rehabilitation program in patients with CHF.
P1454
Early recovery ventilatory indices after maximal cardiopulmonary exercise
testing examination depicts CHF severity
A Georgantas1 ; S Dimopoulos1 ; L Karatzanos1 ; A Tasoulis1 ; G Tzanis1 ; O
Papazachou1 ; X Pantsios2 ; E Tripodaki1 ; E Repasos2 ; S Nanas1
1
Cardiopulmonary Exercise Testing & Rehabilitation Laboratory, NKUA, Athens,
Greece; 2 3rd Cardiology Department, NKUA, Athens, Greece
Purpose: Peak oxygen uptake (VO2 peak) is considered an established measure of
functional capacity with prognostic significance in patients with chronic heart failure
(CHF). However, VO2 peak obtained by cardiopulmonary exercise testing (CPET),
may not be always reproducible. Data derived from early recovery period after
maximal CPET seems that can predict functional capacity, as effort independent
variables. The aim of this study is to evaluate the severity of CHF (as estimated by
VO2 peak and VEVCO2) based on early recovery ventilatory CPET variables.
Methods: 56 stable CHF patients, (42 Male/14 Female, 49 ± 13yrs, VO2
peak:19.9 ± 6.5ml/kg/min) performed a symptom-limited CPET to exhaustion.
Besides the measurement during maximal CPET, we calculated during the first
minute of recovery VO2, carbon dioxide output (VCO2), tidal volume (Vt), minute
ventilation (VE) and respiratory ratio (RR). The first degree slope of VO2, VCO2 and
VE (VO2/t slope, VCO2/t slope 𝜅𝛼𝜄 VE/t slope) was also measured during the same
period.
Results: Significant correlations (p < 0.05) were demonstrated between CPET
variables and ventilatory recovery indices. VO2 peak was correlated to VO2/t slope
(r% = -0.74), VCO2/t slope (r% = -0.79), and VE/t slope (r% = -0.64). VEVCO2 was
correlated to VO2/t slope (r% = 0,61), VCO2/t slope (r% = 0,70), and VE/t slope
(r% = 0,46). Also, the severity of CHF was evaluated by VO2 peak and VEVCO2
(cut-off points: 18.3ml/kg/min and 34, respectively) and ventilatory recovery variables. All patients were categorized to two groups according the aforementioned
cut-off values, which were the medians of the sample. There were statistical significant differences between groups of patients (p < 0.05) for VO2/t slope, VCO2/t
slope and VE/t slope in relation to VO2 peak and VEVCO2 (table).
Conclusions: Early recovery ventilatory CPET kinetics seems to correlate with
established CPET indices adding to the evaluation of CHF severity, as effort
independent variables.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
286
Abstracts
61353
patients with VO2peak < 18.3
patients with VO2peak ≥ 18.3
P
patients with VEVCO2 < 34
patients with VEVCO2 ≥ 34
P
VO2 /t slope (l/min2 )
-0.450±0.202
-0.834±0.363
< 0.01
-0.728±0.359
-0.410±0.186
< 0.01
VCO2 /t slope (l/min2 )
-0.369±0,148
-0.702±0.246
< 0.01
-0.605±0.263
-0.338±0.130
< 0.01
VE/t slope (l/min2 )
-11.49±4,67
-19.86±6.92
0.09
-16.95±6.97
-12.85±7.52
0.07
Table. Differences between patients according to VO2 peak and VEVCO2.
P1455
Exercise capacity indices are better preserved in HFpEF than in HFrEF
JJelena Celutkiene1 ; E Ambrasas1 ; A Grigaliuniene2 ; A Laucevicius1
Vilnius University, Medical Faculty, Clinic of Cardiovascular diseases, Vilnius,
Lithuania; 2 Vilnius University Hospital Santariskes Clinic, Vilnius, Lithuania
1
Background: some prior studies show that exercise capacity indices, including
oxygen uptake efficiency slope (OUES), are similarly diminished in HFpEF and HFrEF
patients.
Aim: to compare oxygen uptake and indices of ventilatory efficiency, including
OUES, in HFpEF and HFrEF populations.
Method: HFrEF patients (n = 217, mean age 55.1 ± 12.3, 175 males, mean LV
EF 31.02 ± 9.5%, mean BNP 682 ± 795 ng/l), HFpEF patients (n = 190, mean age
63.1 ± 10.5, 69 males, LV EF >50%, BNP 92 ± 177 ng/l) and control group (n = 88,
mean age 39.0 ± 11.5, 64 males) underwent cardiopulmonary exercise (CPX) test
on an electronically braked lower extremity ergometer using an incremental staged
protocol. HFpEF criteria included diminished VO2 peak, LV hypertrophy, left atrial
enlargement, diastolic dysfunction, and increased BNP level. Minute ventilation
(VE in l/min), oxygen uptake (VO2 in l/min) and carbon dioxide production (VCO2
in l/min) were acquired breath-by-breath, using a SensorMedics Vmax 229 gas
analyzer. Peak respiratory exchange ratio was ≥ 1.05 in all three groups. OUES
was retrospectively calculated with a computer software package. One way ANOVA
compared the CPX indices amongst HFrEF, HFpEF and healthy control groups.
Results: Etiology of HFrEF included hypertensive heart disease (n = 76), dilative
CMP (n = 58), ischemic heart disease (n = 42), primary valve disease (n = 21) and
other causes (n = 20). In HFrEF group 19 patients were in NYHA I, 75 in NYHA II, 121
in NYHA III and 2 in NYHA IV class. In HFpEF group 24 patients were in NYHA I, 74
in NYHA II, 91 in NYHA III and 1 in NYHA IV class. In HFpEF group at rest 1st degree
of diastolic dysfunction was found in 117 patients, 2d degree - in 70, 3d degree - in
3 patients. Exercise capacity indices are presented in the Table.
Conclusions: Oxygen uptake seems to be significantly lower in HFrEF compared to
HFpEF. Indices of ventilatory efficiency – OUES, VE/VCO2 and VE/VO2 slopes - are
significantly better preserved in HFpEF than in HFrEF population.
2D-speckle tracking echocardiography. Exercise capacity was evaluated by treadmill exercise test (symptom limited) and assessed with metabolic equivalant units
(MET).
Results: Enlarged LAV was observed in group 1 (p < 0.001) and related to diastolic
dysfunction (p% = 0.011), metabolic syndrome (p% = 0.040), and higher high sensitive C-reactive protein (h-CRP) (p% = 0.009) and triglycerides levels (p < 0.001).
LAV correlated with AHI (r% = 0.541 p < 0.001), left ventricular (LV) end-diastolic
volume (r% = 0.248 p% = 0.046), and LV filling pressure (r% = 0.405 p < 0.001).
Impaired LA deformation was observed in group 1 (LA-S, LA-SRs, LA-SRe and
LA-SRa; all p values < 0.050) and only weakly correaleted with disease severity (r% = -0.458; r% = -0.424; r% = -0.655; r% = -0.485 respectively; all p values
< 0.001). Decreased MET units was more prevalent in group 1 (p < 0.001) and
correlated with AHI (r% = -0.603, p < 0.001), LAVI (r% = -0.632, p < 0.001) and LA-S
(r% = 0.453, p < 0.001). After cessation of exercise the LAV and LA deformation
parameters (except LA-SRs) in group 1 were increased but still was lower than
group 2. Predicted increments of LA deformation during test were less pronounced
in group 1.
Conclusions: Enlarged LAV and impaired LA deformation are associated with
impaired treadmill exercise capacity and are correlated with increasing of disease
severity. AHI is the only independent predictor of exercise performance in OSA.
P1457
Heart failure exacerbation is the main cause of hospital readmissions among
patients who refused or abandoned cardiac rehabilitation after myocardial
infarction within the first eighteen months
J Mora-Robles; JA De La Chica; MA Roldan Jimenez; M Mora Martin
Regional University Hospital Carlos Haya, Malaga, Spain
Purpose: Refusing participation in cardiac rehabilitation programs (CRP) is usually
due to difficulties in access to hospital (distance or transport reasons) or because
60831 Exercise capacity indices in 3 study gr.
VO2 ml/kg/min
VO2 % predicted
VO2 l/min
VO2 % predicted
VE/VCO2
VE/VO2
OUES
HFrEF
17.0±5.4•†
59.2±19.4•†
1.4±0.5•†
61.1±18.9•†
33.9±9.7•†
38.8±12.7•†
1.8±0.6•†
HFpEF
18.2±5.3†
74.1±21.0†
1.5±0.6†
80.6±19.9†
30.1±6.3†
34.2±9.3†
2.0±0.7†
Control
33.5±6.5
90.1±15.2
2.7±0.6
96.8±16.3
23.6±3.3
27.7±5.9
3.2±0.8
• p < 0.05 compared to HFpEF † p < 0.05 compared to control
P1456
Impaired deformation and dilatation of left atrium in obstructive sleep apnea
is associated with impaired exercise performance
M GMustafa Gokhan Vural1 ; S Cetin2 ; R Akdemir3 ; H Firat1 ; E Yeter1
Ankara Diskapi Education and Research Hospital, Ankara, Turkey; 2 29 Mayis
Private Hospital, Department of Cardiology, Ankara, Turkey; 3 Sakarya University,
Faculty of Medicine, Sakarya, Turkey
1
Background: Left atrial volume (LAV) and LA deformation has been proposed
as a good marker of exercise performance in patients with diastolic dysfunction.
As diastolic dysfunction is more prevalent in obstructive sleep apnea (OSA) we
aimed to evaluate the influence of LAV and LA deformation parameters on exercise
performance in varying severity of OSA.
Methods: OSA was diagnosed after polysomnography and classifed according to apnea-hipopnea index (AHI). Fifty five newly diagnosed OSA patients (aged
49.4 ± 8.6 years, 32 men) were enrolled in the study. OSA patients were divided into
two groups, AHI> 30 (n = 29; AHI% = 61.1 ± 21.0) as group 1 and AHI < 30 as group
2 (n = 26; AHI 8.9 ± 9.8). LAV was calculated assuming the ellipsoid model with two
ortogonal planes and was indexed to body surface area. LA deformation as defined
LA strain (LA-S) and LA strain rates (LA-SRs, LA-SRe, LA-SRa) were assessed with
of need of premature employment reinstatement after myocardial infarction, mainly
in self-employees. However, heart failure exacerbations, especially related to dyspnoea and functional class worsening, may be more common in these patients than
in those assisting and completing the program before returning to work.
Objectives: we included in our study 116 participants who completed our CRP during 2012 (84,2% male; mean age 57,3 years old) and 39 who rejected it (89,1%
male; mean age 54,5 years old). All of them had been previously revascularized
during the same year. We followed them until December 2013 when they were
re-interviewed about possible heart failure and/or angina symptomatic complications (mean follow-up time: 18,4 months; 95% CI 13,4-21,1)
Results: from 116 participants who completed the program in 2012, only 12
(10,34%) returned to hospital within the follow-up until December 2013, whereas
22 of a total of 39 (56,41%), who had rejected or abandoned our CRP needed
readmissions, 14 at our cardiology unit and 8 at emergencies for stabilization and
pharmacological readjustments due to cardiac reasons (relative risk 0,18; 95% CI
0.10-0,34 p < 0.01). From those 22 readmitted patients, 16 consulted for heart failure
(72,7%), being usual dyspnoea worsening the main reason for consultation in all of
them. The other 6 patients (27,3%) complained of angina at emergencies, needing
revascularization again 2 of them, due to re-stenosis of implanted stents.
Conclusions: Cardiac rehabilitation not only improves functional class among heart
failure patients but also avoids readmissions at cardiology units. Furthermore, dyspnoea worsening is the most prevalent reason for consultation among patients who
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
287
rejected to participate or abandoned a CRP within the first eighteen months after
revascularization. Therefore, we can conclude that CRP is essential for heart failure patients, especially before returning to assuming labour obligations, reducing
avoidable readmissions.
(R% = 0.85 and 0.82 respectively, both P < 0.0001).
Conclusion: Free-living TEE and PA can be accurately estimated from the DAQIHF
questionnaire in patients with CHF, both at the group and individual level. As well,
peak V’O2 appears strongly related to TEE and can also be accurately estimated
from the DAQIHF questionnaire in these patients.
P1458
ClinicalTrials.gov Identifier: NCT00676390
Respiratory drive and respiratory muscle strength in CHF patients after LVAD
implantation
A Tasoulis1 ; S Dimopoulos1 ; G Tzanis1 ; E Repasos2 ; N Panagopoulou1 ; C
Pantsios2 ; E Tripodaki1 ; C Manetos1 ; I Terrovitis2 ; S Nanas1
1
National & Kapodistrian University of Athens, Pulmonary & Critical Care Med.
Dep., Cardiopulmonary Exercise Testing & Rehabilitation Lab., Evgenidio H ,
Athens, Greece
Purpose: Left ventricular assist device (LVAD) implantation modifies the vicious
cycle of chronic heart failure (CHF) and therefore improves functional capacity,
quality of life and survival. The aim of this study was to examine respiratory drive
and respiratory muscle strength after LVAD implantation.
Methods: 7 patients with end stage CHF (6 males, mean age: 44 ± 19yrs,
𝛽𝜇:23 ± 2kg/m2 ) after LVAD implantation were enrolled in the study. 1st , 3rd
and 6th month after LVAD implantation our patients underwent symptom limited
cardiopulmonary exercise testing, measurements of mouth occlusion pressure
(P0.1) and maximum inspiratory pressure (Pimax). Respiratory drive was estimated
by P0.1 and P0.1/Pimax ratio.
Results: VO2 peak increased from 0.78 ± 0.08lt/min (1st month) to 0.87 ± 0.17lt/min
(3rdmonth) and 1.1 ± 0.14lt/min (6th month)(p < 0,001). First month after implantation
Pimax was increased from 63 ± 16 cm H2 O to 78 ± 17 cm H2 O (3rdmonth) and to
93 ± 20 cm H2 O the 6th month (p < 0,05). P0.1 decreased from 2,6 ± 0,6 cm H2 O
to 2,4 ± 0,4 cm H2 O (3rd month) and to 2,3 ± 0,4 cm H2 (6th month). P0.1/Pimax
*100% ratio decreased from 4,2 ± 0,4%(1st month) to 3,3 ± 0,9%(3rd month) and
2,6 ± 0,4%(6th month) (p < 0,001).
Conclusions: LVAD implantation improved respiratory drive and respiratory muscle
strength in end stage CHF patients. A possible explanation of our findings is that
LVAD implantation and the hemodynamic changes that follow improve respiratory
muscle myopathy and autonomic nervous system dysfunction. This study suggests
a further beneficial effect of LVAD in CHF patients.
P1459
Assessment of free living daily energy expenditure and physical activity in
CHF: validation of a questionnaire with doubly labelled water
MMartin Garet1 ; S Normand2 ; M Laville3 ; L Gabert2 ; V Sauvinet2 ; A Da Costa4 ; JC
Barthelemy1 ; F Roche1
1
University Hospital - University Jean Monnet, Lab. SNA-EPIS, EA 4607, Clinical
and Exercise Physiology Department, Saint-Etienne, France; 2 University Claude
Bernard of Lyon, CENS, CRNH Rhône-Alpes, Lyon, France; 3 University Hospital of
Saint-Etienne, Cardiology Unit, Saint-Etienne, France
Aim: To provide individually adapted functional support to patients with chronic
heart failure (CHF), objective and reliable methods must be used to assess patient
energy requirements. In that intent, questionnaires are frequently used. The aim of
this study was to evaluate free-living total energy expenditure (TEE) and physical
activity (PA) and to assess the validity of the DAQIHF questionnaire, providing a
quantitative and qualitative assessment of TEE and PA in patients with CHF along
with an estimation of peak V’O2, against the doubly labelled water (DLW) method
in free-living patients with CHF.
Methods: 29 patients with CHF (women/men 12/17, NYHA I to IV, age: 60 ± 12
ys, LVEF% = 33.1 ± 9.3%) taking their habitual medication (diuretics, vasodilators,
beta-blockers) performed an incremental symptom-limited peak V’O2 test. Daily
physical activity and free-living TEE were estimated with the DAQIHF (TEEquest)
and measured over 2 weeks using doubly labelled water (TEEDLW). After a 12-h
overnight fast, resting metabolic rate was assessed from several Methods: indirect
calorimetry (RMRcalo), 50-Hz bioelectrical impedance analysis (RMRBIA), and
questionnaire (RMRquest). The methods were compared using Bland-Altman analysis and Student T-Test. Statistical significance was set for P < 0.05.
Results: Mean TEE did not significantly differ between TEEDLW and TEEquest
(-419 ± 438 kJ.24h-1; P% = 0.18). TEEquest from the questionnaire slightly overestimated TEEDLW by 2.8% (P% = NS). Bland-Altman plots revealed no systematic
bias for TEE between the two methods. There was no significant difference
in TEEDLW vs. TEEquest for the whole group (10009 ± 2821 vs. 10290 ± 2382
kJ.24h-1 respectively, P% = NS), nor between women and men. No significant
differences were found in RMR between RMRcalo and RMRquest (P% = NS) but
RMRBIA overestimated RMR (14%, P < 0.001).
Patients spent only 9.4% of their TEE in activities above the 3 METs threshold,
known to be associated with prognostic factors.
Peak V’O2 estimated from the questionnaire and measured peak V’O2 were similar (P% = NS) and correlated (13.9 ± 4.7 vs. 14.7 ± 3.5 ml.min-1.kg-1; R% = 0.71,
P < 0.0001). Both TEEDLW and TEEquest were correlated to measured peak V’O2
P1460
The influence of anaemia and iron deficiency on exercise capacity.
NNicole Ebner; M Valentova; T Bekfani; L Steinbeck; S Elsner; A Sandek; W
Doehner; SD Anker; S Von Haehling
Charite - Campus Virchow-Klinikum, Department of Cardiology, Division of Applied
Cachexia Research, Berlin, Germany
Background: Anaemia and iron deficiency (ID) are important factors for muscle
function and exercise capacity in patients with chronic heart failure (HF). Their interaction in HF remains to be defined.
Methods: A total of 601 out-patients with stable chronic HF were enrolled with
mean age of 71 ± 11 years, 22%female, mean left ventricular ejection fraction
(LVEF) was 43 ± 14%, Body Mass Index (BMI) ± kg/m2 ]. Anaemia was defined
according to World Health Organization criteria [Haemoglobin (Hb) < 13 g/dL in
men and < 12 g/dL in women]. ID was defined as ferritin < 100 𝜇g/L or ferritin
< 100 < 300 𝜇g/L than with transferrin saturation (TSAT) < 20%. As controls were
enrolled 56 healthy subjects and 61 subjects with diabetes mellitus. Iron deficiency
in healthy controls and diabetes controls was defined as ferritin below 30𝜇g/L.
Exercise capacity was assessed by spiroergometry (peak VO2) and 6 minute walk
test (6MWT).
Results: A total of 192 (32%) chronic HF patients had anaemia and 189 (32%) had
iron deficiency. Seven healthy controls and 14 diabetes subjects had anemia. None
of the controls showed ID. Patients with anaemia showed significant lower peak
VO2 and lower 6MWT compared to patients without anaemia (peak VO2 15.0 ± 4.8
vs.18.1 ± 4.6ml/kg*min, 6MWT 329.2 ± 137.3 vs. 399.3 ± 150.0m, both p < 0.0001)
and compared to healthy controls and diabetes subjects (all p < 0.0001). The same
were found in patients with ID (peak VO2 15.7 ± 5.4 vs. without ID 17.7 ± 4.5
ml/kg*min, p% = 0.007, 6MWT 325.5 ± 160.7 vs. 396.9 ± 141.7 m, p% = 0.0001) and
compared to healthy controls and diabetes subjects (all p < 0.01). Logistic regression analysis showed that age, cholesterol, BMI, high sensitivity c-reactive protein (hsCRP), presence of hospitalisation, peak VO2, 6 minute walk distance are
significantly associated with anaemia (all p < 0.05) and gender, hsCRP, presence
of co morbidities, peak VO2, 6 minute walk distance are associated with ID (all
p < 0.05). A total of 79 patients showed both ID and anaemia and exercise capacity was more decreased with both syndromes [peak VO2 13.3 ± 4.9 ml/kg*min,
6MWT 274.5 ± 146.4 m] than with anaemia alone [peak VO2 16.4 ± 4.4 ml/kg*min,
6MWT 365.6 ± 118.4 m] or with ID alone [peak VO2 17.8 ± 4.9ml/kg*min, 6MWT
368.8 ± 161.0 m]. We observed a significant reduction in peak VO2 parallel to
decreasing haemoglobin levels in patients with anaemia (r% = 0.30, p < 0.01) compare to patients without anaemia (r% = 0.05, p% = 0.53).
Conclusion: Both anaemia and ID are strongly associated with reduced exercise
capacity in patients with HF. The effect of anaemia and iron deficiency together is
stronger than that of anemia and ID alone.
EXERCISE TESTING AND TRAINING – POSTER DISPLAY
P1461
Biological variation, reference change value (RCV) and minimal important
difference (MID) of inspiratory muscle strength (PImax) in patients with stable
chronic heart failure
TTobias Taeger1 ; FH Wians2 ; M Schell1 ; R Cebola1 ; H Froehlich1 ; HA Katus1 ; L
Frankenstein1
1
University Hospital of Heidelberg, Department of Cardiology, Heidelberg,
Germany; 2 Baylor University Medical Center, Dallas, United States of America
Purpose: Despite the widespread application of measurements of respiratory muscle force (PImax) in clinical trials there is no data on biological variation, reference
change value (RCV), or the minimal important difference (MID) for PImax irrespective
of the target cohort.
Methods: From the hospital outpatients’ clinic, we retrospectively selected 3 groups
of patients with stable systolic chronic heart failure (CHF). Each group had two
measurements of PImax – 90 days apart in group A (n = 25), 180 days apart in group
B (n = 93), and 365 days apart in group C (n = 184), Stability was defined as a) no
change in NYHA Class between visits and b) absence of cardiac decompensation
3 months prior, during, and 3 months after measurements. For each group, we
determined within-subject (CVI), between-subject (CVG), and total (CVT) coefficient
of variation (CV), the index of individuality (II), RCV, reliability coefficient, and MID of
PImax.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
288
Abstracts
Results: CVT was 8.7%, 7.5%, and 6.9%, for groups A, B, and C, respectively.
The II and RCV were 0.21, 0.20, 0.16 and 13.6%, 11.6%, 10.8%, respectively. The
reliability coefficient and MID were 0.83, 0.87, 0.88 and 1.44kPa, 1.06kPa, 1.12kPa,
respectively. Results were similar between age, gender, and etiology subgroups.
Conclusions: In patients with stable CHF, measurements of PImax are highly stable
for intervals up to one year. The low values for II suggest that evaluation of change
in PImax should be performed on an individual (per patient) basis. Individually
significant change can be assumed beyond 14% (RCV) or 1.12 kPa (MID).
reserve (the change in HR from rest to peak exercise divided by the difference of
rest HR and age-predicted maximal HR). A decrease in HR from peak exercise to
1-minute of active recovery < 18 bpm was considered abnormal (aHRr). Pts with CI
and/or aHRr were compared with pts with normal parameters in their demographics,
medical history, therapeutics, reason for ET and ECG changes in ET. Kaplan-Meier
analysis regarding the primary end-point (all-cause mortality or hospitalization for
ACS) was performed to study the influence of CI and aHRr on outcomes.
Results: Pts mean age was 58.15 ± 11.52 years; 77.2% were male. Pts with CI
were older (p% = 0.045); pts with aHRr were also older (p < 0.001) and more frequently male (p% = 0.046). When both parameters (CI and aHRr) were used together
they were also more frequently found in older pts (p% = 0.002). After a median
follow-up of 1291 days the frequency of the primary endpoint was higher in pts with
aHRr (p% = 0.029) and in pts with both CI and aHRr (p% = 0.004). Pts with aHRr
had a 24-fold increased risk of all-cause mortality or hospitalization for ACS (HR:
24.16;95%CI:7.29-80.02). Pts with both CI and aHRr had a 35-fold increased risk of
all-cause mortality or hospitalization for ACS. Kaplan-Meier curves showed a significant increase in the incidence of the primary endpoint and significant difference
in the survival of pts with aHRr (Log Rank 0.016) and in pts with CI and aHRr (Log
Rank 0.009).
Conclusion: In our population, aHRr (isolated or combined with CI) was a predictor
of ACS and/or mortality. Its prognostic value seems stronger than that of CI and was
independent of previous history of cardiovascular disease. The risk of ACS and/or
mortality was most powerfully defined when both aHRr and CI were used together.
PROGNOSIS – POSTER PRESENTED
P1465
Gender differences and prognosis in chronic systolic heart failure patients
A Manerba; M Triggiani; L Lupi; E Rocco; C Villa; N Dasseni; S Suardi; A Pizzuto;
A R Mbadjeu Hondjeu; S Nodari
Department of Clinical and Surgical Specialities, Cardiology section, University and
Civili Hospital, Brescia, Italy
Blant-Altman plot for Pimax values
P1462
Functional Independence Measure is an independent predictor for prognosis
in Japanese heart failure patient in elderly
HHirosshi Saito1 ; Y Matsue2 ; Y Endo1 ; K Takanashi3 ; H Iizuka3 ; M Suzuki2 ;
A Matsumura2 ; Y Hashimoto2
1
Kameda Medical Center, Department of Rehabilitaion, Kamogawa, Japan
Introduction: The prevalence of heart failure (HF) increases with age, and life
expectancy of Japanese population is longer than westerners. The prognosis of
elderly HF patients is worse compared to younger population, and physical disability
might contribute to this worse prognosis. However, whether the severity of disability
predict prognosis of HF even in the elderly is not well elucidated.
Methods: A total of 338 HF patients over 75 years old who had been discharged
from our hospital were retrospectively included in our study. Functional Independence Measure (FIM) was measured in all patients before discharge. Endpoint was
readmission due to HF or death. Included patients cohort was divided by median
of FIM (97 points) into two groups, high FIM group (n = 163) and low-FIM group
(n = 175).
Results: Mean age of all cohort was 84.3 ± 5.5 years old and 38.1 % were male.
During follow-up for mean of 322 days, 169 patients (50.0%) were readmitted due
to HF or died. Kaplan-Meier curve analysis showed that prognosis of low-FIM group
was worse compared to high-FIM group (P% = 0.002). Both in univariate and multivariate Cox regression analysis, being low-FIM group was independent predictor for
worse prognosis in elderly HF patients (HR 1.62, 95% CI: 1.62-2.21, and HR: 1.55,
95% CI: 1.13-2.11, respectively)
Conclusion: The degree of disability predicts the prognosis in this high-risk population of elderly HF patients.
Purpose: Significant knowledge gaps exist in our understanding of sex-related differences for risk factors and outcome of Chronic Heart Failure (CHF) patients. The
aim of this study was to explore the differences in clinical characteristics and prognosis between women and men with CHF and left ventricular (LV) systolic dysfunction.
Methods. We performed a retrospective analysis of patients with LV Ejection Fraction
(LVEF) < 45%, in stable clinical condition (neither events nor therapeutic changes in
the previous 3 months), followed in our ‘HF outpatient clinic’. Demographic, clinical,
echocardiographic and laboratory parameters were compared between men and
women using 2-sided Student t test for continuous variables and 𝜒2 test for categorical variables. At two years follow-up, we considered as primary end points the
occurrence of hospitalization for HF (HHF) and the composite of HHF and cardiovascular (CV) death. Results. Among 535 CHF pts (mean age 68.20 ± 12.22 years),
88 (16.45%) were women. Compared with men, women were older (70.45 ± 12.96
vs 67.79 ± 1.03; p% = 0.05), were less likely to have ischemic etiology (49% vs 59%;
p% = 0.05) and chronic obstructive pulmonary disease (9% vs 19%; p% = 0.02)
and had a higher LVEF mean value (35.13 ± 7.68 vs 34.40 ± 7.72; p < 0.0001). There
was no significant difference regarding the use of evidence-based medications. On
Univariate analysis no sex related differences were seen both for the composite endpoint HHF+CV mortality (32.9% for women vs 30.42% for men), and for the rate of
HHF (18.1% for women vs 18.3% for men). During two years follow-up, a slightly
higher number of HHF was seen in men (1 ± 0.59 for women vs 1.84 ± 1.32 for men;
p% = 0.01). Conclusion. In stable CHF outpatients we found gender related differences for the powerful HF prognostic predictors, but long-term outcome seems to
be similar between men and women.
P1466
Clinical characteristics and therapy predictors of an adverse long term
outcome in the ongoing APRET Heart Failure Study
P1463
Chronotropic incompetence and heart rate recovery: predictors of mortality
among patients referred for treadmill exercise test
AAlexandra Castro; R Santos; A Pereira; H Guedes; N Moreno; MC Queiros; P
Pinto
Hospital Centre do Tamega e Sousa, Penafiel, Portugal
P Arsenos1 ; KA Gatzoulis1 ; P Dilaveris1 ; D Tsiachris1 ; C Chrysohoou1 ; S Vaina1 ;
S Sideris1 ; D Mytas2 ; IE Kallikazaros1 ; C Stefanadis1
1
First Department of Cardiology, Medical School, National & Kapodistrian
University of Athens, Athens, Greece; 2 Department of Cardiology, Sismanogleion
Hospital, Marousi, Greece
Introduction: Exercise testing (ET) is commonly used in Cardiology for both diagnostic and prognostic purposes. Aside from the diagnostic criteria, analysis of
heart rate (HR) changes during and after exercise improves ET prognostic value.
Chronotropic incompetence (CI) and heart rate recovery (HRr) are associated with
adverse cardiovascular events; however, their importance is underappreciated.
Objectives: To estimate the ability of both CI and HRr to predict the risk of acute
coronary syndromes (ACS) and/or mortality in patients (pts) undergoing treadmill ET.
Methods: Retrospective study of 215 consecutive pts undergoing treadmill ET. CI
was defined as failure to attain ≥ 80% (>62% in pts taking 𝛽-blockers) of the HR
Purpose: Heart Failure (HF) presents with increased rates of total mortality (TM).
Methods: A sample of 376 HF patients (LVEF:32 ± 10%, CAD:80%, DCMP:20%)
prospectively followed up.After 38.8 months 114 out of 376 patients (30%)died.Data
analyzed for TM.
Results: After Cox regression analysis adjusted for age, diabetes, LVEF, NYHA
class, urea, 𝛽-blockers and diuretics the NYHA class presented HR:2.294 for
TM (95%CI:1.478-3.561), p < 0.001, diabetes presented HR:1.562(95% CI:1.0302.368), p% = 0.036 and b-blockers therapy HR:0.658 (95% CI:0.428-1.011),
p% = 0.056.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
289
Conclusions: The deceased HF patients were older, had biabetes, were treaded
during their ACS with lower rates of PTCA and thrombolysis, had more often atrial
fibrillation and suffered from severe systolic dysfunction and had serious affected
NYHA whereas had lower Hematocrit and Sodium with higher Urea and Creatinine.Their received significantly less often b-Blockers, ARBs and Clopidogrel and
more often Coumarine, Nitrates, Diuretics and Digoxin
All (n = 376)
Dead (n = 114)
Alive (n = 262)
p value
Age (years)
66±13
71±10
64±13
< 0.001
Diabetes (%)
36
48
31
0.002
PTCA (%)
25
17
29
0.013
Thombolysis (%)
4.2
0.9
5.6
0.046
Atrial Fibrillation (%)
18
25
14
0.011
LVEF (%)
32±10
28±9.7
33±9.9
< 0.001
NYHA (class)
2.3±0.5
2.6±0.4
2.2±0.4
< 0.001
Ht (%)
40±0.5
38±0.5
41±0.4
< 0.001
Urea (mg/dl)
56±36
68±43
51±32
< 0.001
Creatinine (mg/dl)
1.3±0.6
1.4±0.6
1.2±0.7
0.026
Sodium (mEq/L)
138±4
137±4
138±3
0.038
b-blockers (%)
66
55
70
0.005
ARBs (%)
20
13
23
0.028
Clopidogrel (%)
27
18
32
0.007
Coumarine (%)
21
30
17
0.012
Diuretics (%)
63
80
56
< 0.001
Spironolactone (%)
18
32
11
< 0.001
Digoxin (%)
12
25
7
< 0.001
P1467
The role of diastolic dysfunction for prognosis of sudden cardiac death in
patients with sudden cardiac death in patients with myocardial infarction
I Leonova; E Bykova; S Boldueva
North-Western Sate Medical University named I.I. Mechnikov, St-Petersburg,
Russian Federation
Thepurpose of the study was studying of prognostic roles of diastolic dysfunction
(DD) of left ventricular (LV) concerning sudden cardiac death (SCD) at the patients
with myocardial infarction (MI).
The used method were ECHO CG, signal-averaging ECG, heart rate variability
measurement (HRV), arterial baroreflex sensitivity (ABS) and investigation of leucocytes, IL 1𝛽, 6, TNF-𝛼, CD 95 of lymphocytes. The SCD rate at restrictive type of
DD was (𝜌% = 0,002) higher (16,7%) compared with nonrestrictive DD (5,0%) and
at patients without DD (7,5%). We analyzed interrelation of DD with such known
predictor of SCD, as ventricular arrhythmias (VA), late ventricular potentials (LVP),
decreasing of HRV and arterial baroreflex sensitivity. So, VA at patients with the
DD restrictive type met (𝜌% = 0,004) more often (in 63%), than at patients with not
restrictive DD (35,4%) and without DD (29,1%). Distinctions in frequency of LVP
registration depending on DD type was not established (without DD — LVP were
registered in 23,2% pts.; at not restrictive DD - 25,6% pts; at restrictive DD —
28,8% pts.; 𝜌% = 0, 8). At DD the general variability of a sinus rhythm was authentically less (SD, TP). At the same time violations of vegetative balance at these
patients was more expressed, and, mainly at the expense of more considerable
decreasing in parasympathetic activity (NN50, PNN50). An ABS on 1-st day of MI
was decreased; correlations between BS and DD (r% = -0,4, 𝜌 < 0,05), BS and left
atrium size (r% = -0,4, 𝜌 < 0,05). By 10-14 days authentic correlation between these
parameters was not revealed. At DD only authentic increasing level of CD95 of
lymphocytes, (0,44 ± 0,3*109/l against 0,34 ± 0,2*109/l, 𝜌% = 0,01) was noted. Possibly, the obtained data can indirectly testify that at DD, apoptosis processes in a
myocardium are more expressed whereas inflammatory changes have smaller value.
By results of one-factorial regression analysis of the Cox it has been received that
among the ECHO EG of the indicators influencing risk of SCD, at the surveyed
patients along with several parameters DD has so appeared. According to data
of Cox multifactorial regression analysis LVDD was not an independent prognostic factor. But it increased SCD risk at the account of interrelationship with such
predictors as VA, lowering of HRV, and sensitivity of cardiochronotropic component
of ABS.
Conclusion: low EF of LV has appeared independent predictor of SCD. At the same
time, it is impossible to underestimation negative prognostic influence of DD and
not to consider it at stratification of risk of SCD at the patients with MI.
P1468
Prognostic value of heart failure survival score and seattle heart failure model
in chronic heart failure with reduced and preserved ejection fraction
IYUIlya Giverts; MG Poltavskaya; AV Brand; DA Andreev; AA Doletsky; ON Dikur;
VP Sedov; PSH Chomakhidze; EE Yakubovskaya; AL Syrkin
I.M. Sechenov First Moscow Medical Academy, Clinic of Cardiology, Moscow,
Russian Federation
Objectives: to compare prognostic value of Heart Failure Survival Score (HFSS) and
Seattle Heart Failure Model (SHFM) in chronic heart failure with reduced and preserved ejection fraction (HFrEF and HFpEF).
Methods: 111 patients (83 men, 28 women, mean age 60,6 ± 12,8 years) with
chronic HF NYHA class I-III of various etiologies and mean left ventricular (LV)
EF% = 37,7 ± 13,6% were enrolled in the study. Among them 34 patients (30,6%)
had preserved LVEF. All patients received optimal medical treatment. Maximal
fucntional capacity was assessed by cardiopulmonary exercise testing with estimation of peak oxygen consumption (VO2 peak). Life expectancy was evaluated using HFSS and SHFM depending on EF. HFSS includes LVEF, mean blood
pressure (BP), VO2 peak, serum sodium, presence or absence of coronary heart
disease (CHD), presence or absence of QRS ≥ 120ms and resting heart rate.
SHFM score is estimated from 20 variables including clinical parameters (age,
gender, NYHA class, weight, LVEF, systolic BP, ischemic etiology), medications
(angiotensin-converting enzyme inhibitor, angitotensin-receptor blocker, 𝛽-blocker,
statin, aldosterone blocker, loop diuretic equivalent dose, allopurinol), device therapy (implantable cardioverter-defibrillator, cardiac resynchronization therapy) and
laboratory data (hemoglobin, lymphocyte percentage, uric acid, total cholesterol and
serum sodium). Average period of observation amounted 25,1 ± 9,7 months. Cardiovascular mortality (CVM) was considered the primary end-point.
Results: CVM due to sudden cardiac death (n = 7) and progression of HF (n = 13)
amounted 18,0%. In patients with HFrEF Cox regression analysis showed significant relationship between both HFSS (hazard ratio (hr)% = 0,198; 95% confidence
interval (CI) 0,085-0,464, p < 0,001) and SHFM (hr% = 0,656;95% CI 0,525-0,821,
p < 0,001) and lethal outcome. In patients with HFpEF only HFSS was authentically related to CVM (hr% = 0,089;95% CI 0,011-0,740; p% = 0,025). ROC-curve
analysis showed similar results. In patients with HFrEF values of area under
curve (AUC) for HFSS (AUC% = 0,810;95% CI 0,701-0,718, p < 0,001) and SHFM
(AUC% = 0,855;95% CI 0,801-9,969, p < 0,001) confirmed high prognostic significance of both models. In patients with HFpEF only HFSS (AUC% = 0,889;95% CI
0,691-1,000, p% = 0,013) had predictive value for CVM.
Conclusions: In patients with HFrEF both HFSS and SHFM demonstrate prognostic
value for CVM. In patients with HFpEF only HFSS was essentially related to CVM.
SHFM showed no predictive value for lethal outcome in HFpEF. Further investigations on larger cohort of patients with HFpEF are necessary to confirm this data.
P1469
Ventricular-arterial coupling has independent prognostic value in patients
with arterial hypertension and heart failure with reduced ejection fraction
R Akhmetov; S Villevalde; V Moiseev
Peoples Friendship University of Russia (PFUR), Moscow, Russian Federation
Thepurpose of the study was to determine the prognostic value of ventricular-arterial
coupling (VAC) in patients with arterial hypertension and stable heart failure with
reduced ejection fraction (HFrEF).
Methods: In prospective study (follow-up 12-24 months, median 18 months) prognosis of 93 stable patients (75% male, age 64 ± 9 years (M ± SD), history of myocardial infarction 67%, diabetes mellitus 32%, heart rate 75 ± 13/min) with controlled
hypertension (blood pressure (BP) < 160/100 mmHg, 131 ± 14/80 ± 10 mmHg),
symptoms and signs of HF, left ventricular (LV) EF < 40% (34 ± 5%) and N-terminal
pro brain natriuretic peptide >100 pg/ml (650 ± 679 pg/ml), II/III NYHA class 25/75%
was evaluated. Adverse outcomes included all cause death or first HF hospitalization. 2-dimentional echocardiography was used to assess arterial elastance (Ea)
and end-systolic LV elastance (Ees). VAC was assessed as the ratio Ea/Ees. Arterial stiffness was assessed using applanation tonometry. Clinical and demographic
parameters, parameters of LV function, VAC and arterial stiffness were included in
multivariate analysis. P < 0.05 was considered significant.
Results: Adverse outcomes were revealed in 39% of patients (15% deaths, 24%
HF hospitalizations). The following factors increased the risk of adverse outcomes:
LVEF < 25% (odds ratio (OR) 26.1, 95% confidential interval (CI) 24.9-27.3), index
of VAC ≥ 3.3 (OR 23.3, 95% CI 22.1-24.5), stroke work (SW)/pressure volume area
(PVA) (LV work efficiency) < 38% (OR 8.2, 95% CI 7.0-9.4), augmentation index (AI)
≥ 25% (OR 2.3, 95% CI 1.3-3.2), time to reflected wave (Tr) < 135 ms (OR 2.1, 95%
CI 1.2-3.0). Pulse wave velocity ≥ 15 m/s (OR 5.4, 95% CI 3.7-7.1), office systolic
BP < 120 mmHg (OR 5.1, 95% CI 4.2-6.0) were associated with increased risk of HF
hospitalizations. AI ≥ 35% (OR 7.3, 95% CI 5.9-8.6), office systolic BP < 120 mmHg
(OR 3.4, 95% CI 1.3-5.5) and diastolic BP < 70 mmHg (OR 3.4, 95% CI 1.3-5.5), Tr
< 116 ms (OR 2.3, 95% CI 1.1-3.5), SW/PVA < 48% (OR 2.3, 95% CI 1.1-3.5) were
associated with increased risk of all-cause death.
Conclusions: Parameters of VAC, LV work efficiency and arterial stiffness have
independent prognostic value as well as LVEF and BP in patients with arterial
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
290
Abstracts
hypertension and HFrEF. Assessment of VAC via Ea/Ees, an additional noninvasively
derived metric, can be used for risk stratification of patients with HFrEF.
P1470
Forecasts in patients with HF according to leading guidelines constructed on
randomized controlled trials
C Lewinter1 ; E Fosboel1 ; M Thomsen2 ; JGF Cleland3 ; L Kober1
Rigshospitalet - Copenhagen University Hospital, Heart Centre, Copenhagen,
Denmark; 2 University of Copenhagen, Copenhagen, Denmark; 3 University of Hull,
Department of Academic Cardiology, Hull, United Kingdom
1
Purpose: Quantitative forecasts of prognosis in heart failure (HF) patients are rarely
done taking into account the composite of multicentre randomised controlled
trials (RCTs). Intuitive clinical assessments add great volatility for both accuracy
and precision of the prognosis in patients. Therefore, we decided to undertake
meta-analyses of multicenter RCTs including HF treatments according to the leading guidelines adjusted and calculated through accumulated NYHA classes.
Methods: Guidelines involving HF treatment from the European Society of Cardiology, American Heart Association, and American College of Cardiology were
investigated for pharmacological- and device therapy. Multicenter RCTs supporting the evidence of ACE-I-, beta-blocker-, aldosterone-antagonist-, ivabradine-,
digoxin-, ICD- and CRT-treatments were included in the meta-analyses. The primary
outcome was all-cause death.
Results: A total of 25 studies were gathered for the analysis. The mean age of the
participants was 64 years and 32% were women. The proportion of studies with
majority of patients in NYHA I, II, and III to IV classes were 3, 13, and 9, respectively.
The relative risk reduction (RRR) of patients in NYHA I, II, and III to IV class were
16% (hazard ratio (HR), 0.84; 95 % confidence interval [CI], 0.76 to 0.92); 17%
(HR, 0.87; 95 % CI, 0.76 to 0.90); and 22% (HR, 0.78; 95 % CI, 0.73 to 0.84),
respectively.
Conclusion: Our findings suggest a better composite treatment outcome in higher
NYHA classes. Addition of recommended treatments according to leading guidelines seems to be beneficial.
rhythm was maintained at 85,5% vs 61,5%, P≤0,001; left ventricular (LV) hypertrophy was present in 67,4% vs 47,4%, P≤0,001, but complete left bundle block was in
4,9% vs 25,6%, P≤0,001, permanent atrial fibrillation –10,7% vs 38,5%, P≤0,001,
pulmonary congestion – 30,4% vs 93,2%, P≤0,001, pulmonary thromboembolism
- 0,7% vs 10,3%, P≤0,01. An Increasing number of noncardiac comorbidities was
associated with a higher risk for all-cause admissions (P≤0,01). Among died the rate
of those with EF ≤35% was 51,4% and EF ≥ 50% - 18,9%, P≤0,001. In the survivors
group respectively 16,7% and 49,8%, P≤0,001.
Conclusion: Studied comorbidities had a greater risk for all-cause hospitalizations
and similar comparative impact on mortality in patients with HFpEF and HFrEF.
P1472
Left ventricular hypertrophy as predicting factor for sudden cardiac death in
patients with myocardial infarction
I A Leonova; E Bykova; S Boldueva
North-Western Sate Medical University named I.I. Mechnikov, St-Petersburg,
Russian Federation
Thepurpose was studying of a role of left ventricular hypertrophy (LVH) in sudden
cardiac death (SCD) at the patients with myocardial infarction (MI).
It was 300 pts. with M who was divided on two groups: 1 – pts. with increasing of
ventricular mass index (LVMI) (134 g/m2 at men and 110 g/m2 at women) 208 pats., 2
– pts. with normal LVMI 92 pts. In group 1 the level of leukocytes (7,6 ± 3,4% against
5,3 ± 3,6%, p% = 0,01), eosinophyls (2,49 ± 1,8% against 2,06 ± 1,8%, p% = 0,01)
and monocytes (0,47 ± 0,3 against 0,3 ± 0,1%, p% = 0,01), and also level of expression of CD95 on lymphocytes (0,98 ± 0,3% against 0,32 ± 0,1%, 𝜌% = 0,05) was
authentic above. Distinctions on fibrinogen, IL-1, IL-6 and TNF-𝛼 between groups
weren’t found. Late ventricular potentials (LVP) met at 1 group pts. more often:
37% against 21,7%, p < 0,001. Pts. with LVH had more severe VA: 38% against
18,5% at pts. without LVH (p% = 0,011). More expressed decrease of ejection fraction (EF) (49,9 ± 1,0% against 43,0 ± 10,1%, p% = 0,05) and LV systolic (end systolic
volume (ESV) 59,1 ± 27,5ml against 51,4 ± 23,6 ml p% = 0,04) and diastolic (end
diastolic volume (EDV) 131,9 ± 39,9 against 124,4 ± 42,0 ml, p% = 0,03) dilatation
were found in group with LVH compared without LVH. Diastolic dysfunction (DD)
also was revealed more frequently (83,6% against 42,4%, p% = 0,001). In group 1
decreasing of following HRV parameters was observed: SD, dRR, pNN50, the total
power of spectrum. The increasing of Amo, LF/HF in this group was found. Decrease
of vagal activity in group LVH is especially distinct came to light at test with deep
breath: SD - 29,6 ± 15,9 against 46,9 ± 23,9 (p < 0,01) and dX - 171,2 ± 91,1 against
249,2 ± 109,1 (p < 0,001). The correlation analysis has confirmed (p < 0,05) interrelations between LVH and LVP, VA and indicators of HRV: tot QRS - 0,5; RMS 40-0,4;
LAS 40-0,4; SD-0,3; R-R-0,3; %HF-0,3; LF/HF 0,3. The analysis of death has shown
that in 1 group during the 1 year after MI 32 pts. have died, from them SCD - 26
(12,5%), not suddenly - 6 pts. (2,9%). In 2 group the death was observed at 5 pts:
SCD 4 (4,3%) and not SCD at 1 (1,1 %). The Cox analysis for SCD, at one-factorial
model from 194 variables allocated LVH as a significant sign for SCD: relative risk 2,2; 95 % confidential intervals: 1,09 - 8,3; beta - 1,6; p% = 0,02.
Conclusion: it was revealed that LVH in MI makes the contribution as in formation
of an arrhythmogenic substratum (LVP), and promotes realization of trigger mechanisms (HRV, VA) of fatal VA. The inflammatory process plays an important role in
remodeling of a myocardium.
P1473
Prognostic impact of small airways obstruction in systolic heart failure
S Brenner1 ; G Guder1 ; D Berliner2 ; N Deubner1 ; C Maile1 ; G Ertl1 ; C Angermann1 ;
S Stork1
1
University of Würzburg, Department of Internal Medicine I / Comprehensive Heart
Failure Center , Würzburg, Germany; 2 Hannover Medical School, Department of
Cardiology and Angiology, Hannover, Germany
All NYHA classes
P1471
The effect of coexistence of multiple noncardiac diseases on the one year
prognosis of hospitalized patients with post infarction chronic heart failure.
EBEleonora Vataman1 ; DM Lisii1 ; SS Filimon1 ; AA Grivenco1 ; VM Vataman2
1
Institute of Cardiology, Chisinau, Moldova, Republic of; 2 State University of
Medicine and Pharmacy, Chisinau, Moldova, Republic of
Thepurpose of this study was to examine the comorbidity in a prospective observational study of adults hospitalized for heart failure (HF) and to determine prognostic significance of comorbidities between patients with preserved ejection fraction (HFpEF) compared with those with HF with reduced ejection fraction (HFrEF).
Comorbidity was defined as any other chronic condition in the presence of HF.
Methods. In a cohort of 2364 hospitalized HF patients we examined the comorbidity burden of 12 noncardiac diseases. 385 from the patients with HF after a
Q-wave old myocardial infarction were observed during 12 months for comparative study using the Charlson comorbidity instrument (CCI). Patients with HFpEF had
higher prevalence of hypertension at hospitalization comparative with HFrEF (81,6%
vs 53,8%, P≤0,001), impaired thyroid (9,2% vs 2,8%, P≤0,05), diabetes (27,7%
vs 19,3%), were smokers (27,7% vs 16,7%, P≤0,05), but had a lower prevalence
of chronic obstructive pulmonary disease, anemia, chronic kidney disease. Sinus
Purpose: In systolic heart failure (SHF), central airways obstruction (CAO) has
extensively been investigated and is associated with increased mortality risk. By
contrast, small airways obstruction (SAO) as a co-morbid condition has hardly been
studied. We compared prevalence and prognostic impact of CAO and SAO in SHF.
Methods: Stable outpatients were evaluated 6 months after hospitalization for
congestive SHF (LVEF ≤40%) including a physical exam, echocardiography, and
spirometry. CAO was diagnosed if the Tiffeneau index (FEV1/FVC) was < 0.7. SAO
was defined as ≥ 60% reduction of the expected value of maximum expiratory flow
after 50% of expired FVC in the absence of CAO.
Results: We studied 589 patients: mean age 65 ± 12 years; 75% male. In the total
cohort, airways obstruction was excluded by spirometry in 61% (n = 359). CAO was
diagnosed in 16% (n = 92) and SAO in 23% (n = 138). During a median follow-up
time of 44 months, 163 patients died (28%). Both, CAO and SAO predicted an
increased all-cause mortality risk (hazard ratio with 95% confidence intervals: 1.93
[1.36-2.75] and 2.11 [1.42-3.14]; both p < 0.001). Adjustment for age, sex and NYHA
functional class only mildly attenuated this assocation (Figure, Cox plot)
Conclusion: In stable SHF, SAO is a frequent finding and has a similar adverse
impact on mortality as CAO. CAO may indicate a predominantly pulmonary
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
affection, whereas SAO may be indicate more advanced heart disease. Regular
screening for both CAO and SAO may help to identify and better treat these high
risk patients.
291
widening of the QRS-T angle during follow-up was independently associated with
an increase in mortality (Figure).
Conclusion: QRS-T angle is relatively stable in patient with HF and is a powerful
predictor of outcome. Widening of the QRS-T angle is an ominous sign.
Figure: QRS-T angle change and outcome
Airways obstruction and mortality in SHF
PULMONARY HYPERTENSION – POSTER PRESENTED
P1474
Echocardiographic assessment of jugular vein distensibility in patients with
heart failure and its prognostic significance.
PPierpaolo Pellicori; A Bennett; J Zhang; P Putzu; R Dierckx; S Parsons; B
Dicken; A Shoaib; AL Clark; JGF Cleland
University of Hull, Department of Academic Cardiology, Hull, United Kingdom
Aims: Jugular venous distension reflects increased right atrial pressure and is a classical sign of heart failure (HF). However, its clinical assessment may be difficult.
Methods: Ambulatory patients with HF and control subjects enrolled in the SICA-HF
study were assessed. Internal jugular vein diameter (JVD) was measured using a linear high-frequency ultrasound probe (10 MHz) at rest, during a Valsalva manoeuvre
and during deep inspiration. JVD ratio was calculated as the diameter during Valsalva to that at rest.
Results: 311 patients (mean age 71 years; mean left ventricular ejection fraction
42%, median (inter-quartile [IQR] range) NT-proBNP 979 (441-2007) ng/l) and 66
controls were included. JVD (median and IQR range) at rest was smaller in controls (0.16 (0.14-0.20) cm) than in patients with HF (0.23 (0.17-0.33) cm; p < 0.001)
but similar during Valsalva (1.03 (0.90-1.16) cm vs 1.08 (0.90-1.25) cm; p% = 0.28).
Consequently, JVD ratio was greater in controls (6.3 (4.9-7.6)) than in patients (4.5
(2.9-6.1); p < 0.001).
During a median FU of 516 (IQR: 335-622) days, 48 patients with HF died or were
hospitalized for heart failure. Different multivariable models were tested. Amongst
clinical, echocardiographic or biochemical variables, only NTproBNP and ultrasound
assessment of internal jugular vein (either at rest, JVD ratio or deep inspiration, but
not JVD during Valsalva) provided independent prognostic information. Compared
to those in lowest tercile, HF patients in the highest tercile of JVD ratio had 10-fold
greater risk of an adverse event (HR: 10.05, 95% CI: 3.07-32.93).
Conclusions: Echocardiographic assessment of internal jugular vein identifies
ambulatory patients with heart failure who have a high risk of an adverse outcome.
Greater JVD diameter at rest or during deep inspiration or smaller JVD ratio provide
similar prognostic information.
P1475
Temporal changes in electrocardiographic frontal QRS-T angle and survival in
patients with heart failure
IIsrael Gotsman; A Shauer; DR Zwas; C Lotan; A Keren
Hadassah University Hospital, Jerusalem, Israel
Background: Heart failure (HF) is associated with considerable mortality. The
electrocardiographic frontal QRS-T angle is a simple parameter to measure, reflects
changes in the direction of the repolarization sequence and predicts outcome in
patients with HF. Data regarding temporal changes in the frontal QRS-T angle in
patients with HF and its impact on outcome is limited.
Aim: To evaluate temporal changes in the frontal QRS-T angle and its effect on
survival in patients with HF.
Methods: Baseline and follow-up QRS-T angle were calculated from the frontal
QRS and T axis of the 12-lead surface electrocardiogram. Patients were followed
for death.
Results: 2,929 HF patients were evaluated. Median interval between baseline ECG
and follow-up ECG was 895 days, median follow-up time was 1526 days. Overall,
the QRS-T angle tended to be stable, with minor changes in the angle. The median
QRS-T angle change was +3∘ (IQR -19∘ to +30∘ ). Overall survival during follow-up
was 60%. Cox regression analysis after adjustment for significant predictors including age, gender, IHD, hypertension, atrial fibrillation, body mass index, pulse, serum
hemoglobin, sodium, eGFR and urea levels demonstrated that the baseline as well
as the follow-up QRS-T angle were incremental predictors of increased mortality. A
P1477
Late presentation of pulmonary arterial hypertension and right heart failure in
neurofibromatosis type 1 treated with treprostinil
FForum Kamdar; K Picel; E Missov; T Thenappan
University of Minnesota, Cardiology, Minneapolis, United States of America
Introduction: Neurofibromatosis type 1 (NF1) is a rare autosomal dominant disease with an incidence of 1 in 3500 individuals. NF1 typically presents with cutaneous neurofibromas, axillary freckling, and vascular involvement. Pulmonary arterial hypertension (PAH) has rarely been described in this patient population.
Case: A 69 year-old woman with NF1 initially presented with dyspnea on exertion
and presyncope. She underwent coronary angiography and percutaneous revascularization of the mid LAD and D1 with minimal improvement in her symptoms, which
were subsequently attributed to hypersensitivity pneumonitis. Pulmonary function
testing demonstrated a severe decrease in DLCO without evidence of restriction or
obstruction. Two years later, she presented with dyspnea at rest and frank syncope.
She underwent a nuclear stress test without evidence of ischemia. Echocardiography demonstrated marked right ventricular enlargement, severe tricuspid regurgitation, and pulmonary hypertension. Right heart catheterization demonstrated right
atrial pressure of 10 mmHg, pulmonary artery pressure of 63/28 mmHg, mean
39 mmHg, pulmonary capillary wedge pressure of 3 mmHg, cardiac index of 1.5
L/min/m2 , and pulmonary vascular resistance of 23 Wood units,, consistent with
severe pulmonary hypertension. Additional investigations excluded other associated
causes of PAH including connective tissue disease, congenital heart disease, HIV,
portal hypertension, and chronic thromboembolic disease. Therapy with intravenous
treprostinil and digoxin was initiated with significant improvement of her symptoms.
She is the first in her family to have manifested PAH; her daughters with neurofibromatosis have not been diagnosed with pulmonary hypertension.
Summary: PAH with right heart failure in a patient with NF1 is a rare, severe, and
late onset manifestation. Screening echocardiography and early referral to a specialized heart failure or pulmonary hypertension center may be warranted in this patient
population to facilitate early diagnosis and treatment. The mutation of the tumor
suppressor gene NF1 may lead to pulmonary arterial endothelial cell proliferation
and formation of plexiform lesions. Further understanding of the molecular pathways underpinning PAH in NF1 may provide insights into pathogenesis of idiopathic
PAH.
P1478
Role of Transthoracic Echocardiography in the management of CTEPH
WWalter Serra1 ; TU Ugolotti1 ; AC Chetta2 ; EM Marangio2 ; AD Ardissino1 ; TG
Gherli3
1
Cardiology Division AOU Parma, Parma, Italy; 2 Hospital of Parma, Clinical
Pneumology Institute, Parma, Italy; 3 Hospital of Parma, Cardiac Surgery Institute,
Parma, Italy
Background: Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a
life-threatening condition attributed to incomplete resolution of pulmonary emboli
and abnormal vascular remodelling, leading to increased pulmonary vascular
resistance.
It is estimated that 2-3.8 % of patients suffering an acute Pulmonary Embolism (PE)
will develop (CTEPH). CT pulmonary angiography (CTA) has a diagnostic value in the
initial phase, and a prognostic value to develop CTEPH in the short and long term
risk statification. In most cases Transthoracic Echocardiogram (TTE) is the first step
toward the diagnosis.
Methods: We prospectively evaluated 20 consecutive patients (mean age 63 years)
admitted with an acute episode of PE. Patients underwent a 24 months follow-up
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
292
Abstracts
with periodical clinical evaluations, Transthoracic Echocardiogram and CT pulmonary angiography were performed every 6 months. We evaluated possibile correlations between CT pulmonary angiography and Echocardiographic parameters:
pulmonary artery systolic pressure (PAPs), tricuspid annular plane sistolic excursion (TAPSE), acceleration time of pulmonary outflow (acTpo), right atrial area (RAS),
pericardial effusion (PE), NYHA functional classification and continuation of oral antiocoagulant therapy.
Result: At diagnosis 12 patients (60%) had pathological Echocardiographic estimated pulmonary artery systolic pressure (PAPs) values (> 36mmHg, 3m/sec);
after 24 months only 5 (20%) had still Echocardiographic findigs suggestive for
CTEPH. Patients on oral anticoagulant therapy after 24 months were 12 (60%). No
patient died for complication related to PE in the 24 months follow-up period. We
found a significant correlation between CTA ostruction score (Qanadli) at diagnosis
and a reduced TAPSE: ROC curve analisys: AUC% = 0.804, p% = 0.035; Pearson’s
chi-squared% = 3.810, p% = 0.050. Prosecution of oral anticoagulant therapy for
24 months after an acute PE is significantly associated with an improvement in the
NYHA class (Pearson’s chi-squared% = 4.432, p% = 0.035).
Conclusion: Patients with severe PE have an high risk (odd ratio of 9) to
develop right ventricular disfunction. Prolonged oral anticoagulant therapy (beyond
6 months) after an acute PE is associated with an improvement in the NYHA functional class.
P1479
Right ventricular size and systolic function predict exercise capacity in
pulmonary arterial hypertension. A cardiac magnetic resonance study
S ASophia Anastasia Mouratoglou1 ; G Giannakoulas1 ; A Kallifatidis2 ; J Grapsa3 ;
G Pitsiou4 ; I Stanopoulos4 ; S Hadjimiltiades1 ; H Karvounis1
1
Aristotle University of Thessaloniki, AHEPA University Hospital, 1st Department of
Cardiology, Thessaloniki, Greece; 2 Agios Loukas Hospital, Department of
Radiology , Thessaloniki, Greece; 3 Imperial College Healthcare NHS Trust,
Department of Cardiovascular Sciences, Hammersmith Hospital, London, United
Kingdom; 4 Aristotle University of Thessaloniki, Respiratory Failure Unit, “G.
Papanikolaou” Hospital, Thessaloniki, Greece
Purpose: Right ventricular (RV) dilatation is a compensatory mechanism to pressure and volume overload occurring in patients with pulmonary arterial hypertension
(PAH). The aim of our study was to investigate the relationship of RV size and function as assessed with the use of cardiac magnetic resonance (CMR) with exercise
capacity measured by 6-minute walking test (6MWT) distance in adult patients with
PAH.
Methods: All patients underwent 6MWT and CMR study on the same day. RV
end-systolic (RVESarea) and RV end-diastolic area (RVEDarea) were defined in the
short-axis view at the level of papillary muscles. RV diameter was measured in the
4-chamber view at the level of RV inlet at end-diastole (RVEDd) and end-systole
(RVESd). Right ventricular ejection fraction (RVEF) and RV end-systolic (RVESV) and
end-diastolic volume (RVEDV) were obtained according to Simpson’s rule.
Results: Our study included 29 patients with PAH [22 women, mean age 49.7 ± 14.3
years, mean body mass index (BMI) 24.8 ± 5.1Kg/m2 ], who walked 468.8 ± 102.0 m
in 6MWT. After controlling for confounding parameters as age, sex and BMI, a direct
linear correlation between distance walked in 6MWT and RVEF, RVEDV, RVESV,
RVESarea, RVEDarea, RVEDd, RVESd was observed. Multivariate regression analysis showed that only RVEF, RVEDarea and RVEDd are independent predictors of
6MWT distance in the studied population.
Conclusions: The degree of RV dilatation and systolic function may be used as
predictors of functional capacity of patients with PAH.
mean ± SD
N
29
Age (years)
49.7±14.3
Multivariate
regression
r
p
B
p
2.759
< 0.05
< 0.05
6MWT distance (m) 468.8±102.0
RVEF (%)
48.7±12.2
0.535
< 0.05
RVESV (ml)
105.2±64.4
-0.618
< 0.005
RVEDV (ml)
192.1±81.0
-0.568
< 0.05
RVESarea (cm2 )
24.7±9.3
-0.693
< 0.001
RVEDarea (cm2 )
33.5±10.2
-0.597
< 0.005 2.796
RVESd (cm)
3.8±1.1
-0.56
< 0.005
RVEDd (cm)
4.3±0.8
-0.495
< 0.05
1.659
Pulmonary hypertension in patients with left heart disease: comparison
between transpulmonary pressure gradient and diastolic pulmonary vascular
pressure gradient
T Ibe1 ; H Wada1 ; K Sakakura1 ; Y Yamada1 ; T Nakamura1 ; N Ikeda1 ; Y Sugawara1 ;
T Mitsuhashi1 ; J Ako2 ; S Momomura1
1
Saitama Medical Center, Jichi Medical University, Division of Cardiology, Saitama,
Japan; 2 Kitasato University, Division of Cardiovascular Medicine, Sagamihara,
Japan
Purpose: A recent report suggested that diastolic pulmonary vascular pressure
gradient (DPG) is more sensitive and specific indicator of out-of-proportion (OoP)
pulmonary hypertension (PH) than transpulmonary pressure gradient (TPPG). The
aim of this study was to investigate the incidence and clinical features of OoP PH
determined by DPG, compared with TPPG, in left heart disease (LHD).
Methods: We analyzed 410 patients admitted for symptomatic heart failure and
underwent right-side catheterization at compensated stage before discharge
between 2007 and 2012. The definition of DPG and TPPG are the difference
between diastolic pulmonary artery pressure and pulmonary artery wedge pressure
(PAWP), and the difference between mean pulmonary artery pressure and PAWP,
respectively. DPG ≥ 7mmHg or TPPG>12mmHg were diagnosed as OoP PH.
Results: PH due to LHD was observed in 164 patients (40%) in symptomatic heart
failure. OoP PH was diagnosed in 13 patients (3%) by DPG, and 34 patients (8%)
by TPPG. The clinical characteristics of two groups are shown in Table. Right atrial
pressure was significantly higher in DPG group.
Conclusions: Out-of-proportion pulmonary hypertension determined by diastolic pulmonary vascular pressure gradient would be stricter indicator of
out-of-proportion pulmonary hypertension compared with transpulmonary pressure
gradient, and may identify patients with more severe right heart overload.
Clinical and Hemodynamic Characteristics
DPG ≥ 7 (n = 13)
TPPG>12 (n = 34)
Age
59.1±14.1
57.9±14.0
0.81
Male
12 (92.3%)
27 (79.4%)
0.29
Heart rate (beat/min)
79.9±22.1
78.4±14.8
0.82
Mean right atrial
pressure (mmHg)
15.5±4.9
12.0±4.8
0.027
Pulmonary artery
systolic pressure
(mmHg)
56.3±14.7
60.1±12.9
0.38
Mean pulmonary artery
pressure (mmHg)
42.1±9.3
41.7±7.4
0.89
Diastolic pulmonary
artery pressure (mmHg)
34.2±6.8
29.6±7.0
0.048
Pulmonary artery wedge
pressure (mmHg)
24.5±5.9
24.9±5.9
0.87
Cardiac index (L/min/m2 )
2.65±0.91
2.77±0.63
0.64
P value
P1481
Treatment with sildenafil citrate of patients with end-stage left ventricular
systolic heart failure and pulmonary hypertension
D Anagnostou1 ; E Kaldara1 ; T Sfakianaki1 ; C Kapelios1 ; C Pantsios1 ; C Repasos1 ;
Z Margari1 ; J Kanakakis2 ; J Nanas1
1
University of Athens, School of Medicine, 3rd Cardiology Dept. , Athens, Greece;
2
University of Athens, Athens, Greece
Parameters correlated to 6MWT distance
Univariate
refression
P1480
< 0.05
Purpose: Pulmonary hypertension in patients with heart failure impairs their exercise
capacity, worsens their prognosis and deprive them of the option of cardiac transplant.We aimed to evaluate the effect of the sildenafil administration in addition to
optimum pharmacotherapy on pulmonary heamodynamics in patients with systolic
heart failure.
Methods: The study population constists of 20 patients with end-stage heart failure and pulmonary hypertension. All of them underwent a right heart catheterisation
(RHC) before and after conclusion of therapy. Baseline RHC results showd :cardiac
index (C.I): 1.69 ( ± 0.36) ml/min/Kgr, pulmonary capillary wedge pressure (PCWP):
25.5 ( ± 8.03) mmHg, mean pulmonary artery pressure (MPAP): 40.7 ( ± 9.73) mmHg,
transpulmonary pressure gradient (TPG): 15.2 ( ± 5.1) mmHg, and pulmonary vascular resistance (PVR): 4.88 ( ± 1.75) WU. Ten (10) of the patients have received pos
sildenafil (group A) additionally to the optimum heart failure medical treatment in a
dosage regimen ranging from 40mg to 100mg daily (mean daily dose: 56.7mg). The
remaining ten patients did not receive sildenafil (group B) but remained on optimum
medical treatment for the rest of the study .The mean duration of the treatment was
10.3 ( ± 7.37) months for group A and 3 months for group B.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
Results: At the end of follow-up period we did not observe significant difference
between the groups regarding the change in the mean values of the MPAP {group A:
2.14 ( ± 13.2) vs group B: -11.1 ( ± 14.53) mmHg -p:0.161}, the PVR {-0.25 ( ± 2.68) vs
0.48 ( ± 4.08) WU -p:0.836}, the TPG (-0.43 ( ± 4.72) vs -1.3 ( ± 4.72) mmHg-p:0.740},
the PCWP {2.57 ( ± 11.21) vs -9.8 ( ± 11.62) mmHg -p:0.055} and the C.I {0.15
( ± 0.63) vs 1.06 ( ± 2.06) ml/min/Kgr -p:0.680}.
Conclusion: In a patients’ population with end-stage heart failure accompanied by
severe pulmonary hypertension, the addition of the sildenafil citrate in heart failure medical treatment does not seem to improve pulmonary haemodynamics significantly. This observation remains to be verified by large scale, prospective and
randomised clinical trials.
P1482
Pulmonary hypertension in CKD predialysis patients with preserved left
ventricular function
CChristos Paliouras1 ; T Haviatsos2 ; F Lamprianou1 ; N Papagiannis2 ; G Ntetskas1 ;
K Roufas1 ; G Aperis1 ; E Anastasakis3 ; N Moschos2 ; P Alivanis1
1
General hospital of Rodos, Nephrology Department, Rhodes, Greece; 2 General
hospital of Kos, Nephrology Department, Kos, Greece
Purpose: To evaluate the prevalence of pulmonary hypertension among patients
suffering from CKD stage 3 and 4 and its relation with serum PTH and albuminuria.
Methods: Thirty three CKD stage 3 and 4 patients (eGFR 60-15 ml/min/1,73 m2 )
were enrolled in the study. Inclusion criteria included preserved left ventricular
systolic function (EF < 55%) and absence of secondary pulmonary hypertension.
We recorded demographic data, biochemical and hormonal parameters (PTH,
calcium, phosphorus, Ca×P product), as well as eGFR and albuminuria. We used
the modified Bernoulli equation (PAP% = 4×(tricuspid systolic jet)2+10 mmHg) to
measure systolic pulmonary artery pressure (sPAP) considering values >35 mm Hg
as indicative of pulmonary hypertension. We also measured LVEF, Sa (RV) (cm/sec),
E/E′ and CO (L/min).
Results: Thirteen out of thirty three patients studied were found with pulmonary
hypertension (group highPAP) (prevalence 39%) and twenty without (group normal
PAP).We found in all the studied patients a significant correlation between eGFR
levels and degree of PAP (r% = 0.34, p < 0.04). Moreover the patients in high PAP
group presented significantly lower values of eGFR 28,5 ± 9,9ml/min/1,73 m2 vs
37,9 ± 14,4 ml/min/1,73 m2 in normal PAP group (p < 0,04). There was also a
statistically significant difference between these two groups regarding levels of
serum PTH (174 ± 107 vs 99 ± 48 pg/ml, p < 0,02) and albuminuria (827 ± 974 vs
330 ± 370 mg/24 h) respectively.
Conclusions: Pulmonary hypertension not only is highly prevalent among CKD
predialysis patients but it is also inversely correlated to renal function. This may
be associated with PTH and albuminuria levels in these patients.
P1483
The importance of cardiopulmonary exercise testing and six- minute walk
test in noninvasive monitoring of patients with pulmonary hypertension.
A VAygun Kazimli; NS Goncharova; AV Naymushin; AV Beresina; OM Moiseeva
Almazov’s Federal Heart, Blood and Endocrinology Centre, St.Petersburg, Russian
Federation
Purpose: The six minute walk test and cardiopulmonary exercise testing are used
in clinical practice for assess of physical performance in patients with pulmonary
hypertension (PH). The purpose of the study was to compare clinical values of
different exercise parameters in noninvasive assessment of PH severity.
Methods: 42 pts with PH (mean age 41.4 ± 14.8 yrs, m:f% = 12:30): 26 idiopathic
pulmonary arterial hypertension (IPAH) pts, 11 with inoperable chronic thromboembolic pulmonary hypertension (iCTEPH), 7 pts with corrected congenital heart
disease (CCHD) and 4 scleroderma (Sc) pts, were examined. ECHO, 6-min walk
test (6MWT), right heart catheterization (RHC), cardiopulmonary exercise testing
(CPET) and laboratory tests (serum NT-proBNP, uric acid levels) were performed in
all pts.
Results: The mean 6MWT distance was decreased (383 ± 85 m). The distance
was decreased in proportion to the severity of functional class (WHO) and correlated with cardiac index (CI) (r% = 0.36; p < 0.05), pulmonary vascular resistance
(PVR) (r% = - 0.36; p < 0.05), NT- proBNP (r% = - 0.48; p < 0.01) and uric acid
levels (r% = - 0.43; p < 0.05). Peak VO2, PetCO2 oxygen pulse determined
by CPET were also decreased and Ve/ VCO2 slope was increased in proportion to functional class (WHO). The peak VO2 correlated with distance walked
(r% = 0.43; p < 0.01), CI (r% = 0.47; p < 0.01), PVR (r% = -0.38; p < 0.05), NT- pro
BNP (r% = -0.53; p < 0.001), uric acid (r% = -0.54; p < 0.001). There was positive
correlation between PVR and increase in oxygen pulse from rest to peak (ΔO2/HR)
(r% = - 0.46; p < 0.01). Canonical analysis demonstrated the best canonical correlations were between such exercise parameters as VO2 peak (r% = 0.77),
ΔO2/HR (r% = 0.45) and hemodynamic characteristics of patients with PH
(r% = 0.67; p < 0.05)
Conclusions: VO2 peak and ΔO2/HR determined by CRT are the valuable parameters reflect hemodynamic, clinical characteristics of patients with pulmonary
293
hypertension and may be used for noninvasive monitoring of patients with pulmonary hypertension.
P1484
Increase of pulmonary capillary wedge pressure above 15 mmHg in patients
with pre-capillary pulmonary hypertension
JJulien Wain-Hobson1 ; R Sabatier1 ; M Kone2 ; D Legallois1 ; T Lognone1 ; F
Beygui1 ; G Grollier1 ; P Milliez1 ; E Bergot3 ; V Roule1
1
University Hospital of Caen, Cardiology, Caen, France
Purpose: Daily practice shows that patients with pre-capillary pulmonary hypertension (PH) sometimes develop a secondary elevation of their pulmonary capillary
wedge pressure (PCWP) above the 15 mmHg limit. This phenomenon has not been
precisely described yet. We aimed at identifying factors present at initial diagnosis
that could predict this secondary elevation of PCWP, its possible causes and impact
on survival.
Methods: We included 90 patients followed between 2004 and 2011 in our centre. At
the end of follow-up (3.0 ± 1.6 years), patients were divided into two groups according to the successive PCWP measurements (always ≤ 15 mmHg or > 15 mmHg on at
least one right heart catheterization (RHC)). Demographical, biological, echographic
and hemodynamical data at first RHC were compared. Possible causes for PCWP >
15 mmHg were searched. A Kaplan-Meier method was used to assess differences
on survival.
Results: One third of our cohort developed an increase of PCWP > 15 mmHg and
patients with idiopathic pulmonary arterial hypertension were at smaller risk (OR 0.20
[0.05-0.82]; p% = 0.026). We did not identify any other baseline predictive factors.
No systolic dysfunction nor severe left valvuopathy was observed. We highlighted
several possible causes such as ventricular interdependence, high cardiac output,
supraventricular tachycardia or silent ischemic cardiomyopathy that may unmask
an underlying left ventricular diastolic dysfunction (LVDD). Survival was not different
between both groups (p% = 0.42).
Conclusions: Secondary elevation of PCWP in pre-capillary PH was frequent but
less observed in idiopathic PH. Many possible causes can be sought, many of which
may be related to an underlying LVDD.
P1485
Severe right ventricular dysfunction in pulmonary arterial hypertension:
prevalence, clinical markers and treatment in Argentinean HINPULSAR
registry
ML Coronel1 ; E REduardo Perna1 ; C Nunez2 ; G Cursack2 ; M Fleitas2 ; C Botta2 ;
D Garcia Brasca2 ; R Bonafede2 ; C Babi2 ; D Echazarreta3
1
J.F. Cabral Cardiology Institute, Corrientes, Argentina; 2 Heart Failure and
Pulmonary Hypertension Committee, Corrientes, Argentina; 3 Hospital “San Juan
de Dios”,, La Plata, Argentina
Severe right ventricular dysfunction (SRVD) is a high risk marker in patients
with pulmonary arterial hypertension (PAH). However, its clinical characteristics in
Latin-Americans are poorly known. We sought to assess the prevalence, clinical
markers and treatment of SRVD in Argentinean patients with PAH.
Methods: Between Jan-10/Dec-11, 422 patients with diagnosis of PH were
prospectively included in 31 centers from 13 provinces from Argentina. The inclusion criteria were: ≥ one year old, clinical diagnosis of PH and one of the followings:
systolic pulmonary arterial pressure (SPAP) estimated by echo Doppler ≥ 40 mmHg
or mean pulmonary arterial pressure (MPAP) obtained by right heart catheterization
(RHC) ≥ 25 mmHg. Of them, 124 (29.4%) with diagnosis of PAH were included in
the present analysis. SRVD was defined by moderate to severe RV dysfunction or
TAPSE < 15 mm.
Results: Mean age was 45 ± 17 and 78% were female. According with Dana
Point classification, the distribution was idiopathic 51.6%, inherited 1,6%, drugs
2.4%, connective tissue disease 15.3%, portal hypertension 1.6% and congenital heart disease 27.4%, with a prevalence of SRVD of 33, 0, 33, 32, and 27%,
respectively (p% = ns). The clinical profile of patients with or without SRVD differed in: fatigue (73 vs 39%, p% = 0.001), functional class at diagnosis (I: 0
and 13%, II:37 and 26%, III: 25 and 51%, IV: 53 and 10%, p% = 0.012), heart
rate (HR) (82 ± 11 vs 76 ± 13, p% = 0.017), previous heart failure related hospitalization (41 vs 22%, p% = 0.033), and cardiomegaly detected on chest x-ray
(65 vs 32%, p% = 0.001). In logistic regression analysis, independent clinical
predictors were fatigue (HR% = 5.2, 95%CI% = 1.9-14.1, p% = 0.001), heart rate
(HR% = 1.045, 95%CI% = 1.003-1.088, p% = 0.033), and cardiomegaly (HR% = 2.9,
95%CI% = 1.2-7.5, p% = 0,024). Echocardiogram in SRVD showed more frequently
right atrial dilation (84 vs 61%, p% = 0.013), and higher SPAP (89 ± 28 vs 77 ± 27
mmHg, p% = 0.045), with lower LVEF (59 ± 12 vs 67 ± 10 %, p% = 0.002). Treatment
in SRVD was different in the use of diuretics (87 vs 63%, p% = 0.010) and digoxin (38
vs 20%, p% = 0.031), and it was similar in the use of sildenafil (87 vs 74%); iloprost
(11 vs 10%); bosentan (19 vs 9%); treprostinil (5 vs 5%), and ambrisentan (5 vs 5%)
Conclusions: One out of three patients with PAH presented SRVD. Physical examination and chest x-ray permit clinical identification. These patients received more
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
294
Abstracts
frequently drugs to treat heart failure, but with similar rate of specific drugs, suggesting the need of optimization of therapy driven to PAH in these more severe cases.
PULMONARY HYPERTENSION – POSTER DISPLAY
P1486
Predicting survival in pulmonary arterial hypertension in a single centre in
latin america
M LMaria Lujan Talavera; LE Favaloro; JO Caneva; F Klein; RP Boughen; JM
Osses; AM Bertolotti; RR Favaloro
Favaloro Foundation University Hospital, Buenos Aires, Argentina
Purpose: To evaluate middle-term survival in patients (pts) with pulmonary arterial
hypertension (PAH), identify factors associated with a poor outcome and describe
them.
Methods and Materials: Of 134 pts with PAH of Group 1 of Dana Point, consecutively collected from January-2004 to march-2012, 125 pts. with idiopathic
and associated PAH (congenital heart disease and collagen disease) were analyzed. Numeric variables were expressed as a percent/mean-DS or median-IIC25-75
and analyzed by chi2/Kruskal Wallis as appropriate. Kaplan-Meier curves were performed. P < 0.05 was considered statistically significant.
Results: Median follow up was 39.1 (IIC25-75% 21.2-61,5) months. Mean age was
34 (+/-15,7) years and 79.2% were females. Regarding etiologies, 61 pts had idiopathic PAH and 64 pts associated PAH (35, 18, 2 and 1 pts with congenital heart
disease, collagen disease, familial and HIV infection, respectively); 68% was on
combination therapy. Death and/or transplant rate was 37% (39 deaths, 7 transplants). Survival without transplant at 12, 24 and 36 months was 94%, 90% and
83%, respectively. Functional class III/IV (OR 3.6 IC95% 1.5-8.9, p < 0.01), pericardial effusion (OR 4.2 IC95% 1.3-14.6 p% = 0.021) and 6-min walk distance < 380
m (OR 2.7 IC95% 1.1-6.5 p% = 0.023) were baseline clinical characteristics associated with poor outcome. PAH associated with collagen disease showed the worst
survival (93%, 81% and 74% at 12, 24 and 36 months, respectively) and pts with
congenital diseases had the best outcomes: 95%, 95% and 93% at 12, 24 and 36
months, respectively; survival in pts with idiopathic PAH was 89%, 89% and 78%
at 12, 24 and 36 months, respectively.
Conclusions: In our registry, the survival rate was similar to reported in currently
and higher pts number registries. Easy acquired variables that allowed us to identify
pts at risks of death and transplant in the middle-term.
P1487
Evaluation of total pulmonary vascular resistance during exercise in patients
with pulmonary hypertension
A R Almeida; L Lopes; MJ Loureiro; C Cotrim; D Repolho; LR Lopes;
B Stuart; D Caldeira; H Pereira
Hospital Garcia de Orta, Department of Cardiology, Almada, Portugal
Background: The total pulmonary vascular resistance (TPVR) contribute to afterload
of the right ventricle (RV), significantly influencing it’s performance.
Purpose: Assess the behavior of TPVR with treadmill exercise (SE) in healthy
subjects (controls) and in patients with pulmonary hypertension (PH) (cases).
Methods: Prospective study of 10 cases and 10 controls "age and sex-matched.
They went SE, symptom-limited, using the modified Bruce protocol. We analysed at
rest (R) and at peak exercise (E) the following parameters: heart rate (HR), diameter
of left ventricle outflow tract (LVOT), velocity time integral (VTI) of LVOT, gradient
between the right ventricle and right atrium (gradRV/RA), diameter of inferior vena
cava and its collapsibility.
To determine the total pulmonary vascular resistance (TPVR) we calculated: cardiac
output (CO), in L/min, using the formula - CO% = stroke volume (SV) × HR, where
SV% = area × VTI of LVOT; mean pulmonary artery pressure (MPAP), in mmHg, using
the formula of Chemla - MPAP% = systolic pulmonary artery pressure (SPAP) × 0.6
+ 2, where SPAP% = gradVD/AD + the estimated right atrial pressure (RAP). We
calculated the TPVR, in UWood, with the formula TPVR% = MPAP/CO.
We analyzed the change in TPVR between rest and exercise for cases and controls.
Results: In cases there was a non significant increase in TPVR (R-11,8 ± 5,0 to
E-16,4 ± 12,0 UWood (p% = 0,285); in controls we verified an almost significant
decrease in TPVR with exercise (R-2.4 ± 0,6 to E-1,7 ± 0.8 UWood (p% = 0,056)).
Conclusions: The determination of the behavior of TPVR with exercise is feasible by
treadmill exercise echocardiography. With exercise the TPVR in controls decrease,
whereas in cases they do not decrease.
Background: Iron availability influences the pulmonary vascular response to
hypoxia and may be significant in the pathogenesis of pulmonary hypertension (PH).
Moreover, it is believed it play a critical role in mitochondrial functioning, a critical
point in the conversion of right ventricular hypertrophy to failure. We aimed to assess
the prevalence of iron deficiency in a pulmonary arterial hypertension (PAH) cohort.
Methods: We performed a clinical and hemodynamic characterization of 38 PH
patients with the diagnosis of pulmonary arterial hypertension or Eisenmenger syndrome currently being followed in PH clinic between 2008 and 2012. We have
assessed the prevalence of iron deficiency in this population by the evaluation of
ferritin and transferrin saturation along the evolution of the disease, during a 3-year
follow-up period with trimestral intervals.
Results: Patients were equally divided into the groups of pulmonary arterial hypertension and Eisenmenger syndrome (19 in each). The mean age was 46 ± 18 in the
first group and 42 ± 14 in the second. We found that the values of ferritin decrease
along the evolution of the disease (mean initial value of 92 ng/mL and mean final
value of 58 ng/mL) with statistical significance (p < 0.0001). In contrast, the transferrin saturation values remain relatively stable (mean initial value of 26% and mean
final value of 31%).
Conclusions: This study demonstrates that ferritin decreases over the course of
the disease. Despite the efforts to give oral iron supplements to these patients the
answer is not effective. Perhaps a parenteral iron administration program could be
beneficial since oral absorption is impaired, as it is in left heart failure.
P1489
Prognostic value of right heart failure hospitalizations in pulmonary arterial
hypertension
M LMaria Lujan Talavera; LE Favaloro; JO Caneva; F Klein; RP Boughen; JM
Osses; AM Bertolotti; RR Favaloro
Favaloro Foundation University Hospital, Buenos Aires, Argentina
Background: Right failure is one of the worse prognostic factors in pulmonary arterial hypertension (PAH). Once right ventricle is installed, prognosis is really adverse.
Objectives: To evaluate the prognostic value of right heart failure hospitalizations in
patients with PAH.
Methods: Of 134 pts with PAH of Group 1 of Dana Point, consecutively collected
from January-2004 to march-2012, 125 patients with idiopathic and associated
PAH (congenital heart disease and collagen disease) were analyzed. Numeric variables were expressed as a percent/mean-DS or median-IIC25-75 and analyzed by
chi2/Kruskal Wallis as appropriate. P < 0.05 was considered statistically significant.
Results: Median follow up was 39.1 (IIC25-75% 21.2-61,5) months. Mean age was
34 (+/-15,7) years and 79.2% were females. Regarding etiologies, 61 pts had idiopathic PAH and 64 pts associated PAH (35, 18, 2 and 1 pts with congenital heart
disease, collagen disease, familial and HIV infection, respectively); 68% was on
combination therapy, 58% had NYHA functional class III/IV and 56% had at least
moderate/severe right ventricle dysfunction, median six minute walk distance was
360 m (IIC25-75: 247-432 m). In the follow up, 29% required at least one hospitalization because of acute right heart failure (3+/-1,6 per patient). Death and/or transplant
rate was 37 % (39 deaths, 7 transplants). Patients with hospitalizations had worse
NYHA functional class (class III/IV: 78% vs 30% p% = 0,005), worse right ventricle function (moderate/severe impairment: 78% vs 22%, p% = 0,002) and worse six
minute walk test (312 IIC 25-75: 205-384 vs 384 IIC 25-75: 283-456, p% = 0,006). In
the follow up, pts with hospitalizations had worse outcomes (death/transplant: 67%
vs 33%, p < 0,001).
Conclusions: Once patient develops right failure sings, the prognosis is bad. Acute
right heart failure hospitalization is a readily and noninvasive variable that allowed
us to identify a high risk population in PAH. Its occurrence should alert about the
needing of lung transplant waiting list inclusion.
HYPERTENSION/LV HYPERTROPHY – POSTER PRESENTED
P1491
Trend and predictors of arterial compliance in a group of normotensive and
untreated hypertensive cameroonian subjects in yaounde.
NJIMBUC Walinjom; S Kingue; A Menanga; P Mintom; M Ntep; B Fesuh;
W Muna
Faculty of Medicine and Biomedical Sciences , yaounde, Cameroon
Iron metabolism in patients with pulmonary arterial hypertension: A 3-years
prospective study on the variations on the ferritin and iron saturation levels
Objective: Arterial compliance, an important independent predictor of cardiovascular events decreases with age and this decrease is accelerated by hypertension.
The main objectives of this study were to determine the trend and predictors of
arterial compliance in a group of normotensive and untreated hypertensive stage 1,
2 and 3 Cameroonian subjects.
Methods: A cross-sectional study was conducted from August 2012 to February
2013 in Yaounde. Our sample size involved a total of 88 participants .The PulsePen®
NNadia Moreira; R Baptista; G Castro; A Marinho; M Pego
University Hospitals of Coimbra, Coimbra, Portugal
device was used to determine; carotid-femoral or aortic PWV and central augmentation index % (AIx). Left ventricular hypertrophy (LVH) was investigated using
P1488
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
a 12 leads Cardiax® ECG machine. Other measurements obtained were blood
pressure (BP), body mass index (BMI), fasting glycaemia, lipid profile and serum
creatinine.
Results: Of the 88 participants studied, 51.1% were females and 48.9%
were males. The mean age of the study population was 35.48 years and
ranged from 20 to 60 years. The mean of hemodynamic parameters (cfPWV,
carotid-radial.PWV, Central Systolic Blood Pressure (SBP), Central Diastolic Blood
Pressure (DBP), Central Pulse Pressure (PP), Peripheral SBP, Peripheral DBP,
Mean Arterial Pressure (MAP), Heart Rate (HR), and Central AIx) showed a statistically significant increase in trend (p-value < 0.05) as we moved across the
groups from normotensive to severely hypertensive patients. Also, the number of subjects who had a cfPWV>12m/s increased across the groups with
the greatest number found amongst severely hypertensive patients. cfPWV
was significantly correlated (p-value < 0.05) to Age, Central SBP, Central DBP,
Central PP, Peripheral SBP, Peripheral DBP, MAP, HR, BMI and central AIx.
cfPWV was significantly dependent on LVH (p-value < 0.05). We found out
that, hypertension stage, Age, BMI and HR were potential predictors of arterial
stiffness.
Conclusion: The values of cfPWV increased in trend as we moved across the
groups, with most subjects having a PWV >12m/s being severely hypertensive
patients. This study suggests that in a typical sub Saharan African setting like ours,
arterial compliance decreases with increase severity of hypertension, indicating a
higher risk of developing cardiovascular events in severely hypertensive patients.
295
Changes of heart structure (changes of LV geometry, cardiomyocites and
extracellular matrix alterations) in patients with arterial hypertension lead
to function disorders of the heart which results in development of heart
failure (HF).
The purpose of our study was to evaluate role of plasma markers of myocardial
fibrosis and renin-angiotensin-aldosteron system (RAAS) in hypertensive patients
with heart failure with preserved ejection fraction.
Were examined 141 patients with arterial hypertension (AH) 2-3 grade complicated by HF I-III NYHA functional class. The mean age of patients - 53
(4) years. Patients with arrhythmias, diabetes mellitus were excluded from
the study. In all patients was performed ECG in 12 standard leads, EchoCG
(ASE/EAE recommendations 2005) and were evaluated plasma levels of aldosteron, angiotensin 2 (AT-2), angiotensin-converting enzyme (ACE), tissue inhibitor
of metalloproteinases-1 (TIMP-1) and Insulin-like growth factor 1 (IGF-1). HF NYHA
functional class was determined by using the 6MWT. Mean ejection fraction - 65.1
(52.0; 69.1)%.
Statistical significance was defined at the level of methods for p < 0,05.
As it seen from Table 1 plasma levels of AT-2 and ACE play great role in progressing
of HF. TIMP-1 is the marker of interstitial myocardium fibrosis and it concentration
in blood plasma was higher with increasing HF function class. IGF-1 as a primary
mediator of the effects of growth hormone showed lowering plasma levels with
increasing HF functional class which can be evaluated as lowering adaptive abilities
of myocardium.
Thus, results of the study indicates significant role of myocardium interstitial fibrosis and renin-angiotensin-aldosteron system activity in heart failure
development in hypertensive patients with heart failure with preserved ejection
fraction.
P1492
Plasma levels of vascular natriuretic peptide in women with essential
hypertension
OS Olena Sakovych; ZV Zhebel Vadym; GA Gumenyuk Alla; PI Paliy Irina; SO
Starzhynska Olga; PY Pashkova Yuliya
Vinnytsya National Medical University n. a. N.I Pirogov, Vinnutsya, Ukraine
Purpose: To study the plasma levels of vascular natriuretic peptide (VNP) in women
of postmenopausal age, residents of Vinnitsya Region, patients with Essential
hypertension (EH): uncomplicated (stage II) and complications of chronic heart
failure (CHF) IIA stage (stage III).
Methods: We examined 100 post-menopausal age’s women, residents of Vinnitsya
Region, patients with EH of varying severity (50 women with EH stage II 2 and 50
women with EH complicated CHF stage II A, which constitute the main group. The
control group formed 80 women without evidence of cardio - vascular diseases
in history and at the time of the study. Determination of VNP’s plasma levels was
carried out using the method of ELISA. Condition of systolic function of the left
ventricle (LV) was assessed in terms of ejection fraction (EF) of LV. Systolic function
was considered reduced when EF was less than 45%.
Results: Systolic dysfunction of left ventricle was detected in 62% of patients with
symptoms of CHF stage IIA. Mean plasma concentrations of VNP in women with
CHF were 5,61 ± 0,14 pmol / ml, it was significantly higher (p < 0.01) than plasma
concentrations of VNP in patients with EH stage II (4,04 ± 0,08 pmol / ml) and healthy
women (2,38 ± 0,06 pmol / ml). Higher levels of VNP were in patients with CHF
stage IIA and systolic dysfunction of left ventricle, than in patients without systolic
dysfunction: 6,05 ± 0,16 and 4,88 ± 0,15 pmol / ml, respectively (p < 0.01). We
calculated boundary level of VNP in women of postmenopausal age, with Essential
hypertension for an approximate identification of persons with left ventricular’s
systolic dysfunction . Thus, the boundary level of VNP, which is 4.6 pmol / ml
(sensitivity - 90.32 %, specificity - 63.16 %, correctness - 82 %) makes it possible
to detect persons with systolic dysfunction.
Conclusions:
1. Plasma levels of VNP in women of postmenopausal age with EH complicated
by CHF stage IIA significantly higher than in patients with uncomplicated Essential
hypertension (stage II) and healthy individuals. Products of VNP in patients with
Essential hypertension is defined as structural changes in the myocardium of the
left ventricle, as systolic function of the left ventricle.
2. Established boundary plasma level of VNP can be used in the screening a
large number of people to quickly estimated left ventricular’s systolic function in
postmenopausal ages’ women with EH complicated by CHF stage IIA different
severity, which allows to select patients for in-depth examination and assignment
to the appropriate treatment.
P1493
Markers of myocardial fibrosis and renin-angiotensin-aldosteron system
activity in hypertensive patients with heart failure with preserved ejection
fraction
MV Krestjyaninov1 ; VA Razin2 ; RH Gimaev2
Ulyanovsk Hospital Of Word War Veterans, Ulyanovsk, Russian Federation;
2
Ulyanovsk State University, Ulyanovsk, Russian Federation
1
Markers of myocardial fibrosis & RAAS
Parameters
HF NYHA functional class
1 (n = 86)
2 (n = 35)
3 (n = 20)
Aldosteron (pg/ml)
127.19 (39.03)
149.42 (36.99)
149.39 (33.69)
ACE (u/l)
47.05 (22.35)
73.8 (31.68)*
85.6 (32.81)*
AT-2 (pg/ml)
42.46 (14.79)
52.11 (12.75)
58.1 (9.78)*
TIMP-1 (ng/ml)
319.46 (117.26)
373.84 (130.43)* 362.5 (135.89)*
IGF-1 (ng/ml)
157.26 (25.52)
155.09 (21.78)
140.08 (18.67)*
Results are shown in M (SD). * - p < 0.05 in comparison with HF 1 functional class
P1494
Association between the development of anti-angiotensin II type-1 receptor
antibodies and hypertension in kidney transplantation
F Davila-Radilla; AArturo Orea-Tejeda; J Alberu-Gomez; L Castillo-Martinez;
A Hernandez-Mendez; E Alcala-Davila; MI Salcedo; A Hernandez-Izelo;
M Vilatoba; E Calvario-Mayorga
Instituto Nacional de Ciencias Médicas y Nutrición “SZ”, Mexico, Mexico
Background: Hypertension is a very common condition after kidney transplantation (KT) and is a major risk factor for graft and patient survival. Its incidence reaches to 67-90% in renal recipients. Previous studies demonstrated the
significance of Anti-Angiotensin II Type 1 Receptor Antibodies (AT1 R). These
autoantibodies are prevalent among KT recipients who develop severe transplant rejection and malignant hypertension during the first week after transplantation. Objective: The aim of the study is to evaluate the association between the
development of AT1R receptor antibodies and hypertension in kidney transplant
patients.
Methods: From pretransplant samples of 105 recipients from March 2009 to December 2012, with functional graft (Glomerular filtration rate >15 ml/min/1.73m), was
determined the presence of antibody to AT1R by a cell-based ELISA method using
a cutoff of 17U to distinguish high from low binding. Glomerular filtration rate (GFR)
was estimated using the four-variable equation of the Modification of Diet in Renal
Diseases (MDRD) study. Blood pressure was evaluated before and 3, 6, 12 months
after KT.
Results: The mean age of subjects was 28 (22-38.5) years and 55.2% were men.
High-binding AT1 R antibodies were identified in 13 (12.4%) recipients. Before KT
the mean arterial pressure (MAP) was 98.0 ± 15.3 mmHg for those with positive
antibodies to AT1 R and 101.3 ± 16.6 mmHg for those with negative antibodies to
AT1 R. One year after KT the MAP was 91.2 ± 11.5 mmHg in the group with positive antibodies and 89.8 ± 12.01 mmHg in the group with negative antibodies. The
systolic and diastolic pressure 3, 6, 12 months after transplantation was not significantly different between groups. Mean measured GFR (mGFR) three months
after KT was 64.6 ± 19.2 mL/min/1.73m in the group with positive antibodies to
AT1R and 73.2 ± 18.6 mL/min/1.73m in the group with negative antibodies. Six
months after KT the mGFR was 62.8 ± 21.3 mL/min/1.73m in the positive group and
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
296
Abstracts
73.1 ± 21.6 mL/min/1.73m in the negative group and one year after KT 59.7 ± 18.6
mL/min/1.73m and 70.88 ± 21.01 mL/min/1.73m respectively. The mGFR was significantly decreased in those patients with positive antibodies to AT1R.
Conclusions: This study found significant association of AT1R antibodies with low
GFR in renal recipients buy unlike other studies which describe the association of
AT1R antibodies and hypertension, our study didn ́ t show difference in blood pressure behavior.
HYPERTENSION/LV HYPERTROPHY – POSTER DISPLAY
P1497
Combining body mass index with measures of central obesity in the
assessment of geometric patterns in healthy obese population
Q Zhang; L Gong; JZ Chen; RT Hui
Department of Cardiology, FuWai Hospital and Cardiovascular Institute, Peking
Union Medical College , Beijing, China, People’s Republic of
P1495
Relationship between cardiac function and exercise capacity in patients with
hypertension and obesity
MSMi-Seung Shin1 ; BR Kim2 ; MY Baek1 ; YM Park1 ; SY Suh1 ; WJ Chung1
Gachon University Gil Medical Center, Incheon, Korea, Republic of; 2 Seoul
Medical Center, Seoul, Korea, Republic of
1
Background: Obesity and hypertension are well known risk factors of cardiovascular disease. The purpose of this study is to evaluate the relationship between cardiac
structure and function and exercise capacity in patients with hypertension and obesity and in patients with simple hypertension.
Methods: Four hundred thirty two persons without structural cardiovascular
disease were divided to 4 groups – 120 healthy control persons (group A),
123 patients with a lone hypertension (group B), 87 obese persons with BMI
> 25 Kg/m2 , without hypertension (group C) and 102 patients with hypertension and obesity (group D). All study subjects were taken echocardiography
and treadmill exercise test. Peak velocity of early(E) and late(A) mitral inflow
and early(Ea) and late(Aa) diastolic tissue velocity of mitral annulus were measured. Exercise duration and peak exercise metabolic equivalents (METs) were
analyzed.
Results: Group B showed lower Ea, lower E/A, higher E/Ea and higher LV mass
index compared with group A. Group C showed shorter exercise duration, lower
METs and higher peak BP during exercise compared with group A. Group D showed
similar exercise duration but lower Ea(p < 0.001), lower E/A(p% = 0.014), higher
E/Ea(p% = 0.009), higher LV mass(p% = 0.023) and higher LA diameter(p < 0.001)
compared with those of group B. Group D showed lower Ea(p < 0.001) and
higher LV mass(p% = 0.020) and shorter LA diameter(p% = 0.003) compared with
group C. In group B, total exercise duration showed weak positive correlation
with diastolic function. Multivariate analysis showed positive correlation between
METs and Ea velocity. In group C, multivariate analysis did not show significant
correlation between METs and diastolic parameters. In group D, BMI showed
negative correlation with Ea and showed positive correlation with systolic function. Multivariate analysis showed positive correlation between METs and E/A
ratio.
Conclusion: Hypertension mainly influenced on LV mass and obesity influenced
on LV mass and LA size. A lone obesity or lone hypertension did not influence
exercise capacity, but showed decreased diastolic function. Patients with hypertension and obesity showed obviously decreased diastolic function but did not show
decreased exercise capacity compared with simple hypertensive or obese persons.
There were some differences in the relationship between cardiac diastolic function
and exercise capacity according to the group. Therefore, early treatment of obesity in
patients with hypertension is very importance in the point of cardiac remodeling and
function.
Objective: To investigate the role of waist circumference (WC) combined with body
mass index (BMI) in discrimination for cardiac structural abnormalities in healthy
obese population.
Design and Methods: we measured left ventricular mass index (LVMI), relative
wall thickness (RWT) and the geometric patterns through echocardiography, and
analyzed the associations of these indices with the patterns of body adiposity
based on a combination of BMI and WC in 3722 participants without prevalent
cardiovascular diseases.
Results: In this whole study population, the main LV structural abnormality was LVR
(28.2%), followed by concentric (6.4%) and eccentric left ventricular hypertrophy
(LVH) (4.4%). RWT and LVMI were obviously higher in overweight and obese patients
with central obesity compared with the ones without central obesity (p < 0.05). After
adjustments for potential confounders, WC rather than BMI was a strong contributor
to RWT (p% = 0.006). Central obesity leaded to a higher occurrence of concentric
LVH in normal BMI and overweight group, but not in obese group. The normal BMI
subjects with central obesity have a trend of higher prevalence of concentric LVH
and significantly lower incidence of eccentric LVH compared to the obese ones
without central obesity. Logistic regressions demonstrated that BMI promoted both
concentric and eccentric LVH, whereas WC was only contributed to concentric LVH.
Conclusions: Combining BMI with WC allows us to better stratify those with
different LVH patterns, and thus prevent the occurence and progression of heart
failure more effectively.
P1498
New calculation ‘PTIN’ measured during a sleeping period highly correlates
with the LVMI
IIgor Posokhov1 ; J Baulmann2 ; N Kulikova3 ; A Rogoza4
Haemodynamic Laboratory Ltd, Nizhny Novgorod, Russian Federation; 2 University
Hospital of Schleswig-Holstein , Lubeck, Germany; 3 3rd Republican Hospital,
Saransk, Russian Federation; 4 Russian Cardiology Research and Production
Complex, Moscow, Russian Federation
1
Measuring of pulse wave velocity (PWV) is recommended for the evaluation of
cardiovascular risk. New 24-hour ABPM monitors (BPLab with Vasotens technology,
OOO Petr Telegin, Russia) provide single PWV measurements as well as several
PWV measurements over a period of 24 hours. Such 24-hour PWV analysis led to
the development of the novel Pulse Time Index of Norm (PTIN), which is defined as
the percentage of a 24-hour (or sleep or awake) period during which the PWV does
not exceed the 10 m/sec PWV threshold. The aim of this study is to test the new
PTIN for correlation with the left ventricular mass index (LVMI).
60198 The comparison of cardiac geometry
Normal BMI group
(n = 1616)
Overweight group
(n = 1578)
Obese
group
(n = 528)
No central obesity
(n = 1545)
Central obesity
(n = 71)
p
No central
obesity
(n = 859)
MWT (mm)
8.8±1.1
9.3±1.5
Central obesity
(n = 719)
p
9.1±1.2
9.5±1.3
< 0.001
LVEDD (mm)
41.9±4.0
43.2±3.8
0.010
No central
obesity (n = 28)
Central obesity
(n = 500)
p
8.8±1.0
9.5±1.3
0.001
45.2±4.5
45.5±4.3
0.654
< 0.001
43.2±4.0
44.2±4.6
< 0.001
RWT&
0.42±0.07
0.43±0.09
0.155
0.42±0.07
0.43±0.08
0.022
0.39±0.07
0.42±0.07
0.036
LVMI (g/m2.7 )
32.6±8.5
35.9±11.9
0.007
36.7±10.0
37.9±11.0
0.018
38.0±9.9
41.0±11.3
0.027
Normal geometry
998(64.6%)
41(57.7%)
0.239
522(60.8%)
405(56.3%) 0.074
18(64.3%)
289(57.8%)
0.498
LVR
465(30.1%)
22(31.0%)
0.873
236(27.5%)
208(28.9%) 0.522
6(21.4%)
111(22.2%)
0.924
Concentric LVH
49(3.2%)
8(11.3%)
0.001
59(6.9%)
70(9.7%)
0.038
1(3.6%)
51(10.2%)
0.252
Eccentric LVH&
33(2.1%)
0(0.0%)
0.213
42(4.9%)
36(5.0%)
0.915
3(10.7%)
49(9.8%)
0.874
& p < 0.05 when compared the normal BMI patients with central obesity to the obese ones without central obesity.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
297
Oscillometrically generated waveform files (n = 137) previously used for clinical
research studies with ABPM and with two-dimensional guided M-mode echocardiography performed with standard methods were re-analyzed using the new
2013 software version of the Vasotens technology program, which enables PTIN
calculations.
Correlations obtained in the study are presented in Table 1. Important results were
also obtained when PTIN was compared in patients with and without LVH. The
boundaries of the PTIN percentile limits for ‘asleep’ period in these subgroups do not
intersect. There are high significance levels (Yates corrected Chi-square% = 34.2,
p < 0.001) if we construct a 2 by 2 table for awake and asleep periods in the subgroups listed above.
Thus, generated by the Vasotens technology PTIN, especially during a sleeping
period, can be recommended as an indicator of end organ damage resulting from
hypertension.
Table 1
LVM/height2.7
r
LVM/BSA
p
r
p
PTIN
-0.72
0.0001
-0.67
0.0001
Mean 24 - h PWV
0.32
0.01
0.32
0.01
Systolic BP “load’
0.41
0.001
0.37
0.01
Mean systolic BP
0.14
>0.05
0.15
>0.05
Abbreviations: LVM, left ventricular mass; BSA, body surface area; PTIN, Pulse Time
of Norm; PWV, pulse wave velocity; BP, blood pressure;
TRANSLATIONAL RESEARCH – POSTER PRESENTED
Consumption of coenzyme Q10 (CoQ10) longer than 2 weeks protects heart effectively against ischemia. Single per os CoQ10 intake does not increase its myocardial levels due to its low bioavailability. Fast rise in plasma CoQ10 levels and
subsequent uptake by myocardium could be reached with intravenous (i.v.) injection.
The aim was evaluation whether a single i.v. injection of solubilized CoQ10 before
ischemia/reperfusion (IR) could increase its myocardial levels rapidly and limits subsequent myocardial IR injury.
Methods: 1st series: rats received i.v. a bolus of CoQ10 (30 mg/kg, solubilized CoQ10, Kudesan solution, ‘Akvion’, Russia, n = 5) or saline (1 ml/kg, 0,9%
NaCl, n = 7). 30 min after injection myocardial CoQ10 levels were quantified by
reversed-phase HPLC with electrochemical detection. 2nd series: rats received i.v.
CoQ10 (n = 10) or saline (n = 11) 30 min prior to coronary artery occlusion. After 30
min of ischemia and 120 min of reperfusion infarct zone and CoQ10 content in left
ventricle (LV) were determined. Cardiac rhythm was monitored during the experiments by ECG.
Results: 1st series. Single i.v. bolus of solubilized CoQ10 increased its myocardial
levels by 18,5% (p < 0,05) in 30 min versus control rats. 2nd series. At the end of
reperfusion infarct size of saline treated infarct rats was 47 ± 6%. Single i.v. CoQ10
injection prior to coronary occlusion limited myocardial injury to 31 ± 7% (p < 0,05).
CoQ10 level was increased in LV by 210% (p < 0,01) 180 min after i.v. administration. The higher levels of CoQ10 were accompanied by decreased zone of damaged
myocardium (r% = - 0,77, p < 0,001). Arrhythmias in CoQ10-treated rats arose later
(40 ± 8 sec) and had shorter duration (26 ± 14 sec) vs in saline treated rats, 14 ± 13
sec and 52 ± 17 sec, respectively.
Conclusion: Single i.v. preventive injection of solubilized CoQ10 solution increased
rapidly myocardial CoQ10 levels that resulted in reduction of subsequent IR injury:
the infarct zone inversely correlated with the CoQ10 levels in the LV. Rapid increase
of myocardial CoQ10 content can be beneficial in urgent cases, in particularly at
the time of restoration of coronary blood flow during acute myocardial infarction or
planned heart surgeries.
P1502
P1500
Effects of amlodipine and perindoprilate on the structure and function of
mitochondria in ventricular cardiomyocytes during ischemia-reperfusion in
the pig
Protein Disulfide Isomerase is a fundamental regulating factor of Cardiac
Stem Cell survival during hypoxia.
1
DDomenico D’amario; AM Leone; A Severino; M Manchi; L Ottaviani;
A Siracusano; PG Bruno; M Massetti; F Crea
Catholic University of the Sacred Heart, Institute of Cardiology, Rome, Italy
Thehuman heart is a self-renewing organ characterized by the presence of
c-kit-positive cardiac stem cell (hCSC) stored in niches and widespread within
the myocardium. Stem cell niches are exposed to low oxygen tension and this
metabolic adaptation offers a selective advantage to CSC compared to terminally
differentiated cells, such as myocytes, during hypoxia. However, the molecular
mechanisms are poorly understood. Protein disulfide isomerase (PDI), is a member
of the unfolded protein response, which is activated to prevent protein misfolding during stress, as occurs during ischemia. The objective of this work was to
determine whether PDI is present and functional in CSC and it is involved in the
preservation of the stem cell pool during hypoxia.
Surgical specimens were collected from the atrial and ventricular myocardium of 21
patients and hCSCs and myocuted were isolated. This cohort of patients included
20 women and 16 men affected by ischemic cardiomyopathy; 11 patients also had
diabetes. Age was comparable in women and men. The yield of CSCs harvested
from each sample did not vary with age or diabetes
The PDI was very low expressed in the myocytes, sampled from the ventricle and
atria of the patients investigated. Interestingly, by qRT-PCR, a 2000-fold difference
was found in PDI expression comparing CSC and myocytes . Subsequently, the
effects of hypoxia (1% O2) were studied in hCSCs in vitro and analyzed at 12, 24, 48
and 96 hours. With respect to cells cultured in normoxia, 1% O2 led to upregulation
of PDI and HIF1𝛼 transcripts in a time dependent manner. This results were coupled
with an increase of the transcripts for the stemness associated genes c-kit, Oct4,
Nanog and IGF-1R. Moreover, a high correlation was found between the expression
of PDI in the CSC and the infarct size evaluated 5 months after revascularization. A
highly significant direct correlation between improvement of ejection fraction at FU
and hCSC length of telomeres (p < 0.01; R2 0.33) telomerase activity (p < 0.05; R2
0.38) and PDI expression was observed (p < 0.05; R2 0.41).
In conclusion, our data indicate PDI is a key regulator of CSC response to
hypoxia and favors the conservation of their undifferentiated phenotype and most
importantly their potential activation after injury.
P1501
Rapid increase in myocardial CoQ10 levels after i.v. administration protects
myocardium against ischemia/reperfusion induced injury
O Medvedev; AAlexander Ivanov; E Kalenikova; E Gorodetskaya
M.V. Lomonosov Moscow State University, Faculty of Basic Medicine,
Pharmacology dpt, Moscow, Russian Federation
QQuadiri Timour Chah1 ; L Dehina1 ; JD Descotes2
Universite Claude Bernard, Lyon, France; 2 Poison Center and Pharmacovigilance
Department, Lyon, France
Introduction: The aim of the present study was to determine whether amlodipine
and/or perindoprilate injected intravenously (iv) prior to ischemia exerted protective
effects on mitochondria structural and functional alterations induced by ischemia
and aggravated by reperfusion.
Materials and Methods: Heart rate, the duration of monophasic action potentials
(dMAP), the peak of the time derivative of left ventricular pressure (LV dP/dt max),
mitochondria structural and functional parameters in the left ventricle ischemic
area were measured after 45-min ischemia and 1-min reperfusion in domestic
pigs either untreated or pretreated with amlodipine, perindoprilate or amlodipine +
perindoprilate iv.
Results: Ischemia-reperfusion induced tachycardia, reduced dMAP and LV dP/dt
max, and alterations of mitochondria structural and functional parameters with
decreased oxygen consumption, increased reactive oxygen species production
and reduced calcium retention capacity with opening of mitochondrial permeability
transition pores. No drug treatment changed hemodynamic and electrophysiological
parameters, but amlodipine and perindoprilate, either alone or combined, prevented
mitochondrial alterations.
Conclusion: Amlodipine or perindoprilate pretreatment decreased all mitochondrial
I/R lesions in this pig model. The calcium antagonistic properties of amlodipine and
the prevention of NO synthesis reduction by both amlodipine and perindoprilate are
suggested to account for these cardioprotective effects.
P1503
Early changes in neutrophil morphology predict myocardial damage after
myocardial infarction
G P JGeert Van Hout1 ; R De Jong2 ; MPJ Teuben3 ; F Nijhoff4 ; HJ Duckers4 ; L
Koenderman3 ; P Stella4 ; WW Van Solinge5 ; G Pasterkamp1 ; IE Hoefer1
1
University Medical Center Utrecht, Division Heart and Lungs, Experimental
Cardiology, Utrecht, Netherlands; 2 Erasmus Medical Center, Department of
Cardiology, Rotterdam, Netherlands; 3 University Medical Center Utrecht,
Department of respiratory medicine , Utrecht, Netherlands; 4 University Medical
Center Utrecht, Department of Cardiology, Utrecht, Netherlands; 5 University
Medical Center Utrecht, Department of Clinical Chemistry and Haematology ,
Utrecht, Netherlands
Background: Myocardial infarction (MI) induces a strong inflammatory response
resulting in an increase of circulating neutrophils. Neutrophil quantities have found
to be a good predictor for future adverse events, including heart failure, after MI. In
this study, we hypothesized that the extent of morphological changes in circulating
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
298
Abstracts
neutrophils also reflects the myocardial damage after MI and therefore relates to
outcome.
Methods: One hundred seven STEMI patients with at least one white blood cell
count determined by an hematology analyzer within 24 hours after PCI were
selected. This analyzer differentiates between leukocyte subsets based on morphological characteristics derived from light scatter patterns. Neutrophil morphology
was compared with simultaneously measured creatine kinase (CK). Pigs (n = 9) were
subjected to 75 minutes of coronary artery occlusion followed by 3 days of reperfusion. Blood was collected at baseline, during ischemia and during reperfusion
followed by whole-blood analysis with the same hematology analyzer as above.
Cardiac damage was determined by histological infarct size, ejection fraction measured by echocardiography and Troponin measurements. Coronary blood sampling
was performed to determine differences in neutrophil morphology between simultaneously sampled arterial and venous coronary blood. Flow cytometry (CD11b,
L-selektin, CD16) and cell sorting was performed to assess changes in the composition of the total circulating neutrophil population.
Results: In STEMI patients, we observed a significant increase in neutrophil axial
light loss (ALL, p < 0.001), correlating with CK levels (R% = 0.314, p < 0.001). In pigs,
neutrophil ALL increased over time (p < 0.001). Neutrophil ALL measured 15 min
after reperfusion correlated significantly with infarct size (R% = 0.745, p% = 0.021),
Troponin I levels (R% = 0.792, p% = 0.019) and ejection fraction (R% = -0.760,
p% = 0.017). Neutrophil ALL differed significantly between arterial and coronary
sinus sampled blood (p% = 0.013). Flow cytometry and cell sorting showed a
relative increase in circulating hypersegmented and banded neutrophils in pigs
after MI.
Conclusion: MI alters the morphology of circulating neutrophils in both patients and
pigs. In pigs, neutrophil ALL early after reperfusion predicts infarct size and cardiac
function after 3 days and coronary sampling pinpoints the heart as a direct source
of the induced changes. The change in neutrophil ALL reflects an altered composition of circulating neutrophil subsets after MI. These results suggest neutrophil
morphology could serve as a prognostic marker for the prediction of heart failure
after MI.
P1504
The potential of myocardial shockwave therapy to cause reverse remodeling
in patients with ischemic cardiomyopathy
G Burneikaite1 ; G Zuoziene2 ; J Celutkiene1 ; A Laucevicius1
Vilnius University, Faculty of Medicine, Vilnius, Lithuania
1
Objectives: New myocardial revascularisation method – myocardial shockwave
therapy (MSWT) - stimulates angiogenesis in experimental studies. We hypothesize, that MSWT improves myocardial global and regional contraction in patients
with ischemic cardiomyopathy (ICMP).
Design: Stable patients (n = 28) with a history of one or more myocardial infarctions were selected for MSWT. Patient eligibility was based on positive functional imaging testing: technetium-99m SPECT or dobutamine stress echocardiography (DSE). Full clinical and functional evaluation was performed before
and 6 months after study therapy. MSWT was applied using commercially available MSWT generator system under echocardiographic guidance. Protocol of
MSWT application formed 3 sessions every month during 3 months, each session included 3 application procedures per week. Left ventricular (LV) morfometry and function were assessed by cardiac MRI. Wall motion score index (WMSI)
was evaluated by 2D echo at rest and during dobutamine stress. The statistical software package SPSS 17.0 (version for Windows) was used for the data
analysis.
Results: 28 patients (9 women and 19 men; mean age 67.7 ± 9.5 years, range 44-83;
8 women and 17 men after CABG, half of patients after PCI) were included in the
study. After MSWT LV EF increased from 50.0 ± 13.1% to 54.9 ± 12.9% (p < 0.001),
WMSI at rest and at peak stress decreased from 1.61 ± 0.43 to 1.45 ± 0.38 (p < 0.001)
and from 1.53 ± 0.44 to 1.33 ± 0.36 (p < 0.001), respectively . Transient ischemic
dilatation (TID) estimated by SPECT decreased from 1.15 ± 0.12 before treatment to
1.08 ± 0.11 after treatment (p < 0.001). In the subgroup of elderly patients (age ≥ 74,
n = 12) after treatment LV EF increased by 5.2% (from 45.4 ± 11.3% to 50.6 ± 10.4,
p% = 0.008), LV volumes reduced (LV EDV from 163.3 ± 83.3 ml to 154.8 ± 62.9 ml,
LV ESV from 94.5 ± 71.2 ml to 84.6 ± 57.5 ml, p% = ns). WMSI decreased in the
elderly subgroup by 0.2 (p% = 0.005) and 0.15 (p% = 0.016) at rest and at peak
stress, respectively. SPECT revealed a reduction of transient ischemic dilatation by
0.09 after treatment. Improvement of contraction was associated with the improvement of local perfusion by SPECT.
Conclusions: This study demonstrates the potential of MSWT to cause the
reverse remodelling in patients with ICMP as demonstrated by the dynamics
of LV global and regional contraction in parallel with LV volumes. Improvement of LV function and morfometry coincides the improvement of myocardial
perfusion.
P1505
Modulation of the diastolic response to hemodynamic overload in the
ischemic myocardium - a novel promising therapeutic benefit of
phosphodiesterase 5 inhibition
JSJoao Sergio Neves; J Almeida-Coelho; AM Leite-Moreira; M Neiva-Sousa;
R Castro-Ferreira; R Ladeiras-Lopes; AF Leite-Moreira
University of Porto, Faculty of Medicine, Department of Physiology and
Cardiothoracic Surgery, Porto, Portugal
Purpose: Acute myocardial stretch induces both systolic and diastolic adaptive
responses. The diastolic response appears to be dependent on Protein Kinase G
(PKG) activity. This adaptive response is impaired in the ischemic setting. Therefore, we aimed to evaluate the effects of the modulation of PKG related signaling
pathways in the diastolic response to acute hemodynamic overload under ischemic
conditions.
Methods: Rabbit papillary muscles (0.2Hz, 30∘ C) were acutely stretched from 92%
to 100% of Lmax in a modified Krebs-Ringer solution in the absence (A) (n = 9)
or presence of (B) Rp-8-Br-PET-cGMPS (inhibitor of PKG, 10-6M, n = 7). Group C
was stretched during ischemia and other protocols were performed in the ischemic
setting in the presence of (D) 8-Bromo-cGMP (agonist of PKG, 10-5M, n = 7), (E)
B-type Natriuretic Peptide (BNP, 10-6M, n = 7), (F) S-Nitroso-N-acetylpenicillamine
(SNAP, nitric oxide donor, 10-5M, n = 9), (G) Sildenafil [phosphodiesterase 5
(PDE5) inhibitor, 10-6M, n = 7] and Sildenafil combined with either (H) BNP
(n = 8) or (I) SNAP (n = 6). Immediate and delayed responses to muscle stretch
were evaluated. Results are presented as mean ± standard error of mean
(P < 0.05).
Results: Under basal conditions, after immediate increase in myocardial passive tension (PT) induced by acute myocardial stretch, there was a significant
decrease in PT of 46.2 ± 1.8% in the 15 minutes following stretch. The inhibition of PKG significantly blunted this response (decrease in PT of 26.3 ± 1.1%).
Under ischemic conditions, the diastolic adaptive response to acute stretch was
completely abolished (increase in PT of 3.5 ± 8.1%). The presence of an agonist of PKG promoted a significant decrease in PT of 20.6 ± 3.2% after stretch
during ischemia, as did the addition of sildenafil (decrease of 14.9 ± 5.3%).
The presence of either BNP or SNAP did not significantly improve the diastolic
response (decrease in PT of 5.6 ± 6.7% and 9.2 ± 6.2%, respectively). Interestingly,
the simultaneous addition of sildenafil with BNP or SNAP elicited a synergistic effect, with the fall in PT being significantly greater than the one observed
when either drug was added alone (decrease of 30.3 ± 6.4% and 34.1 ± 4.7%,
respectively).
Conclusions: The impaired diastolic response to stretch under ischemic conditions
can be reversed by PDE5 inhibition and the improvement of the diastolic response
by BNP or NO was only observed in the presence of sildenafil. These results suggest that PDE5 inhibition may be a promising therapeutic target to boost cardiac
adaptation to hemodynamic overload during acute myocardial ischemia.
P1506
Bendavia (MTP-131), a novel mitochondria-targeting peptide, normalizes
expression of cardiolipin remodeling genes and proteins in left ventricular
myocardium of dogs with advanced heart failure
HNHani Sabbah; RC Gupta; S Rastogi; P Mohyi; M Wang; KJ Szekely;
K Zhang
Henry Ford Hospital, Detroit, United States of America
Background: Cardiolipin (CL) is a phospholipid localized to the inner mitochondrial (MITO) membrane. CL is essential for oxidative phosphorylation (OX-PHOS)
and is synthesized by CL synthase 1 (CLS1) and remodeled by Tafazzin1 (TAZ1),
monolysocardiolipin acyltransferase- (MLCLAT1) and acyl-CoA:lysocardiolipin
acyltransferase-1 (ALCAT1). We previously showed that CL and ATP synthesis are
reduced in LV myocardium of dogs with heart failure (HF) and restored after chronic
therapy with Bendavia (BEN), a novel MITO targeting peptide. This study examined
the effects of BEN on mRNA expression of CLS1, TAZ1, MLCLAT1 and ALCAT1
and protein levels of TAZ1 and ALCAT1 in LV of dogs with microembolizationinduced HF.
Methods: 14 HF dogs were randomized to 3 months therapy with subcutaneous
injections of BEN (0.5 mg/kg once daily, n = 7) or saline (Control, n = 7). LV tissue was
obtained from all study dogs and from 6 normal (NL) dogs. mRNA expression was
measured by real-time PCR, normalized to GAPDH and expressed as fold changes.
Protein levels were measured with Western blots and expressed in densitometric
units (du).
Results: Compared to NL, mRNA expression of TAZ1 and CLS1 decreased in
HF-Controls while mRNA of MLCLAT1 and ALCAT1 increased (Table). Protein level
of TAZ1 decreased in HF-Controls and that of ALCAT1 increased. Treatment with
BEN normalized expression of all genes and proteins (Table).
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
299
Conclusions: Dysregulation of CL synthesizing/remodeling enzymes exist in HF.
Therapy with BEN reverses these maladaptations allowing for improved OX-PHOS.
NL
HF-Control
HF-BENDAVIA
TAZ1 mRNA (Fold Change)
1.0
2.25 (decrease)* 1.23 (decrease)†
TAZ1 Protein Level (du)
0.69 ± 0.04 0.36 ± 0.04*
0.58 ± 0.04†
MLCLAT1 mRNA (Fold Change) 1.0
2.60 (increase)*
1.18 (increase)†
ALCAT1 mRNA (Fold Change)
1.0
3.56 (increase)*
1.54 (increase)†
ALCAT1 Protein Level (du)
0.28 ± 0.03 0.54 ± 0.02*
CLS1 mRNA (Fold Change)
1.0
0.37 ± 0.03†
2.19 (decrease)* 1.39 (decrease)†
*% = p < 0.05 vs. NL; †% = p < 0.05 vs. HF-Control
P1507
Statins as potential FXR modulators in atrial cardiomyocytes: a gender, age
and miR328 controlled response
VVassilios Salpeas1 ; J Tsoporis2 ; S Izhar2 ; G Proteau2 ; E Sakadakis1 ; M
Anastatasiou-Nana1 ; TG Parker2 ; I Rizos1
1
Attikon University Hospital, Athens, Greece; 2 St. Michael’s Hospital, Toronto,
Canada
Farnesoid × receptor (FXR) plays an important role in lipid and glucose metabolism
and statins are known negative regulators of FXR expression at the RNA, protein
and DNA-binding activity levels in experimental hepatocyte models.
FXR antagonists could potentially lower LDL cholesterol levels and even modulate
high-density lipoprotein metabolism. FXR is a complicated but fascinating target for
the development of new therapeutic approaches.
MicroRNAs are small non-coding RNAs that play an important role in gene regulation. Each microRNA likely regulates hundreds of mRNAs and thus has the potential
to affect many biologic processes. MicroRNA-328 (miR-328) contributes to adverse
electrical remodeling in Atrial Fibrillation a common complication after coronary
artery bypass grafting (CABG).
The present study aimed to examine the levels of FXR mRNA and miR328 in 30 consecutive patients undergoing CABG. The patients group was made up of 10 women
and 20 men with a mean +/- S.E. age of 68.5+/-2.1 and 64.3+/-2.3 years respectively, 14 of them in statin therapy. We analysed right atrial biopsies taken before
aortic occlusion and after reperfusion.
Mean (S.E.) FXR mRNA levels were 3.41+/-1.07 and mean (S.E.) miR-328 levels were
0.61+/-0.15.
We assessed miR-328 expression in human tissue to confirm its potential relevance
to human FXR cardiac gene regulation and adjusted the results for the combined
confounding effect of age, gender and statin therapy. The linear model described
showed a significant relationship of all the above predictors to FXR mRNA levels
(p% = 0.004).
On average and holding everything else fixed:
-mRNA FXR levels post-pre CABG in patients under statin therapy were -2.6 units
lower (95% C.I. -4.43,-0.80) than in patients not taking statins (p% = 0.007).
-every additional year of age results to FXR mRNA being 0.27 units higher (95% C.I.
0.04, 0.48) (p% = 0.018).
-female patients FXR levels were 2.10 units higher (95% C.I. 0.12, 4,09) than their
male counterparts (p% = 0.039).
-miR-328 levels post-pre CABG (after log transformation for normality) showed an
significant inverse relation (p% = 0.035) with FXR mRNA levels, specifically for every
unit increase of miR-328 a 16 unit decrease of FXR mRNA levels occurred (95% C.I.
-30.96, -1.28).
These results suggest that FXR regulation during CABG is dependent on statin therapy, is gender specific and increases with age. Also the inverse relation of FXR mRNA
with miR-328 suggests a possible interplay between metabolic and electrical substrate alterations for the atrial myocardium during CABG.
P1508
Genetic polymorphism of plakophilin-2 (PKP2) and desmoglein-2 (DSG2)
genes in Russian patients with arrhythmogenic right ventricular
cardiomyopathy
A Shestak1 ; O Blagova2 ; YU Frolova1 ; S Dzemeshkevich1 ; E Zaklyazminskaya1
Russian Research Center of Surgery, Laboratory of Medical Genetics, Moscow,
Russian Federation; 2 I.M. Sechenov First Moscow State Medical University,
Moscow, Russian Federation
1
Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease characterized by progressive fibro-fatty replacement of the myocardium
leading to malignant electrical instability and sudden cardiac death. Mutations in five
genes encoding desmosomal proteins cause ARVC. Mutation rate in those genes in
Russian cohort had not been studied yet.
Methods: Twenty unrelated Russian ARVC patients were examined with collecting
of personal and family history, physical examination, ECG, Echo-CG, myocardial
biopsy and cardiac MRI. Analysis of PKP2 and DSG2 genes was performed by direct
Sanger sequencing.
Results: Screening of mutations in PKP2 and DSG2 genes in 20 DNA samples
was performed. We found three rare genetic variants in PKP2 gene: two truncating mutations (𝜌.W538X and c.1523_1538del) and one missense variant, p.S140F.
Patients carrying 3 genetic variants had manifestation at third-fourth decade of life
with high-grade ventricular arrhythmia; ICDs were implanted in two cases.
We found three rare genetic variants in DSG2 gene: p.S194L, p.N245H, p.R49H,
and two missense VUCSes (p.V533I and p.V158G). Variants p.S194L, p.N245H and
p.R49H were analyzed by PolyPhen2 and considered ‘probably damaging’. These
genetic variants have not been observed in healthy cohort (100 samples). Four
patients carrying 5 genetic variants had a manifestation at third decade of life with
ventricular tachycardia, RV hypertrophy, and indications for ICD.
Conclusion: We identified eight genetic variants in 20 Russian ARVC index patients.
Three probands (15%) were PKP2-positive. Four probands (25%) carry mutations in
DSG2 gene. This prevalence matches with the prevalence of ARVD9 and ARVD10 in
other European populations (HRS/EHRA Expert Consensus Statement). Truncated
mutations and probably damaging variants (according to bioinformatics prediction)
account for 25% mutations. This ratio of positive DNA-diagnostics tests looks reasonable to be introduced into clinical practice in our Centre.
P1509
The role of intercellular interaction mechanisms in pathogenesis of
hypertensive remodelling
GGanna Tytova; O Liepieieva; N Ryndina; PG Kravchun
Kharkiv National Medical University, Kharkiv, Ukraine
Purpose: Research different links of intercellular interaction at the level of
immune-inflammatory chain (TNF-𝛼), nitric oxide system (NO2, NO3, S-nitrosothiol)
and function activity of 𝛼2- and 𝛽2 - adrenoreceptor complex in different types of
hypertensive heart remodelling.
Methods: 314 patients with hypertensive disease (HD) II st. and 20 healthy people
as control were examined. The level of NO metabolites was defined by method of
diazo reaction with Gris’s chemical and further colorimetry with estimation of nitric
compound.Functional activity of platelet 𝛼2 and 𝛽2-AR complex was detected in
vitro by ultra high frequency dielectrometry.TNF-𝛼 was accessed by immunoenzyme method. Echocardiography with doppler was performed to all patients with
determination of standart datas of structural and functional parameters of left
ventricle myocardium. Patients were divided into 4 groups according to types of left
ventricle remodelling by A.Ganau (1992). 1st gr (n = 75 pts) - normal geometry, 2nd
gr (n = 81 pts) - concentric remodelling, 3rd gr (n = 80 pts) - concentric hypertrophy,
4th gr (n = 78 pts) - eccentric hypertrophy.
Results are shown in the table.
Conclusions: In hypertensive patients with normal geometry, concentric remodelling and concentric hypertrophy compensatory reactions such as increased
secretion of NO and increased activity of adrenoreceptor complex were found,
eccentric hypertrophy was characterized by highest expression of these reactions
and their further transformation into irreversible pathologic processes with complete
depletion of compensatory mechanism with apoptosis induction, oxidative stress
activation, destructive processes, decreasing of mollecular-cellular response and
increasing of myocardial dysfunction.
P1510
Will the myosin activator omecamtive mecarbil provide a potent therapeutic
approach for systolic heart failure?
L Nagy1 ; A Kovacs1 ; B Bodi1 ; A Toth1 ; I Edes2 ; Z Papp1
University of Debrecen, MHSC-Faculty of Med., Institute of Cardiology, Division
Clinical Physiology, Debrecen, Hungary; 2 University of Debrecen, MHSC-Faculty of
Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
1
Decreased cardiac contractility is a central feature of systolic heart failure, and
omecamtive mecarbil, a novel cardiac myosin activator drug may provide inotropic
support for weakened cardiac contractions. The aim of this study was to characterize a hypothetical Ca2+-sensitizing effect of omecamtive mecarbil and to determine
the tissue selectivity of its action.
Direct force measurements were performed in myocyte-sized preparations
derived from left ventricular tissue samples and in isolated skeletal muscle
myofibers isolated from the diaphragm of Wistar rats. Isolated and permeabilized
muscle preparations attached between a force transducer and an electromagnetic motor were exposed to test solutions with increasing concentrations of
omecamtive mecarbil (between 10nM and 100mM) to test its concentration
dependent effects on Ca2+-regulated force production and on its Ca2+-sensitivity.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
300
Abstracts
60051 Datas and results
Datas
Control group
(n = 20)
1st group
(n = 75)
2nd goup
(n = 81)
3rd group
(n = 80)
4th group
(n = 78)
TNF-𝛼, picogram/ml
32.14±11.95 ×
40.71±5.88 ×
46.16±6.31 ×
45.62±10.82 ×
61.23±14.5
𝛼2 - AR
1.07±0.2 ×
1.19±0.67 ×
0.75±0.14
1.3± 0.62 ×
2.08±0.92 ∘ ,2 , ×
0.53±0.18
𝛽2 - AR
1.77±0.96 ×
1.72±0.28 ∘ ,×
NO3, mg%
0.59±0.17 ×
0.50±0.17 ×
0.49±0.17 ×
0.89±0.17
NO2, mg%
0.31±0.19
0.30±0.19
0.33±0.19
0.79±0.21 ,2
0.52±0.22 ∘ ,,2
S-nitrosothiol, mg%
0.98±0.013
0.92±0.213
1.01±0.253
1.36±0.27
0.98±0.173
1.2±0.85
0.92±.0.61
0.51±0.17 ∘ ,,2
0 -p < 0.05 vs control -p < 0.05 vs 1st group 2 -p < 0.05 vs 2nd group 3 -p < 0.05 vs 3rd group × -p < 0.05 vs 4th group
Moreover, we made efforts to characterize drug induced changes in passive
(Ca2+-independent) mechanical muscle properties, and on the rate constant of
actin-myosin cross-bridge cycle (ktr).
Administration of omecamtive mecarbil in a concentration range between 0.1𝜇M
and 1𝜇M led to significant increases (P < 0.05) in the Ca2+-sensitivity of force production in cardiomyocytes (pCa50 in drug free controls: 5.85 ± 0.016; at 0.1𝜇M
and 1𝜇M drug concentrations: 5.98 ± 0.014 and 6.452 ± 0.05, respectively; n = 10;
mean ± SEM) as well as in diaphragmatic skeletal myofibers (pCa50 in drug free
controls: 5.61 ± 0.004; and at 1𝜇M drug concentration: 5.85 ± 0.02; n = 8). Moreover, omecamtive mecarbil significantly increased passive forces at 1𝜇M concentration and higher in isolated cardiomyocytes (Fpassive drug free: 0.62 ± 0.05
kN/m2 and at 1𝜇M drug concentration: 2.12 ± 0.12 kN/m2 ; n = 10) and in diaphragmatic muscle fibers (Fpassive in drug free controls: 0.68 ± 0.09 kN/m2 , and at 1𝜇M
drug concentration: 0.93 ± 0.08 kN/m2 , n = 10) as well. Finally, omecamtive mecarbil slowed down the actin-myosin cycle as indicated by significant decreases in
ktr parameter measured in isolated skeletal myofibers (ktr in drug free controls:
1.14 ± 0.06 1/s and at 0.3𝜇M drug concentration: 0.96 ± 0.05 1/s; IC50: 1.44 𝜇M;
n = 8).
Our data illustrate omecamtive mecarbil as a potent positive inotropic agent, exerting its cardiotonic effect via a Ca2+-sensitizing mechanism. However, omecamtive
mecarbil appears to be a non-selective myosin activator drug also enhancing the
contractility of the rat diaphragm. Moreover, the drug may also impair diastolic function by reducing the rate of the actin-myosin cycle and by increasing cardiomyocyte
passive force.
P1511
P1512
Effect of Danqi Tablet on the heart function and plasma proteome of chronic
myocardial ischemia swines
S Guo; W Chuo; Y Wang; H Lian; X Feng; B Fu; H Xie; L Zheng; W Wang
Beijing University of Chinese Medicine, School of Preclinical Medicine, Beijing,
China, People’s Republic of
Purpose: Danqi Tablet is one of the most widely used Chinese herbal medicines in
cardiovascular disease. In this study, we will investigate the effect of Danqi Tablet on
chronic myocardial ischemia and explore its mechanism by proteomic techniques.
Methods: Myocardial ischemia was induced by a constrictor on the left coronary
artery of Chinese Mini Swines(25 ± 4kg, 6-10 months, 6 animals in each group). After
treated by Danqi Tablet with the clinical equivalent dose (9g per day per animal) for 4
weeks, echocardiography was performed. And then changes of both general heart
and paraffin sections stained by hematoxylin-eosin staining or Masson trichrome
staining were observed. At last, two-dimension electrophoresis and mass spectrometer was used to analyze the changes of plasma proteome.
Results: Increased end-systolic thickness of ventricular interval was detected by
echocardiography. Decreased number and areas of white scares under endocardium as well as the collagen deposit areas in Masson trichrome stained sections
were found in the Danqi Tablet treated animals. In the plasma proteome, the abundances of 9 protein spots were decreased while 11 protein spots increased in animals treated by Danqi Tablet. Among them, Apolipoprotein A-I and apolipoprotein E
were identified as increased proteins after the treatment of Danqi Tablet.
Conclusions: Danqi Tablet may reduce the ischemia area and hold back myocardial
remodeling in chronic myocardial ischemia animals, which may partly result from its
negative regulation of the excessive inflammation by increasing plasma apolipoprotein A-I and apoliopoprotein E.
Role of galectin-3 in vascular remodelling associated with obesity
E Martinez1 ; E Rousseau2 ; M Miana3 ; R Jurado-Lopez3 ; L Calvier2 ; P Rossignol2 ;
F Zannad2 ; V Cachofeiro3 ; N Lopez-Andres1
1
Cardiovascular Translational Research. NavarraBiomed (Fundación Miguel Servet),
Pamplona, Spain; 2 INSERM, Centre d’Investigations Cliniques- 9501, UMR 1116,
Université de Lorraine and CHU de Nancy, Nancy, France; 3 Complutense University
of Madrid, Department of Physiology, Madrid, Spain
Purpose: Obesity is associated with vascular remodelling, mainly characterized
by media thickening and arterial stiffness, a change known to be predictive of
increased cardiovascular mortality. Vascular remodelling is accompanied by alterations in extracellular matrix (ECM) composition. Galectin-3 (Gal-3) is a beta
galactoside-binding protein that induces vascular fibrosis in vitro. In the present
study we explore the role of Gal-3 in vascular remodelling associated with obesity
in vivo.
Methods: Male Wistar rats were fed a high-fat diet (HFD; 33.5% fat, n = 8),
or a standard diet (CT; 3.5% fat, n = 8) combined with modified citrus pectin
(MCP, an inhibitor of Gal-3 activity) (100 mg⋅kg(-1) ⋅day(-1); n = 10) in water
drinking for 6 weeks. Levels of ECM components and inflammatory markers were evaluated in the media of the aorta by RT-PCR, Western blot and
immunohistochemistry.
Results: HFD group showed a significant increase in body weight as compared to
the control group. Co-treatment with MCP did not modified body weight in obese
animals. HFD group presented increased vascular mRNA and protein expressions
of Gal-3, collagen type I, collagen type III, fibronectin, TGF-𝛽, CTGF, osteopontin and monocyte chemotactic protein-1. The inhibition of Gal-3 reversed all the
above effects. MCP did not modify aortic structure or composition in control
animals.
Conclusions: Obesity is associated with increased vascular ECM protein deposition. Gal-3 inhibition blocks the development of vascular remodelling and
dysfunction in obesity. Thus, our data suggest that Gal-3 could be a new biotarget
in vascular alterations and its blockade could have beneficial effects independently
of body weight.
P1513
Production of autoantibody to beta1-receptor is suppressed by treatment
with omega-3 ethyl ester in experimental failing heart model.
N Tribulova1 ; J Radosinska2 ; B Bacova1 ; G Wallukat3 ; V Knezl4 ; J Zurmanova5 ;
T Soukup6 ; M Barancik1 ; J Slezak1
1
Slovak Academy of Sciences, Institute for Heart Research , Bratislava, Slovak
Republic; 2 Comenius University, Faculty of Medicine, Bratislava, Slovak Republic;
3
Max Delbruck Center for Molecular Medicine, Berlin, Germany; 4 Slovak Academy
of Sciences, Institute of Experimental Pharmacology & Toxicology, Bratislava,
Slovak Republic; 5 Charles University of Prague, Faculty of Sciences, Dept.Physiol.,
Prague, Czech Republic; 6 Academy of Sciences of the Czech Republic, Institute of
Physiology, Prague, Czech Republic
Background and Purpose: Autoantibody production to the adrenergic beta-1
receptors (b1-AAB) is known to contribute to development of dilated cardiomyopathy and arrhythmogenic substrate. Hypertension if not properly controlled is
deleterious to health due to inflammation, myocardial remodelling and enhancement
of b1-AAB. Numerous reports, including ours, indicate cardioprotective effects of
omega-3 FA in condition when omega-3 index is low. We hypothesized that omega-3
intake may affect production of b1-AAB, myocardial remodelling and connexin-43
(Cx43) mediated electric cell-to-cell coupling in aged spontaneously hypertensive
rats (SHR).
Methods: Male and female SHR as well as their age-and-sex-matched healthy Wistar rats fed by standard laboratory chow were compared with those supplemented
with pure omega-3 ethyl ester (200 mg/kg b.w. /day) for two months. Omega-3 index
was determined using red blood cells and b1-AAB in blood serum. Left ventricular tissue was examined for Cx43, myosin heavy chain (MyHC), activity of matrix
metalloproteinase 2 (MMP2) and ultrastructure. Susceptibility to electrically-induced
ventricular fibrillation (VF) was examined using Langendorff-perfused heart.
Key Results: Comparing to healthy rats, male and female SHR exhibited lower
omega-3 index, significant increase of b1-AAB, activity of MMP2, shift of alpha to
beta MyHC isoform, down-regulation and miss-localisation of Cx43 and subcellular
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
injury of the cardiomyocytes. It was associated with higher incidence of VF. Omega-3
intake resulted in clear-cut decrease of BP, b1-AAB levels and MMP2 activity in both
male and female SHR. In addition, there was an increase of Cx43 mRNA and protein
expression, partial elimination of Cx43 miss-localisation and preservation of subcellular integrity of cardiomyocytes and their junctions as well as decrease of VF
comparing to untreated SHR. MyHC profile was not affected by treatment in SHR
but increase of alfa MyHC was observed in aged Wistar rats.
Conclusions: Findings revealed novel mechanisms implicated in cardioprotective
effects of omega-3 fatty acids via suppression of beta1-adrenoceptors autoantibody production and extracellular MMP-2 activity. It was linked with up-regulation of
myocardial Cx43, improvement of cardiomyocytes integrity and protection from VF.
P1514
Initial reperfusion of DCD hearts under hypothermic conditions impairs
myocardial functional recovery during ex vivo heart perfusion
CW White1 ; E Ambrose2 ; A Muller2 ; J Thliveris3 ; TW Lee4 ; RC Arora1 ; G Tian5 ;
J Nagendran6 ; LV Hryshko2 ; DH Freed6
1
University of Manitoba, Cardiac Surgery, Winnipeg, Canada; 2 Institute of
Cardiovascular Sciences, Winnipeg, Canada; 3 National Research Council Institute
for Biodiagnostics, Winnipeg, Canada; 4 Mazankowski Alberta Heart Institute,
Edmonton, Canada
Purpose: Initial reperfusion (IR) of donor hearts following circulatory death (DCD)
with cardioplegia may facilitate restoration of ion homeostasis prior to myocardial
contraction, minimize ischemia-reperfusion injury, and optimize functional recovery.
We investigated the impact of IR temperature on the recovery of myocardial function
during ex vivo heart perfusion.
Methods: Eighteen pigs were anesthetized, mechanical ventilation was discontinued, and cardiac arrest ensued. A 15-minute standoff period was observed and then
hearts were procured and reperfused with a normokalemic adenosine-lidocaine
crystalloid cardioplegia for 3 minutes at 3 different temperatures (5∘ C; N = 6, 25∘ C;
N = 5, and 35∘ C; N = 7). Hearts were then perfused ex vivo in a normothermic
beating state and transitioned into working mode (left atrial pressure: 8 mmHg)
at 1, 3, and 5 hours for assessment of myocardial function using a conductance
catheter.
Results: Hearts sustained an equivalent period of warm ischemia (5∘ C% = 28 ± 1,
25∘ C% = 29 ± 1, 35∘ C% = 27 ± 1 minutes, p% = 0.50) prior to IR. IR coronary blood
flow (5∘ C% = 483 ± 53, 25∘ C% = 722 ± 60, 35∘ C% = 906 ± 36 mL/min, p < 0.01) and
coronary sinus lactate concentration (5∘ C% = 0.73 ± 0.06, 25∘ C% = 1.33 ± 0.03,
35∘ C% = 1.75 ± 0.15 umol/L, p < 0.01) differed among treatment groups. IR under
hypothermic conditions impaired systolic (dP/dt max) and diastolic (dP/dt min)
functional recovery (Figure 1). Electron microscopy revealed greater preservation of
endothelial cell integrity in hearts reperfused at warmer temperatures (injury score
5∘ C% = 3.2 ± 0.5, 25∘ C% = 1.8 ± 0.2, 35∘ C% = 1.7 ± 0.3 minutes, p% = 0.01).
Conclusions: Avoidance of profound hypothermia during IR with an
adenosine-lidocaine cardioplegia preserves endothelial integrity and improves
the functional recovery of DCD hearts.
301
receptor antagonist), norepinephrine and endothelin-1 in concentration range of
10-7-10-5 M.
Results: Diabetes induced HF manifested mainly by cardiac output and Opie index
fall by 43-48%, doubly end-diastolic pressure rise and endothelium dependent aorta
relaxation impairment (Ach reduced phenylephrine plateau up to 62% from control).
Coronary reserve measured during Ach, adenosine and Br action was significantly
reduced by 31, 23,6 and 19,4% respectively. However, Br action after B2 receptor inhibition led even to a higher coronary flow increment than control heart (9,8 vs
7,3%), that suggests up expression of B1 receptor in HF. Hydrogen peroxide infusion
showed a preserved coronary reserve in concentration of 10-7 M and even higher
than control in 10-5 M (15,2 vs 13,8%). Likewise, Ang 1-7 infusion determined a similarly to control coronary flow increase in all concentrations (7-10 vs 7-11%), effect
abolished by mas receptor antagonizing. On the other hand, A779 boosted Ang II
induced coronary flow fall: more in control in low concentration and more in HF in
high concentration. Norepinephrine and endothelin-1 decreased coronary flow more
pronounced in HF by 11,7 and 14,2% (p < 0,05).
Conclusions: (1) Endothelium dependent coronary reserve due to Ach, adenosine
and Br action is decreased in HF, associated with increased norepinephrine and
endothelin-1 induced coronary constriction. (2) Coronary reserve is preserved in HF
when bradykinin acts in condition of B2 receptor inhibition underlining the B1 receptor up expression as a compensatory event. (3) Hydrogen peroxide and Ang 1-7
demonstrated a similarly to control pattern coronary flow rise and coronary reserve
mediated by pyrimidine and mas receptors may be also viewed as important compensatory mechanisms in condition of endothelium dysfunction.
P1516
Angiotensin-(1-7) modulates Angiotensin II vasoconstrictor effect in human
mammary artery
LLuis Mendonca; P Mendes-Ferreira; A Leite; M Pintalhao; MJ Amorim;
P Pinho; C Bras-Silva; A Leite-Moreira; P Castro-Chaves
Faculty of Medicine University of Porto, Physiology and Cardiothoracic Surgery,
Porto, Portugal
Purpose: Renin-angiotensin system is central in cardiovascular pathophysiology,
particularly in hypertensive disease. Angiotensin-(1-7) (ANG-(1-7)) has received
increasing importance by its ability to counter-regulate angiotensin II (ANG II) effects.
However, the mechanisms underlying ANG-(1-7) effects in human vessels remain
unexplored. We investigated ANG-(1-7) effect on ANG II-induced vasoconstriction
in human mammary artery (HMA) from patients submitted to coronary revascularization surgery.
Methods: Samples of HMA from 17 patients (mean age 67 ± 16 years) were cut into
small rings, mounted in a myograph bath system, normalized and allowed to contract and dilate isometrically. In baseline experiments the rings were incubated with
ANG-(1-7) or vehicle, followed by increasing concentrations of ANGII. This protocol was repeated in the presence of A-779 (Mas receptor inhibitor), PD123177 (AT2
receptor inhibitor), losartan (AT1 receptor inhibitor) and after mechanic endothelium
removal. Western blot analysis and immunohistochemistry techniques were also
performed in order to verify the presence of Mas receptor in HMA.
Results: ANG-(1-7) significantly attenuated ANGII-induced contraction, producing a maximal inhibition of 65.2 ± 3.7%. This effect was not abolished by A-779,
PD123177 or endothelium removal. In the presence of losartan, ANGII response
was attenuated and no differences were observed between ANG-(1-7) and vehicle treated rings. ANG-(1-7) effect was significantly higher in statin-treated patients.
Finally, we observed, for the first time, that Mas receptor is expressed in HMA, particularly in endothelium.
Conclusions: In conclusion, ANG-(1-7) significantly attenuates ANGII-induced
vasoconstriction and, although Mas receptor is expressed in HMA, this effect
seems to be independent of its activation. Additionally, AT2 receptor and endothelium were shown not to mediate this mechanism, which suggests a specific AT1
receptor antagonism. ANG-(1-7) effect seems to be potentiated in statin-treated
patients.
P1517
P1515
Compensatory mechanisms of coronary reserve regulation in heart failure
VValeriu Cobet; L Ciobanu; E Panfile; I Moraru
Institute of cardiology , Chisinau, Moldova, Republic of
Aim: Disclosure of mechanisms of the coronary reserve preservation in heart failure
associated with endothelial dysfunction.
Material and methods: Heart failure (HF) and endothelial dysfunction (ED) were
reproduced in rats by streptozotocin administration. Using model of perfused
isolated working heart and isolated aorta ring HF and ED have been assayed.
The coronary reserve and coronary reactivity were determined using isovolumic perfused heart (Langendorff model) in conditions of vasomotor agents infusion: acetylcholine (Ach), adenosine, bradykinin (Br) or Br+HOE140 (B2 receptor antagonist of Br), hydrogen peroxide, Ang 1-7, Ang II or Ang II+ A779 (mas
Reduced number of circulating progenitor cells in patients with chronic heart
failure and type 2 diabetes mellitus is associated with cardiovascular death
during three years follow-up
TTatyana Kochegura1 ; A Ovchinnikov2 ; L Zhigunova2 ; YE Lakhova2 ;
P Makarevich2 ; V Masenko2 ; YE Parfyonova2 ; F Ageev2
1
Faculty of Basic Medicine M.V. Lomonosov Moscow State University, Moscow,
Russian Federation; 2 Cardiology Research and Production Center, Institute of
Clinical Cardiology, Moscow, Russian Federation
Purpose: Bone marrow-derived CD 34+ circulating progenitor cells (CPCs) play
an important role in myocardial repair and neovascularization of ischemic tissues.
We have shown previously that the number of CPCs decreased in patients with
severe ischemic heart failure (HF) especially in patients with decompensated type
2 diabetes mellitus (Dm2 ) comorbidity. This study was aimed to evaluate the
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
302
Abstracts
relationship between CPCs number and cardiovascular events during the three years
follow-up in patients with ischemic HF.
Methods: The number of CPCs (CD 34+ cells/per million leukocytes) was evaluated
by flow cytometry in 55 patients with postinfarction HF (NYHA classes II - 70%
pts. and III - 30% pts.) and in 22 healthy volunteers. 25 of HF patients had Dm2
comorbidity (HF+Dm2 subgroup).
Results: During the three years follow-up three deaths (all cardiovascular) were
registered in HF group, and no one in the control group. Thus three-years survival
rate in the total group of HF patients was 94% versus 100% in the control group.
In the HF+Dm2 subgroup three-years survival was 88% versus 100% survival in
HF patients without Dm2 because all three deaths were in the HF+Dm2 subgroup.
15 nonfatal events with rehospitalizations were registered in the total HF group
(6 - HF decompensation, 5 - acute coronary syndrome and stenting, 4 - Dm2
decompensation). There was no difference in the number of CPCs in control group
and total HF group (649.9 ± 276.8 vs 638.8 ± 426.2, p>0.1). However the trend
towards lower number of CPCs was found in the subgroup of HF patients with
rehospitalizations and deaths (n = 18) comparing to HF patients without any events
(n = 37), (518.7 ± 447.5 vs 642.5 ± 407.5, p>0.05).
Moreover the number of CPCs in patients with fatalities (n = 3) was significantly lower
than in all other subgroup of HF patients or control group (149.3 ± 92.7, p < 0.01). The
number of CPCs in patients with all hospital admissions for non-fatal cardiovascular
events and decompensation of Dm2 was 554.3 ± 426.1 which was also significantly
higher than in patients with lethal outcomes, but not significantly different from
patients without events.
Conclusions: Substantially reduced number of CPCs in patients with ischemic HF
and Dm2 comorbidity associated with lethal cardiovascular events during 3 years
follow up. These results suggest that low CPCs could be considered as an additional
predictor of cardiovascular mortality in HF patients that should be tested in future
study including large HF patients group.
correlation between high sensitivity troponin T (hsTp T) and BNP and to study the
correlation according to HF etiology.
Materials and Methods: This is a cross-sectional study conducted in a tertiary care academic hospital. Patients admitted with the primary diagnosis of
acute/decompensated HF were eligible; patients with acute coronary syndrome as
the cause of acute HF were excluded. Treatment during hospitalization, timing of
discharge and discharge medication were determined by the attending physician.
A venous blood sample was collected on the discharge day. Patients with higher
and lower hsTp T were compared (cut off 36pg/mL). Correlation between hsTp T
and BNP was determined using the Spearman correlation coefficient. Analysis was
stratified according to ischemic etiology. Predictors of elevated hsTp T were determined by multivariate regression analysis.
Results: A total of 154 patients were studied; 48.1% were male, median age was 78
years, the etiology was ischemic in 48.7% and median (interquartile range) hsTp T
was 36.3 (22.0-65.6) pg/mL. Patients with higher hsTp T were older and had higher
C-reactive protein, IL 6, serum creatinin and BNP, they also had lower hemoglobin
and were less medicated with beta blockers. HsTp T had a moderately strong and
positive correlation with BNP (Rho% = 0.37, p < 0.001) that was of similar magnitude for both patients with ischemic and non-ischemic etiology (Rho 0.34 and 0.36
respectively). HsTp T has a moderately strong and positive correlation with IL 6. The
independent predictors of high hsTp T were older age, higher creatinine and higher
IL 6.
Conclusions: The correlation of high sensitivity troponin T with BNP is similar
in ischemic and non-ischemic HF. Our results suggest that myocardial injury in
HF probably reflects mechanisms other than ischemia and necrosis. Inflammation
appears to play a more important role in myocyte injury and myocardial dysfunction
than necrosis.
P1520
Endogenous glycoside-like factors in patients with chronic heart failure
P1518
Role of novel heart failure metabolite alpha-ketoglutarate and its receptor
gpr99 during pressure overload-induced cardiac hypertrophy
AAmeh Omede; M Zi; S Prehar; A Maqsood; E Cartwright; L Neyses;
M Mamas; D Oceandy
University of manchester, Manchester, United Kingdom
Introduction: Metabolomics is an emerging field aimed at the characterisation of
the serum metabolite patterns in a particular disease. We have recently applied this
approach to heart failure (HF) patients, and identified alpha-ketoglutarate (AKG) as
a novel potential biomarker of HF. AKG can bind to a G-protein coupled receptor,
GPR99, and interestingly this receptor is expressed in the heart. Here we investigated the role of GPR99 during cardiac hypertrophy, a key process in the development of HF.
Results: Genetic ablation of GPR99 in mice (GPR99-/-) resulted in increased hypertrophy following pressure overload by transverse aortic constriction (TAC). Furthermore, GPR99-/- mice showed significantly increased interstitial fibrosis and
increased cell cross sectional area compared to wildtype mice. The cardiac function,
as indicated by fractional shortening (FS), was significantly reduced in the knockout
mice compared to wildtype mice after TAC.
Using a combination of microarray and yeast two hybrid screening analysis we identified a novel signalling pathway downstream of the GPR99 receptor. GPR99 was
found to interact with COP9 signalosome element (CSN5), a proteasome believed
to attenuate the pro-hypertrophic molecule interferon regulatory factor 5 (IRF5) via
the ubiquitin proteasome system. CSN5 expression showed a marked decrease in
knockout TAC mice, while IRF5 was significantly increased in knockout TAC mice
compared to the wildtype littermates. Consistently, we found a significant increase in
IRF5 ubiquitination in neonatal rat cardiomyocytes (NRCM) overexpressing GPR99.
Furthermore, stimulation with AKG induced IRF5 ubiquitination in NRCM overexpressing GPR99. In essence, AKG regulates the stability of a pro-hypertrophic factor
(IRF5) via GPR99-CSN5 complex.
Conclusion: Our findings suggest that AKG and its receptor GPR99 can modify a
hypertrophic response through regulation of IRF5 stability. This study provides additional insight into the role of AKG in the development of cardiac hypertrophy and the
possibility to target this pathway for therapeutical approach.
P1519
Cardiac troponin t correlates with BNP in ischemic and non-ischemic heart
failure
J Vilaca1 ; P Lourenco1 ; L Nogueira Silva1 ; C Pereira1 ; S Silva1 ; JT Guimaraes2 ;
P Bettencourt1
1
Centro Hospitalar de S. João, Internal Medicine Department, Porto, Portugal
Background: Cardiac troponins are markers of myocyte injury with an established
role in the diagnosis of acute coronary syndromes and with known prognostic value
in numerous cardiovascular diseases including heart failure (HF). B-type natriuretic
peptide (BNP) is a marker of ventricular dysfunction. We aimed to determine the
AAlexey Kuchmin; M Nagorny; A Kulikov; S Shulenin; A Bagrov; O Diskalenko
The Kirov Military Academy, St-Petersburg, Russian Federation
Purpose: To study the level of excretion endogenous digitalis-like factors with urine
and their relationship with symptom’s severity, structural and functional parameters
of cardiovascular system in patients with CHF.
Methods: We examined 31 patients aged 41 - 64 years with CHF (I-III classes
according to NYHA functional classification system). The control group included 15
patients with coronary artery disease without symptoms of CHF. ECG, echocardiography and excretion of marinobufogenin and ouabain with urine were assessed.
Excretion of marinobufogenin and ouabain was determined by ELISA reagents company ‘R&D’ (USA) on an automatic photometer ELx 800 firm ‘Biotek’ (USA).
Results: It was found that levels of urinary excretion of MBG and OUA in patients
with CHF were increased. Level of excretion of marinobufagenin correlated positively with ejection fraction of LV and was poorly associated with NYHA class of
CHF. Level of ouabain excretion in patients was related to heart failure symptom’s
severity and NYHA class of CHF.
Conclusion: The development of CHF in patients is accompanied by increased
excretion marinobufagenin and ouabain. It was found different relationships between
levels of marinobufogenin and ouabain excretion and severity of symptoms, structural and functional parameters of cardiovascular system in patients with CHF.
P1521
Prophylactic and therapeutic effects of oleuropein on reperfusion-induced
arrhythmia in anesthetized rat: compared to lidocaine
SYSeyed Yahya Hoseini Nasab; MANSOU Esmailidehaj; JAMILE Alihosaini;
SHIRIN Bajoovand; SAEEDE Esmailidehaj; MOHAMM Ebrahim Rezvani
Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Physiolog,
Yazd, Iran (Islamic Republic of)
Purpose: Although reperfusion of ischemic myocardium is an important prerequisite for its survival, reperfusion itself can cause tissue damage through an excess
generation of free radicals. The goal of the present study was that whether intravenous injection of oleuropein as a potent antioxidant has any effect on reperfusion
arrhythmias in anesthetized rat or not?
Methods: Eighty male Wistar rats were divided into eight groups of ten in each:
group 1 and 2 as the prophylactic and treatment control groups, group 3 as the
prophylactic group with lidocaine, group 4 and 5 as the prophylactic group with
10 and 50 mg/kg oleuropein, group 6 as the treatment group with lidocaine and
groups 7 and 8 as the treatment groups with 10 and 50 mg/kg oleuropein, respectively. Reperfusion was induced by 5 min regional ischemia and 15 reperfusion of
left anterior descending coronary artery. Heart rate and blood pressure were monitor
throughout the procedure.
Results: Normal blood pressure significantly decreased in groups 5 and 8, but unlike
groups 3 and 6 had no significant effect on heart rate. The onset of arrhythmia in
groups 4, 5, 7 and 8 was significantly delayed. The mortality rate due to irreversible
ventricular fibrillation significantly decreased in groups 4, 5, 7 and 8. Intravenous
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
303
infusion of lidocaine in groups 3 and 6 had a stronger effect on the magnitude of
arrhythmia than oleuropein.
Conclusions: These findings indicate that intravenous injection of oleuropein possibly through its antioxidant activity strongly reduces reperfusion-induced arrhythmia.
P1522
Comparative evaluation of cardiac remodeling parameters in patients after
coronary revascularization in dependency of positive vs negative dynamics
wall motion index
AAliona Grivenco; E Vataman; S Filimon; S Aprodu; D Lisii
Institute of Cardiology, Department of Heart failure, Chisinau, Moldova, Republic of
Purpose: to analyze cardiac remodeling parameters in patients with old myocardial
infarction Q-wave the first six months after coronary revascularization dynamics
dependence wall motion index.
Methods: The study included 42 patients, mean age 58,2 ± 1,2 years, who
were undergoing coronary revascularization. All patients performed the initial
echocardiographic examination (phase I) and 6 months (phase II) after coronary
revascularization . Patients whose wall motion index (WMI), calculated in 17 segments, initially and after 6 months was normal limits (score% = 1,0) were excluded.
The remaining patients were divided into two groups depending on the dynamics of
WMI: group 1 (n = 18) included patients, of which more than 6 months WMI had a
positive dynamics and group 2 (n = 17) patients in the WMI had a negative dynamics.
Both groups were compared on the method of revascularization (coronary angioplasty or coronary artery by-pass grafting), functional class (NYHA), the presence
of myocardial hypertrophy of hypertensive origin. Parameters were assessed left
ventricular (LV): end systolic diameter (LVES, mm), end diastolic diameter (LVED,
mm), end-systolic volume (ESV, ml), end-diastolic volume (EDV, ml); sphericity index
at systole (SIs), sphericity index at diastole (SId), wall motion index (WMI), relative
wall thickness (RWT), ejection fraction (LVEF). Results : At the initial phase there
was significant difference LVED (45,8 ± 1,5 vs 50,33 ± 1,3, p < 0,025) and EDV
(109,66 ± 5,5 vs. 137,83 ± 6,09; p < 0,001), both parameters is higher in group
2. In phase II - LVES, LVED, SI or increased importantly, all with decreased LVEF
(60,8 ± 2,5 vs 53,7 ± 2,7, p < 0.05), RWT (0,48 ± 0,02 vs 0,40 ± 0,04, p < 0,05) in
group II . The clinical course was different, the need for repeated hospitalization for
cardiovascular causes in group 2. Of comorbidities in group 2 were only 9 patients
with type II diabetes, severe form, treated with Insulin .
Conclusions: 1 Dynamics negative wall motion index than 6 months after coronary
revascularization was accompanied by negative cardiac remodeling evidenced by
increased LV dimensions, left ventricular ejection fraction decreased, decreasing
the relative wall thickness index LV.
2.This diabetes is a factor that adversely influences global left ventricular contractility development and parameters of cardiac remodeling after coronary
revascularization.
P1523
Non invasive generation of right ventricular pressure volume loops at the
bedside: a feasibility study
J Mathew1 ; K R Balakrishnan2 ; R K Kumar3
Indian Institute of Technology (IIT) Madras, Department of Engineering Design,
Chennai, India; 2 Malar Fortis Hospital, Director, Cardiovascular Division, Chennai,
India
1
Purpose: The aim of this work is to develop an inexpensive and non-invasive
method to generate a pressure volume (PV) relationship of right ventricle(RV) using
clinically available data to evaluate right ventricular function during normal and
pathological conditions. Clinically available hemodynamic measurements are used
as the input for the model. Also, estimation of ventricular- vascular coupling ratio
(VVCR) using a modified single-beat method have also been attempted.
Methods and Results: A closed loop zero dimensional lumped parameter Windkessel model is set up in Simulink to represent the full body arterial system. Based
on Law of conservation of mass a computational mathematical model is developed in MATLAB to model ventricles, arteries and veins using their corresponding
PV relationship. Dynamic interaction between the ventricles is indicated through
volume of the septum. Sensitivity analysis on biological parameters like elastance,
inertance and resistance is done to find the robustness of PV relationship of RV
with respect to the changes of biological parameters. A 45% change in pulmonary
artery resistance produces a significant change in right ventricle PV relationship
as shown in Figure 1.Inertance doesn’t have much role in changing PV loop. It is
inferred that end systolic and end diastolic volume is not fixed for a given ventricle.
Ventricle interaction via ventricular septum will cause change in right ventricle PV
relationship as a consequence of change in left ventricle characteristics.
Conclusion: It is possible to generate PV loops noninvasively from readily available
clinical data. The complete model is utilized to assess the influence of change in
biological parameters like elastance and resistance in PV relationship and thereby
identify various pathological conditions.
P1524
Characteristics of vessels wall, myocardium and epicardial fat in patients with
heart failure with preserved ejection fraction with and without metabolic
syndrome
E Zyatenkova; O Drapkina; V Ivashkin
I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
Rationale: the structure of the vessels wall and myocardium is an independent predictor of cardiovascular events among patients with heart failure. There is a data
that metabolic syndrome (MS) accelerates the progression of structural and functional disorders of vessel wall and myocardium. Epicardial fat thickness was shown
to correlates with visceral fat thickness and to be a independent predictor of cardiovascular diseases.
Objectives: to investigate the characteristics of vessels wall, myocardium and epicardial fat in patients with heart failure with preserved ejection fraction (HFpEF) with
and without MS.
Materials and Methods: 59 patients with HFpEF were included. First group –
patients without MS (n = 29), second group – patients with MS (n = 30). Following
characteristics were evaluated: arterial stiffness (stiffness index, SI), reflection index
(RI), augmentation index (Alp). The function of big vessels was evaluated by phase
shift (PS), of the small vessels – by the occlusion index (OI). Investigations were performed by the device “Angioscan”. Sizes of the heart chambers and the thickness of
the myocardium wall and epicardial fat thickness were evaluated echocardiographically.
Results: among the patients from both groups significant changes of the vessels
wall and myocardial structure were found.
SI at the first group was 8.26 ± 1.72 𝜇/s, at the second group – 9.62 ± 5.61 m/s
(nonsignificant, p% = 0.25). RI at the first group was 39.79 ± 18.12%, at the second – 31.43 ± 17.23% (nonsignificant, p% = 0.086). Alp at the first group was
23.47 ± 14.69%, at the second – 11.16 ± 17.14% (significant, p% = 0.011). PS at
the first group was 8.05 ± 7.72 ms, at the second – 5.34 ± 4.4 ms (nonsignificant,
p% = 0.36). OI at the first group was 1.34 ± 0.58%, at the second – 1.46 ± 0.54%
(nonsignificant, p% = 0.46).
Significant intergroup differences were found in the interventricular septum thickness: 10.3 ± 1.2 mm at the first group and 11.3 ± 1.6 mm at the second (p% = 0.01);
left ventricle wall thickness: 10.1 ± 1.1 mm at the first group and 11.3 ± 1.6 mm –
at the second (p% = 0.001); left ventricle myocardium mass: 157.75 ± 46.11 g at the
first group and 201.19 ± 58.82 g – at the second (p% = 0.005). The epicardial fat
thickness was 14.8 ± 1.8 mm at the first group and 36.7 ± 1.7 mm – at the second
group (significant, p% = 0,001).
Conclusion: among patients with HTN and HFpEF with and without MS significant
changes in the structure of vessel wall and myocardium were found. The presence
of MS lead to the more pronounced myocardial remodeling. The epicardial fat thickness is significantly higher among patients metabolic syndrome.
P1525
Ventriculo-vascular interaction and diastolic dysfunction
E Hamodraka; NNestoras Kontogiannis; M Kallistratos; G Apostolidis;
K Tsoukanas; A Skyrlas; N Papanikolaou; P Tsinivizov; K Vergis; AJ Manolis
Asclepion Voulas Hospital, Athens, Greece
Hypertension is often associated to left ventricular (LV) dysfunction. Structural
alterations of arteries and endothelial dysfunction has also been described
in hypertensive patients .In this study we investigated carotid-femoral
pulse wave velocity (PWV) in hypertensive patients with preserved systolic
function.
Methods: 95 hypertensive patients (mean age 55 ± 12.2 years) with preserved
LV systolic function (EF: 60 ± 5%) and 35 healthy controls (group C: mean age
53.5 ± 10.1 years) were included. Patients and healthy controls were studied
thoroughly by tissue- Doppler- echocardiography and carotid -femoral PWV was
measured. In order to examine left ventricular diastolic function patients were
divided in 2 groups according to the E mitral / E mitral annulus ratio (E/ Em), group
A: patients without diastolic dysfunction (E/ Em ratio < 8), group B: patients with
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
304
Abstracts
suspected diastolic dysfunction (E/ Em ratio: >8).
Results: Hypertensive patients had higher E/Em ratio (8 ± 2.6 vs 6.5 ± 1.7,
p% = 0.01) and higher PWV(9.4 ± 2.8 vs 6.9 ± 0.7, p% = 0.02) compared to the
control group. PWV showed a statistically significant increase in patients with
higher E/Em ratios (group A: 8.5 ± 1.3, group B: 10.1 ± 2.6, group C: 6.9 ± 0.7,
Anova p < 0.001), and it was significantly increased in patients with suspected
diastolic dysfunction in comparison to patients without diastolic dysfunction and
healthy controls (p < 0.05).
Conclusion: PWV is increased in hypertensive patients with LV diastolic dysfunction
suggesting an underlying pathogenetic mechanism of ventriculo-vascular interaction and can be used in order to guide a more intensive treatment of cardiovascular
risk factors.
TRANSLATIONAL RESEARCH – POSTER DISPLAY
P1526
Palmitate induced cardiomyocyte apoptosis through authophagy
CYChing-Yi Chen1 ; HC Hsu2 ; SJ Li1 ; CH Chu1 ; MF Chen2
National Taiwan University, Taipei, Taiwan; 2 National Taiwan University Hospital,
Taipei, Taiwan
1
Themajor fate of palmitate in the cell is to supply energy and compose cell
membrane. Nevertheless, overdose palmitate constitutes lipotoxicity by causing
cellular dysfunction, apoptosis, and eventual organ failure. Autophagy is a process
for recycling cellular waste to provide a survival advantage for cells undergoing
nutrient deprivation or other stress, while excessive autophagy contributes to
disease pathogenesis. The aim of this study was to elucidate the role of autophagy
on cardiomyocyte death under palmitate-induced lipotoxicity. The results showed
that palmitate treatment (400 𝜇M) for 24 hrs induced apoptosis in H9C2 cells,
with increased expression of the autophagy markers LC3II and p62. An increase
in the accumulation of autophagic vacuoles was observed in H9C2 cells exposed to
palmitate. Palmitate decreased the expression of unfolded protein response (UPR)
marker CHOP and GRP94, while increased the expression of ER stress-induced
apoptosis marker caspase 12. These results demonstrated that palmitate induced
excessive autophagy and ER stress, and then leaded to apoptosis. Blocking this
autophagic response with 3-methyladenine resulted in a significant increase in cell
death and apoptosis of palmitate-treated H9C2 cells, with a further decreased
expression of CHOP and GRP94. To summarize, the response of autophagy plays
a critical role in the survival of cardiac cells under palmitate-induced lipotoxicity.
Autophagy is essential for cariomycoyte survival when exposure to palimtate;
however, excessive autophagy damaged the cellular functions and caused the
apoptosis of cardiac cells. In addition, there is a crosstalk between autophagy
and ER stress when exposure to lipotoxicity, and the underlying mechanism needs
further study.
P1527
cells. It is possible that the conformations of the heteromeric Kir2.x channels are
different in the injured cells and these changes may lead to alter in distribution of
Kir2x heteromers.
P1528
Decellularized human heart matrixes. First experiences after stem cell
seeding and electrophysiological assessments
R Sanz Ruiz1 ; PL Sanchez Fernandez2 ; ME Fernandez Santos1 ; AM Climent1 ;
S Costanza1 ; R Matesanz3 ; DA Taylor4 ; F Atienza1 ; F Fernandez-Aviles1
1
University General Hospital Gregorio Maranon, Department of Cardiology, Madrid,
Spain; 2 Hospital Clínico Universitario, Salamanca, Spain; 3 Organización Nacional
de Trasplantes, Madrid, Spain; 4 Texas Heart Institute, Houston, United States of
America
Background: Bioartificial human heart constructs have been proposed as a possible alternative to whole-heart transplantation for patients with end-stage heart
failure. Decellularization techniques have been proved to be efficient when applied to
the myocardium. Here we report the first experiences with perfusion-decellularized
human heart matrixes after seeding of different types of stem cells and introduce a
new technology for electrophysiological studies.
Methods: Eighteen human hearts rejected for transplantation were decellularized by coronary perfusion with 1% SDS detergent, as part of the first phase
of the SABIO project. 10 𝜇m sections of both ventricles were obtained for further cell-seeding analyses. Matrixes were examined structurally (echocardiography, intravascular ultrasound, angiography, optical coherence tomography), histologically (hematoxylin and eosin, Masson ́ s trichrome, silver solution, antibodies
against collagen IV and elastin, DNA quantification) and with immunofluorescence
(a-sarcomeric actin, vimentin). Biocompatibility of the decellularized matrix was
assessed by in vitro 7-days culture of human mesenchymal bone-marrow-derived
stem cells (hMSC), human umbilical vein endothelial cells (HUVEC), human cardiac
stem cells (hCSC) and murine cardiomyocytes (H9c2 and HL-1 cells). In order to
evaluate the electrophysiological properties of the matrixes, optical calcium mapping (Rhod-2AM staining) was performed on patches seeded with HL-1 cardiomyocytes, after 7 and 21 days.
Results: Complete decellularization of the heart was achieved at day 4. Matrixes
obtained after decellularization showed no traces of the native cells on histology and
DNA quantification. The 3-D macrostructure, chamber geometry, valve competency,
fiber orientation, composition of the extracellular matrix, and the native microvascular network of the heart in a perfusable state were demonstrated with the different
tests. The 3-D decellularized heart matrix reseeded with cells supported cell attachment, alignment, proliferation and survival at 7 days (H9c2). Experiments with optical
mapping showed that murine cardiomyocytes presented electrical coupling and calcium wavefront propagation at 21 days.
Conclusions: The SABIO project has demonstrated that decellularization of human
hearts and matrixes is feasible, that obtained matrixes keep their 3-D and vascular architecture, and are biocompatible with different types of adult and stem cells.
On the other hand, calcium optical mapping emerges as a novel and useful tool to
assess electrophysiological properties of human heart scaffolds.
Expression of Kir2.x ion channel complex distorted under stress effects on
cardiomyocytes and neuronal cells
V Szuts1 ; M Horvath2 ; F Otvos1 ; D Borcsok2 ; JG Kiss3 ; L Rovo3 ; L Toth4 ;
M Szuts4 ; E Welker1 ; CS Vagvolgyi2
1
Hungarian Academy of Sciences, Center for Biological Research, Szeged,
Hungary; 2 Department of Microbiology, Faculty of Science and Informatics,
University of Szeged, Szeged, Hungary; 3 University of Szeged, Department of
Otorhinolaryngology–Head and Neck Surgery, Faculty of Medicine, Szeged,
Hungary; 4 Saint George Educating University Hospital, II Department of Cardiology,
, Szekesfehervar, Hungary
Background: The inward rectifier potassium current (IK1) determines the resting
membrane potential and contributes to the final repolarization in the muscle and
nerve cells but its molecular biological background is still uncertain. The Kir2.x is
pore-forming a-subunit genes underlying the structural base of IK1. Ophiobolins are
sesterterpene-type secondary metabolites of fungi and these posses with antitumor,
antibacterial, antifungal activities.
Aim and Methods: Therefore we examined the contribution of Kir2.x ion channels
with modulator and its possible contribution to electrophysiological remodelling after
external stress effect using ophiobolin. We compared the accumulation of Kir2.x
ion channel complex by molecular biological techniques in cardiomyocytes and
neuronal cell lines.
Results: The Kir2.x channel isoforms associate with synapse-associated protein
97 (SAP97) anchoring protein in the healthy myocytes, neuroblastoma cells and
lymphocytes. However the SAP97 binding to Kir2.x channels and distribution of their
complexes are changed in the cardiomyocytes and neuronal cells. We observed that
Kir2.1 protein expression was opposite of Kir2.2 protein densities after ophiobolin
P1 treatment in all cell types. Discussion: These data provide valuable information
concerning stress factor remodels the expression of Kir2.x proteins. SAP97 has the
major role in the events of the injury with other modulators of myocytes and another
P1529
Serum cystatin C and BNP as biomarkers of cardiac diastolic dysfunction in
patients with acute coronary syndrome and preserved ejection fraction
SSalma Charfeddine1 ; L Abid1 ; M Turki2 ; L Charfi2 ; S Ben Kahla1 ; S Kammoun1
Hédi Chaker hospital, cardiology, Sfax, Tunisia; 2 Habib Bourguiba hospital,
Biochemistry, Sfax, Tunisia
1
Purpose: Diastolic dysfunction or heart failure preserved - ejection fraction (EF) is
correlated with poor outcome after acute coronary syndrome (ACS). Serum cystatin
C is an endogenous marker of kidney function. It is not clear whether serum Cystatin
C is associated with diastolic dysfunction in patients with cardiac disease and
preserved ejection fraction. The aim of this study was to investigate whether serum
cystatin C and BNP levels were associated to diastolic dysfunction after ACS.
Methods: Serum Cystatin C and BNP were measured and echocardiography was
performed in 127 consecutive patients with first ACS and without renal dysfunction
(estimated glomerular filtration rate ≥ 60 mL/minute). Preserved EF was defined by
left ventricular EF ≥ 50%. Trans-mitral flow (TMF) patterns representing diastolic
function were categorized into two groups: a normal group and an abnormal group.
All patients were followed-up for 12 months. An echocardiography was performed
at the follow-up.
Results: Ninety-three patients with ACS and preserved EF were examined. Serum
Cystatin C and BNP were associated to diastolic dysfunction. Serum cystatin C
levels were significantly associated with left atrium diameter (LAD) and E/A ratio
(r% = 0.293, P% = 0.03 and r% = 0.274, P% = 0.04). Moreover, LAD and abnormal
TMF patterns were independent determinants of BNP (P < 0.01). The area under the
ROC curve for cystatin C to predict any diastolic dysfunction was 0.685. A cystatin
C value of 0.95 mg/L had a sensitivity of 78% and a specificity of 65% for predicting
E/A > 2. A BNP value of 80 pg/mL had a sensitivity of 84% and a specificity of
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
305
66% for predicting diastolic dysfunction. Furthermore, patients with elevated serum
Cystatin C and BNP levels had poor prognosis.
Conclusions: Serum cystatin C and BNP were associated to diastolic dysfunction
in patients with ACS and preserved EF. Serum Cystatin C and BNP might predict
cardiac diastolic dysfunction in patients with preserved EF after ACS.
could be used in HF risk stratification. EMPs may not only reflect the presence of
HF but also play a causative role in its development. Additional larger scale studies
will be needed in order to identify the additive power of EMP levels to the actual
biomarkers used in HF risk stratification and evolution.
P1530
P1532
Cystatin C and brain natriuretic peptide assessment for predicting left
ventricular dysfunction progression after acute myocardial infarction
Soluble ACE2 as biomarker of hypertension with imminent heart failure
SSalma Charfeddine1 ; L Abid1 ; M Turki2 ; L Charfi2 ; S Ben Kahla1 ; S Kammoun1 ; F
Makni2
1
Hédi Chaker hospital, cardiology, Sfax, Tunisia; 2 Habib Bourguiba hospital,
Biochemistry, Sfax, Tunisia
Purpose: Left ventricular (LV) dysfunction is a major cause of poor prognosis after
myocardial infarction (MI). The aim of this study was to investigate whether the
addition of cystatin C and brain natriuretic peptide (BNP) might be useful in the
prediction of post-infarct LV dysfunction progression.
Methods: We enrolled 127 patients with a first myocardial infarction. BNP, CRP,
Cystatin C, and troponin Ic were measured in all these patients who were followed
up for 12 months. Echocardiography was performed during the first hospitalization
and follow-up.
Results: In this study, LV ejection fraction (EF) decrease at follow-up exceeding
20% was predicted by CRP [odds ratio (OR): 4.17, 95% confidence interval (CI):
1.08-12.35, P% = 0.02], BNP (OR: 7.17, 95% CI: 1.46-35.07, P% = 0.015) and
multivessel disease (OR: 4.09, 95% CI: 1.05-11.52, P% = 0.017). However, peak
early diastolic mitral flow velocity to peak early diastolic mitral annular velocity ratio
(E/E′ ) exceeding 15 indicating elevated LV filling pressure was predicted by Cystatin
C (OR: 4.53, 95% CI: 1.28-14.26, P < 0.01) and BNP (OR: 3.84, 95% CI: 1.47-13.58,
P% = 0.015). Troponin Ic, BNP, and Cystatin C were independent determinants of
major cardiac and cerebrovascular events (heart failure hospitalizations, recurrent
ischemic events and mortality). Receiver operator characteristic (ROC) analyses
identified BNP as being the best marker in discriminating LVEF decrease exceeding
20% and Cystatin C as the most valuable in predicting E/E′ exceeding 15. A BNP
value exceeding 133 pg/mL had a sensibility of 83% and a specificity of 67% for
predicting LV systolic dysfunction during follow-up.
Conclusions: Using biomarkers may contribute to a better prediction of the risk of
adverse cardiac events in patients with MI. Cystatin C and BNP may improve the
evaluation of LV dysfunction progression.
KKatalin Uri1 ; M Fagyas1 ; A Kertesz2 ; Z Csanadi2 ; G Sandorfi2 ; M Clemens2 ;
I Edes2 ; Z Papp1 ; A Toth1 ; E Lizanecz2
1
University of Debrecen, MHSC-Faculty of Med., Institute of Cardiology, Division
Clinical Physiology, Debrecen, Hungary; 2 University of Debrecen, MHSC-Faculty of
Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
Angiotensin converting enzyme 2 (ACE2) is member of the renin-angiotensin system (RAS) and is considered as an enzyme catalyzing Angiotensin II conversion to
Angiotensin 1-7. Growing evidence exists for soluble ACE2 (sACE2) as a biomarker
in definitive heart failure (HF), but there is little information about changes in sACE2
activity in hypertension with imminent heart failure.
In this single centre prospective clinical study hypertensive patients (n = 239) with
preserved ejection fraction (EF>50%) were compared to patients with moderate to
severe systolic heart failure (NYHA II-IV, n = 100) and to a healthy cohort (n = 45). Left
ventricular end-diastolic (EDD) and end-systolic diameter (ESD) as well as EF were
measured by echocardiography. Serum ACE2 activity was determined by fluorescence intensity measurement.
A remarkable elevation of sACE2 activity was present in hypertensive patients with
preserved left ventricular EF, compared to normotensive, healthy people (healthy:
16.2 ± 0.8 UF/mL, hypertensive: 24.8 ± 0.8 UF/mL; P < 0.0001). Serum ACE2 was
further elevated in patients with systolic heart failure (heart failure: 30.2 ± 1.7
UF/mL; P < 0.0001). Serum ACE2 activity correlated with the clinical status of
heart failure. Serum ACE2 activities negatively correlated with EF in hypertensive patients (r% = 0.198; P% = 0.002) similarly to heart failure patients (r% = 0.46;
P% = 0.0001). In contrast, no correlation was present between EF and sACE2
activity in healthy individuals (r% = 0.04; P% = 0.793). While sACE2 activities positively correlated with NT-proBNP levels in heart failure patients (P < 0.01, r% = 0.52)
there was no such correlation in individuals with normal left ventricular systolic
function.
Based on these observations soluble ACE2 activity appears to be biomarker not
only in heart failure but also in hypertension, where heart failure may be imminent.
Our data suggest that sACE2 is involved in the pathomechanism of hypertension
and HF.
P1531
Endothelial microparticles in heart failure patients
O Vittos1 ; R Huica2 ; M Serban3 ; I Serban4 ; D Marta2 ; A Vittos3 ; E Moldoveanu2
Medone Research, Buchares, Romania; 2 Victor Babes National Institute,
Department of Pathology, Bucharest, Romania; 3 University of Medicine and
Pharmacy Carol Davila , Bucharest, Romania; 4 Emergency Institut of
Cardiovasculare Diseases “C.C.Iliescu”, Bucharest, Romania
1
Background: Heart Failure (HF) is associated with endothelial dysfunction.
Endothelial-derived circulating microparticles (EMP) are circulating submicron-sized
membranous vesicles released by endothelium. EMPs are active messenger in
pathophysiological responses and differential presence of EMPs is linked to different disease manifestation.
Aims: The purpose of this study was to determine the profile distribution of EMPs
in HF patients compared with healthy subjects and whether there is a correlation
between circulating MP concentration in plasma and LDL associated phospholipase
A2 (Lp-PLA2) known as a HF biomarker.
Methods: We enrolled 40 HF patients with New York Heart Association (NYHA)
class II or more, with stable disease within the last 6 months (age 65.9 ± 10.5
years). The control group consisted of 20 healthy individuals (age-gender matched).
Plasma EMP levels were measured by flow cytometry for the expression of CD31+ ,
CD62E+ , CD42b− and Annexin-V+ antigens. Activity of Lp-PLA2 was determined
by spectrophotometric method.
Results: Total EMP levels were significantly higher in patients with HF compared
with healthy subjects (p < 0.001). The EMP levels of subpopulation expressing the
following antigens CD31+ /CD42b− , CD31+ /CD62E+ and CD31+ /CD42b− /CD62E+
were 2.5, 5.8 and respectively 6.2-fold higher than the one detected in the normal
population. Between HF and control group the most marked increase was noticed
for CD62E+ EMP levels (p < 0.001). Lp-PLA2 activity was higher in HF patients
group (413 ± 67 U/L), compared to healthy subjects (225.65 ± 20.8 U/L) (p < 0.001).
By analyzing the correlation between EMP levels and Lp-PLA2 activity we detected
a positive correlation between CD31+ /CD62E+ and Lp-PLA2, without a statistical
significance.
Conclusion: When incorporated in a multi-marker strategy, the detection and quantification of EMPs may be a valuable biomarker of endothelial dysfunction which
P1533
Correlation between N-terminal peptide of collagen type III (PIIINP) with
clinical, echocardiographical and vessel wall parameters in patients with
heart failure with preserved ejection fraction
E Zyatenkova; O Drapkina; V Ivashkin
I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
Correlation between N-terminal peptide of collagen type III (PIIINP) with clinical,
echocardiographical and vessel wall parameters in patients with heart failure with
preserved ejection fraction.
Rationale and objective: PIIINP is supposed to be a useful tool for assessment
of the severity of heart failure. We investigated the relationship of the PIIINP level
and the clinical parameters, echocardiographic data and the vessel wall condition
among the patients with heart failure with preserved ejection fraction (HF-PEF).
Materials and Methods: 77 patients with HF-PEF were included. The following
characteristics were evaluated: severity of HF symptoms (Scale of clinical state),
6-minute walk test, arterial stiffness (stiffness index, SI), reflection index (RI),
augmentation index (Alp), phase shift (PS), occlusion index (OI), sizes of the heart
chambers and the thickness of the myocardium wall. The PIIINP level was evaluated
by immunoassay.
Results: strong correlation between the PIIINP level and clinical characteristics Scale of clinical state (r% = 0.85, p < 0.05), results of 6 minute walk test (r% = 0.79,
p < 0.05) were found. The mild and strong correlation between the PIIINP level and
the echocardiographic parameters – E peak (r% = 0.76, p < 0.05), E/A (r% = 0.75,
p < 0.05), such structural and functional myocardial characteristics as left atrial
size and maximum volume along (r% = 0.73, p < 0.05) with left ventricular ejection
fraction (r% = -0.85, p < 0.05), end-diastolic volume and end-diastolic dimension
(r>0.63, p < 0.05) was also found. No correlation was found between the vessel
wall parameters and PIIINP level.
Conclusion: in patients with HF-PEF the PIIINP level correlate with clinical condition and echocardiographic parameters, but not with vessels wall
characteristics.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
306
Abstracts
P1534
Abstract 60125 Table
Tetranectin: a potential novel biomarker of heart failure identified using a
proteomics approach
Age (years)
70.7 [57.8-81]
JJames O’reilly1 ; N Glezeva1 ; I Tea1 ; P Collier1 ; M Ledwidge2 ; K Mcdonald2 ; J
Baugh1 ; CJ Watson1
1
University College Dublin, Dublin, Ireland; 2 St Vincent’s University Hospital,
Dublin, Ireland
Sex (male) –no./total no. (%)
34/62 (54.8)
Purpose: Heart failure prevention strategies require biomarkers that predict disease
manifestation. To help address this we adopted a proteomic screening approach
(2D-DIGE and mass spectrometry) to dissect the coronary sinus serum proteome of
asymptomatic hypertensive patients with low and high risk for future development
of heart failure. Risk was based on B-type natriuretic peptide (BNP) levels. Using
this methodology we identified several differentially expressed disease-associated
serum proteins, one of which was Tetranectin, whose precise functional role is yet
to be defined but whose levels within the extracellular matrix increase during development and disease whilst those within the circulation decline. The purpose of this
study was to validate the proteomics discovery, quantify serum levels of Tetranectin
in a heart failure population, and to begin to assess the disease relevance of this
novel protein.
Methods: This study conformed to the principles of the Declaration of Helsinki
of the World Medical Association. Two patient cohorts were used for this study.
Firstly, serum was collected from a validation cohort (n = 100) of asymptomatic
hypertensive patients (n = 60) and heart failure patients with preserved ejection
fraction (n = 40), and were analysed for Tetranectin levels using ELISA. Secondly,
myocardial tissue samples were procured during cardiothoracic surgery (n = 38),
and were analysed for gene expression levels of Tetranectin and the fibrosis related
genes collagen type-1 and collagen type-3 using quantitative real-time PCR.
Results: In the validation cohort, Tetranectin was found to be significantly reduced
in heart failure serum samples (p < 0.001). Within human myocardial tissue samples Tetranectin gene expression levels significantly correlated with both collagen
sub-types, collagen 1 (r% = 0.50, p < 0.01) and collagen 3 (r% = 0.48, p < 0.01).
Discussion: The proteomics approach identified the protein Tetranectin as a
biomarker of heart failure. Furthermore, we demonstrate, for the first time,
Tetranectin is expressed within human cardiac tissue, and its levels correlate
with the degree of tissue fibrosis observed. Further work to explore the potential
role of Tetranectin as a novel diagnostic and therapeutic for heart failure should be
undertaken.
P1535
Prediction of complete recovery of Left Ventricular Function in patients with
Chronic Heart Failure: an observational study
NYHA
3.0 [3.0-3.0]
Ischaemia /Non Ischaemia
18/62(29) 44/62 (71)
Oorzaak? –no./total no. (%) Ischemie Klepvitia
Tachycardiomyopathie Intoxicatie Idiopathisch
Hypertensie
18/62 (29) 4/62 (6.5)
9/62 (14.5) 3/62 (4.8)
9/62 (14.5) 16/62 (25.8)
3/62 (4.8)
NT pro BNP2 missing n = 24
198.5[72.5-442.8]
HB3
8.1 ± 1.2
Creatinine4
89.5 [70-116.8]
Heart rate
75.0 [62.0-89.8]
RR systole RR dyastole
132.5 [110,0-155.0] 80.0
[70.0-90.0]
HR
75.0 [62.0-89.8]
LVF RVF
1.5 [1.0-2.0] 4.0 [1.0-4.0]
Methods: We enrolled 79 consecutive patients with HF and 79 healthy subjects, adjusted for age and sex. Serum levels of cystatin-C were measured
by commercially available ELISA kits. Creatinine clearance was estimated using
Cockcroft-Gault formula (eCcl). Augmentation index (AIx) of the central (aortic) pressure waveform was calculated, as a composite index of wave reflections and arterial
stiffness, using a validated, commercially available system.
Results: Patients with HF, compared to control subjects, had significant higher
AIx (23.56 ± 9.54% vs. 20.38 ± 6.89%, p% = 0.04). Moreover, patients with HF,
compared to control subjects, had significantly increased levels of logCystatine-C
(3.38 ± 0.21ng/ml vs. 3.27 ± 0.25ng/ml, p% = 0.005). Interestingly, in HF patients
AIx was correlated with logCystatine-C levels (r% = 0.26, p% = 0.03). Finally, levels
of logCyctatin-C were inversely associated with creatinine clearance (r% = -0.21,
p% = 0.04).
Conclusions: The present study demonstrated that HF patients had significantly impaired vascular function. Moreover, patients with HF, had significantly
increased levels of logCystatine-C. Interestingly, in HF patients arterial stiffness
was correlated with cystatine-C levels. These findings suggest a possible common pathophysiologic link of arterial stiffness and novel biomarkers of renal
function.
DDaniel Smidi
Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
Heart failure is a chronic condition. However, complete recovery of left ventricular
function (LVF) occurs in a subset of patients. Identification of these patients is of
clinical importance since this may direct therapeutic strategy
An observational and retrospective study was performed in a population ot 680 CHF
patients in a period from 2006 to 2010. 62 (10%) patients showed complete LVF
recovery on echocardiography (LV recovery). All patients were on Beta-blockers
and ACE-inhibitors of ARB. Revascularization and resynchronisation therapy was
performed in 1 and 8 patients respectively. Improvement in functional capacity was
shown in all patients.
Heart Failure involves changes in cardiac structure and myocardial composition, that
impact heart function and reserve capacity.
Optimization on the heart failure medication within a short period of time, can be
very important for improvement or stabilization of the myocardial function, whereby
a reduction of invasive interventions can be possible realized. In addition, we will
analyse the echocardiographic images IVSd, LVIDd and LVIDs in a large-scale
randomized trial in H.F. patients.
P1536
Cystatin-C serum levels and vascular function in heart failure
D Tousoulis; S Michalea; G Siasos; EEvangelos Oikonomou; P Tourikis;
S Mazaris; C Kollia; E Dimitropoulos; N Gouliopoulos; C Stefanadis
Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens,
Greece
Purpose: Heart failure (HF) is a complex clinical syndrome accompanied by hemodynamic disorders, endothelial dysfunction, atherosclerosis, inflammation and activation of neurohormone and the sympathetic nervous system, subsequently accelerating the disease progression. Recently, new biomarkers might have an additional
contribution to reveal an early decline in renal function and to improve the prognostic
assessment in patients with HF. In this study we aimed to examine the association
between cystatin-C and vascular function in patients with chronic HF.
P1537
Endothelial dysfunction in heart failure rats exposed to real urban air pollution
WWeon Kim; SJ Hwang; KH Lee; WS Kim
Kyung Hee University Hospital, Seoul, Korea, Republic of
Background: Traffic emission is associated with increased cardiovascular morbidity and mortality. However, there is little direct evidence of endothelial dysfunction in
impaired animal hearts exposed to real urban air pollution (AP).
Methods: Sprague-Dawley rats were divided into 3 groups: the non-treated control
group (NT, n = 5), the isoproterenol (ISO)-induced heart failure group without exposure to AP (ISO, n = 8), and the ISO-induced heart failure group with exposure to real
urban AP (ISO+AP, n = 5) by mobile emission laboratory equipment. Thoracic aortas
were employed for measurement of endothelial function.
Results: ISO and ISO+AP groups had 1.11 and 1.44 times greater reactive oxygen
species (ROS) levels, respectively, compared with the ROS levels in the NT group.
Malondialdehyde concentration was increased in the ISO+AP group compared to
the NT group (p% = 0.01). Total nitric oxide (NO) levels were lower in the ISO+AP
group than in the NT group (p% = 0.04). Neo-microvascular formation in the aorta
ring were reduced by 64% and 79% in the ISO and ISO+AP groups, respectively,
compared to the NT group (p% = 0.01 and 0.01, respectively).
Conclusion: Real urban AP was associated with endothelial dysfunction, likely due
to increased oxidative stress in rats with heart failure.
P1538
Early changes in left ventricle structure and function induced by a high caloric
diet
N Goncalves; E Correia; AF Silva; CM Moura; I Falcao-Pires;
R Roncon-Albuquerque Jr; AF Leite-Moreira
University of Porto, Faculty of Medicine, Department of Physiology and
Cardiothoracic Surgery, Porto, Portugal
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
Abstracts
Purpose: Hypertension and diet-induced obesity are 2 known cardiovascular risk
factors. This study aimed to assess the impact of chronic pressure overload, a
Western diet and their combination on cardiac structure and function.
Methods:Wistar rats(60-80g) were submitted to ascending aorta constriction (Ba)
or sham procedure (Sh). After 2weeks the animals were randomly divided and fed
with a regular diet(Rd,2.9kcal) or with a high-caloric diet rich in carbohydrates, fat
and salt (Hd,5.4kcal), resulting in 4groups: Sh+Rd, Sh+Hd, Ba+Rd, Ba+Hd. After
8weeks of Ba cardiac structure and function were assessed by echocardiography
and hemodynamics and heart samples obtained for morphometric, histological and
molecular analysis.
Results: Ba resulted in a compensatory cardiac response observed in increased
peak systolic pressure (FigD), cardiomyocyte diameter(FigA) as well as increased
collagen deposition in left ventricle(LV;FigB&C). Intake of Hd for 6weeks resulted
in increased cardiomyocyte diameter(FigA), septal thickness(Sh+Rd 49 ± 2.7,
Ba+Rd 59 ± 0.9𝛼, Sh+Hd 61 ± 0.4𝛼; Ba+Hd 62 ± 1.5𝛼mm/cm2 ) and decreased LV
chamber in systole(Sh+Rd 118 ± 4.1; Ba+Rd 83 ± 6.4𝛼; Sh+Hd 96 ± 5.3𝛼; Ba+Hd
85 ± 3.2𝛼;mm/cm2 ). Similarly, Hd resulted in LV deposition of collagen(FigB&C).
All these structural changes affected cardiac function by increasing ventricular
stiffness(FigE). The concomitant presence of these 2 cardiovascular risk factors led
to a significant increase in type III collagen deposition and deterioration of relaxation
seen by the constant tau (FigF).
Conclusions: This study demonstrated that a high caloric Western diet induces
structural and functional changes similar to those induced by chronic pressure
overload and that the combination of these factors impairs ventricular relaxation
and further increases collagen deposition.
P1539
307
P1540
The relation between left atrial size, left ventricular function, heart rate
variability and QT dispersion in patients after myocardial infarction
V Stoickov1 ; S Ilic1 ; M Deljanin Ilic1 ; M Stoickov2 ; D Petrovic1 ; LJ Nikolic2 ;
S Andonov2
1
University of Nis, Medical Faculty, Institute of Cardiology Niska Banja, Nis, Serbia;
2
Institute of Cardiology, Niska Banja, Serbia
Purpose: In patients with coronary disease it is important to evaluate the functional
state of the left ventricle for their further treatment. Most commonly used parameters, such as left ventricular ejection fraction (LVEF) and internal dimensions of left
ventricle, are in significant correlation with the clinical condition of patients. The aim
of this study was to examine the relation between left atrial size, left ventricular function, heart rate variability and QT dispersion in patients after myocardial infarction
(MI).
Methods: The study included 129 patients after MI (average age 59.8 years) and 35
subjects without cardiovascular disease (average age 51.1 years), that were in the
control group. Patients after MI were divided into two subgroups using the diameter of the left atrium (La): patients with normal (La ≤40mm) left atrium and those
with enlarged one (La >40mm). There was no significant difference in age or gender
between two subgroups of patients. In all subjects echocardiographic examination
and 24-hour ECG recording were performed, and from standard ECG corrected QT
dispersion (QTdc) was calculated.
Results: The study has shown that patients after MI had significantly increased
La compared to the control group (40.3 ± 5.6 vs 35.0 ± 3,3mm; p < 0.001). Patients
after MI and with enlarged left atrium had significantly increased La (44.2 ± 6.9
vs 35.9 ± 3.4mm; p < 0.001), as well as, left ventricular end-diastolic diameter
(LVEDd: 56.2 ± 6.6 vs 52.6 ± 4.9mm; p < 0.001), left ventricular end-systolic diameter (LVESd: 39.4 ± 7.4 vs 35.2 ± 6.5mm; p < 0.001), and QTdc (75.4 ± 22.6 vs
67.3 ± 21.8ms; p < 0.05), they also had significantly decreased LVEF (48.2 ± 12.3 vs
53.4 ± 12.5%; p < 0.02) and a standard deviation of NN intervals during 24 hours
(SDNN: 88.2 ± 34.1 vs 99.2 ± 24.7ms; p < 0.02), compared to patients with normal
La. E/A ratio did not significantly differ between the two subgroups (0.9 ± 0.3 vs
0.8 ± 0.3; p-N.S.). In patients after MI, La had a significant negative correlation with
LVEF (r% = -0.32; p < 0.01) and with SDNN (r% = -0.33; p < 0.01) and significant
positive correlation with internal dimensions of left ventricle (r% = 0.36; p < 0.01 for
LVEDd and r% = 0.37; p < 0,01 for LVESd), with E/A ratio (r% = 0.20; p < 0.05) and
with QTdc (r% = 0.18; p < 0.05).
Conclusions: The study has shown that La had significant correlation with heart rate
variability, QT dispersion and echocardiographic parameters that reflect left ventricular function in patients after MI, so it can be used for the assessment of functional
condition of the left ventricle in those patients.
Resident cardiomyocyte progenitors and association between their number
and heart failure patient characteristics
TTatiana Kulikova; O Stepanova; M Valikhov; A Samko; V Masenko;
S Tereschenko
Russian Cardiology Research and Production Complex, cardiology department,
Moscow, Russian Federation
Chronic heart failure connected with dilated cardiomyopathy is characterized by progressive cardiac dysfunction caused by progressive functional cardiomyocytes loss
too. Evidence that progenitor cells are present in the adult human heart made it
possible the myocardial regenerative therapy development to replace the loss of
mature functional cardiomyocytes and repair damaged myocardial tissue. Resident
cardiomyocyte progenitors represent very attractive cell source for cardiac repair.
These cells are autologous, precommitted, tissue-specific and capable of differentiating into mature cardiomyocytes. Resident cardiomyocyte progenitors were identificated and isolated from normal human endomyocardial biopsies. It is unknown
whether these cells survive during dilated cardiomyopathy and heart failure progression. The influences of patient characteristics on the number of these cells
remain unclear. We identificated resident cardiomyocyte progenitors simultaneously
expressing stem cell markers c-kit and MDR-1 and early stage cardiomyocyte differentiation markers Nkx 2,5 and GATA-4 in endomyocardial biopsies from patients
with dilated cardiomyopathy and heart failure by immunofluorescense approach.
Progenitor cells expressing these markers were revealed in tissue samples from
all 14 patients of all ages, at all stages of the disease. The patient’s medical histories were collected from hospital medical files and included age, sex, disease
stage etc. Diagnosis of dilated cardiomyopathy has been made with a complete history and echocardiographic studies. The diagnostic criteria use parameters that are
measured by echocardiography, including left ventricular end diastolic dimension,
fractional shortening and ejection fraction. Individual patient clinical characteristics
and the progenitor cell number were compared. The association between progenitor
cell number and patient characteristics was not detected and the number of these
cells was stored at all disease stages. Our results have been shown that the myocardial regenerative processes exist at all stages of the disease progression. Future
direction of these studies, progenitor cell isolation from endomyocardial biopsies
and their proliferation, the differentiation into functional mature cardiomyocytes is
very important for regenerative medicine.
P1541
Selective heart rate reduction with ivabradine normalizes left ventricular
dysfunction in a hypertensive conscious pig model of diastolic dysfunction
J Melka; M Rienzo; A Bize; M Jozwiak; L Sambin; J Su; L Hittinger; A Berdeaux;
BBijan Ghaleh
INSERM U 955 Equipe 03, Creteil, France
During chronic hypertension, tachycardia has been demonstrated to induce maladaptative responses of the left ventricle (LV) with a paradoxical lack of reduction
in isovolumic contraction and relaxation times, impeding ejection and LV filling.
Thus reducing heart rate (HR) during chronic hypertension might represent a strategy for protecting the myocardium against LV dysfunction during tachycardia. We
investigated the effects of acute selective HR reduction with the If channel inhibitor
ivabradine on LV dysfunction in eight chronically instrumented pigs. Angiotensin II
was continuously infused during 4 weeks to induce chronic hypertension. A single
intravenous dose of ivabradine (1 mg/kg, iv) was administered at Day 0 and Day 28,
at rest and under dobutamine. At Day 28, HR was significantly increased vs. Day 0
(104 ± 6 vs. 75 ± 2 beats/min, respectively). Paradoxically, both isovolumic contraction and relaxation times failed to reduce and remained unchanged (60 ± 3 vs. 54 ± 3
ms at Day 0 and 72 ± 3 vs. 77 ± 2 at Day 0, respectively), demonstrating maladaptive
responses of LV to tachycardia. Similar abnormalities were found under adrenergic
stimulus with dobutamine, i.e., isovolumic contraction and relaxation times did not
reduce while HR and contractility rose. At Day 28, ivabradine reduced HR to its
respective basal value at Day 0 (77 ± 3 vs. 75 ± 2 beats/min, respectively) and both
isovolumic contraction and relaxation times were significantly reduced while LV filling time was increased. Similar improvements of LV function were observed when
ivabradine was combined with dobutamine. Thus acute HR reduction with ivabradine corrects the maladaptative responses of cardiac cycle phases during chronic
hypertension by restoring a normal profile of isovolumic contraction and relaxation
at rest and under adrenergic stimulation, ultimately favoring LV filling. This demonstrates the pivotal role of controlling HR to avoid the deterioration of LV function
during chronic hypertension.
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365
308
Abstracts
P1542
Table 1. Comparisons between groups
Mitral annular systolic velocity and nocturnal blood pressure
Sm < 6 cm/s
(n = 7)
MV Papavasileiou; D Mytas; A Anastasopoulou; GGeorge Moustakas;
M Likaki; M Bouki; G Gionakis
Sismanoglion Hospital, Cardiology, Athens, Greece
Purpose: The purpose of this study was the investigation of the relationship
between the levels of office as well as 24hour blood pressure monitoring (ABPM)
and early systolic dysfunction of hypertensive patients.
Methods: We studied 84 treated or newly diagnosed untreated hypertensive patients with mild hypertension, mean Systolic/Diastolic Blood Pressure:
135,4/82,4, Mean age: 61years old. All patients underwent 24 hour ABPM. Evaluation of left ventricular systolic function was assessed by echocardiography,
including transmitral conventional and tissue Doppler imaging (Em, Am, Sm waves
were measured).The study population were separated in two groups according the
value of Sm wave Group A : S < 6 cm/s (n = 7) and Group B: S ≥ 6 cm/s (n = 77).
We used student’s unpaired t-test to investigate the differences between the two
groups.
Results: Hypertensive patients with Sm < 6 cm/s compared to Sm ≥ 6 cm/s had
higher values of Mean Systolic BP during night, mean BP during early morning
(awakening), and higher variability of mean BP during early morning (awakening)
(131,6 vs 116,7, p% = 0,018, 139,98 vs 122,9, p% = 0,018, 22,2 vs 14,7, p% = 0,024,
accordingly), while did not differ according to office BP, daytime 24hr ABPM and
nighttime diastolic 24hr ABPM measurements (Table 1).
Conclusions: Nocturnal and awakening but not diurnal mean BP is significantly
higher in hypertensive patients with early systolic dysfunction, possibly playing a
stronger role in the development of heart failure.
Sm ≥ 6 cm/s
(n = 77)
P value
SBPo
136,6
135,4
NS
DBPo
79,8
82,5
NS
MSBP24hr
134,8
125,6
NS
MDBP24hr
82,7
78,5
NS
DSBP
135
129,9
NS
DDBP
85,8
82,1
NS
NSBP
131,6
116,7
0,018
NDBP
76
71,2
NS
NSBPem
139,98
122,9
0,018
NSBPemV
22,2
14,7
0,024
SBPo, DBPo% = Systolic, Diastolic office blood pressure, MSBP24, MDBP24h%
= Mean Systolic, Diastolic 24hours BP, DSBP, DDBP% = mean Systolic,
Diastolic BP during day, NSBP, NDBP% = mean Systolic, Diastolic BP during night,
NSBPem% = mean BP during early morning (awakening), NSBPemV% =
variability of mean BP during early morning (awakening).
© 2014 The Authors
European Journal of Heart Failure © 2014 European Society of Cardiology, 16 (Suppl. 2), 5–365